chronic hair pulling common in young girls
trichotillomania (hair pulling disorder in DSM V)
meds for ADHD
methylphenidate (Ritalin) most common
dextroamphetamine (Adderral)
atomoxetine: norepi reuptake inhibitor
impairments in social interactions, communications, play, repetitive behaviors
autism spectrum
ignoring the basic rights of others
conduct disorder
characterized by hostility, annoyance, vindictiveness, disobedience, and resentfulness
oppositional defiant disorder
multiple motor and vocal tics
Tourette’s
impulsive and inattentive
ADHD
7 yo that avoids going to school to stay home with parent
separation anxiety disorder
electrolyte changes in pts with excessive purging
hypokalemic, hypochloremic metabolic alkalosis
diagnosis of anorexia nervosa
distorted body image
intense fear of gaining weight
refusal to maintain normal body weight
criteria for binge-eating disorder
episodes of eating with sense of lack of control
plus 3/5: eating faster, eating until uncomfortably full, eating large amounts when not hungry, eating alone, feeling badly about it
at least 1x week for 3 months
most common medication for bulimia nervosa
SSRI (fluoxetine)
Wernicke-korsakoff syndrome
Wernicke (acute): confusion, ophthalmoplegia, and ataxia
Korsakoff (chronic): irreversible memory loss, confabulations, personality change
caused by thiamine deficiency
gets worse with administration of glucose
damage to mammillary bodies common
stages of behavioral change
precontemplation contemplation preparation/determination action/willpower maintenance relapse
alcohold withdrawal
benzodiazepines
most effective treatment for alcohol abuse
alcoholics anonymous
atrophy of the mammillary bodies
Wernicke encephalopathy
post op constipation and/or respiratory depression
opioid intox
severe depression, headache, fatigue, insomnia/hypersomnia, hunger
cocaine or amphetamine withdrawal
pinpoint pupils, N/V, seizures
opioid overdose
belligerence, impulsiveness, nystagmus, homicidal ideations, psychosis
PCP overdose
headache, anxiety/depression, weight gain
nicotine/caffeine withdrawal
anxiety/depression, delusions, hallucinations, flashbacks
LSD intox
euphoria, social withdrawal, impaired judgment, hallucinations
marijuana intox
rebound anxiety, tremors, seizures, life-threatening
alcohol, benzodiazepines, barbiturate withdrawal
anxiety, piloerection, yawning, fever, rhinorrhea, nausea, diarrhea
opioid withdrawal
treatment of alcohol intoxication
IVF, respiratory monitoring
treatment of benzodiazepine intoxication
flumazenil (watch for seizures)
treatment of PCP intoxication
benzodiazepines, haloperidol
treatment of opioids intoxication
naloxone, naltrexone
use amphetamines to treat
ADD, narcolepsy/sleep disorders, obesity
positive symptoms of schizophrenia
caused by increased DA in mesolimbic pathway delusions hallucinations (usually auditory) disorganized speech disorganized or catatonic behavior
negative symptoms of schizophrenia
caused by decreased DA in mesocortical tract flat effect social withdrawal lack of motivation (avolition) lack of speech (alogia) or thought
how long must symptoms last: schizophrenia delusional disorder brief psychotic disorder schizophreniform disorder
schizophrenia > 6 months
delusional disorder > 1 month
brief psychotic disorder < 1 month
schizophreniform disorder 1-6 months
hallucination
perception in absence of external stimuli
delusion
false belief that continues despite proof against it
illusion
misinterpret something that is actually there
thinking tree limb outside window is someone’s are trying to reach through
high potency neuroleptics
haloperidol, fluphenazine, trifluoperazine, loxapine, thioridazine
can use Try to Fly High for trifluoperazine, fluphenazine and haloperidol
low potency neuroleptics
chlorpromazine
thioridazine
atypical antipsychotics
olanzapine, clozapine, quetiapine, risperidone, aripiprazole
what antipsychotic is associated with increased risk for diabetes
olanzapine
what antipsychotic is associated with increased risk for agranulocytosis
clozapine
what antipsychotic is associated with treating Parkinson’s drug psychosis
quetiapine
rigidity, myoglobinuria, autonomic instability (tachycardia), hyperpyrexia, delirium
neuroleptic malignant syndrome
manic episode
excessive goal-directed energy for at least 1 week
how to diagnose manic episode
3 of DIG FAST Distractibility Irresponsibility (pleasure without consequence) Grandiosity (inflated self esteem) Flight of ideas Activity/Agitation increased Sleep decreased Talkative
bipolar
at least one manic episode (type I) or one hypomanic episode with depression (type II)
depression will always occur at some point with type 1
antidepressives can increase mania
high suicide risk
side effects of lithium
LMNOP Movement (tremors) most frequent Nephrogenic diabetes insipidus (blocks aquaporins) HypOthyroidism Pregnancy problems (ebstein anomaly)
major depressive disorder
anhedonia plus at least 5 of SIGECAPS for 2 weeks Sleep disturbance loss of Interest Guilt or feelings of worthlessness loss of Energy loss of Concentration Appetitie/weight changes Psychomotor retardation or agitation Suicidal ideations Depressed mood
screening tool for suicide
SAD PERSONS Sex (male) Age (teenager or elderly) Depression Previous attempt Ethanol or drug use loss of Rational thinking Sickness (major medical illness or a lot of prescriptions) Organized plans No spouse (divorced, widowed, or single) Social support lacking
presentation of major depressive disorder with atypical features
SIGECAPS and hyperphagia hypersomnia mood reactivity rejection hypersensitivity
mild depression for 6 years. What’s the diagnosis
persistent depressive disorder (used to by dysthymia)
treatment for serotonin syndrome
benzodiazepines are first line
cyproheptadine (5-HT2 receptor antagonist)
SE effect of priapism
trazodone
lowers the seizure threshold
bupropion, TCA
works will with SSRIs and increases REM sleep
trazodone
appetite stimulant that is likely to result in weight gain
mirtazapine
can be used for smoking cessation
bupropion
can be used for bedwetting children
imipramine
symptoms of TCA overdose
convulsions, coma, cardiotoxicity
symptoms of serotonin syndrome
muscle rigidity, hyperthermia, cardiovascular collapse
ingesting tyramine while on MAOIs
HTN crisis, hemorrhagic stroke
Panic disorder symptoms
PANICS palpitations, parasthesias abdominal distress nausea intense fear of dying or losing control Chest pain, chills, choking sweating, shaking, shortness of breath
unexplained pain
somatic symptom disorder with predominant pain
patient with normal anatomy is convinced a part of their appearance is abnormal
body dysmorphic disorder
unexplained loss of sensory or motor function (tests and PE are negative)
conversion disroder
unwavering belief by the patient that she has a specific disease (despite medical reassurance)
illness anxiety disorder
unexplained complaints in multiple organ systems
somatic symptom disorder
treat generalized anxiety disorder
buspirone
consciously fakes or claims to have a disorder to get a secondary gain
malingering
consciously creates physical or psychological symptoms to assume sick role and get primary gain
factitious disorder
Munchausen’s syndrome
chronic factitious disorder with history of multiple hospital admins or invasive procedures
voluntarily choosing not to think about a piece of bad news
suppression
not acknowledging a piece of bad news, as though it was never said
denial
involuntarily withholding of a feeling from conscious awareness
repression
veteran who can describe horrific war details without any emotion
isolation
child abuser was himself abused as a child
identification
man yells at his family when he has a bad day at work
displacement
8 year old girl who is being bullied starts carrying around security blanket again
regression
cluster A personality disorders
weird
paranoid, schizoid, schizotypal
Cluster B personality disorders
wild
antisocial, borderline, histrionic, narcissistic
Cluster C personality disorders
worried
avoidant, obsessive-compulsive, dependent