Psych step2

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gm1147
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166152
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Psych step2
Updated:
2012-08-15 14:00:00
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psych psychiatry step2
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kaplan
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  1. Retardation cutoffs
    • Mild: 50-70, 6th grade
    • Mod: 30-50, 2nd grade
    • Severe: 20-40, little to no speech
    • Profound: <20, continuous care
  2. ADHD tx
    • First line: Methylphenidate and dextroamphetamine. Sides: insnomnia, dec appetite, headache
    • Second: Atomoxetine - NRI. Sometimes used first due to sides
  3. Tourette disorder treatment
    Dopamine antagonists such as risperidone
  4. Tx for pt with depression and neuropathic pain
    Use desvenlafaxine instead of SSRI
  5. Tx for pt with depression without weight gain or sexual side effects
    Bupropion
  6. Bipolar disorder Tx
    • If acute mania: Lithium, valproic acid, atypical antipsychotics.
    • Bipolar depression: Lithium or lamotrigine
    • No Li if compromised kidneys
  7. Cyclothymia tx
    Li, valproic acid, carbamazepine
  8. Atypical depression tx
    MAOIs, SSRIs
  9. Seasonal affective disorder tx
    Phototherapy and bupropion
  10. Postpartum spectrum
    • Blues: up to 2 weeks, no tx
    • Depression: 1-3 mo, can have negative feelings, use antidepressants
    • Psychosis: 2-3weeks, use antipsychotics, Li
  11. Side effects of TCA
    • Hypotension
    • Dry mouth
    • Constipation
    • Confusion
    • Arrhythmias
    • Sexual
    • Weight gain
    • GI disturbances
  12. Side effects of MAOis
    Hypertension after tyramine
  13. Examples of MAOis
    • phenelzine
    • isocarboxazid
    • tranylcypromine
  14. Side effects of SSRIs
    • Headaches
    • Weight change
    • Sexual
    • GI
  15. Side effects of SNRIs
    • HTN
    • Blurry
    • Weight
    • Sexual
    • GI
  16. Examples of SNRIs
    • Venlafaxine
    • Duloxetine
    • Desvenlafaxine
  17. Side effects of trazodone
    priapism
  18. Side effects of mirtazapine
    • weight
    • sedation
  19. Side effects of Lithium
    • Tremors
    • Weight
    • GI
    • Nephrotoxic
    • Teratogenic
    • Hepatotoxic
    • Leukocytosis
    • DI
    • Severe: Confusion, ataxia, lethargy, abn reflexes
  20. Side effects of valproic acid
    • Tremor
    • weight
    • GI
    • alopecia
    • tertogenic
    • herpatotoxic
    • Toxicity: hypoNa, coma, death
  21. Side effects of lamotrigine
    SJS
  22. Side effects of electroconvulsive
    • headaches
    • transient memory loss
  23. Seratonin syndrome: presentation, tx
    • Cognitive: agitation, confusion, hallucinations, hypomania
    • Autonomic: sweating, hyperthermia, tachycardia, nausea, diarrhea, shivering
    • Somatic: tremor, myoclonus
    • Tx: stop SSRI, symptomatic, cyproheptadine (seratonin antagonist)
  24. Schizophreniform disorder
    >1 mo but less 6 mo.
  25. Types of schizophrenia
    • Paranoid - common and late
    • Catatonic
    • Disorganized - early and worst prognosis
    • Residual - lack of positive symptoms
    • Undifferentiated
  26. Side effects of olanzapine
    • diabetes
    • weight gain
  27. Side effects of risperidone
    movement disorders
  28. Side effects of quetiapine
    less movement disorders
  29. Side effects of ziprasidone
    long QT
  30. Atypical antipyschotics least likely to cause weight gain and diabetes
    Aripiprazole and ziprasidone
  31. Tx of acute dystonia
    • Benztropine
    • Trihexyphenidyl
    • Diphenhydramine
  32. Tx of akathisia
    • Reduce dose
    • beta blockers
    • switch to atypical
  33. Tx for tardive dyskinesia
    Switch to atypical esp clozapine
  34. Neuroleptic malignant syndrome presentation and tx
    • Rigid, fever, autonomics, agitation, obtundation
    • Dantrolene, bromocriptine
  35. Delusional disorder
    • Nonbizarre delusions
    • more than 1 mo
    • No impairment in fx
  36. Tx of OCD
    • SSRIs
    • behavioral therapy
  37. Tx of PTSD or acute stress disorder
    • paroxetine or sertraline
    • relaxation techniques
    • hypnosis
  38. Tx of generalized anxiety disorder
    • SSRIs
    • Venlafaxine or buspirone
    • 2nd line behavioral therapy
  39. Side effects of benzodiazepines
    • Sedation
    • Confusion
    • Memory
    • Resp depression
    • Addiction
  40. Side effects of Buspirone
    • Headaches
    • Nausea
    • Dizziness
  41. Indication for lorazepam
    IM in emergency
  42. Indication for Clonazepam
    Longer half life so good for addiction
  43. Alcohol withdrawal tx
    Chlordiazepoxide
  44. Panic disorder benzo choice
    Alprazolam
  45. Flumazenil
    • benzo antagonist
    • used in acute overdose and no chronic dependence
  46. Tx of amphetamine or cocaine withdrawal
    Bupropion and/or bromocriptine
  47. Tx of opiate withdrawal
    Clonidine, methadone, or buprenorphine
  48. Tx of steroid withdrawal
    SSRIs
  49. Somatization disorder requirements
    • 4 pain
    • 2 GI
    • 1 sexual
    • 1 pseudoneurological
  50. Schizoid
    • Personality disorder
    • Solitary, emotional coldness, no desire for relationships
  51. Schizotypal
    • Personality disorder
    • Ideas of reference, magical thinking, social anxiety, brief psychosis
  52. Narcolepsy tx
    • forced naps
    • modafinil
  53. Frotteurism
    Paraphilia of rubbing self on nonconsenting person
  54. Suicide risk factors
    • previous attempts
    • male
    • Older
    • Social isolation
    • Psychiatric illness or drug abuse
    • Perceived hopelessness

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