Lange Q&A Flashcards
biggest risk factor for suicide
prior suicide attempt
narcolepsy triad
sleep attacks
cataplexy
hypnopompic/hypnagogic hallucinations or sleep paralysis
what stage of sleep does nightmare disorder occur in
what happens quickly upon arousal
latter third of night and during REM sleep
person quickly becomes oriented upon arousal
what stage of sleep do sleep terrors occur?
stages 3-4
when diagnosing MDD in children, what symptom can substitute for depressed mood?
irritable mood
- markedly limited vocab
- making errors in tense
- difficulty recalling words or producing sentences with developmentally appropriate length or complexity
expressive language disorder
avg number of words spoken by a 2 year old
200
criteria for schizoaffective disorder
presence of psychotic sxs for at least 2 weeks in the absence of mood sxs
how to tx schizoaffective disorder
antipsychotic + antidepressant
new mom is sad and always thinks she hears her child crying… what is it? how to tx?
postpartum depression with psychotic features
tx with SSRI and APD
bilateral abducens nerve palsy, horizontal nystagmus, ataxia, global confusion, apathy
wernicke’s encephalopathy
drug to tx delusional disorder
antipsychotic
if someone presents in acute manic state and agitated, what do you give?
antipsychotic and benzo
-start mood stabilizers non-emergently as they take a week to take effect
you can get acute stress disorder or PTSD from witnessing something traumatic (life threatening, serious injury, etc)
T/F
T
which SSRI side effect can persist for the duration of tx?
sexual dysfunction
what to give in TCA overdose? what do ppl die from?
sodium bicarb
cardiac arrhythmia
pharm management of opiate withdrawal
clonidine
methadone
what drug to give to delirious old ppl
haldol
best tx for borderline personality
DBT
what is phenelzine
MAOI
MDD > bereavement if :
- depressive sxs last for longer than 2 moths
- survivor has guilt surrounding anything other than actions they should have taken to prevent the death
- survivor has prominent hallucinatons
- psychomotor retardation
- suicidal ideation
onset of emotional or behavioral disturbances within 3 months of a significant life event that may manifest as marked change in an individual’s ability to function in school, work, or interpersonal relationships
- not as severe as MDD
- not bereavement
adjustment disorder
first line agent for panic disorder
SSRI
treating OCD
CBT and SSRIs
first line drug for tourette’s
what about for severe cases
clonidine
antipsychotic
atomoxetine
what is it and what is it used for
SNRI
tx for ADHD
common side effect of clonidine and what to do about it
sedation
either wait it out for a few weeks or reduce the dose
if alcoholics can abstain from alcohol for 4 weeks, only 5% of them will continue to have sxs of depression (T/F)
T
you can have delusions in dysthymia and adjustment disorder (T/F)
F
MZ twin concordance with bipolar disorder
80-90%
what is residual type of schizophrenia
absence of positive sxs and a preponderance of negative sxs
non addicting sleep agent
benadryl
Li, carbamazepine, depakote
which one does not cause decrease in WBC
Li- it can cause a modest benign increase in WBC
- carbamazepine- benign reduction in WBC count but severe blood dyscrasias occur in 1/125,000 patients
- depakote- often a benign thrombocytopenia but can cause rarely agranulocytosis
what to do with somatization disorder?
look up previous test results/previous care
assess for other treatable psychiatric illnesses
somatization disorder often assoc with which personality disorder
histrionic
what to give a shizotypal personality person who is under stress and has “micropsychotic episodes”
low dose APDs
lab findings in chronic alcoholic
elevated or depressed LFTs
hypomagnesemia
thrombocytopenia
increased PT
which anti-epileptic can be used for alcohol withdrawal
carbamazepine
good test to evaluate short term memry
Brown Peterson task
-useful during ECT as it can result in amnesia
fluvoxamine MOA
SSRI
venlafaxine MOA
serotonin and norepinephrine reuptake inhibitor
factitious disorder by proxy
mother is most likely (anxious/depressed/angry)
2 personality disorder associations
depressed
histrionic and borderline
time cut off for acute stress disorder
within 4 weeks of event
what happens when MAOI + aged cheese, wine, beer, pickled foods
how to tx
hypertensive crisis
tx with alpha blocker (IV phentolamine)
side effects of clozaril
seizures
tachycardia, hypotension, sedation, fatigue, weight gain
does not affect prolactin so does NOT cause galactorrhea
which routine monitoring test do you have to get for patients on clozaril
CBC with diff
frequently used tool to asses dementia
MMSE
20-25 suggestive of cognitive impairment
< 20 definitive impairment
wisconsin card sort test is used to test ________, which is located in _______
executive function
frontal lobe
when assessing mania, rule out this medical condition
thyroid disorder
phenytoin (dilatin) side effects
gingival hyperplasia, nystagmus, dizziness, slurred speech, ataxia, mental confusion, decreased coordination
ebstein anomaly assoc with ______
lithium
hepatic failure assoc with this mood stabilizer
depakote
risk of schizophrenia in general population and if you have one parent with it
1% and 12%
the Rorschach test is a associative projective test (T/F)
T
a manic episode can be due to cocaine intoxication T/F
T
amok
culture-bound syndrome of Malaysian origin that refers to a violent or furious outburst with homicidal intent. often results in multiple casualties
- prodromal brooding
- homicidal outburst
- persistence in reckless killing without an apparent motive
- claim of amnesia
dhat
anxiety regarding the discharge of semen (Indian)
ganser syndrome
patient who responds to questions by giving approximate or outright ridiculous answers
latah
Malaysian or Indonesian term
-middle aged women who have sudden fear, often with dissociation and catatonic-like features (echolalia, echopraxia)
if you can’t use benztropine for EPS, what should you use instead?
amantadine
denial is a ______ defense
regression
rationalization
suppression
denial- narcissistic defense
regression- immature defense
rationalization- neurotic defense
suppression- mature defense
in psychogenic coma, you would still have normal cold water caloric nystagmus (T/F)
T
how to calculated IQ
(mental age/chronological age) x 100
how to tx severe depression in elderly with multiple medical (esp cardiac) conditions
ECT
atypical specifier for depressive episode
mood reactivity
2/4: increased appetite or weight gain, hypersomnia, leaden paralysis, rejection sensitivity
melancholic specifier for depressive episode
loss of interest or pleasure in all or almost all activities or a lack of reactivity to usually pleasurable stimuli
identification
defense mechanism in which the person incorporates the characteristics and qualities of another person or object into his or her own ego system
fixation
overactive attachment to a person or object
catatonia
psychomotor disturbance involving motor immobility, excessive motor activity, mutism, negativism, peculiar voluntary movements, echolalia, echopraxia
catalepsy
an immobile position that is maintained
you should avoid using benadryl as a sleep aid in older pts due to anticholinergic effects and possible delirium (T/F)
T
MAOI + meperidine (demerol)
hypertensive crisis
depression tx during pregnancy
MAOI
ECT
SSRI
- MAOI- contraindicated due to exacerbation of pregnancy induced HTN
- ECT- safe
- SSRI (such as fluoxetine)- relatively safe
most common sx of caffeine withdrawal
HA
tx of NMS
D/C the offending drug
IV dantrolene and PO bromocriptine
cooling measures
lithium toxicity
how to tx?
severe CNS and renal impairment
- dysarthria, coarse tremor, ataxia
- impaired consciousness, fasciculations or myoclous, seizures, coma
tx: gastric lavage, rehydration, hemodialysis
right parietal stroke would most likely cause issues with ______ memory
visual, nonverbal
can test with Rey-Osterrieth Test (copying a complex figure and then drawing it from memory)
fluoxetine takes ______ to wash out of the system
what are the implications
6 weeks
do not start MAOI within this time frame or you might cause serotonin syndrome
some complications of anorexia
osteoporosis, constipation, cold intolerance, leukopenia, thyroid dysfunction, cardiac arrhythmias
mortality rate for anorexia
5-20%
if the sxs of major depressive episode begin within 2 months of the loss and do not persist beyond the 2 month period, it is normal bereavement unless:
- thoughts of death other than feelings they would be better off dead
- expressing guilt other than about the actions taken or not taken at the time of death
- morbid preoccupation with worthlessness
- marked psychomotor retardatio
- hallucinations other than that of the deceased individual
yep
complicated bereavement is chronic and unremitting distress (T/F)
T
sxs within 3 months of an identifiable stressor with marked distress in excess of what would be expected from experiencing the stressor
adjustment disorder
dysthymic disorder requires ________ of sxs
2 years
best studied drug to tx OCD
clomipramine (TCA)
also evidence for SSRIs but need higher doses than for depression
nausea, vomiting, bradycardia, seizures might be due to ________
anticholinesterase toxicity
sxs when you drink while taking disulfiram
flushing, sweating, dyspnea, hyperventilation, tachycardia, hypotension, nausea, vomiting
lithium interacts with these pain meds so that lithium levels are increased –> abdominal pain, diarrhea, drowsiness
ibuprofen, indomethacin, ketoprofen, diclofenac, phenylbutazone, naproxen, piroxicam
-acetaminophen, aspirin, opiates do not interact
mirtazapine (remeron) MOA
what is a benefit?
increases both adrenergic and serotonergic neurotransmission
it’s nice because it doesn’t cause appreciable sexual dysfunction
medically ill patients with depressive disorders may respond to psychostimulants (T/F)
T
ex. methylphenidate
huffing, sniffing, etc intoxication sxs
visula disturbances, dyscoordination, depressed reflexes, euphoria, nystagmus
conjunctival injection, increased appetite
marijuana use
diminished response to pain, euphoria, staring into space
PCP intoxication
hair loss is assoc with this mood stabilizer
also nausea, vomiting, indigestion, sedation, mildly elevated serum transaminase levels, hepatic failure
depakote
SSRIs cause what kind of sexual dysfunction
decreased libido, delayed orgasm
retrograde ejaculation can be caused by ______
antipsychotics
ADHD sxs need to have started before age _____
7
if your first stimulant doesn’t work for ADHD tx, what do you do?
try another stimulant
la belle indifference is classically seen with ____
conversion disorder
-indifference shown toward a deficit or loss of function
in a pregnant schizophrenic in labor, which APD would you give?
a high potency APD like haldol because the lower potency APDs have more alpha blocking properties and my lower BP significantly
conjunctival injection, mild sedation, dose dependent hypothermia, dry mouth, increased appetite, tachycardia, euphoria, sense of slowed time
cannabis intoxication
miosis, bradycardia, hypotension, hypothermia, constipation, euphoria
opiate intoxication
unpredictable behavior, assaultiveness, belligerence, agitation, nystagmus, tachycardia, numbed response to pain, muscle rigidity, hyperacusis, hpertension, echolalia, anticholinergic effects
PCP intoxication
confusion, muscle twitching, weakness, abdominal cramps, depression, palps, coma, respiratory failure
nicotine intoxication
tachycardia, pupils dilated, constriction of coronary arteries, euphoria
cocaine intoxication
mania in bipolar disorder can often present with psychotic symptoms (T/F)
T
cocaine can produce both _____ and _____
mania and psychosis
metabolic disturbances in bulimia patients
hypokalemic-hypochloremic alkalosis (due to vomiting)
elevated Na
best therapy for bulimia
CBT
_______ is more commonly seen in children with mDD compared to adolescents with MDD
psychomotor agitation
-appears anxious and irritable > sad and depressed
most common suicide method in children
substance ingestion
common side effects of DDAVP (2)
headache and nausea
the approximate comorbidity of childhood anxiety disorders and MDD is ______ percent
50%
side effects of fluoxetine (4)
GI (nausea, loose stools)
insomnia
agitation
headaches
Rett disorder is only seen in ______ and demonstrates _______% concordance in identical twins
girls
100%
odd repetitive movements with hands, head circumference normal until 12 months and then halts in growth
Rett disorder
adjustment disorder does not last longer than ______
6 months
first line tx for tourette disorder
clonidine
-others include TCA, high potency APD, atypical APD
what disorder is commonly associated with tourette?
OCD
what do you need to dx tourette?
multiple motor tics AND at least one vocal tic at sometime during the illness
onset before age 18
first line tx for ADHD and its side effects
stimulants
-increased risk of developing tics
how to dx reading disorder
achievement in reading is substantially lower than IQ
_____ % of children with learning disorders have a comorbid psych disorder
50%
pharmacologic tx of enuresis
DDAVP
side effects of stimulants
insomnia, decreased appetite, weight loss, dysphoria, irritability
non-stimulant med for ADHD
atomoxetine- NE reuptake inhibitor
metabolic issues with anorexia patients
hypercholesterolemia
mild normocytic normochromic anemia
leukopenia
early onset schizophrenia (before age 10) is associated with a (better/worse) outcome
worse
ADHD vs. mania… who has the lower self esteem
ADHD
children understand the irreversibility of death around age _____
7-8
biggest averse effect of clonidine upon initiation of tx
sedation
the process of adopting other people’s characteristics
-ex: girl who just came from the doctor’s wants to “play doctor” with her friend
identification
defense mechanism: emotions are shifted from one idea or object to another that resembles the original but evokes less stress
“student who is angry at mother talks back to teacher instead”
displacement
defense mechanism: a person’s character or sense of identity is temporarily but drastically modified in order to avoid emotional distress
dissociation
defense mechanism: unacceptable impulse is transformed into its opposite
“man who is in love with his married coworker insults her”
reaction formation
child abuse most likely results in which psych condition in the grown up child
MDD
what kind of therapy for OCD?
CBT
range for mental retardation
normal: 90-110
mild: 55-70
moderate: 40-54
severe: 25-39
goal of which age group: establish a secure sense of trust that occurs in the relationship with one’s responsive caregiver
infancy
goal of which age group: identification with superheroes
preschool (oedipal phase)
goal of which age group: increasing understanding that they are a separate being from their caregiver and they practice separating and reuniting with their caregiver
toddlers
goal of which age group: ability to think logically and concretely (can identify that equal amounts of liquid in two differently shaped containers hold the same amount)
school age (concrete operations)
goal of which age group: ability to think abstract fashion
adolescence (formal operations)
prevalence of schizophrenia in general population
1%
nihilistic delusion that they have lost blood, heart, intestines, as well as that the world beyond them has been reduced to nothingness
Cotard syndrome
delusion that familiar people assume the guise of strangers
Fregoli delusion
delusional disorder is characterized by the presence of _______ delusions
nonbizzare (potentially feasible)
durations of brief psychotic disorder, schizophreniform disorder, and schizophrenia
brief psychotic disorder: 1 day-1 month
schizophreniform: 1 month-6 months
schizophrenia: > 6 months
good prognosis for schizophrenia
good premorbid functioning later age at presentation female gender acute and rapid onset of sxs presence of mood symptoms
best acute tx for catatonia
benzos or ECT
contraindications to ECT
space occupying lesion (ex. large meningioma)
MI in the last 3 months
most consistent sleep disturbance of depression
early morning awakenings
episodic hypomania and subclinical depression
cyclothymia
only _______ is necessary to diagnose bipolar I
manic episode
major depressive episodes and hypomanic episodes
bipolar II
double depression
major depressive episode superimposed on dysthymic episode
DTs, if untreated, have a mortality of ____
30%
docility, lack of fear response, anterograde amnesia, hyperphasia, hypersexuality
kluver bucy syndrome
Onset of mood and behavioral changes following an acute stressor. Does not last more than 6 months
Adjustment disorder
Patient exposed to traumatic event and has flashbacks, numbing, and increased arousal for up to 1 month after the event
Acute stress disorder
Pregnant heroin addict. What do you give her?
Methadone is safe
Episodic mood symptoms and chronic psychotic symptoms outside of the mood symptoms
Schizoaffective disorder
