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Age of onset of schizophrenia
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Men 15-25
Women 25-35
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Prevalance of schizoprenia
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1% in most cultures
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List the differences between psychotic disorders
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<1 mo=brief psychotic episode
1-6 months = schizophreniform disorder
> 6 month = schizophrenia
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Why are atypical antipsychotics preferred for maintainence therapy in psychotic disorders?
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less EPS and better effect on negative symptoms
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Onset of dystonia if EPS reaction?
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hours to days
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Treatment of acute dystonia
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- anithistamines (diphenhyd)
- anitcholinergics (benztropine, trihexyphenidyl)
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Onset of akathisia if EPS reaction
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within days
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Treatment of akathisia
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can try b-blockers
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Onset of parkinsonism if EPS reaction
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within months of treatment
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Parkinsonism from EPS most common in
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older women
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Acute dystonia from EPS most common in
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young men
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Onset of tardive dyskinesia if EPS reaction
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after years of treatment
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Treatment of tardive dyskinesia
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- none
- likely stop antipscyhotic and switch to atypical
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Features of neuroleptic malignant syndrome
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- rigidity
- high fever (up to 107)
- high CPK
- sweating
- myoglobinuria
- mutism
- altered mental status (agitated of obtunded)
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Treatment of neuroleptic malignant syndrome
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- stop antipsychotic
- supportive care for fever and renal
- consider giving dantrolene
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classic side effect of thorazine
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retinal pigment deposits
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classic side effect of clozapine
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agranulocytosis
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Classic side effects of chlorpromazine
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- jaundice
- photosensitivity
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3 classic side effects of SSRIs
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- insomnia
- anorexia
- sexual dysfunction
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Firs line treatment of depression
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therapy and SSRIs
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Mechanism of action of TCAs
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- NE reuptake block
- serotonin reuptake block
- a-adrenergic block
- AchM block
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Why do TCAs cause orthostatic hypotension?
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a-adrenergic block
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MAOIs may be good for
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atypical depression (eating and sleeping more)
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TCA overdose most concerning for
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cardiac arrhythmias
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MAOIs + tyramine =
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HTN crisis
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Age of onset of bipolar disorder
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16-30 years old
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1st line agents for bipolar disorder
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- lithium
- valproic acid
(carbamezapine 2nd line)
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What is bipolar II?
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hypomania with major depression
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What is cyclothymia
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2 years of hypomania with depressed mood without major episodes of either
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4 classic side effects of lithium
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- renal (DI)
- thyroid
- tremor
- CNS effects
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Classic side effect of valproic acid
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liver dysfunction
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Classic side effect of carbamazepine
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bone marrow depression
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10 major risk factors for suicide
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- age above 45
- substance use
- h/o violence
- prior attempts
- male
- psych history
- recent loss
- loss of health
- unemployment/retirement
- not married/partnered
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Greatest age risk for suicide
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over 65 (15-24 also high)
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Normal grief can last up to
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1 year
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Typical age for panic disorder
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20-40
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Treatment of panic disorder
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SSRIs (fluoxetine)
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Panic disorder is associated with
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agoraphobia
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Describe conversion discorder
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- ppt event
- unexplanable neuro symptoms
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Key features of somatization disorder
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multiple complaints in multiple organ systems with negative workup
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Treatment of somatoform disorders
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- frequent clinic visits and/or therapy
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Difference between factitious disorder and malingering
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factitious disorder the patient wants to assume role of the patient. It's intentional but no monetary or other gain.
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Key features of paranoid personality disorder
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- everyone's out to get them
- law suits
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Key features of schizoid personality disorder
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- loner and not interested in having friends
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Key features of schizotypal personality disorder
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- bizarre beliefs
- bizarre way of talking but no psychosis
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Key features of avoidant personality disorder
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- inferiority complex
- has no friends but wants them
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Key features of histrionic personality disorder
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- center of attention
- seductive
- dramatic and attention seeking
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Key features of narcissistic personality disorder
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- no empathy
- use others for own gain
- sense of entitlement
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Key features of antisocial personality disorder
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* must have had conduct disorder
- criminal
- male
- alcohol and drugs
- somatization
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Key features of borderline personality disorder
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- unstable in every realm
- splitting
- 2 minutes of psychosis
- impulsive
- constant crisis
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