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PA Psychiatry EOR Study Guide Review
- SIGECAPS of Depression: Sleep disturbances Interests are “ Guilt Energy is “ Concentration is “ Appetite is “ Psychomotor Agitation Suicidal thoughts
- Major depressive disorder: Depressed Mood or Anhedonia Dx: 5 or more of the SIGECAPS Sxs for > 2 wks ettecting normal function Tx: SSRI or SNRI > TCA/MAOi > ECT
- S/Es of SSRIs: Sexual Dysfunction Wt gain Anxiety Nausea
- SHIVERS of Serotonin Syndrome: Shivering Hyperreflexia Increased temp (fever) Vitals, unstable Encephalopathy Restless Sweating Tx: Cyproheptadine
- 1st line Tx of depression in children: Fluoxetine (Prozac)
- Longest Half-life of all SSRIs
- Caution ‘SI in the 1st 2 weeks of use
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- SSRI known to cause QT interval prolongation: Citalopram (Celexa)
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- Suicide Risk Assessment SAD PERSONS 0-4 Low 5-6 Moderate 7-10 High: Sex (males) Age (biphasic) Depression Previous attempts Excessive substance abuse Rational thinking, loss Social support lacking Organized plan No spouse Sick (chronic)
- DIG FAST of Bipolar: Distractibility Irresponsibility Grandiosity Flight of ideas Agitation Sleep disturbances Talkative
- Bipolar II: Dx: MDD + Hypomania (DIG ST) < 1wk Function in not fully compromised Tx: Risperdal
- Bipolar I Disorder: Dx: MDD > 2wks + Mania (DIG FAST)
1wk Inhibits function of daily living
5 / Tx:
7 / Tx: Psychotherapy > SSRIs
- Failed medication criteria when using antidepressants to Tx MDD?: Noticeable change of Depressive Sx's in 2-6 weeks of Rx initiation
- Cyclothymic disorder: Dx: (Bipolar II Lite) Hypomania + Dysthymia >2 yrs Sx free for <2 mo Still able to function Tx: Psychotherapy/CBT/Family Therapy
- Premenstrual dysphoric disorder: PMS on an anger pill - attecting function
- Major depressive disorder with peripartum onset: Dx:
2wks of SIGECAPS Within 4 weeks of childbirth Tx: Rest & Support Paroxetine Sertraline - if breast feeding
- Schizophrenia: Dx: Auditory hallucinations Delusions (fixed, false beliefs) Sx's continue for at lease 6mo Tx: Olanzapine
- S/E: ‘wt gain unrelated to caloric intake
- Prodromal Sx's of Schizophrenia: Social Isolation New interest in religion/philosophy Restlessness Diflculty concentrating
- Positive Sx's of Schizophrenia: Delusions Hallucinations Strange behaviors
8 / Incoherent thought process Grossly disorganized Catatonic behavior
- Negative Sx's of Schizophrenia: Flat attect Decreased fluency Decreased productivity of thought & speech Social withdrawal Decrease in goal-directed behavior
- Rx for acute, agitated psychosis in schizophrenic pts S/E's seen w/ chronic use: Typical 1st Generation Antipsychotics
- Haldol -Chlorpromazine (corneal deposits) -Thioridazine (retinal deposits) S/E: ‘risk of extrapyramidal symptoms or Neuroleptic Malignant Syndrome
- Extrapyramidal Symptoms (EPS) seen w/ typical antipsychotics high affinity for D2 receptors: Dystonia "muscle" - hours Akathisia "rustle" - days Akinesia "hustle" - weeks
- Tardive Dyskinesia (haldol)
- Neuroleptic Malignant Syndrome (NMS) seen w/ typical antipsychotic use FEVER: Fever Elevated enzymes (CPK) Vitals are unstable (BP) Encephalopathy Ridgity (psudoparkinsonism) Tx: Dantrolene + ice baths
- Atypical antipsychotic known to “rate of suicide in psychotic patients but can cause agranulocytosis: Clozapine (Clozaril) - 2nd Line Tx of schizophrenia due to S/E's
10 / Hallucinations, fever, seizure, agitation, DT's
11 / Tx: Benzo's to prevent seizure
- Tx of Stimulant-related disorders (Amphetamine-related disorders) Cocaine Amphetamines Cathinones (bath salts): Tx: Mild - individual or group therapy > IOT > CBT Moderate: intensive outpatient therapy 8-12 wks Resistant: IOT + CBT + Desipramine
- Pharmacotherapy for Opioid-related disorders: Tx Strategy: Opioid agonist (Methadone/Buprenorphine) > Opioid antagonist (Naloxone)
- Opioid withdrawal: Flu-like illness Abdominal cramps Diarrhea Mydriasis Pilo-erection Yawning Tx: Clonidine, Antiemetics
- Panic disorder Sx's: Palpitations, pounding heart, tachycardia Sweating, trembling, shaking, SOB or feeling of choking Fear of dying, numbness, tingling, chills, or hot flashes
- Acute Panic Attack (<1hr) Tx vs Panic Disorder (recurrent) Tx: Acute = Alprazolam (Xanax) or Clonazepam (Klonopin) 1st Line to prevent: SSRIs (Paroxetine, sertraline, fluoxetine) or Buspirone 8- months to avoid relapse + cognitive, insight-oriented, relaxations, or behavioral therapy
- Anxiety towards places, situations in which escape may be difficult or embar- rassing: Agoraphobia
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- 3 or more to Dx GAD: Restlessness or hypervigilance Easy fatigability Irritability Sleep disturbance Muscle tension Diflculty concentrating
- Tx of GAD: Acute attacks of anxiety: Longer-acting Benzo - Lorazepam (Ativan) 1st Line to prevent: SSRIs (Paroxetine, Citalopram) + behavioral therapy
- Benzodiazepines Short TOM Medium CAAT Long DivorCe: Short Triazolam (Halcyon) Oxazepam (Serax) Midazolam (Versed) Medium Clonazepam (Klonopin) Alprazolam (Xanax) Lorazepam (Ativan) Temazepam (Resoril) Long Diazepam (Valium) Chlordiazepoxide (Librium)
- ‘frequency of Cl- channel opening = ‘GABA Impaired cognition Motor incoordination Dizziness Drowsiness: Benzodiazepine Overdose Tx: Flumazenil
- Specific Phobia - 5 types: Animal or
14 / Insect Natural phenomena (storm, flood, lightening)
16 / Hyper-alert
17 / Limited emotional response Tx: Psychotherapy > SSRIs if long-term
- Fixed False Beliefs... I.e.; Being followed or Poisoned No hallucinations Persecutory is MC: Delusions (bizarre vs. non-bizarre)
- Schizoid Personality Disorder: Eccentric & reclusive Quiet & unsociable Constricted attect Prefer to be alone Tx: Group therapy + Psychotherapy > low-dose anti-psych or anti-dep
- Schizotypal Personality Disorder: Detached from social relationships Restricted expression of emotion Magical or bizarre thinking Odd speech or peculiar thought patterns -starts in early adulthood Tx: Psychotherapy > low-dose risperdal or zyprexa > SSRIs/Benzo's
- Examples of fixed false beliefs: Delusions: Erroneous beliefs Delusions of grandeur Disorganized speech Loose associations Tangential response
- Antisocial Personality Disorder (Adults): Conduct Disorder Dx < 18 yrs old Selfish, callous, promiscuous, impulsive Breaking the law - legal problems Drug & alcohol abuse No employment or financial responsibility Inability to learn from mistakes
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- Avoidant Personality Disorder: Fear of rejection Hypersensitive to rejection or failure Low self-esteem Poor social-skills Tx: 1st line: Psychotherapy 2nd line: Paroxetine (Paxil) 3rd line: Clonazepam (Klonopin) or BB for performance anxiety
- Dependent Personality Disorder: Inability to make independent decisions Fear of losing support or approval if they disagree Reliant of others to take care of them Dislike being alone Avoid responsibility Tx: Psychotherapy (insight oriented) > Anti-psych/dep
- Delirium Causes: I WATCH DEATH Acute onset of hallucinations & disorientation Waxing/waning confusion: Infections Withdrawal (EtOH, Benzo's) Acute (dehydration/electolytes) Toxins CNS (stroke, bleed) Hypoxia Deficiencies (thiamine, B12) Endocrine Acute vascular shock (encephalopathy) Trauma Heavy metals
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- Progressive loss of short term memory Neurofibrillary tangles & amyloid plaques: Alzheimer Dementia Tx: Donepezil to slow progression
- Associated w/ MDD Memory problems but attention span and concentration are intact Subjective hallucinations: Pseudodementia Tx: SSRIs
- Dissociative amnesia: Pt cannot recall autobiographical info (cognitive, emotional and motivational aspects of events) Trauma or Stress related
- Reporting laws for Child Abuse: Tarasott vs. Regents Physician's Duty to breach patient confidentiality for: Bucket handle fracture Posterior rib fracture Fractures of ditterent ages Cutaneous bruises, bites, burns (cigarette) Shaken baby syndrome (retinal hemorrhages)
- Confidentiality: Physician must not discuss any information regarding a patient's care w/ anyone, even another physician who is not actively involved in that patient's care, including: Name Diagnosis Treatment Prognosis
- Adjustment disorder w/ depressed mood: Behavioral response to stressful event Develops < 3mo after onset of stressor Reaction is excessive Symptoms resolve by 6 mo Pt does not meet criteria for MDD
