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Step 2 CK > Psych > Flashcards

Psych Flashcards

1
Q

timeline and diagnosis of adhd?

A

greater than 6 inattentive and 6 hyperactive in greater than 6 months. generally less than 12 affects and in 2 settings.

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2
Q

timeline for diagnosis and tx of social phobia?

A

greater than 1 social situation for greater than 6 months. ssri or snri or cbt. b-blocker or benzo for performance subtype

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3
Q

timeline and diagnosis of panic disorder and tx?

A

persistent/recurrent attacks with greater than 4 of following PANICS criteria with greater than 1 month of worrying about additional attacks or avoiding situations.. benzo and ssri. begin with both and taper till just ssri

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4
Q

timeline and diagnosis and tx fo specific phobia?

A

greater than 6 month phobia of specific object or stimulus with behavioral therapy gold standard, but can give benzos in acute

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5
Q

tx ocd

A

1) cbt or high dose ssri 2) clomipramine (TCA) or antipsychotic augmentation for tx nonresponse 3) deep brain stimulation for refractory cases

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6
Q

tx hoarding disorder

A

ssri

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7
Q

timeframe and tx GAD?

A

greater than 6 months. cbt, ssri/snri, benzo, combo of both

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8
Q

timeframe somatic symptoms?

A

greater than 6 months

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9
Q

timeframe and diagnosis and tx of tourette?

A

greater than 1 yr of multiple motor tics and at least one vocal tic presenting before 18. 1st gen antipsy (haloperidol and pimozide) or 2nd gen preferred (risperidone) with clonidine as option as well (alpha agonist)

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10
Q

4 pillars of autism?

A

lack of social interaction, restricted interests, repetitive or ritualized behaviors, communication deficits

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11
Q

underlying disorder RLS associated with ?

A

iron deficiency anemia

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12
Q

timing for ptsd and tx?

A

greater than 1 month (3 days to 1 month is acute stress disorder). trauma focused CBT and antidepressants (ssri or snri)

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13
Q

selective mutism timeframe

A

greater than 1 month

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14
Q

tx anorexia if no response to cbt and nutrition rehab?

A

olanzapine

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15
Q

tx anorexia, bulimia?

A

anorexia and bulimia-cbt and nutritinal rehab, but olanzapine (anorexia refractive), and ssri (bulimia combo)

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16
Q

tx binge eating?

A

cbt, behavior wt loss, ssri, lisdexamfetamine, topiramate

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17
Q

pathogenesis refeeding syndrome

A

increase carb leads to increase insulin secretion leadking to uptake of k+ mg2+ and po43- and thiamine with decreased levels in serum and increased chance of CP failure, seizure, chf, wernicke

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18
Q

management of folie a deux?

A

interview separate to assess level of impairment for each. dominant generally requires psychiatric treatment and other only requires in some cases

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19
Q

benzo for inpatient setting that is preferred with alcoholic?

A

iv lorazepam. intermediate acting for patients with comorbid liver disease

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20
Q

tx of adjustment disorder?

A

psychodynamic psychotherapy or brief cognitive psychotherapy

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21
Q

one thing that has to be present before you can consider diagnosing depression?

A

low mood/anhedonia

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22
Q

tx depression length?

A

person who responds and has had one episode-continue for 4-9 months
person who responds and has recurrent/chronic/severe-continue for 1-3 yrs or indefinitely

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23
Q

patient with a terminal illness should be on what that can be an option for longer life expectency

A

ssri and beginning should be a low threshold with low risk and high reward

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24
Q

diagnosis dysthmia

A

depressed mood greater than 2 years and greater than 1 year in children or adolescent with no symptom free greater than 2 months with at least 2 sigecap

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25
Q

timeline brief psychotic, schizophreniform, schizophrenia?

A

1 day to 1 month, 1 month to 6 months, greater than 6 months with functional decline required

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26
Q

best chance for patients not to relapse with schizophrenia?

A

minimizing conflict and stress in home

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27
Q

timeline schizoaffective?

A

greater than 2 weeks

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28
Q

bipolar 1 and 2 definition?

A

1: at least 1 manic with or without hypomanic or depressive episode
2: hypomanic and depressive episode

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29
Q

tx of mania?

A

1) 1st and 2nd gen antipsychotics, 2) lithium (avoid in renal disease), 3) valproate (avoid in liver disease) where you can combine both in severe disease

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30
Q

what do you not use for mania?

A

antidepressants as it can percipitate mania

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31
Q

best maintainence therapy for mania?

A

mood stabilizer and 2nd gen atypical antipsychotic superior to mood stabilizer monotherapy

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32
Q

maintaninence tx for bipolar?

A

1 episode: 1 year maintenance from remission
2 episode: long term (years) if not lifetime
3 or more: lifetime

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33
Q

chronic noncompliance with antipsychotic?

A

antipsychotic that is decanoate

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34
Q

treatment resistance with 2 failed trials of antipsychotic next option for schizophrenia?

A

clozapine

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35
Q

2nd gen antipsychotics?

A

olanzapine, cloazapine, quitiepine, risperidone, aripiprazole, ziprasidone (old closets quietly risper from a to z)

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36
Q

1st gen antipsychotics

A

haloperidol + -azine

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37
Q

delusional disorder diagnosis and tx?

A

greater than 1 delusion for at least 1 month in absence of psychotic symptoms. atypical antipsychotic and psychotherapy

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38
Q

what is kleptomania and tx?

A

rare impulse control egodystonic with stealing little value objects with tension before and pleasure after. guilty and remore common with efforts to stop but not successful. tx cbt

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39
Q

what is reaction formation vs sublimation?

A

responding in a manner opposite to one’s actual feelings where transforming unacceptable emotions or impluses to their extreme opposites vs channeling impulses toward socially acceptable behavior (anger toward father redirected to do well in sports)

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40
Q

suppression vs repression?

A

suppression (stop the worry like worrying about big game in advance of date). repression (removes the memory involuntarily like someone forgetting an event that occured that was traumatic at the time)

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41
Q

most important feature of schizophrenia that predicts a poor prognosis?

A

poor premorbid functioning

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42
Q

greatest age risk suicide?

A

greater than 65

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43
Q

what antidepressant cant you use in anorexic or bulemic?

A

buproprion because lower seizure threshold. also cant use in history of seizure

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44
Q

most common disorder associated with childhood sexual abuse?

A

dissociative identity disorder

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45
Q

schizoid vs avoidant?

A

zoid-classic loners with no friends and no interest in having friends. avoidant-no frineds but want them and avoid others out of fear of criticism and rejection

46
Q

stimulant that can make ppl believe bugs are crawling on them?

A

cocaine

47
Q

conduct disorder timeline?

A

violating basic social norms and rights for at least a year before age of 18

48
Q

patients more likely to complete suicide?

A

SAD PERSONS (sex, age (younger and older than 65), depression, previous attempt**, etoh or substance, rational thought loss (psychosis), social support (lack of), organized plan, no spouse or significant other, sickness or injury

49
Q

top determining factor if patient should be hospitalized for suicidality?

A

active plan in place

50
Q

differentiate nms vs serotonin syndrome physical exam?

A

serotonin has myoclonus

51
Q

therapy for managing current relationship conflict?

A

interpersonal psychotherapy

52
Q

therapy for lower functioning or psychotic or cognitively impaired patient to help build adaptive defense mechanisms?

A

supportive psychotherapy

53
Q

therapy for higher functioning to expore past relationships and conflicts, and break down defense mechanism?

A

psychodynamic psychotherapy

54
Q

therapy for substance use disorder?

A

motivational interviewing

55
Q

therapy for persistent maladaptive thoughts, avoidance behavior, and ability to participate in homework

A

cbt

56
Q

therapy for borderline personality disorder or self injury

A

dialectical behavioral therapy

57
Q

therapy for prominent physical responses that accompany psychiatric symptoms

A

biofeedback

58
Q

indications, tx, and side effects of ECT therapy?

A

severe depression refractory to medical management, pregnancy and depression, acute mania. induce seizure with electric current. amnesia (retrograde may be longer and anterograde shorter time period)

59
Q

increased total brain volume psych condition

A

autism

60
Q

abnormalities in orbitofrontal cortex and striatum psych disorder

A

OCD

61
Q

decreased volume of amygdala psych condition

A

panic disorder

62
Q

decreased hippocampal volume psych disorder

A

PTSD

63
Q

enlargement of cerebral ventricles psych disorder

A

schizo

64
Q

pathway being affected to determine antipsychotic efficacy?

A

mesolimbic

65
Q

pathway being affected that caues EPS symptoms

A

nigrostriatal (snpc to basal ganglia)

66
Q

pathway being affected that causes hyperprolactinemia

A

tuberoinfundibular

67
Q

tx acute dystonic rxn

A

benztropine or diphenhydramine

68
Q

tx of akathasia

A

benzo (lorazepam) or propranolol (b blocker)

69
Q

monitoring for metabolic syndrome in clozapine and olanzapine?

A

bmi (monthly), triglyceride/glucose/BP/waist circumference (baseline, 3 month and 1 yr)

70
Q

norepinephrine and dopamine reuptake inhibitor?

A

bupropion

71
Q

someone who doesnt want sexual side effects or wt gain from ssri?

A

bupropion

72
Q

when is mirtazapine good?

A

pts who can’t sleep (has sedation as side effect) or who are losing weight and have no appetitie (wt gain and increased appetite as side effect)

73
Q

most common atypical antipsychotic to cause EPS?

A

risperidone and also causes prolactin excess side effects (amenorrhea, galactorrea, and decreased libido)

74
Q

adverse effects clozapine?

A

agranulocytosis, metabolic syndrome, seizures, myocarditis

75
Q

contraindication to lithium use?

A

heart disease, ckd, thiazide or hyponatremia

76
Q

presentation and tx hypertensive crisis?

A

HEADACHE most commonly seen first, high bp phentolamine/phenoxybenzamine

77
Q

no underlying psychotic symptoms with induction of medication that can cause psychosis?

A

glucocorticoids particularly at high doses

78
Q

tx serotonin syndrome?

A

cyproheptadine

79
Q

tx adhd?

A

atomoxetine (fewer side effects) and methylphenidate

80
Q

decreased frontal lobe volume psych disorder?

A

adhd

81
Q

disruptive mood dyrstregulation disorder?

A

irritability with temper outbursts and angry, irritable, or sad mood between outbursts most commonly 6-10 toward anyone

82
Q

oppositional defiant vs disruptive mood dysregulation?

A

oppositional defiant only authority talking back and no problem with siblings. disruptive mood is temper thantrums and can become physical with daily outburst in a generally irritable person that can occur toward sibling as well

83
Q

tx of depression and neuropathic pain?

A

duloxetine approved for depression and neuropathy

84
Q

tx of depression who is fearful of weight gain and sexual side effects?

A

bupropion

85
Q

acute mania best tx?

A

antipsychotics because mood stabilizers require several days of titration before proper levels reached

86
Q

hallmarks of atypical depression and tx?

A

increased sleep, increased weight can, increased appetite. MAOi or SSRI

87
Q

single most effective therapy for depression?

A

ECT

88
Q

side effect ssri?

A

sexual side effect, gi disturbance, headache, wt change

89
Q

side effect snri?

A

1) hypertension from NE and than ssri side effect

90
Q

tca side effect?

A

anticholinergic (dry mouth, constipation), hypotension (alpha antagonism), CCC

91
Q

MAOi

A

hypertensive crisis

92
Q

before diagnosing bipolar or schizo what must you do?

A

UDS to rule out cocaine or amphetamine as cause

93
Q

emergency short acting drug for schizophrenia?

A

im ziprazadone or olanzapine

94
Q

long acting injectable schizo for noncompliant?

A

IM haloperidol or fluphenazine. Preferred IM risperidone or paliperidone

95
Q

atypical antipsychotic to use and avoid in movement disorders/

A

avoid risperidone use quetiapine

96
Q

only antipsychotic safer for use in pregnancy?

A

lurasidone

97
Q

more likely group of antipsychotics to cause wt gain vs more likely to cause cardiac conduction issues/movement disorders

A

-pines vs dones (conduction and movement)

98
Q

lorazepam use?

A

acute emergent setting because can be given IM

99
Q

clonazepam use?

A

need to give benzo but worried about addiction because it has longer half life

100
Q

oxazepam or lorazepam>

A

alcohol withdrawal as it is drug of choice with liver problems

101
Q

alprazolam use?

A

panic attack/disorder

102
Q

when can you only use flumazenil?

A

acute OD without any chronic use b/c it can induce tremor or seizure with withdrawal as it is a benzo antagonist

103
Q

tx of cocaine/amphetamine intox and withdrawal?

A

intox-antipsychotic and/or benzo and/or antihypertensive

withdrawal-bupropion and/or bromocriptine

104
Q

cannibis intox tx?

A

consider antipsychotic if psychosis present

105
Q

opiates intox vs withdrawal tx?

A

intox-naloxone, withdrawal-clonidine or methadone

106
Q

drugs to tx alcohol dependance?

A

naltrexone, acamprosate, disulfiram

107
Q

mcc death anorexia?

A

arrhythmia

108
Q

street drug that can cause serotonin syndrome?

A

molly ecstacy (MDMA)

109
Q

alcohol withdrawal symptoms with diff timeframes?

A

6-24: anxiety, tremors, diaphoresis, palpitations, intact orientatioin
12-48: seizures (tonic clonic) or hallucinosis (visual, auditory or tactile)
48-96-DT (hyperthermia, tachy, agitation, fever, confusion (autonomic hyperactivity, and hallucinations)

110
Q

major criteria of schizoaffective?

A

lifetime history of greater than 2 weeks of delusions or hallucinations in the absence of major depressive or manic episode

111
Q

panic disorder puts you at increased risk of developing what?

A

mdd

Step 2 CK (16 decks)

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