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71 Cards in this Set

  • Front
  • Back
First-line treatment MDD
mild to moderate: Rx or psychotherapy (interpersonal or CBT). Severe: requires Rx
Is one Rx for MDD more efficacious than another?
No. all antidepressants are equally efficacious. Exception: MAOIs > TCA in atypical depression
Most effective Rx for depression?
ECT
First line treatment for bipolar p/w mania or mixed episode
mild-mod: lithium, valproic acid or antipsychotic; if severe: add antipsychotic to either lithium or valproic acid
First line treatment for bipolar p/w MDD
lithium or lamotrigine
First line treatment for bipolar p/w rapid cycling?
valproic acid or lithium (VPA is generally better)
first line treatment in schizophrenia
antipsychotic (usually tailoring side effects: consider ziprasidone/aripiprazole for those who are overweight; use sedating Rx at night if not sleeping well, etc.)
First line treatment in schizophrenia w/ history of med non-compliance
consider depot antipsychotic (decanoate formulation of haloperidol or fluphenazine or newer atypical depots, risperidone (consta) or paliperidone (invega sustennal)
first line treatment for delirium
high potency antipsychotic (haloperidol & fluphenazine)
first line treatment for catatonia
lorazepam (ativan)
first line treatment for generalized anxiety d/o?
SSRI
first line treatment for panic d/o
start w/ SSRI + benzo and taper off benzo after a month or so
first line treatment of PTSD
SSRI (esp paroxetine or sertraline)
Time period for delusional d/o
1 month
time period for cyclothymic or dysthymic d/o
2 years in adults; 1 year in children (no period longer than 2 months of sx free)
Time period of sx for GAD?
6 months
duration of sx for MD episode
2 weeks
duration of sx for manic episode
7 days
Duration of sx for mixed episode
1 wk or less if hospitalized as a result of sx
duration of sx for hypomanic episode?
> 4 days
ODD v conduct d/o
ODD children are peevish, obstinate and angry, but those with conduct d/o violate other's right (theft, setting fires, fights, animal cruelty).
ADHD v bipolar d/o
Bipolar are discrete episodes whereas ADHD are defined by ongoing hyperactivity (>6mo) and/or inattention in at least two settings (home, school, etc)
Separation anxiety disorder v reactive attachment disorder
separation anxiety d/o = anxiety when being apart from person to whom child is attached; reactive attachment d/o has two subtypes (both manifesting < 5 y/o): either the child will not attach readily & indiscriminately to just about everyone
Name the 5 pervasive development
autistic d/o, asperger's d/o, rett's d/o, childhood disintegrative d/o, NOS
name the pervasive developmental d/o: poor social interactions, restricted/sterotyped behaviors/interest & communications.
Autistic d/o
Name the pervasive developmental d/o: poor social interaction & restricted/sterotyped behaviors/interests; can be very intelligent and very gifted at communication
Asperger's d/o
Name the pervasive developmental d/o: deceleration of head growth from 5-30mos., sterotyped hand movements (e.g. wringing); generally female
Rett's d/o
Name the pervasive developmental d/o: normal development until 2 yrs. then lose previously acquired skills + 2/3 autistic d/o sx; generally male
childhood disintegrative d/o
Name the pervasive developmental d/o: looks like others but doesn't meet the strict criteria
NOS
MCC of mental retardation
down syndrome
MCC of preventable MR
fetal alcohol syndrome
this common form of MR is found exclusively in males
fragile X syndrome
occurs during childhood and is characterized by persistent failure to speak in one or more major social situations, despite the ability to speak and comprehend spoken language
selective mutism
a behavioral disorder that is most commonly identified among mentally-disadvantaged children, although it is increasingly recognized among adolescents and adults of normal mental capacity. The behavior consists of daily, effortless regurgitation of undigested food within minutes of starting or completing ingestion of a meal.
rumination d/o
Treatment for ADHD
psychostimulants (methylphenidate or amphetamine analogs), the newer non-stimulant atomoxetine (strattera; acts as a norepi reuptake inhibitor), or guanfacine (a2 agonist)
Treatment for enuresis
bed alarms are 1st line; consider imipramine
Tourette's treatment
antipsychotics (risperidone, pimozide) or clonidine/guanfacine
treatment for absent seizures
ethosuximide or valproic acid
postpartum blues v postpartum depression v postpartum psychosis
blues = normla response after pregnancy but sx doesn't meet criteria for MDD & occurs in up to 30% of women. Sx peak ~ 5d post partum and resolve within 2 weeks. Pp Depression meets full criteria for MDD. Pp psychosis is psychosis (bipolar d/o until otherwise proven) address immediately
Premenstrual dysphoric disorder
severe PMS (dx'd as depressive d/o NOS). Can give SSRIs ONLY during luteal phase
What causes ebstien's anomaly?
lithium
what psychiatric medications cause neural tube defects on the fetus?
valproate and carbamazapine
What side effects can SSRIs have fetus?
persistent pulmonary hypertension & fussy babies
what is medication can be used for premature ejaculation
SSRI
painful spasm of external 1/3 of vagina (ectoderm derived under voluntary control)
vaginismus. often h/o sexual trauma
voyeurism
paraphilia of watching others
exhibitionism
paraphilia of revealing self to others
frotteurism
paraphilia of rubbing against strangers typically in crowded places
sadism
paraphilia of feeling pleasure when inflicting pain
masochism
paraphilia of feeling pleasure in being humiliated/experiencing pain
dyssomnias v parasomnias
too much or too little sleep AND abnormalities occur during sleep or the period going to or awakening from sleep
Define restless leg syndrome. Treatment.
crawling/tinglings sensation of legs, worst at night; sensation improves with leg movement. Use pramipexole (Mirapex) or ropinirole (Requip)
What should you rule out first when you suspect restless leg syndrome?
iron deficiency syndrome. If it is, give iron
What are pramipexole (mirapex) and ropinirole (requip) both associated with?
new onset pathological gambling and sleep attacks.
Define night terrors (pavor nocturnus)
most often a child appears to awaken from a terrifying dream and may even scream, but he or she doesn't truly awaken and doesn't recall the event the following morning. Occurs in non-REM sleep; more common in 1st 1/2 of the night. Can treat w/ long-acting benzodiazepines.
Excessive daytime sleepiness, hypnoGOgic hallucinations, cataplexy (loss of motor tone in context of emotion such as laughing/crying), sleep paralysis
narcolepsy
T/F: narcoleptics may have REM episode within 10-20 min
True. healthy individuals have their first REM episode 90min into sleep
delayed sleep phase (in adolescents), advanced sleep phase (elderly), jet lag sleep disorder, shift work)
circadian rhythm sleep d/o
What should always be implemented for sleep disorders?
good sleep hygiene
What should you always rule out when dealing with sleep disorders?
substance-induced sleep disorders
Name the 3 eating d/o
anorexia nervosa, bulimia nervosa, eating d/o NOS
<85% of ideal body weight, amenorrhea, afraid to gain wt. Has restricting and binge-eating/purging types.
anorexia nervosa. Anorexics consider their condition egoSYNtonic (they will tell you they're fat (despite being utterly cachectic) and they need to lose weight).
recurrent binge eating with excessive attention paid to the body and compensatory techniques to lose weight
Bulumia nervosa. There is a purging and non-purging type. egoDYStonic. these patients feel very ashamed of their behavior and go to great lengths to hide it.
What is Russell's sign?
scarring on the extensor surface of a finger/fingers as a result of repetitive purging.
Define eating d/o NOS
NOT anorexia or bulimia
Name the Impulse Control Disorders Not Elsewhere Classified
kleptomania, trichotillomania, pathological gambling, pyromania, intermittent explosive d/o.
What class of disorders contains depersonalization d/o, dissociative amnesia, dissociative fuge, dissociative identity d/o
dissociative disorders
Patient under significant stress, states that they do not feel "real"
depersonalization d/o
patient states he can't recall something
dissociative amnesia
A nun in her own town who works as a prostitute in another town.
dissociative fugue
Patient has multiple personalities or "alters"; often find things at home they don't recall purchasing... controversial fx
dissociative identity disorder