Psych misc 3

imo132's version from 2017-09-20 08:18


Question Answer
Child anxiety epidem3% boys, 5% girls, 15-20% risk in adolescence
Child depression10%, more females, mood more irritable than low, use DASS scale in 14-18, CDI in younger
Suicide in kids25% of all deaths in 15-19 year olds, females higher than males
Child depression RxFluoxetine, fluvoxamine, paroxetine, need expert opinion for SNRI or TCA (SE & low efficacy)
ADHDIn 5% kids, 3% adults, inattention, impulsive behvaiour, difficulty regulating self, commence <12 years, impairment in >2 settings, with combined, inattentive (in girls), hyperactive/impulsive types
ODDIn 4%, angry, irritable mood, defiant, vindictiveness, >6 months, Sx every day if <5, at least once a week if >5 years
Conduct disorder (CD)In 3%, persistent violation of others’ rights, preceded by ODD if onset in childhood or onset in adolescence, deceitful, destructive, aggressive
Externalising disorders epidemADHD 5%, others 4%, M>F, ADD & ODD decline with age, CD has 2 peaks & becomes antisocial personality disorder, ODD often with ADHD
ADHD causeGenetics (75%), perinatal hypoxia/smoking/alcohol/heroin, lead, brain injury, neurofibromatosis type 1, delayed cortical maturation (thinning)
ODD/CD causeGenetics (MAO), perinatal smoking/heroin/alcohol, lead, parenting style, social adversity
ODD/CD RxPsychosocial management (parent-behaviour training for children, strategic family therapy for adolescents), not as effective in ADHD, risperidone, clonidine, fluoxetine
ADHD RxMethylphenidate, dexamphetamine first line, atomoxetine second line (longer onset)
Intellectual disabilityIQ <70, impairment in >2 of communication, self-care etc, onset before 18, profound if IQ <20, 3% population
Anorexia0.5% girls 15-19, 20% chronic
Bulimia prev5%
EDNOS prev10%
Binge eating prev10%
Eating disorder prev20% (total)
ED child presentationKetosis, halitosis, hypoTN, standing BP >20, standing HR >20, ST/T wave changes, long QT, bradycardia, delayed puberty, stunting
ED prognosis80% better & 50% fully recovered (anorexia), 70% asymptomatic (bulimia), 10-20% mortality
Psychosis in deliriumVisual hallucinations, persecutory delusions from poor memory & disorientation, poverty of thought, illogicity
Delirium epidem1-2% community, <50% hospital, >70% ICU
OA psychosisPersecutory delusions, visual hallucinations
BPSD40% Alzheimer’s, more lewy body, Sx fluctuate, with sundowning or ADL help, hallucinations and mild depression resolve, agitation & severe depression persists
BPSD drug RxSSRI or cholinesterase inhibitor if mild-moderate, AP or mood stabilizer if severe, screaming & shouting, hoarding, spitting will not be fixed
SSRIs for BPSDSertraline best in severe depression, Citalopram = Risperidone for agitation (but QT prolongation), SE hypoNa, GIT, akathisia, sleep disturbance, falls
Chol inh in BPSDBest effect on anxiety, apathy, depression/dysphoria, need several weeks for effect
APs for BPSDHaloperidol & risperidone, discontinue after 3 months, continue if severe withdrawal or no alternative Rx
Paranoia in OAMost have dementia, F>M, social isolation RF, those with hallucinations likely to develop dementia in 3 years
Psychosis in OA causeDementia (40%), delirium, drug-induced (benzos & withdrawal), depression/bipolar/schizophrenia, myxedema, hyperPTH, CVA, metabolic abnormality
Paranoid psychosisIn chronic schizophrenics or late-onset (rare)
OA depression RxECT common (melancholic, parkinson’s), TCA>SSRI, SNRI, hypoNa & falls with SSRI, confusion with TCAs, anxiolytics not indicated
OA bipolar10% after 50, high morbidity, with mixed mania, use lower lithium dose
AD switchingMust have 3 week washout (no drugs for 3 weeks to avoid combination)
ImipramineTCA, causes convulsions, cardiac complications, coma, long QT, anti-Ach SE
Valproate effectsSpina bifida, pancreatitis, thrombocytopenia, agranulocytosis
Carbamazepine2nd line for mood, treats trigeminal neuralgia, causes cleft palate, AV block
Lamotrigine2nd line for mood, causes blurry vision
Agitation RxIM lorazepam, haloperidol, Benadryl
Positive schiz RxMesolibmic D2c activation, typicals & atypicals
Typical APsNonspecific, very potent, cause hyperprolactin (tuberoinfundibular), EPSE (nigrostriatal), sedation & anti-ACh SE
Negative schiz Rx5HT1 activation, atypicals only
Typical AP potencyHaloperidol (strongest, more SE) > chlorpromazine (weakest)
Atypical APsLower potency, higher specificity, D2c for pos, 5HT1 for neg, no depot
Atypical AP SEDM & weight gain (olanzapine), prolonged QT
ClozapineAtypical AP, specific for D2c & 5HT1, best for pos & neg Sx, low EPSE & NMS but agranulocytosis
Tardive dyskinesiaFacial tics, irreversible, from upregulated D2 receptors in response to blockade by APs, Rx by stopping drug (not by blocking DA)