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psych Flashcards

0
Q

drug detection window for barbiturates or opiates?

A

1-3d

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1
Q

Drug detection window for amphetamines

A

2-3 d

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2
Q

drug detection window for BZD

A

1-7d

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3
Q

Cocaine/metabolites drug detection window

A

6hrs - 3 days

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4
Q

drug detection window methadone

A

7-9 d

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5
Q

drug detection window phencyclidine

A

8d

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6
Q

difference between substance abuse and dependence

A

abuse: maladaptive pattern, 12 mos of dysfunction
dependency: physical sx of tolerance or w/d (not req), and evidence of loss of control over sx (CAGE…)

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7
Q

What are the stages of change in quitting substance use?

A

precontemplation, contemplation, determination, action, maintenance/relapse

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8
Q

Time period of delirium tremens most likely?

A

2-3 days after last drink (up to 3-5)

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9
Q

First signs of alcohol w/d?

A

tremulousness, sweats, incr HR, BP and w/in 24 hrs w/d sz

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10
Q

when do you get alcohol w/d hallucinations?

A

first 24 hrs but can occur anytime.

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11
Q

sx of Wernicke’s?

A

ataxia, ophthalmoplegia, amnesia

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12
Q

mechanism of thiamine def?

A

stops carbo metab

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13
Q

treatment of thiamine / glucose order?

A

always thiamine before glucose otherwise it can’t be metabolized

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14
Q

What is the drug in disulfiram and how does it work?

A

aldehyde dehyrogenase inhibitor causes rxn w/ alcohol with flushing, vomiting, tremors, resp distress, hypotension, death

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15
Q

what is mechanism of naltrexone?

A

opiate antagonist to decrease craving and amount drank during relapse

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16
Q

What is acamprosate?

A

balances glutamate and GABA to decrease craving and extend remission

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17
Q

pt w/ extreme agitation in ED with drool and nystagmus and high HR, no response to pain
likely dx?

A

phencyclidine PCP intoxication

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18
Q

Danger w/ PCP metab?

A

can have extreme swings of effects and behavior b/c of enterohepatic circulation

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19
Q

muscle rigidity and hyperacusis and violence can be seen w/ what intoxication?

A

PCP

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20
Q

vivid unpleasant dreams can be seen with what w/d?

A

cocaine/amphetamine w/d

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21
Q

Medication to use for acute opiate w/d? can add what for rapid detox?

A

clonidine every 4-8h, can add naltrexone 100mg for rapid detox

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22
Q

How does buprenorphine work? What two formulations

A

partial mu receptor agonist can be given w/ signs of w/d from opiates as:
Subutex sublingual OR suboxone unsupervised which also has naloxone in it

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23
Q

What is a major s/e of Chantix / Varenicline

A

serious neuropsych events, suicide, agitation, violence

its a partial nicotinic Ach receptor agonist

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24
Q

BMI criteria for anorexia vs bulimia?

A

<17.5

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25
Q

when to hospitalize for eating d/o?

A
  1. wt 40% below normal

2. loss > 30lbs / 3 mo

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26
Q

FDA approved medication for bulimia (not anorexia)

A

SSRI Fluoxetine at higher doses for at least 1 yr

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27
Q

schizoid vs schizotypal PD?

A

schizoid: detached from social relationships and restricted range of emotions
schizotypal: scute discomfort in close relationships, cognitive/perceptual disturbance, eccentricities

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28
Q

treatment for borderline PD?

A

dialectical behavioral therapy (version of CBT)

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29
Q

% of kids who still have ADHD sx in adulthood

A

60

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30
Q

academic skills and IQ of mild ID?

A

IQ 50-55-70 and academics to 6th grade

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31
Q

IQ and academic skills of moderate ID?

A

ID 35/40-50/55 and 2nd grade academics

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32
Q

most common preventable cause of ID?

A

fetal alcohol

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33
Q

gout, ID, and severe self injurious behaviors. DX?

A

Lesch Nyhans purine metab defect

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34
Q

CGG repeats

A

Fragile X

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35
Q

Visual change in elderly?

A

presbyopia (poor visual accommodation) and decreased acuity

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36
Q

Initial cognitive change in elderly?

A

visual memory declines before verbal

can’t divide attention or do mental manipulation or timed tasks, or novel tasks

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37
Q

Length of time for an adjustment disorder

A

should be about 2 mos

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38
Q

Adjustment vs depression?

A

no major depression or anxiety

morale and self esteem good in adjustment d/o

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39
Q

Suicide in elderly?

A

increased rate and more deadly means

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40
Q

Factors to help ddx bereavement from depression?

A

pathological guilt, suicidal thoughts, psychomotor, functional impairment, hallucinations other than of deceased

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41
Q

most common anxiety d/o in elderly?

A

phobias

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42
Q

Neurological disorders likely to present w/ depression too (4)

A
  1. stroke (50%)
  2. dementia/AD (50%)
  3. left sided lesions
  4. Parkinson’s disease (40%)
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43
Q

Old lady given too much benadryl needs what antidote/

A

physostigmine

too much anticholinergic, need cholinergic: cholinesterase inhibitor

44
Q

Therapies that can be used in elderly?

A
  1. Grief therapy: education about grief, monitoring

2. reminiscence therapy: life story creation

45
Q

Kubler Ross stages of grief

A
  1. denial
  2. anger
  3. bargaining
  4. depression
  5. acceptance
    * dabda*
46
Q

GAF when you become unable to work?

A

50 or below

47
Q

superior, transient decreased functioning would give what GAF score?

A

80

48
Q

Classical vs operant conditioning? (Conditioning = learning)

A

Classical: modified by antecedent (Pavlov - drool from bell; PTSD)
Operant: modified by consequences (Skinner) - through reinforcing vs punishing consequences; contingency management

49
Q

Classic example of negative reinforcement

A

to avoid nagging, kid does activity (Removal of aversive stimuli)

50
Q

Main concepts of Cognitive-Behavioral Therapy

A
  1. focus: on present goals, problem-solving
  2. therapy: manualized / time limited
  3. theory: a change in thoughts/behaviors will change emotions
51
Q

Three examples of cognitive distortions?

A
  1. all or nothing
  2. overgeneralizing
  3. catastrophizing
52
Q

Two types of exposure therapy?

A
  1. desensitization with slow increase of difficulty

2. flooding: throw into most feared situation

53
Q

Psychological defenses that are mature: name 4

A
  1. humor
  2. sublilmation: change libido to art
  3. altruism
  4. suppression
54
Q

Neurotic defenses (5)

A
  1. isolation of affect
  2. displacement
  3. reaction formation
  4. intellectualization
  5. denial
55
Q

immature defenses (3)

A
  1. regression
  2. somatization
  3. acting out
56
Q

narcissistic defenses (4)

A
  1. splitting
  2. projection
  3. projective identification
  4. distortion
57
Q

What is the name of a language-free intelligence test?

A

Leitner International Performance Scale: specialized IQ test

58
Q

What is the flynn effect?

A

substantial and long-sustained increase in intelligence test scores

59
Q

4 different achievement tests?

A

Weschler Individual Achievement Test (WIAT)
PEabody Individual Achievement Test
Woodcock Johnson III Test of Achievement
Wide-range Achievement Test

60
Q

2 Neuropsychological batteries for cognition?

A
  1. Luria-Nebraska

2. Halstead Reitan

61
Q

What are good tests of attention?

A

continuous performance tests (Conners)

62
Q

What are four good tests of memory?

A
  1. Wechsler memory scale
    Auditory verbal learning test
    California verbal learning test
    Hopkins verbal learning test
63
Q

What are 4 good language tests?

A
  1. Test of Language Development (TOLD)
  2. Peabody Picture Vocab Test - test of verbal comprehension only if can’t talk
  3. Boston aphasia diagnostic test
  4. Western aphasia battery revised
64
Q

How does the Peabody picture vocab test work?

A

pt points to picture most like the stimulus word read out loud by administrator (verbal comprehension only)

65
Q

Great test for Executive function?

A

Wisconsin Card Sorting: assess learning, perseveration, set changes

66
Q

What are projective tests and give 2 ex

A

test w/ ambiguous stimuli so that response reflects preoccupations

  1. Thematic Apperceptive Test
  2. Rorschach
67
Q

Test used in malingering?

A

minnesota multiphasic personality inventory w/ 567 y/n questions w/ scales for faking “good”, faking “bad”, and defensiveness/evasiveness

68
Q

Length of time to consider major depressive episode

A

at least 2 wks

69
Q

what is the term for waxy flexibility

A

catalepsy

70
Q

best tx for depression w/ melancholic features (poor mood reactivity, worse in AM, marked anhedonia)

A

TCA

71
Q

post partum blues vs depression

A

blues: earlier

Depression w/in 4 wks, more severe

72
Q

Risk of relapse after 1 major depressive episode

A

50%

73
Q

adequate trial of antidepressant treatment?

A

4-8 wks at therapeutic dose

74
Q

How long should you treat major depression

A

6-12 mos at full dose

continuation

75
Q

Augmentation Strategies for Depression (MDD) 5

A
  1. Lithium
  2. T3
  3. Aripiprazole
  4. Quetiapine
  5. Combination therapy: SSRI/SNRI + bupropion and mirtaz (Avanza/Remeron)
76
Q

SSRIs and breastmilk

A

yes. Lowest rates with sertraline

77
Q

?Long term behavioral effects with SSRIs in pregnancy

A

No

78
Q

SSRI and pregnancy, what risks?

A

cardiac defects, peristent pulm hypertension, respiratory distress/LBW, neonatal abstinence syndrome

79
Q

issue with MAOi and food?

A

tyramine foods have monoamine effects and can cause htn crisis

80
Q

The black box warning on all antidepressants?

A

incr suicide (but none in studies) for pts < 24 yr

81
Q

Contraindications for ECT?

A

No absolute.
Relative: CV: recent MI, valve dz, CHF, vasc malformations
CNS: incr ICP, recent stroke
Pulm: COPD, PNA

82
Q

What side lesions are more assoc w/ depression vs bipolar

A

left side: depr

right side: bipolar / mania

83
Q

Medication to use for rapid cycling bipolar

A

Valproate 1500mg daily

84
Q

What med is best for euphoric mania vs dysphoric/fixed/or rapid cycling mania?

A

euphoric: lithium
others: VPA

85
Q

What is a good antidepressant in bipolar that doesn’t lead to mania?

A

Lamotrigine

86
Q

Renal complication w/ Lithium and possible treatment?

A

DI (10%), try amiloride

87
Q

Big drug interaction with Li/

A

many renal drugs incr level of Li (Diuretics, NSAIDs, ACEi, Angiotensin II antag

88
Q

What d/o has highest suicide rate and what pop?

A

bipolar disorder

elderly

89
Q

Neuro condition that can cause anxiety/panic?

A

TLE: thing of proximity to amygdala

90
Q

TYpe of med: VEnlafaxine?

A

SNRI

91
Q

Rate of Tourette’s in OCD?

RAte of OCD in Tourettes?

A

Tourettes in OCD 5-7%

OCD in Tourettes: 35-50%

92
Q

First line meds for OCD?

A

SSRIs, Clomipramine

93
Q

MEdication that can be used to reduce PTSD nightmares?

A

Prazosin (alpha 1 antag)

94
Q

acute stress disorder vs ptsd?

A

acute stress only in first month

95
Q

GAD length of time criteria?

A

at least 6 mos

96
Q

DElusional d/o vs schizophrenia?

A

delusional disorder is only non-bizarre thoughts/delusions

97
Q

black box warning for antipsychotics?

A

increased all cause mortality in elderly

98
Q

Antipsychotics with most weight gain?

A

clozapine and olanzapine

99
Q

antipsychotics with most orthostasis?

A

chlorpromazine, clozapine, quetiapine

100
Q

antipsychotics w/ most EPS?

A

high potency first generations and Risperidone

101
Q

antipsychotic with most prolactin elevation?

A

risperidone

102
Q

antipsychotic you need to take with food?

A

ziprasidone (ziplock bag: geodon)

103
Q

antipsychotic with most akathisia/most activation?

A

aripiprazole: partial D2 agonist/antagonist

104
Q

Antipsychotic with most concern for QT prolongation?

A

ziprasadone

105
Q

CAuse of tardive dyskinesia?

A

dopamine receptor hypersensitivity

106
Q

tx of NMS?

A

you basically have blocked DA too much, so you need more DA: Levo/carbidopa, Bromocriptine
Dantrolene for muscle to prevent calcium release for rigidity

107
Q

NMS vs serotonin syndrome major sx?

A

rigidity in NMS not serotonin syndrome

108
Q

Timing of delusional disorder and tx?

A

> 1 month usu don’t respond well to teratment. Try CBT/antipsychotic meds

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