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Psychiatry Clerkship > Emma Holiday Review > Flashcards

Emma Holiday Review Flashcards

1
Q

What has to go on for at least 6 months for it to be schizophrenia?

A

ANY symptoms

Not just positive symptoms. Usually the negative symptoms predate the positive symptoms (this is what produces the schizophrenia prodrome!)

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2
Q

Most common type of schizophrenia

A

Paranoid type

It also has the best prognosis!

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3
Q

Schizophrenia statistics

A

Prevalence 0.5-1%

Twin-twin Concordance 50%

Sibling: 10%

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4
Q

Positive symptoms in schizophrenia are due to. . .

A

. . . too much dopamine in the mesolimbic tract

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5
Q

Negative symptoms of schizoprenia are due to. . .

A

. . . not enough dopamine in the mesocortical tract

This is why 1st generation antipsythotics (which have greater effect in the mesocortical tract) cause so many EPS! 2nd generation avoid these dopamine receptors.

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6
Q

Brain dopamine pathways

A

Blocking the mesolimbic reduces psychotic symptoms.

Blocking the mesocortical produces negative symptoms.

Blocking the nigrostriatal produces extrapyramidal symptoms.

Blocking the tuberoinfundibular produces hyperprolactinemia.

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7
Q

Will treating a patient in a brief psychotic episode with antipsythotics prevent progression to schizoprenia?

A

No

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8
Q

__ is often the treatment for psychotic depression

A

ECT is often the treatment for psychotic depression

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9
Q

Is ECT safe in pregnant patients?

A

YES

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10
Q

Therapy for different delusional disorders

A

Erotomanic -> psychotherapy. If they are functional, don’t necessarily need antipsychotic. If not, you should put them on an atypical.

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11
Q

Two most potent antipsythotics

A
  1. Haloperidol
  2. Fluphenazine

They also have the most EPS and other off-target dopaminergic effects (hyperprolactinemia, etc)

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12
Q

Injectable antipsychotics

A

Fluphenazine decanoate

Haloperidol decanoate

Risperidone decanoate

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13
Q

Low-potency 1st generation antipsychotics

A

Lower off-target dopaminergic effects, BUT also have anticholinergic effects and antihistaminergic effects

Sedating and may precipitate delirium, dry mouth, etc.

Includes chlorpromazine (Thorazine) and thioridazine

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14
Q

Chlorpromazine side effect

A

Can cause anticholinergic/antihistaminergic effects

Also, can cause sun-exposed “purple-gray” skin rash (hypersensitivity dermatitis) and jaundice/liver disease

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16
Q

Thiaridazine side effects

A

Prolonged QTc

Pigmentary retinopathy

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17
Q

Treatment for dystonia

A
  1. Discontinue offending agent
  2. Either benztropine or diphenylhydramine
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18
Q

Treatment for akathisia

A

Benzo

OR

Propranolol

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19
Q

Treatment for drug-induced parkinsonism

A

Often with anticholinergics in young patients (benztropine, trihexyphenidyl, biperiden, sometimes diphenylhydramine)

2nd line: Bromocriptine, amantadine

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20
Q

Antipsychotics less likely to cause tardive dyskinesia

A

Clozapine

Patients who develop TD may be switched to this

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21
Q

Which atypical agent has the highest risk of EPS and hyperprolactinemia?

A

Resperidone

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22
Q

Weight-neutral antipsychotics

A

Ziprasidone (also QTc prolonging!)

Aripiprazole (also causes akathisia!)

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23
Q

Atypical most associated with weight gain

A

Olanzapine

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24
Q

Atypical most associated with orthostasis

A

Quetiapine

Also an alpha-1 blocker

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25
Q

Like buproprion, this antipsychotic also decreases the seizure threshold

A

Clozapine

In addition to causing agranulocytosis in some patients

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26
Q

Depression’s effects on sleep cycle

A

Shortened REM latency period

More frequent REM

So. . . more REM overall, ergo less deep/restfull sleep/stage3-4 sleep.

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27
Q

Depression in a patient with abdominal pain, joint pain, and a photosensitive rash

A

Depression secodary to porphyria cutanea tarda

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28
Q

___ stroke can produce symptoms of depression

A

Left MCA stroke can produce symptoms of depression

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29
Q

Which SSRI has the most drug-drug interactions?

A

Paroxetine

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30
Q

Which SSRI don’t you have to taper when stopping?

A

Fluoxetine

Long half-life due to metabolite norfluoxetine

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31
Q

SSRI with fewest drug-drug interactions

A

Citalopram

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32
Q

Contraindications for buproprion

A
  • Seizures:
    • Epilepsy
    • Bulimia nervosa
    • Recurrent DTs or benzo withdrawals
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33
Q

You can’t take __ with St. John’s Wart

A

You can’t take an SNRI (venlafaxine) with St. John’s Wart

Can cause hypertensive crisis

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34
Q

Treating a tyramine-MAOi-induced hypertensive crisis

A

An IV alpha blocker is effective at treating the hypertensive crisis

Like prazosin or related drug

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35
Q

Treatment of tricyclic toxicity

A

Charcoal if you get them in time

Sodium bicarbonate to help with excretion

36
Q

Depressive symptoms, but sleep more and eat more (tather than less) with “leaden paralysis” in the morning

A

Atypical depression

Treat with CBT +/- SSRIs. MAOis more considered in treatment for this condition, but still not first-line.

37
Q

Twin-twin concordance rate for bipolar disorder

A

90%

One of THE most heritable psychiatric conditions

38
Q

___ stroke can procude manic symptoms.

A

Right ACA stroke can procude manic symptoms.

39
Q

Lithium toxicity is classically precepitated by. . .

A

. . . most NSAIDs

With the exceptions of Aspirin and Sulindac

40
Q

“Prolonged QRS” in drug toxicity

A

TCA toxicity

41
Q

“Flattened T waves” or “Interveted T waves” or “U waves” (like hypolakemia) in drug toxicity

A

Lithium toxicity

42
Q

Lithium levels vs antidote

A

< 4, fluids and watch

>4, dialysis

43
Q

MOST common side effects of lithium

A

GI side effects and acne

44
Q

Therapeutic range of lithium

A

0.6-1.2

45
Q

How do we treat bipolar in pregnancy?

A

Benzodiazepines

Since lithium

46
Q

Elevated AFP can mean ___ with respect to psychiatric medications

A

Can mean presence of an NTD in patients on valproate or carbamazepine

47
Q

Therapeutic range of valproate (for bipolar)

A

6-12

48
Q

Contraindications to benzodiazepines

A

Hx of addiction

COPD, Restrictive lung disease (decraesed respiratory drive)

49
Q

Order of pharmacologic interventions for GAD

A
  1. None! Therapy only.
  2. SSRI or SNRI
  3. Buspirone
  4. Pregabalin
  5. Benzodiazepines
50
Q

Trick question about OCD treatment

A

The gold standard is still clomipramine (TCA).

But the first line is SSRIs.

Read your prompt carefully.

51
Q

PTSD 1st line

A

SSRIs + CBT

+ prazosin if nightmares are present

52
Q

Adjustment disorder is, by definition, . . .

A

. . . out of proportion to what you would expect

53
Q

Comorbidities of somatic symptom disorder

A

Often anxiety and/or depression on Axis I

Very high prevalence of personality disorder on Axis II

54
Q

___ is elevated following a true seizure and can help differentiate seizures from PNES

A

Prolactin is elevated following a true seizure and can help differentiate seizures from PNES

55
Q

Simple factitious disorder vs Munchausen syndrome

A

Simple factitious: They are just lying for no clear gain/to take on sick role. They do not induce real disease in themself (I have a headache).

Munchausen syndrome: They lie AND induce symptoms in themselves (inject faeces, take laxatives, etc).

56
Q

“V code”

A

List of DSM “conditions” that are not pathological diagnoses, but are often on the differential. Include:

Bereavement

Malingering

57
Q

Russel’s sign

A

Callouses on the knuckles from repeated indentation by the incisors

Present in patients with bulimia or anorexia with orally-induced purging behavior

58
Q

Vitals of a patient with anorexia

A

Bradycardia, hypotensive, hypothermic

Loss of volume, inability to maintain body temperature

59
Q

Dyssomnia Not Otherwise Specified

A

Encompasses periodic leg movement disorder (random kicking motions with sleeping) and restless leg syndrome (feeling creepy crawlies)

60
Q

Treatment for restless leg syndrome

A

Dopamine agonists: Ropinirole, pramipexole

61
Q

What do you need to observe on sleep study to diagnose OSA?

A

>10 hypoapneic or apneic events per hour

62
Q

Are sleep attacks diagnostic of narcolepsy?

A

NO!

You also need EITHER: hypogogic/hypnopompic hallucinations OR cataplexy

63
Q

Treatment of paranoid personality disorder

A

Low dose antipsychotic

It is one of the “personality” disorders that is actually a thought disorder, like schizotypal.

64
Q

Most common comorbid conditions with histronic personality disorder

A
  1. Substance use
  2. Eating disorder
65
Q

Patients with narcissistic personality do NOT do well with ___

A

Patients with narcissistic personality do NOT do well with group therapy

66
Q

The biggest risk factor for delirium is. . .

A

. . . advanced age

This is an even bigger risk factor than underlying dementia!!!! They love to ask you to choose between them. Suprisingly, advanced age is more important than whether or not the patient is demented.

67
Q

EEG to distinguish delirium vs psychosis

A

Diffuse EEG slowing in delirium, normal EEG in psychosis (unless they have temporal lobe epilepsy!)

68
Q

Why do patients with Down’s syndrome have a higher incidence of Alzheimer’s?

A

APP is on chromosome 21

69
Q

Memantine mechanism

A

NMDA antagonist

Weirdly enough, same with PCP and anti-NMDAR antibodies!

NMDA is a glutamate receptor activated ion channel

70
Q

Pick bodies

A

Seen in Pick’s disease aka Frontotemporal dementia

Silver-staining bodies within neurons

71
Q

Best treatment for Frontotemporal Dementia

A

Olanzapine

Best drug to treat behavioral disturbance

72
Q

EEG hallmark of Creutzfeld-Jakob disease

A

Triphasic bursts

73
Q

Alcohol is metabolized by __ order kinetics

A

Alcohol is metabolized by zero order kinetics

In other words, a certain fixed amount is metabolized per unit time, not a fixed percentage.

As a result the more you drink/higher your ABV is, the longer it takes to clear.

74
Q

What do you do before naloxone in an opioid overdose?

A

Intubate

75
Q

If a patient is being admitted for opioid detox and is in withdrawal, you treat with. . .

A

. . . symptomatic therapy, NOT methadone. If they are there to withdraw, then let them withdraw.

This involves clonidine and agents to help with symptoms.

However, if they are there for some other reason and happen to withdraw, THEN you give methadone.

76
Q

If you suspect that a patient is presenting with acute cocaine or amphetamine toxicity, what is the FIRST test you order? What is the SECOND test?

A

FIRST, get an EKG. An arrhythmia or vasospasm is how this patient will die.

SECOND, get a u-tox. This will confirm your diagnosis.

77
Q

Never give __ to a patient with cocaine toxicity

A

Never give beta blockers to a patient with cocaine toxicity

Calcium channel blockers are fine.

78
Q

The time when death is permanent/concrete operational

A

7 years

79
Q

Piaget stages

A
80
Q

Average and SD of IQ

A

Average: 100

SD: 15

2 SD below 100 (70) is where mild retardation begins. Then the degree goes up for every z-score.

81
Q

You need symptoms for ___ to receive a Dx of conduct disorder

A

You need symptoms for 6 months to receive a Dx of conduct disorder

82
Q

“Most effective” vs “First line” medications for tic disorders

A

“Most effective” = haloperidol

“First line” = clonidine (OR tetrabenazine if this is available, but not in the US!)

83
Q

Reactive attachment disorder

A

Needs not met by caregiver early in development

Difficulty forming emotional connections, hypervigilance, decreased positive emotions

84
Q

___ and ___ are child behavioral disorders related to food both of which may indicate lead poisoning

A

Rumination disorder and pica are child behavioral disorders related to food both of which may indicate lead poisoning

Psychiatry Clerkship (53 decks)

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