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Panre Prep > Psych > Flashcards

Psych Flashcards

1
Q

Wernicke encephalopathy triad

A

Ophthalmoplegia (double vision)
Ataxia
AMS

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2
Q

Korsakoff syndrome sx

A

Amnesia
Confabulation
Personality changes

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3
Q

Causes of amnesia

A

TBI
Encephalitis, esp herpes
Dementia
Thiamine (B1) deficiency

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4
Q

Depersonalization disorder sx

A

Intact reality / no psychosis
Feel like world isn’t real

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5
Q

Dissociative amnesia disorder

A

Sudden
Often a stressor
Fugue state
Wandering

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6
Q

Dissociative identity disorder

A

Females
PTSD link
LSD and PCP
Distinct personalities
Time loss

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7
Q

List the childhood psych disorders

A

Separation anxiety
Selective mutism
Oppositional defiant
Conduct disorder
Disruptive mood disorder
Tourette’s syndrome
Child abuse
ADHD
Autism Spectrum disorder

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8
Q

Criteria for separation anxiety disorder

A

Excessive anxiety
4+ weeks
Older than 3 yrs

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9
Q

Treatment for separation anxiety disorder

A

Cognitive behavioral therapy
Play therapy
Family therapy

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10
Q

Criteria for selective mutism

A

Less than 5 yrs at onset
Greater than 1 month
Social situations

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11
Q

Treatment for selective mutism

A

CBT
Play therapy
Family therapy
SSRI (Prozac)

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12
Q

Criteria for oppositional defiant disorder

A

Greater than 6 months duration
No injury to others /property
Argumentative and defiant
4+: irritable mood, easily annoyed, resentful, argues, deliberately annoys, blames others
mild=1 setting; mod=2 settings; severe=3+ settings

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13
Q

Criteria for conduct disorder

A

Starts less than 18 yrs old (if continues past 18, dx as antisocial personality)
Violates others rights - aggression, destruction of property, disregard for morals/norms
at least 3 in past 12 months: aggression, bullying, fights, weapon used to cause harm, physically cruel to people or animals, armed robbery, sexual coercion

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14
Q

Criteria for disruptive mood disorder

A

Explosive outburst out of proportion
Onset less than 10 yrs old
3 /wk for 1 yr
Always irritable

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15
Q

Criteria for Tourette’s syndrome

A

2 motor, 1 vocal tic minimum
Less than 18 yrs old
3/week for 1 year

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16
Q

Treatment for Tourette’s syndrome

A

CBT
Alpha 2 receptor agonist (clonidine, tizanidine)
Antipsychotics (haloperidol, risperidone, olanzapine)

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17
Q

Symptoms of serotonin syndrome

A

Autonomic-diarrhea, diaphoresis, mydriasis, hyperthermia, tachycardia, hypertension

Abnormal muscles-twitching, hyperreflexia, tremor, seizures

AMS- hallucinations, confusion, agitation, coma

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18
Q

Treatment for serotonin syndrome and MOA

A

Cyproheptadine

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19
Q

Medications that can cause serotonin syndrome

A

SSRIs, SNRIs
MAOIs
TCAs
Buspirone, vortioxetine, vitazodone
Tramadol
Linezolid
Meperidine
Ondansetron
Triptans
St. John’s wort
MDMA
Dextromethorphan

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20
Q

Causes of neuroleptic malignant syndrome

A

Antipsychotics

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21
Q

Symptoms of neuroleptic malignant syndrome

A

FEVER
Fever
Encephalopathy
Vitals unstable- tachy, htn
Enzymes- COK, myoglobin from rhabdo
Rigidity

Does NOT affect pupil size
Causes hyporeflexia

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22
Q

Treatment for neuroleptic malignant syndrome

A

Dantrolene
Bromocriptine

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23
Q

Causes and Symptoms of acute dystonia
Treatment

A

Cause - antipsychotics; hours / days

Muscle rigidity and spasms
Laryngospasm
Oculogyric crisis- cant look down

Tx- anticholenergic (benztropine)

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24
Q

Cause, sx, tx for tyramine induced hypertension

A

MAO inhibitors plus tyramine from wine, cheese

HTN, tachycardia

Phentolamine- alpha 1 and 2 antagonist

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25
Q

Pathophys of delirium tremens

A

Etoh mimics GABA, causes downregulation of GABA receptors and up regulation of NDMA receptors. Lack of etoh causes overstimulation of NMDA pathways

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26
Q

Sx of delirium tremens

A

Delirium
Tremors
Hypertension
Diaphoresis
Tachycardia
Insomnia
Nausea/vomiting
Seizures
Agitation
Hallucinations

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27
Q

Tx of delirium tremens

A

Benzodiazepines

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28
Q

Name the typical (first gen) antipsychotics

A

Haloperidol
Trifluoparazine
Fluophenazine
Thioridazine
Chlorpromazine

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29
Q

Name the atypical (second gen) antipsychotics

A

clozapine (Clozaril)
olanzapine (Zyprexa)
quetiapine (Seroquel)
paliperidone (Invega)
risperidone (Risperdal)
lurasidone (Latuda)
ziprasidone (Geodon)
aripiprazole (Abilify)
brexpiprazole (Rexulti)

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30
Q

MOA of typical (first gen) antipsychotics

A

block dopamine D2 receptors in mesolimbic pathway - improves delusions/hallucinations

can block dopamine receptors in mesocortical pathway- worsens withdrawal, lack of motivation

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31
Q

Which typical (first gen) antipsychotic is associated with corneal deposits?

A

chlorpromazine

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32
Q

Which typical (first gen) antipsychotic is associated with retinal deposits?

A

thioridazone

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33
Q

MOA of atypical (second gen) antipsychotics

A

block dopamine D2 receptors in mesolimbic pathway - improves hallucinations, delusions

block serotonin 5-HT2A receptors in mesocortical pathway - more dopamine = improved motivation and less withdrawal

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34
Q

side effects of typical (first gen) antipsychotics

A

dystonia
pseudoparkinsonism (face)
wt gain
hyperglycemia, hyperlipidemia
tardive dyskinesia
neuroleptic malignant syndrome
dry mouth, urinary retention
orthostasis
QT prolongation

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35
Q

side effects of atypical (second gen) antipsychotics

A

dystonia
pseudoparkinsonism
tardive dyskinesia
orthostasis
dry mouth, urinary retention, constipation
QT prolongation
weight gain
neuroleptic malignant syndrome

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36
Q

Which atypical (second gen) antipsychotic is most associated with hyperprolactinemia?

A

risperidone

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37
Q

Which atypical (second gen) antipsychotic is most associated with agranulocytosis?

A

clozapine

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38
Q

Criteria for persistent complex bereavement

A

12 months (6 months in adolescence)
obsessive yearning to be with the person

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39
Q

Criteria for normal grief

A

less than 6 months
symptoms wax/wane

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40
Q

Criteria for mania

A

1 week or more duration
3+ symptoms - grandiosity, talkative, flight of ideas, distractable, extreme goals, reckless behaviors, reduced sleep, agitation

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41
Q

Criteria for hypomania

A

4 days duration
3+ symptoms but milder
no psychosis

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42
Q

Criteria for bipolar I disorder

A

at least one manic episode

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43
Q

Criteria for Bipolar II disorder

A

no manic episodes; at least one hypomanic episode

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44
Q

Criteria for cyclothymic disorder

A

2+ years
fluctuating hypomania / depression

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45
Q

Tx for manic disorders

A

lithium
anticonvulsants - valproate, lamotrigine
antipsychotics - quetiapine, lurasidone

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46
Q

Which antipsychotics are used to treat manic disorders?

A

quetiapine
lurasidone

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47
Q

Which anticonvulsants are used to treat manic disorders?

A

valproate
lamotrigine

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48
Q

SIGECAPS

A

sleep
interest
guilt
energy
concentration
appetite
psychomotor
suicidal

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49
Q

Workup for depression

A

B12
folate
TSH
CBC
CMP
UA
UDS
EKG
PHQ-9

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50
Q

Criteria for major depressive disorder

A

at least 2 weeks duration
at least 5 symptoms (SIGECAPS)

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51
Q

Criteria for MDD with atypical features

A

MDD
mood improves with happy events
significant rejection sensitivity

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52
Q

Criteria for MDD with seasonal pattern

A

MDD
at least 2 years with sx in colder months and no sx in warmer months

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53
Q

Criteria for MDD with psychotic features

A

MDD
hallucinations/delusions while depressed
hallucinations/delusions associated with guilt/punishment

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54
Q

Criteria for MDD with perpipartum onset

A

MDD
within 1st year

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55
Q

Criteria for persistent depressive disorder

A

2+ symptoms
2+ yrs in adults, 1+ in adolescents
no period greater than 2 months without sx

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56
Q

Name the SSRIs

A

fluoxetine (Prozac)
paroxetine (Paxil)
sertraline (Zoloft)
citalopram (Celexa)
escitalopram (Lexapro)
fluvoxamine (Luvox) – OCD

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57
Q

MOA of SSRIs

A

block uptake receptors for serotonin - increases serotonin in the synapse

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58
Q

Side effects of SSRIs

A

GI upset
insomnia
sexual dysfunction
suicidal ideation (<25)
mania
dizziness
Hyponatremia

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59
Q

Name the SNRIs

A

desvenlafaxine (Pristiq)
venlafaxine (Effexor)
duloxetine (Cymbalta)

60
Q

MOA of SNRIs

A

Block serotonin and norepinephrine reuptake from the synapse

61
Q

Side effects of SNRIs

A

GI
dry mouth
dizziness
suicidal ideation (<25)
sexual dysfunction
mania

62
Q

Name the MAO inhibitors

A

selegiline (Emsam)
rasagiline (Azilect)
isocarboxazid (Marplan)
phenelzine (Nardil)
tranylcypromine (Parnate)

63
Q

Difference between selective and non-selective MAO inhibitor MOA

A

non-selective inhibit MAO a and b
selective inhibit MAO b only

MAO a = norepinephrine, dopamine, serotonin

MAO b = dopamine only

64
Q

MOA of monoamine oxidase

A

break down neurotransmitters - norepinephrine, dopamine, serotonin

65
Q

Name the atypical medications used to treat MDD

A

mirtazapine (Remeron) - inhibits presynaptic inhibition

trazodone - SSRI, increases binding of serotonin to receptors

vilazodone (Viibryd) - SSRI, 5HT1 agonist

vortioxetine (Trintellix, Brintellix) - SSRI, 5HT1 agonist

bupropion (Wellbutrin) - NDRi

66
Q

Which antidepressant can predispose to seizures?

A

bupropion (Wellbutrin)

67
Q

Name the tricyclic antidepressants (TCAs)

A

desipramine (Norpramin)
nortriptyline (Pamelor)

amitriptyline (Elavil)
imipramine (Tofranil)
clomipramine (Anafranil)

68
Q

MOA of TCAs

A

selective (desipramine / nortriptyline) - inhibit norepinephrine transporters

non-selective (amitriptyline, imipramine, clomipramine) - inhibit serotonin and norepinephrine transporters

69
Q

Side effects of TCAs

A

sedation
orthostasis
dry mouth, urinary retention, constiptation
cardiotoxic!!
prolonged QT
Three Cs - coma, convulsions, cardiotoxicity

70
Q

List the personality disorders by cluster

A

Cluster A - eccentric
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder

Cluster B - emotional
Antisocial personality disorder
Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder

Cluster C - anxiety (cowardly, controlling, clingy)
Avoidant personality disorder
Obsessive compulsive personality disorder
Dependet personality disorder

71
Q

Criteria for Paranoid personality disorder

A

distrustful
fears manipulation
holds grudges

72
Q

Criteria for Schizoid personality disorder

A

avoids social interactions
anhedonia
doesn’t want friendships

73
Q

Criteria for Schizotypal personality disorder

A

No delusions
eccentric thinking - magic; symbolic meaning; influences
wants friends, can’t keep them
inappropriate affect

74
Q

Criteria for Antisocial personality disorder

A

poor impulse control
no empathy or remorse
hx of conduct disorder
ignores social norms/mores

75
Q

Criteria for Borderline personality disorder

A

unstable moods
intense relationships
splitting - sees people / situations as completely good or completely bad

76
Q

Criteria for Histrionic personality disorder

A

excessive attention seeking
excessive emotionality
superficial relationships

77
Q

Criteria for Narcissistic personality disorder

A

grandiosity
poor response to criticism
arrogant/self-centered
lacks empathy

78
Q

Criteria for Avoidant personality disorder

A

low self-esteem
desires friendships
avoids social situations

79
Q

Criteria for Obsessive Compulsive personality disorder

A

rigid, inflexible
doesn’t see anything wrong with their behaviors

80
Q

Criteria for Dependent personality disorder

A

excessive fear of being alone and independent

81
Q

Tx for personality disorders

A

Dialectical behavioral therapy

82
Q

Criteria for anorexia nervosa

A

BMI < 18.5
binge/purge or restricting

83
Q

Symptoms of anorexia nervosa

A

dyspnea
bradycardia
hypotension / orthostasis
amenorrhea
halitosis
lanugo, dry skin
knuckle changes
loss of dental enamel

84
Q

Lab changes with anorexia nervosa

A

hypokalemia
hyponatremia
hypophosphatemia
hypomagnesemia

pancytopenia

85
Q

Tx for anorexia nervosa

A

CBT
SSRI
NOT bupropion

86
Q

Which medication should be avoided in patients with anorexia nervosa?

A

bupropion (Seizures)

87
Q

Criteria for bulimia nervosa

A

BMI > 18.5
binge/purge
> 1 per week for 3 months

88
Q

Sx of bulimia nervosa

A

halitosis
dental erosions
parotid swelling
Russell sign - knuckles

89
Q

Labs in bulimia nervosa

A

increased amylase
metabolic alkalosis
hypokalemia
hypomagnesemia
hypophosphatemia
hyponatremia

90
Q

Which SSRI is prefered with bulimia

A

Prozac

91
Q

Criteria for binge eating disorder

A

1+ / week for 3 months
no compensatory behaviors

92
Q

Criteria for PICA

A

craving/eating non-food items

93
Q

Characteristics of malingering

A

intentional false or exaggerated sx
external incentive

94
Q

Characteristics of factitious disorder

A

intentional false or exaggerated sx
no external incentive
wants to appear sick

95
Q

Examples of inattention in ADHD

A

careless mistakes
lack of focus
doesn’t listen
doesn’t follow directions
forgets daily activities
disorganized
loses things

96
Q

examples of hyperactivity in ADHD

A

fidgets
runs/climbs in inappropriate places
leaves seat inappropriately
can’t wait turns
extended on-the-go time
talks excessively
interrupts

97
Q

Criteria for ADHD

A

starts before age 7
6+ symptoms for 6+ months
hyperactivity occurs in 2+ settings

98
Q

Tx for ADHD

A

methylphenidate (Ritalin)
dextroamphetamine (Adderall)
lisdexamfetamine (Vyvanse)

99
Q

Criteria for autism spectrum disorder

A

deficits in communication and interaction
restricted, repetitive patterns of behavior, interests, activities
sx present early
sx cause impairment

100
Q

Rett’s disorder - pathophys, sx, etc

A

genetic disorder-abnormal chromatin
almost exclusively females
4 stages - developmental arrest, rapid regression, pseudostationary, late motor deterioration

101
Q

Tx for Conduct disorder

A

carbamazepine
stimulants if ADHD
family therapy

102
Q

Persistent Tic disorder

A

pure motor or pure vocal tic(s)
persisted > 1 year
less than 18 yrs old

103
Q

Provisional tic disorder

A

tic disorder less than 1 year
less than 18 yrs old

104
Q

Copralalia

A

involuntary swearing

105
Q

Criteria for intermittent explosive disorder

A

2+ / week for 3+ months
3 outbursts with property/physical damage within 12 months
> 6 yrs old
aggression out of proportion to stressor
mood returns to baseline between episodes

106
Q

Criteria for kleptomania

A

Items of little personal/monetary need
sense of tension prior with pleasure after

107
Q

Which psych disorder has highest rate of suicide?

A

gambling disorder

108
Q

Name the impulse control disorders

A

Trichotillomania
gambling disorder
pyromania
kleptomania
intermittent explosive disorder

109
Q

Criteria for generalized anxiety disorder

A

excessive worry about multiple things
majority of days for 6+ months
3 or more: restless, easily fatigued, difficulty concentrating, irritable, muscle tension, sleep disturbance

110
Q

Tx for generalized anxiety disorder

A

SSRIs (sertraline, escitalopram, fluoxetine)
buspirone
hydroxyzine (Vistaril)
benzodiazepines
CBT

111
Q

Criteria for OCD

A

unwanted recurring thoughts/behaviors
cause anxiety
time consuming and intrusive

112
Q

Tx for OCD

A

SSRIs - will need higher dose

113
Q

Criteria for panic disorder

A

episodes of intense fear with abrupt onset lasting less than 20 minutes
4+ sx: palpitations, tachycardia, chest pain, short of breath, nausea, sweating, trembling, dizzy/unsteady, depersonalization, fear of dying, paresthesias, chills/hot flashes

114
Q

Tx for panic disorder

A

SSRI
short term benzodiazepines
hydroxyzine
increase exercise/avoid stimulants
CBT

115
Q

Criteria for social anxiety disorder

A

fear of social/performance situations
fear is excessive
impairs normal function
6+ months

116
Q

Criteria for agoraphobia

A

fear of being in a situation that is difficult to escape or help might be unavailable
avoidance of situations

117
Q

Difference in criteria between acute stress disorder and PTSD

A

duration < 1 month vs > 1 month

118
Q

What medication is prescribed for nightmares associated with PTSD?

A

prazosin

119
Q

What medications are avoided with PTSD

A

NO benzodiazepines

120
Q

how long is an adequate trial of an SSRI

A

appropriate dose for 6+ weeks

121
Q

Tx for PTSD

A

CBT, trauma-focused
SSRIs

122
Q

What is the washout period for antidepressants prior to beginning MAO inhibitor?

A

14 days

123
Q

Symptoms of abrupt SSRI discontinuation

A

agitation
irritability
headache
dizziness
myalgias
paresthesias

124
Q

Symptoms of lithium toxicity

A

GI symptoms
confusion
ataxia
tremor
seizures

125
Q

Which anticonvulsant that is used with bipolar disorder can cause Stevens-Johnson syndrome?

A

lamotrigine

126
Q

Criteria for brief psychotic disorder

A

delusions/hallucinations
less than 1 month duration
sudden onset, usually related to stressor
full return to baseline

127
Q

side effects of lithium

A

hyperparathyroidism
thyroid disorders
nephrogenic DI
chronic kidney disease
teratogenic

128
Q

Side effects of valproate

A

neural tube defects

129
Q

What are the positive psychotic symptoms?

A

hallucinations
delusions
disorganized speech
abnormal motor behavior / catatonia

130
Q

What are the negative psychotic symptoms?

A

decreased eye contact
decreased expression
decreased speech intonations
avolition - decreased interest in activities
asociality - decreased social interactions
alogia - decreased words
anhedonia - decreased enjoyment

131
Q

Criteria for schizophrenia

A

2+ symptoms in one month
no major mood disorder symptoms
some symptoms last 6+ months
prodromal, active, and residual sx

132
Q

Criteria for delusional disorder

A

1+ delusion for 1+ month
doesn’t meet criteria for schizophrenia

133
Q

Criteria for brief psychotic disorder

A

1+ positive and 1+ negative sx
>1 day, but < 1 month

134
Q

Criteria for schizoaffective disorder

A

Mood disorder sx (MDD, hypo/mania)
sx occur before or after psychotic sx
psychotic sx at least 2 weeks

135
Q

Criteria for schizophreniform disorder

A

Same as schizophrenia, but no sx 6 months duration

136
Q

Which drug causes nystagmus, violent behavior, ataxia?

A

PCP (phencyclidine)

137
Q

Which illicit drug causes miosis, respiratory depression, depressed mental status?

A

Heroin

138
Q

What is the first line treatment for PCP intoxication?

A

Benzodiazepines

139
Q

Psychosis in Parkinson disease

A

Likely medication - reduce dose

140
Q

Hypnagogic

A

upon falling asleep

141
Q

Hypnopompic

A

upon awakening

142
Q

Characteristics of narcolepsy

A

cataplexy (sudden muscle tone loss)
daytime sleep
sleep paralysis
hallucinations falling asleep/waking up

low CSF hypocretin-1 level

3+ / week for 3+ months

143
Q

Characteristics of REM sleep behavior disorder

A

act out dreams

144
Q

What medication for Bipolar disorder is safe in pregnancy?

A

Lamotrigine

145
Q

What medications for bipolar disorder are a strong teratogen?

A

Valproate - neural tube defects
carbamazepine - neural tube defects

Panre Prep (1 decks)

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