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Psych Flashcards

1
Q

5 stages of substance abuse

A

1) pre contemplative - denial
2) contemplative - acceptance
3) preparation - committed steps
4) action - actual behavioral change
5) maintenance - sustained behavioral change

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2
Q

populations more susceptible for alcoholism (MC abused substance)

A

native americans
alaska natives
they have increased for suicide

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3
Q

Wernickes

A

reversible cerebellum

tx - thiamine + folate –> D50

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4
Q

korsakoffs

A

irreversible confuabulation

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5
Q

alcoholic found down and out you give what in what order

A

thiamine followed by d50 after otherwise you worsen the hypoglycemia

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6
Q

acute alcohol intoxication symptoms and tx

A

disinhibtion amnesia ataxia
nausea vomiting and death
slurred speech

tx - IVF, time

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7
Q

EtOH withdrawal symptom order

A 
HTN (diastolic) + tachy
tremors, diaphoresis, 
seizures
agitation, confusion 
DTs then death
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8
Q

mechanism and pathway for etoh withdrawal seizures

A

etoh –> increases GABA which blocks brain activity

chronic etoh –> downregulated gaba receptors since they are always blocked by GABAa–> so with etoh stop (no more inhibitor on activity) there leads to overactivity in the muscles (tremors) and the brain (seizures)

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9
Q

treatment of alcohol withdrawal or benzo withdrawal (same thing)

A

long acting benzos + short acting benzos

as they improve you take away short acting

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10
Q

what are long acting benzos

A

chlordiazepoxide

diazepam

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11
Q

what are short acting benzos

A

loreazepam (IV)

alprazolam (PO)

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12
Q

benzo intoxication symtoms

A

delrium in the elderly
resp depression
coma with increased dose
amnesia

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13
Q

benzo withdrawal symptoms

A 
tachy 
tremor 
HTN 
seizures 
psycosis
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14
Q

antidote for benzos

A

flumazenil

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15
Q

opiate intoxication symptoms

A

euphoria
pupil constriction
resp depression
tract marks

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16
Q

opiate withdrawal symptoms

A 
pain 
yawning 
lacrimation 
NVD 
sweating
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17
Q

treatment of opiate abuse/ withdrawal

A 
naloxone 
methadone (long term)
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18
Q

cocaine intoxication symptoms

A 
psychomotor agitation 
HTN 
tachy 
dilated pupils 
psychosis - hallucinations and paranoia  
angina/ HTN crisis
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19
Q

cocaine withdrawal symptoms

A

depression
suicidality
cocaine bugs
crash

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20
Q

treatment of cocaine abuse

A

supp care or benzos
alpha – > then beta blockade

never give beta blockers early on will lead to unopposed alpha action

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21
Q

MDMA intoxication symptoms

A

overheat (fever, tachy)
water intoxication
pupillary dilation
psychosis

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22
Q

PCP intoxication symptoms

A

vertical and horizontal nystagmus
aggressive psychosis
impossible strength
blunted senses

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23
Q

pcp withdrawal symptoms

A

severe random violence

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24
Q

tx of pcp abuse

A

haloperidol to subdue

acidify urine to enhance its excretion

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25
Q

LSD intoxication symptoms

A

hallucinations
flashbacks
heightened senses

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26
Q

Marijuana intoxications symptoms

A 
tired 
slowed reflexes 
conjuctivitis 
munchies 
overdose brings paranoia
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27
Q

nicotine overdose

A

patient goes in to V tach

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28
Q

treatment of nicotine abuse

A 
bupropion 
chantix ( varenicline) - adr = suicide
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29
Q

amphetamine intoxication symptoms

A

tachy
HTN
pressured speech
flight of ideas

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30
Q

generalized anxiety disorder

females 20s

A 
constant state of worry about most things that leads to impairment of daily life 
>6months/years 
at least 3: 
-irritability 
-somatic pain
-weight change 
-sleep change 
-concentration
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31
Q

treatment of GAD

A

psychotherapy
SSRIS and buspirone

never benzos

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32
Q

panic disorders
acute
without provocation

A 
sob 
trembling 
unsteadiness
depersonalization 
excessive heart rate
numbness 
tingling 
sweating 
palpitations
abdominal distrss
nausea
intense ear of losing control/dying
chest pain
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33
Q

treatment of panic disorder

A

acute attacks - benzos

chronic - SSRIs

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34
Q

agoraphobia

A

fear of going outside, public areas, public transportation , crowds

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35
Q

treatment for public speaking phobia

A

nonselective beta blocker (propanolol, atenolol, nadolol)

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36
Q

treatment of phobias 2 types

A

systemic desensitization - better overalls - slower

flooding - better for quick needs (actor - cave scene)

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37
Q

benzos are metabolized via

A

liver - so in patient’s with hepatic impairments short acting are preferred

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38
Q

MOA of benzos

A

increased frequency of Cl- channel opens

GABAa antagonist - same as etoh

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39
Q

benzos as anesthesia

A

dose dependent anterograde amnesia

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40
Q

paranoid personality disorder

A

distrustful, suspicious,
ppl are out to get them
short lived delusions

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41
Q

schizoid personality disorder

A

loners but enjoy being alone

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42
Q

schizotypal

A

weird

bizarre

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43
Q

borderline personality disorder

A

unstable, impulsive, rapid changes in mood
promiscuous
suicidal gestures

spitting behavioral will be seen
F>M
hx of childhood abuse/ trauma

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44
Q

histrionic personality disorder

A

theatrical
use of physical appearance
dramatic
F>M

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45
Q

narcissistic personality disorder

A

inflated sense of worth

men > women

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46
Q

anti-social personality disorder

A

preceded by conduct disorder
criminal
lacks any remorse

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47
Q

avoidant personality disorder

A

fears rejection and criticism
wants friends and relationships
passes on promotions

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48
Q

dependent personality disorder

A

unable to assume responsibility
clingy/attached
fears being alone

abusive husband relationship example

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49
Q

Obsessive compulsive

A

orderliness at the expense of efficiency

rewriting notes 100 times

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50
Q

SSRIs + MOA

A

blocsk reuptake of serotonin at the presynaptic nerve terminal

citalopram , fluoxetine, paroxetine
sertraline , escotalopram

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51
Q

SSRIs - side effects

A

decreased libido
delayed ejaculation
GI upset, HA, flushing

hypernatremia in elderly

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52
Q

SnRIs

A

venlafaxine
duloxetine

cleaner and more expensive

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53
Q

bupropion MOA

A

atypical antidepressant - increased dopamine activity

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54
Q

bupropion

A

smoking cessation
no weight gain
no sexual dysfunction

C/I - bulimi - lowers seizure threshold

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55
Q

TCAs

A

tryptilines
imipramine
desipramine
doxepin

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56
Q

TCAs uses

A

used for enuresis

1st line for neuropathic pain

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57
Q

Mirtazapine

A

MOA - Serotonin modulator, alpha 2 adrenergic antagonist,
increases NE and fSerotoinin due to dec neg feedback

ADR - weight gain, somnolence

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58
Q

trazadone

A

serotonin modulator
sleep aid

ADR - priaprism

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59
Q

MAO-Is

A

phenelzine
tranylcypromine
selegiline

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60
Q

MAO-Is - ADR

A

HTN crisis when mixed with tyramine (red wine, cheese)

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61
Q

antidepressant tx rules

A

> 6wk trial
6month treatment
3 week washout period

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62
Q

Major Depressive Disorder

A 
at least 5 of SIGECAPS: 
S- sleep 
I - interest
G - guilt 
E - energy 
C - concentration 
A - appetite/weight 
P - pyschomotor retardation 
S - suicidal ideation

MUST HAVE: depressed mood or ahedonia > 2wks

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63
Q

Tx of MDD

A

SSRIs + psychotherapy

ECT (best but used for refractory MDD or catatonia)

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64
Q

Dysthymia (persistent depressive disorder)

A

at least 2 years but without symptoms for > 2months at a time
functioning but will have depressed mood

tx = SSRIs after you r/o - hypothyroidism and SI

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65
Q

Bipolar I

A 
function is impaired - needs hospitalization 
at least (7) days 
DIGFASTER - (3) + "E" 
D - distractibility 
I - insomnia
G- grandiosity 
F- flight of ideas
A- agitation 
S- sexual exploits
T-talkative 
E- elevated mood
R- racing thoughts
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66
Q

bipolar II

A 
hypomania and major depression 
at least (4) days 
functional
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67
Q

tx of bipolar I

A

1) ER - benzo
2) life long - lithium or valproate
3) comorbid = carbamazepine or lamotrigine

another drug = quetiapine (seroquel)

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68
Q

do you give SSRIs to patients with bipolar I or bipolar II

A

NO - they will induce mania

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69
Q

cyclothymia

A

roller coaster up and down but failure to meet any of the criteria for bipolar II

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70
Q

normal grief

A 
< 12 months 
still functional 
waxes and wanes 
praying at them 
glimpses of deceased 
talking to them 
wishing they traded places

not to be treated

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71
Q

persistent complicated bereavement disorder

A

> 12 months
mostly depression - persistent depressed mood
hopelessness
hallucinations

tx = SSRI or SnRIs

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72
Q

post partum depression

A

> # 1 babydoesnt care about baby/ may hurt baby
within 1 month onset and duration ongoing

tx = antidepressants

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73
Q

baby blues

A

1st baby
cares about baby
onset and duration within 2 weeks

no tx needed

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74
Q

post partum psychosis

A

> # 1 babyfears the baby/ likely to kill it
onset within 1 month and duration ongoing

tx = mood stabilizers or antipsychotics

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75
Q

schizophrenia criteria

A 
1 bizarre delusions 
2 hallucinations
3 disorganized speech 
4 disorganized or catatonic behavior 
5 flat affect, cognitive defects, poverty of speech, anhedonia

must have any (2) as long as (1) = 1-3

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76
Q

schizophrenia other facts

A

young male in 20s
> 6 months
overload of dopamine

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77
Q

schizophreniform

A

> 1 month but less than 6 months

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78
Q

schizoaffective disorder

A 
schizophrenia + mood 
at least (2) wks of psychosis without the mood
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79
Q

brief psychotic disorder

A

> 1day and <1 .month

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80
Q

delusional disorder

A

logical thought process
functional
ex: man believes wife is cheating on him and has someone follow her everyday even tho there is no evidence

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81
Q

typical antipyschotics

A

haloperidol
thiazide
chlorpromazine

good for (+) symptoms

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82
Q

atypical antipsychotics

A 
risperidone 
quetiapine
olanzapine
ziprasidone
apriprazole
clozapine

good for (-) symptoms

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83
Q

ADR of Clozapine

A

agranulocytosis - check ANC >1500 - neutropenia
weekly CBCs
last line drug to use for refractory schizophrenia

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84
Q

DOC for bipolar/mania

A

lithium

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85
Q

ADR of lithium

A

narrow therapeutic index
nephrotoxicity
nephrogenic DI

ataxia/ tremor/fasciculations
N/V/D
confusion/ agitation

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86
Q

If Lithium cant be used DOC for bipolar =

A

Valproate

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87
Q

valproate ADR

A 
teratogen (spina bifida) 
elevated LFTs -> hepatic failure 
thrombocytopenia
agranulocytosis 
pancreatitis
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88
Q

ADR of quetiapine (2nd line bipolar tx)

A

weight gain

QTc prolongation

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89
Q

ADR of lamotrigine (2nd line bipolar tx)

A

blurred vision

SJS

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90
Q

ADR of Carbamazepine (3rd line bipolar tx, trigeminal neuralgia, absence seizures)

A

teratogen (cleft palate)
rash, SJS
AV block

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91
Q

MOA of Typical antipyschotics

A

D2 receptor antagonism

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92
Q

ADR of typical antipsychotics

A

EPS side effects

increased prolactin leading to gynecomastia

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93
Q

MOA of atypical antipyschotics

A

D2 and 5HT antagonism

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94
Q

ADR of atypical antipyschotics

A

QTc prolongation
less EPS risk
gynecomastia
sedation

DM and weight gain (olanzapine and clozapine)

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95
Q

drug with the most potent EPS side effects

A

haloperidol (typical)

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96
Q

antipyschotic for combative ED patient

A

Haloperidol depot (sedating)

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97
Q

Extrapyramidal side effects

A

akathisia
acute dystonia
dyskinesia
tardive dysinesia

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98
Q

akathisia

A

restlessness

tx - decreased dose of antipyschotic + beta blockers
tx = benztropine

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99
Q

acute dystonia

A

involuntary muscle contractions
hand ringing
torticollis

oculogyric crisis

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100
Q

dyskinesia

A

parkinsonism

tx - benztropine

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101
Q

tardive dyskinesia

A

irreversible
hypersensitization of dopamin R
oral facial movements

tx - stop drug

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102
Q

Fluoxetine ADR

A

decreased libido

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103
Q

paroxetine ADR

A

serotonin syndrome = fever, myoclonus, AMS

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104
Q

Citalopram - ADR

A

GI

Insomnia

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105
Q

Bupropion ADR

A

minimal sex issues

increased risk of seizures (lowers threshold)

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106
Q

Mirtazapine ADR

A

weight gain

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107
Q

Trazodone ADR

A

priapism

sedation

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108
Q

ADR of MAO-I

A

HTN crisis when mixed together with tyramine (wine, cheese)

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109
Q

ADR of benzos

A

addiction

withdrawal seizures - must taper off

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110
Q

Intermittent explosive disorder

A

action is violent and out of proportion to the initial stressor

2/week for 3 months without harm = mild
3/ever for 12 months with harm = severe

tx - SSRIs or group therpy

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111
Q

pyromania

A

deliberate fire setting on >1 occasion
decreases their anxiety
sexual arousal
pleasure

vs arson - for monetary gain

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112
Q

kleptomania

A

decreases anxiety
unable to resist
item has NO value

remorse and guilt after event
F>M

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113
Q

OCD

A

persistent, intrusive, unwanted thoughts - obsessions that provoke anxiety

obsessions - contamination, symmetry safety
compulsion - cleaning, order/counting, checking

tx - CBT and SSRIs

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114
Q

body dysmorphic disorder

A

perceived defects in physical appearance
appearance checking
excessive unneeded cosmetic surgeries
F>M

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115
Q

muscle dysmoprhia

A

M>F
preoccupation with muscle size
anabolic steroids
excessive exercise

rhabdo
roid rage
copper - small testicles

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116
Q

trichotillomania

A

pulling out there hair to reduce anxiety
greater on dominant hand side
hair in different lengths

small bowel obstruction - from hair ball (trichobezoar)

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117
Q

acute stress disorder

A

timeline <1 month

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118
Q

PTSD

A

> 1 month
exposure to some extreme emotional event
group therapy
SSRIs

benzos - only for panic attacks

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119
Q

reactive attachment disorder

A

<5 years old
stressor is neglect or abuse during infancy and chilhood

kid fails to attach to anyone

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120
Q

disinhibited socia engagement disorder

A

<5 years old

kid is way too friendly with strangers

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121
Q

adjustment disorder

A

start within 3 months of the stressor and duration should be less than 6 months after event

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122
Q

binge purge emesis

A 
dorsal hand scars 
dental erosion 
metabolic alkalosis 
low - K 
low - Mg
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123
Q

binge purge laxative

A

metabolic acidosis

diarrhea

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124
Q

anorexia

A 
F>M 10:1, BMI < 15 
fears she is going to be fat
lacks recognition of a problem 
malnourished 
may require hosptialization

tx - group therapy and SSRIs

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125
Q

bulimia nervosa

A

binge, feeling ashamed
nml weight

hypokalemia
hypochloremia
metabolic alkalosis

Tx - SSRI (fluoxetine) CBT

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126
Q

binge eating disorder

A

its bulimia but without the purge

patients are overweight

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127
Q

dissociative identity disorder

A

> 2 distinct identity states
most severe and prolonged trauma

memory gaps 
paradoxical behaviors (doing things you wouldnt normally do) 
appearance changes

tx - pyschotherapy and hypnosis

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128
Q

dissociative amnesia

A

stressors induce memory loss

memory loss of event -> regular everyday routine –> complete idea of self

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129
Q

dissociative amnesia with fugue

A

= dissociative amnesia + travel

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130
Q

depersonalization derealization disorder

A

adolescent with non severe trauma
feels like a dream
feels detached from own thoughts

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131
Q

Catatonia

A 
3 of the following: 
stupor 
catalepsy 
waxy flexibility 
mutism 
negativsm 
stereotypy 
agitation or grimacing 
echolalia 
echopraxia
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132
Q

stupor

A

decreased alertness and decrease response to stimuli

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133
Q

catalepsy

A

patient can be put in any position

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134
Q

waxy flexibility

A

slight to no resistance to positioning and will hold new position

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135
Q

mutsim

A

no verbal response when there once was

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136
Q

negativism

A

motiveless resistance to instructions

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137
Q

stereotypy

A

repetitive non goal directed movements

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138
Q

echolalia

A

mimicking speech

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139
Q

echopraxia

A

mimicking movements

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140
Q

tx of catatonia

A

lorazepam

ECT

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141
Q

Retarded catatonia

A

mutism
posturing
negativism
staring

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142
Q

excited catatonia

A

hyperkinesis
frenzy
combativeness
restless

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143
Q

malignant catatonia

A 
rigidity 
autonomic instability 
high HTN 
high HR 
high Temp

caused by NO MEDS

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144
Q

neuroleptic malignant syndorme

A

rigidity - lead pipe
autonomic instability
increased CK

patient is ON antipsychotic meds

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145
Q

serotonin syndrome

A 
myoclonus 
hyperreflexia 
lead pipe rigidity 
increased Temp 
increased CK

patient is ON SSRIs

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146
Q

malignant hyperthermia

A

halothane anesthesia rxn
rigidity
autonomic instability
increased CK

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147
Q

tic disorders

A

associated with OCD and ADHD

tx - dopamine antagonists

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148
Q

MOA of benzos

A

increased frequency of Cl- channel opening

GABAa

149
Q

ADR of benzos

A

dose dependent anterograde amnesia - especially in the elderly

150
Q

quetiapine is effective in the

A

depressed phase of bipolar

151
Q

acute dystonia tx

A

benadryl

152
Q

tx of tardive dyskinesia

A

valbenzine

153
Q

naltrexone

A

1st line tx for alcohol use disorder that decreases cravings and heavy drinking

154
Q

somatic symptoms disorder

A

> 1somatic symptom causing distress and functional impairment
excessive thoughts or behavior related to somatic symptoms
6 months in duration

tx - regularly scheduled visits

155
Q

inhalant disorder

A

14-17 y/o boys
common houselhold products

perioral skin changes = glue sniffers rash
rapid onset and relatively short duration

156
Q

tx of specific phobias

A

tx exposure CT therapy

157
Q

buspirone

A

tx of anxiety disorders

158
Q

neuroleptic malignant disorder

A 
F > 104
confusion 
sweating 
muscle rigidity 
abnormal vital signs
159
Q

tx of neurolpetic malignant disorder

A

stop medications –> bromocriptine or dantrolene if necessary

160
Q

tx of serotonin syndrome

A

cyproheptadine

161
Q

tx of bulimia nervosa

A

CBT and fluoxetine

162
Q

tx of anorexia nervosa

A

CBT and olanzapine if refractory

163
Q

complications of anorexia nervosa

A

myocardial atrophy, bradycardia, low BP, arrthymias

dry skin, lanugo, dehydration, seizures

cognitive impairment, amenorrhea, infertility

ostepenia, cytopenia, constipation

hypercholesteremia, hypercarotenemia

164
Q

factitious disorder

A

intentional falsification or inducement of symptoms with goal to assume sick role

165
Q

malingering

A

falsification or exaggeration of symptoms to obtain external incentives

166
Q

conversion disorder

A

neurological symptom incompatible with any known neurological disease

acute onset associated with stress

167
Q

illness anxiety disorder

A

fear of having serious illness despite few or no symptoms and consistently negative evaluations

168
Q

antidepressant discontinuation syndrome

A

abrupt discontinuation or rapid taper of short half life serotonergic antidepressants

tx - restart meds and slow slow taper

169
Q

MOA of 2nd gen antipsychotic

A

serotonin 2A and dopamine D2 antagonists

170
Q

Bupropion MOA

A

NE and dopamine re-uptake inhibitor

171
Q

neuro-imaging finding associated with schizophrenia

A

enlargement of the lateral cerebral ventricles

172
Q

medication induced psychotic disorder

A

acute onset of delusions and/or hallucinations that are temporarily associated with use of a new med

(common = high dose glucocorticoids)

173
Q

sleep latency

A

time from going to bed to falling asleep

its elevated in insomnia
decreased in sleep deprivation

174
Q

REM latency

A

time from falling asleep to REM
avg 40 min

shortened by depression or narcolepsy

175
Q

REM Rebound

A

occurs when the body has been deprived of REM

its easier to get REM AND you get more of it

176
Q

Nightmares

A

during REM

remember everything

177
Q

night terrors

A

during N3
doesnt remember anything
in a child - parents will complain

178
Q

some causes of REM deprivation

A

etoh abuse

sleep apnea

179
Q

obstructive sleep apnea

A

obese
snores
daytime somnolence

dx - polysomnography - 15 obstructive apneas/ hr or 5 per hour with snoring

tx - lose weight and/or CPAP

180
Q

central sleep apnea

A

tx - with bipap
lost their intrinsic drive to breathe

cheynes strokes breathing - no chest rise

181
Q

narcolepsy

A

rapidly plunged into REM sleep
3x/week for 3 months
cataplexy - is the loss of muscle tone while conscious
hypnagogic and hypnopompic hallucinations

tx - schedule naps and stimulants (modafinil, provigil)

182
Q

insomnia

A

difficulty falling asleep
3x/week for 3 months

sleep hygiene

183
Q

sleep medication

A

benadryl - dont give to elderly
quetiapine - off label - prolonged QTc
trazadone - strong - erections, nasal congestion
zolpidem - strong - benzo derivative not as addicting

184
Q

enuresis

A

> 2/wk for 3 months
5 years up to 7 = nml
avoid negative reinforcement

nighttime fluid restriction
water alarm blankets
desmopressin
oxybutynin

watch out for regression = child abuse or new stressor

185
Q

conduct disorder

A 
criminal 
harms animals 
harms friends 
lies steals and cheats 
defiant towards authority
186
Q

oppositional defiant disorder

A

defiant towards authority
does not break the law
does NOT hurt friends

187
Q

paranoid

A

MC delusion

delusion of grandeur and persecution

188
Q

infertility due to what psych meds

A

antipsychotics due to dopamine antagonism –> hyperprolactinemia –> galactorrhea, amenorrhea, infertility

esp in 2nd gen = risperidone

189
Q

ADR of carbamazepine

A

aplastic anemia

190
Q

transient global amnesia

A

anterograde amnesia

resolves within 24 hrs

191
Q

acting out

A

expressing unacceptable feelings through actions

192
Q

denial

A

behaving as if an aspect of reality does not exist

193
Q

displacement

A

transferring feelings to less threatening object or person

194
Q

intellectualization

A

focusing on nonemotional aspects to avoid distressing feelings

195
Q

projection

A

attributing ones own feelings to others

196
Q

rationalization

A

justifying behavior to avoid difficult truths

197
Q

rxn formation

A

transferring unacceptable feelings/impulse into the opposite

198
Q

regression

A

reverting to earlier developmental stage

199
Q

splitting

A

experiencing a pressure/situation as either all positive or all negative

200
Q

sublimation

A

channeling impulses into socially acceptable behavior

201
Q

suppression

A

putting unwanted feelings aside to cope with reality

202
Q

acute mania with non compliant patient tx =

A

olanzapine since it can be given IM

203
Q

hallucinations in kids can be caused by

A

over the counter cold medications

204
Q

HIV associated dementia

A

early sign = subcortical symptoms

205
Q

management of PCP agitation and aggression

A

benzos

206
Q

DOC for ADHD

A

always stimulants unless parents dont want stimulants

207
Q

First line tx for bipolar disorder

A

lithium
valproate
quetiapine
lamotrigine

208
Q

doc for social anxiety disorder

A

SSRIs/SNRIs

such as sertraline

209
Q

REM sleep behavior disorder

A

dream enactment that occurs during REM sleep if muscle atonia is absent - more common in the elderly

210
Q

drug that is associated with dose dependent HTN

A

venlafaxine - SNRI

211
Q

drugs that are associated with hypotension

A

MAO-Is

TCA

212
Q

bipolar pts not adequately controlled with monotherapy should be treated with what med

A

lithium or valproate
+
2nd gen antipsychotic

213
Q

unexplained abd pain
new onset neuropsych symptoms (anxiety, mood changes psychosis)

dx =

A

AIP

214
Q 
overdose patient 
- seizures 
- mental changes 
tachy 
hypotension 
cardiac conduction delay 
anticholinergic (dilated pupils, flushed, dry skin)
A

TCA overdose

215
Q

first line tx for major depressive disorder with psychotic features

A

ECT

216
Q

pathology behind tardive dyskinesia

A

dopamine receptor hypersentivity

217
Q

which 2nd gen antipsychotic has less metabolic risk

A

ziprasidone has the least vs olanzapine

2nd gen has less EPS risk then 1st gen

218
Q

tx of choice for adjustment disorder

A

psychotherapy

219
Q

After SSRIs what are the next tx options for depression

A 
(1) SNRIs 
then 
(2)
buproprion 
mitrazapine 
serotonin modulators
then 
(3)TCAs
220
Q

baseline studies needed before intiating lithium

A 
BMP 
calcium 
thyroid 
UA 
ECG
221
Q

what drug has a high frequency of prolactin elevation

A

respiridone

222
Q

tx of acute dystonia

A

benadryl

diphenhydramine

223
Q

what sign is associated with dementia and not normal aging

A

getting lost in familiar territory

224
Q

sexual assault increases risk for

A

suicidal ideation and attempts

225
Q

caffeine intoxication

A

sympathetic hyperactivity
- anxiety, jitteriness,
insomnia
palpitations

226
Q

nightmare disorder

A

child remembers the disorder and can be consoled

227
Q

alzheimer basics

A

early insidious short term memory loss

later personality changes

228
Q

vascular dementia basics

A

stepwise decline

cerebral infarctions and/o deep white matter changes on neuroimaging.

229
Q

frontotemporal dementia basics

A

early personality changes
apathy
disinhibition
compulsive behavior

frontaltemporal atrophy on neuroimaging

230
Q

dementia with lewy bodies bascis

A

visual hallucinations
spontaneous parkinonism
fluctuating cognition

231
Q

normal pressure hydrocephalus

A

wet wobbly weird

dilated ventricles on neuroimaging

232
Q

prior disease

A

behavioral changes

rapid progression myoclonus and/or seizures

233
Q

side effects of ECT and safety in pregnancy

A

anterograde and retrograde amnesia

safe during all terms of pregnancy

234
Q

tx of choice for borderline personality disorder

A

dialectical behavioral therapy

235
Q

example of reaction formation

A

you hate someone but when you see them you act super nice to them

236
Q

presentation of acute dystonia

A

sudden sustained contraction of the neck, mouth, tongue and eye muscles

tx - benadryl and/or benztropine

237
Q

increased serum cortisol is associated with what disorder

A

MDD

238
Q

depression and sleep

A

decreased REM latency and increased overall REM

239
Q

decreased concentration of 5-hydroxyindoleacetic acid in CSF analysis is associated with

A

depression

5-HIAA metabolite of serotonin (5-HT)

240
Q

increased sensitivity to lactate infusion is associated with

A

panic disorder

241
Q

serology positive for HLA-DR2 is associated with

A

narcolepsy

242
Q

oxalate crystals are associated with

A

ethylene glycol toxicity

243
Q

somatization disorder timeline

A

> 6months and they dont blame themselves

244
Q

nucleus accumbens associated with

A

cannaboids - increased food intake

245
Q

mamillary bodies are associated with

A

wernickes and krosakoff syndromes in alcoholics

246
Q

area of the brain associated with drug induced parksonism

A

substantia niagra

247
Q

locus cereulus is associated with

A

increased NE = anxiety

decreased NE = depression

248
Q

cerebellar vermis associated with

A

truncal ataxia

249
Q

tx of tyramine hypertensive crisis

A

nitroprusside or phentolamine

250
Q

dx test for kids with seizures

A

EEG

251
Q

tramadol when combined with an SSRI can lead to what

A

serotonin syndrome

252
Q

beta blockers can induce what type of moods

A

depressed moods that mimic MDD

253
Q

smelling rubber -

A

temporal lobe seizure - focal spikes on EEG

254
Q

only TCA approved for OCD

A

clomipramine

255
Q

caudate atrophy =

A

huntingtons dz

256
Q

ADR of metoclompramide or prochlorperazine

A

akithesia - tx beta blockers

EPS

257
Q

Contraindication for beta blockers

A

asthma

258
Q

marker of malnutrition

A

albumin - low in anorexia

259
Q

part of the brain of affected by alzheimers

A

nucleus basalis of meynert

260
Q

ADR of IV methylprednisolone therapy

A

corticosteroid psychotic disorder

261
Q

closed fracture in kid

A

abuse

262
Q

drug for anxiety that is safe during pregnancy

A

buspirone

263
Q

tx of tourette syndrome

A

antipyschotics 2nd gen Respiridone is an option

264
Q

illness anxiety disorder vs somatic disorder

A

illness anxiety disorder - more concerned with being sick rather then about their actual symptoms like somatic syndrome which are concurrent

265
Q

serotonin syndrome is typically caused by

A

drug drug interaction between SSRIs and MAO Is

266
Q

signs of pyschomotor retardation

A

quiet

rocking back and forth

267
Q

dx of narcolepsy

A

plysomnography

268
Q

tx of choice for OCD if no SSRI

A

TCA such as clomipramine

269
Q

OCD affect on brain

A

increased size of caudate nucleus and increased frontal lobe metabolism

270
Q

PET scan shows hypoactivity in the frontal lobs and hyperactivity in the basal ganglia - disorder = ?

A

schizophrenia

271
Q

positive symptoms - neuro trans and receptor

negative symptoms - neuro trans and receptor

A

pos = dopamine receptors

neg = muscarinic receptors

272
Q

bipolar is associated with increased levels of

A

NE and serotonin

273
Q

MDD is associated with

A

decreased NE, serotonin dopamin and REM latency

increased REM

274
Q

ADHD is associated with lower levels of

A

dopamine

275
Q

first symptom to disappear after treatment of ADHD is

A

hyperactivity

276
Q

tx of nightmares

A

prazosin

277
Q

inhalants effect on the brain

A

white matter changes

diffuse brain atrophy

278
Q

alcoholic withdrawal delusions tend to be more

A

visual than auditory

279
Q

tx of essential tremor secondary to lithium

A

propanolol

280
Q

increased amylase is found in what type of patient

A

purging vomiting patient

alcoholic with pancreatitis

281
Q

benztropine MOA

A

anticholinergic effect - restores ACh/Dopamine balance

used for EPS tx

282
Q

hydroxyzine

A

MOA - antihistamine - tx of anxiety and pruritus

283
Q

use for buprenorphine

A

tx of opioid dependence

284
Q

acetylcholinesterase inhibitors

A

donepezil and rivastigmine

tx of mild to mod dementia

285
Q

Memantine

A

NMDA antagonist - reduces glutamate

tx of mod to severe dementia

286
Q

conditons that mimic depression

A 
anemia
b12/folate def 
hypothyroidism 
hypoglycemia
hypercalcemia/hypocalcemia 
cushings/addisons 
parkinons
alzheimers
287
Q

before starting an SSRI what labs do you need to check

A

platelets - since SSRIs decrease platelet adhesion

Na - since SSRIs can decrease Na

288
Q

SSRIs with shortest half life

A

paroxtine

fluvoxamine

289
Q

longest half life SSRI

A

Fluoxetine

290
Q

which SSRI has the least drug drug interaction

A

citalopram

291
Q

ADR of venlafaxine

A

risk of increased BP - C/I in patients with untreated HTN

292
Q

tx of lewy body dementia

A

quetiapine

293
Q

atypical antipsychotics least associated with metabolic syndrome

A

ziprasidone

aripriprazole

294
Q

dielectival behavioral therapy is indicated for the tx of

A

borderline personality disorder to prevent splitting

295
Q

tourette syndrome brain involvement

A

basal ganglia involvment

impaired regualtion of dopamine in caudate

296
Q

loss of hypocretin

A

narcolepsy

297
Q

insomnia has a decrease in what receptor

A

GABA

298
Q

lithium drug drug interactions

A 
thiazides 
nsaids 
ace inh
tetracyclines 
metronidazole
299
Q

why are TCAs C/I in elderly

A

confusion
halucinations
irritability

300
Q

in a TCA overdose what determines the severity of the outcome

A

QRS prolongation length

301
Q

primary cause of NMS

A

dsyregulation of dopamine

302
Q

what type of psychotherapy is for PTSD pts

A

prolonged exposure

eye movement desensitization and reprocessing

303
Q

pancreatitis is an ADR to what drug

A

depakote

304
Q

DOC for atypical depression

A

MAO-Is

305
Q

DOC for melacholic depression

A

TCAs

306
Q

defense mechanism most commonly used by paranoid ppl

A

projection

307
Q

defense mechanism most commonly used by OCD ppl

A

undoing

308
Q

C/I to 4 pt restraints

A

pregnant women

309
Q

most common type of anxiety disorder

A

phobias

310
Q

most common comorbid condition with depression

A

anxiety

311
Q

GAD req in kids vs adults

A

kids - 1/6

adults 3/6

312
Q

first SSRI created

A

fluxoetine

313
Q

cotard syndrome

A

belief that one has lost their soul or is dead

314
Q

capgreass syndrome

A

family or ppl they know have been replaced by imposters

315
Q

fregoli syndrome

A

shapeshifter belief someone keeps changing into different ppl

316
Q

koro

A

south and east asia syndrome - anxiety that their penis will recede into the body leading to death

317
Q

what is the only relative C/I to ECT

A

recent acute MI

318
Q

mesocortical pathway

A

cognition

reward

319
Q

meslombic pathway

A

+ symptoms of schizophrenia

320
Q

nigostriatal pathway

A

EPS

parkinson symptoms

321
Q

tuberoinfundibular

A

sexual side effects

amenorrhea issues

322
Q

typical antipsychotic with the ADR of photosynesitivity

A

chlorpromazine

323
Q

typical antipsychotic with ADR of pigment retinopathy

A

thioridazine

324
Q

what are the only 2 drugs that reduce suicide

A

clozapine and lithium

325
Q

ADR of Ziprasidone

A

prolonged QT interval

326
Q

Lurisidone

A

atypical antipsychotic >13 y/o schizophrenia

adr - renal dsyfunction

327
Q

clonidine moa

A

alpha 2 antagonist

328
Q

RETT syndrome

A

deceleration of head growth and small hands and feet
seizures
normal function up to 5 months than regression begins

329
Q

uses for clonidine

A

ADHD
tourrette
opiod withdrawal

330
Q

risk factors for suicide

A 
white 
old 
man 
jew 
divorced/single
331
Q

atrophy of cingulate gyrus seen in

A

schizophrenia

332
Q

bupropion MOA

A

NE and dopamine reuptake inhibitor

333
Q

major tool of tx for psychoanalysis

A

interpretation of transferrence

334
Q

TCA - MOA

A

blok 5-ht and NE
alpha adrenergic blockade
antihistaminic
anticholinergic

335
Q

SSRI –> MSO-I washout period

A

2wks unless fluoxtine washout takes 5-6 weeks

336
Q

washout period from MAO-I to SSRI

A

2 weeks

337
Q

uses for duloxetine

A

diabetic neuropathy

fibromyalgia

338
Q

nefazodone

A

blackboxed

liver toxicity

339
Q

MC - ADR of buproprion

A

nervousness
HA
Insomnia

340
Q

normal lithium levels

A

0.8 -1.2

341
Q

how many days until you measure lithium levels or depakote levels

A

3 - for lithium

5- for depakote

342
Q

stroke patients are at highest risk for developing what mood disroder

A

depression along with pancreatic cancer patients

343
Q

what drugs are C/I in breast feeding

A

antidepressants

lithium

344
Q

defense mechanism that histrionic patients use

A

regression

345
Q

methadone

A

long acting opioid receptor agonist

ADR - prolonged QT

346
Q

most common finding in derlium aptients

A

impairment with recent memory

visual hallucinations and short attention spans are 2 other very common symptoms

347
Q

lithium reversible vs irreversible damage

A

thyroid damage = reversible

renal damage = irreversible

348
Q

stage I sleep EEG

A

theta waves

absent alpha waves

349
Q

stage 2 sleep EEG

A

k complexes

sleep spindles

350
Q

stage 3 sleep EEG

A

delta waves

351
Q

increased ACH associated with what sleep function

A

increased dreams

352
Q

increased serotonin = what sleep effect

A

increased sleep

353
Q

increased dopamine = what sleep effect

A

increased awakeness

354
Q

increased NE = what sleep effect

A

increased arousal

355
Q

increased GABA =

A

decreased sleep latency

decreased NREM 3

356
Q

zolpidems increase what

A

sleep walking

357
Q

over oxygenation of COPD patients can lead to

A

central sleep apnea

358
Q

OSA tx vs CSA tx

A

OSA tx = cpap

CSA tx = bipap

359
Q

abnormal labs seen in refeeding syndrome

A

fluid retention

decreased phosphorus Mg Ca

360
Q

complications of refeeding syndrome

A

arrhythmias
resp failure
delirium
seizures

361
Q

cortisol in anorexia nervosa

A

increased like depression

362
Q

dopamine does what to sexual function

A

increases libido

363
Q

serotonin does what to libido

A

inhibits sexual function

364
Q

tx of TCA overdose

A

sodium bicarbonate

365
Q

complications involved with catatonia

A

malnutrition - check albumin
DVT - tx with low molecular weight heparin
rhabdo - check cpk

366
Q

busprione is for

buproprion is for

A

buspirone is for –> anxiety

buproprion is for –> depression add on

367
Q

criteria for hospitlization for anorexia nervosa

A

BMI < 15

vital sign abnormalities

368
Q

first line tx of anorexia nervosa that doesnt require hosptilization

A

CBT

369
Q

tx for social anxiety disorder

A

SSRI/SNRI

Step 2 Rotation Cards (14 decks)

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