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Clinical Medicine > Psych > Flashcards

Psych Flashcards

1
Q

HPI of sleep problems

A
  • Duration
  • Number and duration of awakenings at night
  • Sleep times including bedtime, naps, and wake-up
  • Symptoms of disturbed sleep: fatigue, daytime sleepiness, etc
  • Stressors
  • Sleep hygiene: environment, light, sounds, pets, partners
  • Routine
  • Caffeine intake
  • Other substances: drugs, sympathomimetics
  • IMPORTANT: sleep log for 2 weeks
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2
Q

ddx of sleep problems

A
  • Anxiety
  • Insomnia
  • OSA
  • Restless legs
  • Periodic limb movements of legs
  • Drug abuse/withdrawals
  • Narcolepsy
  • Primary hypersomnia
  • Circadian rhythm disorder (shift worker, jet lag, etc)
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3
Q

theories of bipolar pathophys

A

? Calcium channel gating
Lithium effects sodium and calcium channels
Kindling theory
In the temporal lobes, repeated subthreshold stimulation causes a seizure like reaction in the brain hence anticonvulsants work for bipolar

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4
Q

RFs for suicide in bipolar

A 
Single 
Family history of suicide
Earlier onset BPAD
More depressive symptoms
Increasing severity of depressive sxs
Mixed state
Rapid cycling 
Comorbid with anxiety and substance abuse
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5
Q

protective factors for suicide

A
  • Social support churches, religion
  • Family connectedness
  • Pregnancy or parenthood though worry if they don’t want to have the baby and want to take them with them, or if they think their kids are better off without them
  • Religiosity or participating in religious activities
  • Thinking of or planning for future events
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6
Q

RFs for suicide in adults

A
  • Sex
  • Age
  • Depression
  • Previous attempt
  • Ethanol abuse
  • Rational thinking (or lack there of)
  • Social support lacking
  • Organized plan
  • No spouse
  • Sickness
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7
Q

RFs for suicide in kids

A
  • Ideation – talk of suicide, looking for ways to kill self, talking or writing about death, dying or suicide not journaling after therapy—that’s what they are taught to do—parents shouldn’t read their journals!
  • Substance abuse
  • Purposelessness
  • Anxiety – agitation and changes in sleep patterns can be only way to stop the anxiety
  • Trapped – feeling no way out
  • Hopelessness
  • Withdrawal – isolating from friends, family and society
  • Anger
  • Recklessness
  • Mood changes
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8
Q

bipolar dx criteria

A

◦ A. Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least one week (or needing hospitalization)
◦ B. During the period of mood disturbance, 3 or more of the following sxs have persisted (4 if the mood is only irritable) and have been present to a significant degree:
• Inflated self esteem or grandiosity
• Decreased need for sleep
• More talkative than usual or pressure to keep talking
• Flight of ideas or subjective experience that thoughts are racing
• Distractibility
• Increase in goal directed activity or psychomotor agitation
• Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g. buying sprees, sexual indiscretions, reckless business investments)
◦ C. Causes marked impairment in occupational functioning or social functioning or necessitates hospitalization to prevent harm to self or others, or psychotic features
◦ D. Not due to medical reasons or drugs

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9
Q

depression labs

A
  • TSH r/o hypothyroidism thinning hair, weight gain, cold intolerance, weight gain
  • BG r/o DM thirst, polyuria
  • r/o bipolar mania
  • Utox
  • If you think you need them: CBC, electrolytes, BUN/Cr, hepatocellular enzymes, RPR (syphilis), B12, folate, UA, EKG, MRI (stroke, brain tumor…)
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10
Q

sleep disorder pE/labs

A
  • Epworth Sleepiness Scale
  • Depression or Anxiety scales
  • EKG
  • Thyroid function tests
  • BG
  • HgA1c
  • BUN
  • Creatinine
  • Iron
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11
Q

sleep disorder pE/labs

A
  • Epworth Sleepiness Scale
  • Depression or Anxiety scales
  • EKG
  • Thyroid function tests
  • BG
  • HgA1c
  • BUN
  • Creatinine
  • Iron
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12
Q

ddx of mania

A
  • Kids: PTSD, drugs etoh, caffeine, cocaine, amphetamines, heroin, meds steroids, antidepress.
  • Under 50: bipolar and substance abuse ask if they have ever had mania when they are not using, may also be that they know they get manic and then use drugs
  • Over 50: Organic medical cause MS, temporal lobe epilepsy
  • Other causes: Endocrine hyperthyroid, cushing’s Infections HSV, HIV encephalitis, syphilis AI lupus metabolic states hypoglycemia, hypoxia
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13
Q

when does narcolepsy begin usually/

A

early teens or 20s

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14
Q

etiology of narcolpesy

A

loss of orexin signaling, genetics

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15
Q

dx and tx of narcolepsy

A

sleep study; tx: scheduled naps, sleep hygiene, modafinil

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16
Q

dx and tx of primary hypersomnia

A

compelled to sleep at innapropriate times, gets lots of sleep but does not feel refreshed (naps do not help) tx is modafinil or stimulants

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17
Q

dx and tx of insomnia

A

difficulty initiating, maintaining or early waking from sleep associated with IMPAIRMENT despite ADEQUATE SLEEP OPPORTUNITY

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18
Q

what comorbid conditions are with insomnia?

A

mental health like depression or anxiety and substance abuse

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19
Q

what is short term insomnia associated with?

A

stressors

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20
Q

what medications can cause insomnia?

A

CCBs, BBs, glucocorticoids, respiratory stimulants (saba??)

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21
Q

tx of insomnia

A

tx underlying psych or medical conditions, sleep hygiene, behavioral therapy (relaxation techniques), stimulus control (don’t nap, bed for sleep and sex, only go to bed when sleepy, wake up at same time, get out of bed if not falling asleep), sleep restriction

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22
Q

indications for sleep study

A

suspecting ob. sleep apnea, narcolepsy or periodic limb movements of sleep

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23
Q

what 2 things must you do history to look for in depression?

A

other psych condition and other medical conditions (highly correlated)

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24
Q

what makes you suspect adolescent/childhood depression?

A

drop in grades, more accidents (clumsy), anxiety, social withdrawal, concentration probe, weight, irritability, neglect of appearance, HA/body aches

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25
Q

ddx of depression

A

endocrine (hypothyrodism), other psych illness, substance abuse, systemic illness, neuro illness (dementia, parkinson), meds

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26
Q

labs to r/o stuff in suspected depression

A

TSH, utox, CBC, B12, folate, CMP: glucose, BUN/cr, LFTs, electrolytes, UA, RPR, EKG, mRI

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27
Q

tx of depression

A

lifestyle changes (sleep hygiene, healthy diet, exercise, no substances, hobbies, relaxation) + therapy and/or medication

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28
Q

when to refer in depression

A

if severe, comorbid conditions, no response to tx

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29
Q

tx of adjustment disorder

A

social support, coping mechanisms, problem solving skills, relaxation techniques, meds

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30
Q

is bipolar common in kids?

A

NO very rare. think PTSD and substance abuse first.

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31
Q

difference between mania and hypomania

A

mania lasts at least one week, hypomania at least 4 days. mania is severe and usually requires hospitalization, hypomania does not cause impairment.

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32
Q

criteria for rapid cyclign

A

4 or more in a year (4 or more per day is something else–drug use, anxiety,e tc)

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33
Q

bipolar 3 definition

A

manic sx only on antidepressants, sx clear when meds are stopped

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34
Q

bipolar ddx

A

depression, substance abuse, medications (antidepressants, steroids), endrocrine (hyperthyroidism, cushings), neuro (MS, temporal lobe epilepsy, infections (syphilis, hIV), AI (lupus), metabolic states (hypoxia, hypoglycemia)

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35
Q

main RFs for suicide

A

major psych diagnosis, substance abuse, prior attempt, living alone, unemployed, poor health, abuse, family history, access to guns

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36
Q

psychometric testing that can be requested by primary care providers to “figure it out” from a broad perspective

A

neuropsychological assessment

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37
Q 
who to refer to for these issues?
•	Failed MMSE
•	Neurodevelopmental disorders—
•	Distinguish dementia from depression- 
•	Decision making capacity- 
•	Sensory processing
•	determine ADHD and OT for kids
•	Long term substance abuse—
•	Problems with understanding language
A
  • Failed MMSE—neuropsych testing?
  • Neurodevelopmental disorders—neuropsych testing
  • Distinguish dementia from depression- neuropsych testing
  • Decision making capacity- neuropsych testing
  • Sensory processing—OT referral
  • Refer for comprehensive testing to determine ADHD and OT for kids
  • Long term substance abuse—refer for functional testing
  • Problems with understanding language—refer to speech language therapist
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38
Q

T or F: 99% of those who think they have memory problems have dementia

A

F! Most who think they have memory problems don’t

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39
Q

which types of hallucinations usu have a medical cause?

A

olfactory and gustatory

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40
Q

false sensory perceptions occurring in any of the five senses

A

hallucinations

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41
Q

fixed false belief

A

delusion

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42
Q

ddx of psychosis

A 
Substance induced psychosis
Mood disorder with psychotic features
Schizophrenia
Schizoaffective
Schizophreniform
Brief psychotic disorder
Delusional disorder
Psychotic disorder NOS
Pervasive Developmental disorder (autism)
Personality disorders
Delirium
Dementia
Post partum psychosis (really scary, comes on really fast)
TBI
Mental retardation
Sleep deprivation (misperceive things as brain is trying to catch up)
Shared psychotic disorder
Factitious disorder/malingering
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43
Q

T or F: there is a higher incidence of violence with persons with mental health disorders

A

T, HOWEVER Mental illness is not an independent predictor to violent behavior

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44
Q

RFs for schizophrenia

A

family member with it, family member with bipolar, advanced paternal age, winter bipolar, insults to 1st and 2nd trimester fetus, insults to perinatal period

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45
Q

which sx of schizophrenia are most responseive to meds?

A

positive sx (i.e. delusions, hallucaintions)

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46
Q

what are the positive sx of schizophrenia

A

psychosis, delusions, hallucinations

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47
Q

what are the negative sx of schizophrenia?

A

flat affect, loss of social drive, no personal motivation, alogia (loss of verbal expression)

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48
Q

4 sx of schiozophrenia

A

positive sx, negative sx, cognitive impairments (ADLs, function), and affective disorders

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49
Q

DSM criteria for schizophrenia

A

2 of more of these for at least one month:
Delusions
Hallucinations
Disorganized speech (e.g. frequent derailment or incoherence)
Grossly disorganized or catatonic behavior
Negative symptoms (i.e. affective flattening, alogia, or avolition)
+plus social or cognitive impairment
+signs of the disturbance for 6 months

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50
Q

disorder with mood disorder and psychotic sx

A

schizoaffective

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51
Q

better px of schrizophrenia

A

Female, significant positive/affective symptoms, good initial response to meds

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52
Q

experiencing psychological distress in the form of physical symptoms and seeking medical help for these symptoms

A

somatization

53
Q

T or F: if someone is somatizing they are pretending they have the sx

A

F: they really think they have the sx

54
Q

Symptoms affecting voluntary motor or sensory function suggesting a neurological disorder or other general medical illness
Clinical findings provide evidence of incompatibility between the symptoms and recognized neurological or medical conditions

A

converson disorder

55
Q

Preoccupation with having or acquiring a serious illness

A

illness anxiety disorder

56
Q

Preoccupation with an imagined defect in appearance or excessive concern with slight physical anomaly (not anorexia)

A

body dysmorphic disorder

57
Q

difference between malingering and factitious disorder (munchausen)

A

malingering is faking a sx to get something, factitious is faking or causing an illness to get something for an unknown reason

58
Q

how do you tx somatization patients?

A

still need PE and work ups–they still get problems

59
Q

tx for somatiform disorders

A

see patients once a week in primary care to discuss sx and it puts them at ease, set limits on care (i.e. no narcotics), encourage psychotherapy, don’t engage whether its mental or physical

60
Q

psych emergency definitions

A

danger to themselves or others, overwhelmed and can’t function,

61
Q

critiera for hospitaliztion

A

imminent danger to self or others (suicide, et. or vulnerable adult or child), failing outpt tx (even if not acutely ill), not able to function in ADLs, detox

62
Q

T or F: you must notify the person someone wants to kill every time

A

F: must inform them unless hospitalized for 3 days

63
Q

biggest RFs for violence

A

drug use and trauma

64
Q

best predictors of violenceq

A

Obsessing over an event where a person was perceived to be unfairly treated
Recent threats to act violently
Evidence of making plans to act violently
Threatening, pressured, and/or loud speech
Hypervigilance
Staring
Agitated behavior: Tremors, Sweating, Pacing, Clenching of hands and teeth

65
Q

drugs for etoh withdrawal

A

ativan, librium or valium

66
Q

drugs for benzo withdrawl

A

phenobarbital taper

67
Q

sx of opiate withdrawal

A

Symptoms include runny nose, watery eyes, diarrhea, muscle aches/cramps, nausea, vomiting, high blood pressure

68
Q

3 drugs commonly used in ER for psych emergencies

A

Haldol 1-5 mg PO/IM/IV
Ativan 1-3mg PO/IM/IV
Benadryl 25-5omg PO/IM/IV

69
Q

when can you put someone on a hold?

A

if imminintely a danger to self or others

70
Q

is it better to do a transport hold or a 72 hour hold?

A

transport–b/c psych can evaluate them then and 72 hour hold starts when psych says it does. 72 hour hold is taken very seriously.

71
Q

who can write 72 hour holds?

A

MD, PA, NP

72
Q

which tx is most effective for generalized anxiety?

A

CBT

73
Q

how long can it take SSRIs to work for anxiety?

A

2-4 weeks

74
Q

short acting benzo for anxiety

A

lorazepam (ativan)

75
Q

longer acting benzo for anxiety

A

diazepam (valium)

76
Q

1st line txs for generalized anxiety

A

SSRIs, SNRIs, benzos (for short term)

77
Q

who should benzos not be used for for anxiety?

A

older adults–> risk of falls, confusion

78
Q

TCAs that can be used for generalized anxiety

A

desipramine and imipramine

79
Q

what anti-anxiety med is good for older adults and those who have a hx of substance abuse?

A

buspirone (b/c no tolerance develops and no effect on cognition)

80
Q

non pharm for panic disorder

A

avoid caffeine, decongestants and diet pills, do CBT

81
Q

how long does it take SSRIs ( and other antidepressants) to be effective for panic disorder?

A

at least 4 weeks for antigenic effect, optimal response in 6-12 wks

82
Q

examples of first gen antipsychotics

A

haloperidol, chlorpromazine, perphenazin

83
Q

examples of second generation antipsychotics

A

aripiprazole, asenapine, olanzapine, paliperidone, risperidone, quetiapine

84
Q

extrapyramidal side effects of antipsychotics

A

parkinson like AE (cogwheel rigidity, flat effect, resting tremor), akathisia (inner restlessness), acute destinies, tardive dyskinesia

85
Q

uncontrolled sense of inner restlessness

A

akathisia

86
Q

AE of 1st gen antipsychotics

A

extrapyramidal side effects, anticholinergic effects, orthostatic HOTN, QT prolongation, neuroleptic malignant syndrome, agranulocytosis

87
Q

AE of 2nd gen antipsychotics

A

sedation, weight gain (most with clozapine and olanzapine), hyperglycemia (most with clozapine and olanzapine), triglyceride elevations, impulse control problems

88
Q

impulse control problems most common with which antipsychotic?

A

aripiprazole

89
Q

which types of antipsychotics are the first choice for schizophrenia?

A

2nd generation

90
Q

what is an adequate trial of antipsychotics for schizophrenia?

A

at least 6 weeks at the upper end of the dose range

91
Q

what can happen to those with dementia on antipsychotics?

A

increased mortality

92
Q

eating disorder beahviors

A 
Starvation(withorwithoutpurging)
•Binging(with/withoutpurging)
•Purging(vomiting,exercise,laxatives)
•Chewingandspitting
•Dietpills/Laxatives/Appetitesuppressants
•Foodrules/fears
•Waterrestricting/loading
•Caloriecounting
•CompulsiveBodyChecking
•RigidTablebehaviors(cutting/smearing/slowpace)
93
Q

common sx that bring someone into the office with an eating disorder

A

marked weight loss, fatigue, weakness, dizziness, syncope, irregular menses, cold intolerance, constipation, mood changes

94
Q

T or F: in anorexia labs are often normal

A

T

95
Q

when to consider a dexa in eating disorders?

A

if anorexia and amenorrhea for 1 year, or if poor nutrition and excessive exercise, excess soda intake, high sodium, high caffeine, smoking or etoh use

96
Q

causes to hospitalize anorexia/bulimia

A

Dramatic weight changes; weight cut offs vary 500)

•Electrolyte abnormalities and unable to orally hydrate or take replacement: especially low phos(

97
Q

model for development of eating disorders

A

biopsychosocial model

98
Q

main neurotransmitter involved in reward behaviors

A

dopamine

99
Q

reward area of brain

A

nucleus accumbens

100
Q

RFs for drug abuse

A

genetics: 30-60%
environment–abuse, exposure, risk taking, peers using, lack of supervision, low perception of harm, younger age of first use, poor school achievement,

101
Q

length of time req’d for substance use disorder

A

12 months

102
Q

specifiers of substance abuse disrode

A

mild-severe or course: early or sustained remission (sustained after 12 months)

103
Q

etoh intoxication signs and sx

A 
Breath odor
Skin flushing, hypotension
Slurred speech
Lability/inappropriate behavior and emotions
Incoordination/dysmetria/ataxia
Nystagmus pupils slowed if intoxicated, 
nystagmus if intoxicated
Nausea/vomiting
Seizures/coma/death
104
Q

etoh withdrawal sx

A 
Nausea/vomiting
Hypertension
Tachycardia
Tremor
Irritability/anxiety/insomnia
Seizures
Hallucinosis usu talking to ppl in their using scenarios
Death possible if untreated
105
Q

what is delirium tremens?

A

altered mental status (global confusion)
and sympathetic overdrive high BP and pulse
which can progress to
cardiovascular collapse and death

106
Q

intoxication of sedatives (benzos)

A 
Fewer autonomic signs than alcohol
Somnolence
Dysarthria
Incoordination
Respiratory depression or arrest
Lethargy/coma/death
107
Q

sedative withdrawal sx

A 
Hypertension, tachycardia
Agitation
Tremor
Confusion
Hallucinations
Seizure higher risk than etoh
Death possible if not treated
Anxiety high, intolerable
108
Q

tx of choice for etoh withdrawal

A

benzos

109
Q

when do delirium tremens start?

A

usu 48-72 hours or up to 5 days after withdrawal

110
Q

tx of benzo withdrawal

A

phenobarbital taper

111
Q

opioid intoxication sx

A 
Miosis pinpoint pupils (not reliable)
 Constipation
 Hypotension, bradycardia
 Respiratory suppression or arrest
 Somnolence, ataxia
 Coma/death
112
Q

opioid withdrawal sx

A 
Anxiety
 Nausea/vomiting
 Abdominal pain
 Myalgias
 Diarrhea
 Piloerection
Diaphoresis
 Lacrimation/rhinorrhea
Hypertension/tachycardia
 Yawning
113
Q

supervised opioid withdrawal

A

Methadone taper (needs monitoring)
Buprenorphine (suboxone) taper (needs monitoring)
Clonidine 0.1-0.2 mg Q4-6 alpha blocker to help with HTN
Neurontin + Vistaril + Flexeril
NSAID, antidiarrheal

114
Q

stimulant intoxication sx

A 
Euphoria, irritability, talkativeness
 Mydriasis
 Hypertension, tachycardia
 MI, stroke, death
 Paranoia, hallucinations common
 Hyperthermia, death
 Hypertensive crisis, death
 Pulmonary edema in smokers
115
Q

stimulant withdrawal sx

A 
Non-specific
 “Cocaine crash” “crack nap”
 Depression
 Somnolence
 May want to die but they probably won’t
 No inpatient detoxification
116
Q

who gets the dysphoric/paranoid and mood lability sx of cannabis intoxication more often

A

teens

117
Q

sx of cannabis withdrawal

A 
Irritability, anger, or aggression
 Nervousness or anxiety
 Sleep difficulty
 Decreased appetite or weight loss
 Restlessness
 Depressed mood
 At least one of the following physical 
	symptoms causing significant discomfort:
	abdominal pain, shakiness/tremors,
	sweating, fever, chills, or headache
118
Q

who gets inpatient detox?

A

etoh, benzos, opiates

119
Q

CRAFFT screening tools for kids

A
  1. Have you ever ridden in a CAR driven by someone (including yourself) who was high or had been using alcohol or other drugs? If + stat. sig there is drug problems
  2. Do you ever use alcohol or other drugs to RELAX, feel better about yourself, or fit in?
  3. Do you ever use alcohol or other drugs while you are ALONE?
  4. Do you ever FORGET things you did while using alcohol or other drugs?
  5. Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?
  6. Have you gotten into TROUBLE while you were using alcohol or drugs?
120
Q

T or F: there is no such thing as inpatient tx for substance abuse

A

tx: they have to be there voluntarily. there is housing for them and they stay there but not locked.

121
Q

AE of naltrexone

A

increased LFTs, CI if liver dz or hepatitis

122
Q

AE of acamprosate (campral)

A

kidney probs

123
Q

why do you have to wait 12-24 hours before giving buprenorphine for etoh withdrawal?

A

it knocks some opiates off receptors and you need to wait until a while after they used to not cause severe withdrawal sx

124
Q

for what ages can you tell parents results of tox screens?

A

up until age 15

125
Q

cluster A, B and C personality disorders

A

A is paranoid schizoid (odd, eccentric), B is histrionic, antisocial, borderline, narcissistic (emotional, dramatic) C is anxious fearful like avoidant, dependent and OCD

126
Q

features of paranoid personality disorder

A

distrust others, distrust loyalty of friends, hostile, stubborn

127
Q

features of schizoid personality disorder

A

little interest in others, relationships, sex, restricted emotion, indifference to praise

128
Q

features of schizotypal personality disorder

A

ideas of reference, odd thinking, magical ideas, unusual perceptual experiences, odd or eccentric behavior or appearance, social anxiety

129
Q

management of schizotypal personality disorder

A

feedback, guidance, tracking errant thoughts

Clinical Medicine (19 decks)

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