UWorld
Low BMI in a teen who recently became an animal rights activist. Her mother is concerned. No signs of negative body image.
Reassurance
A balanced vegetarian diet is fine.
Just make sure she is balanced and eating the right foods.
UWorld
Persistent depressive disorder (dysthymia)
Fat guy who never asks a girl on a date, overeats, video game programmer.
UWorld
Neuroleptic malignant syndrome
Dopamine antagonism in the antipsychotics is the cause
ex: Olanzapine
UWorld
Suicide risk and protective factors
Single strongest factor
is prior attempt.
UWorld
Antipsychotic extrapyramidal effects
correction
For TD --> Clozapine helps
correction for parkinsonism --> Benztropine OR amantadine
Akathisia can also use propanolol
Note:
If the question tells you the dose of an antipsychotic has been gradually increased; when treating the extrapyramidal s
UWorld
Bipolar I Tx
Mood stabilizers: (continue these
indefinitely
)
1) Lithium
2) Valproic Acid
Depressive episode
1) Atypical antipsycotics --> Quietapine, Lurasidone, Lamotigine
UWorld
Tardive Dyskinesia
Use clozapine to tx
UWorld
Delirium
May cause psychosis
ex: a post-op old lady
UWorld
Survivors of sexual assault are at risk for...
PTSD
Depression
Suicidality
UWorld
SSRI doesn't work after 4 weeks at max dose
try an SNRI now...
UWorld
Acute drug intoxication
UWorld
Grief reaction (bereavement) vs MDE
MDE has:
-more persistent and pervasive sadness
-feelings of hopelessness and worthlessness
-SI
-possibly pschotic features or delusions
GR
-waves of grief
-positive memories of person
UWorld
Benzodiazepine Overdose
Increased GABA conductance
AMS
Ataxia
Slurred Speech
IF
Vitals are messed up or there is respiratory depression --> co-ingestion with other sedative-hypnotics should be suspected.
UWorld
Inhalants
Boys ages 14-17
Multiple common household chemicals
Rapid and transient --> life threatening
Characteristic perioral skin changes (glue sniffer's rash)
UWorld
Kleptomania
UWorld
Eating disorders
UWorld
Cocaine withdrawl
Depression
Fatigue
Hypersomnia
Increased daydreaming
Hyperphagia
Impaired Concentration
Intense Drug Craving
UWorld
MDD
5/9 SIG E CAPS
>= 2 weeks
May be in conjunction with somatic sx, i.e. from cancer
[2 questions on this scenario --> make sure to count each SIG E CAPS]
Give an SSRI!!!
UWorld
Suicide assessment - ideation, intent & plan
EVALUATION:
1) Ideation
2) Intent
3) Plan
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Obsessive-compulsive disorder
Recurrent/intrusive thoughts
ex: keep thinking you will stab co-workers
ex: keep thinking you run over a child everytime you hit a bump in the road while driving --> causing you to get out and check
Tx:
SSRI
CBT (exposure and response prevention)
UWorld
Dialectical behavioral therapy
For Borderline Personality Disorder
UWorld
Electroconvulsive therapy
UWorld
Electroconvulsive therapy for depression
If tx resistant
PSYCHOTIC FEATURES PRESENT
-MDD w/ psychotic features
Emergency conditions:
-Pregnancy
-
Refusal to eat/drink
-Imminent risk of suicide
NO ABSOLUTE C.I. :)
UWorld
Delivering bad news
Best done in person
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Key Defense Mechanisms
Reaction formation = Pt resents caring for her father, but is super nice to him/very caring in person with him.
Intellectualization = transformation of an emotionally difficult event into purely intellectual problem to avoid confronting its uncomfortable
UWorld
Clozapine
Worry about agranulocytosis
aka leukopenia (neutropenia)
UWorld
Cocaine abuse d/o
Behavioral changes
Weight loss
Erythema of the nasal turbinates
UWorld
Metabolic effects of second-generation antipsychotics
UWorld
Differential diagnosis of DSM-5 psychotic disorders
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PCP Use
Glutamate antagonist
Agitation
Aggression
Nystagmus
Miosis
vs amphetamine (mydriasis)
PCP intoxication is characterized by aggressive behavior, sympathetic activation, vertical nystagmus, and often by a need to undress.
Treatment is with diazepam.
UWorld
Somatic symptom disorder
Tx:
Repeat/scheduled visits regularly
Focus on emotional stressors + coping
Legitimize sx but make functional improvement the goal
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Differential diagnosis of depressed mood
Adjustment disorder w. depressed mood --> psychotherapy
ex: Poor self-esteem + difficulty sleeping after a breakup x2 months ago
UWorld
Abrupt cessation of Alprazolam (Xanax)
[Short acting Bz]
Generalized tonic-clonic seizure
Confusion
UWorld
Pharmacotherapy of psychosis
Haloperidol
2nd gen antipsycotics
Bzs for agitation
Oral b4 injectable, especially if compliant
SHort acting before long acting
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Antidepressants
For at least 4-6 weeks before switching...
SSRI --> continue 4-9 months after pt feels better before stopping
If recurrent, severe --> consider maintenance therapy for 1-3 years or indefinitely
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Specific Phobia
Tx
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Bipolar Tx
Lithium or Valproate
+
2nd gen antipsycotic
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Guidelines for lithium therapy
Check kidney and thyroid prior to initiation
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Shared Psychotic Disorder
Dominant person's delusion is transferred to a more submissive partner
Dx: separate for interview
Tx: separate therapeutically to break the cycle of reinforcement
UWorld
Narcolepsy
associated with sleep paralysis
Tx:
Amphetamines
Modafinil
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Depression often presents w/...
Physical complaints
ex: headaches
In addition to mood problem
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TCA Overdose
AMS
Seizures
Cardiac conduction delay
Anticholinergic toxicity
-hyperthermia
-dilated pupils
-flushed and dry skin
-intestinal issues
QRS > 100 msec
--> increases risk of arrhythmia or seizures
--> Tx = NaHCO3 (Sodium bicarb)
UWorld
Delirium Tremens
Lorazepam (Ativan) = intermediate acting
(preferred inpt, esp if comorbid liver dz)
vs
Chlordiazepoxide (librium) = long acting
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Clozapine treatment guidelines
Tx-resistant schizophrenia
Schizophrenia associated w. suicidality
UWorld
Generalized anxiety disorder
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Afraid of public speaking...
Social anxiety disorder
-fear of scrutiny and embarassment
UWorld
Gambling disorder
> 1 year
Can't stop
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Competency
Pts w/ psychiatric illnesses can give informed consent as long as they have capacity meaning that there judgement and decision making abilities are determined to be intact at the time of treatment
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Adjustment disorder
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Chronic alcohol use
Initiation of chronic alcohol use may be due to an adjustment disorder
ex: kids go off to college, mother has difficult time adjusting --> alcohol before bed x1 year
Leads to -->
Insomnia and/or anxiety
Transaminitis
Macrocytosis
UWorld
Schizoid vs Avoidant Personalities
Schizoid = distant, prefers to be a loner, is happy with this; does not desire social relationships
Avoidant = wants social relationships, but fears rejection and embarrassment
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Bipolar w/ mildly elevated creatinine
Choose Valproate over lithium
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Antipsychotic medication effects (dopamine antagonism) in dopamine pathways
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Medication-induced psychosis
Can be caused my high dose glucocorticoids...
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Dopaminergic pathways
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Delusional disorder
Tx: Antipsycotics
CBT
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Borderline personality disorder
Primary tx = psychotherapy
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Social Anxiety Disorder
Pt comes in and wants ambien to help sleep (doesn't say this but thats what the question is eluding to)... treat w/ SSRI and his sleep should improve as a result
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Serotonin Syndrome
UWorld
Antipsychotics MOA
Typical: D2 Blockers
Atypical: D2 and Serotonin 2 blockers
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Anabolic steroid side effects
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Postpartum blues, depression & psychosis
PPBlues should resolve w/in 2 weeks w/out intervention
PPPsychosis --> HOSPITALIZE MOM; takes away risk from infant and allows tx w/ an antipsychotic
UWorld
Anorexia nervosa
If unstable:
-signs of dehydration
-unstable vitals:
bradycardia <40 min
hypotension
hypothermia
-cardiac dysarrythmias
-e- disturbances (hypo-kalemia/phosphatemia)
-organs
liver/heart failure
-seizures
pancreatitis
syncope
-very low weight
HOSPITALIZE
fo
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HIV-associated dementia
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Risperidone
Block D2 and serotonin 2A --> Hyperprolactinemia --> galactorrhea, amenorrhea, and infertility
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Panic disorder
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Mirtazapine
Antidepressant (atypical)
Good for pt who has MDD 2/2 pathological grief w/ insomnia + wt loss
Sedating + anti-depressant
UWorld
Bipolar & related disorders
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Alcohol withdrawal syndrome
Alcohol hallucinosis
-stable vitals
-sensorium intact
-12-24 hrs after last drink
UWorld
Hoarding disorder
Tx: CBT
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Amphetamine Intoxication
Diaphoresis
Mydriasis
Irritability
Agitation
Psychosis
UWorld
Schizoaffective disorder
UWorld
Depersonalization/derealization disorder
Dissociative amnesia
Dissociative identity disorder
UWorld
Premenstrual Syndrome (PMS)
Premenstrual Dysphoric Disorder (PDD)
Dx: menstrual diary
Tx: SSRI
UWorld
Conversion DIsorder
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Sleep terrors
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REM sleep behavior disorder
REM -->
RE
call Drea
M
s
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Confidentiality
You cannot even disclose if the patient is in fact a patient
"I am not able to confirm whether he is a patient at this clinic
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Antidepressants in Adolescents
Slight increased risk in suicidality initially
Benefits outweigh the risks, monitor at first.
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Bupropion
Good for:
low energy
impaired concentration
weight gain
smoking cessation
depression
UWorld
Methamphetamine abuse
Paranoid delusions
A/V hallucinations
Tactile hallucinations --> bugs crawling on skin
Marked weight loss
Severe tooth decay
Excoriations due to skin pricking
UWorld
Normal age related sleep changes
Decreased total sleep time
Increased nighttime awakenings
Sleepiness earlier in the evening with earlier morning awakening
Increased daytime somnolence(napping)
Tx: Reassurance
NOT EVEN MELATONIN
UWorld
Acute Stress Disorder vs PTSD
UWorld
Methylphenidate
Sfx:
Decreased apetite
Wt loss
Insomnia
UWorld
Alprazolam (Xanax) Sfx
Use in extreme caution in elderly
Increased risk of:
-cognitive impairment
-falls
-paradoxical agitation
UWorld
Schizophrenia Neuroimaging
UWorld
Pediatric SLE
PSYCHOSIS
Arthralgia
Thrombocytopenia
Hematuria
Proteinuria
Dx: ANA 1st --> more specific Abs depending
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Psychosis in a child
SLE
Thyroiditis
Metabolic/e- disorders
CNS Infection
Epilepsy
UWorld
Generalized anxiety disorder
UWorld
Body dysmorphic disorder
UWorld
Attention-deficit hyperactivity disorder
UWorld
Nightmare disorder
UWorld
Acute mania
UWorld
New onset insomnia in elderly w/ depressive sx
MDD
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Tourette disorder
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Major depressive disorder
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Bipolar disorder
UWorld
Hypertensive crisis
Acute onset of headache in pt taking phenelzine... (MAO-i)
HTN after a meal w/ "heavy sauces and wine."
NOTE:
This headache leads to ICH, Stroke, & Death
UWorld
Don't use bupropion in...
Bulimics
UWorld
Nicotine patches/gum
1st line along with bupropion & varenicline
UWorld
MDMA effects
Euphoria
Increased sexual desire
Empathy
Intoxication:
-HTN
-Tachycardia
-Hyperthermia
-
Serotonin syndrome
--> flushing, sweating, hyperreflexia, myoclonus
-Hyponatremia
--> Coma, seizures, death
UWorld
Obsessive-compulsive personality disorder
vs OCD is when the pt does more ridiculous things because s/he has to
ex: turning on/off lights
UWorld
Olanzapine adverse effect
Wt gain
UWorld
Alcohol cessation
Brief intervention is actually 1st line, followed by...
1st line:
1) Naltrexone (mu antagonist)
-Best initiation therapy
-decrease cravings
-CI: if taking opioids, acute hepatitis/liver failure
2) Acamprostate (glutamate modulator)
-Once cessation has com
UWorld
Delusional Disorder
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Gender dysphoria
Tx:
Support (psychotherapy + family)
Hormone therapy
Gender reassignment if > 18
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Tardive dyskinesia
Prolonged exposure to dopamine blocking agents --> upregulation + supersensitivity of DA receptors
UWorld
Autism Spectrum DIsorder
Requires
early diagnosis and intervention
UWorld
Key features of DSM-5 personality disorders
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Acute Intermittent Porphyria
Unexplained abd pain
New onset neuropsychiatric symptoms
-neuropathies
-anxiety
-mood changes
-psychosis
Acute sx can last days to weeks
UWorld
Catatonia
Catatonia is a
syndrome
that occurs in severely ill patients with mood disorders with psychotic features, psychotic disorders, autism spectrum disorder, and medical conditions (infectious, metabolic, neurologic, rheumatologic)
-decreased motor activity
-l
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Common withdrawal symptoms
Heroin --> an opiate --> muscle aches
UWorld
Cyclothymic disorder
MDD vs Normal Bereavement
Count the SIG E CAPS. if the patient meets the criteria, the diagnosis is made.
Antisocial personality disorder
Associate of criminal behavior.
Disregard for others
Engage in activities such as drugs, theft, and assault.
Must be at least 18 years of age.
Conduct disorder often precedes this diagnosis.
Oppositional defiant disorder
Recurring patterns of negativistic, defiant, disobedient, and hostile hostile behavior toward authority figures that persists for at least six months it is not due to a mood or psychotic disorder.
Does not include aggression towards others or forced sexua
Rumination disorder
Regurgitation of food.
At least one month.
Physical:
-raw/chapped lips
-bad breath
-tooth decay
-weight loss
Expect in very young patients.
Other specified Feeding and Eating Disorder.
Bulimics/anorexics DO NOT eat a balanced diet.
Key giveaway
May be vomiting/restricting. Just like the others.
Anorexia Nervosa
Dry skin
Lanugo body hair
Hair loss
Arrested growth
Hypotension
Hypothermia
MVP
Bradycardia
Cardiomyopathy
Inadequate caloric intake:
Low BMI
Breast atrophy
Parotid gland swelling
Liver malfunction
Family based therapy for anorexia (family involved in ref
Bulimia nervosa
Binge eating
Inappropriate compensatory behavior
Normal BMI
MOST LIKELY TO ABUSE LAXATIVES (
Bisacodyl
)
+Russell Sign
Tx:
SSRIs (Fluoxetine best) + Psychotherapy + Group/Family counseling for highest efficacy.
Russell Sign
Binge Eating Disorder
Eating a large amount of food in a short amount of time with no purging.
Generalized anxiety disorder
Constant sense of fear or worry.
Irrational thoughts
Always thinking the worst
Palipitations
Diaphoresis
Tachypnea
Muscle aches
Difficulty swallowing
Avoidant personality disorder
Anxious/fearful
Display behavior and traits that suggest a personality disorder.
Avoids activities with intimate contact because they fear rejection or disapproval
Social inhibition and are preoccupied with other thoughts.
Thinks of themselves as inept an
Post traumatic stress disorder (PTSD)
Feelings of helplessness or intense fear in response to a tragic experience.
Intrusive symptoms:
-Nightmares.
-Intrusive memories.
-Avoidance of stress-inducing stimuli.
-Worsening mood or cognition.
-Changes in reactivity due to the event.
Social Phobia
Intense anxiety when in social situations.
Panic during public speaking or using a public restroom.
Patient tends to avoid socializing in large groups with friends.
Panic disorder
Abrupt onset of intense anxiety when exposed to a trigger.
Triggers include:
Illness
Personal conflict
Social situations
Specific setting
Stimulants can also elicit this response.
Agoraphobia
Avoidance of public places.
Onset: MC in 3rd or 4th decade of life.
Women > Men
Panic attack often triggers.
Tx:
CBT
SSRIs
Delirium
Acute onset of cognitive impairment and altered consciousness due to an underlying medical condition.
Drugs are a common cause in the elderly.
Ex: xanax
Paranoid personality disorder
Distrust and are suspicious of others.
Preoccupied with thoughts that other actions are malevolent and that they at actively trying to deceive him or her.
Angry when confronted.
Bears grudges.
Derives benign comments as threats.
Schizoid personality disorder
Do not display emotion
Are "distant
Avoidant Personality Disorder
Fear of socialization due to fear of in adequacy
Obsessive-compulsive personality disorder
Inflexible
Obsessed with order
Constructive to daily life
Schizotypal personality disorder
Eccentric behavior
Unable to maintain close relationships
Cohort study vs Case-sontrol
Cohort
Case-control
-Work from outcome to predictor (backwards)
1st test to order in an anxiety attack
EKG
-check for tachyarrythmias
Schizophrenia
Delusions
Hallucinations
Disorganized thinking
> 6 months
Schizophreniform disorder
Delusions
Hallucinations
Disorganized thinking
< 6 months
Schizoaffective disorder
Schizophrenia+ Mood sx
Schizophrenia alone
NO MOOD SX ALONE
Voyeurism, Exhibitionism, & Frotteurism
ADHD Associataions
ODD
Conduct Disorder
--> risk of development of
Anti-social personality disorder
Tourette's
Acid-base disorder of bulimia
Metabolic alkalosis
--> hypokalemia
From vomiting
MC Compulsions associated with OCD
Excessive grooming
Hand washing
Tooth brushing
Narcissistic personality disorder
Lacks empathy
Acts grandiose
Dependent personality disorder
Submissive
Unable to make own decisions
Borderline personality disorder
Unstable relationships
Impulsive
May act depressed/suicidal
substance abuse
eating disorders
Histrionic personality disorder
Attention seeking
Excessive emotions
Lithium/Valproic Acid teratogenic effects
Defense mechanisms
Seasonal Affective Disorder
Tx: Light therapy
Natural sunlight vs light box
Hyperventilation syndrome
Respiratory alkalosis
(panic attacks cause this)
ADHD increases the risk for development of...
Conduct disorder
(ODD if < 18)
Battery
Intentional act on the part of the caregiver to fail to respect a patients advance directive.
Only perform procedures that a patient has consented for.
Ex: remove a mass during a surgery for something else.
Ex: putting a patient of a ventilator when their
Breach of duty
Failure to maintain the duty that the physician owes to the patient, deviating from the "standard of care.
Standard of care
Level at which a professional having the same training and experience in good standing in a same or similar community would practice under the same or similar circumstances.
Ex: person who does not pay for his medical care is entitled to the same care tha
Vicarious liability
Employers are liable for negligent acts or omissions by their employees in the course of employment.
Ex: patient brings a a suit against the surgeon AND the hospital for the surgeon leaving a sponge inside him after the surgery.
Opioid dependence in pregnancy
Methadone is treatment of choice.
Prevents adverse effects from withdrawal.
IV drug use --> placental abruption
(Heart palpitations, headache, htn, tachycardia)
Note:
Buorenorphine and naloxone can be used if not pregnant
Frontotemporal dementia
<60 y/o
Short term memory usually intact
Two subtypes:
1) behavioral variant
Pick's disease
2) progressive aphasias
Exhibit paucity of speech --> cannot name twelve animals in one minute.
Antidepressnt
Works best with psychotherapy.
Helpful in addressing interpersonal issues that are not relieved with antidepressive meds.
Neuroleptic malignant syndrome
Life threatening
Dopamine blockade
Muscular rigidity
Dystonia
Obtundation
Autonomic instability
Fever
Unstable BP
Unstable HR
Tx: Danteolene + cooling blankets
Serotonin syndrome
MAO-i + SSRI
Wait 14 days between one of these before switching to the other.
Intimate partner violence
Requires interdisciplinary collaboration among healthcare workers as it has been shown to provide positive treatment outcomes.
Develop a safety plan!
Immediate access to the resources and services needed for safe escape when ready to leave.
Severe depression on pregnancy
Use ECT!
Gifts from pharmaceutical companies
Medical devices are okay
Everything else isn't.
Bereavement
Loss of a loved one
Resembles MDD without 5/9 SIG E CAPS
Sadness comes in waves.
COMAT
Status epilepticus
Epileptic seizure that lasts more than 30 minutes or a constant/near constant state of having a seizure.
1st line: benzodiazepine such as lorazepam
2nd line: (if bz does not work)
Phenytoin
If refractory:
PHB can be used
COMAT
CAGE questionnaire interpretation
1 point: at risk for alcohol dependency
2-3 points: highly suspicious for alcohol dependency
4 points: diagnostic for alcohol dependency
COMAT
Tourette's disorder
Presents with both motor and vocal text at some time during illness and is believed to be the result of dysfunction in the basal ganglia and related to structures in the midbrain and cortex.
Eye blinking, facial grimacing, shoulder shrugging, head jerking
COMAT
Syndenham's chorea
Self limited childhood consequence of strep, infectious exposures, or ARF.
Motor movements that are generally choreiform (involuntary brief, random and irregular movements of the limbs and face)
St. Virus' dance.
Inappropriate laughing, gross fasciculatio
COMAT
Tardive dyskinesia
Movement disorder that typically affects older adults who have been chronically taking anti-psychotic medication.
Orofacial dyskinesias
Choreoathetosis
Motor tics
Vocal tics
COMAT
Huntington's disease
Movement disorder transmitted through AD genetic transmission (expansion of triplet regions) and characterized by choreiform movements, cognitive decline, and neuropsychiatric symptoms.
MC ages is 30s-40s
Caudate and putamen atrophy
Rapid, involuntary, no
COMAT
Wilson's disease
Error of copper metabolism
Dystonias, chorea, ataxia, wing-beating tremors, mood disorders, psychosis, intellectual decline.
COMAT
Acute mania
Valproic acid
Lithium
Atypical antipsychotics
COMAT
Bulimia Nervosa
CBT is MORE EFFECTIVE than SSRIs
So if you have to pick one pick CBT.
COMAT
Delusional disorder
Delusions of at least one month's duration and is not marked by psychosis.
COMAT
Capgras syndrome
Illusion of doubles
Familiar person has been replaced by an imposter!
COMAT
Cotard syndrome
Aka nihilistic delusional disorder
Patients claim they lost posessions, status, strength; their heart, blood, and intestines.
The world around them has been reduced to nothingness
Precursor to schizophrenic or depressive episode often times.
COMAT
Fetishistic disorder
Fetishism
Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the use of non-living objects such as female undergarments; high heels, lace stockings, shoes, jackets, boxing shorts etc.
At least 6 months and are clinically
COMAT
PCP
Glutamate antagonist
Horizontal and vertical nystagmus
Violent behavior
Psychosis
Miosis
vs amphetamine (mydriasis)
PCP intoxication is characterized by aggressive behavior, sympathetic activation, vertical nystagmus, and often by a need to undress. Treat
COMAT
Salvia divinorum
Hallucinations
Euphoria
Perceptual distortions
Last 1-2 hours (less when smoked)
COMAT
LSD
Anxiety
Depression
Pupillary dilation
Delusions
Visual hallucinations
Flashbacks
COMAT
Cocaine
Euphoria
Anxiety
Anger
Hypervigilance
Poor judgement
Tachycardia
Pupillary dilation
Htn or hypotension
Muscle weakness
Seizures
Arrhythmia
Withdrawal:
Dysmorphic mood
Fatigue
Vivid dreams
Sleeping problems
Psychomotor agitation
Increased appetite
COMAT
Methamphetamine
Amphetamine intoxication is characterized by autonomic hyperactivity with hypertension, tachycardia and diaphoresis, pupillary dilation (mydriasis) and psychomotor agitation that can progress to paranoid psychosis with delirium.
Fatigue
Apprehension
Troub
COMAT
Lithium and hypothyroid
Lithium can depress thyroid function resulting in secondary hypothyroidism and may present as symptoms of depression in bipolar disorder type II
Dry skin
Patchy hair loss of scalp
Mild bilateral ankle edema
Delayed relaxation of patellar deep tendon refle
COMAT
General Drug Intoxication Approach
Recall that only alcohol and sedative-hypnotic (benzodiazepine and barbiturate) withdrawal are life-threatening due to risk of seizure.
Pupillary constriction (miosis) occurs with opiate and phencyclidine intoxication while pupillary dilation (mydriasis)
COMAT
Oculogyric Crisis is a type of dystonia
Treatment: IM benztropine or diphenhydramine
COMAT
Medical abandonment
Caregiver-patient relationship is terminated without making reasonable arrangements with an appropriate person so that care by others can be continued.
Ex: an ER physician abandons a patient after his shift ends with no idea if the next doctor knows about
COMAT
Acute panic attack
Benzodiazepine
SSRIs are for long term
MC ASSOCIATION
MDD
COMAT
Alcoholism
Brief intervention
is a short-term counseling strategy based on motivational enhancement therapy that concentrates on changing patient behavior and increasing patient compliance with therapy.
Thirty to sixty percent of alcoholics maintain at least one yea
COMAT
OCD
The most common compulsion associated with obsessive-compulsive disorder is excessive grooming, hand washing, tooth brushing, etc. This occurs in approximately 60% of patients.
COMAT
Obstructive sleep apnea
Obstructive sleep apnea is defined as the coexistence of excessive daytime sleepiness with multiple episodes of obstructed breathing per hour of sleep.
The diagnosis is most commonly made in obese middle-aged males.
Associated clinical features include
-d
COMAT
The single most important predictor of future suicide attempts is ...
a history of prior attempts.
COMAT
Rett's disorder
Rett's disorder, individuals have normal development in the first few months of life, but in later months, they have regression of development of physical, social, and language skills.
COMAT
Agoraphobia
Agoraphobia is the fear of being in crowded places or in places from which escape is difficult and may or may not occur with recurrent panic attacks.
COMAT
Social phobia/social anxiety disorder
Social phobia, otherwise known as social anxiety disorder, comprises of marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others.
Social phobia is char
COMAT
Wernicke-Korsakoff's syndrome
Wernicke-Korsakoff's syndrome occurs in individuals with chronic alcohol use and consists of confusion, ataxia, ophthalmoplegia, vestibular problems, confabulation, and anterograde amnesia.
nystagmus, ataxia, confusion, anterograde amnesia, confabulation
COMAT
Wernicke's encephalopathy
Wernicke's encephalopathy occurs due to thiamine deficiency or malabsorption, which occurs frequently in those who abuse alcohol. Thiamine is a co-factor for several important enzymes and may also be in nerve conduction along the axon and in synaptic tran
COMAT
Korsakoff's syndrome
The cardinal features of Korsakoff's syndrome are impaired recent memory and anterograde amnesia (loss of the ability to create new memories after the event that caused amnesia) in an alert and responsive patient.
Ex: cannot describe sx or the last 2 mont
COMAT
TCA overdose
An overdose of TCAs such as amitriptyline may cause prolongation of the QTc interval and widened QRS complexes, leading to possibly fatal arrhythmias.
Tx:
Sodium bicarbonate
is the mainstay of anti-arrhythmic therapy in TCA intoxication.
Also dilated pupi
COMAT
PTSD Treatment
Individuals with PTSD experience marked cognitive, affective, and behavioral responses to stimuli reminding them of trauma they experienced, eg, flashbacks, severe anxiety, and fleeing or combative behavior.
A
trauma-focused cognitive-behavioral therapy
(
COMAT
Psychological debriefing
Psychological debriefing is a short intervention provided immediately after a person has experienced trauma.
Critical Incident Stress Debriefing is a widely used version that is often part of a multi-component program. It is typically delivered in a group
COMAT
ECT in pregnany patients
When a patient has devised a plan to commit suicide, immediate and emergent treatment is indicated, especially in a pregnant patient since there is risk to the fetus along with risk to the mother.
This patient has recognized her depression and is willing
COMAT
Dissociative fugue
Dissociative fugue is characterized by an inability to remember most or all of one's past (dissociative amnesia) coupled with travel far from home. It is usually triggered by a traumatic event.
Tx:
Psychodynamic psychotherapy
The approach to treatment usu
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Psychodynamic psychotherapy
Based upon the idea that childhood experiences, past unresolved conflicts, and previous relationships significantly influence an individual's current situation in life.
Adult relationships are understood to be a byproduct of unconscious patterns that begi
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Cognitive and behavioral therapies
Cognitive and behavioral therapies can be used individually or in combination as a program of interventions known as cognitive behavioral therapy or CBT. In cognitive therapy, the therapist helps the patient identify and correct distorted, maladaptive bel
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Interpersonal therapy (IPT)
Interpersonal therapy (IPT) addresses interpersonal difficulties that lead to psychological problems.
Interpersonal psychotherapy focuses on the individual's interpersonal life in four problem areas:
1) grief over loss
2) interpersonal disputes
3) role tr
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Motivational interviewing
Motivational interviewing is a type of psychotherapy that is used in primary care and mental health care to encourage patients to change maladaptive behaviors.
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Narcolepsy
Narcolepsy often starts in adolescence or early twenties, and comprises of a tetrad of:
1) cataplexy
2) sleep paralysis
3) sleep-onset REM sleep attacks
4) hypnagogic hallucinations.
Treatment:
Maintain a regular sleep schedule, timed daily naps, moderate
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Somniloquism
Somniloquism, known as sleep-talking, arises during NREM (non-REM) sleep periods 1 and 2. It involves vocalizations ranging from simple words and phrases to complete conversations.
It is frequently spontaneous, but may be elicited by speaking to the sleep
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Olanzapine overdose
Olanzapine is an atypical antipsychotic; therefore, it can carry anticholinergic properties. Overdose may lead to anticholinergic toxicity, characterized by:
-hyperthermia
-facial flushing
-dry mucus membranes
-delirium
"Red as a beet" - caused by cutaneo
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Salicylate overdose
Salicylate overdose causes tinnitus, nausea, vomiting, metabolic acidosis, respiratory alkalosis, seizure, coma, and death.
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Acetaminophen overdose
Acetaminophen overdose leads to abdominal pain, nausea, vomiting, and possibly severe liver toxicity.
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Haloperidol overdose
Haloperidol overdose causes lethargy, tremors, and dystonia. The typical antipsychotics may cause anticholinergic toxicity as do the atypical antipsychotics, however, they cause this at a much lower frequency than do atypicals.
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Lithium overdose
Lithium overdose causes nephrogenic diabetes insipidus, hyperreflexia, tremor, ataxia, nystagmus, and seizure.
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Attention-deficit/hyperactivity disorder
Attention-deficit/hyperactivity disorder is the
most common
behavioral disorder among American children. Symptoms of inattention, impulsivity, hyperactivity and emotional lability appear before age 7 and cause persistent impairment in at least two setting
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Sleep related-eating disorder
Sleep related-eating disorder involved eating while asleep. It can be caused by hypnotics used for insomnia, such as zolpidem.
...
Answer A: Patients with avoidant personality disorder exhibit avoidance and fear of interpersonal contact due to feelings of inadequacy and fear of embarrassment. A diagnosis of avoidant personality disorder is made when a pervasive pattern exists and is
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Schizotypal personality disorder
A pervasive pattern of eccentric behavior and social and interpersonal deficits beginning in early adulthood characterize schizotypal personality disorder.
Five or more of the following characteristics must be present: inappropriate or constricted affect,
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Histrionic personality disorder
Histrionic patients are described as dramatic, flamboyant and attention seeking.
Five or more of the following are present: inappropriately seductive or provocative behavior, discomfort in situations in which he/she is not the center of attention,
rapidly
...
Answer B: Borderline personality disorder is marked by unstable affect and self-image as indicated by five or more of the following: a pattern of intense and unstable interpersonal relationships, frantic efforts to avoid abandonment, persistently unstable
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Schizoid personality disorder
Schizoid personality disorder is characterized by social withdrawal, a lack of desire for interpersonal relationships and reduced range of affect. Four or more of the following are present: neither desires nor enjoys close relationships including family i
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MAO-i to SSRI
Serotonin syndrome can develop with combination use of MAO inhibitors and SSRI's. At least 14 days after MAO discontinuation should pass to avoid possible complication.
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SSRI has no effect after 2 weeks...
Since this patient has only been on paroxetine for 2 weeks, it would not be appropriate to switch to a different class or increase dose of SSRI yet as it can take up to 6 weeks for the dose to take effect.
ex: Augment w/ a bz (short acting like ativan (lo
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TCA overdose... again
Wide complex tachycardia
hyperthermia
hypotension
flushed and dry skin
hypoventilation
Tx: sodium bicarbonate.
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Delirium tremens
Delirium tremens typically presents within 48 to 96 hours after cessation of alcohol consumption.
Symptoms include:
tachycardia
psychomotor agitation
combativeness
hypertension
fever
Left untreated, it can be fatal.
Tx:
IV benzodiazepines to control psych
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Delusional disorder of the somatic subtype
Patients with delusions of parasitosis have a fixed belief that they have pruritus due to a parasitic infestation. Antipsychotic medications are the accepted treatment.
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Neuroleptic malignant syndrome
Neuroleptic malignant syndrome is an emergency that is associated with neuroleptic medication use, such as haloperidol, risperidone, chlorpromazine, etc. Symptoms include severe muscular rigidity, hyperthermia, altered mental status, tachycardia, and hype
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Separation anxiety disorder
Separation anxiety disorder occurs in children and adolescents when they experience excessive anxiety at being separated from attachment figures or when they experience fear about harm befalling the attachment figures.
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Borderline Personality Disorder
Borderline Personality Disorder is characterized by affective lability, fear of abandonment, suicidal or self-destructive gestures, and splitting.
It is best treated with a combination of
medication
and
dialectical behavioral therapy.
NOTE:
Cognitive beha
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Interpersonal therapy
This is a short term-therapy that has been used for treatment of depression. Patients usually pick one or two topics to address throughout the therapy sessions.
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Somatization Disorder
Multiple physical complaints beginning before age of 30 years that result in treatment being sought or significant impairment in functioning, with no medical condition or substance fully explaining the symptoms.
Specifically, four pain complaints (in the
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Post-traumatic stress disorder
PTSD describes syndrome of post-traumatic emotional distress with avoidance, hypervigilance, detachment, nightmares, flashbacks, etc. at a moderate to severe level which lasts for
more than a month.
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A 54-year-old male complains of decreased appetite, poor concentration, restlessness, and early morning awakenings over the past month. He lacks interest in his usual activities and reports to be unable to experience pleasure. He also reportedly hea
Mood disorder secondary to a general medical condition
This patient presents with a distinctive period of mood disturbance characterized by anhedonia, change in appetite impaired concentration, psychomotor agitation and sleep disturbance which is characte
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Paraphilia
Frotteurism
is defined as recurrent and intense sexual fantasies, urges or behaviors that involve rubbing against or touching a non-consenting person. The condition must cause marked distress or disturbance in functioning and be present for at least 6 mon
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Schizoaffective disorder
To make the diagnosis of schizoaffective disorder, the psychotic symptoms must be present in the absence of the mood symptoms for at least two weeks.
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Acute benzodiazepine withdrawal
Go this wrong twice!!!!!
Benzodiazepines work by modifying
gamma-aminobutyric acid (GABA) receptors to increase conductance of this inhibitory channel.
Benzodiazepines are commonly used for the treatment of seizure control, anxiety, alcohol withdrawal, in
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Opioid withdrawal
An opioid agonist, such as heroin, is an abused drug that causes apathy, central nervous system depression, constipation, pupillary constriction, and respiratory depression. Acute intoxication can be treated by use of naloxone to block opioid receptors.
W
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SSRIs can cause acute microcytic hypochromic anemia
Acute microcytic hypochromic anemia.
Serotonin reuptake inhibitors, especially fluoxetine and paroxetine, can increase risk of abnormal bleeding. This is thought to be caused by two mechanisms:
1)Serotonin is known to directly promote platelet aggregation
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TCA Overdose
Tricyclic antidepressants can cause significant cardiac arrhythmias due to sodium channel inhibition and are potentially fatal in overdose.
-flushed/dry skin
-hypotension
-AMS
-mydriasis
-suicidal ideation
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Methylphenidate overdose
Psychostimulant overdose is characterized by:
-Pupillary dilation (mydriasis)
-fever
-diaphoresis
-psychomotor agitation
-hypervigilance that in some patients can progress to paranoid psychosis with delirium.
Autonomic hyperactivity with tachycardia and h
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Acetaminophen overdose
A patient who acutely overdosed on acetaminophen would present with:
-nausea
-vomiting
-fever
-pancytopenia
-possible renal failure
-hypoglycemic coma
Acetaminophen overdose can be potentially fatal due to hepatotoxicity and patients should be immediately
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Opioid overdose
Opioid overdose presents with:
-pupillary constriction (miosis)
-CNS depression manifested by decreased level of consciousness (on a continuum from drowsiness to coma based on quantity ingested)
-decreased respiratory drive
Patients often appear unconscio
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Lithium overdose
Acute lithium toxicity causes:
-vomiting
-ataxia
-course tremor
-dysarthria
-confusion
-seizure
-bradycardia.
Arrhythmia can result and ECG should be monitored. ECG changes due to lithium toxicity include flattened T waves, ST segment depression and QTC p
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TCA Toxicity Monitoring
EKG
MOST IMPORTANT TEST TO MONITOR SEVERITY OF TOXICITY
TCA toxicity has a number of manifestations including the 3Cs: Convulsions, Coma, and Cardiotoxicity and anti-HAM: (H) anti-histaminic: sedation (A) anti-adrenergic: cardiovascular side effects, such
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Serotonin Syndrome
Serotonin syndrome tends to be seen in patients who are taking antidepressants and presents with hyperthermia, muscle rigidity, tremors and altered mental status.
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Conversion disorder aka functional neurological symptom disorder
Characterized by symptoms suggesting a neurological disorder that are preceded by conflict or stress and cannot be explained by a general medical condition or the effects of a substance.
"I'm sure everything will be okay." = La belle indifference
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Social anxiety disorder
Social phobia, now known as social anxiety disorder in DSM-5, comprises of marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others.
Social phobia refe
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Defense mechanisms
Splitting is the labeling of people as either all good or all bad, often used by patients with borderline personality disorder. It may have the effect of causing conflict within the treatment team if not recognized.
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Bulimia nervosa
The classic presentation of bulimia nervosa is a female of average to above average weight, who presents with dizziness, dehydration, muscle weakness, possible parotid gland enlargement, and erosion of the tooth enamel on physical examination.
Patients wi
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Bipolar I treatment
High quality evidence supports the use of lithium, valproate, quetiapine and olanzapine for maintenance therapy in patients with bipolar disorders. Quetiapine plus lithium or valproate is superior to monotherapy for maintenance treatment and can be used f
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Acute Stress Disorder
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Adjustment disorder
There are several subtypes of adjustment disorders: adjustment disorder with depressed mood, with anxiety, with mixed anxiety or depressed mood, with disturbance of conduct, with mixed disturbance of emotions and conduct, and unspecified.
When significant
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Drug therapy in dementia
Donepezil is helping, but patient is still forgetting some things...Next step?
Continue Donepezil, no need to add/change meds...
Dementia is a progressive and irreversible illness associated with decreased acetylcholine due to loss of cholinergic neurons in the locus ceruleus.
Common pharmacotherapy options include the acetylcholine
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Adjustment disorder
Psychotherapy
to increase insight and modify behavior is the first line treatment for adjustment disorders.
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Amphetamine toxicity
Amphetamine toxicity can occur with low doses in young children taking ADHD medication and can present with sympathomimetic crisis.
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Charles Bonnet Syndrome
The onset of complex visual hallucinations in an otherwise healthy blind patient with no psychiatric history and no other evidence of psychotic or mood disorder is suggestive of Charles Bonnet Syndrome. Patients with this syndrome realize that the halluci
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Tricyclic antidepressants
Imipramine is a TCA known to be associated with cases of
orthostatic hypotension.
Nortriptyline is also a tricyclic antidepressant but is least likely in this class of medications to cause orthostatic hypotension. It can cause cardiac symptoms and convuls
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Childhood disintegrative disorder (The Rett syndrome of boys)
Childhood disintegrative disorder is characterized by normal development until age 2 and then loss of previously acquired skills. Onset is between the ages of 2 and 10, and boys are more commonly affected than girls.
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Cyclothymic disorder
good and bad days"
dysthymia + hypomania
Bipolar 1:
MDD + mania
Bipolar 2:
MDD + hypomania
Serotonin Syndrome vs NMS
The combination of the monoamine oxidase-inhibitor (MAOI) selegiline with any other serotonergic agent, fluoxetine, is most likely to cause serotonin syndrome.
Serotonin syndrome, which is characterized by:
-
HYPERREFLXIA + CLONUS
-FAST ONSET (HOURS)
-hyp
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Schizotypal PD
The personality disorder usually begins to emerge in early adulthood. Diagnosis requires five or more of the following: (1) odd beliefs or magical thinking,
(2) ideas of reference,
(3) unusual perceptual experiences,
(4) excessive social anxiety,
(5) susp
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Conduct d/o --> ?
Children with conduct disorder often go on to develop antisocial personality disorder.
COMAT
A 24-year-old female presents to the primary care office with multiple complaints that began one month ago. She states that she is concerned because she has been gaining a lot of weight in the last month. Despite sleeping about twelve hours a day, s
Serotonin
Diagnosis of depression requires depressed mood or anhedonia in addition to five or more signs/symptoms from the mnemonic 'SIG E CAPS' (sleep, interest, guilt, energy, concentration, appetite, psychomotor agitation, suicidal ideation) occurring
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NT dysregulation
Decreased acetylcholine has been linked to Alzheimer's disease, which is usually a disease of the elderly. The first presenting sign is often amnesia and can include aphasia, agnosia, and apraxia.
Abnormal levels of cortisol may occur in Cushing's syndrom
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Dysthymic disorder
Dysthymic disorder, now known as persistent depressive disorder (dysthymia) in DSM-5, represents a consolidation of chronic major depressive disorder and dysthymic disorder. Criteria (abridged) include the following:
A. Depressed mood for most of the day,
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Bipolar + SSRI
Patients with presumed unipolar depression that have a rapid, overwhelming upswing in mood following the start of treatment with an antidepressant should be screened for bipolar disorder since certain antidepressants, especially paroxetine, can send a bip
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GAD
Insomnia can be either primary or secondary.
With secondary insomnia, the sleep disorder is better accounted for by another Axis I mental disorder, a medical condition or substance use. Mood and anxiety disorders are commonly associated with sleep disturb
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Adjustment disorder
An adjustment disorder is a reaction to an event, or stressor, that is more extreme than normal, causes impairment in social or occupational (academic) function, and does not meet criteria for another Axis I disorder.
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Insomnia
The first treatment for insomnia is behavioral change to encourage proper sleep hygiene.
This includes going to bed when tired, not staying in bed after trying to sleep for more than 20 minutes, arising at the same time each day, moderate exercise during
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Random definitions
Formal operation
emphasizes deductive logic and the emergence of the ability to use abstract thought for hypothetical situations.
Loosening of association
(also known as derailment or asyndetic thinking) is a thought disorder characterized by disorganized
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Bupropion C.I.
Seizure disorder is an absolute contraindication to use of bupropion.
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Sleep terror disorder
Sleep terror disorder is characterized by unresponsiveness during the event and amnesia after the event. It occurs during NREM sleep.
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Somatoform disorders
Somatoform disorders are characterized by multiple clinically significant, but unexplained, physical symptoms that cause significant emotional distress and lack primary or secondary gain. After appropriate rule out of organic pathology, treatment includes
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Oppositional defiant disorder (ODD)
Oppositional defiant disorder (ODD) comprises of a pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which at least 4 or more of the following criteria are present where the child often:
Loses temper
Argues with adul
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Tyramine containing foods + an MAO-i
Tyramine-containing foods cause hypertensive emergency/urgency in the setting of monoamine oxidase inhibitor (MAOI) use because tyramine is normally broken down by monoamine oxidase.
Tyramine acts as an indirect sympathomimetic, causing the increased rele
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OCD
OCD comprises of obsessive, intrusive thoughts or compulsive behaviors, or both, that cause marked anxiety and distress.
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Some Psych Vocab (In relation to tangentiality)
1) Tangentiality - the responses given to questions never reach the goal of answering the question, which is in contrast to circumstantiality where extra and unnecessary details are added but a question is eventually answered. Tangentiality describes the
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NT causing Hallucinations/Delusions in Schizophrenia
Schizophrenia is associated with increased levels of dopamine.
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Cri-du-chat
Partial deletion of the short arm of chromosome 5 at 5p15.3, and is characterized by;
-high-pitched
-cat-like crying
-low birth weight
-failure to thrive
-hypotonia
-psychomotor retardation
-severe intellectual disabilities
-microcephaly
-hypertelorism (a
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Fetal alcohol syndrome (FAS)
Fetal alcohol syndrome (FAS) refers to a cluster of symptoms found in children with in-utero exposure to alcohol, and the severity of symptoms correlates with the severity of the mother's alcohol intake. Children with FAS have a characteristic facial appe
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Prader-Willi syndrome (PWS)
Prader-Willi syndrome (PWS) occurs due to the absence of a critical region on paternally-inherited chromosome 15q11-q13. This genetic area undergoes the process of imprinting, which is the differential expression of the region based on whether the chromos
Angelman syndrome
Deletion of the same region on the maternal 15q11-q13 inherited chromosome results in Angelman syndrome, which is characterized by:
-severe intellectual disabilities
-postnatal microcephaly
-seizures
-frequent laughter and smiling
-excitable personalities
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Fragile X syndrome
Fragile X syndrome is a maternally inherited condition due to an increased number of triplet CGG repeats in the FMR1 gene located on chromosome Xq27.3.
It is the
most common
inherited form of mental retardation.
Down syndrome, on the other hand, is the mo
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Down syndrome
Down syndrome, also known as Trisomy 21, occurs due to an extra copy of chromosome 21. It is the
most common
genetic cause of mental retardation.
The average IQ amongst individuals with Down syndrome is in the 25-50 range.
Common physical features include
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Haldol & Olanzapine can be used interchangeably in acute psychosis.
Quietapine is NOT fast enough working for acute psychosis but can be used for maintenance.
The main indications for the use of psychotropic medications in an emergency room include for violent or assaultive behaviors, paranoid patients, patients in catatonic states, massive anxiety or panic attacks, and extrapyramidal side effects (such as dyst
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Some Anorexia Fluff
Anorexia nervosa is characterized as an eating disorder in which patients refuse to maintain a minimally normal weight, have intense fear of gaining weight, and have a distorted self-image of their body and weight.
A combination of genetic, biological, ps
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Calcium Channel Blocker Overdose
Calcium channel blocker overdose presents with profound bradycardia, hypotension, and preserved or mildly depressed mentation.
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Buproprion Overdose
Bupropion overdose presents with hypertension, tachycardia, and seizure.
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Acetylcholine & REM
Elevated levels of acetylcholine result in prolonged REM and total sleep times.
COMAT
Hypersomnolence disorder
Hypersomnolence disorder, previously known as primary or secondary insomnia in DSM-IV. Diagnostic criteria (abridged) include the following:
A. Excessive sleepiness despite at least 7 hours of sleep with at least one of the following: recurrent sleep or l
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Vascular dementia
Patients with vascular dementia manifest cognitive impairments and memory problems in a step-wise, progressive way along with focal sensory or motor deficits, and they usually have risk factors for stroke or cerebrovascular disease.
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Caffeine intoxication
Caffeine intoxication is characterized by insomnia, restlessness, agitation, muscle twitching and diuresis. Nicotine intoxication causes insomnia, anxiety and restlessness as well.
Excessive caffeine and nicotine intoxication can both result in cardiac ar
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Long Term Care Ombudsman Program
The Long Term Care Ombudsman Program (LTCOP) receives complaints and advocates on behalf of long-term care residents and community dwelling elders are protected in all states by state adult protective services agencies (APS). These agencies receive and in
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Ganser's syndrome
Ganser's syndrome is a poorly understood condition and has been classified by some as a sub-type of factitious disorder while others have a classified it is a dissociative disorder.
The ratio of men to women with this disorder is 2:1. Patients with Ganser
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Depression in individuals with eating disorders
For the treatment of depression in individuals with eating disorders, fluoxetine would be a good choice.
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Briquet's syndrome
Briquet's syndrome is an eponym for somatization disorder (now called somatic symptom disorder in DSM-5). The DSM-5 diagnostic criteria include:
A. One or more somatic symptoms that are distressing or result in significant disruption in daily activity.
B.
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Duloxetine
Duloxetine is an SNRI that can be used in the treatment of depression and diabetic neuropathy.
COMAT
Isolation of affect
A new defense mechanism: 2018
Isolation of affect is the unconscious limitation of the feeling of emotion associated with a stressful life event.
COMAT
Naloxone
Naloxone antagonizes opioid receptors and should be given in suspected opioid overdose. The most life-threatening and sensitive symptom of opioid toxicity is respiratory depression.
NOTE:
Flumazenil is used to treat respiratory depression from benzodiazep
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Countertransferance
Countertransference comprises of the reactions that the provider has towards the doctor-patient relationship, and these reactions may be quite negative in which the doctor finds him/herself to be disliking the patient very much and having a challenging ti
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Seasonal Affective Disorde
Seasonal Affective Disorder, now known as Major Depressive Disorder with Seasonal Pattern, is a subtype of major depressive disorder in which depressive episodes occur and remit in regular seasonal patterns. Most commonly, this occurs in the fall and wint
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Tardive dyskinesia
Tardive dyskinesia is a movement disorder caused by prolonged exposure to dopamine receptor blocking antipsychotic medications over several months and years. Tardive dyskinesia is differentiated from acute dyskinesia, pseudoparkinsonism and akathisia whic
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Play therapy
-->Used for MDD in kids ages 3-11 INSTEAD of CBT
Play therapy is generally used with young children ages 3-11 years old and replaces CBT for this age group.
Play therapy allows them to express themselves and their emotions, feelings, and experiences through a natural and self-guided process as they can
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Dialectical behavior therapy (DBT)
Helps individuals modify thoughts of self-harm, suicidal thinking, and substance abuse.
Often for individuals with
borderline personality disorder
and
chronic suicidality.
This approach works towards helping people to increase their emotional and cognitiv
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Family therapy
Family therapy would be more suitable when there are family dynamics contributing to stressors that are exacerbating symptoms.
COMAT
Alcoholic hallucinosis
Alcoholic hallucinosis occurs within 12 to 48 hours after cessation of chronic alcohol abuse. Symptoms include tactile, visual, and/or auditory hallucinations, however, vital signs and mental orientation remain normal.
The treatment is supportive therapy,
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Amygdala
In subjects with anxiety, the
amygdala
demonstrates increased brain activity on PET scans, as the amygdala is associated with the body's response to anxiety, fear, and emotion.
vs
The hippocampus, together with the amygdala = parahippocampal gyrus, lies p