1. USMLE Step 3 Psychiatry – Flashcards
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Positive symptoms
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Delusions, Disorganized Speech/behaivor, hallucinations, agitation. Dopamine Rec
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Negative Symptoms
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Flat Affect, social withdrawal, anhedonia, apathy, poverty of thought. Muscarinic Rec
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Less 1 month PD
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Brief Psychothic attack
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1 to 6 months PD
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Schizophreiform disorder,
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more 6 months PD
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Schizophrenia
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Many years no impairment baseline, delusions are nonbizarre,
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Delusional Disorder
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Greatest risk to progression to Schizophrenia
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Schizophreniform disorder
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Schizophrenia with better response
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Paranoid Schizophrenia
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Schizophrenia management
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Hospitalize if bizarre or paranoid/ Benzo for agitation and start antipsychotics/ long term pshycotherapy
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Antipsychotics indications
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Sedation if benzo are contraindicated/ Movement disorders: Huntington's and Tourette
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High Potency Conventional Antipsychotics
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Fluphenazine, haloperidol
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Low Potency Con Antipsychotics
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Thioridazine, chlorpromazine
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Atypical Antipsychotics
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Risperidone, Olanzapine, Quetapine, Clozapine
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Side effect Clozapine
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Agranulocytosis Check CBC
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Side of Low potency antipsychotics
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Alpha blockade (Orthostatic Hypotension)/ Anticholinergic effect (Urinary retention, dry mouth, blurry vision, delirium)
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Side Thioridazine
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Prolonged QT and Retinal pigmentation (eye exam if prolonged therapy)
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Insomnia problem in Schizophrenia
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tx with Atypical antipsychotics
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Sedation problem in Shizophrenia
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tx with risperidone
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Acute dystonia
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Muscle spasms, 1st week, tx reduce dose and anticholinergics (Benztropine, diphenhydramine, trihexyphenidyl)
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Bradykinesia (Parkinsonism)
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weeks, tremors, rigidity, tx reduce dose, anthicholinergics(benzptropine, diphenhydramine, trihexyphenidyl)
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Akathisia
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weeks to chronic, restlessness, tx reduce dose, benzo or B-bloq, new antipsychotic
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Tardive Dyskinesia
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M to Y, choreoathetosis, involuntary movements, often irreversible, tx stop antipsychotic, switch(ex clozapine)
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Neuroleptic Malignant Syndrome
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Muscle rigidity, hyperthermia, volatile vital signs, altered LOC, increase WBC and CK, tx stop antipsychotic.
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Adjustment disorder with anxious mood
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Benzodiazepines with brief psychotherapy/ After change in personal life
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Panic Disorder
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SSRI, Alprazolam, Clonazepam/ Brief attacks of anxiety with autonomic symp (taq, hypervent, dizziness, sweating) clear precipitant
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Generalized anxiety disorder GAD
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Supportive relaxation tec Venlafaxine, SSRI, Buspirone/ Anxiety daily more 6 months. No event or focus.
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Obsessive-Compulsive Disorder OCD
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Behaivor tx SSRI and clomipramina Decrease obsession
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Social Phobia
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SSRI and Buspirone/ Specific situation knows is excessive, no clear precipitant
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Acute Stress Disorder ASD
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Less than 1 Month within 1 month of stressor
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Postraumatic Stress Disorder PTSD
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longer than 1 month. 1 Re-expirience, 2 Avoidance stimuli, 3 Increased arousal Tx Benzo acute, SSRI long
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Benzodiazepines longest half life
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Alprazolam(Xanax)-Lorazepam(Ativan)-Diazepam(Valium)
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Buspirone
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Anxiolytic, no withdraw, no sedative
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Major Depressive Disorder MDD
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Depressed mood anhedonia at least 2 weeks SIGE CAPS
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SIGE CAPS
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Sleep, Interest, Guilt, Loos energy, Concentration, Appetite, Psychomotor activity , Suicide
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Meds cause depression
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Corticosteroids, B Blockers, antipsychotics
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Tx MDepressiveD
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1.Hospitilize(suicidal) 2.SSRI 3.Benzo(agitated) 4.ECT(suicidal, pregnancy)
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Dysthymic disorder
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low level depression symptoms most days at lest 2 years.
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Tx Dysthymic disorder
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Psychotherapy, 2nd SSRI if 1st fails
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Bipolar Disorder
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Depression, Mania or mixed at least 1 week/
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Tx Bipolar Disorder
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1.Hospiltalize 2.Lhitium(mood stabilizer 1w) 3.Antipsychotics 4.IM phenothiazine 5. antidepressant tx together with mania. Pregnancy 1st T ECT Lamotrogine 2nd 3rd T
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Drug that prevents suicide in Bipolar disorder
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Lithium
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Cyclothymia
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Recurrent episodes depression and hypomanic mood for at least 2 weeks. Functional
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Tx Cyclothymia
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Psychotherapy, divaloproex if function impaired
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Difference of Grief and Depression
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Las up to 1 year, symp wax and wane, shame and guilt less common, suicide less common, return to baseline 2 M, tx supportive. Dep- more 1 year, tx antidep
