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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
Q

Major Depressive Disorder, S&S, d/t?

A

2+ wks of 5 of 9 CISEGAPS, d/t ↓ 5HT

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26
Q

What would you see on PET Scan of MDD?

A

↓ frontal lobe blood flow

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27
Q

Tx MDD

A

SSRIs, TCAs, MAOIs, ECT if pregnant

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28
Q

DIGFAST of Bipolar I

A

Distracted

Impulsive

Grandiose

Flighty

Activity

Sleep

Talkative Manic Episodes last 1 wk, may have depressive episodes

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29
Q

Tx. Bipolar I

A

Lithium (mood stabilizer), Carbamazepine or Valproic Acid, Atypicals

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30
Q

Bipolar II (Hypomanic)

A

less severe DIGFAST, more prevalent, 1+ major depressive episode is required

31
Q

Delirium

A

wax and waning, worse at night, impaired cognition

32
Q

Hypertensive Crisis caused by? Tx.

A

Taking Tyramine while on MAOIs

S&S: HTN, HA, sweating, N&V

Tx: Phentolamine

33
Q

Lithium toxicity S&S

A

Li > 1.5

N&V, slurred, ataxia, myoclonus, hyperreflexia

34
Q

DSM IV Axis

A

I. mental illness + developmental disorders II. personality disorders + MR

III. medical condition

IV. psychosocial issues

V. Global Assessment of Functioning

35
Q

Schizophrenia

A

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
Q

(-) symptoms

A

blunt affect, anhedonia d/t deficient DA in Prefrontal Cx

37
Q

What would you see on CT in Schizophrenia?

A

enlarged lateral ventricles and cortical atrophy

38
Q

Atypical antipsychotics: DA and 5HT blockers.

Tx: for (-) symptoms

A

Old Closets Quietly Risper from A to Z: Olanzapine, Clozapine, Quetiapine, Risperidone, Aripiprazole, Ziprasidone

39
Q

Schizophreniform, Tx.

A

“Short-term” schizophrenia lasting 1-6 mo.

Tx: 3-6 mo of Atypical antipsychotics

40
Q

Schizoaffective Disorder, Tx

A

Schizophrenia + Bipolar or Depression

Tx: Atypical antipsychotics, mood stabilizers, antidepressants, ECT

41
Q

MAOIs [Phenelzine] MOA

A

blocks inactivation of NE, 5HT, DA, Tyramine

42
Q

5 Stages of Grief

A
  1. Denial, 2. Anger, 3. Bargain, 4. Depression, 5. Acceptance
43
Q

Anxiety/Panic Disorder neurotransmitter changes

A

↑ NE, ↓ GABA and 5HT

Tx: SSRI

44
Q

OCD

d/t?

Tx?

A

abnormal 5HT regulation

Tx: SSRI then TCAs

45
Q

OCPD pt.

A

ego-syntonic - don’t perceive a problem

46
Q

Txs. for Nicotine Dependence, MOA

A

Varenicline [Chantix]: prevents withdrawal S&S by affecting nicotinic cholinergic receptor

Bupropion: partial agonist at nAChR

47
Q

Somatization disorder

A

multiple physical symptoms, multiple organ systems: 4 Pain, 2 GI, 1 Repro, 1 “Neuro”

48
Q

Anorexia key labs

A

HypOnatremia, Alkalosis (if vomiting), ↑ Cortisol

49
Q

Sleepwalking occurs during what part of sleep

A

Stage 3-4 Non-REM (slow wave sleep)

50
Q

Tx. for Sleep Terror

51
Q

Freud Structural model of the psyche

A

ID: unconscious sexual/aggressive urge

EGO: defense mechanisms, seeks relationships,

SUPEREGO: moral conscious

52
Q

5HT Antagonists [Trazodone, Nefazodone] is used for?

A

Refractory MDD

53
Q

Carbamazepine MOA

A

blocks Na+ chan to inhibit action potentials

54
Q

Tx. for Bipolar Depression

A

Lamictal (levels increase with Depakote administration)

55
Q

Benzodiazepines MOA

A

potentiates GABA-A by ↑ Cl- conductivity

56
Q

Buspar MOA

A

5HT-1A partial agonist that is often used in combo with SSRI to Tx Anxiety

57
Q

Narcolepsy S&S

Tx?

A

short REM latency, cataplexy, hypnagogic hallucinations, sleep paralysis

Tx. Sleep hygiene/regular sleep schedule

58
Q

Projection

A

when a patient projects onto the physician qualities that he cannot tolerate in himself

59
Q

What important side effect of Haloperidol and other antipsychotics like Atypical Antipsychotics should you keep in mind?

A

Prolonged QT –> Torsades

60
Q

Benzodiazepine and Alcohol OD

A

“unresponsive pt. with otherwise normal PE”

↓ mentation/obtunded, delirium Dilated pupils (mydriasis)

HypOreflexia, weakness, ataxia, HypOthermia, Mild Resp depression

61
Q

Tylenol OD

A

Fatal hepatotoxicity

62
Q

B-Blocker OD

A

Bradycardia

CNS depression

OrthohypoTN

Pulm edema

Seizures

63
Q

Sulfonylurea OD

A

Hypoglycemia

64
Q

Opioid (e.g. Heroin, Morphine, Meperidine, Demerol) OD?

Withdrawal?

A

CNS depression

Constricted pupils (miosis) - Opioid

Resp depression

Constipation

W/D: Piloerection

65
Q

Amphetamines OD

A

Dilated pupils (mydriasis) - meth heads are always on the lookout for more!

Psychomotor agitation

Tachycardia

Seizures

66
Q

Cocaine OD

A

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
Q

PCP OD

A

Assaultiveness/impulsive

HTN

Vertical nystagmus

Hyperthermia

68
Q

LSD OD

A

Marked anxiety/depression/panic

Delusions, hallucinations

Dilated pupils (mydriasis)

Heightened senses

Flashbacks

69
Q

Marijuana OD

A

Euphoria Hunger, dry mouth Slowed sense of time

70
Q

Barbiturates OD

A

Respiratory depression

Low safety margin

71
Q

Sequelae of prolonged IV Lorazepam use? Why?

A

Lactic acidosis. IV Lorazepam is preserved with propylene glycol. Prolonged propylene glycol intoxication manifests as lactic acidosis.

72
Q

1º Hypersomnia

A

excessive daytime sleepiness despite more than adequate nighttime sleeping and daytime napping for at least 1 mo.

Tx: Amphetamines

73
Q

EKG Hallmark of TCA OD Tx?

A

Wide QRS >100ms

Tx: Sodium bicarb

74
Q

What do you do if a pt. is acutely suicidal?

A

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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