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121 Cards in this Set
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- Back
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tx of social/specific phobias
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cog beh therapy: recreate the attack, flooding , implosion, systematic desens,
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what is biofeedback for ?
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tx hypertension, raynaud's, migraine and tension haches, chronic px, fecal incontinence, tmj
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what is dynamic p+'-
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recreation of the past through clarification, confrontation, and interpretation ...pt lies on couch away from therapist,
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good diff b/w suppression and repression?
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suppression = consciously postponing the feelings/to deal w/ later, etc. repression = indefinitetely witholding an idea from consciousness
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what is supportive psychotherapy?
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absence of interpretations of pts thoughts, with emphasis on helping the pt funcion in the real world and supporting him with positive communication and concrete suggestsion of how to fxn
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what is reciprocal inhibition?
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type of desensitization in which the perceived fearful stimulus is paired with a feeling incompatible w/ anxiety , ie relaxation, good thoughts, etc.
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what is reframing?
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used i family therapy; involves giving a new meaning to a problematic behavior/situation that makes it more acceptable to the family
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c/i's to hypnosis?
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paranoid / suspicious patients (ie p schizo or paranoid delusions)
(will not comply well w/ losing control in hypnosis) trauma pts |
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what must family members be taught about schizophrenia?
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1) about schizophrenia
2) to keep communiations at low emotional level b/c environment of negative emotions induce further relapsing in schizophrenic pts 3)learning more ways to cope w/ stress |
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limited predetermined number of sessions for tx of specific areas of problems in life of an otherwise normal patient?
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brief individual insight-oriented psychotherapy
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psychoanalytic therapy is for?
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ppl who can think well, abstract well, etc, who want to understand themselves...good for pts w/ neuroses ie OCD, hysterical, phobias, personality disorders, or ppl w/ problems w/ intimacy, relationships, self-esteem/worth, etc
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cognitive therapy vs behavioral therapy for panic disorder?
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cog ther = giving pt info about how harmless the perceived sx she is feeling during attack are...giviong pt different interpretations of the situation/ her sx, than what she is currently believing
beh ther = desensitization with stimuli, exposure, etc. |
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what is interpersonal psychotherapy?
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dev by Gerard Klerman as time related tx for depression by identifying all the relationships an individual has and its effect on: ( role w/sign others, transitions in life, current relats, social deficits, etc) and how his depression fits into these relationships
basis is that depression stems from dysfxn in relationships |
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desensitization vs extinction?
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desens: unwanted situation causing feeling/anxiety is linked to desirable feeling/relaxation/calming
extinction: not linked; instead, just wait until feared result does NOT occur and if repeated, eventually the anxiety about it will go away |
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chance that monozygotic twin will have depr if other has?
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70%!!!
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which cancer may have a prodrome of depression or crying spells, etc
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pancr cxr ...check amylase levels
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post partum blues usually peak when and resolve when?
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peak at 5-7 days, resolve by at least 2 wks if not less
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diff b/w normal bereavement and adjustment disorder?
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both occur w/in 3 months of event, may last up to 6 mo.
ad causes SOCIAL/OCCUP impairment |
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tx of psychotic depression?
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start on ssri AND antipsychotic
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post stroke depression %?
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30-50%
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which lobe affected in strokehas highest prevalence of post stroke depression?
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LEFT FRONTAL lobe
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percent of mothers developing post partum blues? depression?
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blues = 30-50%...
depression = 10-15% |
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post-stroke pts at high risk for depression for how long after stroke?
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2 yrs!
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what behavior has an antidepressant efffect in depressed pts and can causa a manic event in bipolar pts? tx?
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sleep deprivation...
ie think when pt cramming for tests gets irritable/manic. give sleeping pill or benzo |
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lifetime risk fo suicide in affective disorders? in schizo?
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aaffective = 10-15%
schizo = 10% (with 50% attempted) |
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depression w/ hypersomnia and hyperphagia lasting for a few months...
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think seasonal affective disorder! presents w/atypicalsx like eating more, sleeping more.
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what of antidepressants has slightly lower risk for triggering mania ie for tx of bipolar on lithium w/ new onset of depression?
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buproprion
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if pt w/ hypoth becomes depressed, then you tx hypoth and 6wks later pt still depressed, what to do?
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start ssri...
often depression SECONDARY to hypoth may still remain after hypoth is treated..!neet to then treat w/ ssri |
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m/c side effect of ect?
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hache, nausea, muscle soreness
less common but more concerning = antero /retro grade memory loss |
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dysthymia / cyclothymia/ in adolescents may be dx'd after sx for how long?
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over 1 yr
vs adults = over 2 yrs |
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standard tests to give any pt on lithium, regularly?
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plasma lithium
creatinine urinalysis thyroid fxn (ECG if over 50) |
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ECT for whom?
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dep resistant to antidep's
severe dep that needs immediate tx before ssri's are able to work dep w/ psychotic features ppl who can't stand side effects of antidep's ppl w/ medical illnesses (or pregnancy) catatonic schizophrenia depression in elderly / parkinsonism w/ depression (lowers extrapyramidal signs) (also mania, nms, schizo w/variable results) |
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how does depression manifest in preschoolers? in school aged kids?
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preschoolers - irritable, w/drawn, aggressive, clingy
not nec. sad school aged - loss of interest in school or friends adolescent - similar to adults |
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you should give ssri then what, next line in tx for refractory depression?
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lithium!
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main contraindications or ECT?
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increased ICP or RECENT (within 2 WEEKS) MI,
relative = space occupyikng lesion or something disrupting the BBB |
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% of depressed pts who will also at some pt be alcoholic?
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35%!!
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PET test results for all depressed pts?
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decreased blood flow and metabolism in frontal lobes, bilaterally
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melancholic depression? tx?
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anhedoina, lack of reactivity, intense guilt, wt loss, early awakening, and pm retardation.
tx = TCA's |
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major dep developing in person w/ dysthymic disorder?
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double depression
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tx for atypical depression?
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try MAOI's...ahve been shown to work better for atypical dep
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tx of dissociative disorders?
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hypnosis
amobarbital sodium interviews psychoanalytically oriented psychotherapy to recover lost memories of disturbing emotinal experiences |
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what is depersonalization disorder?
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recurrent feelings of detachment, from own body or from environment (derealization)
has insight; NORMAL reality testing and knowst hat these are just feelings |
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under what somatiform disorder does pseudoseizure (psychogenic non-epileptic seizure) fall?
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somatiform disorder
(not = conversion disorder, and not actually factitious) |
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conversion disorder vs factitious?
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conversion is NOT voluntary, although manifestation of physical sx follows PATEINT's understanding of disease, NOT usual diagnostic signs used by medicine.
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acute episode of urinary incontinence that resolves, then later acute episode of other neurol deficiency ie blurry vision?
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think MS!! not conversion b/c sx of incontinence are uncommon among conversion disordedr...but if ie arm paralysis, consider conversion
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what is common finding in dissociative identity disorder ( multiple personality disorder)
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significant memory gaps (hours-days)
auditory hallucinations |
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most cases of dissociative amnesia resolve spont or not?
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do resolve spont
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buspirone vs benzos?
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bus = same potency (as ie diazepam) but less sedating, less addictive, less quick in onset: takes upt o 3 weeks to work.
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OCD requires SSRI in higher or lower doses than that for depression?
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HIGHER..!
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nocturnal erection and depression?
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may be decreased or absent in depression
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diff b/w social phobia and avoidant personality disorder?
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spp = certain situations causes fear, self-consciousness, etc;
apd = interpersonal comm / relations causes it |
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common medication causing erectile dysfxn?
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propanolol (bblocker = also has serotonergic effect)
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life time prevalence of personality disorders?
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5-20!
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tx of personality disorder?
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psychodynamic psychotherapy
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common affective sx of anabolic steroid use?
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irritability, mania, hypomania, aggressiveness
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(fever, tachycardia, hypertension, creeping bugs on skin or other vis halluc in previous substance abuser? tx?
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think delirium tremens caused by either benzo / barb withdrawal or chronic alcohol withdrawal.
tx =diazepam, +- brief antipsychotics if pt hallucinating |
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mort rate of delirium tremens?
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20%!!
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which opiate is often accompanied w/seizures w/ illegal use, and why?
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meperidine in chronic user causes accumulation of normeperidine, a toxic metabolite causing seizures
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duration of LSD intoxication/hallucinations?
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usually 8-12 hrs
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duration of PCP hallucinations?
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may last up to weeks!
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signs of alcohol intoxication may be seen at what blood alcohol level (in mg/dL?
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20-30 = signs seen
100-200 = signif. motor/mental impariment 200+ slurred speech/ blackout, etc >400 resp coma / death |
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sleep effect of aldcohol?
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causes decreased REM, stage 4 sleep, while more fragmented sleep
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2 fast acting benzo's that you can give a pt with delirium tremens?
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diazepam or
chlordiazepoxide |
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what to give pt with delirium tremens?
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1) benzo
2) folate + thiamine (before glucose) 3) MgSo4 if pt has hx of seizures upon withdrawal |
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alcohol abuse vs dependence?
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abuse = abnorm use causing social/occup impairment
dependence = abuse PLUS: 1) w/drawal sx 2) Tolerance or 3) Pattern of repetitive use 4) ineffective attempts to cut down (addiction) |
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lifetime prevalence of alcohol dependence? females? males?
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3-5% females
10% males!! |
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drug used to tx opoid withdrawal sx?
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clonidine (alpha 2 blocker)
(usually given WHILE methadone is given for detoxification from heroin) |
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postop headache, fatigue, inability to concentrate due to what withdrawal?
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caffeine!!
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amt of alcohol in blood over which, if no signs of intoxication, patient has alc tolerance?
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if over 150 mg/dL and no signs = tolerant
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tx for PCP intox?
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short acting benzo (diazepam or chlordiazepoxide) and then antipsychotic for halluc's
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long term effects of marijuana?
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respiratory compromise
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PCP acts by what mech?
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stim's glutamate NMDA receptors
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time after smoking cannabis that judgment ie for driving is still impaired?
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8-12 hrs
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agitation, restlessness, tc, tremors, htn, mydriasis, and feeling like one can fly?
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LSD - has sympathomimetic properties
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drug associated with bruxism, shortness of breath, cardiac arrhythmias, and death?
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ecstasy
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which bblockers do NOT cause bronchospasm?
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atenolol, metoprolol
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tx of akathisia?
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bblocker
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why not use MAOInhibitors in elderly?
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b/c MAIN side effect is ortho hotn (although other side effects may be more severe)
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effective tx for OCD?
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SSRI's
OR clomipramine (TCA) |
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emergency tx of very high lithium toxicity?
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emergency dialysis
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what dose of tca's is fatal?
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only 2-3 g!! that's why don't give to suicidal pt!
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tx for sexual dysfxn while continuing causative ssri?
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give cyproheptadine
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benzo overdose tx?
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flumazenil
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2 low potency antipsychotics?
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chlorpromazine, thioridizine
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whaty type antipsychotic to give elderly?
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DONT give low potency ie chlorpromazine or thioridizine, b/c they have sedating anticholinergic and orthostatic hotn s/e's! this is disastrous in elderly.
so give haloperidol, low dose |
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washout period necessary after ssri stoppage and before MAOI initiation to prevent serotonin syndrome?
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2 weeks
5 weeks for fluoxetine |
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tx of tardive dyskinesia?
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1) discontinue antipsychotic
2) if cannot do this, switch to clozapine |
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tca drugs?
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amitryptiline,
desipramine, clomipramine, doxepin imipramine, |
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tx of tca overdose?
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MONITOR ECG for qrs prolongation /arrhythmias!
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preferred tx for mania in pregnant women during 1st trimester (time of risk of ntube defects)
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antipsychotics
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types of drugs used for non-compliant schizophrenia?
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haloperidol decanoate (inj)
or fluphenazine (inj) |
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fluoxetine inhibits metabolism of what drugs?
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carbamazepine,
haloperidol, diazepam! |
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s/e's of ritalin?
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tics
crying spells insomnia (so don't give after lunch!!) gi distress decr appetite |
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tx for elderly pseudodementia (depression)
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SSRI, NOT TCA b/c causes hypotension, cardiac arrhythmias
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disulfiram works how?
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inhibits acetaldehyde dehydrogenase
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tx for narcolepsy? cataplexy?
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narc = methylphenidate (remember, ritalin causes insomnia)
cataplexy = SSRI's TCA's b/c they reduce REM |
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tx of psychotic pts with parkinsons?
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clozapine - b/c doesn't cause extrapyramidal sx / parkinson sx
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how lojng should tx with one antidepressant be given (with increasing doses), if no effect is seen?
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up to 3-4 wks, then SWITCH antidep's rather than continuing to incr dose or to add another
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lithium takes how long to reach equilib in blood?
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half life is 20hrs, so takes 5-7 days to reach equil in blood
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tx of akathisia in pt w/asthma (so can't give propanolol)?
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benzo
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what is a "poor metabolizer"
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concerning TCA's, 10% of caucasians have poorly metabolizing P450 2D6, so they have higher chance for TCA toxicity/side effects
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PTSD Tx?
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1st do CBT / psychotherapy
also SSRI but for Hyperarousal sx, tx w/ bblocker or clonidine |
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which of the antipsychotics does NOT cause ortho or postural hotn?
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only haloperidol does not have these anticholinergic effects.
olanzapine = postural hotn clozapine = ortho hotn low potency drugs = anticholinergic effects = ortho hotn |
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MAOI's taken with what may cause a hypertensive crisis?
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any sympathomimetic! (in addition to any tyramine containing food like aged cheese, red wine, alcohol, or smoked meats like pepperoni) Pseudoephedrine, ephedrine, methylpehnedate, phenylephrine, etc.
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used to tx enuresis, as well as ADHD?
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Imipramine
"I" nuresis "I" DHD |
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target range for lithium in bipolar?
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1-1.5 meq/L
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tx for acute dystonia?
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benztropine; diphenydramine (anticholinergics)
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m/c cause of malpractice claims against psychiatrist?
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1physical injury caused by tx's
2suicide, or attempted |
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what is beneficience? nonmalevolence?
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b = preventing harm and promoting well being
n= do no harm |
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fiduciary principle?
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doctor patient relat is built on honor and trust that dr will act competently and responsibly in partnerhsip w/patient and w/ patient's consent....done by cointinued attention to ptn's needs (= 'responsibility')
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Tarasoff I vs II?
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I = if phys finds that pt has intnent to do harm to someone else, physician must warn potential victiim
II =phys must protect potential victim ie by notifying police, ensuring protection, etc. |
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How surrogate decision makers should make decisions?
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1 first decide what pt WOULD have wanted.
2 if this is unknown, make decision based on pt's best interest |
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pt tx'd for depression and insomnia, comes to ER w/ severe respiratory depression?
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secobarbitol / barbituate o/d
from barb's given for insomnia..! Or fluoxetine causes decr metab of carbamazapine, halo, and DIAZEPAM...so may be inhibiting b/d of diazapam ...? |
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intense hunger, tiredness, headache are signs of what withdrawal?
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amphetamine!
remember: ie methylphenidate / amphetamines causes wt loss and decr appetite! |
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nystagmus, psychotic features, and aggression in what drug use?
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PCP
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dyspareunia vs vaginismus?
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d = px upon intercourse
v = px upon intercourse OR vag exam |
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retinal pigmentation is a side effect of ?
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thioridazine (low-potency antipsychotic)
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disorder with the greatest sex difference?
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MDD (women >>men)
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what is used to evaluate hearing loss in newborns/infants?
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auditory evoked potential test
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what is negative reinforcement?
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when a person increases behavior due to the reward of having an adverse reaction decreased (ie pt continues going to dr. b/c each time, px decreases)
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ECT indications?
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1severe major depression with psychotic features
2manic delirium or severe mania 3catatonia 4depression refractory to tx 5schiz refract to tx (some say y/some no) 6pregnant or elderly (is less harmful than other drugs) 7pt w/ medical illnesses 8parkinsons w/ depr (lowers extrapyr signs) 9severe suicidal depr that needs tx before meds can kick in |
