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FA Psychiatry

First Aid Psychiatry

QuestionAnswer
DOC to treat EPS produced by neuroleptics Benztropine
TCA & low-potency antipsychotic sfx HAM: anti-Histamine (sedation, weight gain), anti-Adrenergic (hypotension), anti-Muscarinic (dry mouth, blurred vision, urinary retention)
Initial: lethargy, restless, confusion, flushing, diaphoresis, tremor, myoclonic jerks; Progression: hyperthermia, hypertonicity, rhabdomyolysis, renal failure, convulsions, coma, death Serotonin syndrome, often d/t SSRI + MAOI
Hypertensive crisis Buildup of stored catecholamines, usu d/t MAOI + tyramine or sympathomimetics
Grimacing, tongue protrusion; choreoathetoid muscle movements (mouth, tongue) Tardive dyskinesia; occurs YEARS after high-potency typical neuroleptics (>6mo); can be irreversible; usu older women; 50% spontaneously remit; d/c neuroleptic tx & change to med w/ less risk of TD
Twisting, abnormal postures, sustained painful contraction of muscles of neck (torticollis), tongue, eyes (oculogyric crisis), diaphragm (life-threatening) Acute dystonia (EPS)
Inability to sit still, restlessness & agitation, subjective anxiety, objective fidgeting Akathisia (EPS)
Decreased/slow body movement Bradykinesia
Bradykinesia, masklike face, cogwheel rigidity, pill-rolling tremor Parkinsonism (EPS)
Extrapyramidal side effects High-potency traditional antipsychotics; reversible; occur w/in DAYS of starting medications; can be life-threatening (ex. dystonia of diaphragm-->asphyxiation)
Hyperprolactinemia sfx of... High-potency typical antipsychotics & risperidone
Fever, Autonomic instability (tachycardia, labile hypertension, diaphoresis), Leukocytosis, Tremor, Elevated creatine phosphokinase, Rigidity (lead pipe), Excessive sweating, Delirium Neuroleptic Malignant Syndrome; d/t any antipsychotic after short or long time (esp high-potency traditionals); 20% mortality; young male; tx: d/c meds & admin cooling; pt CAN re-start med later
Smoking induces CYP... A12
Carbamazepine induces CYP... A12, 2C9, 3A4
Barbiturates induce CYP... 2C9
St. John's Wort induces CYP... 2C19, 3A4
Fluvoxamine inhibits CYP... 1A2, 2D6, 3A4
Fluoxetine inhibits CYP... 2C19, 2C9, 2D6
Paroxetine inhibits CYP... 2D6
Duloxetine inhibits CYP... 2D6
Sertraline inhibits CYP... 2C19
Alzheimer's can be exacerbated by... Anticholinergic drugs
SSRI mechanism of action Inhibit presynaptic serotonin pumps that take up serotonin-->increased serotonin availability in synaptic clefts
Fluoxetine (Prozac) SSRI, longest t1/2 w/ active metabolites & no need to taper; safe in pregnancy & kids; more common sleep changes & anxiety; can INCREASE levels of neuroleptics-->sfx
Sertraline (Zoloft) SSRI; highest risk of GI disturbance; more common sleep changes
Paroxetine (Paxil) SSRI; highly protein bound--> many drug intrxns; more anticholinergic sfx (sedation, constipation, wt gain); short t1/2-->w/drawal phenomena
Fluvoxamine (Luvox) SSRI; approved only for OCD tx; N/V common; many drug intrxns
Citalopram (Celexa) SSRI; fewest drug intrxns; poss fewer sexual sfx
Escitalopram (Lexapro) SSRI; similar efficacy, fewer sfx than Celexa; expensive
Tx'ing sexual sfx of SSRI Augment regimen w/ buproprion (DA part restores sexual fxn), change to non-SSRI, or add sildenafil (for men)
Black Box warning for all SSRIs Increased suicidal thinking & behavior; most documented in children & adolescents
SSRI sfx Sexual dysfxn (25-30%), GI disturbance (N/V/D), insomnia, vivid dreams, HA, anorexia, restlessness (esp at initiation & termination), seizures (.2%); can INCREASE WARFARIN LVLS
Velnafaxine (Effexor) SNRI; Tx: depression, anxiety, ADHD; low drug intrxn; sfx similar to SSRI; can incr BP
Desvenlafaxine (Pristiq) SNRI, active metabolite of venlafaxine
Duloxetine (Cymbalta) SNRI; Tx: depression & neuropathic pain, fibromyalgia; sfx similar to SSRI + dry mouth & constipation (NEpi fx); incr liver sfx in pts w/ hepatic dz or EtOH abuse
Bupropion (Wellbutrin) NE, DA, 5-HT RI; Tx: depression (esp atypical--decr appetite & sleep) ADHD, smoking cessation; exacerbates anxiety; less sexual sfx than SSRIs; incr seizures & psychosis at high dose; contraindicated in pts w/ seizures, eating disorders, taking MAOIs
Trazodone (Desyrel) Serotonin Receptor Antagonist & Agonist; Tx: refractory major depression, major depression w/ anxiety, insomnia (2/2 sedation); no sexual sfx, do not affect REM; sfx: nausea, dizziness, orthostatic hypoTN, arrhythmias, sedation, priapism
Nefazodone (Serzone) Serotonin Receptor Antagonist & Agonist; similar to trazodone in sfx & tx; Black Box Warning--rare but serious liver failure
Mirtazapine (Remeron) a2-Adrenergic Receptor Antagonist; Tx: refractory major depression, esp in pts who need to gain weight; sfx: sedation, wt gain, dizziness, somnolence, tremor, dry mouth, constipation, rare agranulocytosis
Heterocyclic Antidepressants--mechanism of action Inhibit reuptake of NEpi & 5-HT, incr availability of monoamines in synapse; can be lethal in OD
Tertiary Amine TCAs Highly anticholinergic (block M1R), sedating (block H1R), lethality in OD (cardiotoxic), orthostatic hypotension (block a1-Rs); Amitriptyline, Imipramine, Clomipramine, Doxepin
Amitriptyline (Elavil) Tertiary TCA: tx chronic pain, migraines, insomnia, peripheral neuropathy
Imipramine (Tofranil) Tertiary TCA: tx enuresis, panic disorder; has IM form
Clomipramine (Anafranil) Tertiary TCA: tx OCD, most serotonin-specific
Doxepin (Sinequan) Tertiary TCA: tx chronic pain; sleep aid low doses
Secondary Amine TCAs Metabolites of tertiaries, less anticholinergic, less sedating; Types: Nortriptyline, Desipramine
Nortriptyline (Pamelor, Aventyl) Secondary Amine TCA: least likely to cause orthostatic hypotn; can check therapeutic blood levels; Tx: chronic pain
Desipramine (Norpramin) Secondary Amine TCA; more activating, less sedating; least anticholinergic
Tx of TCA OD IV Sodium Bicarbonate
Amoxapine (Asendin) Tetracyclic Antidepressant: metabolite of antipsychotic Loxaine; may cause EPS; similar sfx to typical antipsychotics
Maprotiline (Ludiomil) Tetracyclic Antidepressant; higher rate of seizure, arrhythmia, & fatality on OD
TCA interxn w/ other meds (general) Highly protein bound & lipid soluble & can interact w/ other meds w/ high protein-binding
TCA anti-histaminergic sfx Sedation
TCA anti-adrenergic sfx Cardiovascular--orthostatic hypotension, dizziness, reflex tachycardia, arrhythmias, EKG changes (widening QRS, QT, PR intervals); avoid in pts w/ pre-existing conduction abnormalities or recent MI
TCA antimuscarinic (anticholinergic) sfx Dry mouth, constipation, urinary retention, blurry vision, tachycardia, exacerbation of narrow-angle glaucoma
Signs of TCA OD Agitation, tremors, ataxia, delirium, hypoventilation from CNS depression, myoclonus, hyperreflexia, seizures, coma
TCAs & seizures .3% of pts have seizures; more common at higher plasma levels & w/ clomipramine & tetracyclics
TCA serotonergic sfx Erectile/ejaculatory dysfxn in males; anorgasmia in females
MAO-I mechanism of action Prevent inactivation of biogenic amines (NEpi, 5-HT, DA, tyramine); irreversibly inhibit MAO-A & MAO-B incr NTs in synapses
MAO-A specific mechanism Preferentially deactivates 5-HT; also acts on DA & tyramine
MAO-B specific mechanism Preferentially deactivates NEpi/Epi; also acts on DA & tyramine
MAO-I use Effective for certain types of refractory depression & refractory panic/anxiety disorder; not first line for depression d/t sfx
Phenelzine (Nardil); Tranylcypromine (Parnate); Isocarboxazid (Marplan) MAO-I's
MAO-I side effects Serotonin syndrome; hypertensive crisis; orthostatic hypotn, drowsiness, wt gain, sexual dysfxn, dry mouth, sleep dysfxn, parasthesias w/ concurrent pyridoxine deficiency (tx w/ B6), liver tox, seizure, edema
Tyramine + MAOI Buildup catecholamines-->elevated BP, HA, sweating, N/V, photophobia, autonomic instability, chest pain, arrhythmias, death
Major sfx of clozapine Agranulocytosis--check WBC weekly for 6 months after initiation
Labs to monitor in lithium therapy Lithium levels, creatinine, thyroid hormone
Antidepressant tx of OCD SSRIs (high dose), clomipramine (TCA)
Antidepressant tx of panic disorder SSRIs, imipramine (TCA), MAO-I
Antidepressant tx of eating disorder SSRI (high dose), TCA, MAO-I
Antidepressant tx of dysthymia SSRI
Antidepressant tx of social phobia SSRI, TCA, MAO-I
Antidepressant tx of GAD SSRI, venlafaxine (SNRI), TCA
Antidepressant tx of PTSD SSRI
Antidepressant tx of IBS SSRI, TCA
Antidepressant tx of enuresis Imipramine (TCA)
Antidepressant tx of neuropathic pain Amitryptiline, nortriptyline (TCAs), Duloxetine (SNRI)
Antidepressant tx of chronic pain SSRIs, TCAs
Antidepressant tx of fibromyalgia SSRIs
Antidepressant tx of migraines Amitryptiline (TCA), SSRI
Antidepressant use for smoking cessation Buproprion (NDRI)
Antidepressant tx of premenstrual dysphoric disorder SSRI
Antidepresant tx of depressive phase of bipolar SSRI
Antidepressant tx of insomnia Mirtazapine (a2R antagonist), Amitryptiline (TCA)
Atypical antipsychotics used to tx dementia & delirium in elderly--> Increased risk of all-cause mortality & stroke
Typical antipsychotic method of action Block D2 receptors
Atypical/2nd generation antipsychotics method of action Block D2R and serotonin 2A receptors
Typical vs atypical antipsychotic efficacy in tx'ing presence of positive psychotic sx (hallucinations, delusions) EQUAL efficacy
Typical vs atypical antipsychotic efficacy in tx'ing presence of negative psychotic sx (flattened affect, social withdrawal) Atypicals more efficacious
Low potency typical antipsychotics Chlorpromazine, Thioridazine; lower affinity for D2Rs; higher incidence of anticholinergic & antihistaminergic sfx; lower incidence of EPS & NMS; more lethality d/t QTc prolongation, potential for heart block, & ventricular tachycardia; higher risk of sz
Chlorpromazine (Thorazine) Low-potency typical antipsychotic; can cause orthostatic hypotension, blue skin discoloration, photosensitivity, corneal & lens deposits; also used to tx N/V & hiccups
Thioridazine (Mellaril) Low-potency typical antipsychotic; sfx include retinitis pigmentosa
Mid-potency typical antipsychotics Loxapine, Thiothixene, Trifluoperazine, Perphenazine
Loxapine (Loxitane) Mid-potency typical antipsychotic; higher risk of seizure; metabolite is an antidepressant
Thiothixene (Navane) Mid-potency typical antipsychotic; can cause ocular pigment changes
Trifluoperazine (Stelazine) Mid-potency typical antipsychotic; can reduce anxiety
High potency typical antipsychotics Haloperidol, Fluphenazine, Pimozide; greater affinity for D2Rs, cause less sedation, orthohypotn, & anticholinergic fx; greater risk for EPS & tardive dyskinesia; can be given IM to tx acute psychosis & agitation
Haloperidol (Haldol) High-potency typical antipsychotic; injectable form available
Fluphenazine (Prolixin) High-potency typical antipsychotic; injectable form available
Pimozide (Orap) High-potency typical antipsychotic; assoc w/ heart block, ventricular tachycardia, & other cardiac fx
Positive sx of schizophrenia thought to be treated by actions of medications on... Mesolimbic dopamine pathway (nucleus accumbens, fornix, amygdala, hippocampus)
Negative sx of schizophrenia thought to be treated by actions of medications on... DA action in mesocortical pathway
Extrapyramidal sfx of typical neuroleptics are thought to be d/to DA pathways in nigrostriatum
Increased prolactin levels d/t typical neuroleptics are related to... DA action in tuberoinfundibular area
Anti-dopaminergic fx of typical neuroleptics EPS, Hyperprolactinemia
Extrapyramidal symptoms Parkinsonism, Akathisia, Dystonia
Hyperprolactinemia can lead to Decreased libido, galactorrhea, gynecomastia, impotence, amehorrhea, osteoporosis
Anti-HAM effects of typical neuroleptics Histaminic (sedation, wt gain), Adrenergic a1 (orthostatic hypotension, cardiac abnormalities, sexual dysfxn), Muscarinic (anticholinergic fx--dry mouth, tachycardia, urinary retention, blurred vision, constipation, precipitation of narrow-angle glaucoma)
Onset of neuroleptic side effects Acute dystonia: hrs/days; EPS/Akathisia: days/months; Tardive Dyskinesia: months/years
Clozapine (Clozaril) Atypical antipsych; MORE efficacy vs typicals; tachycardia hypersaliva, most anticholinergic sfx; myocarditis; 1-2% agranulocytosis, 2-5% sz; stop if neutros drop <1500microL; DECR suicide risk; less TD; 30% of tx-resistant psychosis WILL respond
Risperidone (Risperdal) Atypical antipsych; incr prolactin, orthohtn, reflex tachy; long-acting injectable form
Quetiapine (Seroquel) Atypical antipsych; sedation, orthohtn
Olanzapine (Zyprexa) Atypical antipsych; wt gain sfx
Ziprasidone (Geodon) Atypical antipsych; LESS wt gain than others
Aripiprazole (Abilify) Atypical antipsych; unique mechanism--D2 partial agonist; more activating (akathisia), less sedating; less wt gain
Paliperidone (Invega) Atypical antipsych (newer); metabolite or risperidone; long-acting injectable
Atypical antipsychotics to tx mania Quetiapine, olanzapine, aripiprazole, risperidone, ziprasidone
General sfx of atypical antipsychotics Metabolic syndrome; anti-HAM; wt gain; HLD; hyperglycemia, DM ketoacidosis; liver fxn; QTc prolonged
Mood stabilizer use Tx acute mania, prevent mania relapse(in BPD & schizoaffective), potentiate anti-d's in pts w/ MDD refractory to monotx; potentiate antipsychotics in pts w/ schizophrenia; enhance abstinence from EtOH; tx aggression & impulsivity (dementia, EtOH, MR, PDs)
Mood stabilizer types Lithium; Anticonvulsants (valproate, lamotrigine, carbamazepine)
Blood levels are useful for... Lithium, valproate, carbamazapine, clozapine
Things that affect lithium levels Decr: NSAIDs; Incr: dehydration, salt deprivation, sweating, impaired renal fxn; ASA, thiazides
Lithium used to tx... Acute mania; manic & depressive episodes of BPD & schizoaffective prophylaxis; cyclothymia; unipolar depression
Lithium is metabolized... In the kidney--dosage adjust for renal dysfxn
Before initiating lithium, pt must have... EKG, basic chemistries, thyroid function tests, CBC, pregnancy test
Onset of lithium action 5-7 days
Lithium blood levels, therapeutic range Blood levels correlate w/ clinical efficacy; check after 5d & then Q2-3d until therapeutic; therapeutic index: 0.6-1.2; toxic >1.5, lethal >2.0
Sfx of Lithium Toxic levels; AMS, coarse tremors, convulsions, death; fine tremor; nephrogenic diabetes insipidus; GI disturbance; wt gain; sedation; thyroid enlargement, hypothyroid; EKG change; benign leukocytosis; Ebstein's anomaly (babies)
Drug-->elevated prolactin d/t D2 receptor blockade Risperidone
Drug-->cataracts, no muscarinic fx Quetiapine
Drug-->retinitis pigmentosa Thioridazine
Drug-->eosinophilia, decreases tardive dyskinesias, no movement disorder risk, 1% agranulocytosis risk Clozapine
Drug-->weight gain, glucose issues (DMII), increased lipids Olanzapine (Zyprexa)
Drug-->cholestatic jaundice, photosensitivity Chlorpromazine
Drug-->prolonged QTc Ziprasidone (Geodon)
Drug that is a DA receptor agonist, postsynaptic D2R partial agonist Aripiprazole (Abilify)
Amantidine has no... anticohlinergic side effects
Buproprion (Welbutrin) works on... NE & DA
Drug-->increased appetite, sedation; a2 adrenergic antagonist Mirtazapine (Remeron)
Give fluoxetine (Prozac) in... AM (activating)
Give paroxetine (Paxil) in... PM (sedating); heavy discontinuation syndrome
Drug-->SJS, renal AND hepatic excretion Lamictal
Anti-depressant also good for pain Duloxetine (Cymbalta)
Drug-->hypothyroidism, increased by NSAIDs & ACE-Is, decreases suicidality, leukocytosis, T wave flattened/inverted, Epstein's anomaly Lithium
Drug for pts who don't respond to lithium; induces own metabolism (drug levels decline in 3-8 weeks); can-->aplastic anemia, agranulocytosis, elevated serum ammonia Carbamazepine (Tegretol)
Drug-->thrombocytopenia, alopecia; lowest toxicity of all mood stabilizers Depakote
Gabapentin (neurontin) is excreted by the... Kidney
Blockade of ______ receptors-->weight gain 5HT-2C, histamine
Blockade of ________ receptors-->sedation H1 receptors
Blockade of _______ receptors-->orthostatic hypotension Alpha1 adrenergic receptors
Treatment of neuroleptic malignant syndrome side effect Bromocriptine + Dantrolene
Treatment of acute dystonia side effect Benztropine
Treatment of drug-induced Parkinsonism Benztropine (Cogentin)
Treatment of akathisia side effect Propranolol
Lab values in NMS Incr WBCs, CPK, LFTs
Pupils in people on cocaine Mydriasis (dilated)
Pupils in people on opioids Miosis (constricted)
Drug-->nystagmus, decreased pain sensation PCP
Bereavement sx last less than _______ 2 months
Acute dystonia onset is _________ after starting antipsychotics 3-5 days
ECT is good for ________ patients & should be given with ______ pregnant; succinylcholine & methohexital
Drug type contraindicated in narrow-angle glaucoma anticholinergics
Drugs that can cause AV nodal block Tricyclic antidepressants
Axis I All psych disorders except MR & Personality Disorders
Axis II MR & personality disorders
Axis III Medical/physical disorders
Axis IV Environmental & psychosocial problems of clinical significance
Axis V GAF=clinician judgment of individual's overall level of functioning
Defense mechanism: attempt to return to an earlier developmental phase to avoid tension & conflict at present level of development Regression
Defense mechanism: idea/feeling is expelled or withheld from consciousness Repression
Defense mechanism: unconscious wish/impulse expressed through action to avoid an accompanying affect Acting out
Defense mechanism: awareness of painful aspect of reality is avoided by negating sensory data Denial
Defense mechanism: thought, impulse, or effect is transiently inhibited, causing tension or distress Blocking
Process of adopting other people's characteristics; important w/ a parent in personality formation Identification
Defense mechanism: unacceptable impulse transformed into its opposite Reaction formation
Defense mechanism: emotions are shifted from one idea/object to another that resembles the original but evokes less distress Displacement
Defense mechanism: explanations are offered in attempt to justify unacceptable attitudes, beliefs, or behaviors Rationalization
Defense mechanism: person's character or sense of identity is temporarily but drastically modified in order to avoid emotional distress Dissociation
Consistent failure to speak in a specific social situation despite speaking in other situations Selective mutism
Only personality disorder requiring previous diagnosis of something Antisocial personality disorder--requires evidence of conduct disorder before age 15
Personality disorder showing reduced capacity for close relationships, eccentric behavior Schizotypal personality disorder
Recurrent suicidal behavior, identity disturbance, rapid mood swings, efforts to avoid abandonment, chronic feelings of emptiness, intense anger outbursts, impulsivity, fluctuations b/t idealization & devaluation, splitting, primary defense mechanisms Borderline PD; best tx: psychotherapy, steady social support
Excessive attention-seeking behavior in PD Histrionic
Abnormalities in anorexia amenorrhea, hypercholesterolemia, normocytic normochromic anemia, leukopenia, incr CRH, hypoglycemia, hypothyroidism, decr estrogen, incr BUN (catabolic state), incr cortisol (stress), nml TSH response, incr GH; lanugo hair, hypOtn, bradycardia
Physiological abnormalities in bulimia 1-3% adolescent girls; hypokalemia, hypochloremia, metabolic alkalosis, hyponatremia
Inability to read Alexia
Specific inability to name objects even though object is recognizable & can be described Anomia
Global abnormality in either expression or comprehension of language Aphasia
Inability to recognize objects but object can be perceived by the patient's intact senses Agnosia
Inability to perform learned motor skills despite normal strength & coordination Apraxia
Toxocara canis or cati infection, visceral larva migrans in a kid Pica-->soil, feces ingestion
6yo boy w/ rectal bleeding & anemia Stereotypic movement disorder-->self-inflicted bodily injury severe enough to require medical attention
Nml development 1st 5 months; 5-48mo deceleration head growth, hand skills loss, stereotyped hand mvmt, loss social interxn, uncoordinated gait/trunk mvmts, impaired expressive & receptive lang, psychomotor retardation Rett disorder; only in girls
Age onset of trichotillomania 5-8, 13
Most common initial sx in Tourette's Eye tics: blinking, eye rolling
Pervasive developmental disorder w/ impaired social interaction & development of stereotyped or repetitive patterns of behavior w/o significant delay in language skills or cognitive function Asperger's; more common in males
Conduct disorder criteria Aggression toward people & animals; Destruction of property; Deceitfulness; Serious violation of rules
Oppositional defiant disorder criteria 6mo of negativistic, hostile, & defiant behavior directed mostly at authority figures
Mild MR IQ 55-70
Moderate MR IQ 40-54
Severe MR IQ 25-39
Profound MR IQ <25
Prevalence & monozygotic concordance of schizophrenia 1%, 50%
Psychotic/delusional theme seen potentially in multiple psychotic illnesses, often have nihilistic delusion content Cotard syndrome
Belief that people have been replaced by imposters Capgras syndrome
Shared delusion aroused in one person by the influence of another Folie a deux
Delusional disorder is characterized by Nonbizarre delusions (involving situations that are logically possible) for at least 1 month
Simple schizophrenia All negative (no positive) sx
Postpartum psychotic episode w/ depression, mood lability, delusions, hallucinations Bipolar disorder usually the cause; less frequently d/t MDD
Prodrome of schizophrenia Progressive social withdrawal
Schizophrenic symptoms lasting b/t 1 & 6 months Schizophreniform disorder
Intellectualization & undoing are considered to be _______ defenses Neurotic
Altruism & sublimation are considered to be _______ defenses Mature
Bleuler's description of schizophrenia 4 A's: association, affect, autism, ambivalence
Negativism, hypomotorism, echolalia, echopraxia Classic catatonic features of schizophrenia
Universally accepted criteria for ECT in major depression Depression severity, history of poor response to many medications, need for quick antidepressant action
Early morning awakening can be a sign of Depression
Levels of cortisol, catecholamines, sex hormones, immune fxn in depression Increased cortisol; Decreased catecholamines, sex hormones, immune fxn
Strongest genetic link of all psychiatric illness Bipolar I disorder
Episodes of hypomania & dysthymia Cyclothymia; tx same as BPD
1st degree relatives of pts w/ BPD have a X% risk of any mood disorder 25%
Manifestation of porphyria Psychiatric (manic/psychotic), abdominal pain
Nonauditory hallucinations suggest... Delirium
Docility, lack of fear response, anterograde amnesia, hyperphagia, hypersexuality Kluver-Bucy syndrome; assoc w/ severely damaged or disconnected amygdala bilaterally
Frontal & temporal lobe atrophy-->dementia Pick disease (often indistinguishable from Alzheimer's)
Hydrocephalus & cerebellar anatomic abnormalities & functional abnormalities Arnold-Chiari syndrome
Acquired movement disorder assoc w/ traumatic damage to substantia nigra Punchdrunk syndrome
Congenital absence of facial nerves & nuclei-->bilateral facial paralysis Mobius syndrome
3 or more missed periods not d/t physiological issues automatically diagnoses w/... Anorexia (even if binging/purging)
DOC tx panic disorder w/ or w/o agoraphobia Fluoxetine (SSRI)
Pts w/ MDD: cortisol response to dexamethasone challenge 50% of all pts w/ MDD do NOT have normal blunted cortisol level response to dexamethasone; indicates abnormal feedback control in HPA-axis; pts w/ psychotic depression even more likely to have poor dexamethasone suppression
TRH administration/TSH response in patients w/ depression 30% of all pts w/ MDD do NOT show an increase of TSH w/ administration of TRH
Reclusive, aloof, isolated, don't mind lack of social interaction, indifferent to praise or criticism; able to recognize reality (no bizarre cognition or psychosis) Schizoid personality disorder
Fear of panic in public Agoraphobia
Shy, fearful of social rejection, lack of socializing is distressing Avoidant personality disorder
Eccentric behavior, reduced capacity for close relationships, magical thinking, bizarre fantasies, belief in clairvoyance, sixth sense, etc. Schizotypal personality disorder
Minimum dose of methadone to sufficiently decrease craving for heroin during initial detox 60mg/day; will NOT decr libido, bone mass
Side fx of imipramine (TCA) Anticholinergic & antiadrenergic blocking fx-->dry mouth, dizziness (assoc w/ hypotension), urinary hesitancy
Side fx of fluoxetine (SSRI) GI upset, sexual dysfxn, agitation
Sidefx of phenelzine (MAOI) Hypotension; less likely to have anticholinergic fx
Side fx of lithium Polyuria, polydipsia, tremor, mental confusion
Side fx of divalproex Na GI upset, sedation, tremor
Confusion, gait ataxia, incontinence Normopressure hydrocephalus; normal opening pressure
Oculomotor difficulties can indicate Wernicke-Korsakoff syndrome
Frontal release signs, perseveration=nonspecific findings common in... demented patients
NPH CT findings Dilated ventricles 2º/2 incr pressure waves impinging on ventricular system
Underlying cerebral atrophy-->dementia shows _____ on CT Frontal sulcal widening
Lacunar stroke seen on CT Hypodensities in subcortical areas
Cerebellar atrophy on CT often seen in Congenital disorders, alcoholism
Labs in alcoholics Incr GGT, ALT, AST, AST:ALT ratio, uric acid, serum triglycerides; macrocytic anemia
Length of sx differentiating acute stress disorder vs. PTSD 4 weeks
Lifetime incidence of suicide in general population vs. schizophrenics 1% vs 10%
Occurs when one assigns emotions to another person in an attempt to psychologically cover up the presence of those emotions within oneself (ex. doc says pt attracted to him when in reality, he is attracted to pt) Projection
ECT in catatonia vs. depression vs. psychosis/mania Catatonia: 2-4 sessions; Depression: 6-12 sessions; Psychosis/Mania: 20+ sessions; Memory impairment at 20-40
Recurrent, distressing thoughts conceived as a product of patient's mind can indicate... OCD
Recurrent thoughts perceived as "implanted messages" can indicate... Schizophrenia
Best tx for OCD SSRIs--antiobsessional fx, antidepressant fx, antianxiety fx
Antidepressants: placebo vs. tx effects 30% placebo, 70% drug
Histopathology of Alzheimer's brain, current tx Selective loss of cholinergic neurons; tx: reversible AChE-inhibitors (donepezil, rivastigmine, galantamine, tacrine)
6 hrs after last drink--> Mild withdrawal (can still lead to DTs): anxiety, tremors, sweating, palpitations
12-48 hrs after last drink--> Withdrawal seizure (can still progress to DTs): single or multiple seizures in short period of time
12-24 hrs after last drink--> Alcoholic hallucinosis: auditory, visual, tactile hallucinations w/ normal vital signs & intact sensorium
48-96 hrs after last drink--> DTs (5% mortality); fever, hypertension, tachycardia, diaphoresis, hallucinations, disorientation
Treatment of alcohol withdrawal Long-acting benzo (diazepam, lorazepam, chlordiazepoxide): stimulate the GABA receptor-->sedation
Treatment of benzodiazepine toxicity Flumazenil
Normal development of at least 2 years-->loss of previously acquired skills in at least 2 of: expressive or receptive language, social skills, bowel/bladder control, play or motor skills; then develop autistic sx Childhood disintegrative disorder; more common in boys (pervasive developmental disorder)
Onset of sx before 3yo; qualitative impairments in communication & social interaction; repetitive, stereotyped behavior + strange preoccupations Autism (PDD), more common in boys
Initial normal development (up to 6mo old)-->loss of hand coordination, development of stereotyped hand movements; decelerated head growth, poor coordination, seizures, ataxia, MR, diminished social interaction Rhett disorder (PDD), more common in girls
Qualitative impairment in social interaction & restricted repetitive & sterotyped patterns of behavior; normal cognitive & language development Asperger's
Child w/ pattern of defiant, hostile behavior; disobedient, irritable, spiteful, argumentative; blame others for their feelings Oppositional defiant disorder
Presents prior to 7yo; inattention, impulsivity, overactivity, forgetfulness, poor organization, poor attention span ADHD
Increased DA activity--> Psychosis
Treatment of psychosis DA-2R blockers (ex. risperidone)
Added ________ receptor binding of atypical antipsychotics reduces likelihood of EPS Serotonin (5-HT 2A R's)
Treatment of NMS Dantrolene (direct muscle relaxant), Amantadine, Bromocriptine (DA agonist)
NMS can lead to--> Hyperthermia, autonomic instability, muscular rigidity, altered sensorium, elevated CPK, rhabdomyolysis & myoglobinuria-->ARF
Treatment of toxic CNS fx caused by anticholinergic drugs Physostigmine
Treatment of akathisia 2º/2 neuroleptics Propranolol
Difficulty falling or staying asleep for at least 1 month Primary insomnia
Disregard for & violation of rights of others; illegal activities; hx of diagnosis in adolescence Antisocial PD
Delusions, hallucinations, disorganized speech, or grossly disorganized behavior lasting >1 day & <1 month, completely resolve Brief psychotic disorder
Systolic HTN, tachycardia, staring, muscle weakness, hyperactivity, anxiety, increased perspiration, heat intolerance, tremor, palpitations, weight loss, oligomenorrhea Thyrotoxicosis
Dx of mania 3+ of DIGFAST for ≥1 week: Distractibility, Insomnia, Grandiosity, Flight of ideas, Activity increase (goal-oriented), Speech (pressured), Thoughtlessness (high-risk behavior)
Decreased DA in tuberoinfundibular pathway--> Hyperprolactinemia: sexual dysfxn, gynecomastia; tuberoinfundibular path neurons usually secrete DA-->inhibit PRL release from anterior pituitary-->incr PRL
Increased DA activity in nigrostriatal (substantia nigra to basal ganglia) pathway--> Movement disorders (chorea, tics)
Increased DA activity in mesolimbic (ventral tegmentum to limbic) pathway--> Euphoria assoc w/ drug use; Delusions, hallucinations in pts w/ schizophrenia
Decreased DA in nigrostriatal pathway--> EPS assoc w/ neuroleptics; s/sx of Parkinson's
Hypersensitivity to criticism, social inhibition, feelings of inadequacy; want friendships but fear ridicule; view self as inferior; reluctant to engage in new activities Avoidant personality disorder
Hallucinations, delusions, disorganized speech, disorganized or catatonic behavior, or negative sx (flattened affect) for >1mo & <6mo Schizophreniform disorder
Pharmacological tx of specific phobia Benzos, esp short-acting
Excessive anxiety/concern re: multiple events/activities for ≥6 mo + ≥3 of: sleep impairment, easily fatigued, restless, muscle tension, poor concentration, irritability Generalized anxiety disorder; tx/ w buspar, benzos, or anti-D's
Buproprion used to tx Depression, smoking cessation, SAD, dysthymia, PTSD, chronic fatigue syndrome, ADHD, narcolepsy, neuropathic pain, periodic limb movement disorder
Stepwise deterioration & neurological signs Multiinfarct dementia
Progressive cognitive decline, memory impairment; apraxia, aphasia, agnosia, disturbed executive fxn Alzheimer's