COMBANK Psych COMAT Flashcards
1
Q
symptoms of tricyclic antidepressant (TCA) overdose
A
wide complex tachycardia, hyperthermia, hypotension, flushed and dry skin, hypoventilation
confusion, agitation
2
Q
Tx of TCA overdose
A
Sodium bicarbonate as soon as IV access is obtained
3
Q
factitious disorder
A
intentionally feigning of sx for secondary gain of assuming the sick role
4
Q
malingering disorder
A
intentionally feigned s/sx for primary gain (benefit to self - ex/ money, housing, obtaining drugs).
5
Q
functional neurological sx disorder
A
- aka conversion disorder
- voluntary motor or sensory sx that suggest neuro illness
- not intentionally produced but can’t be explained by med condition, substance effect, cultural behavior, or experience
- sx often preceded by stress
6
Q
bulimia nervosa dx
A
- binging + purging
- normal weight
7
Q
bulimia tx
A
CBT > ssri/snri
both better
8
Q
repression defense mechanism
A
unconscious prevention of an undesirable thought or feeling from reaching consciousness
9
Q
suppression defense mechanism
A
consciously ignores unacceptable impulses or emotions in order to achieve a desired outcome
- mature defense mechanism
10
Q
isolation of affect defense mechanism
A
unconscious limitation of the feeling of emotion associated with a stressful life event
– but still consciously aware the feeling exists
11
Q
MDD SIGECAPS
A
S = decreased or increased sleep *I = decreased interest in most activities G = increased feelings of worthlessness or guilt E = decreased energy or fatigue C = decreased concentration on tasks or activities or in decision-making A = decreased or increased appetite and weight loss or weight gain P = psychomotor agitation or retardation S = recurrent thoughts of death or SI
*Have to have I or depressed mood as one of the sx to make dx
12
Q
PTSD dx timeline
A
sx > 1 month
13
Q
Ganser’s syndrome
A
- *- approximate answers to questions (paralogia)
- may have pseudohallucinations, clouded consciousness, and somatic complaints
- Ganser so close to answer but not quite.
14
Q
Briquet’s syndrome
A
- aka somatization disorder
- throw a brick at em and they’ll think it hurts
15
Q
Munchausen syndrome
A
- sub-type of factitious disorder
- involves traveling from hospital/clinic to hospital/clinic
- habitual lying about extensive histories
16
Q
Munchausen syndrome by proxy
A
- aka factitious disorder by proxy
- individual intentionally produces physical s/sx in someone under their own care
17
Q
Wernicke’s encephalopathy sx
A
nystagmus
ataxia
ophthalmoplegia (ex/ horizontal nystagmus, lateral orbital palsy, gaze palsy)
confusion
18
Q
difference between conduct disorder and antisocial personality disorder
A
- antisocial PD is the progression of conduct disorder as pt ages. It is dx’d at or above 18yo
19
Q
distinguishing features of sleep terror disorder
A
- unresponsiveness during the event
- amnesia after the event
- occurs during NREM sleep (stage III or IV)
20
Q
Danger of TCA overdose
A
may cause QTc prolongation and widened QRS complexes, leading to possibly fatal arrhtyhmias.
21
Q
tx of TCA overdose
A
sodium bicarb (anti-arrhythmic)
22
Q
schizotypal personality disorder
A
- magical thinking, bizarre, borders on psychosis (ex/ Lady Gaga)
- eccentric behavior
- social and interpersonal deficits
- – impairment in self function (confused boundaries, distorted self concept, emotional expression off, unrealistic goals)
- – impairment in interpersonal functioning (misinterpretations, can’t develop closer relationships)
- some typa lady
23
Q
schizoid personality disorder
A
- loner, happy that way (ex/ night shift toll booth worker)
- social withdrawal, reduced range of affect, no interest in sexual relationships
- schizoid like an android
24
Q
paranoid personality disorder
A
- distrustful, suspicious
- interprets others as malicious
25
histrionic personality disorder
- theatrical, attention-seeking, uses physical appearance
- dramatic, flamboyant
- shallow expression of emotions that can be rapidly shifting (similar to borderline)
- usually women
- Ex/ marilyn monroe
26
borderline personality disorder
- unstable, rapid changes in mood, suicidal gestures
- impulsive, promiscuous, emotional emptiness
- usually women
27
anti-social personality disorder
- criminal, lacks remorse
- must be >18yo (otherwise is conduct disorder)
- manipulative, impulsive, no regard for rights of others
28
avoidant personality disorder
- wants relationships but doesn't pursue them out of fear of rejection and criticism
- passes on promotions
29
countertransference
- rxn the provider has towards the dr-pt relationship
| - can be positive or negative
30
pseudocyesis
false pregnancy
31
reaction formation defense mechanism
- pt develops a socialized attitude or an interest that is the direct antithesis of an infantile wish, desire, or impulse that is harbored consciously or unconsciously
- ex/ businessman engaged in fraud to earn money and then donates large sum of money to charity (unconsciously to avoid guilt)
32
sublimation defense mechanism
- energy associated with unacceptable impulses or drives is diverted into personally and socially acceptable channels
33
tx of status epilepticus (sz state over 30min)
- initially benzos: lorazepam, diazepam, midazolam
- second line = phenytoin then phenobarbital
- if still no relief then pentobarbital, midazolam, or propofol
34
Capgras syndrome
illusion of doubles
- delusion of misidentification that a familiar person has been replaced by an imposter
- seen after sudden brain damage
- is it a cap, is it gras? its two things! but not really...
35
Cotard syndrome
- aka nihilistic delusional disorders
- believe the world around them has been reduced to nothingness and that they've lost everything (including their own organs)
- precursor to schizophrenic or depressive episode
36
serotonin syndrome sx
```
hyperthermia
muscle rigidity
tremors
altered mental status
fever
autonomic instability
hyperreflexia
```
37
frotterism
- recurrent and intense sexual fantasies, urges or behaviors that involve rubbing against or touching a non-consenting person
- frotternizes (fraternizes) up against ppl
38
fetishism
- sexual fantasies, urges, or behaviors focused on nonliving objects such as shoes, stockings, or gloves
39
voyeurism
recurrent and intense preoccupation with observing an unsuspecting person who is disrobing, naked, or engaged in sexual activity
- aka scopophilia
- voyages to spy on naked ppl
40
psych meds where you often see anticholinergic toxicity with overdose
atypical antipsychotics >> typical antipsychotics (according to combank but not actually)
also TCAs
41
s/sx anticholinergic toxicity
```
red as a beet
dry as a bone
hot as a hare
blind as a bat
mad as a hatter
full as a flask
```
42
haloperidol overdose s/sx
lethargy
tremors
dystonia
(mayyy cause anticholinergic toxicity)
43
lithium overdose s/sx
```
nephrogenic DI
hyperreflexia
tremor
ataxia
nystagmus
SZs
```
44
Can you switch immediately from MAOi to SSRI?
No, have to wait at least 14d after stopping MAOi to avoid serotonin syndrome
45
s/sx of narcolepsy
- cataplexy (sudden, transient, bilateral weakness or paralysis. usually triggered by strong emotions... perplexed cat)
- sleep paralysis (on falling asleep or waking up)
- sleep-onset REM sleep attacks
- hypnagogic hallucinations
46
common laxatives
bisacodyl
cascara
senna
high fiber supplements
47
Russell sign
bulimia nervosa
= callus formation on the back of the index and long fingers
-- occurs secondary to self-inflicted vomiting
48
Waddell signs
malingering
49
brain area associated with anxiety
1. amygdala - increased activity
2. anterior cingulate cortex
3. insula
50
neuroleptic malignant syndrome s/sx
```
severe muscular rigidity
hyperthermia
AMS
tachyC
HTN
```
51
neuroleptic malignant syndrome labs
```
elevated CK
metabolic acidosis
hyperkalemia
leukocytosis
myoglobinuria
```
52
NMS tx
- supportive care
- dantrolene (muscle relaxant. for muslce rigidity and hyperthermia)
- bromocriptine (reverse loss of dopaminergic tone)
53
Calcium channel blocker overdose sx
profound bradycardia
hypotension
preserved or mildly depressed mentation
54
opioid/narcotic OD sx
```
AMS
bradycardia
miosis
respiratory depression
hypotension
hypothermia
ithcing, nausea, constipation
```
55
EtOH intoxication sx
hypotension (due to vasodilation) with reflex tachycardia
56
Bupropion OD sx
HTN
TachyC
SZ
57
tx of acute bipolar mania
valproate, lithium, antipsychotics (haloperidol, olanzapine)
- benzos if particularly agitated
58
illness anxiety disorder
- aka hypochondriasis
- disease preoccupation and conviction despite medical reassurance
- >= 6mo
59
MAOi's MOA
prevent breakdown of dopamine but also of tyramine, which acts as an indirect sympathomimetic, causing increased release of endogenous catecholamines
60
biggest distinction between schizotypal PD and schizoid
schizotypal has MAGICAL thinking/odd beliefs. Schizoid is just weird by society standards
61
best option for maintenance tx for bipolar
quetiapine + lithium or valproate
sometimes use olanzapine
62
Tourette's disorder
- onset before age 18
- motor and vocal tics
- -- tic = sudden, rapid, recurrent, non-rhythmic, sterotypic motor movement or vocalization
- ex/ repetitive eye blinking, facial grimacing, shoulder shrugging, and head jerking
- sx waxes and wanes
63
Huntington's chorea
- genetic movement disorder, AD
- appears in adulthood
- choreiform movements (rapid, involuntary, non-repetitive or arrhythmic movement), cognitive decline (dementia), neuropsych sx (attention, judgment, depression, apathy, social withdrawal, irritability)
64
Tardive dyskinesia
- movement disorder seen in older adults chronically on anti-psychotics
- mainly mouth and tongue
- blepharospasm, lip smacking, sucking, facial grimacing
- axial or tuncal choreoathetosis or dystonia
65
Wilson's disease
- error of copper metabolism
- dystonias (ex/ torticollis, blepharospasm, cramps), chorea, ataxias, wing-beating tremors, mood disorders, psychosis, intellectual decline
- Keyser Fleischer rings, liver dysfunction
66
Sydenham's chorea
- self-limited consequence of strep infection or ARF
- childhood
- choreiform movements (involuntary brief, random and irregular movements of limbs and face)
- emotional lability, hypotonia, muscle weakness, loss of fine motor control
67
Common SSRI side effects
- abnormal bleeding -> acute microcytic hypochromic anemia
- sexual disturbances, GI, agitations, insomnia, tremor
- beware serotonin syndrome
68
most common OCD compulsion
excessive grooming, hand washing, tooth brushing, etc
| 60% pts
69
loose associations
- disruption of logical connection between thoughts expressed sequentially
- pt unaware
- thoughts difficult to understand
70
Tangentiality
- extra ideas are included, never actually answering a question
- logical connections between thoughts remain
71
word salad
- incoherent illogical speech that lacks meaningful connection between words
- extreme form of loose association
72
circumstantiality
- extra and unnecessary details included before ultimately answering a question
- clear link between ideas expressed
73
circumstantiality vs tangentiality
- C answers the question, T does not
| - both have logical connections
74
loose associations vs tangentiality
T still has logical connections, L doesn't
| - neither answers the question
75
tx for dissociative fugue
- psychodynamic psychotherapy (to deal with stressor and minimize recurrence risk)
- supportive care
76
what is interpersonal therapy used for
- focuses on 4 main areas:
1. grief over loss
2. interpersonal disputes
3. role transitions
4. interpesronal skill deficits
77
sympathetic viscerosomatic reflex for thyroid gland
T2
| - associated with an upper thoracic flexion hump
78
cyclothymic disorder dx
hypomania + dysthymia
79
PCP intox sx
```
psychosis
unpredictable violent behavior
horizontal and vertical nystagmus
pupillary constriction (miosis)
tachyC
```
80
LSD intoxication sx
anx, depression
pupillary dilation
delusions, visual hallucinations, flashbacks
synesthesias (haering colors, seeing sounds)
panic
81
methamphetamine intox sx
fatigue, apprehension, trouble with concentration
HTN
pupillary dilation
fever
euphoria
possible psychosis, restlessness, irritability
prolonged wakefulness
82
salvia intox sx
hallucinations
euphoria
perceptual distortions
lasts 1-2hrs
83
CAGE scoring
1 point - at risk for dependency
2-3 = highly suspicious
4 = diagnostic for alcohol abuse disorder
84
borderline tx
dialectical behavioral therapy with adjuvant meds
85
best tx for alcohol abuse
brief intervention with follow-up visits (motivational enhancement therapy)
86
delerium tremens sx
```
tachyC
psychomotor agitation
combativeness
HTN
fever
```
87
meds with greatest risk for serotonin syndrome
MAO-Is when taken with other serotonergic meds, herbal supplements, or tyramine- and tryptophan-containing drinks/food
88
childhood disintegrative disorder
- normal development until age 2 then loss of previously acquired skills
- onset between 2-10
- boys > girls
89
Rett's disorder
- normal dev until age 5mo
- disintegration in previously acquired milestones onset between 5mo-48mo
- girls only
90
drugs with pupillary constriction (miosis)
opiates intox
| PCP intox
91
drugs with pupillary dilation (mydriasis)
cocaine intox
amphetamine intox
LSD intox
opiate withdrawal
92
cocaine intox sx
agitation
autonomic hyperactivity
pupillary dilation (mydriasis)
psychosis
- exact same as amphetamines so differentiate via urine drug screen
93
neurotransmitter that promotes REM sleep
acetylcholine
94
sx of vascular dementia
- manifest cognitive impairments and memory problems in a step-wise, progressivev way
- focal sensory or motor deficits
95
normal pressure hydrocephalus (NPH) sx
wet wacky wobbly
urinary incontinence
dementia
"magnetic gait"
96
Sx of alzheimer's dementia
memory impairment + cognitive disturbance
- aphasia
- apraxia (inability to execute learned purposeful movements)
- agnosia (inability to recognize objects)
- disturbance in executive functioning
97
wernicke-korsakoff syndrome sx
```
confusion
ataxia
ophthalmoplegia
vestibular problems
confabulation
anterograde amnesia
```
98
cri-du-chat sx
```
high-pitched cat-like crying
low birth weight
FTT
hypotonia
psychomotor retardation
severe intellectual disabilities
microcephaly
hypertelorism
```
99
prader-willi syndrome sx
```
upslanting, almond-shaped eyes
thin upper lips
down-turned mouth
light skin
small hands and feet
hypogonadism
prominent low tone
FTT in infancy
hyperphagia -> obesity
high pain threshold
psych: obsessions, compulsions, temper tantrums, skin-picking, anx, depr, psychosis
```
100
angelman syndrome sx
```
severe intellectual disabilites
postnatal microcephaly
SZ
frequent laughter and smiling
excitable personalities
hypermotoric behaviors
attention problems
decreased speech or absence of speech output
ataxia
```
101
fragile x syndrome sx
large head with long face, prominent jaw and forhead, large ears
large-sized testes
Connective tissue dz
hypotonia
Psych: mod-sev mental retardation, pervasive developmental disorder, ADHD, mood lability
102
alcohol withdrawal timeline
- early: 8-9h after last drink, tremulousness, face flushed, mild anx, HA, GI upset, insomnia, hallucinations, diaphoresis, grand mal SZ, mild disorientation
- late/acute: 48-96h after last drink. Delirium tremens
103
SI tx for pregnant pt
ECT very effective for acute tx of depressive episode
104
anti-depressants assoc with orthostatic hypoT
TCAs - mainly Imipramine
105
adverse effects of trazodone
hypotension
sedation
priapism
106
adjustment disorder timeline
sx begin within 3mo of the change and stop w/in 6mo
107
concrete thinking
- age 7-11
- characterized by actual things, events, and immediate experience, rather than by abstractions
- - seen in young children and ppl who can't generalize (schizophrenia, and certain cognitive disorders)
108
formal operation
- age 12-adulthood
| - deductive logic and emergence of ability to use abstrct thought for hypothetical situations
109
sleep-related eating disorder can be caused by ...
hypnotics, ex/ zolpidem
110
Charles Bonnet Syndrome
- onset of complex visual hallucinations in an otherwise health blind pt with no psych hx and no other evidence or psych or mood disorder
- pts know hallucinations aren't real
111
narcolepsy tx
- maintain regular sleep schedule
- timed daily naps
- moderate exercise
- emotional support
- stimulant drugs if needed
112
benzo withdrawal sx
*HTN
*TachyC
anxiety
SZ
aud or vis hallucinations
insomnia
113
PCP intox tx
Diazepam or lorazepam
| - then haloperidol or risperidone if sx don't improve
114
ADHD associated with development of
conduct disorder -> antisocial personality disorder
115
absolute contraindication to bupropion use
- SZ disorder (b/c lowers sz threshold)
- MAOi use w/in 14d
- anorexia or bulimia
- linezolid or IV methylene blue use
116
bupropion common adverse effects
tachyC
insomnia
headaches
