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Psych Flashcards

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1
Q

When is postpartum psychosis?

A

Within 2 weeks of childbirth

Most often seen in those with bipolar disorder

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2
Q

Acute stress disorder timeline

A

Within 1 month of traumatic event

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3
Q

Adjustment disorder timeline

A

Starts within 3 months of stressor, ends within 6 months of stressor ending

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4
Q

Delusional disorder definition

A

> =1 month delusions without other psychotic or mood symptoms

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5
Q

Vascular dementia strategic stroke locations

A

Medial frontal, medial temporal, thalamus

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6
Q

Malignant catatonia

A

Autonomic instability (like NMS) but with posturing and waxy flexibility

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7
Q

How long to continue antidepressant in MDD?

A

Single episode: continuation-phase treatment for additional 6 months after symptoms controlled

> =2 episodes, persistent residual symptoms: maintenance treatment for 1-3 years

> =3 episodes, chronic episodes (>=2yr), strong FHx, or severe: maintenance indefinitely

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8
Q

Bipolar II vs borderline personality disorder: timeframe

A

Bipolar II: discrete periods lasting weeks
Personality disorder: labile mood states that last hours-days; lifelong pattern of identity disturbance

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9
Q

Bipolar major depression - treatment

A

Lurasidone or quetiapine (2nd-generation anti-psychotics)

Alternatives:
Lithium, valproate, lamotrigine, or olanzapine + fluoxetine

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10
Q

Medications to avoid with bipolar disorder

A

Antidepressant monotherapy - if necessary, use in combination with mood stabilizers (e.g. lithium, valproate, 2nd gen antipsychotics)

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11
Q

Borderline personality disorder - firstline treatment

A

Dialectical behavior therapy

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12
Q

Schizoid personality disorder

A

Lifelong pattern of behavior characterized by lack of desire for and detachment from social relationships and restricted emotions

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13
Q

Sleepwalking
Sleep terrors
REM sleep behavior disorder
Nightmare disorder

A

Sleepwalking and sleep terrors are during slow-wave (N3), non-REM sleep; longer period of confusion before becoming fully alert, do not recall concurrent dreams

REM sleep behavior disorder occurs in latter half, awakened easily and alert and oriented, in older adult men and may be sign of neurodegeneration and possible later onset of Parkinson or dementia with Lewy bodies

Nightmare is vivid recall of disturbing dream content without motor activity

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14
Q

Depersonalization/derealization disorder
Dissociative amnesia
Dissociative identity disorder

A

Depersonalization/derealization: intact autobiographical memory but feelings of unreality/detachment

Dissociative amnesia: typically sudden and preceded by overwhelming or intolerable events; localized amnesia for particular event or generalized for personal identity and history

Dissociative identity disorder: requires >=2 distinct personality states; associated with severe trauma/abuse

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15
Q

PTSD length

A

> 1 month (vs acute stress disorder, which is >=3d and <=1 month

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16
Q

Dialectical behavioral therapy

A

Borderline personality disorder

Improves emotion regulation, distress tolerance, mindfulness
Decreases self-harm; builds skills

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17
Q

Psychodynamic therapy

A

For higher functioning patients; personality disorders

Builds insight into unconscious conflicts and past relationships

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18
Q

When is electroconvulsive therapy used for MDD with psychotic features?

A

Rapid response in case of severe suicidality or refusal to eat/drink

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19
Q

Persistent depressive disorder (dysthymia)

A

> =2 years with >=2 symptoms
No symptom-free period for >2 mo

Specifiers:
with pure dysthymic syndrome - never major depressive episode
with intermittent major depressive episodes
with persistent major depressive episodes (criteria met throughout previous 2 years)

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20
Q

Bulimia nervosa - drug of choice

A

Fluoxetine

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21
Q

How does somatic symptom disorder differ from illness anxiety disorder?

A

Significant somatic symptoms, as opposed to concern with the idea of having a serious illness

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22
Q

Dissociative identity disorder - treatment

A

Long-term, trauma-focused psychotherapy

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23
Q

Difference in auditory hallucinations between dissociative identity disorder and psychotic disorder

A

DID - voices perceived as inside patient’s head
Psychotic - voices seem from outside of head

24
Q

How long for schizophrenia diagnosis?

A

Impaired functioning >=6 mo

Episodes of acute psychosis and negative symptoms

25
Q

Panic disorder - acute and long-term treatments

A

Acute: Benzo (e.g. lorazepam)
Long-term: SSRI/SNRI and/or CBT

26
Q

Medication for sedation

A

Benzos
Haloperidol
Haloperidol + lorazepam can achieve more rapid sedation in severely agitated, combative patients

27
Q

Kleptomania

A

Impulse control disorder with typical onset in adolescence - steal objects of low monetary value or not needed for personal use (as opposed to shoplifting)

Tend to feel guilt or shame afterward and want to return or give away item

28
Q

Medication-induced dystonia - signs

A

Sudden, sustained contraction of muscles, most often impacting neck, mouth, tongue, and extraocular muscles

May be associated with other extrapyramidal effects

Anticholinergics will help treat

29
Q

Differentiate medication-induced dystonia (dopamine antagonists, antipsychotics) with serotonin syndrome (serotonin antagonists)

A

Serotonin syndrome is more pronounced in extremities (e.g. spontaneous clonus, hyperreflexia) with prominent autonomic hyperactivity (e.g. hyperthermia, hypertension)

30
Q

Lithium-enhanced physiologic tremor vs lithium toxicity tremor

A

Physiologic: symmetric, limited to hands/upper limbs, occurs when medication started or increased; nonprogressive and often decreases

Toxicity: Irregular, coarse, multiple parts of body +/- GI or neuro symptoms

31
Q

Essential tremor

A

Action tremor - more pronounced at end of goal-directed movements and improves with rest
Typically older patients or FHx

32
Q

Akathisia

How to manage?

A

Most common extrapyramidal symptoms associated with antipsychotic medication
Dose-dependent effects

Management:
1. Cautiously reduce antipsychotic dosage
2. Change to alternative antipsychotic
3. Add beta-blocker (e.g. propranolol - block noradrenergic and serotonergic inputs on dopamine pathways), anticholinergic (e.g. benztropine), or less commonly benzo

33
Q

Common sites of dystonia (related to antipsychotic or dopamine antagonist)

A

Head and neck small muscles
Oculogyric crisis - forced upward gaze deviation
Torticollis (stiff neck)
Blepharospasm (blinking, other eyelid movements that you can’t control)
Trismus

34
Q

Narcolepsy definition

A

Recurrent lapses into sleep or naps (>= 3x/week for 3 months)

> =1 of following:
1. Cataplexy - brief loss of muscle tone precipitated by strong emotion
2. Low CSF orexin A/hypocretin-1
3. Shortened REM sleep latency

May come with hypnagogic or hypnopompic hallucinations, sleep paralysis - these are intrusions of REM sleep phenomena

35
Q

Narcolepsy workup

A
  1. Polysomnography - to rule out other sleep disorders
  2. Multiple sleep latency test - demonstrates decreased sleep latency and sleep-onset REM periods
36
Q

Histrionic personality disorder

A

Excessive emotionality and attention-seeking since early adulthood
Inappropriate, sexual, provocative behavior
Suggestible (easily influenced)
Considers relationships more intimate than they really are

37
Q

Narcissistic personality disorder

A

Want to be center of attention but without emotional displays
Lack of empathy
Interpersonal exploitation

38
Q

Intermittent explosive disorder

A

Intermittent verbal or physical aggressive behavior that is disproportionate to the objective triggering offense

Treat with CBT and SSRIs

39
Q

Persistent complex bereavement disorder (complicated grief)

A

Persistent yearning for deceased and prolonged emotional pain related to loss, accompanied by maladaptive, ruminative thoughts and dysfunctional behaviors

40
Q

Bulimia nervosa vs binge eating vs anorexia nervosa

A

Bulimia nervosa: inappropriate compensatory behavior; treat with fluoxetine

Binge eating: no compensatory behaviors; lisdexamfetamine, topiramate

Anorexia: BMI <18.5; olanzapine if no response to first-line treatments

41
Q

How long must binge and compensation last to make diagnosis of bulimia nervosa?

A

Each at least once a week for 3 months

42
Q

Borderline vs intermittent explosive disorders

A

Borderline - anger and rage occurs in context of unstable relationship, related to underlying fears of abandonment; also suicidal, empty feeling, etc.

43
Q

Disruptive mood dysregulation disorder vs intermittent explosive

A

DMDD requires onset before age 10 and persistent irritability or anger between episodes; diagnosis not made after age 18

44
Q

Eccentric behaviors and odd beliefs

A

Schizotypal disorder

No fixed delusions or frank hallucinations, paranoia not of delusional proportions

Requires ruling out psychotic disorders

45
Q

Schizotypal personality disorder vs schizoid vs schizophrenia

A

Schizotypal - eccentric behaviors, odd beliefs, magical thinking

Schizoid - socially detached, “loners”; do not have odd thinking or perceptual distortions

Schizophrenia - delusions, hallucinations, disorganized speech/behavior, negative symptoms

46
Q

When is electroconvulsive therapy immediately indicated in MDD?

A

Emergency:
1. Suicide risk
2. Not eating or drinking
3. Pregnancy

Non-emergency:
1. Treatment resistance
2. Psychotic features

47
Q

Premenstrual dysphoric disorder (PMDD) diagnosis

A

Prospective daily ratings for >=2 cycles demonstrating a symptom-free period in the follicular phase

48
Q

Subconjunctival hemorrhage can be a sign of what psych disorder?

A

Anorexia or bulimia nervosa - from intraabdominal pressure from vomiting

49
Q

Tourette syndrome - treatment

A

Habit reversal training
Antidopaminergic: tetrabenazine (dopamine-depleting), antipsychotics
a2-agonists

50
Q

Social anxiety disorder treatment - difference between performance-only version

A

Performance-only: beta-blocker or benzo PRN instead of SSRI

51
Q

Treatment for nightmares in PTSD

A

Prazosin - decreases adrenergic hyperactivity seen

52
Q

Bipolar medication that isn’t teratogenic

A

Lamotrigine

53
Q

OCD treatment alternative to SSRI

A

Clomipramine (TCA)

54
Q

Dementia - sequence of medications

A
  1. Cholinesterase inhibitors: Donepezil, rivastigmine, or galantamine
  2. NMDA antagonist: Memantine
55
Q

Which SSRI should be avoided in pregnancy?

A

Paroxetine - cardiac defects in 1st trimester, pulmonary HTN in 3rd trimester

Neuro/Psych (7 decks)

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