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What are the timeframes for the schizophrenia-spectrum disorders?
- Brief psychotic episode--less than 1 mo
- Schizophreniform--1 to 6 mo
- Schizophrenia--6 mo
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What are the negative symptoms of schizophrenia?
- Anhedonia
- Flat affect
- Apathy
- Avolition
- Alogia
- Poor attention
-
What is the incidence of schizophrenia?
1% of the population
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Low potency typical antipsychotic
Chlorpromazine
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Atypical antipsychotics
- Risperidone
- Quetiapine
- Olanzapine
- Aripiprazole
- Ziprasidone
-
Side effects of typical antipsychotics
- Acute dystonia
- Akathisia
- Parkinsonism
- Tardive dyskinesia
-
Management of akathisia in a patient on neuroleptics
Beta blockers--but don't always work
-
Management of a patient on typical antipsychotics who develops Tardive dyskinesia
Stop the drug, switch to an atypical
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Signs of NMS
- Rigidity
- Mutism
- Fever
- High CPK
- Myoglobinuria
Treat with dantrolene
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Side effect of thioridazine
Retinal deposits
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Side effect of chlorpromazine
Corneal deposits
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Which atypicals cause serious weight gain?
Olanzapine, quetiapine
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Which atypicals cause prolonged QT?
Ziprasidone, paliperidone
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What are the two first line mood stabilizers?
- Lithium
- Valproate (give to patients with renal disease)
-
Side effects of lithium
- Renal dysfunction
- Diabetes insipidus
- Thyroid dysfunction
- Tremor
-
Cyclothymia
Hypomania + depressed mood for at least 2 years
-
Bipolar II
Hypomania + MDD
-
What age group has the highest suicide rates?
Age over 65
-
Adjustment disorder
- Distress and impaired functioning following a stressor
- Does not meet the criteria for MDD
-
Dysthymia
Depressed mood most of the time for at least 2 years
-
What is the problem with giving antidepressants as monotherapy to a bipolar patient?
They can trigger mania
-
Side effects of tricyclics
- Orthostatic hypotension
- Anticholinergic (dry mouth, blurred vision, constipation, urinary retention)
- Sedation
- Low seizure threshold
- Cardiac arrhythmias
-
Which antidepressants is known for lowering the seizure threshold?
Buproprion (so do NOT give to an anorexic)
-
List three SNRIs
- Venlafaxine
- Duloxetine
- Desvenlafaxine
-
List two MAOIs
- Phenelzine
- Tranylcypromine
-
Antidepressants that are good for atypical depression (hypersomnia, hyperphagia)
MAO inhibitors
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Timline for normal grief
- One year
- Worst symptoms last for 2 months
- Illusions or hallucinations are normal
-
Signs that distinguish pathological grief from normal bereavement
- Feelings of guilt or worthlessness
- Psychomotor retardation
- Suicidal ideation
-
What psych disorder is strongly associated with panic disorder?
Agoraphobia
-
First line tx for panic disorder
SSRIs (e.g. fluoxetine)
-
Management of GAD
- CBT
- Meds--buspirone (non-addicting, non-sedating, but slow), SSRIs, benzos (addictive and sedating)
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Symptoms of PTSD
- Re-experiencing
- Avoidance
- Hyperarousal
-
What are the four major somatoform disorders?
- Somatization disorder--multiple complaints in many organ systems over many years
- Conversion disorder--inexplicable neuro signs following a stressor (blindness, mutism, paralysis)
- Hypochondriasis--intense fear of having a disease, despite extensive workup
- Body dysmorphic disorder--preoccupation with an imagined physical defect
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Factitious disorder
The patient deliberately fakes being sick in order to assume the sick role
-
Malingering
The patient fakes being sick for some secondary gain (e.g. time off of work, money)
-
Which psychiatric disorder is most likely to be associated with a childhood history of sexual abuse?
Dissociative personality disorder
-
Borderline personality disorder
- Unstable moods, behaviors, and relationships
- Splitting
- Hx of multiple suicide attempts
- Impulsive, constantly in crisis
-
Management of OCD
- SSRIs (OCD is associated with low serotonin)
- Clomipramine
- CBT
-
When can a patient be hospitalized unwillingly?
Danger to self or others
-
Signs of narcolepsy
- Daytime sleepiness
- Cataplexy
- Hypnopompic and hyponogogic hallucinations
- Characterized by loss of REM latency (patients go immediately into REM sleep)
-
How is narcolepsy treated?
Modafinil or methylphenidate
-
Signs of autism
- Impaired social interaction
- Impaired communication skills--strange words, babbling, repetition
- Restricted activities--head banging, strange movements
-
What is the childhood version of antisocial personality disorder?
Conduct disorder--antisocial PD can only be diagnosed after age 18, and requires a history of conduct disorder before age 15
-
Way to distinguish oppositional-defiant disorder from conduct disorder
Kids with ODD behave badly to adults, but normally to peers. Kids with conduct disorder behave badly to everyone.
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Criteria for anorexia
- Body weight at least 15% below normal
- Fear of gaining weight/feeling fat
- Amenorrhea (missing 3 consecutive periods)
-
Treatment for Tourette's
Typical antipyschotics (haldol, pimozide)
-
At what age can a diagnosis of encopresis be made?
- After age 4
- (enuresis can be diagnosed after age 5)
-
What drug of abuse is associated with conjunctival injection?
Marijuana
-
Signs of cocaine intoxication
Sympathetic stimulation--insomnia, mydriasis, tachycardia, HTN, diaphoresis
-
Signs of opiod intoxication
- Euphoria, analgesia, drowsiness
- Pinpoint pupils
- CNS depression--dangerous!
Treat with naloxone
-
Signs of LSD intoxication
Hallucinations and nystagmus
-
Difference between PCP and LSD intoxication
- Both are associated with nystagmus and hallucinations
- People on LSD are pretty happy
- People on PCP can be aggressive, confused, and agitated
-
Management of a benzo overdose
Flumazenil
-
Symptoms of caffeine withdrawal
AAAGGGHHH! I KILL YOU!!!!
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