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DIT Level 3 > Clinical questions - Psychiatry > Flashcards

Clinical questions - Psychiatry Flashcards

1
Q

Anorexia nervosa

A

less than 85% ideal body weight, amenorrhea, worried about gaining weight, excessively thin, without binge eating

Tx:
Interdisciplanary team: physician, dietician, MH
CBT, family therapy
only SSRI if comorbid depression/anxiety
Inpatient if severe malnutrition
-less than 75% Ideal body wt
-dehydration
-elyte derangements
-cardiac arrhythmias
-SI or psychosis
Nutritional therapy
Ca/Vit D supplementation

Weight gain goals:
Inpt: 2-3 pounds/wk
Output: 0.5 - 1 pound/week

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2
Q

Criteria for hospitalizing a psych patient

A

danger to self
danger to others
unable to provide for themselves

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3
Q

PTSD treatment

A

Psychotherapy: exposure therapy, CBT

Pharmacotherapy
SSRI 1st line
other antidepressants - TCAs, MAOIs
Mood stabilizers: impulsive behavior, hyperarrousal, flashbacks
Alpha blockers - prazosin for nightmares
Atypical antipsychotics for refractory sxs

Avoid benzos - inhibit ability to process event, and addictive/abuse risk

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4
Q

Traditional, 1st gen, antipsychotics

A

Low potency:

  • chlorpromazine
  • thioridazine
    se: anticholinergic effects

High potency:

  • Haldol
  • thoracenazine
    se: neuroleptic malignant sn, movement disorders
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5
Q

Atypical, 2nd gen, antipsychotics

A

respirdol
quietapine
olanzapine

se: sedation, wt gain, diabetes

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6
Q

Tardive dyskinesia

A

Chorea of mouth/tongue

Side effect of traditional neuroleptics

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7
Q

Movement disorders seen in high potency traditional neuroleptics (halloo, throacenazine)

A

1st several days: acute dystonia - muscle spasm, stiffness, oculargyric crisis; torticollis

1st month: parkinsonism sxs - bradykinesia, akinesia

2nd month: akathisia - restlessness, constant movement

months to years: tardive dyskinesia - lip smacking, irreversible

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8
Q

Medical conditions that can cause major depression

A 
Hypothyroidism
Hyperparathyroidism - increased Ca -> depression, delirium
Parkinsons
Cancer - CNS neoplasm, pancreatic CA
Strokes - ACA stroke esp.
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9
Q

Obsessive compulsive disorder

A

Obsession - intruding recurrent, anxiety provoking thoughts or urges
Compulsions - repetitive behavior or mental acts to relieve anxiety created by obsessive thoughts

Tx:
SSRI 1st line
Clomipramine (TCA) -> anticholinergic se
venlafaxine (SNRI)
CBT
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10
Q

Potential side effects of lithium

A

CNS effects:

  • depression
  • tremor
  • cognitive dulling

Thyroid changes - up or down
-euthyroid goiter

GI:

  • N/V/D
  • metallic taste
  • wt gain

Nephrogenic DI
-kidney stops responding to desmopressin (ADH) -> can’t concentrate urine -> polyuria, thirst, polydipsia

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11
Q

Serotonin syndrome

A

SSRI with MAOI, SNRI, TCA, or triptan

Mental status changes:
anxiety, agitation, delirium, restlessness, disorientation

Autonomic excitation:
diaphoresis, tachycardia, hyperthermia, HTN, N/V/D

NM hyperactivity:
Tremor, rigidity, hyperreflexia, myoclonus, ocular clonus (slow horizontal eye movements)

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12
Q

Major risk factors for suicide

A 
psychiatric disorder
hopelessness or worthlessness
impulsivity
advanced age - more successful
male
access to firearms
prior Hx of suicide attempts
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13
Q

Clozapine monitoring

A

Used in treatment-resistant schizophrenia
Risk of agranulocytosis

Get baseline CBC then weekly for 6 months, biweekly for 6 mo then monthly
Baseline Wt, BMI, waist circumference - risk of weight gain and subsequent DM
Baseline FBG or A1c
Baseline ECG: rare myocarditis with rapid progression to CM and CHF
Weekly ESR and troponin for 4 weeks

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14
Q

Personality disorder characterized by controlling, perfectionistic, orderly, stubborn, possible hoarding

A

Obsessive compulsive disorder - rigid, organized, inflexible

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15
Q

Personality disorder characterized by excessive need to be taken care of, submissive and clinging behavior, low self-confidence, fears of separation and losing support

A

dependent PD

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16
Q

Personality disorder characterized by criminality, unable to conform to social norms, disregard for others’ rights, reckless disregard for safety

A

antisocial PD

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17
Q

Personality disorder characterized by grandiosity, sense of entitlement, lack of empathy

A

narcissistic PD

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18
Q

Personality disorder characterized by excessively dramatic, emotional, and extroverted, attention seeking, sexually provocative behavior, unable to maintain intimate relationships

A

Histrionic PD

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19
Q

Heroin/opioid overdose

A

s/s:
depressed consciousness - drowsy, slurred speech, unarrousable
Miosis - pinpoint
Resp depression -> low sats, respiratory acidosis

Tx:
Naloxone (narcan) - wears off in 2-3 minutes, keep giving it again and again if needed

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20
Q

Antidepressant/class that is generally 1st line tx for unipolar major depression

A

SSRIs

21
Q

Antidepressant/class that is a good choice for depressed patient with insomnia

A

trazodone or mirtazapine

22
Q

Antidepressant/class that is a good choice for patient who discontinued an SSRI due to sexual dysfunction

A

bupropion

23
Q

Antidepressant/class that is a good choice for depressed patient with appetite suppression and wt loss

A

mirtazapine

24
Q

Antidepressant/class that may help with smoking cessation

A

bupropion

25
Q

Antidepressant/class that overdose causes sedation and life threatening arrhythmias

A

TCAs

26
Q

Medications used to treat ADHD

A

ADHD: careless mistakes, easily distracted, not following instructions, frequently interrupts and blurts out answers

Stimulants:

  • methylphenidate
  • dextroamphetamine

Nonstimulants:
Atomoxetine (Strattera) - SNRI

27
Q

Acute stress disorder vs PTSD

A

acute stress disorder - sxs 3 days to less than 1 mo
PTSD sxs longer than 1 mo

Both:
exposure to dramatic event
recurrent intrusive memories, dreams, flashbacks
avoidance of stimuli
altered arousal - insomnia, irritability, hyperviligence, self destructive behavior
Persistent negative change in mood or cognition - amnesia, detachement, blame self

28
Q

Drugs that cause or mimic psychosis

A 
hallucinogens - LSD, PCP
Stimulants - cocaine, amphetamines
Withdrawal from benzos, barbs, alcohol -> tactile hallucinations and psychosis
anabolic steroids
glucocorticoids
29
Q

Panic disorder

A

recurrent unexpected panic attacks with constant worry about more panic attacks

Psychotherapy: CBT - triggers, train coping mechanisms

Meds:
SSRI
SNRI
TCA - imipramine, clomipramine - dangerous in OD, more s/e

Benzos: immediate sx relief to break attack
-> rebound anxiety and dependence

30
Q

bulimia nervosa

A

Meds:
SSRI - fluoxetine
TCAs - desipramine, imipramine, amitriptyline
Buspirone (buspar)

31
Q

Acute mania/manic episode

A

decreased need for sleep, increased goal directed activity, excessive spending, grandiosity, pressured speech

Mood stabilizers - alone or in combo for acute mania
Lithium
Anticonvusants - valproate, carbamazepine
Atypical antipsychotic - olanzapine, quetiapine, aripiprazole, risperidone

32
Q

management of torticollis associated with antipsychotic medication

A

benztropine or diphenhydramine - counteract ACh at NMJ with anticholinergic drug

33
Q

Psychiatric disorder: Patient with normal anatomy is convinced a part of his/her anatomy is abnormal

A

body dysmorphic ds

34
Q

Psychiatric disorder: unexplained loss of sensory or motor function without any basis in medical or neurological condition

A

conversion ds

35
Q

Psychiatric disorder: patient is preoccupied with the possibility of contracting a serious illness and is constantly checking his/her body for signs of illness

A

illness anxiety dx

36
Q

Psychiatric disorder: patient produces false s/s of an illness in order to receive sympathy or medical attention

A

factitious ds

37
Q

Generalized anxiety disorder medical treatment

A

1st line:
SSRI: paroxetine, sertraline, citalopram
SNRI: venlafaxine, duloxetine

2nd line:
TCA: imipramine
Benzos: clonazepam, diazepam - long acting
-short acting risk rebound anxiety
Buspirone + SSRI or SNRI
38
Q

MAOI major side effect concern and dietary trigger

A

Hypertensive crisis
MAO inactivates catecholamines, inhibition -> increased catecholamine -> serotonin, dopamine, norepinephrine with resultant HTN

trigger - Tyramine - promotes catecholamine release
Found in aged, pickled, smoked or fermented foods
-sausage, pepperoni, salami, cheeses
-Chianti, beers/wines
-Brown bananas
-Soy sauce

39
Q

Neuroleptic malignant syndrome

A

associated with antipsychotic drugs

s/s:
Mental status change: agitation, delirium, psychosis
Muscle rigidity -> fever, rhabdo
Autonomic dysfunction: tachycardia, labile BP, tachypnea, diaphoresis

Tx:
Stop offending medication
Supportive care in ICU - IVF, cooling blankets, icepacks
Clonidine or nitroprusside for elevated BP
Clonazepam/lorazepam for agitation prn
DANTROLINE to relax skeletal muscle - inhibits Ca release (used in NMS and malignant hyperthermia)

40
Q

Withdrawal from opiates

A 
Dysphoria - unwell, discontent
Restlessness, insomnia
Yawning
rhinorrhea, lacrimation, diaphoresis
mydriasis
myalgia, arthralgia
N/V/D
Abd craming
piloerection - "uiting cold turkey"
41
Q

Features that distinguish adjustment disorder with depressed mood from major depressive disorder

A

Adjustment disorder has an identifiable stressor that causes emotional or behavior symptoms
-job loss, financial stress, divorce, death in family

Sxs begin within 3 months of stressor, resolves within 6 months of disappearance of stressor
disturbance does not meet criteria for MDD

42
Q

Personality disorder: lifelong voluntary social withdrawal, lacks close friends, limited range of emotional expression, indifferent to the price/criticism of others

A

schizoid PD - schizoids avoid

43
Q

Personality disorder: socially inhibited, shy, feelings of inadequacy, hypersensitive to rejection or criticism

A

avoidant PD

44
Q

Personality disorder: social awkwardness and difficulty with personal relationships plus eccentric appearance, behavior, or thinking

A

schizotypal PD

45
Q

Personality disorder: distrustful, suspicious, litigious

A

paranoid PD

46
Q

Personality disorder: unstable personal relationships, unstable mood and behavior, unstable self-image, impulsiveness, suicide threats or gestures, sense of emptiness and loneliness

A

borderline PD

47
Q

Depression management in bipolar

A

Mood stabilizers:
Lithium
anticonvulsants - lamotrigine (watch for rash), valproate
Atypical antipsychotic - olanzapine, quetiapine
ECT for severe depression

48
Q

Indications for electroconvulsive therapy (ECT)

A

painless, electrode induced seizure

Refractory depression

  • severe
  • psychotic features
  • severe SI
  • refusing food, nutritional compromise
  • catatonia

Rapid response necessary - pregnancy

Prior good response

Bipolar disorder/mania

Schizophrenia/psychosis esp catatonic

DIT Level 3 (32 decks)

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