Psych 2- Final Flashcards
Where does serotonin re-uptake occur and what happens w/ increased levels present
What are the 6 common SSRI names
What are the 2 common SNRIs
Pre-synaptic; down regulate autoreceptors and inc raphe firing rate
Fluoxetine/Fluvoxamine
Paroxetine Es/Citalopram Sertraline
Duloxetine, Venlafaxine
What SSRIs are the most activating and who needs to avoid them
What SSRIs are the most sedating
Which one has the worst weight gain and EPS associated w/ use
Fluoxetine Sertraline- sleep trouble
Paroxetine Fluvoxamine- take at bed/night
Paroxetine
SNRI use needs to be avoided in ? populations
What anticholinergic effects can TCAs cause
What CV risk do TCAs have
CVDz BPH Urinary retention Glaucoma SI
Dry mouth Retention/constipation Blurred vision
Worsens arrhythmias
What is the MOA of Bupropion
What three d/o populations need to avoid this med
What are the 3 Serotonin Receptor Antagonists and when are they used
Dopamine/NorEpi reuptake inhibitor w/ low 5-HT impact
Seizure Eating Withdrawal/Using alcohol/benzos
Mirtazapine: depression w/ SSRI
Nefazodone: anxious depression/SSRI sex dysfunction
Trazaodone: depression, insomnia
What is the MOA of Bupropion
What three d/o populations need to avoid this med
What are the 3 Serotonin Receptor Antagonists and when are they used
Dopamine/NorEpi reuptake inhibitor w/ low 5-HT impact
Seizure Eating Withdrawal/Using alcohol/benzos
Mirtazapine: depression w/ SSRI
Nefazodone: anxious depression /SSRI sex dysfunction
Trazaodone: depression, insomnia
? serotonin receptor antagonist has a black box warning
MOA of MAOIs
What food interaction is associated w/ these meds
Nefazodone: liver failure
Block enzymes that break down neurotransmitters
Tyramine digestion- indirect sympathomimetic causing HTN crisis d/t catecholamines releasing Epi/NorEpi
What SSRIs have pregnancy risks associated w/ use
When starting use of anti-psychotics, start w/ ? ones and why
When is this rule ignored
Fluoxetine: 3rd-T low weight
Paroxetine: heart defects
Atypical: less EPS
Preference/Past response to typical
What black box warning is w/ anti-psychotics
Typical anti-psychotics
Atypical anti-psychotics
Geriatrics w/ dementia related psychosis
Chlorpromazine Haloperidol Fluphenazine Loxapine Meso/Perp/Thio-zine
Clause: Clozapine Quit: Quetiapine Luring: Lurasidone Ascending: Asenapine Zebra: Ziprazidone Ghost: Olanzapine Tombstone RIP: Aripiprazole and Risperidone Pale Pear: Ilo/Pali-peridone
What EPS effects can be seen when using anti-psychotic meds
What are the low potency typical anti-psychotics
What are the high potency typical anti-psychotics
Tdyskinesia Akathesia- MC Dystonia Sex dysfunction
Chlorpromazine Thioridazine
Haloperidol Fluphenazine Trifluperazine
Atypical antipsychotics were made to reduce EPS and have similar efficacy except for ? one
Effects of benzos w/ long half life
Effect of benzos w/ short half-lief
Clozapine
Longer lasting effect
Less withdrawal/breakthrough
More hangover/daytime sedation
Quicker Sxs control for acute management
Tolerance to hypotonic effect quickly builds
Common withdrawal Sxs
What are the short acting benzos
What are the intermediate benzos
What are the long acting benzos
Triazolam Oxazepam Midazolam
Temazepam Estazolam Alprazolam Lorazepam
Chlordiaepoxide Clonazepam Diazepam Flurazepam Quazepam
What is seen when Pts abruptly stop taking short or intermediate acting benzos
Benzos are pregnancy class ?
If use is needed in geriatric population, use ? ones
Rebound insomnia
D-X
Lorazepam Oxazepam Temazepam
What anticonvulsant meds are used for Bipolar D/o
All atypical agents are approved for acute mania/mixed episodes except for ? two
What benzos can be used
Valproic Topiramate Lamotrigine Carbamazapine
Clozapine, Iloperidone
Lorazepam, Diazepam
Prolonged use of lithium can cause ? changes
Lithium toxicity is managed how
Anticonvulsant Topiramate needs to be used w/ caution d/t ?
Hypothyroidism
TSH induced non-toxic goiter
D/c med, Hydrate, Gastric lavage, >3mEq= dialysis
Causing depression
Prolonged use of lithium can cause ? changes
Lithium toxicity is managed how
Anticonvulsant Topiramate needs to be used w/ caution d/t ?
Hypothyroidism
TSH induced non-toxic goiter
D/c med, Gastric lavage, >3mEq= dialysis
Causing depression
First line med for alcohol dependence
Second line med for alcohol dependence
What is the disulfram reaction seen if consumption occurs
Naltrexone (opioid receptor antagonist w/ mu affinity) to dec dependence, cravings, consumption
Disulfiram (dec ALDH ethanol metabolism at acetaldehyde) w/ SSRIs for motivated Pts
HA/N/V/HOTN w/ tachy/tachy
Prior to starting stimulants for ADHD, ? is needed
What is their MOA
Three non-stimulants can be used for ADHD
BP, HR, Height/Weight
Promote catecholamine (Dop/NorEpi) release from presynaptic terminals
Clonidine Atomoxetine Guanfacine
What was the first non-stimulant approved by FDA for ADHD Tx in Pts >6y/o
What can this worsen in Pts
When is Clonidine used
Atomoxetine- blocks NorEpi reuptake
Aggression
A2 agonist tics/intolerant to stimulants, Monotherapy for ADHD
Concurrent Tx- Impulse behavior/Tourettes
How can Specific Phobias be Tx
Social Anxiety may also co-exist w/ ? other d/o
Agoraphobia is Tx just like ? w/ ?
Desensitization, CBT, Gabapentin, Propranolol, SSRI/SNRI
Avoidant Personality D/o
GAD w/ SSRI and CBT
Define Panic D/o
How is this Tx
What is used for acute Sxs Tx
Unexpected attacks w/ Sxs peaking <10min, followed by worry/maladaptive changes in behavior x 1mon
CBT, Relaxation/Desensitization
SSRI/SNRI/TCA,Propranolol
Alprazolam/Clonazepam
Define Agoraphobia
How are they Tx
Define GAD
Anxiety of least two situations causing OOP responses and are now avoided
Support group w/ S/SNRI/Gabapentin
Excessive worry about many things x6mon
What RFs put Pts at risk for GAD
What meds are used for GAD Tx
MDD OCD PTSD
SSRI/SNRI/TCA
Benzo- Lorazepam
Buspirone Gabapentin Propranolol
What are Somatic Sxs
Define Somatization
Define Somatic Sx D/o
Fatigue Paralysis Pain SOB Tremor
Psychological stress felt in physical form w/out a Dz being present
Somatic Sx disrupting life d/t excessive thought/anxiety/time x6mon
What is the MC Sx of Somatic Sx D/o
What annoying feature can these Pts have
How is this Tx
Pain
Doctor shopping
Support/Therapy
Refractory- S/NRI but w/ Sx exacerbation
Define Illness Anxiety D/o
How is this Tx
What is Conversion D/o AKA
Worry of possible illness w/ minor/no somatic Sxs x6mon
Therapy
SSRI if MDD/Anxiety present
Functional Neurological Sx D/o
Define Conversion D/o
What PE findings can help w/ Dx
Sxs of altered voluntary motor or sensory function
Hoovers Sign: hip extension weakness corrected w/ contralateral hip flexion
Ankle weakness while laying down but walked to appt
Tremor entertainment test
Tubular visual field for visual Sxs
How is Conversion D/o Tx
Define Factitious D/o
How is this managed
Hypnosis w/ anxiolytics
False S/Sxs w/ intent to deceive but no secondary gain
Psychiatric confrontation
CPS takes child if Munchausen by proxy
Define Obsession
Define Compulsion
One-third of OCD Pts will also have ? Dx and MC be ? gender
Intrusive or unwanted urges, thoughts, images
Repetitive behaviors or mental acts
Tic d/o in males
Define Obsession
Define Compulsion
One-third of OCD Pts will also have ? Dx in their life
Thought/Urge/Image that is intrusive and unwanted
Behavior/Mental acts performed
Tic d/o
How is OCD Tx
What separates OCD from OCPD
Define Body Dysmorphic D/o
Desensitization w/ CBT
SSRIs/Clomipramine
OCD behavior is ego-dystonic- inconsistent w/ beliefs/attitude
Pre-occupation w/ perceived defect of physical appearance not seen by others
What are the MC areas focused on w/ Body Dysmorphic D/o
How is this Tx
What two other D/os are commonly present
Skin Hair Nose
Psychotherapy
SSRI/Clomipramine
Psychotic d/o, OCD
Although it can involve any area, ? parts of the body are MC affected by Trichotillomania
How is this Tx
Define Excoriation D/o
Scalp Brows Eyelids
Desensitize/Habit reversal
Anti-depressant/psychotics
Steroids
Hydroxyzine
Picking at skin w/ repeated attempts to stop
What parts of the body are MC affected by excoriation
How is this Tx
Define MDD
Face Arm Hands
CBT w/ habit reversal and Fluoxetine, Naltrexone
Required: Depressed mood/Lost interest PLUS four SIGECAPS Sxs x 2wks
What are two common presenting complaints of MDD
What presenting issue indicates greater severity
What is the biggest RF and an increased factor for suicide in this population
Fatigue, Insomnia
Psychomotor Sxs
Hx of prior attempts;
Borderline Personality D/o increases risk
What are 3 variations of MDD
When is electroconvulsive therapy indicated
What is added to SSRI regiment if Pt experiences sex dysfunction
Peripartum Melancholic Seasonal
Meds can’t be used/Severe suicidality
Sildenafil, Buproprion
What are 3 variations of MDD
When is electroconvulsive therapy indicated
What is added to SSRI regiment if Pt experiences sex dysfunction
Peripartum Melancholic Seasonal
Meds can’t be used
Severe suicidality
Sildenafil, Buproprion
When/Why are stimulants used for MDD Tx
Criteria for Persistent Depressive D/o
What other d/o can this AKA
Short term Tx or refractory depression
Depressed mood x2yrs (1yr if child/adolescent)
Dysthymic
When/Why are stimulants used for MDD Tx
Criteria for Persistent Depressive D/o
What other d/o can this AKA
Short term Tx
Refractory depression
Depressed mood x2yrs (1yr if child/adolescent)
Dysthymic
How is PMDD Tx
Define Bipolar 1
Define Bipolar 2
Fluoxetine/Sertraline
Venlafaxine if predominantly psych Sxs
Clomipramine
Mania > depression w/ impairment x 7d;
Spends savings, destroys relationships, neglects work
Depression > mania w/ uncharacteristic behavior:x 4d
Sad, distracted, dec sleep, flight of ideas w/ spending sprees
How is Bipolar 1 Tx
What needs to be avoided in this population
What is a less intense, longer lasting form of bipolar
First line: valproic acid w/ admission
SSRIs
Cyclothymic d/o
How are bipolar Pts that are rapid cyclers managed
What bipolar population has a higher rate of lethal suicide attempts
Define Insomnia
2nd gen antipsychotic w/ benzo
Lethal: BP2; Prevalence- same
Poor sleep quality/quantity 3/wk x 3mon w/ enough opportunity
Criteria for Hypersomnolence D/o
Criteria for Narcolepsy
What is a common presentation complaint
Excessive sleepiness after 7hrs of sleep w/ lapses of sleep, sleep >9hrs or difficulty waking up 3x/wk x 3mon
Need to sleep 3/wk x 3mon w/ cateplexy, hypocretin or +sleep study
Cataplexy: bilateral loss of muscle tone precipitated by emotions (laughter, jokes)
How is Narcolepsy Tx
What types of hallucinations can these Pts have
What causes this d/o
Amphetamines
Modafinil: s/e of HA/anxiety/dec OCP efficacy
Hypnagogic: before sleep
Hypnopompnic: before awakening
Hypocretin deficiency in hypothalamus
Criteria for OSA on polysomnography
? MC fact does this hold
How does Circadian Rhythm Sleep-Wake d/o present
5 episodes/hr w/ Sxs
15 episodes/hr
MC breathing related sleep d/o
Insomnia, difficult wakening and excessive early day sleepiness that get normal sleep quality/duration when on own schedule
How is Circadian Rhythm D/o Tx
Criteria for Restless Leg Syndrome
What meds are used for Sx relief
Sleep hygiene
Melatonin Zolpidem Benzos
Urge to move legs d/t discomfort when at rest 3x/wk x 3mon
Ropinirole Iron Gabapentin Clonazepam
Scale used to measure sleep quality and quantity
Scale used for sleep apnea
What part of the night do sleepwalking, nightmares, sleep terrors and REM behavior d/o occur
Epworth
Stop-Bang:
Snore Tired Observed Pressure
BMI Age Neck Gender
Walking: first half
Behavior: second half
Terror: first third
Nightmare: last third
How are sleepwalking/terrors Tx
How are nightmares Tx
Define Delusion and Hallucination
Clonazepam
Prazosin
D: fixed beliefs that are unchangeable
H: perception-like experience w/out stimulus
How is a suspected Schizophrenia’s thinking labeled a disorganized
What PE finding can also suggest this
What are the positive and negative Sxs of schizophrenia
Speech- derailement, tangent answers
Catatonia
N: flat affect, emotionless, withdrawn
P: hallucination, delusion, repetitive movements
Criteria for Delusional D/o
When compared to bipolar d/o, delusional d/o Sxs are considered ?
How are these Pts Tx
One positive delusional Sx x 1mon w/out meeting schizophrenia criteria
More severe
Protect self/others
Atypicals: Olanzapine and Risperidone
Define Brief Psychotic D/o
How is this Tx
If suspected schizophrenia Pt has ? childhood Dxs, how are criteria for Dx changed
Delusion, Hallucination or Disorganized speech for at least one day but less than one month
Protect self/others
Atypical: Olanzapine + Risperidone
Autism, Communication d/o;
prominent delusions/hallucinations present
Define Brief Psychotic D/o
How is this Tx
If suspected schizophrenia Pt has ? childhood Dxs, how are criteria for Dx changed
Delusion, Hallucination or Disorganized speech for at least one day but less than one month
Protect self/others
Atypicals: Olanzapine and Risperidone
Autism, Communication d/o;
delusions/hallucinations present
Define Schizoaffective D/o
How are these Pts Tx
Criteria for schizophrenia
Schizophrenia w/ MDD x 2wks
Psychotherapy
Atypicals, Anticonvulsants and SSRIs
Major psychosis w/ difficulty functioning x6mon
Why is Clozapine not used first line for schizophrenia Tx
First period of schizophrenia psychosis needs ? added to work up
Define Schizophreniform D/o
Agranulocytosis
Brain imaging
Major psychosis for greater than one month but less than 6mon w/out social/occupational impairment
What adverse effects may be seen when starting SSRI therapy
What are the MC presentations of Serotonin Syndrome
How will Pts look on PE/vinette
Tremor Anxiety Panic
Cognitive: confusion/disorientation
Autonomic: hypertheria/diaphoresis
Neuromuc: myoclonus
HTN/Tachy Clonus w/ hyper-reflexia Hyperthermic Agitated/confused Dilated pupils
What are the common adverse effects of SNRI use
MOA of TCAs
Why is TCA therapy associated w/ weight gain
Somnolence HA Insomnia Nausea Sex dysfunction
Block 5-HT and NorEpi uptake increasing monoamines in synaptic cleft
Dry mouth causes increased caloric intake via drinks
What are he common adverse effects of SNRI use
MOA of TCAs
Why is TCA therapy associated w/ weight gain
Somnolence HA Insomnia Nausea Sex dysfunction
Block 5-HT and NorEpi uptake increasing monoamines in synaptic cleft
Dry mouth causes increased caloric intake via drinks
MAOIs are used for atypical depression which include ? three presentations
Adverse effects of MAOI use
Normally, what happens when GABA binds to GABA receptor
Hypersomnia Hyperphagia Reactive moods
HTN crisis
Serotonin syndrome
Weight gain
Sex dysfunction
Relaxation, Sedation
What type of binding is seen w/ benzos to the GABA receptor
What is the preferred effect of benzos hence why they’re used in surgical procedures
What two populations need to avoid benzo use
Allosteric inhibition
Anterograde amnesia
Geriatrics, Pregnant
What med used for ADHD is a mix of dextroamphetamine and amphetamine salts
What happens when Lisdexamfetamine is ingested
MOA and use of Atomoxetine
Adderall
Converted to active dextroamphetamine in blood
Blocks re-uptake of NorEpi for ADHD monotherapy in Pts >6y/o
Define Dissociation
What are the two dissociative Sxs
Define Acute Stress D/o
Mentally disconnecting from thoughts, feelings or memories
Depersonalization: detached; in a dream
Derealization: unreal; world is distorted
Exposure/Threatened death or injury w/ Sxs lasting 3-30days
How are Acute Stress D/o Pts managed for Tx and what meds can be used
What part of the PTSD Tx needs to be started as early as possible
What is the only class of medication approved for Tx
Trauma/Exposure therapy;
Benzos Morphine Propranolol SSRIs
Psychotherapy x 8-12 sessions
SSRIs- Sertraline, Peroxatine
Time frame criteria for adjustment d/o
What meds can be used for Tx
Timeframes for the three trauma/stress d/os
OOP distress/impaired function starting w/in 3mon/ending w/in 6mon of stressor ending
Benzos Antihistamines SSRIs
Acute: traumatic event causing Sxs x 3-30d
PTSD: traumatic event causing Sxs >30d
Adjustment: stress causing Sxs 3-6mon
Define Bereavement and what is a natural response to this event
What are the two phases of this natural response
What can make the transition from the first to second phase be prolonged/delayed
Event when someone close dies;
Grief
Acute- numb/denial adaptive mechanism
Integration- healing
Death/loss d/t suicide
What are the four hallmarks of healing from a death
When does grief become reclassified as Persistent Complex Bereavement D/o
What are common comorbidities that increase likelihood of developing this
Recognition of grief process
Equanimity w/ subject
Return to activities/work
Seeks pleasure/company
6mon for child; 12mon or longer for adult
Death of a child
PTSD Substance abuse Depression
What is first line Tx for Persistent Complex Bereavement D/o
What is considered second line therapy
What will develop in these Pts if they go untreated
Behavioral therapy: Loss acceptance and restoration of living
Serotonin active antidepressants for Pts w/ comorbid psych conditions
13mon: Smoking HTN Eating Depression
25mon: CV, Neoplastic Dz
What is the strongest risk for suicide
What are the other associated RFs in descending order
What is a strong predictor for suicide
Previous attempt/threat
Never married Widowed Separated Divorced Married w/out kids
Psych illness
What is the strongest risk for suicide
What are the other associated RFs in descending order
What is a strong predictor for suicide
Previous attempt/threat
Never married
Widowed Separated Divorced Married w/out kids
Psych illness
When does age become a RF for suicide
What acronym is used for the objective assessment of suicide
What part is subjective and what part is objective
Males >85y/o
AMSIT:
Appearance Mood/Affect Sensorium Intellect Thoughts
Mood: subjective
Affect: objective
Who is the first responder to suspected elderly abuse
Define Anorexia Nervosa
What safety step may be ordered for these Pts
Adult protective services
Energy intake restriction w/ excessive calorie burn/loss w/ intense fear of obesity/weight gain and distorted self image
EKG d/t hypocalcemia and prolonged QTc
Who is the first responder to suspected elderly abuse
Define Anorexia Nervosa
What safety step may be ordered for these Pts
Adult protective services
Energy intake restriction w/ excessive calorie burn/loss w/ intense fear of obesity/weight gain
EKG d/t hypocalcemia and prolonged QTc
Define Bulimia Nervosa
What Tx combo has shown the best results
Define Binge Eating D/o
Recurrent binges of eating too much w/ sensation of lost control 1/wk x 3mon of a Pt who is normal/over weight
Psychotherapy w/ Fluoxetine* hydrochloride
Eating too much, when already full, eating alone or feeling guilty 1/wk x 3mon w/out compensatory mechanisms
How is binge eating d/o Tx
What are the two types of anorexia nervosa
Criteria for ADHD
Psychotherapy and CBT
Restricted Type: restricted intake w/out binge/purge behavior
Binge-Purge Type: binge eat then misuse laxatives/diuretics/enemas
6 Sxs of Inattention, Impulse, hyperactive <12y/o x 6mon in two environments
>17y/o= 5 Sxs
How is binge eating d/o Tx
What are the two types of anorexia nervosa
Criteria for ADHD
Psychotherapy and CBT
Restricted Type: restricted intake w/out binge/purge behavior
Binge-Purge Type: binge eat then misuse laxatives/diuretics/enemas
Inattention, Impulse, hyperactive <12y/o x 6mon in two environments
What meds are used for the Tx of ADHD
Stimulants
TCA: Desipramine for Pts w/ depression/neuropathic pain
Buproprion- when stimulants are c/i or suffer from MDD
Atomoxetine- second line FDA approved
Guanfacine/Clonidine- also help w/ BP
Criteria for Autism
What are the first Sxs usually seen
What are the only two psychotropic meds FDA approved for Autism Tx
Impaired reciprocal communication and social interactions w/ restricted, repetitive behavior
Delayed language development w/ lack/unusual social interactions
Risperidone, Aripiprazole
What is the more severe form of Opposition, Defiant d/o
What does Opposition, Defiant have that is missing in the more severe form
What mes are used for the more severe form
Conduct d/o
Emotional dysregulation
Haldol/Olanzapine/Risperidone- agression
Lithium- mood
Stimulants- ADHD
What is the more severe form of Opposition, Defiant d/o
What does Opposition, Defiant have that is missing in the more severe form
What mes are used for the more severe form
Conduct d/o
Emotional dysregulation
Haldol/Olanzapine/Risperidone- agression
Lithium- mood
SSRI- ADHD
Define Intermittent Explosive D/o
What drug combo is recommended for Tx
What medications can help reduce labido/disruptive sexual behavior in men
Episodic anger/violence
Dextromethorphan and Quinidine
Medroxyprogesterone acetate
Fluoxetine
Dissociative Identity d/o is more common in ? gender and w/ ? MedHx
Define Dissociative Amnesia
This can also be called ? state
Women w/ sexual abuse
Psychotherapy
Sudden inability to recall personal info/autobiography info of stress/traumatic nature
Fugue
Dissociative Identity d/o is more common in ? gender and w/ ? MedHx
Define Dissociative Amnesia
This can also be called ? state
Women w/ sexual abuse
Psychotherapy
Sudden inability to recall personal info/autobiography info of stress/traumatic nature
Fugue
What is Dissociative Amnesia associated w/
What will be missing from these Pts Hx
How are they Tx
Disaster/war stressors
Substance/Sexual abuse
Psychotherapy
Cluster A personality d/os
Cluster B personality d/os
Cluster C personality D/os
Schizotypal Paranoid Schizoid- Odd/Weird/Eccentric
Narcissistic Borderline Antisocial Histrionic- Dramatic/Emotional/Erratic
Dependent OCD Avoidant- Anxious/Fearful/Worried
Alcohol withdrawal S/Sxs
Tremors, hand Autonomic hyperactivity Insomnia N/V Transient hallucinations Agitation/anxiety Seizure
Tremulousness: 6-12
Hallucination: 12-48
Seizure: 12-48hrs
DTs: >48hrs
Define Schizotypal personality D/o
This groups of personality d/o will improve when placed on ? class of medication
Define Antisocial Personality D/o
Discomfort w/ relationships and eccentric behavior
Antipsychotics
Disregard for/violation of rights of others since 15y/o and is now at least 18y/o
Define Schizotypal personality D/o
This groups of personality d/o will improve when placed on ? class of medication
Define Antisocial Personality D/o
Discomfort w/ relationships w/ distorted/eccentric behavior
Antipsychotics
Disregard for/violation of rights of others since 15y/o and is now at least 18y/o
Define Borderline Personality D/o
What defense method can these people use?
Define Histrionic Personality D/o
Instability w/ relationships and self image w/ impulsivity starting in adulthood
Splitting- view self/others as all good/bad
Excessively emotional and attention seeking
What defense system do Histrionic personality d/os use
Histrionics as a group are more functional than ? personality d/o
Define Narcissistic Personality D/o
Regression- revert to child like behaviors
Borderline
Grandiosity, need for admiration and lack of empathy
Define Avoidant personality d/o
Define Dependent Personality d/o
Define OCD
Social inhibition w/ feeling of inadequacy and a hypersensitivity to rejection/negative evaluation; Tx w/ SSRIs and Benzos
Excessive need to be cared for leading to submissive/clinging behavior w/ fear of separation
Preoccupation w/ order, perfection or control at expense of openness/efficiency
What type of behavioral therapy is used for personality d/o Tx
Operant conditioning: recognizes and reinforces acceptable behavior
Aversion conditioning: punishment/removal of privaleges for poor behavior
What class of med is used for borderline personality d/o to improve anxiety, depression, or sensitivity of rejection
What class is used to decrease impulsivity
What class is used to dec hostility, agitation and an adjunct used w/ antidepressants
Anti-depressants
SSRIs
Antipsychotics
What class can be used to decrease the severity of behavior dyscontrol in personality d/o Pts
Avoidant personality d/o may benefit from anxiety reducing exercises and ? meds
What type of onset makes a Dx of schizophrenia more favorable in prognosis
Anticonvulsants
SSRI and Benzos
Late onset
What class can be used to decrease the severity of behavior dyscontrol in personality d/o Pts
Avoidant personality d/o may benefit from anxiety reducing exercises and ? meds
What type of onset makes a Dx of schizophrenia more favorable in prognosis
Anticonvulsants
SSRI and Benzos
Late onset
Define Alcohol Use D/o
When will these Pts have had their first experience of intoxication
What characterizes their course through the d/o
Behavioral/Physical Sxs including craving, withdrawal and tolerance.
Mid-Teens
Remission and relapse
Episodes of alcohol intoxication increase w/ ? personality characteristics
What are two examples of medical conditions that can mimic alcohol withdrawal
What medication can help w/ hallucinations during withdrawal
Sensation seeking, Impulsitivity
Hypoglycemia, DKA
Haloperidol
What two medications can be used during alcohol withdrawal if the efficacy of benzos is lacking
Caffeine intoxication is considered ingestion of ? much
How long is the t1/2 of caffeine
Propofol, Phenobarbital
> 250mg
4-6hrs
Hallucinogen abuse can leave residual Sxs resembling ?
What PE findings can help differ PCP from other hallucingens
What are the most common clinical presentations of PCP intoxication
Schizophrenia
Nystagmus Analgesia HTN
Disorientation, Catatonic-like syndrome
What is the hallmark of hallucinogen persisting perception d/o
This d/o primarily exists after abuse of ?
How are these severe intoxications Tx
Re-experiencing the effects while Pt is sober
LSD
Protect Pt/others w/ Haloperidol
What is the hallmark of hallucinogen persisting perception d/o
This d/o primarily exists after abuse of ?
How are these severe intoxications Tx
Re-experiencing the effects while Pt is sober
LSD
Protect Pt/others
Antiphsychotics- Haloperidol
What adverse effects can be seen in Pts that abuse inhalants and require admission
What is the risk of opioid abuse compared to other substance abuse
What will be seen on PE if Pt is using opioids
Respiratory suppression Arrhythmias Coma Hypokalemia
Inc risk for attempted/completed suicides
Dry membranes
Constipation
Pupil constriction
What adverse effects can be seen in Pts that abuse inhalants and require admission
What is the risk of opioid abuse compared to other substance abuse
What will be seen on PE if Pt is using opioids
Respiratory suppression
Ventricular arrhythmias
Hypokalemia
Coma
Inc risk for attempted/completed suicides
Dry membranes
Constipation
Pupil constriction
The anxiety and restlessness seen in opioid withdrawal is similar to ? other substance withdrawals
What is seen in opioid withdrawal that distinguishes it
What are the MC medical conditions associated w/ opioid use d/o
Sedative-Hypnotic
Rhiorrnea Lacrimation Dilated pupils
HIV, Hep C, bacterial infection
What is the prominent feature of sedative/hypnotic abuse
How are benzo ODs Tx and what adverse reaction can occur
This adverse reaction is more likely to occur in Pts w/ ? Hx
Memory impairment
Flumazenil- seizures
Benzo addiction
Seizure d/o
TCA/convulsant overdose
How long can a d/o to amphetamine/cocaine develop
Withdrawal states are associated w/ ? that resolves w/in ?
What two prominent presenting issues may exist with this abuse d/o and need to be r/o
W/in one week
Severe depression that resolves <1wk
Auditory hallucinations, Paranoid ideations
How long can a d/o to amphetamine/cocaine develop
Withdrawal states are associated w/ ? that resolves w/in ?
What two prominent presenting issues may exist with this abuse d/o and need to be r/o
W/in one week
Severe depression that resolves <1wk
Prominent auditory hallucinations
Paranoid ideations
What two issues are seen w/ tobacco withdrawal
What S/Sx may Pts complain of during abstinence
First line pharmacotherapy for smoking cessation include ? combo w/ increased rates reported if ? is added to Tx
Craving sweets, Impaired performance on vigilant tasks
Constipation Dizziness Cough Dreams Nausea
Varenicline, Buproprion;
Behavior therapy
What two issues are seen w/ tobacco withdrawal
What S/Sx may Pts complain of during abstinence
First line pharmacotherapy for smoking cessation include ? combo
Craving sweets, Impaired performance on vigilant tasks
Constipation Dizziness Cough Dreams Nausea Sore throat
Varenicline and Buproprion
MOA of antipyschotics
Typical Anti-psychotics
Block dopamine receptors in brain to decrease neurotransmission
Colorful magazine: Chlorpromazine
Halo pear: Haloperidol
Flu fencing: Fluphenazine
Loxa/Meso/Perp/Thio-ine
Second generation antipsychotics tend to cause more ? s/e compared to first generation
What is the AMSIT acronym used for?
Metabolic- weight gain, DM, hypercholesterol
Mental status exam:
Appearance
Mood- open ended questions, affect?
Sensorium- orientation, attention, memory
Intelligence/Cognition- calculation, proverb interpretation
Thought/Perception/Insight/Judgement
When conducting psychiatric interview, what is circumstantialities and when is it seen?
When conducting psychiatric interview, what is derailment and when is it seen?
When conducting psychiatric interview, what is flight of ideas and when is it seen?
Indirect/delayed speech d/t unnecessary details; Pts w/ obsessions
Shifting topics w/ minimal/no relation to previous subject; schizophrenia, mania, psychosis
Continuous flow of accelerated speech shifting from topic to topic; mania
When conducting psychiatric interview, what is neologisms and when is it seen?
When conducting psychiatric interview, what is incoherence and when is it seen?
When conducting psychiatric interview, what is blocking?
Invented/distorted words; psychotic d/os
Schizophrenia
Sudden, mid-sentence interruption of speech prior to completion
When conducting psychiatric interview, what is confabulation and when is it seen?
When conducting psychiatric interview, what is perseveration?
When conducting psychiatric interview, what is echolalia and when is it seen?
Fabricated facts to fill in gaps of memory; amnesia
Persistent repetition of words/ideas
Repetition of words/phrases; autism
When conducting psychiatric interview, what is clanging and when is it seen?
Thoughts are made up of ?
Perceptions are made up of ?
Choosing words based on sound; schizophrenia/manic episodes
Obsession Phobia Anxiety Feeling Delusions
Hallucinations Illusions
How is insight assessed during a psych interview
How is judgement assessed during a psych interview
What adverse effects can be seen early on when starting SSRIs
Interpretation of parable/events of history
Clock/Figure drawing
Tremor Anxiety Panic Agitation
What are the NorEpi/Dopamine Reuptake Inhibitors
Paroxetine may be particularly good for ? populations
Fluoxetine may be particularly good for ? populations
Buproprion
Underweight, Insomnia
Overweight, Psychomotor slowing
SNRIs four uses
Avoid/Caution in ? populations
Psychomotor slowing
Adults <65
Chronic pain
Anxiety d/o
HTN, Agitation, Insomnia
When are SSRIs used w/ caution or avoided
When is the use of Mirtazapine done w/ caution or avoided
Avoid the use of Vortioxetine in ? populations
Paroxetine w/ overweight/obese/elderly
Citalopram w/ QT prolongation/Torsades risk
Fluoxetine/Sertraline w/ agitation/insomnia
Fluoxetine/Paroxetine w/ pregnancy
Obese Agitation Insomnia
(Serotonin modulator) concern w/ nausea
When is the use of Buproprion considered
When is it’s use avoided or done w/ caution
What are the three phases of adjusting therapy w/ antidepressants
Sex dysfunction Smokers Psychomotor slowing Fatigue Overweight
Seizure HTN Agitation Insomnia
Acute: resolve Sxs <6wks
Continuation: Sx remission x 9mon
Maintain: therapy to prevent relapse
Response to antipsychotic meds can take up to ? long
Once response is achieved, maintain therapy for a minimum of ?
Only two typical antipsychotics that are IM form
6mon
6mon
Fluphenazine- IM only
Haloperidol- IV/IM/PO
How/Why do NSAIDs increase lithium levels
How/Why do thiazide diuretics increase levels
Inc Na absorption, Dec prostaglandin synthesis
Na absorption blocked in distal tubule causing increase absorption of Na and lithium in proximal tubules
MOA of guanfacine
Define Bipolar 1
Define Bipolar 2
Central A2 agonist
One manic episode w/ or w/out depression
One hypomanic episode w/ depressive episode
MOA of guanfacine
Central A2 agonist
For bipolar, what is a manic episode defined as
One week w/ 3 findings that are occupational/social disturbances or necessatates admission:
DIGFAST
Distractability Impulsitivity Grandiosity Flight of ideas Activities Sleep, dec need Talkative w/ pressured speech
Define MDD w/ Psychotic features
What med combo is recommended for Tx
Criteria for persistent depressive d/o
Five SIGECAP Sxs x two weeks w/ delusion/hallucinations (auditory/visual)
Sertraline w/ Olanzapine
Depressed x 2yrs w/out Sx free for >2mon (MDD- episodic depression w/ periods they are Sx free) along w/ two additional Sxs
What is the MC s/e of Olanzapine
? is the MC manifestation of head trauma in infants
What is the triad of shaken baby syndrome
Weight gain
Retinal hemorrhage
Retinal hemorrhage
Subdural hematoma
Brain swelling
How is Delusional D/o Tx
S/e of Clozapine
In the anxiety block, the topics are listed in order of developmental occurrence, what is the sequence
Therapeutic alliance
Antipsychotics: Aripiprazole
Agranulocytosis
Myocarditis w/ eosinophilia
Specific phobia Social anxiety Panic disorder Agoraphobia GAD
? Tx method for Panic D/o can work just as well as medication
What are the two types of Illness Anxiety D/os
What form of obsessive/compulsive d/o occurs almost exclusively in males
Desensitization/Relaxation training
Care Seeking, Care Avoiding
Muscle dysmorphia
Presence of ? disqualifies Dx of hoarding
? is rarely seen in this population
How much weight loss is considered relevant for SIGECAPS
Inheritence of clutter
Stealing
> 5% w/in a month
Presence of ? disqualifies Dx of hoarding
? is rarely seen in this population
Inheritence of clutter
Stealing
What are the scores of a PHQ-9 categorized into
? is a subtype of dissociative amnesia
1-4: minimal 5-9: mild 10-14: moderate 15-19: moderate severe 20-27: severe
Dissociative fugue: sudden, unexpected travel/wandering in dissociative state affecting autobiographical memory
What are the scores of a PHQ-9 categorized into
1-4: minimal 5-9: mild 10-14: moderate 15-19: moderate severe 20-27: severe
What medication can be used to relieve Sxs of opioid withdrawal
Avoid ? SSRI in the Peds population
What 3 meds can be used as adjuncts to therapy after a second medication has bee tried for MDD Tx
Clonidine
Paroxetine
Buspirone Lithium Thyroid hormone
Where is Buspirone (Buspar) used
Where is Buproprion (Wellbutrin) used
What is the risk of using Zolpidem for sleep
MDD adjunct
GAD miscellaneous
Antidepressant augmentation
Antidepressant w/ SSRIs
Tobacco cessation
ADHD stimulant c/i
ADHD w/ major depression
Amnesia
Where is Buspirone (Buspar) used
Where is Buproprion (Wellbutrin) used
MDD adjunct
GAD miscellaneous
Antidepressant augmentation
Antidepressant w/ SSRIs
Tobacco cessation
ADHD stimulant c/i
ADHD w/ major depression
What are the 6 dominant Sxs of panic d/o
Typical antipsychotics are mainly effective against ? Sxs of schizophrenia
What is the MC type of delusional d/o
Choking sensation Angina Palpitations, sudden onset Dizzy Unreal feeling Secondary fear of dying/losing control
Positive- Hallucination Delusion Repetitive movement
Persecutory
What medication is added to conduct d/o in Peds w/ ADHD
What bipolar Tx med has shown to decrease SIs
What are the 4 second line therapy options
Stimulants Antidepressants Lithium
Lithium
Lithium Valproate Quetiapine Lamotrigine
What medication is added to conduct d/o in Peds w/ ADHD
Stimulants Antidepressants Lithium
What are the 3 categories of insomnia
Hypersomnolence D/o is a broad term for ?
What type of behaviors can these Pts have
Episodic: last 1mon but <3mon
Persistent: >3mon
Recurrent: two or more episodes <12mon
Excessive sleep w/ deteriorated wake
Automatic- driving for miles w/out memory
? OCD Tx causes CNS agitation
Define MDD w/ Melancholic features
What three or more criteria must be met for a Dx
SSRIs
Depressed mood w/ lack of reaction to pleasurable stimuli
Worse depression in AM Inappropriate guilt Psychomotor agitation/retardation Early morning awakening Depressed mood
What are the 6 types of elderly abuse
Domestic violence assaults more commonly occur at ? time
Peds must be ? old for a Dx of PTSD to be given
NF PEAS:
Neglect Finance Physical Emotion Abandonment Sexual
Near end of relationship/prior to leaving
6y/o
What are the 6 types of elderly abuse
Domestic violence assaults more commonly occur at ? time
NF PEAS:
Neglect Finance Physical Emotion Abandonment Sexual
Near end of relationship/prior to leaving
Define Dissociated Reaction
What 3 forms of Tx help reduce the duration of PTSD Sxs
What is done for immediate Sx reduction for adjustment d/o
Flashbacks to PTSD trauma
Cognitive processing therapy
Exposure therapy
Eye movement desensitization therapy
Hyperventilation into bag
How is the severity of anorexia nervosa measured
Pts w/ ADHD may have what two Sxs indicating hyperactivity or impulsivity
Conduct d/o staying out at night or truant from school needs to be prior to ? age
Mild: BMI 17kg/m3 or >
Mod: 16-16.99
Sev: 15-15.9
Extreme: < than 15kg/m3
Peer rejection, Accidental injury
<13y/o
What is often in the MedHx of Pts categorized in Cluster A, B or C
How is Cluster A personality D/os labeled if Dx criteria are met prior to onset of Schizophrenia
What med can be added w/ Naloxone for opioid abuse Tx
A: FamHx psych illness
B: FamHx mood d/o
C: FamHx anxiety d/o
XXX D/o- premorbid
Buprenorphine
? is the MC Psych d/o
? type of Tx can help Pts w/ Borderline Personality D/o
What lab abnormality may be seen in anorexia nervosa
Depression
Dialectic behavioral therapy
Inc total cholesterol d/t inc production of cardioprotective HDL
MC behavior d/o in Peds
OCD screening method
Screening tool for BP1
ADHD
Working Alliance Inventory
Mood d/o questionnaire
MC behavior d/o in Peds
OCD Tz method
Screening tool for BP1
ADHD
Working Alliance Inventory
Mood d/o questionnaire
Define Ergolines
Define Psilocybin
Define Mescaline
LSD
Mushrooms
Peyote
Define Ergolines
Define Psilocybin
Define Mescaline
LSD
Mushrooms
Peyote
? is the MC used tobacco product
What are the MC medical Dzs that arise from this
Smokers going through tobacco cessation/withdrawal will have a more severe withdrawal if ? exist
Cigarettes
CVDz, COPD, Cas
Substance abuse ADHD Bipolar Anxiety Depressive
