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IPAP > Psych 2- Final > Flashcards

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
Q

Define Illness Anxiety D/o

How is this Tx

What is Conversion D/o AKA

A

Worry of possible illness w/ minor/no somatic Sxs x6mon

Therapy
SSRI if MDD/Anxiety present

Functional Neurological Sx D/o

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26
Q

Define Conversion D/o

What PE findings can help w/ Dx

A

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

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27
Q

How is Conversion D/o Tx

Define Factitious D/o

How is this managed

A

Hypnosis w/ anxiolytics

False S/Sxs w/ intent to deceive but no secondary gain

Psychiatric confrontation
CPS takes child if Munchausen by proxy

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28
Q

Define Obsession

Define Compulsion

One-third of OCD Pts will also have ? Dx and MC be ? gender

A

Intrusive or unwanted urges, thoughts, images

Repetitive behaviors or mental acts

Tic d/o in males

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29
Q

Define Obsession

Define Compulsion

One-third of OCD Pts will also have ? Dx in their life

A

Thought/Urge/Image that is intrusive and unwanted

Behavior/Mental acts performed

Tic d/o

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30
Q

How is OCD Tx

What separates OCD from OCPD

Define Body Dysmorphic D/o

A

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

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31
Q

What are the MC areas focused on w/ Body Dysmorphic D/o

How is this Tx

What two other D/os are commonly present

A

Skin Hair Nose

Psychotherapy
SSRI/Clomipramine

Psychotic d/o, OCD

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32
Q

Although it can involve any area, ? parts of the body are MC affected by Trichotillomania

How is this Tx

Define Excoriation D/o

A

Scalp Brows Eyelids

Desensitize/Habit reversal
Anti-depressant/psychotics
Steroids
Hydroxyzine

Picking at skin w/ repeated attempts to stop

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33
Q

What parts of the body are MC affected by excoriation

How is this Tx

Define MDD

A

Face Arm Hands

CBT w/ habit reversal and Fluoxetine, Naltrexone

Required: Depressed mood/Lost interest PLUS four SIGECAPS Sxs x 2wks

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34
Q

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

A

Fatigue, Insomnia

Psychomotor Sxs

Hx of prior attempts;
Borderline Personality D/o increases risk

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35
Q

What are 3 variations of MDD

When is electroconvulsive therapy indicated

What is added to SSRI regiment if Pt experiences sex dysfunction

A

Peripartum Melancholic Seasonal

Meds can’t be used/Severe suicidality

Sildenafil, Buproprion

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36
Q

What are 3 variations of MDD

When is electroconvulsive therapy indicated

What is added to SSRI regiment if Pt experiences sex dysfunction

A

Peripartum Melancholic Seasonal

Meds can’t be used
Severe suicidality

Sildenafil, Buproprion

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37
Q

When/Why are stimulants used for MDD Tx

Criteria for Persistent Depressive D/o

What other d/o can this AKA

A

Short term Tx or refractory depression

Depressed mood x2yrs (1yr if child/adolescent)

Dysthymic

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38
Q

When/Why are stimulants used for MDD Tx

Criteria for Persistent Depressive D/o

What other d/o can this AKA

A

Short term Tx
Refractory depression

Depressed mood x2yrs (1yr if child/adolescent)

Dysthymic

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39
Q

How is PMDD Tx

Define Bipolar 1

Define Bipolar 2

A

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

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40
Q

How is Bipolar 1 Tx

What needs to be avoided in this population

What is a less intense, longer lasting form of bipolar

A

First line: valproic acid w/ admission

SSRIs

Cyclothymic d/o

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41
Q

How are bipolar Pts that are rapid cyclers managed

What bipolar population has a higher rate of lethal suicide attempts

Define Insomnia

A

2nd gen antipsychotic w/ benzo

Lethal: BP2; Prevalence- same

Poor sleep quality/quantity 3/wk x 3mon w/ enough opportunity

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42
Q

Criteria for Hypersomnolence D/o

Criteria for Narcolepsy

What is a common presentation complaint

A

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)

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43
Q

How is Narcolepsy Tx

What types of hallucinations can these Pts have

What causes this d/o

A

Amphetamines
Modafinil: s/e of HA/anxiety/dec OCP efficacy

Hypnagogic: before sleep
Hypnopompnic: before awakening

Hypocretin deficiency in hypothalamus

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44
Q

Criteria for OSA on polysomnography

? MC fact does this hold

How does Circadian Rhythm Sleep-Wake d/o present

A

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

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45
Q

How is Circadian Rhythm D/o Tx

Criteria for Restless Leg Syndrome

What meds are used for Sx relief

A

Sleep hygiene
Melatonin Zolpidem Benzos

Urge to move legs d/t discomfort when at rest 3x/wk x 3mon

Ropinirole Iron Gabapentin Clonazepam

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46
Q

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

A

Epworth

Stop-Bang:
Snore Tired Observed Pressure
BMI Age Neck Gender

Walking: first half
Behavior: second half
Terror: first third
Nightmare: last third

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47
Q

How are sleepwalking/terrors Tx

How are nightmares Tx

Define Delusion and Hallucination

A

Clonazepam

Prazosin

D: fixed beliefs that are unchangeable
H: perception-like experience w/out stimulus

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48
Q

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

A

Speech- derailement, tangent answers

Catatonia

N: flat affect, emotionless, withdrawn
P: hallucination, delusion, repetitive movements

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49
Q

Criteria for Delusional D/o

When compared to bipolar d/o, delusional d/o Sxs are considered ?

How are these Pts Tx

A

One positive delusional Sx x 1mon w/out meeting schizophrenia criteria

More severe

Protect self/others
Atypicals: Olanzapine and Risperidone

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50
Q

Define Brief Psychotic D/o

How is this Tx

If suspected schizophrenia Pt has ? childhood Dxs, how are criteria for Dx changed

A

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

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51
Q

Define Brief Psychotic D/o

How is this Tx

If suspected schizophrenia Pt has ? childhood Dxs, how are criteria for Dx changed

A

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

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52
Q

Define Schizoaffective D/o

How are these Pts Tx

Criteria for schizophrenia

A

Schizophrenia w/ MDD x 2wks

Psychotherapy
Atypicals, Anticonvulsants and SSRIs

Major psychosis w/ difficulty functioning x6mon

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53
Q

Why is Clozapine not used first line for schizophrenia Tx

First period of schizophrenia psychosis needs ? added to work up

Define Schizophreniform D/o

A

Agranulocytosis

Brain imaging

Major psychosis for greater than one month but less than 6mon w/out social/occupational impairment

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54
Q

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

A

Tremor Anxiety Panic

Cognitive: confusion/disorientation
Autonomic: hypertheria/diaphoresis
Neuromuc: myoclonus

HTN/Tachy  
Clonus w/ hyper-reflexia
Hyperthermic
Agitated/confused
Dilated pupils
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55
Q

What are the common adverse effects of SNRI use

MOA of TCAs

Why is TCA therapy associated w/ weight gain

A

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

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56
Q

What are he common adverse effects of SNRI use

MOA of TCAs

Why is TCA therapy associated w/ weight gain

A

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

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57
Q

MAOIs are used for atypical depression which include ? three presentations

Adverse effects of MAOI use

Normally, what happens when GABA binds to GABA receptor

A

Hypersomnia Hyperphagia Reactive moods

HTN crisis
Serotonin syndrome
Weight gain
Sex dysfunction

Relaxation, Sedation

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58
Q

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

A

Allosteric inhibition

Anterograde amnesia

Geriatrics, Pregnant

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59
Q

What med used for ADHD is a mix of dextroamphetamine and amphetamine salts

What happens when Lisdexamfetamine is ingested

MOA and use of Atomoxetine

A

Adderall

Converted to active dextroamphetamine in blood

Blocks re-uptake of NorEpi for ADHD monotherapy in Pts >6y/o

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60
Q

Define Dissociation

What are the two dissociative Sxs

Define Acute Stress D/o

A

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
Q

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

A

Trauma/Exposure therapy;
Benzos Morphine Propranolol SSRIs

Psychotherapy x 8-12 sessions

SSRIs- Sertraline, Peroxatine

62
Q

Time frame criteria for adjustment d/o

What meds can be used for Tx

Timeframes for the three trauma/stress d/os

A

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
Q

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

A

Event when someone close dies;
Grief

Acute- numb/denial adaptive mechanism
Integration- healing

Death/loss d/t suicide

64
Q

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

A

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
Q

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

A

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
Q

What is the strongest risk for suicide

What are the other associated RFs in descending order

What is a strong predictor for suicide

A

Previous attempt/threat

Never married Widowed Separated Divorced Married w/out kids

Psych illness

67
Q

What is the strongest risk for suicide

What are the other associated RFs in descending order

What is a strong predictor for suicide

A

Previous attempt/threat

Never married
Widowed Separated Divorced Married w/out kids

Psych illness

68
Q

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

A

Males >85y/o

AMSIT:
Appearance Mood/Affect Sensorium Intellect Thoughts

Mood: subjective
Affect: objective

69
Q

Who is the first responder to suspected elderly abuse

Define Anorexia Nervosa

What safety step may be ordered for these Pts

A

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
Q

Who is the first responder to suspected elderly abuse

Define Anorexia Nervosa

What safety step may be ordered for these Pts

A

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
Q

Define Bulimia Nervosa

What Tx combo has shown the best results

Define Binge Eating D/o

A

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
Q

How is binge eating d/o Tx

What are the two types of anorexia nervosa

Criteria for ADHD

A

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
Q

How is binge eating d/o Tx

What are the two types of anorexia nervosa

Criteria for ADHD

A

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
Q

What meds are used for the Tx of ADHD

A

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
Q

Criteria for Autism

What are the first Sxs usually seen

What are the only two psychotropic meds FDA approved for Autism Tx

A

Impaired reciprocal communication and social interactions w/ restricted, repetitive behavior

Delayed language development w/ lack/unusual social interactions

Risperidone, Aripiprazole

76
Q

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

A

Conduct d/o

Emotional dysregulation

Haldol/Olanzapine/Risperidone- agression
Lithium- mood
Stimulants- ADHD

77
Q

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

A

Conduct d/o

Emotional dysregulation

Haldol/Olanzapine/Risperidone- agression
Lithium- mood
SSRI- ADHD

78
Q

Define Intermittent Explosive D/o

What drug combo is recommended for Tx

What medications can help reduce labido/disruptive sexual behavior in men

A

Episodic anger/violence

Dextromethorphan and Quinidine

Medroxyprogesterone acetate
Fluoxetine

79
Q

Dissociative Identity d/o is more common in ? gender and w/ ? MedHx

Define Dissociative Amnesia

This can also be called ? state

A

Women w/ sexual abuse

Psychotherapy

Sudden inability to recall personal info/autobiography info of stress/traumatic nature

Fugue

80
Q

Dissociative Identity d/o is more common in ? gender and w/ ? MedHx

Define Dissociative Amnesia

This can also be called ? state

A

Women w/ sexual abuse

Psychotherapy

Sudden inability to recall personal info/autobiography info of stress/traumatic nature

Fugue

81
Q

What is Dissociative Amnesia associated w/

What will be missing from these Pts Hx

How are they Tx

A

Disaster/war stressors

Substance/Sexual abuse

Psychotherapy

82
Q

Cluster A personality d/os

Cluster B personality d/os

Cluster C personality D/os

A

Schizotypal Paranoid Schizoid- Odd/Weird/Eccentric

Narcissistic Borderline Antisocial Histrionic- Dramatic/Emotional/Erratic

Dependent OCD Avoidant- Anxious/Fearful/Worried

83
Q

Alcohol withdrawal S/Sxs

A 
Tremors, hand
Autonomic hyperactivity
Insomnia
N/V
Transient hallucinations
Agitation/anxiety
Seizure

Tremulousness: 6-12
Hallucination: 12-48
Seizure: 12-48hrs
DTs: >48hrs

84
Q

Define Schizotypal personality D/o

This groups of personality d/o will improve when placed on ? class of medication

Define Antisocial Personality D/o

A

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
Q

Define Schizotypal personality D/o

This groups of personality d/o will improve when placed on ? class of medication

Define Antisocial Personality D/o

A

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
Q

Define Borderline Personality D/o

What defense method can these people use?

Define Histrionic Personality D/o

A

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
Q

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

A

Regression- revert to child like behaviors

Borderline

Grandiosity, need for admiration and lack of empathy

88
Q

Define Avoidant personality d/o

Define Dependent Personality d/o

Define OCD

A

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
Q

What type of behavioral therapy is used for personality d/o Tx

A

Operant conditioning: recognizes and reinforces acceptable behavior

Aversion conditioning: punishment/removal of privaleges for poor behavior

90
Q

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

A

Anti-depressants

SSRIs

Antipsychotics

91
Q

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

A

Anticonvulsants

SSRI and Benzos

Late onset

92
Q

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

A

Anticonvulsants

SSRI and Benzos

Late onset

93
Q

Define Alcohol Use D/o

When will these Pts have had their first experience of intoxication

What characterizes their course through the d/o

A

Behavioral/Physical Sxs including craving, withdrawal and tolerance.

Mid-Teens

Remission and relapse

94
Q

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

A

Sensation seeking, Impulsitivity

Hypoglycemia, DKA

Haloperidol

95
Q

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

A

Propofol, Phenobarbital

> 250mg

4-6hrs

96
Q

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

A

Schizophrenia

Nystagmus Analgesia HTN

Disorientation, Catatonic-like syndrome

97
Q

What is the hallmark of hallucinogen persisting perception d/o

This d/o primarily exists after abuse of ?

How are these severe intoxications Tx

A

Re-experiencing the effects while Pt is sober

LSD

Protect Pt/others w/ Haloperidol

98
Q

What is the hallmark of hallucinogen persisting perception d/o

This d/o primarily exists after abuse of ?

How are these severe intoxications Tx

A

Re-experiencing the effects while Pt is sober

LSD

Protect Pt/others
Antiphsychotics- Haloperidol

99
Q

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

A

Respiratory suppression Arrhythmias Coma Hypokalemia

Inc risk for attempted/completed suicides

Dry membranes
Constipation
Pupil constriction

100
Q

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

A

Respiratory suppression
Ventricular arrhythmias
Hypokalemia
Coma

Inc risk for attempted/completed suicides

Dry membranes
Constipation
Pupil constriction

101
Q

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

A

Sedative-Hypnotic

Rhiorrnea Lacrimation Dilated pupils

HIV, Hep C, bacterial infection

102
Q

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

A

Memory impairment

Flumazenil- seizures

Benzo addiction
Seizure d/o
TCA/convulsant overdose

103
Q

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

A

W/in one week

Severe depression that resolves <1wk

Auditory hallucinations, Paranoid ideations

104
Q

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

A

W/in one week

Severe depression that resolves <1wk

Prominent auditory hallucinations
Paranoid ideations

105
Q

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

A

Craving sweets, Impaired performance on vigilant tasks

Constipation Dizziness Cough Dreams Nausea

Varenicline, Buproprion;
Behavior therapy

106
Q

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

A

Craving sweets, Impaired performance on vigilant tasks

Constipation Dizziness Cough Dreams Nausea Sore throat

Varenicline and Buproprion

107
Q

MOA of antipyschotics

Typical Anti-psychotics

A

Block dopamine receptors in brain to decrease neurotransmission

Colorful magazine: Chlorpromazine
Halo pear: Haloperidol
Flu fencing: Fluphenazine
Loxa/Meso/Perp/Thio-ine

108
Q

Second generation antipsychotics tend to cause more ? s/e compared to first generation

What is the AMSIT acronym used for?

A

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
Q

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?

A

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
Q

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?

A

Invented/distorted words; psychotic d/os

Schizophrenia

Sudden, mid-sentence interruption of speech prior to completion

111
Q

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?

A

Fabricated facts to fill in gaps of memory; amnesia

Persistent repetition of words/ideas

Repetition of words/phrases; autism

112
Q

When conducting psychiatric interview, what is clanging and when is it seen?

Thoughts are made up of ?

Perceptions are made up of ?

A

Choosing words based on sound; schizophrenia/manic episodes

Obsession Phobia Anxiety Feeling Delusions

Hallucinations Illusions

113
Q

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

A

Interpretation of parable/events of history

Clock/Figure drawing

Tremor Anxiety Panic Agitation

114
Q

What are the NorEpi/Dopamine Reuptake Inhibitors

Paroxetine may be particularly good for ? populations

Fluoxetine may be particularly good for ? populations

A

Buproprion

Underweight, Insomnia

Overweight, Psychomotor slowing

115
Q

SNRIs four uses

Avoid/Caution in ? populations

A

Psychomotor slowing
Adults <65
Chronic pain
Anxiety d/o

HTN, Agitation, Insomnia

116
Q

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

A

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
Q

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

A 
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
Q

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

A

6mon

6mon

Fluphenazine- IM only
Haloperidol- IV/IM/PO

119
Q

How/Why do NSAIDs increase lithium levels

How/Why do thiazide diuretics increase levels

A

Inc Na absorption, Dec prostaglandin synthesis

Na absorption blocked in distal tubule causing increase absorption of Na and lithium in proximal tubules

120
Q

MOA of guanfacine

Define Bipolar 1

Define Bipolar 2

A

Central A2 agonist

One manic episode w/ or w/out depression

One hypomanic episode w/ depressive episode

121
Q

MOA of guanfacine

A

Central A2 agonist

122
Q

For bipolar, what is a manic episode defined as

A

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
Q

Define MDD w/ Psychotic features

What med combo is recommended for Tx

Criteria for persistent depressive d/o

A

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

124
Q

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

A

Weight gain

Retinal hemorrhage

Retinal hemorrhage
Subdural hematoma
Brain swelling

125
Q

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

A

Therapeutic alliance
Antipsychotics: Aripiprazole

Agranulocytosis
Myocarditis w/ eosinophilia

Specific phobia
Social anxiety
Panic disorder
Agoraphobia
GAD
126
Q

? 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

A

Desensitization/Relaxation training

Care Seeking, Care Avoiding

Muscle dysmorphia

127
Q

Presence of ? disqualifies Dx of hoarding

? is rarely seen in this population

How much weight loss is considered relevant for SIGECAPS

A

Inheritence of clutter

Stealing

> 5% w/in a month

128
Q

Presence of ? disqualifies Dx of hoarding

? is rarely seen in this population

A

Inheritence of clutter

Stealing

129
Q

What are the scores of a PHQ-9 categorized into

? is a subtype of dissociative amnesia

A 
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
Q

What are the scores of a PHQ-9 categorized into

A 
1-4: minimal
5-9: mild
10-14: moderate
15-19: moderate severe
20-27: severe
131
Q

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

A

Clonidine

Paroxetine

Buspirone Lithium Thyroid hormone

132
Q

Where is Buspirone (Buspar) used

Where is Buproprion (Wellbutrin) used

What is the risk of using Zolpidem for sleep

A

MDD adjunct
GAD miscellaneous
Antidepressant augmentation

Antidepressant w/ SSRIs
Tobacco cessation
ADHD stimulant c/i
ADHD w/ major depression

Amnesia

133
Q

Where is Buspirone (Buspar) used

Where is Buproprion (Wellbutrin) used

A

MDD adjunct
GAD miscellaneous
Antidepressant augmentation

Antidepressant w/ SSRIs
Tobacco cessation
ADHD stimulant c/i
ADHD w/ major depression

134
Q

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

A 
Choking sensation
Angina
Palpitations, sudden onset
Dizzy
Unreal feeling
Secondary fear of dying/losing control

Positive- Hallucination Delusion Repetitive movement

Persecutory

135
Q

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

A

Stimulants Antidepressants Lithium

Lithium

Lithium Valproate Quetiapine Lamotrigine

136
Q

What medication is added to conduct d/o in Peds w/ ADHD

A

Stimulants Antidepressants Lithium

137
Q

What are the 3 categories of insomnia

Hypersomnolence D/o is a broad term for ?

What type of behaviors can these Pts have

A

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

138
Q

? OCD Tx causes CNS agitation

Define MDD w/ Melancholic features

What three or more criteria must be met for a Dx

A

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
Q

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

A

NF PEAS:
Neglect Finance Physical Emotion Abandonment Sexual

Near end of relationship/prior to leaving

6y/o

140
Q

What are the 6 types of elderly abuse

Domestic violence assaults more commonly occur at ? time

A

NF PEAS:
Neglect Finance Physical Emotion Abandonment Sexual

Near end of relationship/prior to leaving

141
Q

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

A

Flashbacks to PTSD trauma

Cognitive processing therapy
Exposure therapy
Eye movement desensitization therapy

Hyperventilation into bag

142
Q

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

A

Mild: BMI 17kg/m3 or >
Mod: 16-16.99
Sev: 15-15.9
Extreme: < than 15kg/m3

Peer rejection, Accidental injury

<13y/o

143
Q

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

A: FamHx psych illness
B: FamHx mood d/o
C: FamHx anxiety d/o

XXX D/o- premorbid

Buprenorphine

144
Q

? 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

A

Depression

Dialectic behavioral therapy

Inc total cholesterol d/t inc production of cardioprotective HDL

145
Q

MC behavior d/o in Peds

OCD screening method

Screening tool for BP1

A

ADHD

Working Alliance Inventory

Mood d/o questionnaire

146
Q

MC behavior d/o in Peds

OCD Tz method

Screening tool for BP1

A

ADHD

Working Alliance Inventory

Mood d/o questionnaire

147
Q

Define Ergolines

Define Psilocybin

Define Mescaline

A

LSD

Mushrooms

Peyote

148
Q

Define Ergolines

Define Psilocybin

Define Mescaline

A

LSD

Mushrooms

Peyote

149
Q

? 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

A

Cigarettes

CVDz, COPD, Cas

Substance abuse ADHD Bipolar Anxiety Depressive

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