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Psych 2- Final Flashcards

1
Q

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

A

Pre-synaptic; down regulate autoreceptors and inc raphe firing rate

Fluoxetine/Fluvoxamine
Paroxetine Es/Citalopram Sertraline

Duloxetine, Venlafaxine

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2
Q

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

A

Fluoxetine Sertraline- sleep trouble

Paroxetine Fluvoxamine- take at bed/night

Paroxetine

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3
Q

SNRI use needs to be avoided in ? populations

What anticholinergic effects can TCAs cause

What CV risk do TCAs have

A

CVDz BPH Urinary retention Glaucoma SI

Dry mouth Retention/constipation Blurred vision

Worsens arrhythmias

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4
Q

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

A

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

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5
Q

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

A

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

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6
Q

? serotonin receptor antagonist has a black box warning

MOA of MAOIs

What food interaction is associated w/ these meds

A

Nefazodone: liver failure

Block enzymes that break down neurotransmitters

Tyramine digestion- indirect sympathomimetic causing HTN crisis d/t catecholamines releasing Epi/NorEpi

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7
Q

What SSRIs have pregnancy risks associated w/ use

When starting use of anti-psychotics, start w/ ? ones and why

When is this rule ignored

A

Fluoxetine: 3rd-T low weight
Paroxetine: heart defects

Atypical: less EPS

Preference/Past response to typical

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8
Q

What black box warning is w/ anti-psychotics

Typical anti-psychotics

Atypical anti-psychotics

A

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
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9
Q

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

A

Tdyskinesia Akathesia- MC Dystonia Sex dysfunction

Chlorpromazine Thioridazine

Haloperidol Fluphenazine Trifluperazine

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10
Q

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

A

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

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11
Q

What are the short acting benzos

What are the intermediate benzos

What are the long acting benzos

A

Triazolam Oxazepam Midazolam

Temazepam Estazolam Alprazolam Lorazepam

Chlordiaepoxide Clonazepam Diazepam Flurazepam Quazepam

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12
Q

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

A

Rebound insomnia

D-X

Lorazepam Oxazepam Temazepam

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13
Q

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

A

Valproic Topiramate Lamotrigine Carbamazapine

Clozapine, Iloperidone

Lorazepam, Diazepam

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14
Q

Prolonged use of lithium can cause ? changes

Lithium toxicity is managed how

Anticonvulsant Topiramate needs to be used w/ caution d/t ?

A

Hypothyroidism
TSH induced non-toxic goiter

D/c med, Hydrate, Gastric lavage, >3mEq= dialysis

Causing depression

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15
Q

Prolonged use of lithium can cause ? changes

Lithium toxicity is managed how

Anticonvulsant Topiramate needs to be used w/ caution d/t ?

A

Hypothyroidism
TSH induced non-toxic goiter

D/c med, Gastric lavage, >3mEq= dialysis

Causing depression

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16
Q

First line med for alcohol dependence

Second line med for alcohol dependence

What is the disulfram reaction seen if consumption occurs

A

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

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17
Q

Prior to starting stimulants for ADHD, ? is needed

What is their MOA

Three non-stimulants can be used for ADHD

A

BP, HR, Height/Weight

Promote catecholamine (Dop/NorEpi) release from presynaptic terminals

Clonidine Atomoxetine Guanfacine

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18
Q

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

A

Atomoxetine- blocks NorEpi reuptake

Aggression

A2 agonist tics/intolerant to stimulants, Monotherapy for ADHD
Concurrent Tx- Impulse behavior/Tourettes

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19
Q

How can Specific Phobias be Tx

Social Anxiety may also co-exist w/ ? other d/o

Agoraphobia is Tx just like ? w/ ?

A

Desensitization, CBT, Gabapentin, Propranolol, SSRI/SNRI

Avoidant Personality D/o

GAD w/ SSRI and CBT

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20
Q

Define Panic D/o

How is this Tx

What is used for acute Sxs Tx

A

Unexpected attacks w/ Sxs peaking <10min, followed by worry/maladaptive changes in behavior x 1mon

CBT, Relaxation/Desensitization
SSRI/SNRI/TCA,Propranolol

Alprazolam/Clonazepam

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21
Q

Define Agoraphobia

How are they Tx

Define GAD

A

Anxiety of least two situations causing OOP responses and are now avoided

Support group w/ S/SNRI/Gabapentin

Excessive worry about many things x6mon

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22
Q

What RFs put Pts at risk for GAD

What meds are used for GAD Tx

A

MDD OCD PTSD

SSRI/SNRI/TCA
Benzo- Lorazepam
Buspirone Gabapentin Propranolol

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23
Q

What are Somatic Sxs

Define Somatization

Define Somatic Sx D/o

A

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

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24
Q

What is the MC Sx of Somatic Sx D/o

What annoying feature can these Pts have

How is this Tx

A

Pain

Doctor shopping

Support/Therapy
Refractory- S/NRI but w/ Sx exacerbation

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25
# 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
26
# 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
27
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
28
# 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
29
# 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
30
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
31
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
32
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
33
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
34
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
35
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
36
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
37
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
38
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
39
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
40
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
41
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
42
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)
43
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
44
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
45
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
46
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
47
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
48
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
49
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
50
# 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
51
# 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
52
# 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
53
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
54
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 ```
55
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
56
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
57
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
58
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
59
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
60
# 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
61
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
62
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
63
# 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
64
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
65
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
66
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
67
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
68
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
69
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
70
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
71
# 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
72
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
73
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
74
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
75
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
76
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
77
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
78
# 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
79
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
80
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
81
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
82
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
83
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
84
# 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
85
# 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
86
# 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
87
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
88
# 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
89
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
90
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
91
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
92
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
93
# 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
94
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
95
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
96
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
97
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
98
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
99
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
100
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
101
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
102
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
103
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
104
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
105
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
106
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
107
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
108
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
109
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
110
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
111
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
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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
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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
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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
115
SNRIs four uses Avoid/Caution in ? populations
Psychomotor slowing Adults <65 Chronic pain Anxiety d/o HTN, Agitation, Insomnia
116
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
117
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
118
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
119
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
120
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
121
MOA of guanfacine
Central A2 agonist
122
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 ```
123
# 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
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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
125
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 ```
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? 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
127
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
128
Presence of ? disqualifies Dx of hoarding ? is rarely seen in this population
Inheritence of clutter Stealing
129
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
130
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 ```
131
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
132
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
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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
134
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
135
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
136
What medication is added to conduct d/o in Peds w/ ADHD
Stimulants Antidepressants Lithium
137
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
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? 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 ```
139
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
140
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
141
# 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
142
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
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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
144
? 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
145
MC behavior d/o in Peds OCD screening method Screening tool for BP1
ADHD Working Alliance Inventory Mood d/o questionnaire
146
MC behavior d/o in Peds OCD Tz method Screening tool for BP1
ADHD Working Alliance Inventory Mood d/o questionnaire
147
# Define Ergolines Define Psilocybin Define Mescaline
LSD Mushrooms Peyote
148
# Define Ergolines Define Psilocybin Define Mescaline
LSD Mushrooms Peyote
149
? 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

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