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Psychiatry > Case Files 1 > Flashcards

Case Files 1 Flashcards

1
Q

% of people with ID that have another psychiatric disorder

A

30-40%

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2
Q

Fragile x mutation

A

Xq27.3

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3
Q

What kind of ID can hold a job

A

Only mild

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4
Q

When must ID be diagnosed

A

Onset must be before age of 18

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5
Q

Medical conditions that cause pain can cause what in severe ID

A

Aggressive or self-destructive behavior in an individual with limited means of communicating

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6
Q

MCC of ID

A

Idiopathic or unknown

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7
Q

Characteristic of impairment associated with ID

A

Global and fairly consistent across all areas of function

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8
Q

ASD key features

A
  1. Difficulty with social reciprocity
  2. Poor peer interaction
  3. Poor language development
  4. Repetitive and odd play
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9
Q

What is Rhett disorder

A

Progressive encephalopathy, loss of speech, gait problems, microcephaly, and poor social interaction only seen in women who were normal in infancy

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10
Q

Autism MRI

A

Increased cortical thickness

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11
Q

What separates ASD from ID

A

ID children generally do not exhibit restricted activities and interests or impairments in communication and social skills

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12
Q

What drug may help with irritability symptoms of ASD

A

Aripipazole

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13
Q

Focus on one certain kind of toy works with what part of ASD

A

Stereotyped behavior

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14
Q

Best predictor of future outcome in ASD

A

Language development

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15
Q

First line ADHD drug in families with a hx of substance abuse

A

Atomexetine (SNe transporter inhibitor)

also 24 hour half life

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16
Q

3 major things for ADHD

A

Distractibility, hyperactivity, impulsivity

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17
Q

ADHD timing

A

Symptoms for at least 6 months
Begin before age 12
Be observed in more than one setting

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18
Q

What should be ruled out in a child with hyperactivity

A

Lead poisoning

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19
Q

Stimulants to treat ADHD can lead to development of

A

Tics

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20
Q

Imipramine AE

A

QT prolongation

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21
Q

How long to have Tics to dx Tourettes

A

At least 1 year

need multiple motor and vocal

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22
Q

Only FDA approved Tourettes drugs

A

Haloperidol and Pimozide

not most often used though

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23
Q

What are athetoid movements

A

Slow, irregular, writhing movements

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24
Q

What is coprolalia

A

Vocal tic involving involuntary vocalization of obscenities

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25
Q

What are hemiballistic movements

A

Intermittent, coarse, large-amplitude unilateral movements of the limbs

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26
Q

Best non-drug therapy for TD

A

Habit reversal training

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27
Q

Drugs for ADHD/Tourette’s combo

A

Clonidine (alpha 2 agonist)

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28
Q

What other disorder is very common in Tourettes families

A

OCD

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29
Q

Tics worse in winter and early spring months could be

A

PANDAS (group A strep)

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30
Q

Key to schizoaffective disorder dx

A

Psychotic episodes occur during the mood episodes, but the mood symptoms do not always occur during the psychosis

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31
Q

What is Anergia

A

Lack of energy

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32
Q

What is anhedonia

A

lack of interest in one’s usually pleasure seeking activities

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33
Q

Schizoaffective disorder dx criteria

A

Must meed criteria for a major mood episode for the majority of the illness and have delusions or hallucination for 2 or more weeks in the absence of a major mood episode
(sometimes present with just psychosis and other times present with mood and psychosis)

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34
Q

Tx for Schizoaffective and manic? schizoaffective and mood?

A

S and Manic: Mood stabilizer and antipsychotic

S and Mood: Antipsychotic alone

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35
Q

What is catatonia

A

Three or more of stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, grimacing, and friends

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36
Q

What are ideas of reference

A

Thinking something is meaningful to you and a message “like where a care is parked”

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37
Q

Schizophrenia timing

A

6 months and at least 1 month of active phase symptoms including delusions, hallucinations, or disorganized speech

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38
Q

Delusional disorder timing

A

One month of delusions with no other psychotic sypmtoms

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39
Q

What sets apart schizophrenia from other psychiatric disorders

A

Negative symptoms causing extreme social dysfunction

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40
Q

Brief psychotic disorder timing

A

1 day to 1 month

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41
Q

Schizophreniform disorder timing

A

1-6 months

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42
Q

Mood disorder with psychotic features

A

Psychosis occurs only in the context of mood symptoms

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43
Q

Most AE from what 2nd gen antipsychotics

A

Clozapine and olanzapine

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44
Q

Lest AE with what 2nd gen antipsychotics

A

Ziprasidone and ariprazole

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45
Q

Most effective drug for schizophrenia

A

Clozapine (but AE so bad its not first line)

46
Q

Dystonia treatment

A

Benztropine of diphenhydramine (anticholinergics)

47
Q

Thing you always forget as AE of typical antipsychotics

A

Hyperprolactinemia

48
Q

Only antipsychotic with antisuicidal properties for schizophrenia

A

Clozapine

49
Q

What is formacation

A

Tactile hallucination of insects crawling on or under the skin
can be caused by coke or meth use

50
Q

First line tx for non-psychotic mania

A

Lithium or divalproex (under 12)

51
Q

Bipolar type I vs II

A

I: complete manic symptoms occurring during course of the disorder
II: hypomanic episode + major depressive episode

52
Q

What is hypomania

A

Like diet mania, pt’s do no usually exhibit psychotic symptoms, racing thoughts, or marked psychomotor agitation
at least 4 days

53
Q

What is rapid cycling bipolar disorder

A

Occurrence of at least four mood episodes (depression or mania) in a year

54
Q

What are episodes of mania often accompanied by

A

Psychotic features and hospitalization

55
Q

Measure what in lithium patients

A

Thyroid and kidney functions

56
Q

Measure what in carbamazepine pathients

A

Monitor for aplastic anemia or agranulocytosis

57
Q

No what in manic patients

A

Antidepressants, will make worse

58
Q

Manic like episode lasting less than 4 days

A

Cyclothymic disorder

59
Q

Weight gain without increase in appetite in depression suggest

A

Depressive disorder due to another medical condition

60
Q

Decreased need for sleep with no decrease in energy level is highly suggestive of

A

bipolar disorder

61
Q

What are somatic delusiosn

A

False beliefs about one’s body (someone in depression thinks they have cancer)

62
Q

What are vegetative symptoms in depression

A

Physiologic or related to body functions (sleep, appetite, energy, sexual interest)

63
Q

What is needed to add “with psychotic features” to major depressive disorders

A

Must meet criteria for MDD and in addition have evidence of delusions and/or hallucinations appearing AFTER the onset of depressive symptoms

64
Q

How long can normal bereavement last

A

4 months

65
Q

Patient on antipsychotic and antidepressant who is now better routine

A

Antipsychotic for 3 months and then taper

Continue the anti-depressant for 6-12 months

66
Q

How do children with major depression often present

A

As angry or mad as opposed to sad or depressed

67
Q

SSRI AE

A

GI symptoms, sweating, dizziness, tremor, sexual dysfunction (only one that occurs later in medicine course)

68
Q

Best antidepressent for sexual dysfunction? MOA?

A

Bupropion
Blocks NE and Dopa reuptake
also used for anxiety and to stop smoking

69
Q

Biggest TCA AE

A

Anticholinergic (dry eyes, mouth, constipation)

70
Q

How long can baby blues last

A

Up to a week

71
Q

MDD recurrence risk

A

85% lifetime risk

40% in on year

72
Q

Venlafaxine at higher doses risk

A

Elevated blood pressure

73
Q

One of the symptoms for MDD must be what

A

Depressed mood or anhedonia (loss of interest)

74
Q

How long to be diagnosed with persistent depressive disorder? What can it be viewed as

A

At yeast 2 years

Can be viewed as a less intense, longer lasting depressive illness (often with onset in teenage years)

75
Q

When can persistent depressive disorder be diagnosed in children

A

1 year time (as opposed for 2 years in adults)

76
Q

PMDD diagnostic criteria

A

Symptoms for half of their cycles in a year

77
Q

SSRIs work the fastest in what disorder

A

PMDD

Use OCPs w/ caution in this disorder b/c they may affect mood

78
Q

Panic disorder diagnostic criteria

A

At least one panic attack followed by 1 month of concern about having additional attacks, worrying about the consequences of the attacks, or maladaptive change in behavior related to the attacks

79
Q

Panic disorder hallmark vs other panic inducing things? Tx?

A

Unexpected panic attacks not provoked by any particular stimulus
Tx SSRIs

80
Q

Agoraphobia vs Social Anxiety Disorder

A

Agoraphobia is multiple fears of public things, Social anxiety disorder is one specific phobia (related to public things)

81
Q

Best tx for specific phobia

A

Cognitive behavioral therapy with exposure

82
Q

Separation anxiety disorder peak age? tx?

A

9-10 years old

Tx is multicentric – but NO benzos, SSRIs instead for attacks

83
Q

Separation anxiety disorder kids can develop what

A

Panic diorder and generalized anxiety disorders

Also MDD

84
Q

Treatment of choice for social anxiety disorder

A

CBT

85
Q

Single most common mental disorder in US

A

Phobias (mostly specific)

86
Q

B blockers that an be used for social anxiety disorder

A

Atenolol and Propranolol

87
Q

Part of the brain involved in anxiety

A

Amygdala

88
Q

How long before you can diagnose social anxiety disorder

A

> 6 months

89
Q

GAD diagnostic requirements

A

Persistent, excessive, uncontrollable anxiety about various domains of life for the majority of a 6 month time period

90
Q

GAD life course

A

Chronic condition that can worsen with life stressors

Tx is SSRI

91
Q

What is clompiramine

A

Serotonin and dopaminergic neurotransmitter inhibitor

For OCD when SSRIs don’t work

92
Q

Mean age of OCD presentation

A

20 years

93
Q

OCD commonly seen with what disorder

A

Tourettes

94
Q

Sertraline most common AE

A

Nausea and diarrhea

95
Q

OCD presentation in children

A

May no see symptoms unreasonable yet (developmental thing)

96
Q

PTSD features

A

Ongoing symptoms of re-experiencing, avoidance of reminders, negative alterations of thoughts and mood, and symptoms of increased arousal

97
Q

% of PTSD patients who have another psych disorder

A

80%

symptoms lasting > 3 months after incident unlikely to resolve without treatment

98
Q

Good drug for re-experiencing and arousal symptoms of PTSD

A

Prazosin (alpha 1 blocker)

99
Q

Adjustment disorder timing? tx?

A

Symptoms less than six months duration
Within 4 months of the stressor
Tx is psychotherapy

100
Q

Irritability unique to depression in what age group

A

Young ones

101
Q

3 subtypes of adjustment disorder symptoms

A

Depressed mood
Anxiety
Disturbance of conduct

102
Q

Acute stress disorder timing and criteria

A

More than 3 days, less than 4 weeks (PTSD when after 4 weeks)
With Intrusion symptoms, negative mood, dissociative symptoms, avoidance symptoms, and arousal symptoms

103
Q

Drug for short term tx of insomnia in Acute stress disorder

A

Zolpidem

104
Q

Most patients with dissociative identity disorder have experienced

A

Significant physical and sexual trauma often during childhood

105
Q

Negative and additive symptoms in DID

A

Neg: amnesia
Pos: derealization and depersonalization

106
Q

Most patients with DID develop what

A

PTSD

107
Q

Illness anxiety disorder diagnostic criteria

A

Preoccupation with having or acquiring a serious illness that has been present for at least 6 months where nay somatic symptoms that are present of mild intensity

108
Q

Illness anxiety disorder vs delusional disorder somatic type vs somatiform disorder

A

Delusional disorder somatic type will be worry about one specific illness every time but CANNOT be reassured and will not reconsider
IAD can change over time (BUT WORRY ALWAYS WITH ILLNESS), always mild, and patient can usually be reassured for a short time (misinterpretation of bodily functions)
Somatic disorder will be long term with worry always about complaint (i.e pain)

109
Q

Pseudo seizures likely

A

Conversion disorder

110
Q

Distinctive feature of illness anxiety disorder

A

Feat of having serious illness based on misinterpretation of bodily sensations

111
Q

Essential feature of factitious disorder

A

Falsification of medical or psychological signs and symptoms in oneself or others that are associated with an identified deception
conscious but no motivation for external reward - desire to play the patient role

112
Q

What personality disorder is most likely to occur with factitious disorder

A

Borderline

Psychiatry (6 decks)

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