Psych Flashcards
Most common cause on intellectual disability
Fetal alcohol syndrome
Most common genetic causes of intellectual disability
Down and Fragile X
Deficits in Autism spectrum disorders
Social interactions, behavior, and language
ASD is also with which perinatal infections?
Rubella and CMV
ASD patients have a higher incidence of …
abnormal ECG, seizures, and abnormal brain morphology
Which drugs are approved for tx of irritability in ASD?
Risperidone and aripiprazole
ADHD is asso w lower levels of …
dopamine
Disruptive mood dysregulation disorder (DMDD) features
Chronic, severe, persistent irritability with temper outbursts and angry, irritable, or sad mood between outbursts. Should not be dx’ed before age 6 or after 18.\
Intermitten explosive disorder features
not aggressive on a continuous basis; periods of good behavior
Tourette disorder is asso w what other psych disorders?
ADHD and OCD
MDD is asso w decreased levels of …
NE, 5HT, and DA
How is sleep affected in MDD?
Decreased REM latency, increased REM
Tx of depression + neuropathy
Duloxetine (an SNRI)
Tx of depression +/- fear of gaining weight / sexual s/e’s +/- desire to quit smoking
Bupropion
Tx of depression + insomnia + decreased appetite
Mirtazapine
Bipolar disorder is asso with increased levels of…
NE and 5HT
Bipolar disorder type I features
Mania (>1 week, affects function, warrants hospitalization) + depression
Bipolar disorder type II features
Hypomania (<1 week, does not severely affect function) + depression
Tx of acute mania
Lithium and valproate, may use atypical antipsychotics (e.g. quetiapine) and anticonvulsant lamotrigine
Tx if acute mania + severe sxs
Use atypical antipsychotics (quetiapine) d/t shorter onset of action
Tx of mania in pregnancy
Lurasidone, risk of fetal EPS in third trimester
This is never a correct answer on STEP 2
refer to psych
Persistent depressive disorder timing
> 2 years
Cyclothymic disorder features and tx
Hypomanic episodes + mild depression, >2 years, tx w lithium, valproate, antipsychotics, or psychotherapy
Tx of major depressive disorder with seasonal pattern
phototherapy and bupropion or SSRI
Seasonal affect disorders so with abnormal…
melatonin metabolism
Duration of postpartum blues or “baby blues”
birth to 2 weeks
Duration of depressive disorder with peripartum onset
within 1-3 weeks after birth
Duration of bipolar disorder with peripartum onset and brief psychotic disorder with peripartum onset
during pregnancy up to 4 weeks after birth
Bereavement duration
typically lasts less than 6 mo to 1 yr
Litium s/e’s
tremors, weight gain, GI disturbance, nephrotox, diabetes insidious, leukocytosis, teratogenic
severe tox: confusion, ataxia, lethargy, abnormal reflexes
Valproate s/e’s
Tremors, weight gain, GI disturbance, alopecia, teratogenic, hepatoxicity (elevated LFTs). Must monitor levels of the drug. Tox: hyponatremia, coma, death.
Serotonin syndrome unique feature and tx
Neuromuscular irritability (hyperreflexia and myoclonus); strop the medication and give cyproheptadine (serotonin antagonist)
Neuroleptic malignant syndrome unique feature and tx
Rigidity; most important intervention is d/c’ing the offending drug and if refractory use dantrolene or bromocriptine
Brieft psychotic disorder duration
> 1 day, <1 mo
Schizophreniform duration
> 1 mo, <6 mo
Schizophrenia duration
> 6 mo
Schizophrenia features
> /= 2 of the following sxs, one must be in 1-3, >6 mo
Positive sxs (d/t high DA levels):
1) delusions (persecution/grandiosity)
2) hallucinations (mostly auditory)
3) disorganization of speech and 4) behavior
5) Negative sx (muscarinic receptors and serotonin): flat affect, poverty of speech/movement, anhedonia, cognitive delay
Acutely psychotic pt mgmt
hospitalize, use atypical as 1st line agent, if IM medication needed d/t combative behavior use short acting olanzapine or ziprazidone, if not available use haloperidol
Noncompliant patient with schizophrenia, mgmt
use long acting antipsychotic (risperidone or paliperidone) or use depot (olanzapine, risperidone, less so haloperidol)
If 2 trials of antipsychotics fail, use…
clozapine
Clozapine
last resort, most effect, agranulocytosis, must monitor CBC first weekly then monthly
Typical antipsychotics
Most potent: haloperidol, fluphenazine; less potent: thioridazine, chlorpromazine
Atypical antipsychotics and their major s/e’s
The -pines and the -drones
Pines: metabolic s/e’s
Drones: movement d/o’s, QT prolongation
Atypicals by risk of weight gain / metabolic abnormalities
Highest risk: olanzapine and clozapine
Medium risk: quetiapine and risperidone
Low risk: aripiprazole and ziprasidone
Aripiprazole is a partial _ _ and is approved as adjunct thx for _
dopamine agonist; MDD
Schizoaffective disorder features
mood sxs (meet criteria for depression or bipolar) + psychotic sxs, the psychotic sxs must be present for at least 1 month and be present while the patient has no mood sxs for at least 2 weeks, unlike schizophrenia, where mood sxs may be present some of the time, in schizoaffective mood sxs are present most of the time
Mood disorder with psychotic features
psychotic sxs occur exclusively during mood sxs
Delusional disorder tx
Gentle confrontation, atypical antipsychotics
Acute dystonia, onset and tx
hours to days after starting antipsychotic med; tx with anticholinergic agents (benztropine, trihexyphenidyl, diphenhydramine); e.g. may give haloperidol with diphenhydramine ti prevent s/e’s
Akathisia (restlessness), onset and tx
weeks after starting antipsychotic med; tx with beta-blocker
Tardive diskinesia, onset
> 6 mo after starting antipsychotic
Panic disorder, r/o…
ACS (ECG and trop), hyperTH (TSH), and asthma (wheezing)
Tx of panic disorder vs panic attack
SSRI; benzo (alprazolam)
2 types of phobias
Specific phobia and social phobia, sxs must be present for >6 mo
Tx of specific phobia
exposure techniques, CBT (flooding - “bombing” the pt - or desensitization - exposure in relaxed state)
Tx of social phobia
beta-blocker (atenolol, nadolol, propranolol)
OCD tx
SSRIs, CBT (exposure and response prevention)
Hoarding disorder tx
SSRI
PTSD tx
1st line: paroxetine, sertraline; prazosin reduced nightmare
Acute stress disorder vs PTSD, duration
acute stress disorder: >2 days, <1 mo
PTSD: >1 mo
GAD general criteria
> 6 mo of excessive worry + somatic complaint
Rapid acting benzos
Lorazepam (IV/IM) - use in emergencies, alprazolam (PO) - use in panic attacks
Long acting benzo
Clonazepam
Benzos used in withdrawal
Diazepam, chlordiazepoxide
Liver safe benzos
Lorazepam and oxazepam
Flumazenil, use
benzo antagonist, use only with overdose is acute and you’re certain that there is no benzo dependence (causes acute withdrawal similar to DT, seizures)
How many positive responses needed for positive CAGE test?
2
Adjustment disorder duration
sxs usually occur within 3 months of stressor and remit within 6 mo of removal of the stressor
Russell sign
callus/scarring on dorsum of hand
Electrolyte abnormalities d/t vomiting
hypokalemia, hypochloremia, and metabolic acidosis
Impotence is 50% more likely in …
smokers
Depersonalization/derealization disorder
persistent or recurrent experience of depersonalization (“outside observer”) and derealization (experiencing surroundings as unreal)
Dissociative amnesia
inability to recall important personal information, usually of traumatic or stressful nature; includes dissociative fugue
Dissociative identify disorder
involves fragmentation in to at least 2 distinct personality states
Somatic symptom disorder
excessive anxiety about >/= 1 physical symptom(s) lasting for >/= 6 mo and can occur in patients whose sxs are explained by recognized diseases
Delusional disorder criteria
> /= 1 delusion > month, no other psychotic sxs, normal functioning apart from direct impact of delusions
PCP intoxication unique finding
multidirectional nystagmus
Woman who presents with s/s of early pregnancy and beliefs that she is pregnant when she in fact is not…
pseudocyesis
Antidepressant discontinuation syndrome
caused by the abrupt discontinuation or rapid taper of start half-life serotonergic antidepressant –> leads to sudden onset of dysphoria, fatigue, insomnia, myalgias, dizziness, flu-like sxs, GI sxs, temor, and neurosensory disturbances; tx with re-introduction of the same antidepressant and then tapering over 2-4 weeks
body dysmorphic d/o dx
preoccupation with perceived bodily defect; NOT DX’ED WHEN CRITERIA FOR EATING D/O ARE MET
difference between bulimia and purge-bing type of anorexia nervosa?
bulimia patients typically maintain normal body wt
bradycardia and refeeding syndrome in anorexia patients
SSRIs effective in bulimia, ineffective in anorexia
PCP intoxication
nystagmus, dissociative feelings, psychotic and violent behavior, severe HTN, hyperthermia, quick onset and duration typically <8 h
risk factors for Rx opioid misuse
age <45, psychiatric d/o, personal or FH of substance d/o, presence of legal hx. review the states’ rx drug-monitoring program data, do random urine drug screens and regular f/u’s (at least q3months) to reduce risk of rx opioid misuse
difference between somatic sx d/o and panic d/o
multiple physical sxs, high health care use, and preoccupation with sxs are seen in both conditions; however in somatic sx d/o, physical sxs are persistent overtime. panic attacks have abrupt onset and resolve within minutes
pharmacotherapy in alcohol use d/o
medications that target the reinforcing effects of alcohol by modulating opioid and glutamate functions are effect. first line treatment options include naltrexone, a mu-opioid antagonist, and acamprosate, a glutamate modulator. naltrexone decreases alcohol craving, reduces heavy drinking days, and increases days of abstinence; in patients takin opioids it can precipitate w/drawal. acamprosate is used to maintain abstinence and should be avoided in patients with renal failure.
things that falsely show as positive amphetamines on urine tox screen
pseudoephedrine, bupropion, selegiline
cyclothymic disorder dx in children
sxs for 1 year
cyclothymic disorder part of which spectrum
bipolar
tx of anorexia nervosa
psychotherapy, nutritional rehabilitation, olanzapine if severe/refractory
Tourette time criteria
sxs must be present for >1 year, must occur before age 18
Tourette tx
antipsychotics, alpha-2 agonists, and behavioral therapy (habit reversal training)
PCP intoxication tx
benzos benzos benzos, antipsychotics 2nd-line
