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283 Cards in this Set
- Front
- Back
Order of meds given in pt with AMS and + BAL
|
Thiamine always BEFORE glucose, or can precipitate Wernicke-Korsakoff syndrome (b/c is a coenzyme used in carb metabolism)
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3 topographic theories of psychotherapy
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Unconscious, preconscious, conscious
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3 structural theories of psychotherapy
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Id, ego, supergo
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Normal development of egos
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Id at birth, ego present after birth, superego by 6yo
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What is used to control instinctual urges in the ego?
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Defense mechanisms
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What is used to detect fantasies/ psychoses in the ego?
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Reality testing
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4 mature defense mechanisms
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Altruism, humor, sublimation, suppression
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7 neurotic defense mechanisms
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Controlling, displacement, intellectualization, isolation of affect, rationalization, reaction formation, repression
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What is displacement and what is an example?
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Shifting emotions from an undesirable situation to one that is personally tolerable (student who is angry at his mom talks back to his teacher the next day and refuses to obey her)
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What is reaction formation and what is an example?
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Doing the opposite of an unacceptable impulse (man in love w/ his coworker insults her)
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% of incarcerated patients who have antisocial PD?
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80%
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Difference btwn repression and suppression
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Former is unconscious
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4 immature defenses
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Acting out, denial, regression, projection
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What is acting out and what is an example?
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Giving in to an impulse, even if socially inappropriate, to avoid the anxiety of suppressing it (man who is told his therapist is going on vacation "forgets" his last appt)
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What is projection and what is an example?
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Attributing objectionable thoughts or emotions to others (husband attracted to other women believes his wife is having an affair)
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2 other defense mechanisms
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Splitting and undoing
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What is undoing and what is an example?
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Attempting to reverse a situation by adopting a new behavior (man who briefly fantasizes about killing his wife by sabotaging her car takes the car in for a complete check-up)
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Goal of psychoanalysis
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Resolve unconscious conflicts by bringing repressed experiences/ feelings into awareness
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Psychoanalysis is ____ oriented
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Insight oriented
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5 behavioral therapy techniques for deconditioning
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Systemic desensitization, flooding and implosion, aversion therapy, token economy, biofeedback
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Which technique is used in both systemic desensitization and flooding/implosion
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Relaxation techniques
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Difference between flooding and implosion
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Real vs. imagined, respectively
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Foundation of cognitive therapy
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Identify and replace maladaptive thoughts w/ positive thoughts
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2 common problems addressed in family therapy
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Boundaries that are too permeable
Triangles (2 people forming an alliance against a 3rd) |
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4 types of marital therapy
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Conjoint therapy, concurrent therapy (separate but same therapist), collaborative (seen individually), four-way therapy (2 therapists, common for sexual problems)
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4 topics taught in DBT
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Mindfulness, interpersonal effectiveness
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How does cocaine cause its stimulant/reward effect?
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Blocks dopamine reuptake
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3 ways cocaine overdose can cause death
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Arrhythmia, seizure, respiratory depression
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Cause of MI/CVA in cocaine user
|
Vasoconstriction
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Cocaine intoxication mimics
|
Flight or fight (sympathomimetic)
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Ddx for cocaine intoxication
|
Amphetamines or PCP
Sedative withdrawal |
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How long will urine tox be positive for cocaine?
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3 days (longer in heavy users
|
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Rx for cocaine intoxication
|
Benzos (+ haloperidol for severe agitation/psychosis)
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Rx for cocaine dependence
|
TCAs or dopamine agonists (amantadine, bromocriptine)
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Risk of cocaine withdrawal
|
Really nothing: terrible crash, but not life-threatening
|
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3 classic and 2 designer amphetamines
|
Dextroamphetamine (Dexedrine)
Methylphenidate (Ritalin) Methamphetamine MDMA (ecstasy) MDEA (eve) |
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Difference between classic and designer amphetamines
|
Designer release serotonin (in addition to dopamine) and have hallucinogenic properties (in addition to stimulant)
|
|
How long will urine tox be positive for amphetamines
|
1-2 days (though many tests aren't sensitive enough)
|
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Rx for amphetamine intox/dependence/withdrawal
|
All same as cocaine
|
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Rotatory nystagmus
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PCP intoxication
|
|
Which drug intoxication is most likely to cause violence
|
PCP
|
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Which drug is most similar to PCP?
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Ketamine
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Mechanism and effect of PCP
|
NMDA glutamate antagonist (and dopamine activator) --> hallucinogen
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Risk of PCP overdose
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Seizures, coma
|
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5 components of PCP Rx
|
1) Benzos or dopamine antagonists to control agitation/anxiety
2) Diazepam for spasms/seizures 3) Acidify urine w/ ammonium chloride and ascorbic acid 4) Haloperidol for severe agitation/psychosis 5) Monitor BP, temp, lytes |
|
Ddx for PCP intoxication
|
Psychosis, schizophrenia
|
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How long is a urine tox screen positive for PCP?
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>1 wk
|
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Which lab values are often elevated in PCP use?
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CPK and AST
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Does PCP have withdrawal symptoms
|
No, but pts may have flashbacks
|
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How do benzos and barbiturates work
|
Potentiate GABA by increasing the frequency or duration (respectively) of chloride channel opening
|
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Complication of benzo or barbiturate abuse
|
Respiratory depression
|
|
How long is a urine tox screen positive for sedatives?
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1 wk
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Rx for sedative overdose
|
Activated charcoal to prevent further absorption
|
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Rx for benzo overdose
|
Flumazenil (antagonist)
|
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Risk w/ flumazenil
|
Seizures
|
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Rx for barbiturate overdose
|
Alkalinize urine w/ sodium bicrb to promote renal excretion
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Withdrawal from sedatives
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Autonomic hyperactivity, risk of life-threatening seizures
|
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Rx for sedative withdrawal (2)
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Long-acting benzo (diazepam) and valproic acid for seizures
|
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How long is a urine tox screen positive for opiates?
|
12-36hrs
|
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Triad of opioid overdose
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Respiratory depression, AMS, miosis
|
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Which opioid produces midriasis instead of miosis?
|
Meperidine (Demerol)
|
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Rx for opioid withdrawal
|
Clonidine or buprenorphne; methadone if severe
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3 hallucinogens
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Mushrooms (psilocybin), mescaline, LSD
|
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Hallucinogens don't cause
|
Physical dependence or withdrawal
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Rx for hallucinogen intoxication
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Usually just talking down pt
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Use of marijuana in cancer/AIDS pts
|
Anti-emetic and appetite stimulant, respectively
|
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How long is a urine tox screen positive for marijuana?
|
4 wks (released from adipose stores)
|
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Inhalants are CNS ___?
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Depressants
|
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Risk w/ inhalant overdose
|
Respiratory depression or arrhythmias
|
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Long-term inhalant use can damage
|
CNS, PNS, liver, kidney, muscle
|
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How long is a urine tox screen positive for inhalants?
|
4-10hrs
|
|
Mechanism of caffeine (2)
|
Adenosine antagonist, so increases cAMP
Stimulant via dopaminergic effects |
|
Caffeine intake >1 gram can cause
|
Tinnitus, agitation, arrhythmias
|
|
Caffeine intake >10grams can cause
|
Seizures or respiratory failure --> death
|
|
Neurotransmitter involved in nicotine addition
|
Dopamine
|
|
What is pseudodementia?
|
Depression in elderly --> decrease in memory and cognitive functioning
|
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Difference btwn demented and pseudodemented pts when they don't know an answer
|
Demented pts confabulate
Depressed pts say "I don't know" |
|
Sundowning is more common w/
|
Dementia
|
|
2 good antidepressants in elderly
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SSRIs and mirtazapine
|
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Major antidepressive side effect in elderly
|
Anticholinergic
|
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Abnormal guilt may involve (3)
|
Hallucinations or delusions
Suicidal ideation Duration >1yr |
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Sleep cycle changes in elderly (3)
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Increase number of REM cycles (but no change in total duration)
Increase in Stage 1 and 2 sleep Decrease in Stage 3 and 4 sleep |
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Prevalence of elder abuse
|
10% of pts >65yo
|
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Baseline kidney function should be assessed in pts starting which mood stabilizer?
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Lithium
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Baseline EKG is required in pts starting which antipsychotic?
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Ziprasidone (Geodon)
|
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Manic presentation could be due two which two substances?
|
Cocaine or amphetamines
|
|
4 problems commonly associated w/ panic disorder
|
Depression
Aographobia GAD Substance abuse |
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How long should the intense grieving of bereavement last?
|
<2mo
|
|
CT scan of schizophrenic pt
|
Enlarged ventricles and prominent sulci
|
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Hyperthermia, autonomic instability, muscular rigidity, altered sensorium
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Neuroleptic malignant syndrome
|
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Which drugs cause neuroleptic malignant syndrome?
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Antipsychotics (dopamine antagonists)
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Complication of neuroleptic malignant syndrome
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Rhabdomyolysis (--> myoglobinuria --> ARF)
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Rx for NMS
|
Dantrolene (muscle relaxant)
Dopamine agonists (bromocriptine/ amantadine) D/c responsible drug Supportive (fluids, cooling, alkaline diuresis) |
|
What drugs can be used in lieu of antidepressants for MDD and in what scenario?
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Psychostimulants (e.g. methylphenidate or modafinil)
Short life expectancy (before onset of efficacy of SSRI, for example) |
|
Rx for panic attack/ panic disorder (2)
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Benzos (e.g. alprazolam) for acute attack
SSRI for long-term prevention |
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4 dissociative disorders
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Dissociative amnesia, dissociative fugue, dissociative identity disorder, depersonalization disorder
|
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Another name for dissociative identity disorder?
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Multiple personality disorder
|
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Amnesia due to a stressful life event
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Dissociative amnesia
|
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When do pts w/ dissociative amnesia return to normal?
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Minutes or days
|
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Rx for dissociative amnesia (and dissociative disorders in general)
|
Hypnosis or Ativan during interview to help patient talk freely (retrieve lost memories)
|
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What is abreaction?
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Strong reaction when retrieving traumatic memories
|
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Sudden travel away from home in which a person takes on a new identity and can't remember the past
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Dissociative fugue
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Difference in the amnesia between dissociative amnesia and dissociative fugue
|
In dissociative amnesia, pts are aware they've forgotten something
|
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Prognosis of dissociative fugue
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Hours to days or longer; afterwards pt will resume old identity and not remember fugue
|
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Most dissociative identity disorders pts are
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Women who have experienced prior trauma
|
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Suicide rate for dissociative identity disorder
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30%
|
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What is dissociative identity disorder?
|
2 or more identities that take control of behaviors/ thoughts; unaware of events during prior personality states
|
|
Symptoms of dissociative identity disorder are similar to those of?
|
Borderline personality disorder
|
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Persistent/ recurrent episodes of being detached from one's body or mind (like an outside observer) but w/ reality testing intact
|
Depersonalization disorder
|
|
Depersonalization disorder has a high comorbidity with
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Anxiety/ panic
|
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Rx for depersonalization disorder
|
Anti-anxiety meds or SSRIs for anxiety symptoms
|
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What is primary gain?
|
Expression of unacceptable feelings as physical symptoms to avoid facing them
|
|
DSM criteria for somatization disorder
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2 GI, 1 sexual, 1 neuro, and 4 pain symptoms + onset before age 30
|
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Comorbidities w/ body dysmorphic disorder
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90% depression, 70% anxiety, 30% psychosis
|
|
Rx for body dysmorphic disorder
|
SSRIs, no procedures
|
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Two types of pain disorder
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Acute (<6mo) or chronic (>6mo)
|
|
Ddx for pain disorder
|
Hypochondriasis or malingering
|
|
What must be ruled out w/ all somatoform disorders
|
Hypochondriasis and malingering
|
|
Intentionally producing medical or psychological symptoms to assume role of sick pt
|
Factitious disorder
|
|
Difference factitious disorder and malingering?
|
Factitious disorder involves primary gain
Malingering involves secondary gain |
|
Commonly feigned symptoms in factitious disorder
|
Hallucinations, depression, fever, abdominal pain, seizures, skin lesions, hematuria
|
|
Factitious disorder w/ predominantly physical symptoms
|
Munchhausen syndrome
|
|
Common history of pts with factitious disorder
|
Child abuse or neglect
|
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Failure to resist aggressive impulses --> assault or property destruction
|
Intermittent explosive disorder
|
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Aggressiveness is associated w/ this neurotransmitter (low or high?)
|
Low serotonin
|
|
Rx for intermittent explosive disorder
|
SSRIs, anticonvulsants, lithium, propanolol
|
|
Which therapy technique often fails in intermittent explosive disorder?
|
Individual therapy
|
|
5 impulse control disorders
|
Intermittent explosive disorder
Kleptomania Pyromania Pathological gambling Trichotillomania |
|
Kleptomania is often comorbid with
|
Bulimia (1/4 of bulimics)
|
|
Pyromania is often present in
|
Mentally retarded individuals
|
|
Predisposing factors for pathologic gamgling often involve
|
Childhood/ family
|
|
Most effective therapy for pathologic gambling
|
Gamblers Anonymous
|
|
Rx for trichotillomania
|
SSRIs
Antipsychotics Lithium |
|
What is conversion disorder?
|
Neuro symptoms preceded by psychological stressor
|
|
Common symptoms of conversion disorder
|
Shifting paralysis, blindness, mutism, paresthesias, seizures, globus hystericus
|
|
Conversion syndrome in an older adult
|
Suspect neuro deficit
|
|
How do pts with a conversion disorder discuss their symptoms?
|
With calm indifference
|
|
Prognosis of conversion disorder?
|
Recover in 1mo
25% recur |
|
How long must hypochondriasis persist for?
|
6mo
|
|
Difference between somatization and hypochondriasis
|
Somatization disorder pts are concerned about symptoms
Hypochondriacs are concerned about disease |
|
5 stages of sexual response
|
Desire, excitement, plateau, orgasm, resolution
|
|
2 neurotransmitters that affect libido
|
Dopamine enhances libido
Serotonin inhibits libido |
|
2 most common sexual disorders in women
|
Sexual diesire disorder
Orgasmic disorder |
|
2 most common sexual disorders in men
|
Secondary erectile dysfunction
Premature ejaculation |
|
What is second ED
|
Acquired after previous ability to maintain erections
|
|
Rx for female sexual arousal disorder
|
Release of clitoral adhesions
|
|
Rx for female orgasmic disorder
|
Masturbation
|
|
3 Rx methods for premature ejaculation
|
Squeeze technique
Stop-start technique Use side effects of SSRIs/TCAs |
|
3 most common paraphilias
|
Pedophilia, voyeurism, exhibitionism
|
|
3 paraphilias that can occur in women
|
Sadism, masochism, pedophilia
|
|
Sexual pleasure in men from rubbing their genitals against women in crowded areas
|
Frotteurism
|
|
Sexual excitement from calling unsuspecting women
|
Telephone scatologia
|
|
3 Rx options for paraphilias
|
Insight-oriented psychotherapy
Behavior therapy Antiandrogens |
|
Transsexuality is also known as
|
Gender identity disorder
|
|
Gender identity disorder is associated with an increased incidence of
|
MDD, anxiety, suicide
|
|
Gender identity is usually developed by age
|
3yo
|
|
4 exceptions to confidentiality
|
Subpoena
Child abuse Tarasoff duty (harm to others) Suicidal |
|
How many physicians must determine need for involuntary admission?
|
2
|
|
Legal doctrine that allows forcible commitment
|
Parens patriae
|
|
Competence vs. capacity
|
Competence is a legal term
Capacity is a clinical term |
|
Most important factor in predicting violence
|
History of violence
|
|
Criteria for not guilty by reason of insanity (3)
|
Mental illness, doesn't understand right from wrong, didn't understand consequences of actions at time act was committed
|
|
4 Ds fo malpractice
|
Dereliction (negliect) of a Duty that led Directly to Damages
|
|
2 types of damages awarded
|
Compensatory (for medical expenses, lost salary, physical suffering)
Punitive (to punish doctor for gross negligence) |
|
MMSE dysfunction is below what score?
|
<25
|
|
Difference between impairment in dementia and delirium
|
Dementia: memory impairment
Delirium: sensorium impairment |
|
Minimum workup to exclude reversible causes of dementia
|
CBC, Chem, TFTs, RPR, B12, folate, brain CT or MRI
|
|
Dementia w/ obesity, coarse hair, constipation
|
Hypothyroidism
|
|
2 types of delirium
|
Quiet and agitated
|
|
Rx for delirium symptoms
|
Quetiapine or haloperidol (avoid benzos --> confusion)
|
|
What can't you use haloperidol IV
|
Can cause torsades
|
|
Which has EEG changes, delirium or dementia, and what are they?
|
Delirium: fast waves or generalized slowing
|
|
Apraxia
|
Inability to perform purposeful movements
|
|
Agnosia
|
Inability to interpret sensations correctly (e.g. recognize things previously known)
|
|
Life expectancy of Alzheimer's
|
8 years after diagnosis
|
|
Neurotransmitter levels in Alzheimer's ()
|
Decreased acetylcholine and NE
|
|
2 classes or drugs for Alzheimer's and examples
|
NMDA antagonists: memantine
Cholinesterase inhibitors: donepezil (Aricept), rivastigmine (Exelon), tacrine (Cognex) |
|
Rx for mania w/ kidney disease
|
Valproic acid or carbamazepine
|
|
First line for GAD
|
Buspirone
|
|
Rx for agitated mania
|
Haloperidol (acutely; lithium longterm)
|
|
Elevated cholesterol and carotene, prolonged QT, osteoporosis
|
Anorexia
|
|
Fever, rigidity, mental status changes, and autonomic instability
|
Neuroleptic malignant syndrome
|
|
Rx for neuroleptic malignant syndrome
|
D/c antipsychotics
ICU Control hyperthermia Maintain electrolyte balance Dantrolene in severe cases |
|
High fevers, rigidity, diarrhea, restlessness, autonomic instability
|
Serotonin syndrome
|
|
How long should a single MDE be treated for?
|
6mo following response
|
|
2 subtypes of anorexia
|
Restricting
Binge and purge |
|
Pt who meets criteria for anorexia nervosa except has regular menses
|
Eating disorder NOS
|
|
Rx for Tourette syndrome
|
Typical antipsychotics (haloperidol or pimozide)
|
|
Rx for refractory enuresis
|
Desmopressin is first line (better safety profile)
Imipramine is second line |
|
Two tests to get before starting lithium treatment
|
Creatinine
TFTs |
|
Rx for social phobia (2)
|
Assertiveness training (part of CBT) and SSRI (e.g. paroxetine)
|
|
Management if only one parent consents for a treatment for a minor and the other refuses to agree?
|
Proceed! Only need consent from one parent or guardian
|
|
How to distinguish selective mutism and social phobia
|
Selective mutism: child refuses to talk
Social phobia: often 2/2 learning and communication disorders (e.g. stuttering) |
|
When do kids usually grow out of stranger anxiety?
|
3yo (afterwards is generally attributable to another cause)
|
|
Who uses neurotic defense mechanisms?
|
Adults; usually provide short term relief
|
|
3 criteria for emancipated minor
|
Married
Military Lives separately from parents and manages own finances |
|
Abrupt cessation of what anti-anxiety med can caused generalized tonic-clonic seizures and confusion?
|
Alprazolam (short-acting benzo)
|
|
Methylphenidate should not be used in children younger than
|
6yo (safety/efficacy have not been evaluated)
|
|
Dilated pupils, HTN, tachy, psychosis
|
Amphetamine intoxication (similar to cocaine, but psychosis is more common with amphetamines)
|
|
Altered consciousness, respiratory depression, pinpoint pupils
|
Heroin intoxication
|
|
Rx for bereaved pts with continued extreme symptoms 2months after their loss
|
Antidepressant and psychotherapy
|
|
When might ECT be used as first line for MDD?
|
Severe suicidality and psychosis
|
|
Management of acutely suicidal pt whose parents want her to see her pediatrician instead of being hospitalized
|
Hospitalize anyway!
|
|
IVDU who contracts HCV and blames it on inadequate control of HCV within the community is an example of?
|
Distortion (altered perception of reality to make it more acceptable), an immature defense mechanism
|
|
Unfaithful husband who accuses his wife of infidelity
|
Projection (attributes unacceptable emotions to other individuals), an immature defense mechanism
|
|
Pt who was rescued from a burning building and now denies any memory of the event
|
Dissociation (blocking disturbing feelings form consciousness to avoid emotional upset), a neurotic defense mechanism
|
|
Magical thinking is associated with which PD?
|
Schizotypal
|
|
Birth defects associated w/ anticonvulsants (carbamazepine/ valproate)
|
Craniofacial defects
NTDs Genital anomalies |
|
Important diagnostic criteria for adjustment disorder (vs. normal human experience)
|
Functional impairment
|
|
Inheritability of bipolar disorder
|
High: 5-10% for first degree relatives (vs 1% for general population)
|
|
4 antipsychotics available in depot form
|
Haloperidol, fluphenazine (typical)
Risperidone, paliperidone (atypical) |
|
Rx for psychosis if pt has severe EPS
|
Clozapine (or possibly typical antipsychotics)
|
|
Critical aspect of therapy for schizophrenics
|
Family therapy and keeping family conflict to a minimum
|
|
Pt w/ Hx of alcohol dependence presenting w/ auditory hallucinations and stable vitals
|
Alcoholic hallucinosis
|
|
Normal devt for at least 2yrs, then loss of previously acquired language, social, bowel/bladder, or play/motor skills followed by development of autistic symptoms
|
Childhood disintegrative disorder
|
|
How to distinguish autism from childhood disintegrative disorder
|
Autism symptom onset always begins before 3yo; rarely have a "regression" like in childhood disintegrative disorder, where children are normally before symptom onset
|
|
How to distinguish OCPD from OCD?
|
Pts with OCPD don't see it as a problem, and are more focused on perfectionism than particular obsessions/compulsions
|
|
3 subtypes of delusions
|
Grandiose, paranoid, somatic
|
|
4 first line and 2 second line maintenance meds for mania
|
Lithium, lamotrigine, olanzapine, quetiapine
Divalproex, aripiprazole |
|
Most common side effect of ECT
|
Amnesia (anterograde resolves quickly, retrograde may persist)
|
|
Rare side effects of ECT (5)
|
Prolonged seizures, delirium, headache, nausea, skin burns
|
|
When can lithium be tapered?
|
For pts with one manic episode, after 1yr symptom free
|
|
When is lifelong lithium therapy recommended?
|
After 3 or more manic relapses
|
|
Woman who is angry with her husband and throws away his baseball card collection as retaliation is an example of
|
Displacement (neurotic defense mechanism): shifting of emotion associated w/ an upsetting person or object to a safer alternate object/person that represents the original
|
|
Battered woman who believes her husband is right when he says she is worthless
|
Introjection (immature defense mechanism): assimilating another person's attitude into one's own perspective
|
|
Person who needs to follow the rules of a game precisely may have which PD?
|
OCPD
|
|
Rx for adjustment disorder
|
Psychodynamic psychotherapy or CBT
|
|
Thing to be careful of with adjustment disorder
|
Timeline! If develops within 3mo of stressor and hasn't lasted >6mo, can be adjustment disorder and needs therapy, not SSRIs
|
|
Most common comorbid conditions in Tourette disorder (2)
|
ADHD (60%)
OCD (27%) |
|
Rx for narcolepsy
|
Methylphenidate or modafinil (psychostimulants) for daytime somnolence +/- antidepressents for cataplexy
|
|
MAOI + tyramine containing food can cause
|
Hypertensive crisis
|
|
Stating that being fired is a "blessing in disguise" because pt can now spend more time with his family
|
Rationalization (neurotic defense mechanism)
|
|
Most likely atypical antipsychotic to cause EPS
|
Risperdal
|
|
Least likely atypical antipsychotic to cause EPS
|
Clozapine
|
|
Rx for fear of flying
|
Short acting benzo, e.g. alprazolam
|
|
Stepwise loss of function
|
Vascular dementia
|
|
DSM criteria for dementia
|
Memory impairment and at least one of: aphasia, apraxia, agnosia, diminished executive functioning
|
|
Dementia symptoms + focal neuro symptoms (hyperreflexia or paresthesias)
|
Vascular dementia
|
|
Diagnostic test for vascular dementia
|
MRI
|
|
Dementia w/ more personality/behavioral changes
|
Pick's disease/ frontotemporal dementia
|
|
What are Pick bodies?
|
Intraneuronal inclusion bodies
|
|
Prognosis of Huntington's
|
Death 15yrs after diagnosis
|
|
Psychotic depression, muscular hypertonicity, progressive dementia, choreiform movements
|
Huntington's
|
|
MRI in Huntington's shows
|
Caudate atrophy
|
|
2 classes of dementia w/ examples and symptoms
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Cortical (Alzheimer's, Pick's, CJD): intellectual function declines
Subcortical (Huntington's, Parkinson's, NPH, multi-infarct): affective and movement symptoms |
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What % of Parkinson's pt develop dementia?
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30%
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5 causes of Parkinson's disease
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Idiopathic (most common)
Traumatic Drug-induced Encephalitic Familial |
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Pharma options for Parkinson's (5)
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1) Levodopa + carbidopa (former crosses BBB, latter prevents conversion of levodopa to dopamine in periphery)
2) Amantadine (unknown) 3) Anticholinergics (for tremor) 4) Dopamine agonists (bromocriptine) 5) MAO-B inhibitors (selegiline): inhibit breakdown of dopamine |
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Surgical options for PD
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Thalamotomy or pallidotomy if refractory
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Iatrogenic cause of CJD
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Corneal transplant
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Dementia w/ myoclonus, EPS, LMN signs, ataxia
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CJD
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Prognosis/latency of CJD
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Long latency btwn exposure and symptom onset, but then usually progresses to death w/in 1yr
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4 other prion disease
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Kuru
Gerstmann-Hraussler syndrome Fatal familial insomnia Bovine spongiform encephalopathy |
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What are prions?
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Proteinaceous infectious particles, normally expressed by healthy nuerons but accumulations --> disease
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EEG in CJD
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Periodic sharp waves/spikes
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Pathology of CJD
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Spongiform changes of cerebral cortex, neuronal loss, hypertrophy of glial cells
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Of triad of NPH, which is least likely to improve with shunt treatment
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Dementia
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Contusion w/ lucid intervals
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Delirium
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Best Rx for delirium after treating underlying cause
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Low-dose antipsychotic
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Amnestic disorders are always caused by an underlying ___ condition vs ____ condition
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Medical, not psychiatric
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Unusual antidepressant choice in pts who can't tolerate typicals meds, and risk of its use
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Sympathomimetics (amphetamine-based): addiction potential
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What must be assessed before prescribing TCAs?
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Suicide risk (overdose can be lethal)
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Hallmark of TCA toxicity
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Widened QRS (>100 msec)
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3 side effect categories of TCAs
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Antihistaminic (sedation), antiadrenergic, antimuscarinic
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7 examples of TCAs
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Imipramine
Trimipramine Desipramine Clomipramine Amitriptyline Nortriptyline Doxepin |
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Serotonin syndrome occurs from combining these two meds
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SSRIs and MAOIs
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Consideration when switching from SSRI to MAOI
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Wait at least 2 wks to prevent serotonin syndrome
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Which SSRI doesn't need a taper?
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Fluoxetine/ Prozac
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Which SSRI has the highest risk of GI disturbances?
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Zoloft
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Antidepressant also used for SAD and ADHD
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Bupropion
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Two low potency typical antipsychotics
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Chlorpromazine and thioridazine
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5 high potency typical antipsychotics
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Haloperidol
Fluphenazine Trifluoperazine Perphenazine Pimozide |
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High potency typicals have ___ EPS and ___ anticholinergic/antihistaminic side effects
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More EPS
Less |
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Symptoms of NMS
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FALTER
Fever Autonomic instability Leukocytosis Tremor Elevated CPK Rigidity |
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What monitoring is required for quetiapine
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Slit lamp exam q6mo to look for cataracts
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Why do some atypicals have less weight gain?
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Less anti-histamine action
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Toxic and lethal doses of lithium
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Toxic >1.5
Lethal >2 |
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Carbamazepine is best for which two subtypes of bipolar
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Rapid cycling
Mixed episodes |
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Carbamazepine is also used to treat which condition
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Trigeminal neuralgia
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3 long acting benzos (1-3 days)
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Chlordiazepoxide (Librium)
Diazepam (Valium) Flurazepam (Dalmane) |
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4 intermediate acting benzos (10-20hrs)
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Alprazolam (Xanax)
Clonazepam (Klonopin) Lorazepam (Ativan) Temazepam (Restoril) |
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Common use for Librium
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Alcohol detox
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When can dystonia be life-threatening?
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Dystonia of diaphragm --> asphyxiation
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