Psych

Psych’Solutions
Solution
Schizophrenia 1% ♀=♂ >6 M; [+Delusion, Hallucination, Disorganized, Catatonic +] [- Alogia, Anhedonia, Affect, Avolition-]
5 types: Catatonic, Paranoid, Disorganized, Residual or undifferentiated.
Schizoaffective>1%♀=♂ Schizophrenia + MDD or Bipolar (Schz’ Sx precede mood Sx) [2wks for depression, 1 wk for mania]
Schizophreniform ♀=♂ Schizophrenia criteria met but <6 M [at least 2 Sx > 1M]
Brief Psychotic 0.02% Schizophrenia like Sx < 1 M [younger onset, ↑ risk for suicide]
Delusional 0.03% Irrational, Untrue beliefs, non-bizarre delusion at least for ~1M, no significant disturbance of thought
process or content; may cause functional impairment. (Ø hallucination or disorganized speech)
Delirium (sudden onset) Impairment/Altered level of consciousness, awareness & concentration, disoriented, perceptual
disturbance. –Labile, agitated [medical dz, substance abuse, withdrawal]
Dementia (slow onset) Multiple cognitive deficits (memory impairment + 1 of: apraxia, aphasia, agnosia), Disturbance in executive
3%@65; 20%@85 functioning, significant social/occupational impairment [Alzheimer (65%),Vascular (15%), AIDS, Trauma,
Parkinsons, Huntingtons, Pick’s, JC, Infx, nutrition, toxicity]
Major Depressive Epi. Pervasive depression or anhedonia with 4 of the SIGECAPS for at least 2 wks
Manic Epi. > 1 wk of Manic Sx(elevated, expansive or irritable mood, ↓sleep, FOI, racing thoughts) Fx impairment.
Hypomanic Epi. At least 4 days Manic Sx But does not cause marked social/occupational impairment.
Mixed Mood Epi. MD Sx + Manic Sx at least 1 wk [Sx do cause Fx impairment]
MDD 3-6% ♀2>♂1 History of 1 or more MD epi. >2wks. 15% suicide (recurrence 50% 70% 90%); 2 y for chronic.
Dysthymic 6% ♀3>♂1 2Y mild depression (most h. of most d.) w/ mild Fx impairment. [common sx: anhedonia & ↓productivity]
Bipolar I 0.5-1.5% ♀=♂ At least one Manic or Mixed Epi. w/ Depression [90% of pts’ w/ mania relapse, 10-15% suicide]
Bipolar II 0.5-1.5% ♀=♂ One or more major depressive episode w/ at least one hypomanic episode
Rapid cycling At least 4 mood episodes w/i 1Y w/ 2 months free of sx b/t episodes. Can be for both bipolar I or II.
Cyclothymic 1% ♀3>♂2 Dysthymic disorder w/ hypomanic Sx for 2Y [not more than 2M Sx free] (~ “a mild form of bipolar II”)
GAD 5% ♀2>♂1 (50%→MD) 6M of excessive worry, Anxiety is difficult to control (restless, irritable, easy fatigability, insomnia, tense)
Panic Dis. 1-4% ♀3>♂1 1M of Recurrent unexpected panic attacks & fear or having another attack which causes marked fx impairment
OCD 2.5% ♀=♂ (earlier in ♂) Either Obsession or Compulsion–unreasonable, time consuming, marked fx impairment. Pt has insight to dz.
Social Phobia 3-13% teen 6M of marked, persistent fear of social or performance situations, may provoke panic attacks, pt has insight to dz.
Spec. Phobia 10% ♀>>♂ 6M of excessive fear of spec. object or situation. May take the form of a panic attack. Pt has insight to dz.
PTSD 1-3% [NO BDZ] Sx for at least 1 M (Avoidance, hyperarousal, detachment, amnesia, nightmares, flashbacks, restricted
affect); causes sig. Fx impairment. [acute<3M. chronic>3M, Delayed begins 6 M after event]
Acute Stress Dis. Acute rxn following exposure to extreme stress, w/i 1M of event- lasting 2-4 wks and has 3 or more of:
Detachment, derealization, depersonalization, dissociative amnesia, ↓awareness of surroundings
Adjustment dis. Development of an emotional response to a spec. stressor w/i 3M but< than 6M w/ sig. Sx & Fx impairment
Paranoid ♂>>>♀ Suspicious, doubts, fears, threatens, guards, perceives attacks, questions other’s fidelity w/o justification
A Schizotypal 3% ♂>>>♀ Pervasive discomfort w/ & ↓ capacity for close relationships. Perceptual distortion, eccentric, odd, peculiar
thinking, mystical or magical thinking.
Schizoid (rare) ♂>>>♀ Pervasive Social & emotional detachment, solitary activities, no close friends (neither desire or enjoy close relationships)
Antisocial (conuct disorder<18) Onset < age 15 ( but dx applies only after 18), fail to conform to social norms-no conscience, no remorse.
♂3>>♀1 [deceitfulness, recklessness, impulsivity, irritability & aggressiveness, violation of rules, no empathy]
B Borderline ~2% ♀ >♂ Unstable interpersonal relationships, unstable image of self, chaotic, self-destructive [♀ version of antisocial]
2 1
Histrionic 2-3% ♀>>>♂ Excessive emotionality, attention seeking, dramatic, sexual, provocative, exaggerate, theatrical
Narcissistic <1% ♂>>♀ Grandiosity(in fantasy or behavior), need for admiration, no empathy, exaggerated sense of self importance, envy
Avoidant Excruciatingly sensitive to rejection, view themselves as socially inept, so shy they avoid relationships (even though they would like to have one)
C
C Dependent Pervasive pattern of an excessive need to be taken care of, needs other to assume responsibility for him/her
OC personality 1% ♂2>♀1 Perfectionism, orderliness, details oriented, organized, rigid in way of doing things. Over-conscientious
Somatoform .5% ♀>>♂ Numerous physical complaints, hx of pain, Sx at least in 4 ∆ sites (2 GI, 1 sexual,1 neurological), not
explained by any organic etiology; not intentional/conscious. Sx are being tx or cause sig. fx impairment.
Conversion dis. (up to Complains of deficit affecting sensory & voluntary muscles w/ no explained organic etiology with
3% in psych outpt) temporal relation of Sx to stressful event, causes sig fx impairment.
Hypochondriasis 4-9% Preoccupation w/ & fear of having a serious Dz > 6M that cannot be reassured by negative tests results.
Factitious dis. Sx are intentionally produced to assume the sick role, under conscious voluntary control.
Malingering Pt knowingly fakes Sx for obvious gain.
Pain dis. ♀>>>♂ Pt experiencing pain for which no cause can be found. Appears suddenly & usually after stress.
Body Dysmorphic Dis. Preoccupation w/ self-image/ defect in appearance which causes marked fx impairment.
Substance Abuse Substance use that leads to intoxication and self-destructive behavior for ~12 months
Substance Dependence At least 12 M substance use w/ tolerance, withdrawal, ↑amount used, pt is aware & will do anything to get it
Parasomnias 1º insomnia (no psych or medical cause), nightmares (REM), night terrors, & somnambulism (stage IV)
ADHD 3-5% ♂>>♀ Sx < 7yo at least in two setting(home, school), Sig. Fx impairment and 6 Sx of inattention/hyperactivity
Anorexia Nervosa ~1% 90%♀ Pt refuses to maintain wt above 85% of expected for age and ht; fear of wt gain even though underwt.
Bulimia Nervosa ~5% ♀ .3% ♂ Recurrent (at least twice/ wk for 3 M) binge eating and inappropriate purging (vomiting; laxative) or fasting.
 AntiPsychotics Antidepressants
Chlorpromazine (Thorazine) low- sedation, Side effects: CNS- SSRI
Thioridazine ( Mellaril) low- retinitis pigmentosa extrapyamidal Sx (EPS), Fluoxetine ( Prozac) 1-3D
Tardive dyskinesias (late Side effects: Agitation,
Mesoridazine ( Serentil) low- torsade de pointe onset chreiform & athetoid Sertraline ( Zoloft) 25hr Akathisia, Anxiety, Panic,
st Loxapine ( Loxitane) med- movement), sedation, Paroxetine ( paxil) 24hr Insomnia, Diarrhea, GI,
1 Molindone (Lidone, Moban) med- neuroleptic malignant Fluvoxamine ( LuVox) 15hr H/A, Sexual dysfx.
gen’ syndrome (NMS) [tx w/
Haloperidol (Haldol) high- EPS, dantrolene and Citalopram ( Celexa) 35hr
Fluphenazine ( Prolixin) high- bromocriprine], Escitalopram (Lexapro) 30hr
Trifluoprazine ( Stelazine) high-, Anticholinergic, α-
adrenergic blockade (→
orthostatic hypoTN),
Thiothixene ( Navane) high- Misc. antidepressants
prolonged QT, ↑ prolactin
Perphenazine ( trilafon) high- (→ galactorrhea), wt gain. Venlafaxine (Effexor, IR,XR) SNRI – Anxiety, ↑BP, H/A, Insomnia, Sweating, sexual
Pimozide (Orap) high- Nefazodone (Serzone) 5HT-2 antagonist & SSRI – sedation, hepatotoxicity
Trazodone (Desyrel) 5HT-2 antagonist & SSRI – Priapism, sedation, orthostatic hypoTN
Clozapine ( Clozaril) SDRB- Agranulocytosis (*√CBC) Side effects: Mirtazapine (Remeron) NSRI- wt gain, sedation, No sexual dysfx,
Risperidone ( Risperdal) SDRB- EPS w/high dose, same as Bupropion ( Wellbutrin, IR,IS) NDRI – GI Sx, anorexia, ↓ sexual SE, seizures @ ↑doses
2nd Olanzapine ( Zyprexa) ↑ ALT, [Zydis- SL form] above, but
gen’ less likely to
Quetiapine ( Seroquel) slit lamp eye exam q 6M produce EPS, MAOI: Tyramine-free food
Ziprasidone ( Geodon) dose related prolong QT, (√ K & Mg) Tardive Phenelzine ( Nardil) 4-5hr, Side effects: orthostatic
dyskenesia hypoTN, Somnolence, wt
Aripiprazole (Abilify) and NMS. Tranylcypromine (Parnate) 2-3hr gain
Isocarboxazid (Marplan)
Moclobemide (Manerix), Selegiline (Eldepryl,Atapryl)
Anxiolytics:bind to GABA, metabolism in the liver, Addictive!! TCA:
Alprazolam ( Xanax) Desipramine (Norpramin) 2º Amine, least antiCHL
Diazepam ( Valium)- long t1/2 Side effects: Sedation, Protriptyline (Vivactil) Least Side effects:
behavioral disinhibition,
Triazolam ( Halcion) psychomotor impairment, Nortriptyline ( Pamelor) Sedating Anticholinergic: (dry mouth,
blurry vision, urinary
Flurazepam ( Dalmane) cognitive impairment, Amitriptyline ( Elavil) 3º Amine
retention,constipation,
*Temazepam (Restoril) confusion, ataxia. Doxepin (Adapin) high sedation) Orthostatic
H/A, dizziness, GI.
*Lorazepam ( Ativan) Withdrawal may cause Imipramine (Tofranil) AntiCHL hypoTN by α-blockade,
*Clonazepam ( Klonopin) Trimipramine (Surmontil) Sedating tachycardia, prolonged QT,
seizures and death.
wt gain by antihistamine-1
Chlordiazepoxide ( Librium)-long t1/2 Clomipramine (Anafranil) effect. Cardiac arrhythmias
Methohexital (Brevital) Flumazenil (Romazicon) Amoxapine (Asendin, Asendas) may c/s extrapyramidal synd.
is a BZD Antidote.
Phenobarbital
Midazolam (Versed) Mood Stabilizers (Mania)
*Oxazepam (Serax), Clorazepate (Tranxene SD) Lithium Nausea, tremor, hypothyroidism, cardiac arrhythmias, Diabetes insipidus,
altered LOC, seizures. [*blood test for CBC, BCP, LFT, thyroid panel].
Buspirone ( Buspar) for GAD, Estazolam (Prosom) Carbamazepine (Tegratol) N/V/D, Slurred speech, dizziness, drowsiness, ↓ WBC,
Should not be used w/ MAOI ↑LFT , Craniofacial defects in newborns [*blood test for CBC, BCP, LFT, thyroid panel].
Zolpidem ( Ambien) Insomnia Valproic Acid (Depakote) Thrombocytopenia, pancreatitis, wt gain, hair loss,
GI Sx, NTD in preganacy
Zaleplon (Sonata) Insomnia Gabapentine (Neurontin) Somnolence, dizziness, ataxia ,fatigue, leucopenia, ↑wt
* “CLOT” - No active metabolites, not dependent on liver fx Lamotrigine (Lamictal) Leukopenia, Steven-johnson synd, hepatic failure,
N/V/D, somnolence, dizziness
Anticholinergic / Antiparkinsonian [tx parkinsonism and EPS] Oxacarbazepine (Trileptal) hyponatremia
Benztropine ( Cogentin) ACH antagonist Topramate (Topamax) wt loss, leg edema, paresthesia,
Biperiden ( Akineton) ACH antagonist Zyprexa, Seroquil and other antipsychotic are now commonly
Side effects:
Ethopropazine (Parsidol) anticholinergic, N/V, rash, used (FDA approved) for the use of mood disorders.
Trihexyphenidyl ( Artane) ACH antagonist tachycardia, dizziness,
Diphenhydramine (Benadryl) H1RB orthostatic hypotention Misc.
Amantadine ( Symmetrel) a-m-Dopa
Orphenadrine (Norflex, Dispal), Procyclidine (Kemadrin) L-Dopa
Atropine, Scopolamine Amphetamine
Bromocriptine (DA agonist) Prazosin (α1 antagonist), Tetrazosin (α1 antagonist)
Nalaxon (Narcane),
Alzheimer’s Disease: Bind and inactivate acetylcholinesterase.
Naltrexone (Revia) [opiod antagonist]
Donepezil (Aricept) Memantine (Namenda) Propanolol (β blocker)
Tacrine ( Cognex) Rivastigmine (Exelon) Clonidine (α2 agoinst)
Galantamine (Reminyl) Reserpine