EOR Review Flashcards
Duration required for Dx of MDD…
2 depressive episodes > 2 weeks
ADHD sxs must be present by what age?
7 yo
ADHD dx requires sxs in how many settings?
2 or more
Tx for panic d/o vs panic attack…
panic d/o = SSRI
panic attack = BZs
Duration required for panic d/o dx
2+ attacks x at least 1 month
Persistent depressive d/o (dysthymia) requires duration of…
2+ years (not severe sxs)
One of the strongest risk factors for developing ADHD is…
1st degree relative w/ ADHD
_______ a defense process by which an unacceptable feeling is unconsciously replaced with a course of action that is constructive and personally and socially acceptable.
Sublimation
________is the defense mechanism of conscious or unconscious separating of mental contents (thoughts, feelings, fantasies) from the individual’s awareness, which is disowned and separated from one’s personality.
dissociation
________ is the unconscious defense mechanism by which an unacceptable impulse or idea is attributed to others or the external world.
projection
________ is an unconscious defense mechanism by which unacceptable feelings, ideas, or impulses are transformed into their exact opposites.
reaction formation
Mood stabilizer useful to control anger in borderline personality d/o…
lamotrigine/topiramate
Describe the following lab abnormalities in anorexia nervosa…
LH/FSH TSH ESR WBC Potassium BUN
Low FSH/LH Low TSH Low ESR Low WBC Low Potassium
HIGH BUN
4 major sxs of narcolepsy…
excessive daytime sleepiness
cataplexy
sleep-related hallucinations
sleep paralysis
5 stages described by Kubler-Ross theory of dying patients…
Denial, anger, bargaining, grieving, and acceptance
Blockage of which receptors in which brain area lead to EPS when administering typical antipsychotics like haloperidol?
D2 receptors in nigrostriatal tract
Blockage of which receptors in which brain area give typical antipsychotics their therapeutic effects?
D2 receptors in mesolimbic tract
pathological, parrot-like, and apparently senseless repetition or echoing of a word or phrase spoken by a person or heard on TV; the repetition/echoing is done without actual comprehension.
echolalia
the inability to read and understand written language
alexia
The substitution of a similar sounding word for another
paraphasia
difficulty performing a learned motor activity despite having the understanding, muscular capacity, coordination, and normal sensations to do so.
Inability to execute purposeful movement
apraxia
dextroamphetamine acts as an adrenergic agonist on which 3 receptor types?
DA, 5-HT, NE
Anorexia Nervosa can cause dysfunction in which brain region?
hypothalamus
Isoniazid overdose antidote…
pyridoxine (1:1)
________ differentiates Wernicke’s Encephalopathy from acute alcohol intoxiation… otherwise, the signs and sxs are quite similar
ophthalmoplegia (paralysis/weakness of eye muscles)
Wernicke’s encephalopathy results from a deficiency in _______ which can occur with chronic etoh abuse
thiamin
initial tx of choice for postpartum depression is…
supportive psychotherapy
Duration of sxs for brief psychotic disorder, schizophreniform disorder and schizophrenia…
brief psychotic: 1 mo
Schizophreniform: >1 mo, < 6 mo
schizophrenia: > 6 mo
systematic desensitization is a type of _______ therapy
behavioral
postpartum blues should resolve by _______ and should not meet criteria for MDD
2 weeks (peak day 5)
Tx for TCA toxicity…
sodium bicarb (until pH 7.5-7.55)
_______ is marked by marked incongruence between his experienced and assigned gender for over 6 months
gender dysphoria
2 medications used for maintenance tx of alcohol use disorder…
naltrexone, acomprosate
Divalproex (Depakote) should not be used in elderly patients who already have _______.
poor liver function
In pregnant patients, lithium levels must be monitored weekly beginning at week…
34
________ is a disorder where real neurological symptoms without a medical or neurological cause are experienced by a patient.
Often, this includes weakness, paralysis, seizures, ALOC, numbness, deafness, blindness, etc
Functional neurological symptom disorder (conversion disorder)
Maintenance opioids are only appropriate for use after…
failure of other treatment
Which 3 antidepressant types (all classes) are most strongly associated with weight gain
mirtazapine (atypicals)
TCAs
MAOIs
M/c side effects of mirtazepine
increased appetite/weight gain
dry mouth
somnolence
3 TCAs with strongest anticholinergic/antihistamine action, leading to weight gain and sedation as side effects…
clomipramine, imipramine, doxepin
Serious side effect of clozapine…
agranulocytosis
Cluster A personality disorders… described as:
weird
Cluster B personality disorders… described as:
wild
Cluster C personality disorders… described as:
worried
Which personality disorder?
pervasive distrust and suspiciousness such that other’s motives are interpreted as malevolent
Paranoid Personality Disorder
Which personality disorder?
Pervasive pattern of detachment from social relationships and a restricted range of expression.
Do not desire close relationships.
Schizoid Personality Disorder
Which personality disorder?
Pervasive pattern of social and interpersonal discomfort with reduced capacity for close relationships
cognitive or perceptual distortions, magical thinking and eccentricities
Schizotypal Personality Disorder
Which personality disorder?
Pervasive disregard for and the violation of the rights of others
H/o Criminality
Antisocial Personality Disorder
Which personality disorder?
Pervasive pattern of instability of interpersonal relationships, self image, and affect.
Marked impulsivity
Borderline Personality Disorder
Which personality disorder?
Pervasive pattern of excessive emotionality and attention seeking
Histrionic personality
Which personality disorder?
pervasive pattern of grandiosity, need for attention, lack of empathy
narcissistic personality disorder
Which personality disorder?
pervasive pattern of social inhibition, feelings of inadequacy, hypersensativity to negative evaluation
Avoidant Personality Disorder
Which personality disorder?
pervasive and excessive need to be taken care of that leads to submissive and clinging behavior
fears of separation
dependent personality disorder
Which personality disorder?
Pervasive pattern of orderliness, perfectionism, and control at the expense of flexibility, openness and efficiency
obsessive compulsive personality disorder.
________ is the subjective feeling of restlessness, need to walk, inattention, sweating
akathesia
3 drug classes that can cause akathesia
antipsychotics
antidepressants
sympathomimetics
TOC for akathesia
beta blockers (propranolol)
Patients with eating disorders (esp. bullemia/anorexia) are likely to have mothers with which psychiatric disorder?
OCD
GAD requires ___ of 6 sxs to be present for how long?
3/6 sxs x 6 months
6 sxs for GAD dx…
restlessness fatigue poor concentration irritability muscle tension sleep disturbance
Carbamazepine is metabolized by the liver and induces CYP____
CYP3A4
Which 2 medications are the only FDA approved medications for tx of PTSD?
paroxetine, sertraline
________ disease presents like alzheimers, but is characterized by well-formed visual hallucinations, parkinsonism, and fluctuating attention.
lewy body disease
eosinophilic colitis is associated with which 2 mood stabilizers?
clozapine and valproate
What Dx?
Showing of one’s gentials to unsuspecting person x 6 months or greater
Exhibitionistic Disorder
Female sexual interest/arousal disorder requires _____ of 6 sxs to which cause distress to be present for how long?
3/6 x 6 months
Absence of….
interest in sexual activity
sexual/erotic thoughts or fanticies
initiation of sexual activity/not receptive
excitement/pleasure
sexual interest/arousal in response to internal or external stimuli
genital or non-genital stimulations
female sexual interest/arousal disorder
Over a period of at least 6 months, recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on nongenital body part(s), as manifested by fantasies, urges, or behaviors.
Fetishistic disorder
lack or absence of sexual fantasies and desire for sexual activity in males x 6 months causing distress…
male hypoactive sexual desire disorder
not caused by other mental d/o, or medication
Sexual arousal by prepubescent children (generally 13 years or younger) x 6 months and has acted on urges or caused marked distress
pedophilic disorder
Arousal from being threatened or hurt during sexual activities x 6 months
sexual masochism disorder
Recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity x 6 months with action on thoughts or causing significant distress
voyeuristic d/o
Tx of voyeuristic d/o
therapy, +/- antipsychotics/antidepressants
tx of sexual paraphilia
behavioral therapy
+/- SSRI (impulse control), antiandrogens
Tx of male hypoactive sexual desire disorder
psychotherapy +/- testosterone for short term
Tx of female sexual interest/arousal disorder
psychotherapy
Patient consciously reports false symptoms, or induces symptoms, with the goal of playing the “sick role
Factitious disorder
Tx of factitious disorder
psychiatrist and PCP intervention
if imposed on child, remove child from home
Obsession with the idea of having a serious but undiagnosed medical condition despite repeated negative workups…
illness anxiety disorder
duration required for diagnosis of illness anxiety disorder…
6 mo
Tx of illness anxiety disorder
regularly scheduled appointments with PCP
CBT
1+ real sx experienced by patient which causes significant disruption x 6 months, despite negative workups
somatic sx disorder (somatization d/o)
Tx of somatic symptom disorder
frequent visits to PCP, psychotherapy
physical sxs with no cause on workup, no intentional falsification of sxs by patient
somatic sx disorder
neurologic sxs or deficits with no cause on workup and no intentional falsification by patient
functional neurologic disorder
preoccupation with having undiagnosed serious illness without intentional falsification
patient believes they are ill
illness anxiety disorder
intentional falsification of symptoms for primary gain/assume sick role
factitious disorder
intentional falsification of symptoms for external gain (money, shelter, etc)
malingering
self-harming is common in which personality disorder?
borderline personality disorder
Splitting is a defense mechanism used in _______ personality disorder where a person idealizes someone at once as “all good” or “all bad”
borderline personality disorder
A major difference between OCD and obsessive-compulsive personality disorder is that obsessive compulsive personality disorder is ego________, meaning patient is unaware the behavior is causing issues.
ego-syntonic
_________ is a cluster A personality disorder where patients are able to function in society, but is associated with development of schizophrenia
schizotypal
Delusional disorder is characterized by _______ delusion, meaning it is false, but is plausible despite being highly unlikely
nonbizarre delusion
Dx of delusional d/o requires at least _____ delusion lasting ______ month(s) without other psychotic sxs nor significant impairment in function
1 delusion x 1 month
Good or bad prognosis for schizophrenia?
negative sxs
gradual onset early in life
bad
patient presents with psychotic sxs and hx of predominant mood sxs.
schizoaffective d/o
To diagnose schizophrenia, sxs must be present for ____ months and include one of which three sxs?
6+ months
include:
delusions
hallucinations OR
disorganized speech/thought processes
Which medications are best for managing negative sxs of schizophrenia?
atypical antipsychotics
Which medications are best for managing positive symptoms of symptoms of schizophrenia, but tend to have more side effects?
typical antipsychotics (DA antagonists)
Which antipsychotic?
-greater incidence of movement d/o (EPS)
risperidone
Which antipsychotic?
-lower incidence of movement d/o (EPS)
quetiapine
Which antipsychotic?
-high incidence of weight gain and DM
olanzapine
Which antipsychotic?
- risk of agranulocytosis and myocarditis
- used for refractory schizophrenia
- decreased suicide risk
clozapine
Which antipsychotic?
- high risk of prolonged QTI
- must be taken with food
- less likely to cause weight gain
ziprasidone
Which antipsychotic?
- partial D2 agonist
- less potential for weight gain and sedation
- increased akathisia risk
Aripiprazole
Which antipsychotic?
- safe in pregnancy
- can also be used for bipolar depression
lurasidone
The following are _____ TCAs:
Amitriptyline
imipramine
clomipramine
tertiary TCAs
unique indication for clomipramine…
OCD
unique indiction for imipramine
nocturnal eneuresis
The following are _____ TCAs:
desipramine
nortriptyline
secondary
Secondary TCAs act on the _______ receptor to increase the concentration of…
NERT, NE
Tertiary TCAs act on the ____ and ______ receptors to increase the concentration of which neurotransmitters?
SERT and NERT
5HT and NE
3 major types of side effects of TCAs
sedation (H1 blockade)
Atropine-like SFx (M blockade)
orthostatic hypotension (Alpha 1 blockade)
6 signs/sxs of serotonin syndrome
skin flushing hyperthermia agitation rigidity seizure coma
the 3 most common causes of death from TCA… (3 Cs)
convulsion
coma
cardiotoxicity
5HT2 receptors impact which 3 behaviors?
mood
feeding
reproduction
DA receptors impact which behaviors
cognitive function
awakeness
motivation
MAOIs act on which 3 neurotransmitters via blockade of monoamine oxidase?
DA, 5HT2, NE
MAOIs are effective for what type of depression?
atypical depression (improve mood in response to positive events)
The following three MAOIs are (selective/non-selective)
isocarboxazid
phenelzine
tranylcypromine
nonselective (inhibit MAO A and MAO B)
nonselective MAOIs bind irreversibly and increase levels of…
5HT, NE, DA
The following two MAOIs are (selective/non-selective)
selegiline
rasagiline
selective (inhibit MAO B)
selective MAOIs only increase which neurotransmitter?
DA
2 major side effects of MAOIs
hypertensive crisis
serotonin syndrome
how long must MAOIs be stopped before switching ot a medication like an SSRI?
2 weeks
Tx of MAOI induced hypertensive crisis…
phentolamine
These two types of presynaptic neurons also have alpha 2 receptors
NE, 5HT
Mirtazapine blocks which 4 receptor types?
Blockade of which receptor give it its therapeutic effect?
alpha 2
5HT2a
5HT3a
H1
alpha 2 blockade (reduces inhibition of presynaptic neuron)
Mirtazapine is a partial serotonin antagonist, and its blockade of 5HT2a and 5HT3a leads to increased binding to ______ receptors, which are linked to depression
5HT1a
mechanism of action for bupropion…
blockade of NERT and DART receptors on presynaptic neuron
High levels of dopamine in the ______ pathway are responsible for the positive sxs of schizophrenia
mesolimbic
low levels of DA in the ______ pathway are responsible for the negative sxs of schizophrenia…
mesocortical
Haloperidol and fluphenazine are considered ______ potency antipsychotics
high potency
chlorpromazine, thiothixene and thioridazine are considered _____ potency antipsychotics
low potency
Typical antipsychotics stimulate the release of ______ in the ______ region, resulting in galactorrhea, gynecomastia and oligomenorrhea
prolactin release in tuberoinfundibular pathway
How does NMS differ from serotonin syndrome?
serotonin syndrome: hyperreflexia, dilated pupils
NMS: hyporeflexia, normal puils
Tx for NMS…
dantrolene
This typical antipsychotic causes corneal deposits…
chlorpromazine
this typical antipsychotic causes retinal deposits
thioridazine
DA in the mesolimbic pathway influence which behaviors?
motivation and desire
DA in the mesocortical pathway influences which behaviors?
emotions
DA in the nigrostriatal pathway influences which behavior?
involuntary movements, coordination
DA in the tuberoinfundibular pathway has what effect?
release DA to limit secretion of prolactin
Atypical antipsychotics block ______ in the mesolimbic pathway to alleviate positive symptoms and block ____ receptors in the mesocortical pathway to alleviate negative symptoms
D2, mesolimbic
5HT2a, mesocortical
Which atypical antipsychotic is most likely to cause hyperprolactinemia?
risperidone
dystonia is an EPS characterized by onset of hours-days with muscle spasm such as torticolis or oculogyric crisis where eyes are fixed in an upward and lateral gaze.
Tx for dystonia is…
Anticholinergics: benztropine or diphenhydramine
1st line tx of opioid abuse…
methadone/suboxone
AMS, coma with normal vitals and normal pupils suggests overdose of…
benzos (ACDC = amnesia, confusion, disinhibition/dizziness/drowsiness/disorientation, cognitive impairment
Sialorrhea (drooling) is a unique side effect of which antipsychotic and can be treated with ______
clozapine, glycopyrrolate
nortriptyline is an inhibitor of reuptake of NE and 5HT. The exertion of NE reuptake inhibition occurs in which brain region?
locus coeruleus (location of most NE neurones)
3 main mood stabilizers…
lithium, carbamazapine/oxcarbazapine, valproate
2 main side effects of mirtazapine, which can be advantageous depending on presentation of depression
sedation
weight gain
the antidepressant with the least likely side effects of sexual dysfunction…
trazodone (SFx: priapism)
bupropion decreased sexual side effects, but trazodone has none
Haloperidol is used in acute agitation, but is contraindicated for patients with which condition?
parkinson’s disease
