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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
What are the negative symptoms of schizophrenia?
- Flat affect
- Poor attention
What is the incidence of schizophrenia?
1% of the population
Low potency typical antipsychotic
Side effects of typical antipsychotics
- Acute dystonia
- 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
Signs of NMS
- High CPK
Treat with dantrolene
Side effect of thioridazine
Side effect of chlorpromazine
Which atypicals cause serious weight gain?
Which atypicals cause prolonged QT?
What are the two first line mood stabilizers?
- Valproate (give to patients with renal disease)
Side effects of lithium
- Renal dysfunction
- Diabetes insipidus
- Thyroid dysfunction
Hypomania + depressed mood for at least 2 years
Hypomania + MDD
What age group has the highest suicide rates?
Age over 65
- Distress and impaired functioning following a stressor
- Does not meet the criteria for MDD
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)
- 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
List two MAOIs
Antidepressants that are good for atypical depression (hypersomnia, hyperphagia)
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?
First line tx for panic disorder
SSRIs (e.g. fluoxetine)
Management of GAD
- Meds--buspirone (non-addicting, non-sedating, but slow), SSRIs, benzos (addictive and sedating)
Symptoms of PTSD
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
The patient deliberately fakes being sick in order to assume the sick role
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
- Hx of multiple suicide attempts
- Impulsive, constantly in crisis
Management of OCD
- SSRIs (OCD is associated with low serotonin)
When can a patient be hospitalized unwillingly?
Danger to self or others
Signs of narcolepsy
- Daytime sleepiness
- 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.
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?
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
Symptoms of caffeine withdrawal
AAAGGGHHH! I KILL YOU!!!!