Psychiatry Rotation Study Terms & Definitions for EOR Exam

Bipolar 1: >___ manic episode/s and occasional major depressive episodes

1

Must have ____+ of the following for at least ___ _____ to have mania in Bipolar 1: mood symptoms like euphoria/irritability/lability, racing/expansive/grandiose thoughts, behavior changes like hyperactivity/pressured speech/decreased sleep etc, DIGFAST symptoms

3, 1 week

What dx does DIGFAST go with?

Bipolar 1

Name what DIGFAST stands for

Distractibility, Impulsivity, Grandiosity, Flight of ideas, Activities (psychomotor agitation), Sleep decreased, Talkativeness

1st line tx for BPD 1?

2nd or 1st gen antipsychotic mood stabilizer (+/- SSRI for depressive sx)

What separates BPD1 from BPD2?

Bipolar 2 has *hypomania* while Bipolar 1 has mania

Define hypomania as seen in BPD2: elevated, expansive, or irritable mood for at least ___ _____ that is different from usual non-depressed mood BUT does not cause ____ ____.

4 days, marked impairment

Manage hypomania in BPD2 with what drugs?

Lithium, Valproate, or 2nd generation antipsychotics

You must have depressed symptoms for what period of time to diagnose MDD?

most of the day nearly every day for at least *2 weeks*

Name some symptoms of MDD

fatigue, insomnia or hypersomnia, recurring thoughts of death/suicide, weight change >5%, decreased concentration

T/F: MDD can cause manic symptoms

false

Good screening tool for MDD in a primary care setting?

Beck Depression Inventory for Primary Care

Risk of recurrence of MDD is greatest during which period?

the first few mos of treatment

1st line tx in mild to moderate MDD

psychotherapy

1st line medication for MDD

SSRI (SNRI or TCA if that doesn't work)

T/F: ECT gives rapid improvements in most patients with severe symptoms of depression

true (use in pts who fail med therapy or who have had previous response to ECT)

SIG E CAPS goes with what dx?

depression (symptoms of depression)

Name what SIG E CAPS stands for

Sleep changes, Interest lacking, Guilt excessive, Energy lacking, Concentration decrease, Appetite altered, Psychomotor dysfunction, Suicidal thoughts

Who is more likely to attempt suicide, women or men?

women (BUT men complete suicide more often than women)

Why are SSRIs in particular the 1st line medication of choice in treating suicidal patients with depression?

SSRIs are safer in case of overdose than other agents

SADPERSONS stands for what?

factors that increase suicide risk

What does SADPERSONS stand for?

Sex male, Age relatively young or old, Depression, Previous attempt, Excessive alcohol or substance use, Rational thinking loss, Social support lacking, Organized plan, Not married, Sickness

Name the racial, sex, and age demographic most likely to commit suicide

white males >85yo

Mild chronic form of depression, seems like Eeyore

Dysthymic Disorder (aka persistent depressive disorder)

Dysthymic disorder: chronically depressed mood for >____ _____ in adults (>____ _____ in children); severity of mood not meeting criteria for MDD

2 years, 1 year

Persistent depressive disorder/dysthymia requires at least 2 yrs of feeling sad/down/depressed most of the time and on most days, with at least ____ of the following: decreased or increased appetite, insomnia/hypersomnia, fatigue, low self-esteem, impaired concentration, hopelessness.

2

Dx it: Patient is described as moody, erratic, and impulsive but not as severe as someone with Bipolar; they have elevated mood but never meet criteria for mania. They have depressed symptoms but have not had a severely depressed episode in 1-2 years preceding diagnosis. Never go more than 2 months without symptoms. They have been having these symptoms for at least the past 2 years.

Cyclothymic disorder

Tx of Cyclothymic disorder?

mood stabilizers and antimanic drugs are 1st line (manage similarly to BPD 1)

Most commonly used drug/type to tx postpartum depression?

SSRI like Sertaline (unless she has previously had a good response to a different SSRI which is not harmful to infant, in which case she should take that particular drug)

GAD can be diagnosed when someone has excessive anxiety/worry on most days in a ____ _____ period and has >3 symptoms.

6 month

Name some symptoms of GAD

restlessness, difficulty concentrating, muscle tension, sleep issues, irritability, shakiness, HA, excessive worry

1st line med class for GAD

SSRI

Name the 2 SSRIs in particular we like for GAD

Paroxetine (Paxil) and Escitalopram (Lexapro) (remember- "X out anxiety with paXil and leXapro")

SNRI we like for GAD

Venlaxafine (Effexor)

Buspar is a treatment for GAD. It stimulates ______ receptors and blocks _____. Takes weeks to see improvement

serotonin, dopamine

T/F: we can use benzos short term for GAD

true

MC psych disorder seen in the elderly?

GAD

Recommended treatment for GAD involves what

psychotherapy + pharmacotherapy

You must have at least how many panic attacks to diagnose Panic Disorder?

2

Mgmt of acute panic attack

Benzos

Name 2 things that increase likelihood of developing panic disorder as an adult

-exposure to sexual/physical abuse as a child

-childhood smoking

Panic disorder is most commonly associated with the use of what?

alcohol

Mgmt of panic disorder: 1st line long term tx

SSRIs (Paroxetine aka Paxil, Sertraline aka Zoloft, Fluoxetine aka Prozac)

Used in addition to SSRIs to tx panic disorder

CBT

T/F: CBT is just as effective as SSRIs at treating Panic Disorder

true

Name 3 labs to check before treating Panic Disorder

TSH, CMP, CBC

T/F: patient has some level of insight in Phobic Disorders.

true (patient KNOWS the fear is unreasonable/excessive but can't help it)

Which is more common: social phobias or specific phobias

specific phobias

Specific phobias must last how long to make a dx

6+ mos

Name the term: fear of public/crowded spaces, intense anxiety about being in situations where an incapacitating issue could occur and no help would be available, leads to avoidance of these situations

agoraphobia (type of phobic disorder)

Agoraphobia must last how long to be diagnosed

6+ mos (it is a phobic disorder after all and those must last at least 6 mos to be diagnosed)

Tx of phobic disorders: first line

SSRI (Paroxetine, Fluoxetine, Sertraline, Venlafaxine aka Effexor)

2nd line tx of panic disorder if SSRI doesn't help

Benzos

This is a medication type that reduces autonomic hyperarousal and tremor, can help in performance situations

Propranolol (Beta blockers)

What is most effective at treating phobia disorders?

insight-oriented therapy + graded exposure leading to desensitization + exposure therapy

Does a pt have to be exposed to actual death to develop PTSD?

no, it can be threatened death (or can be from injury/violation to self or others)

In order to dx PTSD, symptoms must persist for how long

>1 month

Name the 3 categories of symptoms that make up PTSD

re-experiencing trauma, avoidance, and hyperarousal

Mgmt of PTSD

SSRIs first line (Paroxetine, Sertraline, Fluoxetine, then TCAs then MAOIs if those don't work) + CBT

Similar to PTSD but lasts

Acute Stress Disorder

Tx for Acute Stress Disorder

counseling/psychotherapy. If persistent, treat as PTSD

Name the 3 MC abused substances

alcohol, nicotine, caffeine

Substance use dx: inappropriate use of a substance resulting in significant impairment with ___+ maladaptive behaviors in a _____ _____ period.

2+, 12 month

Name some substance use disorder symptoms.

increased tolerance, withdrawal, using increasing amounts or over a longer period than intended, unsuccessful efforts to stop or cut back, more time spent attempting to acquire substance or recover from it, continued use despite knowledge of consequences

Mild substance use disorder has how many sx?

2-3

Most likely demographic group for substance use disorders

18-24yo males

Name the 3 most commonly used illicit/recreational drugs

marijuana, cocaine, hallucinogens

A patient with a history of alcohol use disorder presents to the clinic. You notice that he has acne rosacea and palmar erythema. Is this a sign of acute or chronic use?

chronic

What does CAGE screening for alcohol use stand for?

ever tried to Cut down, anyone ever Annoyed/criticized you for drinking, feel Guilty about drinking, had an Eye-opener (drinking in AM to steady nerves)

This lab finding is an early sign of alcohol use disorder

elevated GGT

Jitters from alcohol withdrawal peak about how long after one stops drinking alcohol

24-48 hrs

Timeframe for delirium tremens to occur after cessation of drinking

Usually 2-3 days BUT can occur up to a week after

Name the 3 symptoms of DT's

disorientation, agitation, hyperthermia

Timeframe for seizures to occur after cessation of drinking in alcohol withdrawal

24-48 hrs

T/F: people can hallucinate in alcohol withdrawal

true

T/F: alcohol withdrawal can be life threatening

*true*

*Tx for DT's*

benzos (and possibly antipsychotics if hallucinations)

Give these things to alcohol patients in the ED

glucose, thiamine, fluids, and supportive measures

Alcohol deterrent that causes nausea with EtOH consumption

Antabuse (Disulfiram)

Helps decrease EtOH cravings

Naltrexone

Most widely used illegal psychoactive substance in the world?

marijuana

Marijuana contains Delta-9-tetrahydrocannabinol, which is a partial _____ at both the cannabinoid __ and __ receptors.

agonist, 1, 2

This occurs in pts who use marijuana heavily on a regular basis for months-years

Amotivational syndrome (low drive, poor judgement, introversion, poor communication, etc)

T/F: marijuana withdrawal requires meds

false (but can use antipsychotics if needed)

Marijuana is detectable in urine for how long

1 month

Successful in treating marijuana withdrawal (malaise, irritability, craving, etc)

CBT and motivational incentives

This hallucinogen can cause bizarre or violent behavior, horizontal and vertical nystagmus, and auditory hallucinations

PCP

1st line tx for PCP intoxication for a *agitated or violent* patient

benzos (AVOID antipsychotics because it can cause adverse anticholinergic rxns. If mildly intoxicated/not agitated/violent just use supportive care)

Describe pupils with LSD intoxication

*dilated*

Name some common sx of inhalant intoxication

belligerence, aggressiveness, apathy, HA, mood swings, unusual breath/body odor, euphoria, dizziness, impaired judgement, slurred speech, unsteady gait, weakness, tremor; clears in min-hrs after exposure

Common feature seen in pts using inhaling solvents like glue/paint thinner

erythematous rash around the mouth (contact dermatitis from the substance)

Tx for inhalant substance use

educational campaigns, treat seizures, CBT, individual/fam therapy

T/F: additional behavioral/psych comorbidities are common with inhalant use

true

Name some opioids that are often abused in Opioid use disorders

heroin, oxycodone, codeine, fentanyl, morphine

Big effects of Opioid use

hypoventilation and resp depression, CNS depression, miosis (very constricted pupils)

*Which stage of opioid use is mydriasis seen in: intoxication or withdrawal?*

withdrawal (pupils are very constricted with active intoxication)

Tx for opioid withdrawal?

Clonidine/benzos

Tx for acute opioid OD or intoxication

Airway support and supplemental oxygen, THEN given Naloxone (Narcan)

Name 3 ongoing opioid maintenance drugs

Methadone, Naltrexone; Buprenorphine + Naloxone

Sedative/hypnotic/anxiolytic disorders typically involve what kind of drugs

prescribed drugs like benzos or barbiturates