Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
65 Cards in this Set
- Front
- Back
Tx panic disorder
|
Acute: benzo
Longterm: SSRI/TCA (clomipramine/imipramine) Evt respiratory training, cognitive/behavior therapy |
|
Tx generalized anxiety disorder
|
Buspirone, evt betablocker
biofeedback,relaxation techniques, cognitive/behav tx |
|
Tx specific phobia
|
Desensitization
|
|
Tx social phobia
|
1)assertiveness training and SSRI
2)phenelzine |
|
Tx public speaking fear
|
beta blocker
|
|
Tx OCD
|
1)SSRI
2)clomipramine |
|
Tx hypochondriasis
|
1) enquire about stressors
2) benzo if severe |
|
Tx somatization
|
regular dr appointments
|
|
Tx Depression - how long?
a) also insomnia b) also sexual dysfunction c) also insomnia and sexual dysfunction d) also generalized anxiety e) also psychotic sx f) in kids |
1) SSRI
2) TCA 3) MAOi If first episode: min 6mo If second or more: indefinitely a)trazodone b)bupropion c)nefazodone d)venlafaxine e)antipsych (start with these) f)esp family therapy |
|
Tx bipolar I
a) how long? b) also agitation? |
1) lithium -> min 1yr
2) Carbamazepine/valproate a)min 1yr b)benzo untill lithium kicks in |
|
Tx adjustment disorder
a) also anxiety b) also depressive sx |
psychotherapy (psychodynamic or brief cognitive)
a)add buspirone/pam b)add SSRI |
|
Tx schizophrenia
a) noncompliant b) catatonic type c) insomnia |
1) risperidone
2) clozapine Also: behavioral and family therapy (minimize stress at home) a) injection typical -> fluphenazine or haloperidol b) benzo and/or ECT c) olanzapine |
|
Tx narcolepsy
|
psychostimulants (moldenafil/methylphenidate)
|
|
Tx tourette
|
haloperidol or pimozide (classic antypsych)
|
|
Tx enuresis
|
imipramine or desmopressin
|
|
When should you hospitalize pts with anorexia
|
always
|
|
What is a risk in elderly using benzo's and why?
|
slower metabolism: more cognitive impairment and risk paradoxical agitation
|
|
What is the risk of concurrent use of nicotine patch and bupropion?
|
Hypertension-> monitor tension regularly
|
|
What tx for mania is ass with these pregnancy complications:
a) craniofacial, neural tube, genital# b)Ebstein, goiter, transient neuromuscular dysfunction |
a) carbamazepine and valproate
b) lithium NB Ebstein 20x risk, but still only 1/1000 |
|
Tourette is associated with....
|
OCD, ADHD
|
|
Bulimia is associated with....
|
borderline
|
|
Panic disorder is associated with....
|
depression (60%) and agoraphobia (40%). Many others to lesser extent
|
|
What DD if child develops nl till 3/4 yrs and then looses milestones?
|
childhood disintegrative disorder (also autistic sx), or Rett (only girls, stereotyped hand movements
|
|
What is eating disorder, not otherwise specified?
|
Not:
anorexia = amenorrea and too low BMI bulimia = min 2xpw binge with guilt/compensation, nl weight and no amenorrea, min 3mo -> combi: eg binging with low BMI or 1xpw binging etcetc |
|
Risks for previous anorexic who wants to become pregnant
|
SGA and prematurity.
Also hyperemesis, miscarriage, cs, pp depres. |
|
How do you treat pt on antipsych with:
a) restlessness b) sudden muscle spasms c) rigidity, high temp, delirium and autonomic instability d) slow movements and expressionless e) involuntary movements tongue, fingers, then rest |
a) akathisia (4wk) -> lower dose and give benzo/betablocker
b) acute dystonia (4hr)-> antichol or antihist c) NMS -> stop med, give dantrolene (prevents CA release sarcoplasmic reticulum) d) parkinsonism -> dopamine agonist, benztropine(?) e) tardive dyskinesia -> stop med |
|
What is mechanism antipsych therapy vs adverse events?
|
therapy: D2 antagonist
adverse events: D2 antagonist: EPS, gynecomastia, galactorrea, amenorrea 5HT2 antagonist: sedation alpha antagonist: hypotension antichol: dry mouth etc |
|
What labs should you do before starting lithium?
What are major causes of noncompliance? What adversities does valproate have? |
Creat -> can cause nephrogenic diabetes insipidus
Pregnancy -> teratogenic TSH -> can cause hypothyroidy Noncompliance: acne and weight gain Valproate: hepatotox. Also sedation, cognitive#, gi#, tremor |
|
What is the disease with largest genetic component?
|
Bipolar disorder:
1 1st degree -> 5-10% 2 1st degree -> 60% monozygotic twin -> 70% |
|
What is absolute contra-indication use bupropion?
|
seizures/epilepsy
|
|
Tx premature ejaculation
|
squeeze technique
evt psychotherapy, SSRI |
|
Tx fibromyalgia
|
amitriptyline
|
|
What is a danger if stopping short acting benzo's too fast?
|
seizures, confusion
Most with alprazolam, less with clonazepam |
|
DD specific vs generalized anxiety
|
Specific: 1 thing
Generalized: >1 event and 3 of #: sleep, concentration, fatigue, muscle tension, restless |
|
Convulsions, cardiotox, coma - which intoxication?
What tx? |
TCA
sodium bicarbonate (protects heart) |
|
Tx rapid cycling bipolar disorder
|
Divalproex (valproate)
|
|
Tx insomnia longer term
|
eszopidone - can be used up to 6 mo
|
|
DD bipolar I and II
|
I: mania - manic sc >1w
II: hypomania - manic sx <4d Both also depression |
|
DD depression vs dysthymic
|
Depression: SIGECAPS >2w
Dysthymic: >2yr, mostly mood# |
|
DD grief vs depression
|
grief: shorter duration, waxing and waning, less guilt/shame, less suicidality
|
|
DD denial - blocking - suppression - repression
|
Denial: avoid becoming aware
Blocking: temp forgetting Suppression: conscious forgetting Repression: unconscious forgetting |
|
DD projection - introjection - displacement
|
Projection: attribute ones own wishes/etc to somebody else
Introjection: features of external world made ones own Displacement: turn emotion/drive towards somebody ino something that resembles that somebody |
|
DD reaction formation - undoing - sublimation
|
Reaction formation: impulse into opposite character trait
Undoing: impulse into opposite act Sublimation: impulse channeling from unacceptible to acceptible |
|
DD postpartum blues vs depression
|
Depression: no care self or baby, >2w
|
|
Are there # on a CT scan in pt with schizophrenia?
And on PET scan? |
Yes:
enlarged ventricles and sulci smaller cerebral/hippocampal/temporal mass Pet: decr activity frontal lobes, incr activity basal ganglia |
|
DD delusional disorder vs paranoid type schizophrenia
|
Delusional disorder: 1 delusion, not bizarre, >1mo, nl functioning
Paranoid schizo: >6mo, 1 or more delusions, bizarre, not nl functioning |
|
What is the term for:
a)unnecessarily detailed answer that is only somewhat related to question b)rapid changing from topic to topic c)abrupt permanent deviation of topic d) changes of topic with NO connections |
a) circumstantiality
b) flight of ideas c) tangentiality d) loos associations |
|
DD brief psychosis, schizophreniform, schizoaffective, schizoid, schizotypal
|
Brief psychosis: <30d
Schizophreniform: 1mo-6mo Schizoaffective: also mood# with delusions/hallucinations >2w in absence of mood# (otherwise mood# with psychotic sx) Schizoid: don't like people Schizotypal: don't like people, like supernatural |
|
DD acute stress disorder, PTSD, adjustment disorder
|
1 stressor:
Flashbacks/dreams * start withing 1 mo, last <1mo -> acute stress disorder * last >1mo -> PTSD No flashbacks, start <3mo, disappear <6mo -> adjustment disorder |
|
Conversion vs somatization vs hypochondria
|
Conversion: neuro# with indifference
Somatization: supermany sx Hypochondria: keep thinking they have 1 life threatening disease, despite negative tests |
|
Pain disorder is associated with...
|
depression
NB evt secondary gain, but not faked |
|
What are the physiologic sx of anorexia?
|
osteoporosis
incr che/carotene arrhytmias euthyroid sick syndrome hypo-pit axis# hypoNA (if more electrolyte#: purging) |
|
DD pseudodementia - dementia
|
Dementia: confabulations, insidious, pretents nothing is going on
Pseudodementia: acute, will admit to deficits, no confabulations to answers they don't know, treat with antidepressants |
|
Which sleep stages: EEG and their#?
|
awake: fully=beta, drowsy=alpha
1: theta 2: K, spindles 3/4: delta -> sleepwalking/night terrors REM: sawtooth -> nightmares NB sleeptalking: all stages |
|
Tx paraphilias
|
psychotherapy
SSRI, antiandrogens to reduce sex drive evt averse conditioning |
|
Adversities SSRI
|
agitation, loss appatite, N/V, headache, diarrhea, sexual dysfunction
|
|
Adversities MAOi
|
sedation, weight gain, orthostatic hypotension, hepatotox, sexual#
hypertensive crisis if used with tyramine rich foods, nasal decongestants, antiasthma meds, amphetamines |
|
What intox should always be ruled out if susp mania?
|
cocaine, amphetamines
|
|
What are adversities of ECT?
|
Most common: amnesia
incr intracranial pressure -> caution if intracranial lesions |
|
Panic attack versus phobia
|
Panic attack unexpected
Phobia: panic attach in specific setting |
|
OCD vs OCPD
|
OCD: recognize their absurdity
OCPD: see nothing wrong with their behavior |
|
Tx PTSD
What should NOT be given and why? |
TCA/SSRI
exposure therapy, relaxation techniques DO NOT give benzo - very high association substance abuse |
|
What are sx alcohol withdrawal and how do you prevent it?
|
tremore, seizures, delirium tremens (hallucinations) -> prevent with benzo (chlordiazepoxide- long acting = librium)
|
|
What are axis I-V?
|
I: clinical psych dz
II: personatity disorder/mr III: medical dz IV: environment/social V: level of functioning |
|
PCP vs alcohol intox
|
PCP: nystagmus, ataxia -> with hallucinations, paranoia, psychosis
Alcohol: nystagmus, ataxia |