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MTB step 3 psychiatry

Terms in this set (107)

positive psychotic sx
dopamine
delusions, disorganized speech, hallucinations
negative psychotic sx
flat affect, social withdrawl, anhedonia, apathy, poverty of thought
tx best for negative psychotic sx
atypical
dx schizophrenia
> 6 months
negative plus 1 of
delusions, hall, disorganized speech
r/o for schizo
TSH, electrolytes and CA, HIV, VDRL, drug screen
temporal lobe epilepsy
age schizo male and female
male 15-24, female 25-34
poor prognosis schizo
early age onset, negative sx, poor fxn b4, fhx, disorganized or deficit subtype
tx schizo
bizarre or paranoid: hospitalize
benzo agitation
antipsych for 6 months, longer if repeat
long term psychotherapy
antiphsychotics other indications
sedation for anesthesia when benzo CI
huntingtons and tourette
low potency antipsychotics examples
thioridazine, chlopromazine
low potency antipsychotics adv
low EPS
low potency antipsychotics disadv
more antichol, more sedation, more orthohypotn
thioridazine SE
prolonged QT and arrythmia
retinal detachment after yrs
high potency antipsychotics examples
fluphenazine, haloperidol
high potency antipsychotics adv
less sedating, few antichol, less hypotn, depot injections,
IM for when no PO
high potency antipsychotics disadv
EPS
atypical antipsychotics examples
risperidone, olanzapine, quetiapine, clozapine
atypical antipsychotics adv
DOC initial
greater negative sx
little EPS
clozapine se
agranulocytosis, tx resistant
1% check CBC weekly
best first med when sedation problem psychotic
risperidone
risperidone acts on what 6 receptors
5HT, D1, D2, alpha 1,2 H1
acute dystonia
first week
spasm, difficulty swallowing
young men high risk
tx: reduce dose, antichol (benzotropine, benadryl, trihexyphenidyl)
bradykinesia
within weeks
parkinsons's sx
elderly
reduce dose
antichol (benzotropine, benadryl, trihexyphenidyl)
akathisia
weeks to chronic use
motor restless, no anxiety
reduce dose, benzo or b-blocker
switch to newer antipsychotic
tardive dykinesia
months to yrs
invol movements, often irreversible
stop older, switch to newer
sx worsen after dc
NMS
anytime
rigid, hyperthermia, LOC, inc WBC, CK
stop meds, transfer to ICU
bromocryptine, dantrolene or diazepam
panic do
anxiety with autonomic sx, regularly
CBT, desensitizaition
SSRI, benzo, imipramine, MAO
tx agoraphobia and social anxiety
exposure
pretreat with benzo or b-blocker
generalize anxity do
daily for more than 6 mo, no single focus
supportive phsycotherapy
SSRI, venlafaxine, buspirone, benzo
benzo prescribe tips
dont change dose quickly
lowest dose elderly
no driving
benzo shortest to longest acting
alprazolam<lorazapam<diazepam
buspirone
up to 1 wk to work
safely with other sedative
can drive
no withdrawl
serotonin 5-ht1a partial agonist
OCD
has insight
behavior therapy, SSRI and clomipramine
PTSD
> 1 month (vs acute stress do)
reexperience, avoid stimuli or numbing, increased arousal
benzo acutely, SSRI or other antidepressant long term
best choice for acutely suicidal
ECT
tx dysthymic
long term individual therapy
then SSRI
tx acute mania
admit, lithium (takes 1 wk), risperidone, IM phenothiazine is noncompliant or severely manic
antidepressant only with recurrent of episodes and give with mood stabilizer to prevent mania
MC cause of progression to rapid cycling bipolar
antidepressant
tx rapid cycling bipolar
gradually stop antidepressant, stimulants, caffeine, benzos, and etoh
what medical prob cause rapid cycling bipolar
hypothyroid
drug prevents suicidal ideation in bipolar
lithium
preg pt on lithium next step
dc lithium
ECT for 1st trimester
lamotrigine for 2nd and 3rd
first line bipolar tx
lithium, lamotrigine, reisperidone
2nd line bipolar tx
aripiprazole, divalproex, quetiapine, olanzapine
tx pt with multiple recurrences
combination therapy
cyclothymia
depression and hypomania
psychotherapy.
divalproex when fxn inpaired
postpartum depression
usually after 2nd child
tx antidepressants
postpartum psychosis
after 1st birth
mood stabalizers, antiphychotics, and antidpressants
avoid meds if breast feeding, do ECT
indication for ECT
major depression not rsp to meds
high suicide risk
CI to meds
good rsp in past
MAOI best for
atypical depression
when switch antidepressants
no rsp 8 weeks or SE
how long use antidepressants
6 months
med no wt gain and sex se
bupropion,
SE seizures
depression med not safe in preg
paroxetine
lithium
bipolar and shizoaffective
acne, wt gain
tremor, GI, HA dec dose
hypothyroid
polyuria
divalproex
first line rapid cycling bipolar
carbamazepine
second line bipolar
agranulo and sedation
inducer, dec warafrin, phenytoin, theophylline, valproic acid
lithium tox
elderly with renal failure or hypoNa
N/V acute disoriented, tremors, inc DTR, seizures
tx: dialysis
serotonin syndrome cause, sx
SSRI and triptan or MAOi
agitation, hyperreflexia, hyperthermia, muscle rigid with volume contration 2nd to weating
serotonin syndrome tx
iv fluids
cyproheptadine decrease sero production
benzo for muscle
cyproheptadine
H1 antag with nonspecific 5HT1A and 5HT2A antagonist
MAOI htn crisis
w/ antihistamines, nasal decongestions, tyramine, TCA
tyramine displaces NE from storage vesicles
tx like nrl htn crisis
somatic sx tx
single physician, brief monthly visits, avoid dx testing
individual psychotherapy
do not hopitalize
conversion do
on or more neuro sx cannot be explained
mutism, blindness, paralysis, parathesias
no concern about impairment
psychotherapy
tx anorexia
olanzapine for wt gain
fluoxetine for relapses
behavioral psychotherapy
tx body dysmorphic do
high dose SSRI
if only body shape/wt anorexia
if sex, gender identity do
intermittent explosive do
aggression, may have head trauma hx
>6 yo, 2x week for 3 months, or assault 3x year
SSRI and mood stabalizer
abuse reporting
child and elder must
not indicated with spousal
cluster A personality do
paranoid, schizoid, schizotypal
paranoid PD
distrust and suspiciousness
cold and odd
main defense is projection
schizoid pd
detached and restricted emotionally
main defence is projection
schizotypal
discomfort with relationships
magical thinking, ideas of reference, paranoid ideation
cluster B personality do
mood lability, dissociative
histrionic, borderline, antisocial, narcissistic
histrionic
colorful, shallow expression of emotions
physical apearance for attention
seductive, not comfortable when not center of attention
borderline
recurrent suicidal behavior, mood swings, splitting
antisocial
criminal acts, lacks remorse
narcissistic
self importance, grandiosity, lacks empathy, envious of others, exploitive
cluster C
anxiety, preoccupied with criticism
avoidant
hypersensitive to criticism
want affection
dependant
submissive and clinging
OC personality
orderness, control
lose overall goals
wernicke-korsakoff
ataxia, nystagmus, opthalmoplegia, amnesia
give IV thiamine and Mg
b12 and folate
best benzo etoh withdrawl
chlordiazepoxine, diazepam
when short acting benzo etoh withdrawl
severe liver dz
lorazepam or oxazepam
seizure ppx etoh withdrawl
no ppx
just tx with diazepam
never give haldol bc inc seizures
alcoholic tx
naloxone and acamprosate only work with psychotherapy
disulfiram not effective
etoh withdrawal 6 hrs
insomnia, tremor, HA, sweating,
thiamine, folate, multivitamin, glucose
etoh withdrawal 12-24 hrs
visual hall, maybe auditory and tactile
if hall with disorientation, AMS, etoh hall not the answer
etoh withdrawal 48 hrs
tonic-clonic seizures
CT scan if repeated to r/o other
etoh withdrawal 48-96 hrs
DT, hall, disoriented, tachy, HTN, fever
amp, coke intox
pupil dilation, stroke, MI
short term antipsychotics, benzo, inderal, vit C to promote exretion
amp, coke withdrawal
anxiety, tremor, inc appetite, depression, risk suicide
tx: antidepressants
coke moa
block reup of NE, serotonin, dopamine
amp moa
release of dopamine
LSD intox tx
antipsychotics, benzo
inhalant intox tx
antipsych if delirious or agitated
opiate intox
constricted pupils
naloxone
opiate withdrawl tx
fever, chills, lacrimation, runny nose, abd cramps, spasm
tx: clonidine, methadone
PCP intox
nystagmus, HTN, seizures
benzo, antiphych,
barb and benzo intox
flumazenil
barb and benzo withdrawal
autonomic hyperactivity, tremor, insomnia, seizure
sub short with long: chlorrdiazepoxide, phenobarbitol
long term tx opioid, etoh, and polydrug dependence
naltrexone implant
alpha1 sex se
impaired ejaculation
SSRI sex se
inhibit orgasm
beta blocker sex SE
ED
dopamine agonist sex SE
inc erection and libido
neuroleptic sex SE
ED
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