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IPAP > Psych 2.0 > Flashcards

Psych 2.0 Flashcards

1
Q

Define Fear and what part of the NS controls it

Define Anxiety

How long does anxiety have to be present to be relevant

A

Emotional response to imminent threat; Autonomic

Anticipation of future threats;
Phobic stimulus w/ active avoidance

x6mon

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2
Q

How is Anxiety d/t Specific Phobia Tx first line or w/ meds?

What is the key feature of a Social Anxiety d/o

What is the key feature of a Panic D/o

A

First line: psychotherapy
Meds: SSRI/SNRI

Fear of social situation where scrutiny may occur

Recurrent, unexpected attacks

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3
Q

How are Panic d/os Tx

How is Agoraphobia Tx

Define Generalized Anxiety d/o

A

First line: psychotherapy, S/SNRI, TCA

Just like GAD:
Group therapy w/ SS/NRI, Gabapentin

Excessive worry about multiple things x 6mon

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4
Q

How is Generalized Anxiety D/o Tx

How is Generalized Anxiety categorized into severity

What are five examples of Somatic Sxs

A

Psychotherapy;
Gabapentin Buspirone SS/NRI Propranolol TCA

GAD-7 scores:
5-9: mild 10-14: mod 15-21: severe

Pain SOB Tremor Fatigue Paralysis

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5
Q

Define Somatization

What Sx is MC present

What aggravating issue can these Pts exhibit

A

Physical Sxs mimicking absent Dz x6mon;
Pysch distress felt in physical form

Pain

Dr shopping

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6
Q

How is Somatic Sx D/o Tx

Define Illness Anxiety D/o and how are they Tx?

What is unique about their presentation

A

Social/Peer support
Refractory= SS/NRI but expect exacerbated Sxs

Hypochondriasis;
Pt worries they MAY acquire serious illness;
Therapy; SSRI if underlying A/D d/o

Absent/minimal somatic Sxs w/ high anxiety

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7
Q

Define Conversion D/o and what can it AKA?

How are these Pts managed for Tx

Define Factitious D/o

A

Altered voluntary motor/sensory function;
Functional Neurological Sx d/o

Non-pharm, possibly w/ hypnosis

Falsified S/Sxs or induced issue w/ intent of deception but no secondary gain

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8
Q

How is Factitious D/o managed

Define La Belle Indifference

Define Obsession and Compulsion

A

Psych consult w/ confrontation/biofeedback; Short term anxiolytics
CPS removes child if Munchausen by Proxy

Pt w/ sudden, unexpected lack of concern to Conversion D/o Sx

O: intrusive thought/urge/images causing anxiety
C: behavior/acts done in response to obsession

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9
Q

OCD is MC in ? gender

What are these Pts at risk for in the future

How are these Pts Tx

A

Male

Half have SIs
One quarter will have attempts

Systemic desensitization/CBT
SSRIs/Clomipramine- TCA

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10
Q

Define Body Dysmorphic D/o

What are the MC areas reported

How is this Tx

A

Perceived defect in body not observable by others

Hair Nose Skin

Psychotherapy
SSRI/Clomipramine- TCA

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11
Q

Define Hoarding D/o

What is rare in these Pts Hx

How are they Tx

A

Difficulty discarding items regardless of value

Theft

CBT, rarely SSRIs

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12
Q

Define Trichotillomania

What areas are MC affected

How are they Tx

A

Pulling out own hair

Scalp Eye brow/lid

Biofeedback/Desensitization/Habit reversal
Hydroxyzine, Topical steroids
Anti-depressants/psychotics

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13
Q

Define Excoriation

What parts of the body are MC affected

How is this Tx

A

Picking at skin

Face Arms Hands

CBT w/ habit reversal
Fluoxetine, Naltrexone

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14
Q

Define MDD

What are two common presenting complaints

What risk is present at all time for these Pts

A

Depressed mood/loss of interest w/ 4 SIGECAPS Sxs x 2wks

Fatigue, Insomnia

Suicide w/ biggest RF: Hx of attempts

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15
Q

How is MDD Tx

When is electroconvulsive therapy indicated

What meds may be used

A

CBT w/ phototherapy

Medication can’t be used
Extremely suicidal

SSRI (Tx sex dysfunction w/ PD5-I/buproprion)
SNRI if chronic pain

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16
Q

What medication is safe for Ps w/ MDD and acute MI/unstable angina Hx

What class needs to be used w/ caution for MDD Pts

What class is used as third line Tx

A

Sertraline

TCA w/ cardiac/seizure Pts

MAOI

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17
Q

What class of drug is used for short term Tx or refractory depression of MDD

Maintain therapy x ? long after resolution of MDD Sxs

What are the indications to continue the full dosage indefinitely

A

Stimulants

x12mon

First episode before 20/after 50y/o
Over 40y/o w/ two episodes
One episode after 50y/o
Three episodes over lifetime

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18
Q

Define PDD

How is this Tx

A

Depressed mood x 2yrs w/ two Sxs w/ remission lasting no longer than 2mon

Same as MDD:
CBT, Phototherapy, SSRI, SNRI, TCA

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19
Q

Characteristics of Bipolar 1

Characteristics of Bipolar 2

What is the essential feature needed to make Dx of BP2

A

Manic mood x 1wk or needing admission w/ 3 Sxs d/t severity

Elevated mood x 4d w/ three Sxs w/out impairment or severe enough for admission

Hypomanic and depressive episode

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20
Q

What is first line Tx for Bipolar 1

What is used for acute management in rapid cyclers

What is used for long term management

A

Valproic acid

2nd generation antipsychotic and benzos

Lithium Valproate Quetiapine Lamotrigine

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21
Q

Why is BP2 scarier than 1

How is this Tx

Criteria for insomnia

A

Higher rate of successful suicides

Valproic acid- first line
2nd generation antipsychotic and benzos- rapid cycles
Lithium Valproate Quetiapine Lamotrigine- long term

Unhappy quality/quantity and can’t get to/stay asleep for 3 nights per week x 3mon

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22
Q

How is insomnia Tx

Define Hypersomnolence D/o

A 
CBT w/:
Hydroxyzine
Exzopiclone
Lorazepam
Diphenhydramine
Zolpidem/Zaleplon

Excessive sleepiness despite 7hrs or more of sleep3/week x 3mon

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23
Q

Criteria for Narcolepsy

What can trigger the visible and awake Sx of this condition

How is this Tx/managed

A

Irrepressible sleep/excessive napping 3x/wk x 3mon w/ cataplexy, hypocretin or +sleep study

Cateplexy triggered by laughter/joking

Dextroamphetamine sulfate
Modafinil

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24
Q

What is the s/e of using Modafinil for Narcolepsy Tx

What female Pt education piece is needed w/ this medication

Sleep study criteria for OSA

A

HA, anxiety

Dec OCP efficacy

5 episodes per hour w/ Sxs
15 episodes per hour

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25
Q

? is the MC breathing related sleep d/o

Define Circadian Rhythm sleep-wake cycle d/o

What can resolve this issue for some Pts

A

OSA

Altered rhythm leading to excessive sleepiness

Set own schedules, can have normal sleep quality/duration

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26
Q

How is Circadian Rhythm Sleep Wake d/o Tx

Criteria for Restless Leg Syndrome

How is this Tx

A

Melatonin Zolpidem Benzos

Urge to move legs d/t uncomfortable sensation that is relieved w/ movement

Fe replacement- if deficient
Ropinirole- first line dopamine agonist
Gabapentin
Clonazepam

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27
Q

Define Substance/Medication induced sleep d/o

Define Delusions

Define Hallucinations

A

Disturbed sleep after starting new medication that is capable of disturbing sleep

Fixed beliefs that don’t change w/ conflict/evidence

Perception of experiences w/out external stimulus

28
Q

When/How is disorganized thinking suspected in a Pt

What are two types of disorganized thinking

Three examples of ‘positive’ Sxs of psychotic d/o

A

Inferred by their speech

Derailment- switches from topic to topic
Tangent- questions answered obliquely/unrelated

Hallucination Delusion Uncontrollable repetitive movements

29
Q

Define Delusional D/o

Sxs of ? other d/o are considered mild compared to delusional d/o Sxs

How is this d/o Tx/managed

A

One delusion x 1mon w/out meeting schizophrenia criteria
Not functionally impaired, behavior is not odd

Bipolar

Protection from harm to self/others
Antipsychotics- drug of choice w/ antidepressants

30
Q

Define Brief Psychotic D/o

How is this worked up and managed

A

Delusion, Hallucination or Disorganized speech for at least a day but back to normal within one month

Prevent harm to self/others; possible admit
Eval w/ brain imaging if first psychosis episode
Antipsychotics (TxOC) w/ antidepressants

31
Q

Criteria for Schizophrenia

How does the onset of this Dz indicate the Dx

If Pt has a Dx of Autism or Communication d/o, a schizophrenia Dx can only be made if ?

A

Two of the five Sxs, most of the time, for one month:
Delusion Hallucination
Disorganized speech/behavior or catatonia
Negative Sxs

Dec level of function in one area of life

Prominent delusion/hallucinations w/ schizophrenia Sxs and w/out mood episodes

32
Q

How is schizophrenia Tx

Define Dissociation

What are the two parts of Dissociative Symptoms

A

Protect self/others from harm
Full eval w/ imaging
Antipsychotics (TxOC) w/ antidepressants

Disconnecting from thoughts/feelings/memories

Depersonalization: sense of being in a dream
Derealization: surroundings are dreamlike

33
Q

Criteria for Acute Stress D/o

How is this Tx non-pharm

What meds can be used for Tx/management

A

9 Sxs lasting 3-30d after experiencing trauma

Psych debrief
Exposure therapy
Trauma CBT

Benzos
Morphine- early pain relief= dec PTSD
Propranolol
SSRI

34
Q

Define PTSD

Non-pharm Tx

A

Exposure to trauma w/ intrusive Sxs, avoiding stimuli associated w/ event, and at least two negative alterations in cognition/mood and two alterations in arousal/reactivity

Psychotherapy
Cognitive processing therapy
Prolonged exposure therapy
Eye movement desensitization therapy

35
Q

Pharm Tx for PTSD

A 
SSRIs- only class approved for Tx:
Sertraline Peroxetine

Propranolol- peripheral Sxs

Clinidine- hyperarousal

Prazosin- nightmares

Carbamazepine- impulse/anger management

Benzos- anxiety/panic attacks

Trazodone- insomnia

36
Q

Define Adjustment D/o

One of ? Sxs needs to be present

What time frame should these Sxs resolve

A

Emotional behavior Sxs developing w/in 3mon of identifiable stressor

Distress OOPT stressor intensity
Impaired social/occupational function

<6mon of stressor or consequences

37
Q

How is Adjustment D/o Tx

What meds may be used

A

Immediate: bag breathing
Removal from stressed situation
Log daily stressors
Stress reduction exercises

SSRIs
Benzo/Antihistamine sedatives

38
Q

Time frame for Acute Stress Reaction

Time frame for PTSD

Time frame for Adjustment D/o

A

Trauma causing Sxs 3-30d and PTSD-like Sxs

Trauma causing Sxs 30d/> and PTSD-like Sxs

Stress Sxs presenting <3mon, resolving <6mon

39
Q

Define Bereavement

What is the natural response to this situation and in ? two stages

When the above response becomes ‘complicated’ its AKA ?

A

Someone who is close dies

Grief: Acute, Integration

Persistent Complex Bereavement D/o

40
Q

What happens in the acute phase of grief

What happens in the integration phase of grief

What are the four hallmarks of healing from death

A

Intense, distressing emotions of numb/shock/denial that act as adaptive mechanism to relieve pain

Transition period months later but can be extended if loss was d/t suicide

Recognize they’ve grieved
Think/talk about deceased w/out emotions
Return to work/daily activities
Seek companionship/pleasure w/ others

41
Q

Criteria for Persistent Bereavement D/o

What are the RFs for this to develop

What are common comorbidities seen in these Pts

A

Sxs x 12mon (x6mon if death was of child) that is OOPT to norm

Hx of Anx/Dep
Insecurity
Multiple previous deaths
Death of child/young adult
Violent death
Hostile/insensitive behavior of others

Depression PTSD Substance abuse

42
Q

How is Persistent Complex Bereavement D/o Tx

Without Tx, Pts may develop ? issues by 13mon, 25mon?

What is the strongest RF for suicide and what is a strong predictor for suicide

A

Monitor q1-4wks
Behavioral therapy (first line)
Pharmacotherapy (second line) if PTSD/depression present

13: HTN Eating Depression Smoking
25: CV/Neoplastic dz

RF: Previous attempt/threat
Predict: psych d/o

43
Q

What are the RFs from highest to lowest for suicide risk

When does age become a RF

A 
Never married
Widowed
Separated
Divorced 
Married w/out kids

Males >85y/o

44
Q

What are protective factors against suicide

What acronym is used to assess suicide risk objectively

What are the subjective and objective part of the assessment

A

Social/Family connections
Pregnancy
Parenthood
Religion

AMSIT:
Appearance Mood Sensorium Intellect Thoughts

Mood: subjective
Affect: objective

45
Q

When are SSRIs used in assessing suicide risk

When are suicide rates the highest after d/c

6 red flags for history of child abuse

A

Pt w/ underlying psych condition

First week

Delay in seeking care
Impossible history for injury
No Hx or denies trauma 
Evolving story of events
Resuscitation efforts at home
Self inflicted/inflected by sibling/pet
46
Q

Define Anorexia Nervosa

This condition rarely presents prior to ? milestone

How is this Tx

A

Restricted intake w/ lower than normal body weight and intense fear of weight gain

Puberty

Restore normal weight, eating behavior and psych

47
Q

All Pts Dx w/ Anorexia Nervosa need to be co-managed/Tx w/ ? on the team

What are the four indications to admit

A

Psychiatrist

Hypovolemia
Major electrolyte d/o
Out Pt failure
Protein energy malnutrition

48
Q

Define Bulimia Nervosa

What risk is w/ this type of eating d/o

How are they Tx

A

Loss of control while eating, eating too much in one sitting w/ inappropriate compensatory mechanisms to prevent weight gain x 3mon

Inc suicide risk

Psychotherapy
Fluoxetine hydrochloride/SSRIs

49
Q

Define Binge Eating D/o

How are these Pts Tx

Define ADHD

A

Recurrent binge eating w/out compensatory mechanisms

Psychotherapy w/ CBT

Impaired function/development w/ inattention and hyperactivity/impulsitivity

50
Q

How is ADHD Tx

What medication may be used in Pts when the above is c/i or if Pt has major depression

What meds are used if Pt has underlying HTN issues

A

Psychoeducation w/ Stimulants

1st: Desipramine (TCA)
2nd: Atomoxetine

Guanfacine, Clonidine

51
Q

What may be the first Sx of Autism Spectrum D/o

What are the only two FDA approved psychotropic meds for these Pts

How is Oppositional D/o categorized

A

Delayed language development w/ lack of social interest

Risperidone, Aripiprazole

Mild: one setting
Mod: two settings
Sev: three/more settings

52
Q

Oppositional D/o actions can be at everyone except ?

What background/history indicates this d/o

What are the two MC co-occuring conditions

A

Siblings

Child care disrupted by different caregivers

ADHD, Conduct d/o

53
Q

How is Oppositional Defiant D/o Tx

How is Conduct D/o Tx

Personality d/D/o is a pattern of behavior deviating from cultural norms w/ ? manifestations

A

Psychotherapy: reward/punish of behaviors

Psychotherapy along w/:
Antipsychotics: Haloperidol Risperidone Olanzapine
Lithium- mood stabilizer
Stimulants if ADHD present

CAPRI:
Cognition Affect Personal Relations Impulsive

54
Q

What are the 3 Cluster A personality D/os

A

Paranoid- distrust or suspicion w/ quick reactions of anger (pathologically jealous/suspicious)

Schizoid- detachment from social relationships w/ restricted range of emotions (doesn’t fit in, doesn’t mind)

Schizotypical- discomfort w/ close relations and distorted behavior

55
Q

Schizotypal personalities often improve w/ ? medications

What are the four Cluster B personality d/os

A

Antipsychotics

Antisocial- disregard for others since 15y/o and must be 18y/o for Dx

Borderline- unstable personal relationships w/ impulsivity and poor self image

Histrionic- excessively emotional and attention seeking

Narcissistic- grandiosity w/ need for admiration but lacking empathy

56
Q

What findings are common in the history of Antisocial personality d/os

What are the three Cluster C personality D/os

A

“con man” Abuse Animal cruelty Arson

Avoidant- social inhibition w/ intense fear of rejection

Dependent- submissive/clingy need to be taken care of w/ separation anxiety

OCD- preoccupation w/ order/perfection

57
Q

What class of medication is used for Sx relief of borderline personality d/o

What class is used for hostility, agitation Sxs

What meds are used for avoidant personalities

A

SSRIs reduce aggression, impulse
Anticonvulsant- dec behavior dyscontrol

Antipsychotics

SSRIs, Benzos

58
Q

Alcohol intoxication increases w/ ? personality characteristics

What does alcohol withdrawal look like

A

Sensation seeking
Impulsivity

Tremors
Autonomic hyperactivity
Insomnia
N/V/Tachy
Tonic clonic seizure
59
Q

? medication is used to discourage alcohol use

? medication is used to remove the pleasure effect of alcohol use

What is used if Pt is experiencing hallucinations during withdrawal

A

Disulfiram- aversion med

Naltrexone- opiate antagonist to dec pleasure

Haloperidol

60
Q

Adjustment d/o can rarely but potentially evolve into ? psych Dxs

Pts w/ anxiety d/os are likely to self medicate w/ CNS depressants, MC being ?

Time frame for adjustment d/o to develop?

A

GAD, Major depression

Alcohol

W/in 3mon of stressor

61
Q

What meds may be used for Adjustment D/o Tx

These Pts are at risk for ? future medical issues

Define Sunday Neuroses

A

Lorazepam- acute anxiety
SSRIs- long term management

Increased risk for autoimmune dzs

Pts do well w/ scheduled week but unscheduled weekend/retirement causes anxiety

62
Q

How is GAD Tx w/ meds

What med is possibly the most anxiogenic antidepressant

? medication is used for reducing peripheral Sxs

A

SSRI: Escitalopram Paroxetine
SNRI: Venlafaxine Duloxetine

Buspirone

Propranolol

63
Q

? medication is used in benzo over doses

How is panic d/os Tx w/ meds

Social phobia and agoraphobia can be Tx w/ ? meds

A

Flumazenil- benzo antagonist

SSRIs: Fluoxetine Paroxetine Sertraline
SNRI: Venlafaxine

SSRI: Paroxetine Sertraline Fluvoxamine
SNRI: Venlafaxine
Gabapentin

64
Q

OCD Sxs can overlap w/ ? other spectrum Sxs

What meds are used during Tx

What meds can be used as adjuncts w/ SSRIs for Tx resistant cases

A

Body dysmorphia
Excoriation
Tic/Trichotillomania
Hoarding

SSRI: Fluoxetine Sertraline Paroxetine Fluvoxamine
Clomipramine

Antipsychotics/Topiramate

65
Q

What procedure is FDA approved for Tx of OCD

A

Transcranial Magnetic Stimulation

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