UW3 (02 Psych) Flashcards by M S

Extrapyramidal

Sudden contraction
Neck / Tongue / Eye
Torticollis + Ocullogyric crisis

Diagnosis?
Treatment? 2

Acute Dystonia

DiphenHydramine
Benztropine

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Extrapyramidal
Restlessness
Diagnosis?
Treatment? 3

Akathisia

Propranolol
Lorazepam
Benztropine

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Extrapyramidal

Gradual onset
Tremor
Rigidity
Bradykinesia

Diagnosis?
Treatment? 2

Benztropine

Amantadine

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Extrapyramidal

Gradual onset
Dyskinesia
Mouth / Face
Trunk / Extremities

Diagnosis?
Treatment? 2

Tardive Dyskinesia

Valbenazine
Deuterabenazine

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Major depression - diagnosis

Duration?
What complications if no treatment?

> 2 weeks

CV disease risk increase

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Depression > 2y

Diagnosis?

Persistent depressive disorder

= Dysthymia

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Adjustment disorder

Timeline criteria?

Functional dysfunction onset < 3m after stressor

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Depression

Treatment indication?
If responsive to SSRI but has side effects?
What should be added in addition to medication for moderate/severe?
Is it safe to use at CV disease?

symptom > 6m

Different SSRI type

Add therapy

Safe with CV disease

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Insomnia at elderly
First line treatment?
Others? 4

Cognitive Behavioral therapy

Sleep hygiene
Sleep restriction
Stimuli control
Relaxation techniques

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Schizophrenia with depression or mania
Delusion or hallucination > 2 weeks without depression or mania

Diagnosis?

Schizoaffective disorder

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Acute stress
Timing?
When is it considered PTSD?
1st line therapy?

Duration 3d-1m
PTSD if > 1y
CBT + medications @ insomnia or anxiety

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Lithium toxicity

Risks / Trigger? 3
Management? 3
When is dialysis required?

AKI
Hypovolemia (Thiazide / ACE-I)
NSAID

Li check q24h
IVF
Bowel irrigation

Dialysis

Li > 4
Li > 2 with symptom or AKI

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Personality disorder:
Excessive emotion
Attention seeking

Histrionic vs Borderline difference?

Histrionic
Inappropriate social behavior
Suggestiveness

Borderline
Manipulative
Self injury / SI
Identity disturbance

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Schizophrenia treatment

for positive symptoms? (general)
for negative symptoms?

Anti-psychotics

Pyschosocial:
social skills
employment service

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Androgenic steroid abuse - symptoms

Typical at Male? 1
Typical at Female? 4
Common for both? 1

Aggression

Eating disorder
Clitoromegaly
Hair loss
Deep voice

Mood disorder

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Diagnosis criteria

Provisioal tic?
Chronic tic?
Tourette? - complications? 2

Tic < 1y

Motor / Vocal tic > 1y

Multiple motor + Vocal tic > 1y
OCD / ADHD

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Tourette

Treatment? 4

CBT (habit reversal)

Antipsychotic
1 - fluphenazine / Pinozide / Haloparidol
2 - Risperidone / Aripiprazole

Alpha blocker (clonidine / guanfacine)

Dopamine deplete (tetrabenazine)

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Bipolar treatment:

Hypo/Mania episode while on anti depressant? 2
Severe mania? If worsen?

Stop: anti depressant
Start: mood stabilizer or Anti psychotic g2

Start: Lithium / Mood stabilizer / Valproate
Add: anti-psychotics

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ADHD

1st management?
Medication Indication?

Behavioral therapy

Age > 6y
Failed behavior therapy
Severe impairment

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ADHD medication

What organ system HPI & PE is needed?
What test is NOT needed?
Does it increase risk for substance abuse?

Cardiac
Monitor weight & VS
NO EKG needed
Not increase subspace abuse risk

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Smoking withdrawal symptoms? 5

Smoking cessation treatment? 4

Restlessness
Anxiety / Restlessness
Reduced concentration
Insomnia
Depression

Behavioral
Nicotine replacement
Varenicline
Bupropion

Bupropion

Effects on weight?
Avoid at? 2

Decrease weight

Avoid at seizure & eating disorder

Sleep Terror

Initial management?
Typical course?
When does it require medication? which one?

Reassurance & Education only

Spontaneous resolution within 1-2y

Benzo @ high freq or sig impaired function

Parkinson medication therapy

Mechanism of causing psychosis?
3 management steps?

Elevated Dopamine

Stop/Reduce: adjunct meds
Reduce: Levo/Carbi dopa
Add: quetiapine / clozapine / pimavanserin

Treatment resistant depression (with partial response) Management? 5

``` Augment (add) Anti depressant Anti Psychotics g2 Lithium Thyroid hormone Psychotherapy ```

Treatment resistant depression (with NO response) Management?

1 - Switch anti depressant 2 - psychotherapy 3 - ECT 4 - transcranial magnetic stimulation

Benzodiazepine | Withdrawal symptoms? 10

``` Tachycardia Hypertension Hyperthermia Restless / Irritable Anxiety / Panic Insomnia Tremor Psychosis Seizure Death ```

Lithium Medication types that increases Li? 4 Medication types that decreases Li? 2 Medications types that caused mixed Li changes? 2

Thiazide NSAID (∅ Aspirin) ACE-I / ARB Anti-Biotics K sparing diuretics Theophylline Loop Diuretic CCB

``` Anorexia Hospitalization criteria (10) ```

``` Hemodynamic instability HR < 40 BP < 80/60 Dizziness / Syncope Orthostatic change Hypothermia ``` ``` Refeeding BMI < 15 Refusal to eat Suicidal Psychosis ```

OCD Treatment? 4

1. Exposure & Response therapy 2. SSRI 3. Clomipramine (TCA) 4. Anti psychotics

Behavioral therapy for conditions: 1. Borderline 2. OCD 3. Depression 4. Childhood problems 5. Stress / Coping

1. Dialectical 2. Exposure & Response 3. InterPersonal 4. PsychoDynamic 5. Supportive

Alcohol abuse | 1st line treatment

Psycho/Social

Alcohol treatment: 1. Naltrexone (mechanism, effects & indication, contraindication 2) 2. Acamprosate (mechanism) 3. Disulfiram (use indication)

1. Mu antagonist Reduce craving & drinking (start while drinking) CI @ opioid / hepatitis or liver failure 2. Glutamate modulator 3. highly motivated & not drinking

Steroid induced psychiatric symptoms? 6

``` Mood symptoms Psychosis Anxiety Sleep disturbance Restlessness Memory loss ```

Panic attack 1. Initial treatment 2. medication for acute episode?

1. SSRI/SNRI + CBT | 2. Benzo

SLE - labs General & findings? 5 Serology? 4

Hemolytic Anemia Plt ↓ / WBC ↓ / Cr ↑ ProteinUria C3 ↓ / C4 ↓ ANA Anti-dsDNA Anti-Smith

Somatic Symptom 1. Timing criteria? 2. Main management? 3. 4 goals?

1. Distress or Impairment > 6m 2. Regular office visits 3. Functional improvement Stress reduction Coping strategy Mental health referral

Anti psychotics at dementia | Increased mortality cause 3

CV event Fall Aspiration pneumonia

Catatonia | Treatment? 2

Lorazepam | ECT

Alcohol withdrawal symptom / timing 1. 6-24h (4) 2. 12-48h (2) 3. 48-96h (7) 4. Is Benzo safe to use at liver disease?

1. Anxiety / Insomnia / Tremor / Sweat 2. Hallucination / Seizure 3. Delirium / Confusion / Hallucination / Agitation / T ↑ / HR ↑ / BP ↑ 4. Yes

PCP intoxication treatment For mild? 1 For severe or violence? 2

Reduce stimuli Benzo / Lorazepam Haloperidol

Serotonin syndrome vs Neuroleptic malignant Medication causes? 5 / 1 Presentation differences? 3 / 2 Management? 3 / 1

``` SSRI / SNRI TCA Tramadol MAOI / Linezolid MDMA ``` Dopamine / Anti psychotics -------------------------------------------------- Tremor / MyoClonus / HyperReflexia ``` BradyKinesia / Muscle Rigidty -------------------------------------------------- Strop Medications / Support Benzo Cyproheptadine (serotonin antagonist) ``` Dantrolene

Anxiety / Agitation / Delirium Diaphoresis / BP ↑ / HR ↑ / T ↑ Nausea / Vomiting / Diarrhea On psychiatric medication Differential Diagnosis? 2

Serotonin syndrome Neuroleptic Malignant Syndrome

Tobacco effect at pregnancy: Maternal effects? 5 Fetal effects? 7

``` Pre-Eclampsia Placenta previa Placental abruption PPROM Spontaneous abortion ``` ``` Congenital defects SGA Fetal demise DM Asthma Obesity Sudden infant death ```

Schizophrenia Good prognosis factors: ``` Timing? Gender? Onset / Trigger ? Symptom types? FH? Duration? ```

``` Late onset Female Acute onset / Trigger Positive >> Negative No FH Short duration ```

Believe death is: Temporary Reversible Disbelief age group?

Age < 6y

Sexual dysfunction @ SSRI | Management? 4

1. r/o medical cause 2. Switch to bupropion / mirtazapine 3. Add: sildenafil / bupropion 4. Reduce SSRI dosage & monitor

St. John's Wort Common uses? 3 Medication interactions? 7

Anti-depressant Anti-inflammatory Wound healing ``` OCP Anti-RetroViral ImmunoSuppressant Narcotics Anti-Fungal Anti-Coag Serotonin syndrome risk ↑ @ SSRI/SNRI ```

Substance abuse referral Indication for OP? 3 Indication for IP? 6

Highly functioning Highly motivated Has Good support system ``` Severe Intoxication / Withdrawal Comorbidities Poorly functioning Low motivation Poor support ```

PTSD Diagnosis? Treatment? 2 Medication for nightmare?

Nightmare / Flash back > 1m CBT SSRI / SNRI Prazosin @ nightmare

Varenicline Psychiatric side effects? 3 Treatment?

Agitation Depression Suicidal Bupropion