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COMLEX 2 > Psych > Flashcards

Psych Flashcards

1
Q

Neuroleptic Malignant Syndrome (slow onset 1-3 days),

D/t

S&S

Tx

A

Bradykinesia

Lead pipe rigidity

Fever HTN, tachycardia

↑ CPK

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2
Q

Cyclothymic disorder

S&S

Tx

A

mild form of bipolar alternating hypomania and dysthymia (mild depression) for at least 2 yrs (symptom free for 2 mo. max)

Tx: Lithium, Quetiapine

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3
Q

Hypomania

A

4 day minimum, no social/occupational impairment, no psychotic features, no hospitalization required

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4
Q

Dysthymia, Time frame

Tx

A

depressed for at least 2 yrs (symptom free for 2 mo. max), poor concentration, hopeless, low self esteem, fatigue, insomnia, poor/excessive appetite

Tx: Venlafaxine

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5
Q

Serotonin Syndrome (fast onset)

d/t

S&S

Tx

A

d/t when MAOIs are taken with SSRIs/Serotonergic opioids; e.g. Trancypromise + Meperidine/Dextromethorphan/Tramadol

hyperkinesia

myoclonic jerks/ clonus

confusion, rhabdo, renal failure, coma

Tx: Supportive care then Cyproheptadine (serotonin antagonist)

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6
Q

Tourette’s keywords

A

↓ Frontal Lobe mass

impaired DA regulation in caudate

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7
Q

Tx. for Extrapyramidal SE of antipsychotics

A

Benztropine (anticholinergic)

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8
Q

How do NSAIDs affect Lithium levels?

A

NSAIDs ↓ Lithium levels

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9
Q

What is Lithium used for? Adverse effects?

A

Bipolar disorder and Refractory depression

AE: metal taste, hypothyroidism, polyuria

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10
Q

Factitious disorder

A

getting sick to assume sick role (1º gain)

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11
Q

Histrionic

A

excessive emotionality, attention seeking

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12
Q

Malingering

A

acting out false/grossly exaggerated signs and symptoms for 2º gain (unemployment benefits, narcotics, money)

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13
Q

Extrapyramidal Symptoms (d/t typicals/atypicals i.e. Risperdal or Haldol) Rule of 4’s

A

Rule of After 4’s:

4 hrs: acute dystonia

4 days: akathisia (restlessness)

4 wks: bradykinesia

4 mo: tardive dyskinesia

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14
Q

Dysthymia (Persistent depressive disorder)

A

chronic low grade depression at least 2 yrs

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15
Q

Avoidant personality disorder, Tx

A

feels a “void” and wants to be friends, fear intimate relationships/friendships, Tx: SSRIs

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16
Q

Cluster A ODD personality disorders “PASS”,

Tx: Psychotherapy

A

PAranoid: mistrust others

Schizoid: no desire for close relationships

Schizotypal: “magical thinking” and distorted cognitions/perceptions

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17
Q

Cluster B DRAMATIC personality disorders “BAHN”

A

Borderline: unstable relationships, mood swings. Tx: Dialectical behavioral (DBT)

Antisocial: violate rights of others, steals, kills with no guilt. Tx: DBT

Histrionic: attention seeking but functional. Tx: psychotherapy

Narcissistic: grandiose, need for admiration Tx: psychotherapy

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18
Q

Cluster C ANXIOUS personality disorders “CADO”

A

Avoidant: desires companionship. Tx: SSRI

Dependent: afraid of separation. Tx: psychotherapy

OCPD: rigid rules so tight they exclude friendships. Tx: psychotherapy

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19
Q

Sublimation

A

mature way of channeling impulses into socially acceptable behavior

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20
Q

When treating a single episode of Major Depression, how long should you continue antidepressants to follow a pt.’s response?

A

6 mo.

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21
Q

What a.a. should you avoid while on MAOIs?

Why?

A

Tyramine (age cheese, anchovies, red wine, cured meats, etc.)

Hypertensive crisis

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22
Q

Schizoaffective

A

psychosis + major Depression/Manic S&S lasting 2+ wks

i.e. Schizophrenia + either depression or bipolar disorder. That’s why it has two subtypes (depression type, bipolar type)

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23
Q

Why can’t you abruptly stop benzodiazepines like Xanax?

A

Seizure risk

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24
Q

Hoarding is treated with?

A

SSRIs

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25
Major Depressive Disorder, S&S, d/t?
2+ wks of 5 of 9 CISEGAPS, d/t **↓ 5HT**
26
What would you see on PET Scan of MDD?
**↓ frontal lobe blood flow**
27
Tx MDD
SSRIs, TCAs, MAOIs, ECT if pregnant
28
DIGFAST of Bipolar I
Distracted Impulsive Grandiose Flighty Activity Sleep Talkative Manic Episodes last 1 wk, may have depressive episodes
29
Tx. Bipolar I
Lithium (mood stabilizer), Carbamazepine or Valproic Acid, Atypicals
30
Bipolar II (Hypomanic)
less severe DIGFAST, more prevalent, 1+ major depressive episode is required
31
Delirium
wax and waning, worse at night, impaired cognition
32
Hypertensive Crisis caused by? Tx.
Taking Tyramine while on MAOIs S&S: HTN, HA, sweating, N&V Tx: Phentolamine
33
Lithium toxicity S&S
Li **\> 1.5** N&V, slurred, ataxia, myoclonus, hyperreflexia
34
DSM IV Axis
I. **mental illness** + developmental disorders II. **personality disorders** + MR III. **medical condition** IV. **psychosocial issues** V. **Global Assessment** of Functioning
35
Schizophrenia
2+ of the following for at least 1 mo: catatonia, hallucinations, delusions, (-) symptoms d/t **excess DA** in the **Mesolimbic** pathway, Tx: Atypical antipsychotics
36
(-) symptoms
blunt affect, anhedonia d/t deficient DA in Prefrontal Cx
37
What would you see on CT in Schizophrenia?
enlarged lateral ventricles and cortical atrophy
38
Atypical antipsychotics: DA and 5HT blockers. Tx: for (-) symptoms
**O**ld **C**losets **Q**uietly **R**isper from **A** to **Z**: Olanzapine, Clozapine, Quetiapine, Risperidone, Aripiprazole, Ziprasidone
39
Schizophreniform, Tx.
"Short-term" schizophrenia lasting 1-6 mo. Tx: 3-6 mo of Atypical antipsychotics
40
Schizoaffective Disorder, Tx
Schizophrenia + Bipolar or Depression Tx: Atypical antipsychotics, mood stabilizers, antidepressants, ECT
41
MAOIs [Phenelzine] MOA
blocks inactivation of NE, 5HT, DA, Tyramine
42
5 Stages of Grief
1. Denial, 2. Anger, 3. Bargain, 4. Depression, 5. Acceptance
43
Anxiety/Panic Disorder neurotransmitter changes
**↑ NE**, **↓ GABA and 5HT** Tx: SSRI
44
OCD d/t? Tx?
**abnormal 5HT** regulation Tx: SSRI then TCAs
45
OCPD pt.
ego-syntonic - don't perceive a problem
46
Txs. for Nicotine Dependence, MOA
**Varenicline** [Chantix]: prevents withdrawal S&S by affecting nicotinic cholinergic receptor **Bupropion**: partial agonist at nAChR
47
Somatization disorder
multiple physical symptoms, multiple organ systems: 4 Pain, 2 GI, 1 Repro, 1 "Neuro"
48
Anorexia key labs
**HypO**natremia, **Alkalosis** (if vomiting), ↑ **Cortisol**
49
Sleepwalking occurs during what part of sleep
Stage 3-4 Non-REM (slow wave sleep)
50
Tx. for Sleep Terror
**Diazepam**
51
Freud Structural model of the psyche
**ID**: unconscious sexual/aggressive urge **EGO**: defense mechanisms, seeks relationships, **SUPEREGO**: moral conscious
52
5HT Antagonists [Trazodone, Nefazodone] is used for?
Refractory MDD
53
Carbamazepine MOA
**blocks Na+** chan to inhibit action potentials
54
Tx. for Bipolar Depression
**Lamictal** (levels increase with Depakote administration)
55
Benzodiazepines MOA
potentiates GABA-A by **↑ Cl- conductivity**
56
Buspar MOA
**5HT-1A partial agonist** that is often used in combo with SSRI to Tx Anxiety
57
Narcolepsy S&S Tx?
short REM latency, cataplexy, hypnagogic hallucinations, sleep paralysis Tx. Sleep hygiene/regular sleep schedule
58
Projection
when a patient **projects** onto the physician **qualities** that he **cannot tolerate in himself**
59
What important side effect of Haloperidol and other antipsychotics like Atypical Antipsychotics should you keep in mind?
Prolonged QT --\> **Torsades**
60
Benzodiazepine and Alcohol OD
"**unresponsive pt**. with **otherwise normal PE**" ↓ mentation/obtunded, delirium Dilated pupils (mydriasis) **HypOreflexia**, weakness, ataxia, **HypOthermia,** Mild Resp depression
61
Tylenol OD
Fatal hepatotoxicity
62
B-Blocker OD
Bradycardia CNS depression OrthohypoTN Pulm edema Seizures
63
Sulfonylurea OD
Hypoglycemia
64
Opioid (e.g. Heroin, Morphine, Meperidine, Demerol) OD? Withdrawal?
CNS depression Constricted pupils (**miosis**) - Op**ioi**d Resp depression Constipation W/D: Piloerection
65
Amphetamines OD
**Dilated** pupils (mydriasis) - meth heads are _always on the lookout_ for more! Psychomotor agitation Tachycardia Seizures
66
Cocaine OD
Chest pain substernal **Dilated** pupils (mydriasis) Hallucinations and paranoia - **Psychomotor agitation** HTN **ST elevations** Tx acute intoxication: **Lorazepam** or **Phentolamine** and ASA and O2
67
PCP OD
Assaultiveness/impulsive HTN Vertical **nystagmus** **Hyperthermia**
68
LSD OD
Marked anxiety/depression/panic Delusions, hallucinations **Dilated** pupils (mydriasis) Heightened senses Flashbacks
69
Marijuana OD
Euphoria Hunger, dry mouth Slowed sense of time
70
Barbiturates OD
Respiratory depression Low safety margin
71
Sequelae of prolonged IV Lorazepam use? Why?
***Lactic acidosis.*** IV Lorazepam is preserved with propylene glycol. **Prolonged propylene glycol intoxication** manifests as lactic acidosis.
72
1º Hypersomnia
**excessive daytime sleepiness** despite more than adequate nighttime sleeping and daytime napping for at least 1 mo. Tx: Amphetamines
73
EKG Hallmark of TCA OD Tx?
**Wide QRS** \>100ms Tx: **Sodium bicarb**
74
What do you do if a pt. is acutely suicidal?
notify police allow her to leave if she won't stay voluntarily give them hotline/crisis #s

COMLEX 2 (19 decks)

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