Psych Flashcards
1
Q
Fever, tachycardia, HTN, diaphoresis, tactile or liliputian hallucinations
A
DTs - 48-96 hrs
2
Q
Skin popping, pinpoint pupils, drowsiness, constipation intoxication
A
Heroin
3
Q
SLUDGE - sweating, lacrimation, pupillary dilation, diarrhea, rhinorrhea withdrawal
A
Heroin
- tx w/ clonidine, methadone
4
Q
Agression, paranoia, VERTICAL NYSTAGMUS, HTN, tachycardia, hyperacusis intoxication
A
PCP
5
Q
Visual hallucinations, SENSORY INTENSIFICATION, illusions, sweating, tachycardia intoxication
A
LSD
6
Q
Pupillary dilation, insomnia, delusions, paranoia intoxication
A
Amphetamines
7
Q
Tx for agitation w/ & w/o psychosis
A
With = haldol Without = diazepam
8
Q
Erythema of turbinates, EPISTAXIS, pupillary dilation, bugs crawling on skin, aggression, insomnia intoxication
A
Cocaine
9
Q
INC appetite, hypersomnia, vivid dreams withdrawal
A
Cocaine
10
Q
Unexpected travel, can’t remember past, hx of head trauma
A
Dissociative fuge
11
Q
2+ distinct identities
A
Dissociative identity
12
Q
1+ episode of amnesia related to stressful event
A
Dissociative amnesia
13
Q
Observing own body from afar
A
Depersonalization
14
Q
Experiencing familiar persons and surroundings as if strange or unusual
A
Derealization
15
Q
<85% IBW, fear of becoming fat, absence of 3 periods, show great concern with appearance
A
Anorexia
- arrhythmia –> death
- hospitalization, psychotherapy, SSRIs
16
Q
GLOBAL body desire, low K, acidosis, inc LFTs, dec grey matter in anterior cingulate gyrus
A
Lanugo
- assess severity w/ low albumin
17
Q
Normal weight, large eating volumes, use of exercise, fasting, vomiting, laxative, diuretics, enemas, HX of obesity
A
Bulimia
18
Q
Parotid enlargement, inc amylase, gastric dilation or tear, HX OF PICA, excessive exercising
A
Bulimia
19
Q
Tx for anorexia
A
- Olanzapine
2. CBT & FAMILY therapy
20
Q
Tx for bulimia
A
- CBT
2. FLUOXITINE (prozac = no weight gain)
21
Q
Dependence vs. Abuse
A
Dependence
- withdrawal sx, can’t cut down but trying, time spent recovering, interferes w/ normal life
Abuse
- don’t fulfill obligations, use in dangerous situations, legal and social problems, CONTINUED use despite adverse consequences, ELEVATED GGT
22
Q
Neurotransmitter that initiates sleep
A
Serotonin
23
Q
Neurotransmitter that produces arousal/wakefulness
A
DA
24
Q
Levels of Ach and NE during REM
A
Ach = high NE = low
25
Stage 1 sleep waves
Theta (3-7hz)
26
Stage of sleep with sleep spindle and K complexes
Stage 2
27
Abrupt awakening in early sleep, intense, can't be calmed, NO memory, assoc w/ RLS, precursor to temporal epilepsy
Night terrors
| - tx w/ benzos
28
Tx for enuresis
1. Alarms
| 2. Imipramine, & DDAVP
29
Previously toilet trained now wetting bed after north of new sibling
Regression
30
IVDU gets HCV and blames poor control of HCV in community
Distorsion - altered perception of disturbing aspects of reality
31
Angry w/ person - believes person is angry at them
Projection
32
Classifies things as all good or bad
Splitting = borderline personality
33
Abused child identifies themselves as an abuser
Identification
34
Angry at person, instead goes and wrecks car
Displacement
35
Pt rescued from burning building now denies memory of event
Dissociation - block memory or drastic change in behavior to avoid emotional distress
36
Involuntary withholding idea or feeling from consciousness
Repression
37
Got fired - now claims job was not that important anyway
Rationalization - avoid self blame
38
Replacing behavior/thoughts/feelings opposed to their own with OPPOSITE behavior
Reaction formation
39
Explosive anger channeled into athletic pursuits
Sublimation
40
Kid focuses on homework rather than dad's cancer dx
Suppression - VOLUNTARY postponement of anxiety producing thought
41
3 months of stressful situation, last NO LONGER than 6mo, somatic sx in kids, irritable, short temper, anxiety, depression
Adjustment disorder
| - psychotherapy
42
Abrupt feeling of intense anxiety, palpitations, sweating, SOB, dizziness, hot flashes, following a particular stimuli
Panic attack --> alprazolam
43
UNEXPECTED, out of the blue intense anxiety, worrying about future attacks, behavior change after attack
Lasts >15min but
Panic disorder --> SSRIs
| - w/ agoraphobia
44
Work-up/DDx for panic disorder
1. Thyroid - ? high thyroxine or hypothyroid
2. #1 = depression
3. Agoraphobia
45
>6mo
Worry about multiple things that may not have happened yet, no trigger
Restless, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
Generalized anxiety disorder
- Major depression in 50-90%, Sjogren's, Grave's, hyperthyroid
- SSRIs, also venlafaxine, buspirone
46
Stressful event + in a daze/numbing + derealization/depersonalization + dissociative amnesia and re-experiencing event, avoidance of certain stimuli, MAXIMUM 4 WEEKS
Acute stress disorder
- support
- propanolol to prevent PTSD
47
Re-experience traumatic event, LONGER than 4 WEEKS, hallucinations, intense fear, horror,
PTSD
- paroxetine or sertraline
- prazosin for nightmares
- relaxation, hypnosis, psychotherapy
48
Co-morbidities w/ PTSD
MDD, anxiety, substance abuse
49
Fear of being in places from which escape may be difficult or embarrassing - crowds, public places, traveling
Agoraphobia
| - 91% have MDD, complication of PANIC DISORDER
50
Fear of being humiliated or embarrassed + blushing, shaking, vomiting, urgency or fear of micturition or defecation + >6mo under 18 y/o
Public restrooms, public speaking or eating in public
Social phobia
| - BBs, assertiveness + SSRI
51
Fear of reptiles, blood, heights, tunnels, closed spaces, fear of CONTRACTING disease, even anticipation provokes anxiety + recognized as irrational
Specific phobia disorder
- desensitization, relaxation
- BBs and SSRIs
52
Intrusive thoughts and repetitive behaviors - cleaning, hand washing, ordering, counting, meditating, toe tapping + aware of unreasonableness
OCD --> SSRI
- 2/3 have MDD
- Tourette disorder
- other tx = clomipramine, behavior therapy
53
2 weeks
Sleep disturbance, dec interests, guilt, dec energy, dec concentration, appetite disturbance, psychomotor changes, suicidal thoughts
Major depressive episode - disorder w/ >1 episodes
- ***SSRIs***
- Duloxetine w/ neuropathic pain
- Bupropion if scared of sexual SE or weight gain
- r/o Parkinson, dementia, hypothyroidism
54
1+ week
| Distracted, indiscretion, grandiosity, flight of ideas, activity inc, sleep deficit, talkative/pressured speech
Manic episode
- r/o medical condition/drugs
- OLANZAPINE, haldol, lithium for acute
- ***LITHIUM***, lamotrigine, valproic acid, quetiapine maintenance
- NEVER "refer to psychiatrist"
55
1+ manic episodes, CAN have delusions or hallucinations, low risk of suicide
Bipolar 1
- Lithium, valproic (<12) for non-psychotic
- kids never calm down after they get their way (vs. ODD)
56
1+ MDD + hypomanic episode, higher risk of suicide, no delusions or hallucinations
Bipolar 2
| -
57
<30 y/o, pain + GI + sexual or reproductive + weakness or sensory loss
Somatization disorder
| - weekly psychotherapy
58
Loss of specific bodily function or part of body, hemianesthesia, seizures w/ no LOC or incontinence, UNCONCERNED about seriousness
Conversion disorder
| - reassurance of sensory deficits
59
Preoccupation of HAVING an illness, CAN be reassured (vs. somatic), >6mo
Hypochondriasis
| - regularly scheduled appts
60
Pain without cause, anatomic or imaging findings
Pain disorder
| - validation, TCAs, SSRIs
61
Health care worker, poor parental relationships, borderline personality, intentional feigning of illness to assume sick role - injecting insulin
Factitious disorder
62
Consciously making up an illness for secondary gain - avoiding difficult things, responsibilities, punishment, compensation, drugs, lack of cooperation/compliance, anti-social disorder, common in prisoners and military personnel
Malingering
63
Lack peer relationships, eye contact, social smile & lack separation anxiety.
Routines, rituals, repetitive manners - spinning, banging head, self-injurious.
Impaired non verbal behaviors, NO speech b4 3 y/o, tantrums
Autism
- greater in BOYS
- r/o deafness if child doesn't respond to name
64
Girls w/ progressive encephalopathy, microcephaly - deceleration of head growth after 5th mo
Hang wringer, toe walkers, loss of social engagement/peek a boo, poorly coordinated gait or trunk movements
Rhett disorder
65
NO delay in language, impaired peer relationships, doesn't share, no emotional reciprocity, struggle with peer pressure, drugs -- depression, bullying
Asperger's
| - SSRIs
66
Normal development to age 2 --> Loss of expressive language, bowel/bladder control, motor skills, social skills
May have repetitive, stereotyped behaviors
Childhood disintegrative disorder
67
Pathogenic caregivers, no respect for personal boundaries, indiscriminate
Reactive attachment disorder
68
Cruelty toward animals, destruction of property, theft, setting fires, vandalism, truancy, running away
Conduct disorder
- atomoxetine or guanfacine
- parents have anti-social or etOH dependence
69
Age 8
| Loses temper, argues w/ authority, refuses requests, blames others, easily annoyed, spiteful, resentful
Oppositional defiant disorder
| - teach parents child management skills
70
ADHD can lead to?
Bi-polar
| Oppositional defiant disorder
71
Tx for ADHD
1. Methylphenidate, dextroamphetamine --> insomnia, HA, dec appetite
2. ***Atomoxetine***
3. Clonidine, guanfacine (w/ sleep problems)
72
Delusions, hallucinations, disorganized speech, catatonic behavior, brief mood disorder, >6mo
Schizophrenia
| - if no time-frame is mentions = pick this
73
Brain findings in schizophrenia
Inc ventricle size
Prominent sulci
Hippocampal disarray
5HT --> suicidal & impulsive
74
2+ weeks of delusions, hallucinations with or without mode disorders. Depression only present with psychotic features.
Schizoaffective disorder
| - haldol, risperidone
75
Psychotic features only present during mood disorders
Mood w/ psychotic features
76
Magical thinking, transient psychosis, dresses oddly
Schizotypal
| - fam hx of schizophrenia
77
NO affect, LONERS, NO bizarre cognition or psychosis, NO family hx, NO friends, NO desire for friends, successful at work if isolated
Schizoid personality disorder
78
False beliefs that others want to harm them, ppl will take advantage of them, suspicious
Paranoid personality disorder
79
Schizophrenia that lasts >1mo but <6mo
Schizophreniform
80
Schizophrenia that lasts 1 day to 1 month
Brief psychotic disorder
81
NON-bizzare delusions (vs. schizo) - being followed, poisoned, loved, deceived, or have a disease and see that as normal. NO impairment
Delusional disorder --> atypical anti-psychotic
| - erotomatic, grandiose, jealous, persecutory, somatic types
82
Sense of entitlement, aggressive toward others, violate social norms, >18 and had conduct disorder
Anti-social
| - common to develop somatization disorder when older
83
Can't be alone but has short-lived relationships, EMPTINESS, things are all good or all bad, cut/burn themselves, hx of childabuse/neglect
Borderline personality disorder
| - may have short psychotic episodes
84
Overly emotional, dramatic, hungry for ATTENTION, afraid of intimacy but appear seductive, theatrical
Histrionic personality disorder
85
Self-important, crave ADMIRATION, exploitive, unrealistic inflated views of their accomplishments, grandiose
Narcissistic personality disorder
86
Hypersensitive to criticism, fear of rejection, shy away from situations that expose INADEQUACY, WANT friends but unwilling to get involved --> become isolated
Avoidant personality disorder
| - co-morbid dependent personality disorder
87
Afraid of being on their own, submissive in order to avoid displeasing people, can't make decisions, don't question authority, cling to ONE person
Dependent personality disorder
- regular but brief appts
- group psychotherapy
88
Must attain perfection, adhere to plans, schedules, workaholics, stiff, stubborn, do NOT realize this causes them more distress
Obsessive-compulsive personality disorder
| - perfection & inflexibility
89
Dec DA in tuberoinfundibular
Hyperprolactinemia
90
Dec DA in nigrostriatal
Chorea/tics
91
Inc DA in nigrostriatal
EPS & parkinson
92
Inc DA in mesolimbic
Drug use & hallucinations
93
Dec DA in mesolimbic
Anti-psychotics
94
Anti-psychotic binds DA in nigrostriatal --> brief painful muscle contractions, TORTICOLLIS, eyes, larynx in a matter of HOURS to DAYS
Acute dystonic rxn --> benztropine or benadryl IM
95
Restlessness, anxiety, pacing, rocking, leg crossing, can't get out of chair days to WEEKS after anti-psychotic start
Akathisia --> BBs
96
Increased sleep, weight, appetite, mood worse in evening and feels "heavy."
Atypical depression --> MAOIs
97
Immediate sadness, lability, tearfulness lasting 2 WEEKs after birth
Post-partum blues
98
Depressed mood, weight changes sleep disturbances, excess anxiety, may have negative feelings toward baby for 1-3 months after birth
Post-partum depression --> SSRI
99
Depression, delusions and thoughts of harming baby 2-3 WEEKs after birth
Post-partum psychosis --> anti-psychotic, lithium, SSRI
100
Bereavement vs. Depression
Depression has thoughts of death, WORTHLESSNESS, >2months affecting function, psychomotor retardation, psychosis
101
agitation, confusion, hallucinations, sweating, hyperthermia, nausea, diarrhea, tremor, myoclonus
Serotonin syndrome --> stop SSRI + cyproheptadine
102
1. Schizophrenia w/ persecution, delusions
2. Schizophrenia w/ mutism, stupor, rigidity
3. Schizophrenia w/ disheveled, EARLY age, bizarre emotional responses
4. Schizophrenia w/ no + sx, only flat affect
1. Paranoid = most common
2. Catatonic
3. Disorganized
4. Residual
* choose atypical anti psych for acute psychosis, not haldol*
