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Psych Flashcards

1
Q

Pathology in Korsakoff’s

A

Hemorrhage + sclerosis in mammillary bodies, thalamic nuclei

Diffuse lesions in brainstem, cerebellum, limbic system

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2
Q

CBT vs SSRI in generalized anxiety discord (effectiveness)

A

CTB is as effective as SSRI

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3
Q

Rx of generalized anxiety

A

SSRI: paroxetine, escitalopram

SNRI: duloxetine, venlafaxine

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4
Q

SSRI/SNRI vs Benzo vs Buspirobe for generalized anxiety

A

SSRI/SNRI more effective

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5
Q

Defense mechanism in borderline personality

A

Splitting

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6
Q

Alzheimer’s develops psychotic Sx (hallucinations / delusions)

A

Anti-psychotics

Risperidone

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7
Q

Dx borderline personality

A

5/8:

  • impulsive
  • unstable relationships
  • anger
  • moody
  • self-damage act
  • can’t accept loss
  • emptiness
  • Boredom
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8
Q

Cocaine intoxication Sx

A

Sympathetic (tachycardia, HTN, sweating, mydriasis)

+/- paranoia, psychosis

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9
Q

Freud’s psychosexual development

A
  1. Oral phase:
    0-18 mo
    Stimulating mouth
    Put anything in mouth
  2. Anal phase:
    18-36 mo
    Pleasure in anal area
    Control bowels
  3. Phallic phase:
    3-6 yr
    Manipulation of genitals = 1ry source of pleasure.
  4. Latency phase:
    6- puberty
    Connections to siblings, other children/adults
  5. Genital phase:
    > puberty
    Relationship w/ opposite sex
    Focused on genital area
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10
Q

SE of haloperidol (48hr)

Rx?

A

Acute dystonia (torticollis)
It’s reversible EPS
Due to DA blockade at nigrostriatial

Rx with benzotropine

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11
Q

Non-pharm Rx of insomnia

A

CBT to change believes, techniques, attention shift

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12
Q

Amphetamine toxicity.

A 
High DA + NE
Hallucinations + delusions 
Paranoia 
Low appetite 
Activity w/ fatigue
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13
Q

Conversion disorder population

A

Women
Histrionic personality
Sexual abuse

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14
Q

Conversion disorder

A

Lack of concern regarding extreme decline in health.

Start suddenly after stress and ends suddenly

Not produced intentionally

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15
Q

Population at risk of suicide

A 
Elderly white men 
Single 
Unemployed , low income 
Mental illness 
Hx is abuse (sexual / physical)
Hx of suicide thoughts 
FHx of suicide attempts
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16
Q 
Schizophrenia 
Schizophreniform
Brief psychotic 
Schizoid personality 
Schiozoaffective
A 
Schizophrenia = 6 mo
Schizophreform = 1-6 mo
Brief psychosis = < 1 mo
Schizoaffective = psychosis + mood
Schizoid PD = social withdrawal + no desire for relationships
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17
Q

What’s discontinuation syndrome

A 
After stopping SSRI
Anxiety 
Influenza like
Diarrhea + GI upset 
Insomnia,  hyperarousal, lightheaded
Vertigo, tremor, paresthesia

Lasts 7 days if stop SSRI after 6wk use.

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18
Q

T/F: adults w/ ADHD impulsive + hyperactive as compared to kids

A

F

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19
Q

Patient w/ anorexia
Sever dehydration + orthostatic hypotension + electrolyte imbalance?

  • Would you search pt belongings? Why?
  • Confirm she’s on Rx (contact professionals)
A

Yes!

Pts w/ eating disorders use laxative & diuretics

Facility must be informed to look for contraband.

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20
Q

What’s Cognitive behavioral Rx?

A

Recognize + correct false self-beliefs

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21
Q

What’s dialectical behavioral Rx?

A

Part of psychoanalysis/psychodynamic Rx that

Teach patient to analyze what leads up to a problem and identifies alternatives.

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22
Q

Rx of Tourette’s

A

Anti-DA
Clonidine
Pimozide

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23
Q

Types of delusions

  1. Nihilism
  2. Persecutory
  3. Grandeur
  4. Somatic
  5. Reference
A
  1. Nihilism = belief that aspects of life are meaningless or non-existing
    E.g. Going to work is pointless b/c world is coming to an end
    Or no one is real or arm is dead
  2. Persecutory = others trying to harm him
  3. Grandeur =inflated sense of self
  4. Somatic = belief they have physical defect / disease.
    My brain is melting
  5. Reference = publicly known figures refer to him directly
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24
Q

Percentage of smokers succeed in quitting

A

2-3%

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25
Q

T/F: genetics influence smoking persistence

A

T

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26
Q

What neuro system involved in reinforcing effect of nicotine

A

Mesolimbic

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27
Q

Percentage of population that experiment w/ smoking

A

55%

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28
Q

Hallmark of PCP (phenocyclidine) intoxication

A

Rotary nystagmus

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29
Q

Dx psychogenic seizure

A

Video-electroencephalograph VEEP

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30
Q

Cyclothoymia vs dysthymia

A
  1. Cyclo: hypomania + mini depressive Sx for 2 years

2. Dysthymia: persistent mild depression

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31
Q

Hypnagogic vs hypnopompic hallucinations

A

Hypnoagogic: during sleeep

Hypnopompic: waking up

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32
Q

DOC delirium tremens

A

IV benzo (lorazepam

Use IM if > 65 YO

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33
Q

DOC panic disorder

A

SSRI

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34
Q

Involuntary admission?

A
  1. Mental illness needs inpatient care

2. Danger to safety of patient or others.

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35
Q

Tourette associated w/?

A

OCD

ADHD

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36
Q

What’s sublimation

A

Transform negative emotion to positive action

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37
Q

T/F: imipramine has sigmoidal relationship b/w plasma level and response

A

T

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38
Q

T/F: nortriptyline has sigmoidal relationship b/w response and level

A

F = Curvilinear

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39
Q

MOA of MAOi

A

Stop degradation of monoamine transmitters and increase their levels

(Serotonin, norepi, dopamine)

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40
Q

MOA of typical antipsychotic

A

Risperdione + clozapine

Dopamine antagonist

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41
Q

SE of clozapine (typical antipsychotic)

A

Agranulocytosis

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42
Q

Risk for delirium in hospitalized pts

A

Vision / hearing impairment

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43
Q

Panic disorder associated w/

A

Depression
Anxiety
Agoraphobia

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44
Q

Asthma + social phobia

A

SSRI

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45
Q

When to stop antidepressants

A

3 month for Rx

6 mo after Rx maintenance

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46
Q

Bipolar on lithium develops hypothyroidism

A

Start replacement

Don’t stop lithium

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47
Q

Limbic system dz

A

Emotional disturbance

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48
Q

How Dx alcoholism

A

Ask about problem by alcohol

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49
Q

MAOi

A

Phenelzine

Tranylcypromine

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50
Q

Serotonin syndrome Sx

A

Anxiety + agitation + restless

HTN, tachy, fever, sweat, shiver

Hyperreflexia, tremor, rigidity

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51
Q

Rx serotonin syndrome

A

Stop all med
+/- benzo if anxious and agitated

+/- Cyproheptadine

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52
Q

SSRI + tramadol = ?

A

SSRI + tramadol = serotonin syndrome

MAOi + tamadol = serotonin syndrome

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53
Q

Maintenance drugs for bipolar

A

Lithium
Lamotrigine
Aripiprqzole
Olanzapine

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54
Q

Child with ADHD has future risk of

A

Social withdrawal
Substance abuse
Accident proneness
Normal adult functioning

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55
Q

T/F: D/C SSRIs ass. w/ high rate of relapse

A

T

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56
Q

Signs of marijuana abuse

A

Fatigue
Lethargy
Somnolence

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57
Q

What’s reaction formation

A

Coining extreme opposite

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58
Q

Autism spectrum disorder

A

Repetitive behavior + normal language

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59
Q

Absolute contraindication to electroconvulsive Rx

A

None

Relative = recent cerebral hemorrhage, ICP

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60
Q

T/F: 2/3 of suicide death at 1st attempt

A

T

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61
Q

T/F: risk of suicide is higher in blacks

A

F: whites

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62
Q

Are SSRIs save in kids?

A

Yes 8-18 Yrs

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63
Q

SE of long term lithium

A

Nephrogenic DI

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64
Q

T/F: electroconvulsive therapy causes irreversible memory loss

A

F: reversible

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65
Q

Depression on SSRI => agitation , insomnia , sexual SE?

A

Rx with Mitrazpine = helps sleep , no agitation , rarely sexual. Helps appetite

NB: bupropion cause agitation!

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66
Q

Labs w/ lithium

A

Renal + thyroid

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67
Q

Akathisia

A

Motor restlessness

SE of anti-psychotics

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68
Q

Rx of neuroleptic syndrome

A

D/C med
Dantrolene
+/- bromocriptine
+/- amantadine

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69
Q

MOA of resperidone + SE

A

Dopamine D2 receptor blocker

High prolactin

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70
Q

T/F: phenelzine interacts with st Johns wort and

A

T

Levels become unpredictable

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71
Q

Anti depressant worsen HTN

A

Venlafaxine

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72
Q

Damage to parietal lobes (Rt + Lt)

A

Rt = contralateral hemi-neglect , dent deficit (anosagnosia)

Lt = Gerstmann’s syndrome = Rt-Lt confusion, can’t write, bad math

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73
Q

How to prevent benzo dependence

A

Use for short time

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74
Q

How are Atypical antipsychotics better than typical?

A

Cause less tardive dyskinesia

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75
Q

Sx suggestive of major depression

A

Withdrawal from family

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76
Q 
T/F: anorexia nervosa causes:
Bradycardia 
HTN
Parotid gland
Atropine breast 
Dental caries
A 
T
F
T
T
T
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77
Q

MC SE of TCA?

A

Dry mouth

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78
Q

What neurotransmitters decreased in depression

A

Serotonin
NE
Dopamine

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79
Q

Mature defense mechanisms

A

In healthy adults:
1. Altruism = service to others to experience empathy.

  1. Anticipation = palming for future discomfort.
  2. Asceticism = deny pleasure from experience.
  3. Humor = express feelings in comic way
  4. Suppression = postpone attention to impulse.
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80
Q

Neurotic defenses

A
  1. Control = manage events to reduce inner conflicts.
  2. Displacement = shift emotions
  3. Externalizations = attribute personal matters to external world.
  4. Inhibition = limit function to avoid anxiety.
  5. Intellectualization = intellectual processing to avoid experiencing affect.
  6. Isolation = separate Sth from associate affect.
  7. Rationalization = rational explanation to justify action
  8. Dissociation = modification of sense of self
  9. Reaction formation = transforming unacceptable impulse into opposite
  10. Repression = remove idea from conscious
  11. Sexualize = bestowing sexual importance to objects
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81
Q

Immature defense

A
  1. Acting out = impulsive action.
  2. Block = block thought / impulse
  3. Hypochondriasis = exaggerate illness to avoid situations.
  4. Introjection = victim identity w/ aggressor
  5. Passive-aggressive
  6. Regression
  7. Somatization = unconscious expression is psychotic pain in physical Sx.
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82
Q

Psychotic defense

A

Denial = replace reality w wishes.

Distortion = reshaping reality

Projection =

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83
Q

Is bupropion used in panic attacks? Why?

A

No.

stimulating effect

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84
Q

Drugs contraindicated with lithium

A

Thiazides
ACEI
NSAIDs

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85
Q

Antipsychotic causes high glucose

A

Olanzapine

Clozapine

86
Q

What antipsychotic cause withdrawal if stopped abruptly?

A

Venlafaxine (?) short half life and rapid clearance if D/C

87
Q

Mood stabilizers used in maniac episodes

A

Lithium
Valproic acid
Carbamazepine

88
Q

Monotherpay induces mania in Bipolar

A

Fluoxetine

89
Q

What’s Tarasoff decision

A

Inform authorities when patient show intent towards a person

Keep patient in office till safe disposition is made

90
Q

Neurotransmitter in OCD?

A

Serotonin

91
Q

How to shift safely from MOAi to SSRI

A

Allow for 2 wk wash out period between stopping MOAi and starting SSRI

92
Q

T/F: repeated episodes of alcohol withdrawal increase risk of future Sx?

A

T

93
Q

Milieu therapy

A

Inpatient Rx

Use hospital environment as therapeutic intervention.

94
Q

SE of olanzapine

A

High TG
Agranulocytosis
Dry mouth (xerostomia)
Tardive dyskinesia

95
Q

Panic disorder + BPH

A

No TCA

Use SSRI

96
Q

Addiction vs pseudo-addiction

A

Pseudo is how patients behave when pain is under treated and resolve completely when pain is effectively Rx.

97
Q

What schizophrenic Sx respond well to anti psychotics

A

Positive Sx
Delusions
Hallucinations
Disorganized speech

98
Q

T/F: antipsychotic don’t cause urinary incontinence

A

T

99
Q

MAOi contraindicated with what food

A

Aged cheese
Aged wine

High Tyramine

100
Q

1st line in ADHD

A

Methylphenidate
Dextroamphetamine
Pemoline

101
Q

Does ADHD cause intellectual disability

A

No

102
Q

Psychotherapy for panic disorder

A

CBT

103
Q

Cause of seasonal affective

A

Serotonin

104
Q

Melatonin in seasonal affective

A

Worsens Sx

105
Q

SE of methylphenidate in ADHD

A 
HTN
Tachycardia 
Insomnia 
Headache 
Anxiety
Growth suppression
106
Q

MCC of delirium

A

Dementia

107
Q

SE of antipsychotic + Rx

A
  1. Parkinsonism
    Tremor, Bradykinasia, micrographia
    Rx: low dose, shift to atypical, anti-cholinergic
108
Q

Anticonvulsant for mania

A

Valproic acid

Carbamazepine

109
Q

When dose delirium termens start + how long last

A

Start 3-7 days after stopping

Last 7-10 days

110
Q

% of alcoholic develop DT

Death from DT

A

5%

Death 35% if untreated + 5% of Rx

111
Q

Pacing in Alzheimer’s not Rx with anti cholinesterase

A

No additional Rx

112
Q

Deal with paranoid patient

A

Explain diagnosis + Rx in details

Professional not too friendly

113
Q

Piaget’s Stage of cognition

A
  1. Sensorimotor 0-2 Yrs
    Explore via sensation + motor contact
    Separation anxiety
2. Pre-operational 2-6
Symbols (words + images)
No logics 
Pretend 
Egocentric
  1. Concrete operational 7-12
    Logical about concrete objects
    Add + subtract
    Understand conversation
  2. Formal operational >12
    Reason abstractly
    Hypothesize
114
Q

What’s schizophrenia drift

A

Schizophrenia patient move to cities + become urban poor

It’s not urban poor that cause the disease it’s where patients end up

115
Q

What’s biopsychosocial

A

Approach patient in biological psychological social manner

116
Q

Drugs cause depression (15)

A 
Isotretinoin 
Alcohol
Disulfiram 
Anticonvulsant: Metho + ethosuximide
Barbiturates: phenobarb + secobarb
Benzo:
BB: metoprolol, atenolol, carvedilol
Bromocriptine 
CCB
Estrogen HRT
Fluoroquinolones 
Interferon-alpha 
Opioids
Statins 
Acyclovir
117
Q

Triad in Tourette’s

A

Tourette’s
OCD
ADHD

118
Q

Tourette’s population

A

Males (9x more )

119
Q

Rx Tourette’s

A

Alpha2-adrenergic = clonidine (less efficacy, less SE)

Dopamine antagonist: Haloperidol + pimozide (more effective, more SE)

120
Q

Cardiac side effect of anti-psychotic

A

QT prolongation

Torsades de pointes

121
Q

Anti-psychotics cause hypertensive encephalopathy

A

TCA + MAOi

Tyramine + MAOi

122
Q

How to safely shift from one antipsychotic to another

A

Gradual reduction in dose of 1st drug then overlap with the 2nd drug before completely stopping the 1st one.

123
Q

Rx of seasonal effective

A

early morning light therapy

124
Q

T/F: Mania could be a Sx of MS

A

T

125
Q

Is stammering ass with conversion disorder

A

No

126
Q

Premenstrual dysphoric disorder Rx

A

Mood disorder
Fatigue
Insomnia
During luteal phase lead to missing work.

Rx: SSRI

127
Q

Trazodone sexual SE

A

Priapism

128
Q

Rx of bulimia

A

SSRI esp. fluoxetine

129
Q

Tardive dyskinesia high risk population

A

Females
Older age
Hx or FHx of mood disorders or affective disorders.
Multiple antipsychotics

130
Q

How to deal with borderline personality clinic setting

A

Maintain caring but detached stance.

Combine conflict resolution + social learning to minimize aggression

Be constantly available on phone

Frequent visits to monitor and provide support.

131
Q

When explaining to borderline personality;

  1. Detailed + technical
  2. Simple + clear + non technical
A

Simple

132
Q

Do you prescribe drugs for borderline? Why?

A

No

Use it to self-harm themselves.

133
Q

Drug contraindicated with MAOi (analgesics)

A

Meperidine

Tramadol

134
Q

Goal of Rx in anorexia nervosa

A

Prevent death from malnutrition

135
Q

DOC in alcohol withdrawal

A

Short-acting benzo (liver impairment = short)

136
Q

Smoking withdrawals

A 
Impaired concentration 
Longing for cigarette 
Headache 
Insomnia 
Irritability 
Inc. appetite
137
Q

TCA poisoning

A 
Sx in 2 hrs. 
Palpitations + chest pain 
Low BP
Altered LOC
Resp. depression => acidosis + low O2
138
Q

Drugs cause mania

A 
Definitive:
Levodopa 
Steroids + anabolic steroids
MAOi
TCA
Risky:
Benzo
Amphetamine 
Cimetidine 
Captopril 
Thyroxin 
Methylphenidate
139
Q

Psychiatric disease with T1DM?

A

Adjustment disorder + MDD

140
Q

Rx of delirium in ICU

A

IV haloperidol increase dose q3min

141
Q

Rx of social phobias

A

SSRIs

142
Q

Anti depressant doesn’t cause weight gain

A

Bupropion

143
Q

Anti depressant cause weight gain

A

Mirtazapine > SSRIs (paroxetine > fluoxetine)

144
Q

% of elderly with depression

A

20% in community

40% in nursing homes

145
Q

T/F: TCA contraindicated in elderly

A

True cause postural hypotension + falls.

146
Q

What’s transvestism

A

Dressing and acting in manner of opposite sex

147
Q

When does transvestism start?

Common in M or F?

Do they seek help?

A

Starts late childhood

M > F

Don’t present for Rx

148
Q

SE of amphetamine for ADHD

A

Transient insomnia + weight loss

149
Q

Bipolar 1 vs 2

A

1: mania + depression
2: hypomania + depression

150
Q

What’s not considered conversion according to DSM 5

A

Sx limited to pain or sexual dysfunction

151
Q

OCD risk in monozygotic twins?

A

Negligible

152
Q

OCD more in M or F?

A

F (adults + kids)

153
Q

Shortest half life benzo?

A

Alprazolam (xanax) 12 hrs.

154
Q

Body dysmorphic asso

A

OCD
Social phobia
Delusional disorder

155
Q

SSRI in elderly

A

Risk of falls

156
Q

Activated charcoal helps in 90% of toxins except?

A 
Iron 
Lithium 
Fluoride 
Cyanide 
Alkali
157
Q

Sleep terror vs nightmare

A

Sleep terror = can’t remember nightmares

Nightmare = remember

158
Q

Anxiety vs OCD

A

Compulsions in OCD only.

159
Q

MC neuro SE of SSRI

A

Insomnia > headache

160
Q

What personality doesn’t learn form experience + or feel guilt

A

Antisocial

161
Q

Atypical depression Sx

A

Worst in morning and better at evening (diurnal variation in mood)

162
Q

When is MAOi DOC?

A

Atypical depression

163
Q

Rx of serotonin syndrome

A

Cyrproheptadine

164
Q

Sleep abnormality in depression

A

Decreased REM latency

165
Q

What’s paraphilia? Example

A

Sexually arousing fantasies

Fetishism
Exhibitionism
Sexual sadism
Transvestism

166
Q

T/F: Homosexuality is not paraphilia

A

T

167
Q

MC endocrine SE of lithium

A

Hypothyroid > DI

168
Q

Bupropion is contraindicated in?

A

Anorexia / bulimia
Seizures
Alcoholism

169
Q

Hallucinations in narcolepsy

A 
At sleep (hypnogogic)
On wakening (hypnopompic)
170
Q

How to establish rapport?

A

Ask about feelings

171
Q

How do disulfiram + Naltrexone work in alcoholism

A

Disulfiram = accumulates acetaldehyde

Naltrexone = decrease cravings

172
Q

In bipolar when does mania recur if lithium stopped

A

6 mo

173
Q

Most effective mono therapy in alcoholism

A

Chlordiazepoxide

174
Q

Risk of schizophrenia in monozygotic

A

40%

175
Q

Anti depressant avoid in anorexia nervosa

A

MAOi (phenelzine)

dietary restrictions

176
Q

T/F: lanugo hair in anorexia

A

T

177
Q

Donepzil SE

A

Arrhythmia needs pacemaker

178
Q

Rx of sducidal ideation

A

Hospital admission

179
Q

What overdose is more fatal?

Benzo or amitriptyline

A

TCA > benzo

180
Q

T/F: opiates cause constricted pupils

A

True

Opiates: heroine, hydrocodone, oxycodone, hydromorphone, oxymorphone

181
Q

Atypical cocaine dependence

A

Mood swings
Snorting (inflamed nares : big turbinates)
Paranoia

182
Q

Dr reminded of relative by a patient?

A

Countertransference

183
Q

Patient sexually attracted to Dr

A

Transference

184
Q

T/F: Depression in kids presents as antisocial behaviors

A

T

185
Q

T/F: kids with depression will have schizophrenia as adults

A

F

186
Q

Psychosis + Parkinson’s Rx

A

Atypical antipsychotics: queitapine + clozapine

187
Q

OBGYN SE of antipsychotics

A 
Typical antipsychotic (risperidone) 
Block dopamine = high prolactin = amenorrhea, infertility, galactorrhea
188
Q

Criteria for somatic symptom disorder

A 
Somatic Sx
Excessive thoughts ass. with the Sx 
=> seriousness of Sx
=> anxiety about general health 
=> time + energy to figure out Dx
189
Q

Rx of narcolepsy

A

Methylphenidate

190
Q

Childhood gender identity disorder starts at? How?

A

Age 2
Kids cross-dress + opposite gender games
Hate their genitals

191
Q

Bupropion in panic disorder

A

Not effective

192
Q

Drugs for methamphetamine dependence?

A

None affective

Cognitive Rx only

193
Q

School phobia vs truancy

A

Truancy: leave home but skip school

Phobia: Sx every morning disappear at weekends

194
Q

Agitated with Hx of dystonia

Benzo vs haloperidol

A

Benzo

195
Q

Benzo with shortest elimination half life

A

Triazolam

196
Q

Flooding vs grader exposure Rx in phobia

A

Flooding: exposed and asked to reintegrate the subject, and remain there till anxiety resolve

Exposure: showing picture then going there

197
Q

Capgras syndrome in psych

A

Patient thinks person replaced by exact double that acts exactly like original

198
Q

Rx PTSD (psych)

A

SSRI
Benzo (acute)
Atypical antipsychotics (quetiapine, olanzapine, risperidone)

199
Q

To diagnose adult ADHD

When should Sx start?

A

Since childhood

200
Q

Earliest SE of lithium

A

Tremors

201
Q

Valproic acid vs carbamazepine in bipolar

A

Valproate for maniac episodes

Carbamazepine if multiple maniac episodes, mixed or rapid cycling

202
Q

Which SSRI doesn’t cause D/C syndrome

A

Fluoxetine

Bcz long 1/2 life of 4-6 days

203
Q

ID, Ego, superego

A

ID:
Since birth
Unconscious = primitive + instinctive

Ego:
Based on reality
Satisfied ID in realistic ways

Superego:
Morals + standards
Acquired from parents, society and sense of right.

204
Q

Drug not helpful in tardive dyskinesia

A

Haloperidol

205
Q

Vitamin E in tardive dyskinesia

A

Short duration of benefit

206
Q

Metabolic SE of valproate

A

High ammonia due to low carnitine

Dx. Replace carnitine

207
Q

Insomnia in depression on SSRI

A

Trazdone or zolpidem

208
Q

Delirium tremens in >65 Rx

A

Short acting benzo (lorazepam)

209
Q

Cough / URTI drug causes serotonin syndrome if used with SSRIs

A

Dextromethoephan

210
Q

Level of intellectual disability:
Symbolic communication
Understand gesture + emotions
Express non verbally

A

Profound

CanQB (16 decks)

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