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Psychiatry rotation > First aid psych > Flashcards

First aid psych Flashcards

1
Q

Hypomanic episode

-sx, time criteria

A
  • at least 4 days
  • less severe manic episode
  • not severe enough to cause marked impairment in social/occupational functioning
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2
Q

What drug intox/withdrawal?

Euphoria, grandiosity, pupil dilation, prolonged wakefulness and attention, HTN, tachycardia, anorexia, paranoia, fever

A

Amphetamine intox

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3
Q

Opioid addiction tx options with drugs (3)

A
  1. methadone–long-acting oral opioid
  2. Suboxone (buprenorphine+naloxone)–partial agonist oral, long acting
  3. naltrexone–long acting opioid blocker. Used for relapse prevention once detoxed
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4
Q

Parkinson’s disease

sx (5)

A

parkinsons “TRAPS” the body

Tremor (at rest. pill-rolling tremor)

Rigidity–Cogwhell

Akinesia/bradykinesia

Postural instability

Shuffling gait

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5
Q

Lewy body dementia

-sxs

A

“guy in chair hallucinates to see Louie, then falls”

  • hallucination and dementia
  • Later proression: falls (parkinsonian)
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6
Q

Atypical antipsychotics

-side effects, which drugs (4)

A

Olanzapine/Clozapine–weight gain, hyperglycemia, diabetes

Clozapine–agranulocytosis (do weekly WBC monitoring) so infection risk, weight gain

“watch Clozapine Clozly”

Clozapine is useful for pts whose sxs are refractory to other antipsychotics.

Ziprasidone–long QT (torsade de pointes)

Risperadone–prolactin increase, gynecomastia, galactorrhea

Aripripazole

Quetiapine

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7
Q

What drug intox/withdrawal?

Fever, psychomotor agitation, analgesia, belligerence, impulsiveness, nystagmus, tachycardia, homicidality, psychosis, delirium, seizures

A

PCP intox

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8
Q

Parkinson symptoms: think what 3 diseases

A
  1. parkinsons
  2. lewy body dementia

(old person hallucinates and sees Louie, then falls)

  1. frontotemporal (Pick) dementia

(“Prick,” disease picks frontotemporal)

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9
Q

Antipsychotics

  • extrapyramidal sx (4)
  • mech and tx
A

4 hrs, 4 days, 4 wks, 4 mo

Acute dystonia–neck spasm

Akathesia–restlessness

Bradykinesia–parkinsonism

Tardive dyskinesia–oral-facial movements, potentially permanent.

mech of 1st 3: Increased Ach activity from DA blocking. So, use anticholinergics (benadryl, benztropine)

Tardive dyskinesia: caused by upregulation of DA receptors. Stop antipsychotic. CANNOT use anticholinergic b/c make it worse. Increased antipsychotic will actually improve sxs but only temporarily.

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10
Q

Cognitive disorders (2)

A
  1. delirium

check for anticholergic drugs

  1. dementia

In elderly patients, depression may present like dementia (pseudodementia)

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11
Q

Bupropion

  • side effects
  • what to be careful about
A

increase NE, DA.

  • side effects: stimulant effects–tachy, insomnia. HA, lower threshold for seizures, no sexual side effects
  • contraindicated in Bulimic patients and anorexic for lower seizure threshold
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12
Q

How does anticholinergic action affect the eye? Other than mydriasis

A

Cycloplegia, causing blurred vision

-loss of accomodation (relies on ciliaris muscle to adjust lens)

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13
Q

Parkinsons drugs (5) and mechs

A

BALSA

Bromocriptine (DA agonist)

Amantadine (may increase DA release)

Levo-dopa (with carbidopa)

Selegiline (MAO-B inhibitor in brain)

Antimuscarinics (benztropine)

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14
Q

What drug intox/withdrawal?

Euphoria, anxiety, paranoid delusions, slowed time perception, impaired judgment, social withdrawal, increased appetite, dry mouth, conjunctival injection, hallucinations

A

Cannabis intox

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15
Q

OCD

-drug tx (2)

A

SSRI high dose, Clomipramine (TCA)

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16
Q

Parkinson’s disease

-mech

A

Lewy bodies, loss of DA neurons in substantia nigra

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17
Q

Main side effects to know:

Carbamazapine

Valproic acid

Lamotrigine

Gabapentin

A
  1. agranulocytosis
  2. hepatotoxicity (necrotizing hepatitis), agranulocytosis ( do regular LFTs and CBC)
  3. Stevens-Johnson
  4. Tremor
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18
Q

Bipolar disorder

  • drugs to tx
  • drugs to avoid
A

Mood stabilizers: Carbamezapine, Lithium, Valproic acid

Atypical antipsychotics

-no antidepressants, can cause mania

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19
Q

What drug intox/withdrawal?

Euphoria, resp and CNS depression, reduced gag reflex, pupillary constriction, seizures

A

Opioid intox

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20
Q

Psych ROS, My mnemonic

A

Depressed persons seem anxious, some come psychotic.

Depression/mood

Personality (esp borderline)

Subst abuse

Anxiety disorders

Somatiform/eating disorders

Cognitive (delirium, dementia)

Psychotic disoders

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21
Q

Benzos: What durations? and name them and their main uses, according to FA Psych

  1. long acting (3)
  2. intermediate (4)
  3. short acting (3)
A
  1. 1-3 days
  2. 10-20 hours
  3. 3-8 hrs

Diazepam (Valium)–rapid onset, anxiety and seizure control

Chlordiazepoxide (Librium)–EtOH detox

Flurazepam (Dalmane)–rapid onset, insomnia

Alprazolam (Xanax)–panic attacks

Lorazepam (Ativan)–panic attacks, EtOH withdrawal

Temazepam (Restoril)–insomnia

Clonazepam (Klonopin)–panic attacks, anxiety

Oxazepam (Serax)

Triazolam (Halcion)–rapid onset, insomnia

Midazolam (Versed)–procedural sedation

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22
Q

Mirtazapine

  • mech
  • side effects
A
  • alpha 2 blocker. So, releases NE, 5-HT
  • sedation, increased appetite, weight gain.

(Good side effects for pts with insomnia, low appetite, anorexia, elderly (weight gain).

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23
Q

Tourette syndrome

  • time criteria
  • Tx
A

>1 year persistence of motor/vocal tics

Tx with antipsychotics or bx therapy

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24
Q

Delusional disorder

-sx, time criteria

A

>1 mo

  • persistent untrue belief system
  • functioning not impaired!
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25
Q

What drug intox/withdrawal?

Anhedonia, appetite increase, hypersomnolence, existential crisis

A

Amphetamine withdrawal

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26
Q

Time criteria (when start, how long last)

-postpartum blues, depression, psychosis

A

blues: starts 2-3 days after delivery, usually resolves in 10 days
depression: starts within 4 weeks of delivery, lasts 2 weeks to a year or more
psychosis: usu lasts days to 4-6 weeks.

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27
Q

MAO-I

-toxicity

A

HTN crisis with tyramine ingestion (no MAO to metabolize the food)

Avoid many food such as Cheeses, wine

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28
Q

What drug intox/withdrawal?

Sleep disturbance, depression, anxiety, seizure

A

Benzo withdrawal

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29
Q

Alzheimer’s

  • what percent familial
  • what genes
A

familial, 10%

Early onset: presenilin 1,2, ApoE4

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30
Q

What drug intox/withdrawal?

Depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep

A

PCP withdrawal

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31
Q

Risk factors for suicide

A

SADPERSONS

Sex-male

Age (teen or elderly)

Depression

Previous attempt

Ethanol/drug use

Rational thinking loss

Sickness (illness or 3+ Rx meds)

Organized plan

No spouse

Social support–lacks

32
Q

What drug intox/withdrawal?

tachycardia, tremors, anxiety, seizures,

hallucinations, delusions, confusion

A

DTs from EtOH withdrawal

Autonomic hyperactivity

Psychotic sxs

Confusion

33
Q

Major depressive disorder

  • dx criteria, time criteria
  • how long do depressive episodes last
  • types (4)
A
  1. MDD: >2 weeks. episodes last 6-12 months
  2. Dysthymia (persistent mild depression): >2 years
  3. SAD: winter
  4. Atypical depression: no time criteria. Mood reactivity, interpersonal rejection sensitivity

MDD: Pt-reported low mood + 5 or more of SIGECAPS:

Sleep change

Interest loss

Guilt

Energy loss

Concentration loss

Appetite change

Psychomotor retardation, agitation

Suicidality

34
Q

Manic episode

-criteria (sx, time)

A

>1 week of elevated mood, + 3 or more of following:

DIG FAST

Distractibility

Irresponsibility–seek pleasure with no regard to consequences

Grandiosity–inflated self-esteem

Flight of ideas–racing thoughts

Activity increase (more goal directed activity), psychomotor agitation

Sleep–reduced need

Talkativeness or pressured speech

35
Q

Frontotemporal dementia

-sxs

A
  • “prick”
  • dementia with parkinsonian aspects
  • change in personality, uninhibited behavior
36
Q

Hallucinations–what are MCC

  1. visual
  2. auditory
  3. olfactory
  4. tactile
A
  1. medical illness (drug intox), less likely psychiatric
  2. Psychiatric, less likely medical
  3. brain tumor, epilepsy
  4. Formication, coke bugs: EtOH withdrawal, cocaine abuse
37
Q

What drug intox/withdrawal?

Hypersomnolence, malaise, severe psychological craving, depression/suicidality

A

Cocaine withdrawal

38
Q

What drug intox/withdrawal?

Sweating, dilated pupils, piloerection, fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea (flu like sxs)

A

Opioid withdrawal

39
Q

antisocial, conduct, oppositional defiant

what order, and requirements/descriptions

A

Oppositional defiant–>Conduct–>Antisocial PD

oppositional: pattern of hostile bx against authority, but no serious violations of social norms
conduct: now, violating basic rights of others (hurt people, destroy property, theft)

Antisocial: Must be >18 and have hx of Conduct disorder before age 15

40
Q

GAD

  • time criteria, vs what
  • Drug tx (3)
A

GAD: >6 mo

Adjustment: <6 mo

SSRI, SNRI, buspirone, CBT

41
Q

What drug intox/withdrawal?

Impaired judgment, pupil dilation, hallucinations, paranoid ideations, angina

A

Cocaine intox

42
Q

What drug intox/withdrawal?

Delirium, life-threatening CV collapse

A

Barbiturate withdrawal

43
Q

Smoking cessation

-what drugs can help? (2)

A

Bupropion (Wellbutrin)–increase NE and DA release

Varenicline (Chantix)–nicotinic partial agonist

44
Q

SSRIs

  • time to take effect
  • main side effects (3)
A
  • 4-8 weeks
    1. Anorgasmia, ED, low libido
    2. GI upset (diarrhea), from serotonin activity in gut
    3. Serotonin syndrome–hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures. Tx with cyproheptadine
45
Q

Alzheimers drugs (4)

A

Memantine–NMDA receptor blocker

Rivastigmine, Gallantamine, Donepezil–AchE inhibitors

Mr Rivas is my man…Done with Alzheimers and feels Gallant.

46
Q

Personality disorders

3,4,3

A

“weird, wild, worried”

Paranoid, Schizoid, Schizotypal

Borderline, Antisocial, Histrionic, Narcissistic

Avoidant, Obsessive-compulsive, Dependent

47
Q

Typical Antipsychotics

-side effects (not including extrapyramidal)

A

Typical:

  1. alpha-adrenergic blocker: hypotension, ED
  2. antimuscarinic–dry mouth, incontinence, CNS confusion
  3. antihistaminic–sedation
  4. DA blocker–prolactin increase: gynecomastia, galactorrhea
48
Q

Tricyclics

  • side effects
  • how to tx cardio toxicity
A

(similar to typical antipsychotics)

anticholinergic–incontinence, dryness, CNS confusion, tachy

antihistaminic–sedation

alpha blockade–HoTN, ED

3 C’s:

Cardiac–arrhythmias from long QRS (tx with NaHCO3 to release in urine–use base to bind acid)

Coma

Convulsions

49
Q

What drug intox/withdrawal?

perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis

A

LSD intox

50
Q
A
51
Q

Which nutrition deficiencies can cause dementia (3)

A

B1/thiamine: wenicke-korsakoff syndrome (Beriberi)

Triad for Wernicke encephalopathy: confusion, opthalmoplegia, ataxia.

Korsakoff’s psychosis: confabulation, personality change, permanent memory loss. Damage to mamillary bodies. Tx with thiamine

B3: Pellagra. Diarrhea, dementia, dematitis

B12: CNS/PNS demyelination

52
Q

Bipolar disorder

-types (3), time criteria

A

Bipolar 1–presence of at least 1 manic episode w/ or w/o hypomanic or depressive episode

Bipolar 2–presence of hypomanic and depressive episode

Cyclothymic–dysthymia and hypomania, lasts >2 years

53
Q

Panic disorder

  • dx criteria (3 things)
  • time criteria
A

-Attack, followed by >1 mo of 1+ of the following:

1-persistent concern of additional attacks

2-worrying about consequences of attack

3-Bx change related to attacks

54
Q

Tremor types and assoc disease

(3)

A
  1. Essential (postural/action tremor–pt tries to hold arm in 1 position steady, maintain posture, but can’t)
    - genetic predisoposition, pts often self medicate with EtOH. Tx with propranolol
  2. Resting (pill-rolling)
    - Parkinsons
  3. Intention tremor (slow zig-zag when pointing toward target)
    - Cerebellar dysfunction
55
Q

4 dopaminergic systems in brain, their functions and diseases

A

1,2. schizophrenia

mesolimbic, positive sxs

mesocortical–negative sxs

  1. parkinsonism

Nigrostriatal, coordination of voluntary movements

  1. prolactin

tubuloinfundibular, controls prolactin

56
Q

Lithium

  • what drug interaction to know
  • used for bipolar and what else?
A
  • thiazides. (Lithium follows Na+ absorption in PCT). So, bipolar pt with recently diagnosed HTN gets ataxic with tremor. Cause: HCTZ
  • SIADH
57
Q

Panic disorder

-drug tx (3)

A

SSRI, SNRI-Venlafaxine, Benzos

Not Buspirone

Also CBT

58
Q

Typical antipsychotics

-name them by low/high potency, and specific side effects

A

“Try to Fly High, Cheating thieves are low”

Trifluoperazine, Fluphenazine, Haloperidol–more EPS

Chlorpromazine, Thioridazine–anticholinergic, antihistamine, alpha blocker

Chlorpromazine–cornieal deposits

Thioridazine–reTinal deposits

59
Q

PTSD

  • time criteria, vs what
  • tx
A

PTSD: >1 mo

Acute Stress disorder: 3 days-1 mo

Tx: SSRI, psychotherapy

60
Q

Tricyclics

-why be careful to use in elderly? And which to use if you have to?

A

Anticholinergic side effect can cause CNS confusion, hallucinations in elderly, esp with Amitriptyline.

Use nortripyline (less anticholinergic)

61
Q

Substance abuse: stages of overcoming addiction

(6)

A
  1. precontemplation–not yet acknowledged as problem
  2. comtemplation–acknowledged, but not ready to change
  3. preparation/determination–ready
  4. action/willpower–taking action
  5. maintenance
  6. relapse
62
Q

How does vascular dementia present differently from Alzheimers?

-how common is vascular dementia?

A
  • Often presents with focal deficits from infarcts. unlike alzheimers
  • 2nd most common cause of dementia
63
Q

Dissociative disorders: (2)

A
  1. dissociative identity disorder (formerly multiple personality)
    - presence of 2 or more distinct IDs/personality states
  2. depersonalization/derealization disorder
    - persitent feelings of detachment from one’s own body, thoughts, perceptions, actions
64
Q

What drug intox/withdrawal?

Irritability, depression, insomnia, nausea, anorexia

A

Cannabis withdrawal

65
Q

schizophrenia and related forms of disease

-differences, time criteria

A

Schizoid (distant)–>Schizotypal (thinking, magical)–>Schizophrenia–>Schizoaffective (+mood, >2 weeks)

Brief psychotic disorder (<1 mo)

Schizophreniform (1-6 mo)

Schizophrenia (6 mo)

66
Q

Schizophrenia

-dx criteria (5 sx), time criteria

A

>6 mo, and 2 or more of following 5:

  1. delusions
  2. hallucinations
  3. disorganized speech
  4. disorganized/catatonic behavior
  5. Negative sx (flat affect, social withdrawal, etc)
67
Q

Huntington’s disease

  • mech
  • symptoms (4)
A
  • atrophy of caudate nucleus
  • CAG repeats (Caudate loses Ach and GABA)
  • choreiform movements
  • aggression
  • depression
  • dementia

(sometimes mistaken for substance abuse)

68
Q

Lithium

-side effects

A

LMNOP

Lithium

Movement (tremor)

Nephrogenic Diabetes insipidous (tx for SIADH)

O (HypOthyroidism)

Pregnancy (fetal heart problems)

Also, arrhythmia from heart block

69
Q

Pt with anorexia

-what problems to look for

A
  • osteoporosis (caused in part by reduced estrogen), with metatarsal stress fractures
  • anemia
  • E-lyte disturbances (vomiting–>met alk–>hypokalemia (H+ leaves cell, K+ enters)–> arrythmias)
70
Q

Trazodone

  • mech
  • clinical uses
  • side effects
A
  • blocks 5-HT2, alpha receptors
  • primary use is insomnia, b/c high doses required for antidepressive effects
  • priapism (TrazoBone)
71
Q

SNRI

-side effects, most common

A
  • increase in BP most common
  • also stimulant effects, sedation, nausea
  • sexual side effects less severe than SSRI
72
Q

Buspirone

  • how long to take effect?
  • react with alcohol, benzos?
  • mech
A
  • 1-2 weeks
  • No
  • 5-HT agonist
73
Q

What drug intox/withdrawal?

emotional lability, slurred speech, ataxia, coma, blackouts

A

EtOH intox

74
Q

Normal vs pathologic grief

A

Normal: can last 6-12 mo. may have simple hallucinations (hearing name called)

Pathologic: lasts >6-12 mo. can have depressive sx, delusions, hallucations

75
Q

Bulimia signs

A
  • Russell sign (dorsal hand callouses)
  • parotitis
  • enamel erosion
  • E-lyte disturbances/alkalosis

Psychiatry rotation (1 decks)

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