Exam II Flashcards
1
Q
either difficulty initiating sleep, difficulty maintaining sleep, or early morning waking
A
Insomnia
2
Q
Insomnia:
- timeline
- TX (3)
A
- 3+ nights per week x3 months
- CBT for insomnia (CBTi), Benzos, melatonin
3
Q
MC sleep disorder?
A
Insomnia
4
Q
excessive sleepiness despite 7+ hours of sleep
A
Hypersomnolence Disorder
5
Q
Hypersomnolence Disorder:
- timeline
- TX
A
- 3x per week x3 months
- 15 min naps (no FDA approved pharm)
6
Q
irrepressible need to sleep with 1 or more of the following:
- episodes of cataplexy
- hypocretin deficiency
- REM sleep latency <15 mins
A
Narcolepsy
7
Q
_____ deficiency from the posterior thalamus leads to unstable activation/deactivation of sleep wake centers leading to narcolepsy
A
Orexin
8
Q
CSF Orexin levels <____ can lead to Narcolepsy
A
<110 pg/mL
9
Q
Narcolepsy:
- timeline
- TX (2)
A
- 3x per week x3mo
- 15 min naps at lunch or medication (Modafinil, Armodafinil, Pitolisant, Solriamfetol, Sodium Oxybate)
10
Q
5+ obstructive apneas per hour and either
- breathing disturbances
- daytime sleepiness/fatigue
A
Obstructive Sleep Apnea
11
Q
15+ obstructive apneas per hour regardless of sx
A
Obstructive Sleep Apnea
12
Q
Obstructive Sleep Apnea is associated with what other condition?
A
adult onset DM
13
Q
Obstructive Sleep Apnea tx?
A
CPAP
14
Q
5+ central apneas per hour of sleep
A
Central Sleep Apnea
15
Q
Central Sleep Apnea is associated with…
A
chronic opioid use
16
Q
Central Sleep Apnea Tx? (3)
A
- CPAP
- BiPAP
- Adaptive Servoventilation (ASV)
17
Q
sleep with decreased respiration associated with elevated CO2 levels
A
Sleep Related Hypoventilation
18
Q
Sleep Related Hypoventilation TX?
A
CPAP
19
Q
sleep disruption d/t altered circadian rhythm or a schedule that causes misalignment b/t endogenous circadian rhythm and sleep-wake schedule; leads to excessive sleepiness and/or insomnia
A
Circadian Rhythm Sleep-Wake Disorder
20
Q
50% of ______ pts experience Circadian Rhythm Sleep-Wake Disorder?
A
blind
21
Q
50% of blind pts experience…
A
Circadian Rhythm Sleep-Wake Disorder
22
Q
Circadian Rhythm Sleep-Wake Disorder Tx?
A
light therapy (bright light in am helps delayed phase; in evening helps advanced phase)
23
Q
- incomplete awakening from sleep with 1 of the following: sleepwalking
and/or sleep terrors - NO dream imagery is recalled
- amnesia for the episodes
A
Non-REM Sleep Arousal Disorders
24
Q
Non-REM Sleep Arousal Disorders risk factor?
A
family member who sleep walks
25
Non-REM Sleep Arousal Disorders TX?
avoid sleep deprivation, consistent sleep schedule, safeguard the home
26
dysphoric well-remembered dreams and on awakening, pt rapidly becomes oriented and alert
Nightmare Disorder
27
Nightmare Disorder TX?
usually self-limited
- can do imagery reversal therapy and process underlying trauma
28
arousal during sleep with vocalization and/or complex motor behaviors
episodes occur during REM sleep
REM Sleep Behavior Disorder
29
REM Sleep Behavior Disorder TX?
safe sleeping environment
30
urge to move the legs d/t uncomfortable sensation in legs
Restless Leg Syndrome
31
Restless Leg Syndrome:
- timeline
- TX?
- 3x per week x3 months
- dopaminergic agents (Ropinrole, Pramipexole)
32
EITHER
- delay in ejaculation
- infrequency or absence of ejaculation
Delayed Ejaculation
33
Delayed Ejaculation:
- timeline
- TX
- 6+ months
- decreases substances (alcohol, SSRIs/SNRIs) and behavioral therapy
34
in a pt with Delayed Ejaculation, if you're concerned of a neuro deficit, what should you test?
pudendal nerve conduction study
35
1 or more of the following:
- difficulty obtaining an erection
- difficulty maintaining an erection
- decreased erectile rigidity
Erectile Disorder
36
Erectile Disorder
- timeline
- labs
- TX
- 6+ months
- free T, PRL, fasting glucose, lipids, thyroid
- PDE5 inhibitors
37
Erectile Disorder
- caution with PDE5 inhibitor use in pts with/on...
- nitrates (antiHTN meds)
- unstable angina
38
Either
- delay or absence of orgasm in female
- decreased orgasm intensity in female
female orgasmic disorder
39
female organsmic disorder:
- timeline:
- TX (2)
- 6+ months
- remove SSRI/SNRI, CBT
40
reduced sexual interest / arousal with 3+ symptoms
Female Sexual Interest / Arousal Disorder
41
Female Sexual Interest / Arousal Disorder:
- timeline
- DX tool:
- TX? (2)
- 6+ months
- female sexual function index
- CBT, sex therapy
42
difficulty with 1 of the following
- penetration
- pelvic pain with sex
- fear or anxiety about the pain
- tensing or tightening with sex
Genito-Pelvic Pain / Penetration Disorder
43
Genito-Pelvic Pain / Penetration Disorder:
-timeline:
- tx? (2)
- 6+ months
- manual therapy for pelvic floor, CBT
44
deficient or absent sexual / erotic thoughts and desire for sexual activities in males
Male Hypoactive Sexual Desire Disorder
45
Male Hypoactive Sexual Desire Disorder:
- timeline
- TX
- 6+ months
- CBT, sex therapy
46
ejaculation occurring during partnered sexual activity within 1 minute following vaginal penetration and before individual wishes
Premature Ejaculation
47
Premature Ejaculation:
- timeline:
- TX?
- 6+ months
- CBT, sex therapy
48
incongruence b/t one's experienced gender and assigned gender
at least SIX months of strong desire to be/insistence to be other gender (need SIX criteria)
Gender Dysphoria in kids
49
incongruence b/t one's experienced gender and assigned gender
at least SIX months of strong desire to be/insistence to be other gender (need TWO criteria)
Gender Dysphoria in adolescents or adults
50
Gender Dysphoria:
- DX
- timeline
- TX (3)
- gender identity interview schedules
- 6+ months
- CBT, hormonal tx, surgical interventions
51
sexual arousal from observing an unsuspected person naked, undressing, or engaging in sexual activity
Voyeuristic Disorder
52
Voyeuristic Disorder:
- timeline
- minimum age
- tx
- 6+ months
- 18+ years old
- CBT
53
sexual arousal from the exposure of one's genitals to unsuspecting persons
Exhibitionistic Disorder
54
Exhibitionistic Disorder
- timeline
- tx
- 6+ months
- CBT
55
sexual arousal from touching or rubbing against a nonconsenting person
Frotteuristic Disorder
56
Frotteuristic Disorder:
- timeline
- tx
- 6+ months
- no good treatment; can try GnRH agonist
57
sexual arousal from the act of being humiliated, beaten, bound, or made to suffer
Sexual Masochism Disorder
58
Sexual Masochism Disorder
- timeline
- tx
- 6+ months
- no good tx; can try CBT
59
sexual arousal from the physical or psychological suffering of another person
Sexual Sadism Disorder
60
Sexual Sadism Disorder
- timeline
- TX
- 6+ months
- incarceration; can try CBT
61
sexual arousal from use of nonliving objects or highly specific focus on congenital body parts
Fetishistic Disorder
62
Fetishistic Disorder
- timeline
- tx
- 6+ months
- many consider it a gift and avoid tx!
63
sexual arousal form cross-dressing
Transvestic Disorder
64
Transvestic Disorder
- timeline
- tx
- 6+ months
- psychodynamic psychotherapy (long-standing tx)
65
angry or irritable mood, argumentative/defiant behavior, or vindictiveness with at least 4 sx
Oppositional Defiant Disorder
66
Oppositional Defiant Disorder
- timeline
- tx
- anatomic changes
- 6+ months
- CBT, parent training (if <12 y/o)
- low HR, low cortisol, prefrontal cortex and amygdala changes
67
failure to control aggressive impulses
- verbal or physical aggression x3 months
- OR 3 behavioral outbursts involving damage of property or assault within 12 months
Intermittent Explosive Disorder
68
Intermittent Explosive Disorder
- minimum age
- tx
- risk factors
- 6 y/o
- CBT behavioral modification
- hx of physical or emotional trauma within 1st 20 years of life
69
pattern of behavior in which the basic rights of others or major age-appropriate societal rules/norms are violated; need 3 symptoms
Conduct Disorder
70
Conduct Disorder:
- if less than 18 y/o, criteria for _____ are NOT met
- tx?
- antisocial personality disorder
- head start REDI programs to develop coping skills, trained foster parents, pharm (chlorpromazine, thioridazine, haloperidol)
71
fire setting on 1+ occasion,
tension or arousal prior to event,
fascination with fire,
pleasure/relief when setting fires,
Pyromania
72
Pyromania:
- tx
CBT
73
impulses to steal objects that are not needed for personal use,
tension before threat,
pleasure/relief after theft,
theft is not d/t anger or delusion/hallucination
Kleptomania
74
Kleptomania
- tx
- M or F?
- CBT (target tension and compensatory behavior)
- F > M
75
Alcohol Use Disorder:
- # of sx
- timeline
- relevant labs
- 2+ sx
- within 12 months
- AST:ALT ratio of 2:1
76
Alcohol withdrawal:
- can be life threatening d/t
- tx
Delirium Tremors
Benzos
77
Alcohol Use Disorder:
- tx (3)
- Disulfiram
- Naltrexone
- Acamprosate
78
Caffeine Intoxication
recent caffeine consumption
(usually >250 mg) with __+ sx after intake
5+
79
Cannabis Use Disorder:
- use with __+ sx within __months
2+
12 months
80
Cannabis Use Disorder:
- TX
- endoscopic sedation medication ______ doses in those using cannabis
- CBT, Motivation Enhancement Therapy (MET)
- increase
81
phencyclidine use leading to 2+ sx within 12 months
Hallucinogen-Related Use Disorder
82
Hallucinogen-Related Use Disorder
- tx
- MOA
- hallucinogen persisting perception disorder -- NO good tx! antipsychotics are NOT effective
- NMDA antagonist
83
pattern of hydrocarbon inhalant use with 2+ sx within 12 months
Inhalent Use Disorder
84
Inhalent Use Disorder
- tx
hospitalization with acute intoxication / resp suppression
85
Opioid Use Disorder Prevention of Relapse:
- tx (2)
- Methadone
- Buprenophine
- Naltrexone
86
what must be done before giving Methadone and why?
ECG d/t risk of QT prolongation
87
Opioid Use Disorder OD:
- tx
Naloxone
88
Pt with Opiod use disorder presents with meiosis and decreased RR
Opioid INTOXICATION
89
Pt with Opiod use disorder presents with piloerection
Opioid WITHDRAWAL
90
Sedative, Hypnotic, or Anxiolytic Disorder:
- tx?
taper off! decrease dose 25-50% every 1-2 weeks
91
Sedative, Hypnotic, or Anxiolytic Disorder: OD
- tx?
Flumazenil
92
Amphetamine-type use with 2+ sx within 12 months
Stimulant Use Disorder
93
Stimulant Use Disorder:
- tx?
CBT
94
tobacco use disorder:
- tx? (3)
nicotine replacement
Bupropion
Varenicline
95
Gambling Disorder:
- tx?
CBT
motivational interviewing
96
what are the Criteria for Delirium?
WACC (waxing/waning, acute onset, changes in attention, changes in cognition) as a consequence of another medical condition / substance use
97
up to 1/3 of delirium cases are caused by...
meds!
98
Delirium:
- dx:
- tx:
- confusion assessment method
- olanzapine (BB warning of increased mortality) and tx underlying condition)
99
criteria for major neurocognitive disorder?
significant cognitive decline from a previous level in 1+ cognitive domains (complex attn, executive function, learning/memory, language);
DEFICITS INTERFERE WITH INDEPENDENCE IN EVERYDAY ACTIVITIES
100
criteria for mild neurocognitive disorder?
significant cognitive decline from a previous level in 1+ cognitive domains (complex attn, executive function, learning/memory, language);
DEFICITS DO NOT INTERFERE WITH INDEPENDENCE IN EVERYDAY ACTIVITIES
101
criteria for PROBABLE neurocognitive disorder d/t Alzheimers
- major NC disorder with genetic mutation OR all 3 clues present
- mild NC disorder with genetic mutation
102
criteria for POSSIBLE neurocognitive disorder d/t Alzheimers
mild or major NC impairment with
no genetic mutation or 3 clinical clues
103
neurocognitive disorder d/t Alzheimers
- pathology
- tx (3)
- beta amyloid plaques, tau neurofibrillary tangles
- AchE inhibs (Donepazil, Rivastigmine, Galantamine), NMDA antag (Memantine), mAb (Adacanumab)
104
gradual progressive NC disorder with relative sparing of learning and memory
Frontotemporal NC Disorder
105
two variants of Frontotemporal NC Disorder
behavioral variant
language variant
106
Frontotemporal NC Disorder TX?
behavioral strategies
107
gradual progressing cognitive deficits with
A) Core Dx Features (fluctuating cognition, hallucinations, Parkinsonism)
B) Suggestive Features (REM sleep behavior disorder, neuroleptic sensitivity)
NC Disorder with Lewy Bodies
108
NC Disorder with Lewy Bodies TX?
behavioral strategies
tx hallucinations and REM SBD
109
cognitive deficit is temporarily d/t CVA and evidence of cerebrovascular disease
Vascular NC Disorder
110
Vascular NC Disorder
- TX?
- MRI
- behavioral strategies
- focal infarcts
111
evidence of TBI with 1+ of the following (LOC, post-traumatic amnesia, disorientation/confusion, neuro signs) AND disorder presents immediately after TBI
Neurocognitive Disorder d/t TBI
112
Neurocognitive Disorder d/t TBI
- risk factor
- TX
- repeated concussions
- memory aides
113
criteria met for mild or major NCD and a +HIV test
Neurocognitive Disorder d/t HIV Infection
114
Neurocognitive Disorder d/t HIV Infection tx?
behavioral strategies
115
criteria met for mild or major NCD; rapid progression
motor sx such as myoclonus or ataxia
Neurocognitive Disorder d/t Prion Disease
116
Neurocognitive Disorder d/t Prion Disease tx?
fatal!!
117
criteria met for mild or major NCD;
occurs in the setting of Parkinson's;
gradual progression
Neurocognitive Disorder d/t Parkinsons
118
Neurocognitive Disorder d/t Parkinsons
- Avoid what tx
- Tx
- anticholinergics and antipsychotics
- use Ldopa / carbidopa
119
criteria met for mild or major NCD;
gradual progression;
clinically dx with HD
Neurocognitive Disorder d/t Huntingtons
120
Neurocognitive Disorder d/t Huntingtons
- tx
- genetic
- MRI
- antidepressants
- chromosome 4 CAG repeat
- caudate atrophy
121
pervasive distrust and suspiciousness of others such taht their motives are interpreted as malevolent;
4 of 7 sx
Paranoid Personality Disorder
122
Paranoid Personality Disorder
- tx:
- DX: (2)
- psychotherapy (antipsychotics have no benefit)
- Millón Clincal Multiaxial Inventory (MCMI) or Minnesota Multiphasic Personality Inventory (MMPI)
123
pervasive pattern of detachment from social relationships and a restricted range of expression of emotions
Schizoid Personality Disorder
124
Schizoid Personality Disorder:
- number of Sx
- tx
- 4+ sx
- no pharm; group therapy is helpful
125
pervasive pattern of social and interpersonal deficits as well as by cognitive or perceptual distortions and eccentricities of behavior
Schizotypal Personality Disorder
126
Schizotypal Personality Disorder:
- number of sx
- tx
- risk factor
- 5+ sx (odd beliefs, paranoid, lack of close friends)
- poor candidate for for low structure therapy; no FDA approved pharm; try group therapy
- family member with schizophrenia or other psych disorder
127
pervasive pattern of disregard for and violation of the rights of others; occurring since 15 y/o; evidence of conduct disorder with onset before 15 y/o
Antisocial Personality Disorder
128
Antisocial Personality Disorder
- number of sx
- tx
- risk factor
- 3+ sx
- poorest tx response of any personality disorder! highly tx resistant
- family hx; lower socioeconomic status
129
disorder with poorest tx response of any personality disorder! highly tx resistant
Antisocial Personality Disorder
130
pervasive pattern of instability of interpersonal relationships, self-image and affects, marked impulsivity
Borderline Personality Disorder
131
Borderline Personality Disorder
- number of sx
- tx
- risk factor
- 5+ sx
- no pharm; dialectical behavior therapy (DBT)
- 5x increased risk if family member with disorder
132
pervasive pattern of excessive emotionality and attention seeking with wanting to be center of attention, sexually seductive, dramatic, physical appearance to draw attention
Histrionic Personality Disorder
133
Histrionic Personality Disorder
- number of sx
- tx
- 5+ sx
- group therapy
134
pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, lack of empathy
Narcissistic Personality Disorder
135
Narcissistic Personality Disorder
- number of sx
- tx
- m or f?
- 5+ sx
- group therapy (homogenous narcissistic group)
- M > F
136
pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation (avoids social contact, fear of not being liked)
Avoidant Personality Disorder
137
Avoidant Personality Disorder
- number of sx
- tx
- 4+ sx
- group therapy, CBT
138
pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation (indecisive, lack of independence, etc)
Dependent Personality Disorder
139
Dependent Personality Disorder
- number of sx
- tx
- 5+ sx
- group therapy (individual therapy might encourage the dependence)
140
pervasive pattern or preoccupation with orderliness, perfectionism, and mental interpersonal control at the expense of flexibility, openness, and efficiency
Obsessive Compulsive Personality Disorder
141
Obsessive Compulsive Personality Disorder
- number of sx
- tx
- 4+ sx
- individual CBT
142
_________ are used to avoid anticipated dangers, or to stabilize the individuals emotional state, but often at a loss of other emotional or relational opportunities
Defense mechanisms 
143
Defense Mechanisms:
The withdrawal from consciousness of an unwanted idea, affect or desire by pushing it down or repressing it into the unconscious part of the mind; i.e. not recalling a traumatic experience
Repression 
144
Defense Mechanisms:
The fixation and consciousness of an idea, affect or desire that is opposite to a feared unconscious impulse i.e. resentful mother is overprotective
Reaction formation
145
Defense Mechanisms:
Unwanted feelings are displaced onto another person where they then appear as a threat from the external world i.e an angry person accuses another of hostile thoughts towards them
Projection
146
Defense Mechanisms:
A return to earlier stages of development and abandoned forms of gratification belonging to them prompted by dangers or conflicts arising at one of the later stages i.e. following a stressful encounter and adult lies in bed, sucking their thumb
Regression
147
Defense Mechanisms:
The diversion or deflection of instinctual drives usually sexual ones into non-instinctual channels, i.e. desire and energy to seduce another is channeled into art or work projects
Sublimation
148
Defense Mechanisms:
The cautious refusal to perceive that painful facts exist i.e. denying feelings of hostility consciously allows an individual to escape certain thoughts, or events like an arrest
Denial
149
Defense Mechanisms:
The substitution of a safe or reasonable explanation for the true but threatening cause of behavior, i.e. explaining aggression toward another as self-defense, instead of efforts to fulfill a selfish desire
Rationalization
150
Defense Mechanisms:
Use of irony, sarcasm, or other tools to reframe a situation in a hilarious light i.e. during an argument one person makes fun of themselves diffusing the tension of the interaction.
 Humor
151
Major component of CBT?
Homework
152
Vagus Nerve Stimulation:
electrodes surgically placed around the ____ vagus nerve
left
153
ECT uses ________ for paralytic purposes in the typical pt; what is the ADR?
- succinylcholine (depolarizing)
- increased serum K+
154
ECT uses _______ for paralytic purposes in inactive/bedridden, paretic, or burn pts
Cisatrocurium
Rocuronium
155
ECT:
- uses (2)
- ADRs (1)
- severe MDD episode, catatonia
- retrograde and anterograde amnesia
156
Transcranial Magnetic Stimulation (TMS)
- targets ______ for MDD
- targets ______ for OCD
- dorsolateral prefrontal cortex
- anterior cingulate gyrus
157
indications for TMS?
MDD
OCD
158
three components of suicidal AND homicidal assessment?
1. thoughts
2. plans
3. intent
4. access to means
5. prior attempts
159
TX for agitated pt with psychosis, mania, or unclear etiology?
SGA (quick dissolving or IM)
160
Pt presents with hyperreflexia, fluctuations in vital signs, shivering
Serotonin Syndrome
161
Pt presents with rigidity, mutism, hyperthermia, diaphoresis, tachycardia and HTN CRISIS
Neuroleptic Malignant Syndrome (ADR of antipsychotics)
162
Omega 3 Fatty Acids have most beneficial evidence in...
bipolar
MDD
163
St. Johns Wort indications?
MDD
164
St Johns Wort DDI?
CYP Inducer!
165
S-Adenosylmethionine (SAMe)
- MOA (1)
- indication (1)
- may be better if used with...
- increases serotonin, NE, DA (depending on folate and B12 availability)
- MDD
- augmentation with SSRI/SNRI
166
SE of Valerian for anxiety/sleep
hepatoxicity
167
Melatonin:
- endogenously secreted by
- no human evidence of what ADR?
- pineal gland
- retinal damage
168
ADRs of Kava for anxiety?
hepatotoxicity
liver failure
169
Ginkgo Biloba:
- possible indication?
- minimum length of tx vs maximum?
- memory issues with mild dementia
- min 8 weeks; max 1 year
170
ADRs of DHEA for memory / depression sx? (5)
- wt gain
- hirsutism
- irregular menses
- voice changes
- prostatic hypertrophy
171
both St. johns wort and SAMe have shown similar efficacy to ____ in treating MDD
TCAs
172
Psychotropic Considerations:
- don't start a medication you are not comfortable _____, _____ and _____
- do not exceed FDA ________
- make _____ medication change at a time
- ensure appropriate ongoing ______
- managing, monitoring, weaning off
- approved maximum dose
- one
- monitoring
173
Psychotropics and HIV care:
- initial doses ____ of standard starting dose
- increase dose at ____ the usual pace
1/2 (half)
1/2 (half)
174
Psychotropics and HIV care:
- what HIV drugs INHIBIT CYP450 2B6 and what effect does this have on psychotherapy?
- ritonavir, nelfinavir, efavirenz
- increase bupropion levels
175
Psychotropics and HIV care:
- what HIV drug induces CYP450 and what effect does this have on psychotherapy?
- Nevirapine
- decreases bupropion levels
176
Pregnancy and Antidepressants:
- most used medications? (4)
- Citalopram
- Escitalopram
- Fluoxetine
- Sertraline
177
1st line recommended antidepressants while breastfeeding? (2)
Sertraline
Paroxetine
178
"start low and go slow" refers to psychopharmacology in what population?
elderly
179
Military Resuscitative Meds and Psych ADRs:
- Epi (2)
- Lidocaine (2)
- Atropine (2)
- anxiety, increased BP/HR
- delirium, psychosis
- delirium, anxiety
180
BICEPS for Management of Combat-Operational Stress Reactions:
- what is the B?
brevity (tx should occur over no more than a few days)
181
BICEPS for Management of Combat-Operational Stress Reactions:
- what is the I?
Immediacy (tx should take place ASAP)
182
BICEPS for Management of Combat-Operational Stress Reactions:
- what is the C?
centrality/contact (higher level mental health services should be co-located with higher level care services)
183
BICEPS for Management of Combat-Operational Stress Reactions:
- what is the E?
Expectancy (tx should be geared toward returning service member to his/her unit)
184
BICEPS for Management of Combat-Operational Stress Reactions:
- what is the P?
Proximity (tx should take place as close as possible to member's unit)
185
BICEPS for Management of Combat-Operational Stress Reactions:
- what is the S?
Simplicity (tx should be as simple as possible)
186
who has the highest rate of being a 2C19 poor metabolizer?
Asian individuals
