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PANCE 2024 > Pschy / Behav. > Flashcards

Pschy / Behav. Flashcards

1
Q

What 3 symptoms are effected in GAD

A

1st the amygdala and then

Autonomic nervous system

Followed by HPA Axis influence

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2
Q

Average age at onset for GAD

A

Women at 30 years old

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3
Q

2 physical manifestations of GAD

A

Increased heart rate
Increased sweating

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4
Q

DSM-5 time frame for GAD

A

Worry excessive more days than not for at least 6 months

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5
Q

Management GAD

A

CBT = 1st line

SSRIs = pharma management

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6
Q

Hyperexcitation of what two things occur in panic disorder

A

Amygdala and Hypothalamus

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7
Q

Panic disorder occurs when ?

A

Episodic

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8
Q

Panic order classically has what after an attack?

A

1 month of worry of another attack

Rule out substance USE

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9
Q

Bipolar 1 vs. 2

A

1 = Depressoin with mania ; think more psychosis longer than a 1 week MANIA = any psychosis

2 = Depression with hypomania = less than 4 days of manic sxs

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10
Q

Primary risk factor of bipolar disorder

A

Family history

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11
Q

Pneumonic for Bipolar

A

DIGFAST

Distratibility

Impulsivity

Grandiosity

Flight of ideas

Activity increase

Sleep defecit

Talkativeness

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12
Q

How would we treat mood in bipolar

A

Lithium

Valproate acid

Carbamazepine

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13
Q

What if used alone can cause Mania in bipolar

A

SSRIS

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14
Q

2 concerns for lithium

A

Thyriod issues = hypothyroid

Nephrogenic DI

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15
Q

Decrease in what hormones cause anorexia nervosa

A

Dopamine and serotonin

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16
Q

2 types of anorexia

A

Restricting type

Binge eating/purging type

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17
Q

4 sxs of anorexia nervosa

A

Denial of illness = Dont FEEL they have a problem

Amenorrhea

Weight loss

Intense fear of gaining weight

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18
Q

Type of hair assoc with anorexia nervosa

A

Lanugo Hair

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19
Q

BMI with anorexia

A
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20
Q

Low what 3 electrolytes in anorexia nervosa

A

K+

Magnesium

Chloride

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21
Q

What it’s reseeding syndrome

A

High GLUCOSE = High INSULIN = increase cellular uptake of phosphate

Low phosphate + DEMAND for phosphate when feeding =

Tissue hypoxia
Heart Failure
Peripheral Edema

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22
Q

Type of heart condition assoc with anorexia nervosa

A

MVP

*dont forget seizures

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23
Q

MC electrolyte abnormality seen in bulimia nervosa

A

Low cholesterol
Low K+

Metabolic Alkalosis

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24
Q

4 sxs of bulimia nervosa

A

Distorted body image
Fear of weight gain
Binge eating
Self induced vomiting laxative use

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25
Q

Forced vomit in bulimia nervosa causes what sign on the hand

A

Russell sign ; forced acid on the hand.

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26
Q

Bulimia nervosa treatment

A

CBT and Fam therapy

Dont forget adding fluoxetine ; because they are sad about there selves

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27
Q

Why do you avoid bupropion in bulimia

A

Lowers the seizure threshold

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28
Q

MDD ,,, SND?

A

Sleepy
Not interested
Depressed

Serotonin
Norepinephrine
Dopamine
[all decreased]

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29
Q

DSM 5 for MDD

A

5 or more sigecaps for at least 2 weeks

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30
Q

SSRI side effects

Fluvoxamine

Fluoxetine

Setraline

Paroxetine

A

Paroxetine and Fluvoxamine = sedating ;

Fluvoxamine = N/V

Paroxetine = Weight Gain

Fluoxetine and Sertaline = activating ;

Fluoxetine = akathasia

Sertraline = withdrawal ; sexual dysfunction

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31
Q

SAD PERSONS risk factor for suicide

A

Sex = MALE

Age = adolescents and greater 70

Depression

Poor financial / previous attempts

Excess ETOH

Rational decision making decreased

Spouse absent

On their own // LGBTQ community

No JOB

Sickness or recent stress

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32
Q

PMDD ; what meds

A

Affects quality of life + Breast tenderness + Bloating [ w/ an affective sxs]

SSRI
OCPs
GnRH agonist

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33
Q

What phase does PMDD occur in the cycle

A

Luteal phase ; 2 weeks before period

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34
Q

If PMDD wants pharm management and wants get pregnant do what>

And if they dont?

A

Wants to = SSRI

Does not = OCPS

Refractive = GnRH agonist

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35
Q

OCD patients feel how about their obsession

A

Intrusive
Repetitive

Thoughts that they can’t control; but dont know how to stop
They are embarrassed

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36
Q

OCD sxs must last longer than what

A

1 hour per day

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37
Q

OCD have higher or lower dose SSRI compared to MDD

A

Higher

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38
Q

SCHIZOID

A

AVOID and lifelong

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39
Q

Cluster A think what ; SPS

A

Odd and eccentric ; WEIRDO

Schizotypal = awkward magic thinking

Paranoid = accusatory

Schizoid = aloof ; avoid

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40
Q

Cluster B ; 4 disorder think what

A

Borderline = up and down, labile

Antisocial = BAD, Conduct Disorder in child hood

Histrionic = Drama BOY , center of attention , BIG

Narcissistic = BEST , better than anyone else, react harshly to criticism

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41
Q

Cluster C disorders ; 3

A

Worried !

Dependent = CLINGY

Avoidant = COWARDLY; like people they dont like social situations

Obsessive - compulsive = cant get past DETAILS, RULES, SCHEDULES - over compulsive

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42
Q

Borderline needs what therapy

A

DBT ; dialectical behavioral therapy

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43
Q

Schizophrenia

Schizophreniform

Schizoaffective

[time frame]

A

Phrenia = 6 months, no depressive manic episode

Phreniform = 1 - 6 months

Affective = phrenia with depressive/manic episode ; with 2 at least weeks of normal periods

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44
Q

Risk factor from family for schizo

A

Advanced paternal age

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45
Q

Positive vs. Negative sxs

A

Positive = ADDS = delusions , hallucinations. Strange behavior

Negative = REMOVES = flat, Decresed fluency, social withdrawal

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46
Q

Brief psychotic disorder

A

One day - Less than one month of episodes

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47
Q

Delusional disorder is

A

Greater than 1 month of schizo disorder

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48
Q

Schizophrenia usually starts at what age

A

18 -25 yrs old

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49
Q

First line for schizo

A

2nd generation antipsychotics

Quetiapine
Risperidone

Clozapine ==== AGRANULOCYTOSIS

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50
Q

Serotonin syndrome think what

A

CNA

Cognitive issues
Neuromuscular issues
Autonomic instability

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51
Q

Neuropleptic malignant syndrome

A

Last days to weeks
Hyperthermia
Lead pipe rigidity
Slowed reflexes

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52
Q

1 reason for bad prognosis in schizo

A

Negative symptoms present

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53
Q

Conversion disorder think what

A

Somatic symptom disorder

Overly sensitive to normal body sensations
Only need one sxs

Adults = multiple
Kids = one complaint

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54
Q

Conversion disorder vs. Illness anxiety

A

Conversion = sensation is there, but report is out of proportion ; focused on a SYMPTOM

Illness anxiety = there is no actual sensation and it is blown out of proportion ; focused on a DISEASE

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55
Q

Somatic symptom disorder #1 thing you need to do

A

Make sure they see one provider ; with regular visits

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56
Q

Length of time for illness anxiety disorder

A

6 months of sxs

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57
Q

Cycle of illness anxiety

A

Seek care and also avoid care

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58
Q

Most effective 1st line for illness anxiety

A

CBT

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59
Q

Factious vs. Malingeering

A

Factious = Munchhowsens = want to assume sick role, invasive interventions, will hurt themselves for care ABUSE of self or child, exam inconsistent . NO OBVIOUS EXTERNAL REWARDS.

cpeptides can be used to test for exogenous insulin

Malingeering = They are lying but no obvious reason why. No secondary gain.

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60
Q

1st line ETOH use disorder pharm mangement

A

Naltrexone

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61
Q

Patho of alcohol withdrawal

A

Down regulation of GABA ; up regulation of NMDA receptors

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62
Q

Women vs. Men concerning drinks per day and week

A

W
Day = more than 3 per day
Week = more than 7 per week

M
Day = More than 4 per day
Week = more than 14 per week

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63
Q

Alcohol intoxication vs. withdrawal

A

Intoxication = slurred speech ; blackout ; euphoria

Withdrawal = seizures ; tremors ; cravings ; stomach pains

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64
Q

Delirium tremens happen during what stage of alcoholism

A

Withdrawal ; greater 48 hours after stoping drinks

Hepatic inpury

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65
Q

Wernickes vs Korsakoff

A

Wernickes = encephalopathy [disoriented] ; oculo motor dysfunction ; ataxia

Korsakaoff = same as above by add confabulation [ no understanding of the lies they make ]

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66
Q

Time frame for alcohol use or withdrawal disorder

A

12 month

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67
Q

Lab findings of alcohol use disorder

A

AST : ALT 2/1
GGT
Megalocystosis
Anemia
Carb deficient transferrin

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68
Q

Second line for alcohol use =

A

Disulfiram = they will have a reaction if they drink

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69
Q

Treatment of choice pharm for alcohol withdrawal

A

Benzo’s think:

Chlordiazepoxide
Diazepam
Lorazepam

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70
Q

Preventative measure screening for alcohol

A

Cage

Cut down
Affecting / Annoying life/job/family
Guilty
Eye opener in the morning

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71
Q

Meperidine is what type of drug

A

Opioid

NALOXONE REVERSAL

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72
Q

3 sxs opioid intoxication ; #1 withdrawal

A

Miosis
CNS depression
Hypoventilation

WITHDRAWAL = mydriasis

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73
Q

Opioid withdrawal treatment

A

Buprenoprhine

Methadone

QT prolongation

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74
Q

MC stimulant that I will see

A

Mathamphetamine

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75
Q

Mydriasisi + diaphoresis + dystopia + dyskinesia

A

Think Stimulent intoxication

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76
Q

Rotary nystagmus is what ?

A

PCP use! Intoxication

77
Q

Avoid what medicine in cocaine associated stimulant intoxication

A

Beta blockers

= unopposed alpha receptors = ischemia

78
Q

1st Line best med for PTSD

A

Paroxetine

SSRIs

79
Q

ASD vs. PTSD

A

ASD = 0-28 days

PTSD = at least one month after trauma w/ intrusive sxs / negative mood

80
Q

Trauma must be what in PTSD

A

Experienced first hand

Not seen in movies or told by a story

81
Q

PTSD protective measure

A

Can’t remember all the details of the event first hand.

82
Q

Prazosin can be used for what

A

Nightmares and children with night terrors

83
Q

Adjustment disorder develops in what time frame

A

Within 3 months of a disorder

84
Q

REM sleep behavior disorder occurs most often when

A

1-2 hours before awakening

85
Q

Nightmare disorder

A

Is not associated with motor activity

86
Q

Sleep terrors occur when

A

1st 3rd of sleep

87
Q

Unstable relationships
Everyone is good or bad
Self mutilation

Think

A

Borderline personality disorder

88
Q

Lack of empathy think

A

Narcissist

89
Q

MC SSRI to cause diarrhea

A

Sertraline

90
Q

MC SSRI to cause HTN

A

Venlafaxine

91
Q

with patient presenting in TCA OD think what? [the 3 c’s]

A

Convulsions

Coma

Cardiac issues

92
Q

definition of anhedonia

A

Little interest or pleasure in doin things

93
Q

Lithium in pregnancy can lead to what heart condition

A

Ebsteins anomaly

94
Q

What supplement increases serotonin levels

A

St. John’s wart

95
Q

Schizo patients love what substance most

A

Nicotine

96
Q

What is the best drug in schizo patients to stop suicide

A

Clozapine

97
Q

Major depressive disorder what you need to know

A

5 sxs over
2 week

With depressed mood/loss of interest; at least 1

98
Q

TXM for seasonal Pattern depressive disorder

A

Light therapy

Then maybe—SSRI / Wellbutrin

99
Q

Atypical depression 1st line TXM

A

MAOI’s = 1st line

100
Q

Postpartum time frame

A

Pregnancy —> 4 week of delivery

SSRI’s —> sertraline - best

101
Q

Disruptive mood dysregualtion disorder population

A

2 settings

Greater than 3 x per week

Before age 10 you get first sxs —must continue longer than 1 year

102
Q

PMDD sxs

A

1 week before menses start —> continue through menses —>
Stop after menses

103
Q

Dysthymia depression lasts

A

Longer than 2 years = adults

Kids = 1 year

not longer than 2 months without sxs

no manic/hypomanic sxs

104
Q

Hyperthermia
Hypertonicity
Coma
Tremor
AMS
Restless think what

A

Serotonin syndrome

CNA

105
Q

Serotonin syndrome treatment

A

DC agent

Benzo’s
Aggressive cooling
Cyproheptadine

106
Q

Mc side effect of ECT for mood disorders

A

Short-term Memory loss [temporary]

good in refractive pregnancy

107
Q

manic episodes lasts how long

A

Greater than 1 week ;

Or also epi doses of depressive sxs totally 1 week

108
Q

Type of bipolar with highest suicidal rate

A

Bipolar 1

109
Q

Bipolar 2

A

1 major depressive episodes with hypomania = lasts less 4 days

110
Q

SGAs assoc with bipolar 1 and 2 TXM

A

Olanzipine

Aripiprazole

111
Q

Depression [w/o MDD] and hypomania for longer than 2 years

A

Cyclothymic disorder

112
Q

Brief psychotic d/o

A

Lasts longer than 1 day but less than 1 month

Return gradual to premorbid fxn

113
Q

Schizophrenic form

A

Lasts 1-6 mo’s but no longer than 6

114
Q

Schizophrenia keys

A

Age over 15 less than 50

1 mo : delusions; hallucinations; disorganized speech ; negative sxs

Dont think behavior is abnormal

Lasts longer than 6 months

115
Q

Schizophrenia TXM

A

SAGs = Olanzipine / apriprazoles

Typical - good positive sxs - halodol

116
Q

SE most concerning in Typical antipsychotics

A

Neuroleptic malignant syndrome

Tardive dyskenesia

117
Q

What is neuroleptic malignant syndrome

A

Gradual onset of
Confusion
High fever
Lead pipe rigidity
Elevated CPK

118
Q

Clozapine think

A

Agranulocytosis ; requires weekly CBCs

Special license

119
Q

Delusional disorder lasts how long

A

Greater than 1 month

daily FXN not effected

120
Q

Types of delusions

Erotomanic

Somatic

Persecutory

Grandiose

A

E= another person in love with them

S = having a condition [medical/physical]

P = mistreatment or wrongful persecution

G = inflated self worth ; power ; knowledge

121
Q

Delusions d/o TXM

A

SAGs

122
Q

Schizoafffective disorder

A

Schizophrenia

+

Mood Disorder : MDD ; Mania ; mixed

[at least 2 weeks of only schizo sxs ]

123
Q

Be careful taking SSRIs and what

A

Cold medications with : dextropmorphan

124
Q

Specific adjunct good in GAD

A

Buspirone

125
Q

Length of panic disorder

A

At least 1 month of panic sxs ; with worry of impending attack

Short course: BENZO —> SSRI —> treat for at least 1 year

126
Q

Phobia time frame

A

6 months of sxs

127
Q

Public speaking phobias =

A

Social phobia [social anxiety]

128
Q

Panic disorder commonly accompanied by

A

Agorophobia

129
Q

Obsessions vs. Compulsions

A

O = persist at thought image that are intrusive and unwanted resulting = anxiety

C = ritualistic repetitive BEHAVIORS to relieve anxiety ; time consuming

130
Q

OCD effects the ego how

A

Ego dystonic = difficult for person; they know it’s not good for them.

131
Q

What age do you have to be and sxs last how long for ptsd?

A

Over 6 years ; longer than 1 months

132
Q

Acute stress disorder

A

3 days —> 1 month

Intrusive ; negative mood ; dissociative ; avoidance ; arousal sxs

133
Q

Type of therapy indicated in OCD

A

Self therapy

  • not group *
134
Q

Somatic symptom disorder

A

1 or more physical complaints for 6 months

Concerns of seriousness OOP

TXM = therapy; provide reassurance regular visits with HCP ; minimize 2ndary gain

135
Q

Illness anxiety disorder

A

Normal body sensation interpreted as manifestation of diseaes

Preoccupation with possibility of demise

6 months

-(negative) somatic sxs

136
Q

Conversions disorder

A

No medical reason for the sxs that they ARE experiencing

Think : pseudo seizures

137
Q

Stimulant pupils

A

Dilated

138
Q

Opioid pupils

A

Constricted pupils

139
Q

Cluster A ; B ; C

A

A = MAD ; odd eccentric ; weird

B = BAD ; emotional ; impulsive ; dramatic

C = SAD ; anxious ; fearful

140
Q

Cluster A = MAD

A

Schizoid = recluse; no interpersonal relationships/or family

Schizotypal = disturbed ; perceptual distortion; odd eccentric behavior MAGICAL

141
Q

Cluster B

A

Antisocial = no remorse; break the law; dont conform to a social norm

Borderline = IMPULSIVE ; intense interpersonal relationships; all good or all bad ; feelings of sever inadequacy
—> TXM : dialectical behavior therapy

HISTRIONIC = needs to be center of attention ; regression defense mechanism ; revert to childlike behavior

NARCISSISTIC = egotistical ; grandiose ; lacks empathy ; high performing

142
Q

Cluster C

A

Avoidant = inferiority complex ; fear of rejection ; need to be assured to make any relationships

Dependent = need to be taken care of l submissive I clingy I helpless alone

Obsessive compulsive personality = preoccupied with orderliness ; perfection EGO SYNTONIC

143
Q

ADHD 4 inattentive sxs

A

Careless mistakes

Forgetful

Easily distracted

Difficulty organizing tasks

144
Q

ADHD : hyperactivity and impulsivity sxs

A

Leaves seat often

Fidgeting

Blurting out

Can’t wait turn

145
Q

Stimulant ADE’s

A

Wt loss

Decreased growth

146
Q

Age Austism is usually noticed ?

A

3-6 months

147
Q

Precursor to antisocial personality

A

Conduct disorder

148
Q

Conduct disorder :

A

Basic right s of others or major age appropriate rules are violated

Longer than 12months

149
Q

Oppositional defiance disorder begins before when

A

8 years old

150
Q

Behavior oppositional defiance

A

DONT HURT PEOPLE/DESTROY THINGS :

Angry/ irritable

Argumentative

Vindictive

151
Q

Ego of anorexia

A

Ego syntonic = they dont hate their fear ; in order to control their environment

152
Q

Restictive anorexia tend to have what traits

A

Obsessive compulsive

153
Q

Anorexia BMIs

A

Less than 17 = mild

16 -16.99 = moderate

15-15.99 = severe

Less than 15 - EXTREME

154
Q

Weight findings in bulimia

A

Normal or overweight

Rapid weight fluctuations

155
Q

Bulimia electrolyte disturbance

A

Hypochloremia

Hypokalemia

Metabolic Alkalosis

156
Q

Binge eating disorder BMI

A

Usually over 30 or greater than 20% of ideal

157
Q

Ego of binge eating disorder

A

Ego dystonic

158
Q

Endocrine problems due to eating disorders

A

INCREASE

-Growth hormone
-Plamsa cortisol

DECREASE

-Gonadotropins
-T3
-Estrogen

159
Q

Spiral fx almost always related to

A

Child abuse

160
Q

Care giver induces sxs in a child

A

Fictitious disorder

Munchausen by proxy

161
Q

Insomnia disorder 1st line TXM

A

TXM = sleep hygiene !

2nd = short term hypnotics ; benzos

162
Q

Narcolepsy =

A

Irrepressible need to sleep with

> 1 episode :

-Cataplexy = hypotonia with maintained consciousness ; grimaces or jaw opening episodes with tongue thrusting or global hypotonia

-CSF = + hypocretin

-REM latency on Psmn or multiple sleep tests

163
Q

TXM of narcolepsy ?

Cataplexy —> ?

Cataplexy + sleep paralysis —> ?

A

Stimulants = methylphenidate

Cataplexy —> sodium oxybate

Cataplexy + sleep paralysis —> TCAs

164
Q

Sleep walking vs. Night terrors

A

SW = rising from sleep and walking blank faced unresponsive ; awakened with GREAT difficulty = WILL WAKE UP ; SXS END

NT = terror arousa from sleep; screaming frantic ; intense fear ; unresponsive to comfort = WAKING UP DOESNT HELP

165
Q

What do legs feel like in restless leg syndrome

A

Like worms l relieved by movement

ONLY OCCURS AT NIGHT

166
Q

Erectile D/o =

Mae Sexual desire d/o =

Premature ejaculation =

A

Erectile D/o = PDE Inhibitors

Mae Sexual desire d/o = testosterone

Premature ejaculation = SSRI’s

Sex therapy

167
Q

Female sexual interest arousal d/o TXM

A

Testosterone ; estrogen ; sex therapy

168
Q

What is the definition of running against non consenting persons

A

Frotteurism

169
Q

Akathasia vs. akinesia

A

Akathasia = subjective sense of restlessness with fidgeting rocking pacing ; cant sit still

Akinesia = state of motor inhibition or reduced voluntary movement

170
Q

Avolition defintion

A

Lack in initiative or goals ; a negative sxs in schizophrenia

171
Q

Mimicking behavior is called

A

Echopraxia

172
Q

Concrete thinking =

A

Thinking by : Immediate experience rather than abstractions
-shizophrenia

173
Q

Answeres becoming progressively less related to the original question =

A

Tangentiality

174
Q

What part of MMSE assesses attention

A

Subtract serial 7s from 100

175
Q

Assessing very short term memory assess what

A

Registration of information

176
Q

Autism most closely effects what

A

Social interactions

177
Q

Who is most commonly affected by major depressive disorder

A

Young adult Females

178
Q

Treatments used in opioid dependence

A

Buprenorphine

Methadone

179
Q

After heroin detox what might you see as far as ekectrolyte disturbance at 10 hours

A
180
Q

Borderline personality disorder is best treated with

A

DBT

181
Q

What is a fugue state

A

Traveling away from home without memory of the trip.

182
Q

MC risk factor for bipolar disorder

A

Family history

183
Q

Best therapy for histrionic personality

A

Individual CBT

184
Q

Typical antidepressants common and ADEs

A

Common = halodol ; chlorpromazine ; Olanzipine

ADEs = coarse resting tremor ; excessive blinking

185
Q

2nd gen AP common and ADE’s

A

Common = ripespiridone ; clozapine ; ariprazpole

ADEs = weight gain ; increased lipids; new onset diabetes
Clozapine = agranulocytosis

186
Q

Lithium + an antipsychotic can cause what

A

Tardive dyskinesia

187
Q

ADHD MC Risk Factor

A

Family history

188
Q

Heroin is what kind of drug with what type of withdrawal sxs ; intoxication sxs

A

Opioid

Withdrawal = lacrimation ; rhinorrhea ; sweating ; yawning HTN ; Tachy !

Intoxication = bradycardia ; bradypnea hypotension

189
Q

Most important cause of M and M in the US [preventable]

A

Tobacco use

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