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71 Cards in this Set
- Front
- Back
First-line treatment MDD
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mild to moderate: Rx or psychotherapy (interpersonal or CBT). Severe: requires Rx
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Is one Rx for MDD more efficacious than another?
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No. all antidepressants are equally efficacious. Exception: MAOIs > TCA in atypical depression
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Most effective Rx for depression?
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ECT
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First line treatment for bipolar p/w mania or mixed episode
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mild-mod: lithium, valproic acid or antipsychotic; if severe: add antipsychotic to either lithium or valproic acid
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First line treatment for bipolar p/w MDD
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lithium or lamotrigine
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First line treatment for bipolar p/w rapid cycling?
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valproic acid or lithium (VPA is generally better)
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first line treatment in schizophrenia
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antipsychotic (usually tailoring side effects: consider ziprasidone/aripiprazole for those who are overweight; use sedating Rx at night if not sleeping well, etc.)
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First line treatment in schizophrenia w/ history of med non-compliance
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consider depot antipsychotic (decanoate formulation of haloperidol or fluphenazine or newer atypical depots, risperidone (consta) or paliperidone (invega sustennal)
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first line treatment for delirium
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high potency antipsychotic (haloperidol & fluphenazine)
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first line treatment for catatonia
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lorazepam (ativan)
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first line treatment for generalized anxiety d/o?
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SSRI
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first line treatment for panic d/o
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start w/ SSRI + benzo and taper off benzo after a month or so
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first line treatment of PTSD
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SSRI (esp paroxetine or sertraline)
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Time period for delusional d/o
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1 month
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time period for cyclothymic or dysthymic d/o
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2 years in adults; 1 year in children (no period longer than 2 months of sx free)
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Time period of sx for GAD?
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6 months
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duration of sx for MD episode
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2 weeks
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duration of sx for manic episode
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7 days
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Duration of sx for mixed episode
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1 wk or less if hospitalized as a result of sx
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duration of sx for hypomanic episode?
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> 4 days
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ODD v conduct d/o
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ODD children are peevish, obstinate and angry, but those with conduct d/o violate other's right (theft, setting fires, fights, animal cruelty).
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ADHD v bipolar d/o
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Bipolar are discrete episodes whereas ADHD are defined by ongoing hyperactivity (>6mo) and/or inattention in at least two settings (home, school, etc)
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Separation anxiety disorder v reactive attachment disorder
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separation anxiety d/o = anxiety when being apart from person to whom child is attached; reactive attachment d/o has two subtypes (both manifesting < 5 y/o): either the child will not attach readily & indiscriminately to just about everyone
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Name the 5 pervasive development
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autistic d/o, asperger's d/o, rett's d/o, childhood disintegrative d/o, NOS
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name the pervasive developmental d/o: poor social interactions, restricted/sterotyped behaviors/interest & communications.
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Autistic d/o
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Name the pervasive developmental d/o: poor social interaction & restricted/sterotyped behaviors/interests; can be very intelligent and very gifted at communication
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Asperger's d/o
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Name the pervasive developmental d/o: deceleration of head growth from 5-30mos., sterotyped hand movements (e.g. wringing); generally female
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Rett's d/o
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Name the pervasive developmental d/o: normal development until 2 yrs. then lose previously acquired skills + 2/3 autistic d/o sx; generally male
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childhood disintegrative d/o
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Name the pervasive developmental d/o: looks like others but doesn't meet the strict criteria
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NOS
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MCC of mental retardation
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down syndrome
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MCC of preventable MR
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fetal alcohol syndrome
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this common form of MR is found exclusively in males
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fragile X syndrome
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occurs during childhood and is characterized by persistent failure to speak in one or more major social situations, despite the ability to speak and comprehend spoken language
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selective mutism
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a behavioral disorder that is most commonly identified among mentally-disadvantaged children, although it is increasingly recognized among adolescents and adults of normal mental capacity. The behavior consists of daily, effortless regurgitation of undigested food within minutes of starting or completing ingestion of a meal.
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rumination d/o
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Treatment for ADHD
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psychostimulants (methylphenidate or amphetamine analogs), the newer non-stimulant atomoxetine (strattera; acts as a norepi reuptake inhibitor), or guanfacine (a2 agonist)
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Treatment for enuresis
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bed alarms are 1st line; consider imipramine
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Tourette's treatment
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antipsychotics (risperidone, pimozide) or clonidine/guanfacine
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treatment for absent seizures
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ethosuximide or valproic acid
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postpartum blues v postpartum depression v postpartum psychosis
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blues = normla response after pregnancy but sx doesn't meet criteria for MDD & occurs in up to 30% of women. Sx peak ~ 5d post partum and resolve within 2 weeks. Pp Depression meets full criteria for MDD. Pp psychosis is psychosis (bipolar d/o until otherwise proven) address immediately
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Premenstrual dysphoric disorder
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severe PMS (dx'd as depressive d/o NOS). Can give SSRIs ONLY during luteal phase
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What causes ebstien's anomaly?
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lithium
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what psychiatric medications cause neural tube defects on the fetus?
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valproate and carbamazapine
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What side effects can SSRIs have fetus?
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persistent pulmonary hypertension & fussy babies
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what is medication can be used for premature ejaculation
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SSRI
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painful spasm of external 1/3 of vagina (ectoderm derived under voluntary control)
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vaginismus. often h/o sexual trauma
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voyeurism
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paraphilia of watching others
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exhibitionism
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paraphilia of revealing self to others
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frotteurism
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paraphilia of rubbing against strangers typically in crowded places
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sadism
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paraphilia of feeling pleasure when inflicting pain
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masochism
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paraphilia of feeling pleasure in being humiliated/experiencing pain
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dyssomnias v parasomnias
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too much or too little sleep AND abnormalities occur during sleep or the period going to or awakening from sleep
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Define restless leg syndrome. Treatment.
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crawling/tinglings sensation of legs, worst at night; sensation improves with leg movement. Use pramipexole (Mirapex) or ropinirole (Requip)
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What should you rule out first when you suspect restless leg syndrome?
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iron deficiency syndrome. If it is, give iron
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What are pramipexole (mirapex) and ropinirole (requip) both associated with?
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new onset pathological gambling and sleep attacks.
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Define night terrors (pavor nocturnus)
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most often a child appears to awaken from a terrifying dream and may even scream, but he or she doesn't truly awaken and doesn't recall the event the following morning. Occurs in non-REM sleep; more common in 1st 1/2 of the night. Can treat w/ long-acting benzodiazepines.
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Excessive daytime sleepiness, hypnoGOgic hallucinations, cataplexy (loss of motor tone in context of emotion such as laughing/crying), sleep paralysis
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narcolepsy
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T/F: narcoleptics may have REM episode within 10-20 min
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True. healthy individuals have their first REM episode 90min into sleep
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delayed sleep phase (in adolescents), advanced sleep phase (elderly), jet lag sleep disorder, shift work)
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circadian rhythm sleep d/o
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What should always be implemented for sleep disorders?
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good sleep hygiene
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What should you always rule out when dealing with sleep disorders?
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substance-induced sleep disorders
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Name the 3 eating d/o
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anorexia nervosa, bulimia nervosa, eating d/o NOS
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<85% of ideal body weight, amenorrhea, afraid to gain wt. Has restricting and binge-eating/purging types.
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anorexia nervosa. Anorexics consider their condition egoSYNtonic (they will tell you they're fat (despite being utterly cachectic) and they need to lose weight).
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recurrent binge eating with excessive attention paid to the body and compensatory techniques to lose weight
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Bulumia nervosa. There is a purging and non-purging type. egoDYStonic. these patients feel very ashamed of their behavior and go to great lengths to hide it.
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What is Russell's sign?
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scarring on the extensor surface of a finger/fingers as a result of repetitive purging.
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Define eating d/o NOS
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NOT anorexia or bulimia
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Name the Impulse Control Disorders Not Elsewhere Classified
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kleptomania, trichotillomania, pathological gambling, pyromania, intermittent explosive d/o.
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What class of disorders contains depersonalization d/o, dissociative amnesia, dissociative fuge, dissociative identity d/o
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dissociative disorders
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Patient under significant stress, states that they do not feel "real"
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depersonalization d/o
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patient states he can't recall something
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dissociative amnesia
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A nun in her own town who works as a prostitute in another town.
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dissociative fugue
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Patient has multiple personalities or "alters"; often find things at home they don't recall purchasing... controversial fx
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dissociative identity disorder
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