Adam Shared "Psychiatry" - 66 Picmonics
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Psychiatry
Postpartum Depression 12190
- Postpartum Blues
- 40%-80% of women
- Onset: 2-3 days and resolves in 10-14 days
- Mild depression, tearfulness, irritability
- Treatment: Reassurance & monitoring
- Postpartum depression
- 8%-15% of women
- Onset: Within 4 weeks
- Moderate to severe depression, sleep or appetite disturbance, low energy, psychomotor changes, guilt, concentration difficulty, suicidal ideation
- Treatment: Antidepressants (SSRI), psychotherapy
- In breastfeeding patients, sertraline is preferred as levels in infant sera are usually undetectable
- Paroxetine can also be used
- Electroconvulsive therapy is considered a safe treatment option in the perinatal period for resistant cases
- Postpartum psychosis
- 0.1%-0.2% of women
- Onset: Variable Days to weeks
- Delusions, hallucinations, thought disorganization, bizarre behavior
- Treatment: Antipsychotics, antidepressants, mood stabilizers Hospitalization; do not leave mother alone with infant (risk of infanticide)
Narcolepsy 521
- Disordered regulation of sleep-wake cycles; 1° characteristic is excessive daytime sleepiness (awaken feeling rested)
- Caused by decreased hypocretin (orexin) (measured from CSF fluid) production in lateral hypothalamus
- Hypocretin-1 (orexin-A, measureable in CSF) and hypocretin-2 (orexin-B) promote wakefullness and inhibit REM
- Hypnagogic (just before sleep) or hypnopompic (just before awakening) hallucinations
- Nocturnal and narcoleptic sleep episodes that start with REM sleep
- Cataplexy (loss of all muscle tone following strong emotional stimulus, such as laughter) in some patients
- Treated with muscarinic agonists
- Sodium oxybate (can also be used for non cataplexic narcolepsy) and SSRIs
- Strong genetic component
- Treatment: daytime stimulants (eg, amphetamines (secondary), modafinil (primary)) and nighttime sodium oxybate (GHB)
- Minimum episde count of 3 times per week for 3 months
- Diagnosis polysomnography and multiple sleep latency tests (demonstrates ↓ sleep latency and sleep-onset REM periods)
- Findings: mult iple spon taneous awaken ings, reduced sleep efficiency and latency of rapid eye movement (REM) sleep
- Rapid eye movement sleep latency ≤15 minutes
- Cataplexy: SNRI (eg, venlafaxine) or SSRI, and a tricyclic antidepressant can also be considered
- Sodium oxybate (gamma-hydroxybutyrate): improves nocturnal sleep, relieve daytime sleepiness, cataplexy treatment
- Rarely used due to abuse potentia l and restrictive regulations
Mirtazapine and Varenicline (Atypical Antidepressants)
- Mirtazapine
- Mirtazapine
- α2-antagonist (Increased release of NE and 5-HT)
- α2-antagonist (Increased release of NE and 5-HT)
- Potent 5-HT2 and 5-HT3 receptor antagonist and H1 antagonist
- Potent 5-HT2 and 5-HT3 receptor antagonist and H1 antagonist
- Toxicity: sedation (which may be desirable in depressed patients with insomnia), increased appetite, weight gain (which may be desirable in elderly or anorexic patients), dry mouth
- Toxicity: sedation (which may be desirable in depressed patients with insomnia), increased appetite, weight gain (which may be desirable in elderly or anorexic patients), dry mouth
- Considered a first line antidepressant
- Considered a first line antidepressant
- Varenicline
- Varenicline
- Nicotinic ACh receptor partial agonist
- Nicotinic ACh receptor partial agonist
- Used for smoking cessation (decreases both cravings and decreasing the rewarding effects of nicotine)
- Used for smoking cessation (decreases both cravings and decreasing the rewarding effects of nicotine)
- Toxicity: sleep disturbance
- Toxicity: sleep disturbance
- Has been associated with mood changes and suicidality as well as cardiovascular events in patients with pre-existing cardiovascular disease
- Has been associated with mood changes and suicidality as well as cardiovascular events in patients with pre-existing cardiovascular disease
- More effect ive than bup ropion or nicotine replacement therapy
- More effect ive than bup ropion or nicotine replacement therapy
- It can partially stimulate the receptor, thereby reducing symptoms of nicotine withdrawal
- It can partially stimulate the receptor, thereby reducing symptoms of nicotine withdrawal
- It also prevents the nicotine in cigarette smoke from binding the receptor, reducing the rewarding effects of smoking
- It also prevents the nicotine in cigarette smoke from binding the receptor, reducing the rewarding effects of smoking
- Blackbox suicide warning has been removed
- Blackbox suicide warning has been removed
- However monitored for psychiatric symptoms (eg, agitation , depression , suicidal behavior, suicidal ideation)
- However monitored for psychiatric symptoms (eg, agitation , depression , suicidal behavior, suicidal ideation)
- Advised to discontinue tx and contact physician immediately if they experience any behavioral and/or mood changes
- Advised to discontinue tx and contact physician immediately if they experience any behavioral and/or mood changes
- Might increase the risk of adverse cardiovascular events
- Might increase the risk of adverse cardiovascular events
- Dose reduction is indicated in individuals with moderate renal insufficiency
- Dose reduction is indicated in individuals with moderate renal insufficiency
- Very small chance of seizure and epilepsy is not a contraindication
- Very small chance of seizure and epilepsy is not a contraindication
Bupropion
- Indications
- Depression
- Smoking Cessation
- Mechanism of Action
- Increase Dopamine and NE
- Side Effects
- Stimulant Side Effects
- Seizure
1 min
Inhalant Abuse 11794
- Commonly abused inhalants include glue, toluene, nitrous oxide ("whippets"), amyl nitrite ("poppers"), and spray paints
- Abused by sniffing, huffing (inhaled from a saturated cloth), or bagging (bag over mouth or nose) to concentrate the inhaled substance
- Acute intoxication: brief transient euphoria and loss of consciousness and vary depending on the specific chemicals inhaled
- Inhalants are highly lipid soluble and produce immediate effects that typically last 15-45 minutes
- Act as central nervous system depressants and may cause death.
- Dermatitis (glue sniffer's rash) due to chemical exposure can be seen around the mouth or nostrils
- Rapidly eliminated and are not included in most routine hospital toxicology screens
- Liver function tests may be elevated with repeated use
- Boys age 14-17 are at highest risk for inhalant abuse
Parkinson's Disease Assessment
- Assessment
- Decreased Dopamine
- Older Adult
- Cogwheel Rigidity
- Bradykinesia
- Shuffling Gait
- Resting Tremor
- Pill-Rolling
- Mask-Like Face
- Cognitive Decline
2 mins
Opioid Use Disorder and Withdrawal Assessment (Formerly Opioid Abuse and Withdrawal Assessment)
- Abuse Assessment
- Euphoria
- Miosis
- CNS Depression
- Abuse Withdrawal
- Yawning
- Gooseflesh
- Sweating
- Rhinorrhea
- Kicking Movements
- Consideration
- Naloxone
1 min
Electroconvulsive Therapy 516
- Used mainly for treatment-refractory depression, depression with psychotic symptoms, and acutely suicidal patients
- Catatonia
- Postpartum psychosis in treatment refractory patients
- Bipolar mania
- When pharmacotherapy contraindicated due to comorbid medical illness or poor tolerability
- Emergency conditions (rapid response): Refusal to eat or drink, Imminent risk for suicide
- Produces grand mal seizure in an anesthetized patient
- Adverse effects include disorientation, temporary headache, partial anterograde/retrograde amnesia usually resolving in 6 months
- Safe in pregnancy
- Safety
- No absolute contraindications
- Risk with: Severe cardiovascular disease, recent MI, Space-occupying brain lesion, Recent stroke, unstable aneurysm
- Only if its a RECENT MI, stroke or unstable aneurysm
- Anterograde AND retrograde amnesia
Neuroleptic Malignant Syndrome
- FEVER Acronym
- Fever
- Encephalopathy
- Vital Signs Unstable
- Elevated Enzymes
- Rigidity of muscles
- Reversal Agent
- D2 Agonists
- Bromocriptine
- Dantrolene
2 mins
Alcohol Withdrawal Syndrome 3187
- Withdrawal should be treated with a benzodiazepine to control symptoms and prevent progression to DT
- Lorazepam, an intermediate-duration benzodiazepine, often given intravenously, is preferred in the hospital setting
- Often preferred in the hospital setting , as it is safer in patients with possible liver disease and has no active metabolites
- Intermediate duration benzodiazepine
- Adj unctive management: IV fluids, frequent monitoring of vital signs, thiamine, folate , and nutritional support
- Longer-acting benzos (eg, chlordiazepoxide), have active metabolites , are generally not used in patients with possible liver disease
- Mild Withdrawal
- Anxiety, insomnia, tremors, diaphoresis, palpitations, gastrointestinal upset, intact orientation
- 6-24 hours since last drink
- Seizures
- Single or multiple generalized tonic-clonic
- 12-48 hours since last drink
- Alcoholic hallucinosis
- Visual, auditory, or tactile; intact orientation; stable vital signs, alert sensorium
- Develops 12-48 hours after the last drink and usually resolves within 24-48 hours
Suicide Risk Factors
- Depression
- Previous Attempt
- No Support System
- Access to Firearms or Medications
- Substance Abuse
- Physical or Sexual Abuse
- Chronic Illness or Pain
- Extremes of Age
2 mins
Cocaine Intoxication Assessment
- Euphoria
- Delusions
- Mydriasis
- Hallucinations
- Agitation
- Hypertension
- Arrhythmias
- Hyperthermia
- Seizures
- Nasal Septum Perforation
2 mins
Acute Intermittent Porphyria (AIP)
- Pathophysiology
- Autosomal Dominant
- Inhibited Porphobilinogen Deaminase
- Increased Serum Porphobilinogen
- Increased Serum Delta-ALA
- Increased Urinary Porphyrin Precursors
- Signs & Symptoms
- Precipitated By P450 Inducers
- Painful Abdomen
- Polyneuropathy
- Psychological Disturbances
- Port Wine-Colored Urine
- Treatment
- Glucose and Hemin
- Considerations
- Avoid Triggers
3 mins
Lithium
- Indications
- Bipolar Disorder
- Mechanism of Action
- Mood Stabilizer
- Unknown Mechanism
- Side Effects
- Nephrogenic Diabetes Insipidus
- Hypothyroidism
- Movement (Tremor)
- Heart Block
- Contraindication
- Pregnancy (Ebstein's Anomaly)
1 min
Valproic Acid
- Indications
- First Line Tonic-Clonic Seizure Treatment
- Bipolar Disorder
- Migraine Prophylaxis
- Mechanism of Action
- Increases GABA Concentration
- Blocks Voltage-Gated Na+ Channels
- Side Effect
- GI Distress
- Contraindication
- Contraindicated in Pregnancy
1 min
CNS Stimulants
- Indications
- Attention Deficit Hyperactivity Disorder (ADHD)
- Obesity
- Mechanism of Action
- Increase Catecholamines at Synaptic Cleft
- Increase Norepinephrine
- Increase Dopamine
- Drug Names
- Methylphenidate (Ritalin)
- Methamphetamine
- Side Effect
- Potential for Abuse
57 secs
High Potency Antipsychotic Drugs
- High Potency Drugs
- Fluphenazine
- Trifluoperazine
- Haloperidol
- Pimozide
- Side Effects
- Extrapyramidal Symptoms
- Short Term
- Dystonia
- Restlessness (Akathisia)
- Torticollis
- Long Term
- Tardive Dyskinesia
- Parkinson's-Like Symptoms
- Neuroleptic Malignant Syndrome
3 mins
Dextromethorphan
- Antitussive (antagonizes NMDA glutamate receptors); mild analgesic
- Synthetic codeine analog
- Has mild opioid effect when used in excess
- Naloxone can be given for overdose
- Mild abuse potential
- May cause serotonin syndrome if combined with other serotonergic agents
- Can cause dissociative symptoms and hallucinations
Random Disorders Treatment 8875
- Hoarding disorder
- Cognitive-behavioral therapy (CBT) specifically targeted to hoarding behaviors is the most effective treatment
- SSRIs are not effective unless patient ALSO has OCD
- Shared psychotic disorder (folie a deux, delusional disorder)
- Separate the pair to break the chain of reinforcing each other's beliefs
- Dominant individual, typically requires psychiatric treatment (sometimes inpatient), other individual requires treatment only sometimes
- Conversion disorder (functional neurological symptom disorder)
- Education & self-help techniques - first-line
- Cognitive behavioral therapy - second-line
- Physical therapy for motor symptoms
- Delusional disorder
- Antipsychotics
- Cognitive-behavioral therapy
- Gambling Disorder
- CBT, gamblers anonymous
- SSRI, naltrexone
Phencyclidine (PCP) Intoxication Assessment
- Violent Behavior
- Motor Issues
- Nystagmus
- Increased Pain Tolerance
- Tachycardia
- Delirium
- Seizures
- Psychosis
2 mins
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