Psych Flashcards
1
Q
What do you need to check before starting an SSRI
A
Episodes of hypomania or manic episodes
2
Q
A pt being treated for bipolar develops a targetoid rash. What is his new med?
A
Lamotrigine
Can cause Stevens-Johnson syndrome is titrated up too quickly
Carbamazepine is similar AE’s
3
Q
What are your options for a schizophrenic pt that is non compliant with QD po meds?
A
Long acting depot neuroleptic medications
IM Q2wks
Formulations of: haloperadol, fluphenazine, and risperidone
4
Q
A pt that delay’s getting to their point, includes way too many details while answering a question but does eventually answer the question
A
Circumstantial thinking
5
Q
2 years of depressed mood
A
Dysthymic disorder
6
Q
Pt who has schizophreniza syx for < 6 mo
A
Schizophreniform
7
Q
Syx of Schizophrenia
A
2 or more of:
delusions, hallucinations, disorganized speech, catatonic behavior, negative syx
8
Q
Personality disorder with restricted emotions and social detachment
A
Schizoid PD
Distance from other individuals and happy being loners
9
Q
Manic episode with dilated pupils
A
Cocaine abuse
10
Q
Pt feels restless and psychomotor agitation while taking an antipsychotic med. Dx and management?
A
Akathisia
Decrease dosage, or add a benzo, or a BBlocker
Common w/ risperidone
11
Q
Defense mechanism where an unacceptable impulse (ie sex drive) is transformed into the opposite (restriction)
A
Reaction formation
12
Q
Tourette syndrome is associated with what two other psych conditions?
A
ADHD
OCD
Occurs in 1/3 tourette pts
13
Q
1 or more depressive episodes + 1 or more hypomanic episodes
A
Bipolar I
Hypomanic = elevated mood, abn high self esteem x 1wk
14
Q
Recommended tx for anorexia?
A
Behaviorally-based tx (CBT) outpt
15
Q
What should be given to a schizophrenic that has poor response to typical antipsychotics despite compliance?
A
Clozapine
30% effective in resistant schizophrenia
16
Q
Tx of panic disorder?
A
SSRI
CBT will augment benefits
17
Q
Pt has delirium in the setting of fever. Dx?
A
Febrile delirium
AKA acute confusional state
18
Q
Pt has suxual urges that he has difficulty containing. He has urges to touch strangers innappropriately, including brushing his genitals against people in crowded places
A
Frotteurism
Recurrent fantasies, sexual urges, behavior involving innapropriately touching a non-consenting person
Often causes distress or impairement of function because the pt conciously knows this is bad behavior
19
Q
After starting an antidepressant pt has syx of blurred vision, dry mouth, and orthostatic hypotension
A
Imipramine (TCA’s)
Inhibits NE, Serotonin
Antagonist at muscarininc, histaminic, and alpha-adrenergic receptors.
20
Q
1st line tx for PTSD?
A
SSRI
21
Q
1st line for post partum blues
A
No tx necessary
Condition will resolve when hormones stabilize
22
Q
Incontinence + gait ataxia + dementia. Dx and workup?
A
Normal pressure hydrocephalus (NPH)
CT + LP
Caused by failed resorption of CSF so LP helps
23
Q
Pt is incoherent and been taking a benzo daily. Now what?
A
Admit to the medical floor for delirium
She is in withdrawl which is an emergency
24
Q
Pt has at least 5 of
Odd beliefs, unusual perceptions, lack of close friends, suspiciousness, odd speech, inappropriate affect, and an odd appearance
A
Schizotypal PD
Odd and magical thinking. Functional, but difficult to make friends
25
syx of benzo w/d
```
Anxiety
Diaphoresis
irritability
Insomnia/fatigue
HA/myalgia
Nausea
Perceptual disturbance
Tremors
Seizures
```
26
What disorder predisposes people to Antisocial PD?
Conduct disorder
| Considered necessary for the development of antisocial
27
Syx of lithium intoxication
Weakness, unsteady gait, diarrhea, tremor, confusion
| If lithium>2 -> dialysis
28
PD that wants friends but too afraid of rejection to put themselves out there
Avoidant PD
| Social inhibition, feelings of inadequicies
29
Why is bupropion conta in anorexia pts?
It decreases the seizure threshold
30
How do you medically manage benzo w/d?
IV Lorazepam
| Short acting so helps w/d without allowing seizures
31
Immature defense mechanism where individual places negative feelings from on event onto another person that is safer
Displacement
32
What medication can be used to counter the excessive cholinergic effects of heroine w/d?
Diphenhydramine
Anticholinergice
Inhibits - muscle aches, abd cramps/loose stool, chills, clear nasal discharge, dilated pupils
33
How do you treat phobias?
CBT + exposures
34
Euphoric affect + fast/pressured speech + tangential associations
Mania
35
Pediatrician becomes withdrawn after treating a girl that was seriously injured ina car accident. Started dreaming about a MVA he had 3 years ago
PTSD with delayed expression
| Can also have avoidance behaviors
36
How do you tx PTSD?
Prazosin + Trauma-Focused CBT
| Add SSRI if also anxious or depressed
37
A male on hormone therapy as he is transitioning to become female presents with significant anxiety. How do you treat?
Start sertraline w/ recommendation for Acceptance and Commitment Therapy (ACT)
38
9 y/o Son refuses to go to school, has dreams that father will die, insists on sleeping with dad. Mother passed away suddenly 8 years ago
Serparation anxiety disorder
39
14 y/o had a breakdown during an exam. Sweaty palms, rapid breathing, heart pounding, tremors. Has had similar syx x 1 year Dx?
Generalized anxiety disorder
40
General anxiety after a major life change (ie, death, divorce)
Adjustment disorder
41
What is a mental health hold?
M1; 72 hour hold for S/I
42
How long can short term certifications last in Colorado?
Up to 90 days
43
How long should pts with MDD be treated before considering weaning?
6 months
44
Personality disorder defined by grandiose sense of self and sense of entitlement
Narcissistic PD
| Countertransferrance of boredom
45
Lithium toxicity can mimic which other dz?
Hypothyroidism
| Weight gain, fatigue
46
Pt becomes aggressive and destroys property. Degree of aggressiveness is out of proportion of the precipitating event
Intermittent explosive disorder
| Tx - anticonvulsants, mood stabilizers, psychotherapy
47
Most common treatment for specific phobias?
Exposure therapy (flooding or desensitization)
48
Sexual arousal by exposing genitals to strangers
Exhibtionist disorder
| Goal is to shock and frighten the victim
49
Pt has a long hx of aggressive impulses resulting in destruction of property or result of another person
Intermittent explosive disorder
| Tx - SSRI's, anticonvulsants, mood stabilizers, psychotherapy
50
Why are most pts on classic antipsychotics also given an anticholinergic?
To avoid acute dystonia (extrapyramidal side effects)
| Anticholinergics = benztropine, diphenhydramine
51
What finding in an interview suggests pseudodementia secondary to depression rather than true dementia?
If the patient is concerned of the dementia - pseudo
| If the pt tries toc cover up the memory loss - dementia
52
Weight neutral antipsychotics
ziprasidone
| Increased risk of QT prolongation
53
A pt wants to reach smoking cessation w/ the help of bupropion. What are his instructions?
Decrease smoking gradully during the second week of treatment
Continue tx 7-12 weeks
If they have not reached cessation by week 7, unlikely that they will
54
Behaviors/emotions that develop w/in 3 months of an identifiable stressor
Adjustment disorder
55
When are kids prone to sleep terrors?
2-6 yrs
Abrupt wakening from slee, screaming, unresponsive to others
Tx - supportive, most outgrow this
56
During an interview, a verbal or nonverbal cue to help the pt continue their train of though
Facilitate
| Kindly asking the pt to continue
57
How long can normal grief last?
1 yr
| if >1 yr think MDD
58
Pt in a psychotic state is in a catatonic state and resists against anyone that tries to move his arms/legs
Negativism
Resistance to movement and instruction
Catatonia is associated with schizophrenia, mood disorders, general medical conditions
59
Pt has manic episode w/ no hx of depressive episode
Bipolar I
| Only a manic episode lasting at least 7 days is required for the dx
60
Hypomania + major depression
Bipolar II
61
Hypomania + low grade depression x 2 years
Cyclothymic disorder
62
Which antipsychotics are most likely to cause tardive dyskinesia
Risperidon - most
| Clozapine - least likely
63
Tourette's is associated with?
ADHD and OCD in 1/3 of pts
64
Tx for people that have a fear of public speaking and social situations
Social anxiety disorder
| Give propanolol or SSRI
65
Child reaches milestones in first 5 months of life. During 6-30 months a decel in head growth, FTT, loss of eye contact, and hand wringing
Rett syndrome
X-linked
Almost exclusively occurs in females, males typically die in utero
Associated with seizures and irregular respiratory patterns
Receptive and expressive communication skills remain at developmentally less than a year
66
What do you do for a pt on life support w/o advanced directives and the family disagrees on what to do?
Arrange a family meeting to mediate a decision about w/ding life support
67
How do you work up a child with enuresis (nighttime bedwetting)
Urinalysis (UTI, DKA, DI)
When organic causes have been r/o can do behavioral mangement (fluid management, bladder retention training, enuresis alarms)
Can give desmopressin and imipramine
68
Pt is aware they are faking a disease, but poor insight as to why they are doing it
Factitious disorder
69
Pt loses sight after a traumatic event, but nothing is neurologically wrong
Somatic symptom disorder
70
Pt fakes an injury to get worksman's comp
Malingering
71
What do you do for a trichotillomania pt?
Identify if there are other psych disorders present (OCD, Borderline, depressive)
72
Tx for OCD?
SSRI (fluoxetine, sertaline, paroxetine, fluvoxamine)
| OCD is caused by low levels of serotonin
73
Which antidepressants are contra in pt with a hx of attempted suicide due to OD?
TCAs
| QT prolongation
74
Preggo has psychotic depression and high risk of suicide
ECT
Works faster than a SSRI and safe in pregnancy
NO Benzo or lithium during preggo
75
Tx for akathisia
Lorazepam
| Look for recent use of haloperidol or prochhlorperazine
76
Pt has nystagmus, belligerence, psychomotor agitation
PCP
Give benzo or antipsychotic
Benzo preferred
Acidfying the urine with cranberry juice helps to clear PCP faster
77
What criteria must be met to dx a pt with anorexia?
BMI <17
| Immediately hospitalize
78
What tests abstract thinking on MMS exam?
Interpreting proverbs
79
Pt has at least 1 fixed false belief for at least 1 month. No other impairments
Delusional disorder
80
Many years of HIV infection puts a pt at risk of?
HIV dementia
| Precipitous decline but other causes of encephalopathy are not present
81
Following a psych hospitalization pt is amenorrhic and decreased libido
She is on risperidone
| Associated with elevated prolactin -> amenorrhea, sexual dysfunction, galactorrhea, weight gain
82
Research study in which medical records of individuals that are alike in many ways but differ on one characteristic (ie high vs low exposure) are reviewed to compare for a particular outcome
Retrospective cohort
83
Acute tx for panic disorder
Benzo w/ medium half life (clonazepam, lorazepam, alprazolam)
Long term tx - SSRI, TCA, MAOI
84
After starting anew antihypertensive, pt has decreased appetite, insomnia, and other depressive syx
Propanolol
| One of the most common pharmacologic agents to cause depression
85
Pt with AMS, fever, rigidity, and elevated creatinine phosphokinase (CPK)
Neuroleptic malignant syndrome
Look for a hx of antipsychotic medications
Tx - cooling, hydration, dantroline
86
Prochlorperazine given for chemo related n/v is causing a pt to be stiff and bradykinetic
Counter this EPS rxn with benztropine
87
When is dialysis indicated when a pt has lithium toxicity?
When there is evidence of renal insufficiency
88
Appropriate tx for insomnia in a pt with a recent stroke
Trazodone
89
Pt has amnesia of a traumatic event
Dissociative amnesia
90
Tx for urinary retention secondary to an antipsychotic
Bethanecol
| Cholinergic stimulant
91
common side effect of lithium use
Hypothyroidism
92
Depression for at least 2 years + functioning at a suboptimal level (ie blah work performance)
Persistent depressive disorder
93
Which antidepressant has the fewest sexual side effects?
Bupropion
94
CVA's increase the risk for which psychiatric disorder?
MDD
| Any event affecting the vasculature (MI, CVA)
95
Manic syx + dry mouth + dilated pupils + tachycardia
Amphetamine use
| Increased alertness, energy, mood x days
96
Pt with rape hx has pain w/ sex
Genito-pelvic pain or penetration disorder
Caused by involuntary muscle contraction in the outer thrid of the vagina
Tx - Kegels, vaginal dilators, relaxation techniques
97
Side effect of quetiapine?
Metabolic syndrome, significant weight gain
| Generally prescribed for psychotic depressive disorders
98
Tx for Narcolepsy
Modafinil (stimulant)
99
What should be used for tx resistant schizophrenia?
Clozapine
| Need regular CBC's for agranulocytosis
100
Which syx must be seen to dx a child with conduct disorder?
```
Any of the following for at least 6 months:
Destruction of property
Aggression to animals and people
Deceitfulness or theft
Serious violations of rules
```
101
Why should you be cautious when switching a pt from an MAOI to a SSRI?
Serotonin syndrome can occur if two overlap. Need a minimum of 10 day washout after stopping the MAOI OR 5 week wash out from the SSRI
102
Pt has a dysfunctional fear of losing control and/or being unable to escape from a situation
Agoraphobia
| Tx - antidepressants and behavioral therapy
103
Extreme depressive syx (depressed affect, >5% weight loss, fatigue, poor concentration/sleep) x at least 2 weeks
MDD
| Can also have anhedonia (decreased interest), psychomotor agitation, worthlessness, guilt, SI
104
Tx for Bipolar I with renal dz
Valproate
Lithium is contra in renal failure
Carbamazepine is 3rd line
105
Which atypical antipsychotic has little sedative effects and is weight neutral
Ziprasidone
106
Most common treatments of OCD?
Fluoxetine and fluvoxamine
107
Psych pt has polyuria, vomiting, diarrhea, confusion and lethargy
Water intoxication (psychogenic polydipsia)
108
Tx for Bulimia
Fluoxetine - the only SSRI that can be given
109
Why do TCA's cause orthostatic hypotension?
alpha1 adrenergic receptor blockade
| Dry mouth is caused by anticholinergic effect
110
`What should be done for a panic disorder pt that is having poor control with SSRI
Add CBT
111
What is seen on CT for a schizophrenia pt?
Enlargment of the lateral cerebral ventricles
| Also decreased hippocampus and amygdala volume
112
CT reveals increased total brain volume
Autism
| Can have rapid head growth in infancy
113
CT reveals structural abnormalities of the orbitofrontal cortex and basal ganglia
OCD
114
Two people with a close relationship (family, spouse) share a delusion
Shared psychotic disorder
Seperate the two to break the chain.
The dominant one will require treatment, the more passive one may not
115
Pt's identity fragments into two different personalities
Dissociative identity disorder
116
What does CBT focus on?
Reducing automatic negative thoughts and avoidance behaviors
117
Why are benzo's preferred for treating PCP induced agitation
Antipsychotics can amplify hyperthermia, dystonia, anticholinergic effects
118
Pt that parties reports acute depression, SI after a binger
Cocaine w/d
| Also hypersomnia, increased dreaming, hyperphagia, impaired concentration, intense drug craving
119
Panic episodes are not triggered or expected and pt changes behavior because they are worried about future attacks
Panic disorder
| Unexpected panic attacks, fear of future attacks, avoidance behavior
120
Compare/contrast anorexia and bulimia?
Both have distorded body image and can engage in purge behaviors
Difference - anorexia has a significantly low body weight
121
Psychosis + tooth decay + skin picking
Meth abuse
122
How do antipsychotics cause hyperprolactinemia
Decreased DA activity in the tuberinfundibular pathway (DA antagonists)
123
Transforming an unacceptable feeling/impulse into the extreme opposite?
Reaction formation
124
Decreased concentration of 5-hydroxyindoleacetic acid in CSF
Associated with depression, multiple suicide attempts
125
How can you decrease the risk of TD with a pt on haldol?
Switch to ariprazole (atypical)
126
Benzoylecgonine is a metabolite of?
Cocaine
| Help them withdrawl with clonazepam
127
What do you do with an alcohol withdrawl pt that continues to be agitated despite giving diazepam?
Keep giving diazepam
128
Unspecific abdominal pain + anxiety, paranoia, delsions, depression
Acute intermittent porphyria
genetic defect in heme production (porphobilinogen deaminase)
AD
129
Tx for adjustment disorder
Therapy
130
At what point can the dose of an SSRI be increased if pt is having inadequate response
If taking therapy >6wks (take 4-6 wks to take full effect)
131
SI pt has decreased respration and pinpoint pupils?
Opioid OD
132
Pt has intense anxiety during public speaking
Social phobia (a type of specific phobia)
133
Are compulsions required to dx OCD?
Nope, they can just fixate on a single distressing thought
134
MOA of haloperidol?
D2 antagonist
| Decreases DA binding
135
Neuroleptic malignant syndrome looks a lot like?
Serotonin syndrome
| Look at med hx to determine which
136
5 y/o with epicanthal folds and delayed motor skills
Down Syndrome
137
Pt has staring spells, lip smacking, picks at shirt collar, smells rubber, intense hissing sound
Complex partial seizure
| EEG - focal spikes localized to the temporal lobe
138
Second line Tx for OCD
Clomipramine (consider after SSRI failure)
139
Parkinsonism + visual hallucinations
Lewy Body Dementia
140
Pt's with anorexia are most likely to also have?
amenorrhea
141
Spiral Fx =
Child abuse
142
What do you do for a family that has a kid that is only bratty at home?
Parent management training
143
Pt has acute onset of lots of crazy visual hallucinations
LSD
144
Primary metabolite of Dopamine?
Homovanillic acid
| Found in CSF, Urine, blood
145
Sudden loss of muscle tone in response to strong emotions?
Cataplexy
146
What test is challenging for Alzheimers?
```
Ask the pt to pick up a piece of paper, fold it, put it on the table
Ideational apraxia (abiity to put several skilled acts in a row, controlled by the parietal)
```
147
Why does stress make it harder to remember stuff?
Increased gluccocorticoids in the HPA axis
| Negative effect on hippocampus
148
Hyposexuality, emotional intensity, perseverative (extreme detail orientation) when communicating
Temporal lobe epilepsy personality
149
Benzo's barbs and anticonvulsants act at which receptor?
GABA
150
When does dreming occur?
REM sleep
| Random, fast, saw toothed waves on EEG
151
Tx for Neuroleptic malignant syndrome?
Dantrolene (muscle relaxant) and bromocriptine
| Sometimes amantadine instead of bromocriptine
152
What suggests poor prognosis in schizophrenia?
```
Onset at early age w/o stressors
Poor pre morbid functioning
Neurologic syx
Social isolation/poor support system
FHx of schizophrenia
Presence of negative syx
```
153
If pt has poor response to a first gen antipsychotic, what should be done?
Transition to a second gen
154
when is psychoanalysis appropriate?
Pt that is highly motivated and can handle a great deal of frustration, good insight
155
How do you manage a pt with factitious disorder?
Primary care should be the gatekeeper for all decisions
| Try to limit the number of invasive tests offered
156
Group sessions that help patients realize they are not alone in their ways is called?
Universalization
157
What percentage of new moms have post partum blues
50%
158
Which conditions are associated with increased incidence of anxiet?
```
Endocrinopathies (pheo, hyperthyroid, hypercortisol, hyperparathyroid)
Metabolic problems (hypoxemia, hypercalcemia, hypoglycemia)
Neuro, vascular, trauma
```
159
Hyperchondriac is now called
Illness anxiety disorder
160
Pt has many different syx and see many different docs, several recent surgeries
Somatic syx disorder
161
sybil had
Dissociative identity disorder
162
Which med can you offer to a male pt with MDD that is concerned about sexual dysfunction
Mirtazapine
163
What should be given for a pt on LSD?
Diazepam
164
At what BAC do folks exhibit drunk syx?
20-30mg/dL
165
Pt withdrawing for alcohol is hallucinating
```
Alcohol withdrawl delirium (Delirium tremens)
po chlordiazepoxide (benzo) or diazepam is a good initial treatment
```
166
opiate antagonist used in OD?
Naloxone
167
SSRI w/ longest half life?
Fluoxetine
168
SSRI with greatest risk for GI syx?
Sertaline
169
SSRI highly protein bound and short half life leads to w/d syx if dose is missed
Paroxetine
170
SSRI w/ fewest drug interactions but increases risk of QT prolongation
Citalopram
171
Enantimor of citalopram with less risk of QT prolongation
excitalopram
172
Which SSRI is FDA approved for ICD
Fluvoxamine
173
MOA of cocaine
Competitive blockade of DA reuptake by the DA transporter
174
MOA of opiates?
Disinhibition of inhibitory GABA
175
What is concerning when prescribing a SSRI to a pt on HAART?
Protease inhibitors affect cytochrome P450 and can elicit serotonin syndrome
176
How do you manage if you clozapine pt WBC count falls below 5K
2xwk CBCs with diff, continue clozapine
177
What do you recommend for a pt that has a hard time falling asleep
Ramelteon
Mimics melatonin, most common AE is HA
Make sure they don't have a severe hepatic impairment, severe OSA, or severe COPD prior to starting it
178
Tx for ADHD
Dextroamphetamine
methylphenidate
dexmethylphenidate
179
What 4 elements must be present to file malpractice?
Negligence
Harm to the patient due to the physicians actions
Harm to the patient
Duty to treat
180
Tarasoff I declared?
providers have a duty to warn the potential victim of a violent patient
181
Most common cause of malpractice in psych?
Improper treatment
182
Fluctuating disturbance in attention developed acutely secondary to an underlying condition
Delirium
183
What should you do with a pt that failed SSRI after 8 wks of tx
Try another SSRI or switch to a SNRI
Add psychotherapy
Or augment with a second agent
184
How do you manage a child with acute psychosis?
```
Rule out cohronic medical conditions:
SLE
Thyroiditis
Metabolic
CNS
```
185
Elderly pt with paradoxical agitation (agitation at bedtime)
D/c any benzo use
186
Alcoholic hallucinosis vs. Delirium tremens?
AH - < 24 hours, lots of visual hallucinations, stable vital signs
DT - >48 hours post cessation, disorientation, confusion, hallucinations, fever, tachy HTN, diaphoretic, can be life threatening
187
syx of schizophrenia presenting as a manic or major depressive episode
Schizoaffective
| Delusions, hallucinations >2wks in the absence of a mood episode
188
Tx for catatonia
Benzo
189
Management of a pt with acute stress disorder
Educate on the range of syx
Refer to trauma focused CBT
ASD is very similar to PTSD but more acute. PTSD requires >4 wks of symptoms
190
What endocrine change is associated with MDD?
hyperactive HPA axis -> increased cortisol
| Decreased REM sleep latency
191
How do you handle a teen with SI?
Hospitalize and inform the parents, confidentiality must be broken
Need parental consent to start a psychotropic
Parental consent for hospitalization is not required if the teen is a danger to self or others
192
MAOI + tyramine rich food causes
```
Hypertensive crisis (HA -> stroke -> death)
MAOI = phenelzine
```
193
How is pediatric depression different from adult depression?
Can present as irritability rather than depressed mood
194
What is a normal pupillary size?
2mm
195
What is indicative of poor prognosis on TCA OD?
QT prolongation
196
Which antidepressant is helpful in a depressive pt with low energy, poor concentration, hypersomnia, weight gain
Bupropion
| Mild stimulant properties
197
1st line tx for major depression with psychotic features (ie auditory hallucination)
ECT
| Good option for elderly pts that have stopped eating/drinking due to the rapid response vs pharma
198
Tx for kleptomania?
Impulse control disorder
| Tx - CBT, SSRI, lithium
199
Anxiety/Insomnia pt has Macrocytosis and elevated LFT's
Alcohol use disorder
200
When a pt interprets a proverb literally
Concrete thinking
| Associated with cognitive disorders (IDD, dementia) and schizophrenia
201
An infant that does not get adequate nurturing is at risk for?
FTT and depression
202
What is primary process thinking?
Nonlogical, denying the existence of negatives
| Primitive
203
According the freud, what is id?
Instinctual drives
204
According to Freud, what is the ego?
To find equilibrium between gratification of the instinctual drives and the rules of society
205
According the Freud, what is the supergo?
The agency that contains the internalized parental and societal rules and dictates to the ego what should not be done.
Source of guilt
206
Which mood stabilizer causes Hepatotoxicity
Valproate
| Can cause hepatic failure in first 6 months of use
207
Kid comes to parents room in the middle of the night due to nightmares
Nightmare disorder
| Recurrent awkenings from REM sleep w/ full alretness and dream recall
208
Diaphoretic + dilated pupils
Amphetamine intoxication
209
Pathophys of tardive dyskinesia?
DA receptor hypersensitivity
210
Older pt with bradykinesia begins acting their dreams out at night
REM sleep behavior disorder
| Early sign of neurodegeneration (PD or LBD)
211
In social anxiety disorder, how do you decide between an SSRI or propanolol
Propanolol - only if the anxiety is related to performance, presenting
SSRI - anxiety about going to meetings, parties etc.
212
Pt has akathisia following increase in antipsychotic dose. What do you do?
Decrease antipsychotic
| Add propranolol, benztropine or a benzo
213
What do you do with a schizophrenic that develops TD?
Switch to clozapine
| Diphenhydramine, benztropine only help with dystonias
214
Days aftter receiving a major diagnosis pt is tearful and can't sleep
Benzo's
| Too short time period to dx with MDD, adjustment disorder, etc. Just need to help her sleep
215
Does MDD have to have weight loss?
No, significant weight change is one criteria
216
Oxalate crystals are found in
Ethylene glycol toxicity
217
What is pervasive developmental disorder?
A psychiatry way of saying the child falls ina spectrum of disorders, but feels the child is too young to give an official diagnosis
PDD includes Autism, Aspergers, Rett syndrome, Childhood disintegrative disorder
218
After NSAID use, bipolar pt has seizure, tremors, nystagmus, and ECG changes
Lithium toxicity
219
What do you do with a clozapine pt with a WBC of 2.5 and signs of infection
D/c clozapine
| Needs his white count to fight infection
220
Elderly pt suddenly develops confussion and hallucinations. Which med can cause this?
TCA's
| D/c
221
In a fit of anger, mom slaps 2 year old across the face. What is the most likely outcome?
No impact
222
Kid doesn't like making eye contact, good with numbers, draws the same picture over and over
Asperger's
223
Pt has not engaged in sex since their partner passed away despite dating
Hypoactive sexual desire disorder
224
After trying synthetic heroine pt becomes stiff, unresponsive, and drools
Designer drugs contain MPTP which causes Parkinsonian symptoms due to damage to the substantia nigra
225
Pt with performance anxiety and asthma
Benzo prn
226
Pt has delusions, hallucinations but no mood disorders
Schizoaffective (not weird/isolated like schizophrenia. Not manic like bipolar. Not quite MDD)
227
Pt is having sudden personality changes (high energy to irritable) + dilated pupils
Cocaine abuse (opposite pupils of opioids)
228
Decreased REM latency
Narcolepsy (fall asleep quickly)
229
What lab changes are seen in Bulemia?
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Elevated bicarb (compensating)
Hypernatremia
Increased BUN
Increased amylase
Altered thyroid hormone
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230
Buspirone is?
Anxiolytic, useful in GAD in conjunction with an SSRI
231
Can Hypercalcemia cause hallucinations?
Yup, look for malignancy, hyperPTH
232
Olanzapine should be avoided in pts with?
Diabetes
233
When do you decide a pt has pastpartum depression vs. postpartum blues
If syx persist >2wks. At that point add a SSRI
234
Tx for adjustment disorder
Psychotherpy
| Good for pts that do not meet criteria of MDD
235
GI syx + confusion + ataxia + tremor
Lithium toxicity
Can be seen in a bipolar pt that starts a new thiazide diuretic
Also ACEI, NSAIDs, tetracyclines, and metronidazole
236
MDD pt is getting poor control with 2 trials of SSRI's. Add what?
Bupropion - weight neutral, no sexual effects
| Mirtazapine - sig weight gain
237
Teen that is argumentative and defiant toward authority figures, but does not seriously violate the rights of others
Oppositional defiant disorder
Risk of developing conduct disorder
Increased adult risk of antisocial PD, substance abuse, anxiety, depression
238
Tx for antipsychotic induced parkinsonism?
Benztroping or amantadine
239
MOA of risperidone
Serotonin 2A and dopamine D2 receptor blockade
| MOA of all second gen
240
Sumitriptan acts on
Serotonin
| 5-HT 1D
241
Child fails to develop stable relationship with guardin due to a severely dysfunctional relationship early on
Reactive attachment disorder
242
Child voluntarily abstains from talking at school, but talks freely at home
Selective mutism
243
Confused + can't move eyes up or right + ataxia
Wernicke
244
Most common AE after ECT?
HA
245
How long would cyclothymic syx have to be present?
At least two years with no more than 2 consecutive months w/o an episode
246
Medication induced psychosis in asthmatic
gluccocorticoids
247
Benztropine is a
anticholinergic
| Useful in dystonias
248
To treat neuroleptic malignant syndrome you need?
DA agonists
| Bromocriptine and Amantadine
249
erythema of the nasal turbinates
Cocaine use
250
Tx for hoarding disorder
CBT
251
Survivors of sexual assault are at increased risk for?
PTSD
Depression
SI
252
What should you do with a somatic syx pt?
Schedule regular follow up appointments. Try to avoid specialty referals and limit diagnositic testing
253
Antipsychotics with greatest risk of metabolic side effects?
Olanzapine
| Clozapine
254
Significant mood episode (depressive or manic) with psychotic features > 2, psychotic features persist after resolution of mood episode
Schizoaffective
| In MDD, psychotic features only seen during mood episode
255
Muscle/joint ache + nausea/diarrhea + rhinorrhea + dilated pupils
Heroine w/d
256
1st line therapy for people wanting to quit alcohol
Naltrexone
| Decreases craving/heavy drinking. Appropriate in opioid free folks that are still drinking
257
Tx for tyramine crisis while on MAOI?
Phentolamine
258
Palpebral fissures, epicanthal folds, "fish mouth" appearance
Fetal alcohol syndrome
