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Step 3 UW /FA > Psyc > Flashcards

Psyc Flashcards

1
Q

2 benzo that can be used with alcohol withdrawl

A

lorazepam & oxazepam = safe on liver chlordiazepoxide = toxic to liver but can still be used

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2
Q

3 SSRI’s safe in kids?

A

Fluoxetine, Sertraline & Fluvoxamine

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3
Q

Acute dystonia Symptoms? Treatment? Prevention?

A

Involuntary muscle contraction or spasm, more likely in young men, occurs days to weeks after initiation of antipsychotics * treat with benztropine or diphenhydramine * to prevent can give a prophylactic benztropine w/ antipsychotic

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4
Q

Acute Stress Disorder vs Posttraumatic Stress Disorder(PTSD) duration?

A

ASD: occurs within 1 month and lasts <1 month of event PTSD: >1 month

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5
Q

Adjustment Disorder tx?

A

normal anxiety, depression, irritablity within 3 months of stressful event tx: psychotherapy

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6
Q

Alcohol intoxication sx

A

talkative, sullen(bad tempered/moody), gregarious, moody

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7
Q

Alcoholic Hallucinosis time frame? sx?

A

12-24 hrs, visual hallucinations +/- tactile and auditory *if hallucinations are present with AMS then its not due to alcohol

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8
Q

Alcoholic Withdrawal Seizures time frame? tx? sx?

A

48hrs = tonic-clonic seizures tx: CT to R/O other cause

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9
Q

Amphetamines & Cocaine sx? withdrawl?

A

euphoria, hypervigilance, autonomic hyperacitivity, weight loss, PUPIL DILATION, disturbed percetpion, stroke, MI withdraw: anxiety, tremors, increased appetitie, depression, RISK OF SUICIDE!

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10
Q

Anorexia Nervosa vs buliemia side effects?

A

KEY IS LOW BMI <18!!! *both have great concern over weight fx: hypotension, bradycardia, lanugo hair, edema, EKG changes as a result of K deficiency *buliemia will have binge eating + compensatory behavior but normal BMI

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11
Q

Autism Spectrum Disorder sx? tx?

A

M > F; before 3 yoa, lack of peer relationships, odd preoccupation with repetitive activities tx: family counseling, special ed

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12
Q

Barbiturates and Benzos sx

A

inappropriate sexual or aggressive behavior, impaired memory or concentration

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13
Q

Binge Eating Disorder sx? tx?

A

sx: recurrent episodes of binge eating 3x per weeks for more than 3 months tx: TOPIRAMATE > SSRIs & CBT

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14
Q

Bipolar 1 VS Bipolar 2 VS Cyclothymia

A

Bipolar 1: Mania Bipolar 2: hypomania + depression Cyclothymia: hypomania + hypodepression

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15
Q

Bipolar Disorder sx of mania?

A

depression + hypomania = 2 mania = 1 ^for at least 1 week. Mania: DIG FAST Distractibility, irresponsibility, gradiosity, flight of ideas, activity increased, sleep is decreased, talkativeness

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16
Q

Bradykinesia(Parkinsonism) sx? tx?

A

weeks sx: bradykinesia, tremors, rigidity, sx of parkinsons tx: reduce dose of drugs or Anticholinergics(benztropine, diphenhydramine, Trihexyphenidyl)

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17
Q

Brief psychotic disorder

A

Psychosis lasting less than one month and onset often follows a psychosocial stressors

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18
Q

Cannabis sx?

A

impaired motor coordination, impaired time perception, social withdrawal, increased appetitie, dry mouth, tachycardia, conjunctival redness

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19
Q

Cataplexy

A

sudden loss of M tone; precipitated by loud nose or emotions = this is the person who laughs and collapses *if this occurs 3x per week for 3m = narcolepsy

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20
Q

Cluster A personality Disorders

A

Weird = Paranoid, Schizoid, Schizotypal

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21
Q

Cluster B Personality Disorders

A

Wild = Histrionic, Boarderline, Antisocial, Narcissistic

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22
Q

Cluster C Personality Disorders

A

Worried = Avoidant, Dependent, Obsessive-Compulsive

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23
Q

Compare: Anorexia Nervosa, Bulimia Neurvosa, Binge Eating Disorder, Body Dysmorphic Disorder

A

Anorexia: underweight, food restriction or excessive exercise, history of of purging or compensation Bulimia: normal weight, binge eating + guilt and some sort of compensation(vomiting, diuretics or enema use) Binge Eating Disorder: recurrent episodes of eating large quantities, feelings of lost of control during binge. Do not regularly have compensatory behaviors. Body Dysmorphic Disorder: pt is preoccupied with an imagined or slight defects in appearance with impaired ability to function in social or occupational settings.

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24
Q

Conduct vs Oppositional defiant disorder

A

Conduct: bullying, fighting, cruelty to people or animals, rape, vandalism Oppositional Defiant: typical teen anger, not present with friends

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25
Q

Conversion Disorder

A

one or more neurologic sx that cannot be explained by any medical shit + psychologic factor associated with onset, PATIENT IS NOT CONCERNED ABOUT IMPAIRMENT *bf broke up with me and now my arm doesnt work.

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26
Q

Cyclothymia tx?

A

recurrent hypodepression + hypomania for at least 2 years *patient describes low energy, fatigue times & other times of feeling up and optomistic tx: phototherapy

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27
Q

Defense Mechanism: Regression

A

return to an earlier stage of dvelopment, most immature *9yo kid starts wetting his bed in response to parents divorce

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28
Q

Defense Mechanism: Splitting

A

“the morning staff is perfect, the evening staff is terrible”

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29
Q

Defense Mechanism: Undoing

A

“i need to wash my hands whenever i have these thoughts” Undoing is a defense mechanism in which a person tries to ‘undo’ an unhealthy, destructive or otherwise threatening thought or action by engaging in contrary behavior. For example, after thinking about being violent with someone, one would then be overly nice or accommodating to them.

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30
Q

Defense Mechanism: Blocking

A

temporary block in thinking “i have known him for years but can never seeem to remember his name”

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31
Q

Defense Mechanism: Denial

A

used to avoid somthing painful “i know i do not have cancer”

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32
Q

Defense Mechanism: Displacement

A

An emotion or drive is shifted to another that resembles the original in some aspect. “i had to get rid of the dog since my husband kicked it every time we had an argument”

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33
Q

Defense Mechanism: Dissociation

A

splitting off of the brain from conscious awareness “i heardly remember getting to the hsopital after my husband was hit by a car”

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34
Q

Defense Mechanism: Introjection

A

“resident physician dresses like the attending whom he admires”

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35
Q

Defense Mechanism: isolation

A

separation of an idea form the affect that accompanies it “as she arrived at the station to identify the body, she appeared to show no emotion”

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36
Q

Defense Mechanism: Projection

A

attributing your own wishes, thoughts, or feelings onto someone else ex: ‘im sure my wife is cheating on me”

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37
Q

Defense Mechanism: Reaction Formation

A

an unacceptable impulse is transfored in to its opposite, results in the formatino of character traits “listen to him tell his family he was not afraid, when i saw him crying”

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38
Q

Defense Mechanism: Repression

A

an idea of feeling is withheld from conciousness; unconcious forgetting

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39
Q

Defense Mechanism: Somatization

A

psychic derivatives are converted into bodily symptoms. = thinkin of an exam makes you feel sick

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40
Q

Defense Mechanism: Sublimation

A

sublimation is a mature type of defense mechanism, in which socially unacceptable impulses or idealizations are unconsciously transformed into socially acceptable actions or behavior, possibly resulting in a long-term conversion of the initial impulse.

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41
Q

Defense Mechanism: Suppression

A

conscious forgetting; only consciouse defense mechanism “i would rather talk about my operation after the party is over”

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42
Q

Delirium Tremens sx?

A

occurs 48-96hrs after last drink(2 days) Delirium Tremens = hallucinations, diorientations, tachycardia, HTN, low-grade fever, agitation and Diaphoresis.

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43
Q

Delirium Tremens time frame? sx?

A

48-96hrs = hallucinations, disorientation, tachycardia, hypertension, low-grade fever, agitation and iaphoresis **look for person who hasnt had booz in 2days!

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44
Q

Delusional disorder

A

Non-bizarre delusions for one month or more in the absence of other psychotic symptoms, often chronic, typically will respond poorly to antipsychotics

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45
Q

Delusional Disorder sx? ddx? tx?

A

Delusional Disorder - SX: o >1 delusion for >1m o No other psychotic sx present o Ability to function apart from delusion; behavior not bizarre or odd - DDX: o Schizophrenia: other psychotic sx not present(no hallucinations, disorganization negatie sx) o Personality disorders - TX: o Antipsychotics, CBT

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46
Q

Dependent Personality Disorder

A

Submissive and clinging behavior related to a need to be taken care of. individuals are consumed with the need to be taken care of. they are clingy and worry about abandonment. they feel inadequate and helpless and avoid disagreements with others. they usually focus dependency on a family member or spouse

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47
Q

Depersonalization/Derealization Disorder

A

Depersonalization/Derealization Disorder = persistant or recurrent experiences of 1 or both: depersonalization(feelings of detachment from, or being outside of observer of, one’s self) and/or derealization(experiencing surroundings as unreal)

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48
Q

Description of a child with Rett syndrome?

A

Excellent genetic disorder that affects only girls, normal child development up until the age of 6 to 18 months with arrest or rapid deterioration of mental, language, motor skills. Progressive macrocephaly and purposeless/stereotyped movement of hands. Epilepsy is common

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49
Q

Disruptive Mood Dysregulation Disorder

A

child with prevasively angry or irritable mood involving frequent aggressive outburts that are out of proportion to the stressor do not return to normal mood after the stressor. sx begin before 10 yoa & lasts for 12 months

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50
Q

Dissociative Amnesia

A

Dissociative Amnesia = inability to recall important personal information, usually tramatic or stressfull in nature; not explained by another disorder - Ex: dude found wondering airport after wife asks for divorce, he doesn’t know who he is or how he got there. Wife says he disappeared after she asked for divorce.

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51
Q

Dissociative Identity Disorder

A

Dissociative Identity Disorder = marked discontinuity in identity & loss of personal agency with fragmentation into >2 personality states. - Aka split personality disorder

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52
Q

Dyskinesia Symptoms? Treatment?

A

Parkinsonian him, shuffling gait, cogwheel rigidity, bradykinesia, onset is usually within weeks of initial therapy with antipsychotic * treat with anti-cholinergic such as benztropine or dopamine agonist such as amantadine

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53
Q

Dysthymia

A

Persistent depressive disorder = hypodepression lasting most days for at least 2 years

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54
Q

Eating Disorder not otherwise specified

A

anything that doesnt make the cirteria for other shit. EX: use of compensatory behavior after eating normal amounts of food

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55
Q

ethnic group with the highest rates of suicide?

A

Native Americans

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56
Q

Exhibitionism

A

recurrent urge to expose onself to strangers *must be more than 6months of sexual arousing w/impairment of functioning

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57
Q

Factitious disorder

A

person fakes sick so they can be patient; does this knowningly

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58
Q

Factitious Disorder VS Malingering Disorder

A

Factitious = wants to be patient Malingering = wants $$$

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59
Q

Fetishism

A

use of nonliving objects usually associated with the human body *must be more than 6months of sexual arousing w/impairment of functioning

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60
Q

Gender Dysphoria(Formerly Gender Identity Disorder)

A

persistent discomfort and sense of inappropriateness regarding patients assigned sex tx: psychotherapy & reassignment surgery

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61
Q

Genetic mutation associated with fragile X syndrome? Other characteristics of a child with fragile X syndrome?

A

CGG repeat, macro-orchidism, large body size, long face and intellectual disability

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62
Q

Gentiopelvic Pain disorder/dyspareunia

A

pain with sexual intercourse not due to medical condition tx: psychotherapy

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63
Q

hallucinogens/LSD sx

A

ideas of reference(the notion that everything one perceives in the world relates to one’s own destiny), hallucinations, impaired judgments, dissociative symptoms, pupil dilation, panic, tremors, incoordination

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64
Q

Histrionic Personality Disorder

A

colorful, exaggerated behavior and excitable, shallow expression of emotions, use physical appearance to draw attention to self, sexually seductive, discomfort in situations where not the center of attention

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65
Q

How do you treat a psychotic break? when do you start long term psyc meds?

A
  1. hospitalize if needed 2. benzos for agitation & antipsychotics for 6 months *start long term therapy if there are repeat episodes
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66
Q

How does Zolpidem effect sleep late and and sleep time?

A

Decrease his sleep latency and increase his total sleep time, rapid onset and habit-forming which can lead to problematic or dangerous sleeping behavior such as sleep driving or sleep eating

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67
Q

how long for alcohol withdrawal?

A

5-10days

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68
Q

How long is a patient with MDD on antidepressants?

A

6 months then try to take them off. only need long term with multiple episodes

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69
Q

Hypnogogic & Hypnopompic hallucinations

A

hallucinations that occur as patient is going to sleep or as they wake up

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70
Q

Illness anxiety disorder

A

person isnt sick but is freaking the fuck about baout becomming sick ~AT LEAST 6 MONTHS

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71
Q

Indications for Elecctroconvulsive Therapy(ECT)

A
  • MDD nonresponsive to medications - high risk for immediate suicide - C/I to using antidepressants - good response to ECT in the past
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72
Q

Intermittent explosive disorder tx?

A

aggression out of proportion to the stressor. >6yoa occuring 2x wk for more than 3m or involve destructive episodes 3x within 12m period. *pt return to normal mood after stressor tx: SSRI & mood stablizers

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73
Q

Main difference between a tick disorder and Tourette’s syndrome?

A

Tick disorder’s will be either motor or auditory. Whereas Tourette’s syndrome will have multiple motor and vocal tics present for greater than a year resulting in functional impairment. Tourette’s syndrome is often associated with ADHD and OCD

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74
Q

Major Depressive Disorder

A

depressed mood of anhedonia lasting 5/9 lasting 2+ weeks: SIGECAPS: Sleep changes, Interest loss, Guilt/worthlessness, Energy loss, Concentration difficulties, Appetitie loss/gain, Psychomotor changes, Suicide

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75
Q

Malingering Disoder

A

person fakes sick knowningly to get $$$$$

76
Q

Masochism

A

recurrent urge or behavior involving the act of humiliation or pain *must be more than 6months of sexual arousing w/impairment of functioning

77
Q

MC method of suicide by both men and women?

A

firearms

78
Q

MC method of suicide by women?

A

pills/poisons

79
Q

MCC of death in Anorexia Nervosa?

A

arrhythmia

80
Q

MDD sleep changes?

A
  • Increase sleep latency(time it takes to fall asleep) & decreased REM latency(time it takes to hit REM sleep)
81
Q

Mild Intellectual Disability IQ? features?

A

IQ 50-79; 6th grade level, can live independently in a community or with minimal supervision

82
Q

Minor Alcohol withdrawal time frame? tx? sx?

A

6hrs, Insomnia, tremulousness, mild anxiety, HA, diaphoresis, palpitations tx: B1, Folate, Multivitamin and Glucose

83
Q

Moderate Intellectual Disability IQ? features?

A

IQ 35-50; 2nd grade level, can live in residential community settings, may be able to do some acitivties of daily living

84
Q

Narcolepsy

A
  • DSM5: o Recurrent Lapses into sleep or naps(3x per weeks for 3 months) o At least 1 of the following:  Cataplexy: Brief loss of muscle tone precipitated by strong emotion(laughter, excitment)  Low CSF levels of hypocreti9n-1  Shortened REM sleep latency - Associated: Hypnagogic of Hypnopompic hallucinations(hallucinations before and after nap), Sleep paralysis
85
Q

narcolepsy tx?

A

scheduled naps, Modafinil +- methylphenidate and dextraamphetamine

86
Q

Neuroleptic Malignant Syndrome sx? tx?

A

anytime! sx: M rigidity, hyperthermia, volatile vital signs, altered LOC, increased WBC & CK tx: stop drugs! Dantrolene or Diazepam, Bromocriptine

87
Q

Normal grief vs MDD

A

NORMAL GRIEF/BEREAVEMENT <1Y = sadness, tearfulness, decreased sleep, appetitie, interest in the world - Sx wax and wane - Shame and guilt are mild - Usually resolves in 2m - Tx: supportive MAJOR DEPRESSIVE DISORDER >1Y = sadness, tearfulness, decreased sleep, appetite, interest in the world - sx are pervasive and unremitting - shame and guild are SEVERE - threaten suicide often -tx: antidepressants

88
Q

Obsessive-Compulsive Personality Disorder

A

individuals are preoccupied with orderliness, perfection, and control. They are often consumed by the details of everything and lose their sense of overall goals. they are strict and perfectionistic, overconscientious and inflexible. Associated with difficult interpersonal relationships.

89
Q

Obsessive-Compulsive Personality Disorder

A

individuals are preoccupied with orderliness, perfection, and control. They are often consumed by the details of everything and lose their sense of overall goals. they are strict and perfectionistic, overconscientious and inflexible. Associated with difficult interpersonal relationships.

90
Q

OCD tx

A

Obsessive-Compulsive Disorder: - DX: o Obesssions  Recurrent, intrusive, anxiety provoking  Attempts to suppress  Not related to substance abuse or other illness o Compulsions  Response to obsessive thoughts with repeated behaviors or mental acts  Excessive behaviors intended to reduce anxiety or avoid dreaded outcome  Behaviors not connected with realizstically with preventing anxiety or fear - TX: o CBT or HD SSRI o 2nd Clomipramine o 3rd ECT

91
Q

Opiates sx

A

apathy, dysphoria, CONSTRICTED PUPILS,drowsiness, slurred speech, impaired memory, coma, death

92
Q

Order the benzos from shortest to longest half life: lorazepam, diazepam & alprazolam

A

shortest: Alprazolam(xanax) < Lorazepam(Ativan) < Diazepam(Valium) :longest

93
Q

Paradoxical Agitation seen with Benzodiazepines

A

Paradoxical Agitation seen with Benzodiazepines = old ppl metabolize benzo slowly = increased risk of confusion & increased risk of falls - Old dude who gets irritated and cranky after taking his nightly meds which include Alprazolam. - Usually occurs within 1 hr of administration

94
Q

Paranoid Personality Disorder

A

distruct and suspiciousness in motives and actions of otheres, often secretive and isolated, emotionally cold and odd, often take legal action against other ppl *main defense = projection *dont confused with paranoid schizophrenia

95
Q

PCP sx

A

panic reactions, assaultiveness, agitation, NYSTAGMUS, HTN, seizures, coma, hyperacusis

96
Q

Pedophilia

A

recurrent urges or arousal toward prepubescent children *must be more than 6months of sexual arousing w/impairment of functioning

97
Q

Penetration Disorder

A

involentary constriction of outter 3rd of vagina causing pain on penitration tx: psycotherapy & dilator therapy

98
Q

Postpartum Blues/Baby Blues VS Postpartum Depression VS Postpartum Psychosis

A

Postpartum Blues/Baby Blues = cares about baby, mild depression, self limited Postpartum Depression = +/- thoughts of hurting baby, severe depression, needs antidepressants Postpartum Psychosis = most have thoughts of hurting baby, psychotic symptoms along with severe depression, needs antidepressants and mood stabilizers.

99
Q

Postpartum psychosis

A

Psychiatric emergency due to increased risk of infanticide. More common in mothers with bipolar disorder, treat with lithium and antipsychotics

100
Q

Postpartum… Blues? Depression? Psychosis?

A

Postpartum Blues - Onset: 2-3 days - peaks D5 resolves by 2wks - SX: mild depression, tearfulness, irritability - TX: reassurance & monitoring Postpartum Depression - Onset: 4-6 wks. can last 1 yr - SX: >2wks of moderate to severe depression, sleep or appetite disturbance, low energy, psychomotor changes, guilt, concentration difficulty, suicidal ideation - TX: antidepressants, psychotherapy Postpartum Psychosis - Days to weeks - SX: delusions, hallucinations, thought disorganization, bizarre behavior - TX: antipsychotics, antidepressants, mood stabilizers + HOSPITALIZATION = DO NOT LEAVE MOTHER ALONE WITH INFANT

101
Q

Premature Ejaculation

A

ejaculation just before or just after penitration tx: stop & go, Squeeze technique, SSRIs

102
Q

Pt has depression + Neuropathic pain. best drug? class?

A

SNRI = Duloxetine

103
Q

pt presents with: Orthostatic headache, Tinnitus & clear bilateral nasal discharge. dx? how woudl u dx?

A

Low Cerebrospinal Fluid(CSF) Pressure Headache: - Sx: o Orthostatic headache o Tinnitus o Neck pain/stiffness o NV, dizziness, vertigo, anorexia - Dx: if nasal discharge = test w/Beta-2-transferrin = CSF specific marker - 4% are idiopathic

104
Q

Ramelteon use? C/I?

A

mimics melatonin = good for pt who need help falling asleep C/I: hepatic impairment, severe sleep apnea, severe COPD

105
Q

Sadism

A

recurrent urge or bahvior involving acts in which physical or psychological suffering of the victim is exciting *must be more than 6months of sexual arousing w/impairment of functioning

106
Q

Schizoaffective Disorder

A

Schizo + mood disorder like depression or bipolar(can be schizo & have mania!) **lifetime hx of delusions or hallucinations for >2wks in teh absence of major depressive or manic sx

107
Q

Schizoid Personality Disorder

A

detachment and restricted emotionality = emotionally distant & fear intimacy, absorbed with their own thoughts and feelings and disinterested *main defense is projection

108
Q

Schizophreniform disorder

A

Symptoms of schizophrenia lasting between one and six months

109
Q

Schizotypal Personality Disorder

A

discormfort with social relationshps, thought distortion, eccentricity = like schizoid but have magical thinking, vlairvoyance, ideas of reference or paranoid ideation = sx arnt severe enough for schizophrenia

110
Q

Schizotypal personality disorder versus schizoaffective disorder

A

*Schizotypal personality disorder is a predominantly mood disorder with psychotic features- magical thinking * schizoaffective disorder is a predominantly psychotic disorder with a mood disorder on top of it. Patient needs to have at least two weeks without a mood episode.

111
Q

Seasonal affective disorder

A

depression in winder months = phototherapy or sleep deprivation

112
Q

Serotonin Syndrome

A

hx of SSRI, agitation, hyperreflexia, hyperthermia, Mrigidity, volume contraction secondary to sweating an dinsensible fluid loss tx: ciproheptadine, benzo

113
Q

Severe Intellectual Disability & Pround ID IQ? features?

A

Severe: IQ 20-35 Profound: <20 Cant live on their own, need full time help

114
Q

Sexual Identity, Gender Identitiy, Gender Role, Sexual Orientation

A

Sexual Identity = based on secondary sexual characteristics Gender Identitiy = who they identify with = usually figured out by age 3 Gender Role = based on external patterns of behavior Sexual Orientation = persons choice of love object

115
Q

Side effect profile for Thioridazine

A

prolonged QT and arrhythmias, abnormal retinal pigmentation

116
Q

Side effects for Valproate

A

o Valproate  Side FX: • Tremors, weight gain, GI disturbances • ALOPECIA • TERATOGENIC • HEPATOTOXIC = THROMBOCYTOPENIA • SEVERE TOX: hyponatremia, coma, death o Lamotrigine  Side FX: Stevens-johnson Syndrome

117
Q

side fx clozapine

A

agranulocytosis = reserved for tx resistant shit

118
Q

side fx of Li

A

o Lithium  <2.5 = mild tox = flush with saline  >2.5 = dialysis  Side FX: • Adversely affect the kidneys & thyroid o Tubulointerstital nephropathy o NEPHROGENIC DI • Tremors, weight gain, GI disturbances • TERATOGENIC • LEUKOCYTOSIS • SEVERE TOX: confusion, ataxia, lethargy, abdominal reflexes  C/I: CKD, Heart disease, Hyponatremia or diuretic use  Baseline studies: BUN, Cr, Ca, U/A, Thyroid function tests, ECG in pt with coronary risks

119
Q

Sleep paralysis

A

patient is awake but unable to move; this typically occurs upon awakening

120
Q

Stages/Timeline of Alcohol withdrawal

A

6 hrs: Minor Withdrawal = insomia, tremulousness, HA, palpitations, diaphoresis *give thiamine, folate, vitammin, glucose 12-24hrs: Alcoholic hallucinosis = visual hallucinations 48 hr: Withdrawal Seizures 48-86hr: Delirium Tremens = hallucinations, diorientations, tachycardia, HTN, low-grade fever, agitation and Diaphoresis.

121
Q

Suicide Protective Factors

A

connection to family, pregnancy, responsibility for children, religious affiliation

122
Q

Suicide Risk Factors

A

men, older adults, social isolation, presence of psychiatric illness/drug abuse, percieved hopelessness, previous attempts

123
Q

Symptoms of Major Depressive Disorder(MDD)?

A

SIGECAPS: Sleep changes Interest loss Guilt Energy decrease Concentration difficulty Appetite changes Psychomotor activity changes Suicidal thoughts

124
Q

Tardive dyskinesia Symptoms? Treatment?

A

Stereotypic oral facial movements, likely from dopamine receptors sensitization, often Irreversible, generally occurs after long-term use of antipsychotic medication * discontinue or decrease the dose of antipsychotic or switch to a second generation/atypical antipsychotic ** giving an anticholinergic, decreasing antipsychotic may initially worsen tired of dyskinesia

125
Q

Tardive Dyskinesia sx? tx?

A

months to years sx: choreoathetosis and other involuntary movements after chronic use; often irreversable tx: stop older drugs and switch to newer drugs = sx will worsen ofter drugs stopped initially

126
Q

timeline: schizophrenia, schizophreniform, brief psychotic disorder

A

phrenia = >6m phreniform = 1-6m brief psychotic disorder = <1m

127
Q

Transvestic Fetishism

A

recurrent urge or behavior involving cross dressing or sexual gratification; usually found in heterosexual males *must be more than 6months of sexual arousing w/impairment of functioning

128
Q

Treatment for bipolar disorder?

A

1st line: Lithium, Lamotrigine or Risperidone 2nd line: aripiprazole, divalproex, quetiapine, olanzapine + CBT and psychotherapy

129
Q

True or false diphenhydramine can be used to treat EPS

A

True

130
Q

Tx of ASA toxicity?

A

Na Bicarb! = want alkalosis to prevent protonation which is what allows salicylate’s to cross into BBB & cause damage

131
Q

tx of barb/benzo intoxication

A

Flumazenil

132
Q

tx of cocaine/amphetamines withdrawl

A

bupropion and/or bromocriptine

133
Q

tx of opiate intoxication

A

naloxone

134
Q

Voyeurism

A

recurrent urges to observe an unsuspecting person who is engaging in sexual activity or disrobing. *must be more than 6months of sexual arousing w/impairment of functioning

135
Q

what are negative symptoms of schizophrenia?

A

flattened affect, social withdrawal, anhedonia, apathy, poverty of thought

136
Q

What are positive symptoms of schizophrenia?

A

delusions, disorganized speech, hallucinations

137
Q

What do you give to treat TCA toxicity? Why?

A

Sodium bicarbonate – alkalize the blood to about 7.5 this will prevent TCA from binding cardiac muscles = prevents arrhythmias

138
Q

What is a brief psychotic disorder?

A

psychotic symptoms present for <1m

139
Q

What is Acute Dystonia? timing treatment?

A

TIMING: first few weeks SX: muscle spasms, difficulty swallowing TX: reduce the dose, give anticholinergics(benztropine, diphenhydramine, trihexyphenidyl)

140
Q

What is Adjustment Disorder?

A

anxiety, depression, irritability that occurs soon after profound changes in a persons life. Occurs within 3 months of a stressful event.

141
Q

What is Agoraphobia?

A

fear of avoidance of places due to anxiety about NOT BEING ABLE TO ESCAPE.

142
Q

What is Akathisia? timing? treatment?

A

TIMING: weeks - chonic use SX: motor restlessness. *DO NOT MISTAKE FOR ANXIETY TX: reduce the dose, Benzodiazepines or BB, switch to newer antipsychotic

143
Q

What is Antisocial PD?

A

antisocial or criminal acts, inability to conform to social rules, impulsivity, disregard for the rights of others, aggressiveness, lack of remorse and deceitfulness

144
Q

What is Avoidant PD?

A

individuals have social inhibition, feelings of inadequacy and hypersensitivity to criticism. They shy away from starting anything new or attending social gatherings in fear of failure or rejection. they desire affection and acceptance and are open about their isolated and inability to interact with others.

145
Q

What is Borderline PD?

A

unstable affect, mood swings, marked impulsivity, unstable relationships, recurrent suicidal behaviors, chronic feelings of emptiness, identity disturbances, and inappropriate anger. *defense mechanism is usually splitting

146
Q

What is Bradykinesia? timing? treatment?

A

TIMING: weeks SX: bradykinesia, tremors, rigidity and other signs of parkinsons TX: reduce the dose, anticholinergics(benztropine, diphenhydramine, trihexyphenidyl)

147
Q

What is Conversion Disorder?

A

one or more NEUROLOGIC symptoms that cannot be explained by any medical or neurological disorder. *usually mutism, blindness, paralysis and anethesia/paresthesia. **pt are usually not concerned about the deficit

148
Q

What is Delusional Disorder?

A

person suffers from delusions but minimal to no hallucinations or bizarre behaviour. there is no impairment of baseline functioning.

149
Q

What is Dependent PD?

A

submissive and clinging behavior related to a need to be taken care of. clingy and worry about abandonment. they feel inadequate and helpless and avoid disagreements with others. they usually focus on dependency on a family member or spouse.

150
Q

What is Disruptive Mood Dysregulation Disorder?

A

child with a pervasively angry or irritable mood, with frequent outburst that are out of proportion to the stresses. PATIENTS DO NOT RETURN TO A NORMAL MOODS after outburst. They are just pissy.

151
Q

What is Exhibitionism?

A

recurrent urge to expose oneself to strangers

152
Q

What is Frotteurism?

A

Recurrent urge or behavior involving touching or rubbing against a non-consenting partner

153
Q

What is Generalized Anxiety Disorder(GAD)? Tx?

A

Excess anxiety that occurs daily for more than 6 months. no single focus or event. often coexists with other shit(MDD, specific phobia, social phobia, panic disorder). tx: CBT, SSRI, Benzo, vanlafaxine, buspirone

154
Q

What is Histrionic PD?

A

colorful, exaggerated behavior and excitable, shallow expression of emotions. use of physical appearance to draw attention to self. sexually seductive, discomfort in situations where not the center of attention.

155
Q

What is Illness Anxiety Disorder(IAD)?

A

pt experiences anxiety about having a illness for at least 6 months

156
Q

What is Intermittent Explosive Disorder? tx?

A

Episodes of aggression out of proportion to the stressor +/- history of head trauma. Only dx in AGE 6+. with episodes 2x a week for 3 months or destructive episodes 3x within a 12 month period. tx: SSRI & mood stablizers

157
Q

What is Kelptomania?

A

pt who repeatedly steals items to relieve anxiety

158
Q

What is Narcissistic PD?

A

Characterized by a sense of self-importance, grandiosity, preoccupation with fantasies of success. Person believes he is special, requires excessive admiration, reacts wit rage when criticized, lacks empathy, is envious of others, and is interpersonal exploitative.

159
Q

What is Neuroleptic Malignant Syndrome? timing? treatment?

A

TIMING: anytime SX: muscle rigidity, hyperthermia, volatile vital signs, altered LOC, increased WBC, increased CK TX: stop drugs, transfer to ICU, dantrolene.

160
Q

What is Obsessive-Compulsive Disorder(OCD)? Tx?

A

recurrent obsessions and compulsions. Individual recognizes behavior is unreasonable and excess. Often coexist with depression and substance abuse. **DO NOT HAVE HALLUCINATIONS Tx: behavioral therapy, SSRI and Clomipramine.

161
Q

What is Obsessive-Compulsive PD?

A

individuals are preoccupied with orderliness, perfections and control. They are often consumed by the details of everything and lose their sense of overall goals.

162
Q

What is Panic Disorder? Tx?

A

brief attacks of intense anxiety with autonomic symptoms( tachycardia, hyperventilation, dizziness and sweating), episodes occur regularly. TX: CBT, relaxation, desensitization, SSRIs and Benzos

163
Q

What is Paranoid PD?

A

distrust suspiciousness, individuals are mistrustful and suspicious of the motivations and actions of others are are often secretive and isolated. they are emotionally cold and odd. they often take legal action against other ppl. *main defense is projection.

164
Q

What is Persistent Depressive Disorder(Dysthymia)? tx?

A

Low level depression symptoms that are present on most days for at least 2 years tx: long term individual, insight oriented psychotherapy. SSRIs

165
Q

What is Schizoaffective Disorders?

A

Symptoms of schizophrenia and a mood disorder

166
Q

What is Schizoid PD?

A

detachment and restricted emotionally. Emotionally distant and fear intimacy with others, absorbed in their own thoughts and feelings and disinterested

167
Q

What is Schizophrenia?

A

positive and negative psychotic symptoms lasting for >6m

168
Q

What is Schizophreniform Disorder?

A

symptoms of schizophrena lasting between 1-6months

169
Q

What is Schizotypal PD?

A

Discomfort with socal relationships, thought distortion, eccentricity. similar to schizoid but with magical thinking, clairvoyance, ideas of reference, or paranoid ideation.

170
Q

What is Seasonal Affective Disorder? tx?

A

depressive symptoms in the winter months tx: phototherapy or sleep deprivation

171
Q

What is Tardive Dyskinesia? timing? treatment?

A

TIMING: months - years SX: choreoathetosis and other involuntary movements after chronic use, often irreversible TX: Stop older antipsyc, switch to newer drugs, give valbenazine or benztropine *sx often worsen after medication change

172
Q

What is Tardive Dyskinesia? tx?

A

choreoathetosis that occurs over months to years of use with use of antipsychotics(D antag). Tx: denztropine or Valbenazine

173
Q

What is the mechanism of action of Disulfiram?

A

Disulfiram inhibits the enzyme acetaldehyde dehydrogenase leading to an increase in acetaldehyde when alcohol is consumed. Acetaldehyde causes NV, HA, tachycardia and sweating

174
Q

What is Voyeurism?

A

Recurrent urges to observe an unsuspecting person who is engaging in sexual activity or disrobing. This is the earliest paraphilia to develop.

175
Q

What medications can be used to treat irritability and aggression in individuals with autism spectrum disorder?

A

Antipsychotic such as risperidone or aripiprazole

176
Q

What other two disorders is Tourette’s syndrome often associated with

A

ADHD and OCD

177
Q

What should you do with a patient who is on lithium and currently stable who develops hypothyroidism?

A

Continue on their same dose of lithium and start Synthroid

178
Q

Which 2nd gen antipsyc has least risk of tardive dyskinesia

A

clozapine

179
Q

Which antihypertensive medications are the safest to use in a patient who is taking lithium?

A

Calcium channel blocker‘s! Any medication that affects GFR or sodium/potassium levels will also affect lithium levels. Therefore calcium channel blocker‘s tend to be the safest in these patients

180
Q

which antipsyc can cause QT prolongation

A

thioridazine & ziprasidone

181
Q

which antipsychotic is safe in prego?

A

LURASIDONE

182
Q

which atypical antipsyc has the least risk of DM & weight gain? which has the most?

A

most = olanzapine least = aripiprazole

183
Q

Which mood stabalizer can cause alopecia

A

valproate

184
Q

which SSRI can you NOT use in prego?

A

paroxetine

185
Q

You suspect a psychotic disorder or some sort. What tests do you need to order/run before you go jumping to dx something psyc?

A

TSH(hypo/hyperthyroidism), Electrolytes, Ca, HIV serology, VDRL, Drug screen, r/o temporal lobe epilepsy

186
Q

You suspect pt has MDD? what are other causes of depression you should check for before making the dx?

A

Hypothyroidism, Parkinsons Disease, Medications( BB, antipsyc, steroids), Alcohol, amphetamines

187
Q

You suspect the patient may have an anxiety disorder. What are some other causes of anxiety you should consider before dx.

A

Medical: hyperthyroidism, pheochromocytoma, excess cortisol, heart failure, arrhythmias, asthma, COPD Drugs: corticosteroids, cocaine, amphetamines, and caffeine, withdrawal from alcohol and sedatives.

Step 3 UW /FA (19 decks)

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