-
Retardation cutoffs
- Mild: 50-70, 6th grade
- Mod: 30-50, 2nd grade
- Severe: 20-40, little to no speech
- Profound: <20, continuous care
-
ADHD tx
- First line: Methylphenidate and dextroamphetamine. Sides: insnomnia, dec appetite, headache
- Second: Atomoxetine - NRI. Sometimes used first due to sides
-
Tourette disorder treatment
Dopamine antagonists such as risperidone
-
Tx for pt with depression and neuropathic pain
Use desvenlafaxine instead of SSRI
-
Tx for pt with depression without weight gain or sexual side effects
Bupropion
-
Bipolar disorder Tx
- If acute mania: Lithium, valproic acid, atypical antipsychotics.
- Bipolar depression: Lithium or lamotrigine
- No Li if compromised kidneys
-
Cyclothymia tx
Li, valproic acid, carbamazepine
-
Atypical depression tx
MAOIs, SSRIs
-
Seasonal affective disorder tx
Phototherapy and bupropion
-
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
-
Side effects of TCA
- Hypotension
- Dry mouth
- Constipation
- Confusion
- Arrhythmias
- Sexual
- Weight gain
- GI disturbances
-
Side effects of MAOis
Hypertension after tyramine
-
Examples of MAOis
- phenelzine
- isocarboxazid
- tranylcypromine
-
Side effects of SSRIs
- Headaches
- Weight change
- Sexual
- GI
-
-
Examples of SNRIs
- Venlafaxine
- Duloxetine
- Desvenlafaxine
-
Side effects of trazodone
priapism
-
Side effects of mirtazapine
-
Side effects of Lithium
- Tremors
- Weight
- GI
- Nephrotoxic
- Teratogenic
- Hepatotoxic
- Leukocytosis
- DI
- Severe: Confusion, ataxia, lethargy, abn reflexes
-
Side effects of valproic acid
- Tremor
- weight
- GI
- alopecia
- tertogenic
- herpatotoxic
- Toxicity: hypoNa, coma, death
-
Side effects of lamotrigine
SJS
-
Side effects of electroconvulsive
- headaches
- transient memory loss
-
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)
-
Schizophreniform disorder
>1 mo but less 6 mo.
-
Types of schizophrenia
- Paranoid - common and late
- Catatonic
- Disorganized - early and worst prognosis
- Residual - lack of positive symptoms
- Undifferentiated
-
Side effects of olanzapine
-
Side effects of risperidone
movement disorders
-
Side effects of quetiapine
less movement disorders
-
Side effects of ziprasidone
long QT
-
Atypical antipyschotics least likely to cause weight gain and diabetes
Aripiprazole and ziprasidone
-
Tx of acute dystonia
- Benztropine
- Trihexyphenidyl
- Diphenhydramine
-
Tx of akathisia
- Reduce dose
- beta blockers
- switch to atypical
-
Tx for tardive dyskinesia
Switch to atypical esp clozapine
-
Neuroleptic malignant syndrome presentation and tx
- Rigid, fever, autonomics, agitation, obtundation
- Dantrolene, bromocriptine
-
Delusional disorder
- Nonbizarre delusions
- more than 1 mo
- No impairment in fx
-
-
Tx of PTSD or acute stress disorder
- paroxetine or sertraline
- relaxation techniques
- hypnosis
-
Tx of generalized anxiety disorder
- SSRIs
- Venlafaxine or buspirone
- 2nd line behavioral therapy
-
Side effects of benzodiazepines
- Sedation
- Confusion
- Memory
- Resp depression
- Addiction
-
Side effects of Buspirone
-
Indication for lorazepam
IM in emergency
-
Indication for Clonazepam
Longer half life so good for addiction
-
Alcohol withdrawal tx
Chlordiazepoxide
-
Panic disorder benzo choice
Alprazolam
-
Flumazenil
- benzo antagonist
- used in acute overdose and no chronic dependence
-
Tx of amphetamine or cocaine withdrawal
Bupropion and/or bromocriptine
-
Tx of opiate withdrawal
Clonidine, methadone, or buprenorphine
-
Tx of steroid withdrawal
SSRIs
-
Somatization disorder requirements
- 4 pain
- 2 GI
- 1 sexual
- 1 pseudoneurological
-
Schizoid
- Personality disorder
- Solitary, emotional coldness, no desire for relationships
-
Schizotypal
- Personality disorder
- Ideas of reference, magical thinking, social anxiety, brief psychosis
-
-
Frotteurism
Paraphilia of rubbing self on nonconsenting person
-
Suicide risk factors
- previous attempts
- male
- Older
- Social isolation
- Psychiatric illness or drug abuse
- Perceived hopelessness
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