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53 Cards in this Set
- Front
- Back
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DSM IV TR
what is it what are the axis (I-V) |
diagnostic ref. for inital assess
Axis I- principle disorder - schizo, bipolar etc II- Personality disorder- asshole, cant give meds III-physical disorder - HTN etc IV- severity of pshyco social factors (environmental stressors) V- GAF - global assessment function (1-90) lower worse, admitted round 40ish |
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Sum points about clinical interview of mental pt
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quiet atmosphere
open and closed ended questions ok ask about suicidal thoughts |
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Hallucination vs delusions
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hallucinations - 5 senses, most common auditory
delusion- percieved thought, dont mistake for cultural belief |
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clincial mental pt interview
what lookin for |
dress
motor activity speech and language mood-sustained feeling affect- emotional state sharing mood (flat, blunted, inappropriate) neuropsy eval insight judgment |
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for neuropsyh eval on orientation how many is usual for reg person
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usually 3
time place person situation |
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MMSE test for cognition how many to prove not impaired
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want at least 24
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How check movement disorders
what are the movement disorders |
EPS- use simpson angus EPS scale
Dystonia- simpson scale- prolonged contraction Akathisia- BARS, barnes akathisia rating scale - inner restlessness Tardive dyskinesia - late onset, from extended use |
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Scales /inventories
Depression |
note inventory is pt rated, scale is physician
hamilton depression scale (HAM-D)- gold standard montgomery asberg scale (MADRS)- higher more depressed Beck depression inventory BDI |
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Scales/ inventory
Anxiety |
HAM-A scale- hamilton gold standard
beck anxiety inventory (BAI) State trait anxiety inventory (STIA) member inventory is pt rated |
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scale inventory
schizo |
positive and negative symptom scale (PANSS) - GOLD STAND.
Brief psychiatric rating scale (BPRS) Clinical global impression scale (CGI) |
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Inventories / scales
Bipolar disorder |
mood disorder questionairre (still scale?)
bipolar spectrum disorder scale (BSDS) goldberg mania questionaire |
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ADHD
epidemiology |
males more than females
males- hyperactive, easier to see females- quiet type |
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ADHD patho
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possible prefrontal cortex abnorm (response inhibition)
decreased size cerebral volume Dopamine and NE dysregulation in mesocortical and prefrontal areas respectively |
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ADHD
symptoms types |
both innattentive and hyperactive types
inattentive -fail close attention details -not seem listen -difficulty organize tasks -forgetful daily activities Hyperactive -diff. await turn -take excessively -diff. standing still -interupts |
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ADHD
symptom factors for diagnosis |
must be present before age 7
at least 6 present for 6 months at least 2 environments significant impairment not associated with another issue |
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Guidelines for ADHD
steps |
Step 1 -stimulant (ampetamine or methylphenidate)
Step 2- opposite stim Step 3- atomoxetine Step 4- Bupriopion or TCA Step 5- one you didnt use in 4 Step 6- alpha 2 ags |
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Stims
methylphenidate list em |
Ritalin
Methylin Ritalin SR Methylphenidate SR Methylin ER Metadate ER Concerta Metadate CD Ritalin LA |
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Stims -methylphendates
short acting and their info |
Ritalin
Methylin 3-5 h 5mg - 20mg BID or TID |
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Stims - methylphendates
intermed acting and info |
Ritalin SR
Methylphendate SR Methylin ER Metadate ER 3-8 h 20mg - 40 mg QD - BID |
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Stims- methylphendates
long acting and info |
Concerta- ghost tab - 18mg- 72mg
Ritalin LA 20 - 40 mg Metadate CD 20 mg 8 - 12 h |
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+ves and -ves for methylphendates
vs amphetamines |
generics
less likely supress appetite less likely tics or insomnia -ves erratic conc. w/ IR/SRs concerta GI obstruction possiblility generic diff. reported |
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Daytrana
what is it, what used for, info... |
methylphendate patch- ADHD
10, 15, 20 ,30 QD on hip 2 h before needed NnV 20mg ~ oral 20mg TID 9h wear time covers 12 h |
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Dexmethylphendate product...
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Focalin, Focalin XR
12h less headache greater GI <25kg 2.5-7.5 QD >25kg 2.5-10 BID max 20 |
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Amphatemines
list em |
Dextroamphetamine
Dexedrine spansule Mixed salts (Adderal) Adderal XR |
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Short acting amphetamine
what is it, dose info blah blah blah |
Dextroamphetamine
(Dexedrin, Dextrostat) 3-5 h <25kg = 2.5- 10mg >25kg= 5- 10 BID- TID |
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Intermediate amphetamine
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5-8 h
dexedrine spansules 5- 15 BID Mixed salts (addderall) 0.5 mg/ kg / day` |
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Amphetamine long acting
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8-12 h
Adderal XR 10 - 30 QD ****if taken with high fat meal can lower conc 50%....aka dont fuckin do that can sprinkle in apple sauce |
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amphetamines
+ves and -ves vs methylphenadtaes |
-generics
spansules can be opened and sprinkled predictable kietics -ves ***worsen tics greater growth issues |
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lisdexamfetamine
what is it why is that fucked up info |
Vyvanse
amphetamine is not spelled like that ever prodrug of reg amphetamine 30 - 70 mg 10- 12 h openable and DISSOLVABLE in water not generic |
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General AE with stims
how solve |
Appetite supression -
nausea- ----for these take a high fat meal at night and should calm everything down dizzy insomnia headache |
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whats the BBW on stims
how much is it worriable |
sudden death....
its actually less than stratera sooo durrrr |
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Strattera is
used for general |
atomoxetine
2nd liner selective NE reuptake (presynaptic) 1st nonstim noncontrolled food no matter 2-4 wks for effect no tapering |
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Strattera dosing stuff
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best efficacy 1.2 mg/kg/day start .5
but from chart maybe better... basically said know ranges so whatever their weight is in pounds half of that proxy starting dose kinda... 40-62 ------18 -------25 63-93-------25--------40 94-126-----40-------60 127 and up----40-----80 |
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strattera SE
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down appetitie
up BP, naseau, headache, mood change, liver tox BBW suicide 2d6----antifungals.... not if less than 61 80% response rate |
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TCAs and ADHD
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up NE
most common -nortriptyline- DOC if has to be one of these bastards -imipramine -desipramine- avoid---then dont write it on damn slide.... 10 BID or 25 QD 70% response good w/ comorrbidities -OCD, depression, anxiety, tics, euresis 1-2 wks to work taper monitor vitals, ECG, behavior scale............ |
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Wellbutrin and ADHD
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up DA and NE
70% response rate no controlled trials,,, less abuse Disadvantages- less effective at distractability, excasterbate tics range 50- 300 QD |
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Alpha Agonists and ADHD
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Clonidine and guanfacine
inhib NE (g more selective) less effective inattention 2-4 wks respond can combo with extended release stuff? patch only good 5 days in children!!!! need oral first -PATCH NOT W/ STIMS!! SE brady, hypotension, Depression (CI), taper |
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other ADHD drugs that are random
and when use |
Carbamazepine - use w/ bipolar, intermittant explosive disorder
Antipsychos -very low dose, only w/ severe agression Herbals- Zinc and blah others |
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ADHD drug selections
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1st stims
special considerations -atomoxetine- refuse stim, tic/anxiety -Bupropion - depression - TCAs- depression or anxiety Poss. Adjunct -Carbamzepine- mood stabilize -alpha 2 if on stim and tics (not patch!!) -antipsychos- severe agression |
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Who are a high % of ppl that suffer from insomnia
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depressed ppl
50% |
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how do we measure sleep stages
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latency to persistant sleep (LPS)
Total Sleep Time Quality of sleep- feel good when wake? Polysomnogprahy- electrical Objective- awakenings / night etc |
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what causes these sleep issues
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decrease serotonin --sleep reduction
up dompamine -- up wakefulness melatonin - sleep promoter |
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Primary sleep disorder...
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due to endogenous abnormal of sleep wake cycle or circadian rhythm
dysomnia- primary parasomnia- nightmare, sleep walking |
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different symptoms of sleep disorder
and lengths |
diff fall asleep
diff stay asleep non restorative sleep transient 1-3 nights short term less 30 days long term 30 days or more (comorbidity?) |
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Etiology of sleep issues
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situational
psychiatric medical drug induced - bronchodilators, diuretics, steroids, levodopa, SSRI, thyroid, stims |
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Tx of sleep issue
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Cognitive behavioral therapy (CBT)
-Stim control -Sleep Restrictions -Sleep Hygiene education (works for LPS and TST) Pharm tx -Benzos -Non Benzos (broad) -Ramelteon |
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Benzos
Short Med Long acting |
Short
-Triazolam - for onset Med- maintence -Temazepam -Estazolam Long- maintence and early awaken -Flurazepam Quazapam |
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Benzos sleep overview
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nonselective GABAa aplha 1-3, 5
AE- daytime sleepiness memory impair psycomotor dysfunc addition potential CAREFUL elderly and abusers tolerance |
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NON benzos and sleep
doses |
Zolpidem - 5-10
Zolpidem CR 6.25- 12.5 Zolpimist--- 5-10 spray Zaleplon (sonata)-- 5- 20 mg (short t1/2) Eszopiclone (lunesta) 2-3mg |
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Non benzos general and where each used
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bind alpha 1 GABAa subunit
Zaleplon- LPS Zolpidem- LPS, TST....withdrawl Eszopiclone- LPS, TST, long term... shit taste!!! |
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non benzos caution with
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3A4 inhib - antifungals
zaleplon- hepatic impairment |
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special considerations sleep meds
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diphenydramine
valerium root Seroquel- if psychotic 200-800 Mirtazapine (remeron)- antidepressant Trazadone (deseryl)- antichol SE, but antidepress |
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Ramelteon and sleep
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sleep onset!!!!!!
melatonin receptor agonist 8mg w/i 30 mins of sleep noncontrolled |
