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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
Tx social phobia
1)assertiveness training and SSRI
Tx public speaking fear
beta blocker
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
2) TCA
3) MAOi

If first episode: min 6mo
If second or more: indefinitely

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
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....
Bulimia is associated with....
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?

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?
Tx premature ejaculation
squeeze technique

evt psychotherapy, SSRI
Tx fibromyalgia
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?

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?
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:
* 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...

NB evt secondary gain, but not faked
What are the physiologic sx of anorexia?
incr che/carotene
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

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: recognize their absurdity
OCPD: see nothing wrong with their behavior

What should NOT be given and why?
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