Summary
Summary Psychology Key Points for PEBC Exam
Key points on psychology required to be successful on the PEBC MCQ Exam.
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PSYCH SHORT LESSONAcute Agitation
Drug Antichol, CS, amantadine, DA/DA Ag
Opioid tox/withdrawal, BZD withdrawal
Non-Pharm Ensure safety det cause non-pharm measures
Verbal De-esc: respect personal space, do not be provocative, establish verbal contact, concise/simple
language, ID feelings/desires, listen closely, agree/agree to disagree, lay down law/set clear limits, offer
choices/optimism, debrief PT/staff
Pay attention to safety
- Speak in calm env, assist in controlling behavior, reassure they are in safe environment
Limit sedative use in dementia PTs
Pharm Reserve BZDs where sx are attributed to OH/BZD withdrawal
- Choose long half lives
Use ↓ doses of APh in elderly for shortest duration w close monitoring
***do not admin parenteral BZDs w IM olanzapine dt cardiac/resp complications
Delirium 1gAPh (haloperidol, loxapine) OR 2gAPh (olanzapine, risperidone, quetiapine)
- Haloperidol most studied
- Olanzapine and risperidone ODT
- Olanzapine IM
Dementia Only if risk of harm
- Use low doses and cautiously titrate
2gAPh (Risperidone) OR 1gAPh (Avoid in LBD) OR AChEI (LBD) OR memantine OR
trazodone
- Little evidence for quetiapine
- Haloperidol NR
2nd line: BZD (Lorazepam, oxazapem)
Brain Injury BB OR AED (CMZ, VPA) OR APh
- Avoid BZDs
Mental Mania: 2gAPh OR 1gAPh + lorazepam WITH/WO mood stabilizer
illness - Benzos should not be used as monotherapy
Psychosis: APh
Situational 1/2gAPh OR haloperidol + lorazepam OR BZD
ADHD
Patho Dysfx of DA/NE pathways
1 hallmark: impulsiveness + hyperactivity + inattention
Dx: >6 sx (5 for >17yo) x >6mo and have neg impact AND present in >2 settings
Non-Pharm Less effective at ↓ core sx than stimulants
- Pre-school aged children considered 1st line
Behavior mgmt (sleep hygiene), parent/teacher training, CBT, psychotherapy, mind-body
(neurofeedback, hypnosis)
Diet changes (observational): sugars, dyes, preservatives
Physical exercise
Education considerations: individualized, ID/address disorder and match to environment/teacher
Pharm 1st line (efficacy >6yo): LA stimulant med + non-pharm3-4w trial before RA
i. Short-intermediate (Ritalin IR/SR, Dexedrine IR/spansules): 3-8h
Freq dosing/risk of withdrawal, more ADRs, ↑ abuse potential
ii. Long (Adderall XR, Concerta, Vyvanse): 8-14h
- Doses >60mg/d usually do not result in additional efficacy in children
Stimulants Low abuse potential: Concerta, Adderall XR, Vyvanse
Sprinkle on soft foods: Adderall XR, Biphentin, Dexedrine Spansule, Vyvanse
(water)
Concerta: swallow whole, tab shell elim in feces
Preg: no info re Vyvanse
Methylphenidate Ritalin IR 3-5h
Ritalin SRDR 3-8h
Concerta (OROSIR+DR Methylphenidate): 12h
Dextroamphetamine Dexedrine IR 4-6h
*has most evidence in preg Dexedrine spansulesIR+DR 6-8h
Mixed amphetamines Adderall XRIR+DR 8-12h
, BiphentinIR+DR 10-12h
Lisdexamfetamine Vyvanse 14h
Atomoxetine For >6yo (wt based dosing) if did not respond well/tolerate adeq trial of stimulant or
has comorbid SAD/depression (no known abuse potential) *N/E r/u inh
- Longer onset (2-4 weeks) v stimulants
- Do not crush/chew (↓ GI effects), ↑QT, hepatotox, suicidality
Preg: avoid
ADs 2nd/3rd line or adj
Bupropion (2-4w), venlafaxine (4w), TCAs desipramine/imipramine/nortriptyline (3-
4w effect)
Alpha Ag Less effective than stimulant: 2nd/3rd line (mono or adj)
- ↓ sx of impulsivity and hyperactivity, less effective for inattention
Clonidine: helpful for tics, hyperactivity, impulsivity
- Caution in CVD, depression
- Avoid concurrent use with TCAs, other CNS depressants
Guanfacine: more selective Ag for alpha2A in prefrontal cortex indicated only for
children 6-12yo
- During and after DC, monitor BP/HR until normal
- CYP3A4
*always taper: <1mg q3-7d to avoid HTN crisis
Pregnancy: no data
Lactation: ↓ milk production
SGA Risperidone
- Low doses may be considered for behavioral sx in hyperactive/impulsive
children when stimulants alone are ineff/not tolerated
Monitoring Min duration for trial period: 3-4 wks to assess clinical response, improvement in 1 wk try another
stimulant if one stimulant is not tolerated/no response
- RA child after adeq response q3-6mo
- RA tx on a yearly basis during summer break (2-3w period)
- Cont for 6-12mo
*extended drug holidays NR for mod-sev ADHD doing well on stimulant
*do not stop/begin wi 4w of school year
Taper over several weeks if >3mo use
STOP: psychotic sx
Dementia and Alzheimer’s Disease
Patho ↓Ach + ↑ glu
Cause Potentially rev: meds, VitB12, hypothy, depression, infx, pain, constipation
- Anticholinergics: antiemetics, antiH, antiM, APh, TCAs
Non-Pharm First line for behavioral sx
- Structured psych interventions: ↓ depression/anx in mild dementia
- Edu of disease progression, power of attorney/advance health directives, counsel against driving,
inspect living environment, group activities, music therapy, sensory stimulation for agitation
Pharm AChEI: 1st line in AD, PD, cog/fx sx
Memantine: alt, can be combined w AChEI
SGA (risperidone, olanzapine): agit or psychosis (not in LBD)
- Risperidone: official BPSD indication
AD: when depression present
- SSRI: citalopram, sertraline
- TCA (agit): desipramine, nortriptyline
- Trazodone: agit, sundowning, disturbed sleep/wake
- Benzos: LOT for severely agit
AChEI When to DC: non-adherent, rate of ↓ greater on tx, intolerable ADR, comorbidities,
progression to stage where there would be no benefit
- Taper before stopping
Donepezil Mild-SEVERE
Efficacy at 3-6 mo
- Can adjust dose at 4-6 weeks
Max 10mg/d OD, no renal adj
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