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Mood Disorders
1. Depressive 1 month
2. Bipolar 1 week mania (I); 4 days hypomania sand no impairment (II); rapid
cycling (>4 episodes in 12 mos)
a. depression usually precedes mania
b. Lithium/Valproate; Carb and Oxcarb 2nd line; Lamotrigine or add SSRI if
Bipol w/ depression; Add antipsychotic if psychotic symptoms
(Risperidone, Olanzapine)
c. Cognitive therapy, family therapy
d. Med Mim: steroids, levodopa, stimulants, schizophrenia, schizoaffective
3. Secondary Depressive
4. General Medical conditions
a. CNS, Endocrine, Uremia, Connective Tissue, Vitamins, HIV
5. Drugs
a. Antihypertensives/arrhythmics, Steroids, Sedatives, analgesics,
antineoplastics, antimicrobials, neurologic (PD, Antieplieptics)
Pharmacology
Anxiety
General Anxiety Disorder:
1. Buspirone
a. Decreases seizure threshold!
Specific Phobias:
1. CBT
2. Beta-blockers and/or SSRIs
PTSDL
1. Eye movement desensitization and reprocessing
1. Heroin
o Onset: 24 hours; Not life-threatening
o Intox: pinpoint pupils, CNS depression, constipation, drowsiness
o Withdrawal: Dilated pupils, irritability, autonomic instability, abdominal
cramps, muscle spasms, joint pain, N/V
o Symptoms are severe and out of proportion to physical findings
2. Cocaine / Amphetamines nasal turbinate erythema, suppressed appetite;
nosebleeds, septal perforation
o Intox: formication (bugs crawling all over); anxiety, aggression, psychosis,
delirium; autonomic cardiac changes (either way), sweating, pupillary
dilation, n/v, insomnia, hypervigiliance, weight loss, euphoria
o Overdose: arrhythmia, MI, stroke, seizure
o Onset:
o Rebound suppression of cocaines stimulant effect
o Withdrawal: dysphoric, Irritable, drowsy, fatigued, hypersomnic, Hungry,
psychomotor agitation / retardation
(but SSRIs not indicated, even though appears like atypical
depression)
3. Alcohol
o Intoxication: Ataxia, nystagmus, aggression, impaired judgment
4.
5.
6.
7.
Depression
Episode of depression
-
MDD 5 or more depressive symptoms [SIGECAPS] for the majority of everyday for
2 weeks
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Sleep
Interests loss
Guilt
Energy (low)
Concentration (impaired)
Appetite (up or down)
Psychomotor retardation / agitation
Suicidal Thoughts
In cancer patients:
o 1. Assure appropriate pain control
o 2. Treatment w/ SSRI and psychotherapy
w/ psychotic features
o ssri + antipsychotic
o ECT esp in older patients, or patients immediately suicidal, catatonic,
refusing food
Dysthymia Depressed mood for most days for at least 2 years w/ 2 or more of:
-
Manic episode
-
Avoidant
-
Schizoid
-
Schizotypal
-
4
2
1
1
pain
GI
sexual
pseudoneurological
Defense Mechanisms
Displacement inequitable transferrance of negative emotions onto an alternative
target [Immature]
Acting out expression of unconscious impulse through a physical action
[Immature]
Rationalization creating an alternative rational logical reason for an event instead
of the real reason [neurotic]
Dissociation blocking off disturbing thoughts or feelings in order to avoid
emotional upset [neurotic]
Conversion
Illness Phase
Acute Phase
-
Continuation Phase
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Sustained remission
Relapse re-emergence of the acute symptoms
Maintenance Phase
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Typical SEs
-
For treatment resistant psychosis dirtier drug, less specific, most efficacious
of atypicals more anticholinergic side effects
o At least two failed atypicals and one failed typical
Weight neutral
weight neutral
Quitiepine highest risk for orthostatic hypotension; weight gain; cataracts require
eye exam every 7 months; sedating but less then ziprasidone; bad HAM
Antipsychotic SE tx treat with Antihistamines (diphenhydramine) or
anticholinergics (Benztropine, trihexylphenidyl)
-
NMS
rigidity, mutism, obtundation, agitation, high fever (up to 107 F), very high levels of creatine phosphokinase (more
than 10 times the normal range), sweating, and myoglobinuria. Treat first by discontinuing the antipsychotic; then give
supportive care for fever and potential renal shutdown due to myoglobinuria (primarily IV fluids). Lastly, consider
dantrolene (just as in malignant hyperthermia, which is thought to be a similar condition).
eScitalopram is S enantiomer
Mirtazapine weight gain, sedation
Perform Physical
Additional studies if necessary radiographical, laboratory (coag panel)
Report to Child Protective Services
Admit to hospital if necessary
Consult w/ psychiatrist, evaluate family dynamics
Liver
Depakote
Kidney
Lithium nephrogenic diabetes insipidus
Lorazapem
Personality Disorders:
-
o
o
o
often
Generalized Anxiety Disorder - SSRI / SNRI 1st line (Benzos as bridge); 2nd line
Buspirone (but not efficacious after benzos are used) + CBT
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Schizoid vs Avoidant
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Autism vs Aspbergers
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OCD vs OCPD
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Previous SI attempt
Schizoaffective vs Bipolar
Delirium vs Dementia
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