obinno59's version from 2015-12-08 17:55


Question Answer
Schizoid txtreatment
cognitive, behavioral, psychoanalysis
only if patient suffers from concomitant depression or transient psychosis
Depression EPI5% prevalence
females affected twice as often as males
not associated with economic status
associated with chronic disease
Dpression tx
1st line
2nd line drug
Used in atypical depression
Used when patient also suffers from neuropathic pain
Used when patient has sexual side effects and/or weight gain on SSRI
2. TCAs
3. MAOIs
When do you consider stopping meds in MDD?if patient has had 1 episode of MDD, pharamcologic treatment can be discontinued after 6 months symptom free NOT the duration of tx
if patient has had 2 or more episdoes of MDD, treatment must be continued indefinitely
Which of the following represents an appropriate pharmacologic treatment algorithm for generic major depression in a 30-year-old male with no comorbidities? (starting at left as first line therapy, and working to right)?Because the group has heterogeneous efficacies and side effects in individual patients, it is prudent to have a trial of another SSRI if the first attempt fails prior to moving to another drug class.
Paroxetine(4-6 wks) -> Citalopram -> Amitriptyline
MDD vs Adjustment d/oBoth can >6 months; Adjustment: If stressor persists
Adustment: doesn't meet the criteria for MDD(5+/6 sx)
Cyclothymic vs Rapid cyclingRapid cycling
> 4 episodes of mania/depression/mixed within 1 year
alternating hypomanic episodes with dysthymia
1st line Bipolar pharm tx1.Antiepileptics
Lithium=first line mood stabilizers
check creatinine before initiating therapy
renal failure, hyponatremia, and dehydration all increase likelihood of lithium toxicities
atypical antipsychotics can also be used
may begin antidepressant therapy only after mood stabilizers are started
lamotrigine also used
Haloperidol=used as a first line of treatment in pregnant patients
2nd line Bipolar pharm tx1.valproate or carbamazepine=second line mood stabilizer
2.Atypical antipsychotics
quetiapine or olanzapinecan be used as second line
Bipolar long term tx prognosis?In patients with bipolar disorder who have experienced a first manic episode, lithium treatment may be continued for a year and then tapered off.

Patients with multiple recurrences (three or more) should be on life long therapy.
Bipolar Patients experiencing a_____ episode have the highest incidence of suicide attempts.Mixed
OCD vs OCPDOCD=disorder is ego dystonic
behavior inconsistent with one's own beliefs and attitudes
separates OCD from obsessive-compulsive personality disorder
OCD a/w ____ which can be tx with_____1. Tourettes
2. Risperidone
OCD txPsychotherapy
behavioral therapy(CBT, specifically =ERP=exposure-response prevention)
augmentation therapy with antipsychotics
ProjectionAttributing unacceptable internal feelings to an external source
Philandering husband claims his wife is cheating
Reaction formationReplacing an unwanted idea or feeling with its opposite ("an equal and opposite Reaction")
drug addict speaking out against drugs
SublimationIs the satisfaction of an objectionable impulse in an acceptable manner, channeling these impulses rather than preventing them. It is a mature defense
Isolationis the separation of feelings from ideas and events
UndoingSymbolically nullifying an unacceptable or guilt provoking thought, idea, or feeling by confession or atonement.
Schiophrenia txAtypical antipsychotic medications
first line of treatment
typical first agents are olanzapine, ziprazidone
if compliance is an issue, long acting risperidone may be used
clozapine used as a second line drug if fails first line treatment
Schizophrenia prognosisA.Good outcomes associated with
1.paranoid/catatonic subtype
2.late and quick onset, with inciting event family history of schizophrenia

B.Poor outcomes associated with
disorganized subtype
Harder to tx Neg or Pos sxs?Negative sx
CT findings in schizophrenic patientsIncreased ventricular size
Decreased cerebral, hippocampal and temporal masses.
Schizophrenia presentation in M vs Wlate teens to early 20s in men
late 20s to early 30s in women
Smoking cessation drug CONTRA in pt's with hx of suicide is _____ it's a ____1.Varenicline
2. Partial nicotinic agonist
Best ECG indicator for TCA ODProlonged QRS
Bedwetting is considered normal until age _________. After that _________ and _________ can be used1.Five
2. behavioral therapy(alarm) and 1stLVasopressin/2ndLTCA
____is a complication of tx for Anorexics, which can cause death by _____. With presentations of ____1. Refeeding syndrome
3.Lethargy, shortness of breath and muscle aches
During starving phase= decre insulin and incre glucagon
Since these Insuling requires large amounts of phosphate, magnesium, and potassium,for the refeeding phase stores of these electrolytes can become depleted quickly.
What drugs can cause Lithium toxicity How?Any drug that decreases glomerular filtration including ACE inhibitors, NSAIDs, and diuretics (through dehydration) can cause lithium toxicity.
In pt's who have Renal issues which antiinflamm is softer on the kidneys?aCetaminophen: It works centrally not periph on the Prostaglandins.
_______and anxiety often coexist with panic disorder, especially when the disorder begins in adolescenceDepression
Body Dysmorphic Disorder txSSRIs =have shown mild symptomatic improvement
Pain d/o txTreatment

physical therapy