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Uworld/shelf > Psych > Flashcards

Psych Flashcards

1
Q

diagnosing GAD in adults

A

excessive uncontrollable worry about multiple issues for at least 6 months PLUS at least 3 of:

  • restlessness, feeling on edge
  • fatigue
  • difficulty concentrating
  • irritability
  • muscle tension
  • sleep disturbance
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2
Q

diagnosing GAD in children

A

same as adults (excessive worry for at least 6 months) but only need 1 additional symptom

*can manifest as need for perfectionism/order with difficulty coping when this is not attainable

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3
Q

for social anxiety disorder, performance only, when would you avoid prescribing benzodiazepines?

A
  • when performance could be impaired by sedation and cognitive effects (eg giving presentation, taking oral exam)
  • in patients with substance abuse
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4
Q

treatment of choice for Li toxicity

A

HD

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5
Q

what 2 meds can be used as adjuncts to antidepressants but never monotherapy?

A

aripiprazole, Li

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6
Q

what is a normal MoCA score?

A

> = 26

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7
Q

drug of choice for pediatric depression

A

fluoxetine

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8
Q

options to manage anti-psychotic induced Parkinsonism

A
  1. reducing dose of antipsychotic
  2. switch to antipsychotic with less potential to cause EPS
  3. add anticholinergic antiparkinsonian medication (eg benztropine, amantadine) when antispychotic medication is working well and there is concern for destabilizing pt w/ dosage reduction or switching to a new antipsychotic
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9
Q

what form of EPS is irreversible

A

tardive dyskinesia- lip smacking, tongue protrusion

switching to clozapine is an option

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10
Q

neuropsychiatric symptoms in Cushing syndrome

A
  • depressed or labile mood
  • anxiety, panic attacks
  • irritability
  • insomnia
  • memory deficits
  • fatigue
  • occasionally mania and paranoia
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11
Q

firstline drug for binge eating disorder

A

SSRI - sertraline

if pt can’t access psychotherapy or prefers meds

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12
Q

what should you counsel patients on before prescribing SSRIs?

A
  • common early side effects (insomnia/sedation, headache, dizziness nausea, anxiety)
  • late side effects (sexual dysfunction, weight gain)
  • avoid abrupt discontinuation (can lead to SSRI discontinuation syndrome - anxiety, dysphoria, flu-like symptoms)
  • response takes 4-6 weeks of continued use
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13
Q

tx MDD with psychotic features

A

antidepressant plus antipsychotic (ECT if severe suicidality or refusal to eat/drink)

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14
Q

differentiate dependent from borderline personality disorder

A

dependent pd: submissive. lack mood instability, impulsivity, and self-harm characteristic of borderline

borderline pd: also fear abandonment, but react with rage and demanding behavior.

while other personality disorders can have dependent features, depedent pd is differentiated by predominance of dependent behaviors w/o key personality characteristics of other disorders

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15
Q

nonstimulant options for ADHD

A

Atomoxetine is treatment of choice, nonaddictive

bupropion, TCAs, alpha-2 agonists

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16
Q

tx panic disorder

A

maintenance: SSRI and/or CBT
attack: benzo (should not be used in pts with suspected or h/o substance abuse)

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17
Q

which antidepressants have analgesic properties?

A

SNRIs

TCAs

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18
Q

how does alcoholic hallucinosis differ from DTs

A

alcoholic hallucinosis has rel stable vital signs, intact orientation. onset 12-48h after last drink.

DTs- confusion, HTN, fever, tachy, diaphoresis. onset 48-96h after last drink

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19
Q

what antidepressant is a/w hypertension

A

venlafaxine (dose dep)

BP should be monitored, esp at higher doses

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20
Q

treatment for borderline

A

dialectical behavior therapy

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21
Q

what neurotransmitters does MDMA affect?

A

incr serotonin, dopamine, NE

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22
Q

what strategies can reduce risk of relapse in schizophrenia?

A

educating pt and family about sxs and course of schizophrenia can reduce fam sress and conflict;

pts w/ critical, hostile or over involved families have higher risk of relapse

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23
Q

components of suicide risk assessment

A

Ideation

  • passive (wish to die, not waking up)
  • active (killing self)
  • freq, duration, intensity, controllability

Intent

  • strength of intent, ability to control impulsivity
  • determine how close pt has come to acting on a plan (rehearsal, aborted attempts)

Plan

  • specific details: method, time, place, means, preparations
  • lethality of method
  • likelihood of rescue
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24
Q

diagnostic criteria persistent depressive disorder (dysthymia)

A

chronic depressed mood >= 2 years

at least 2 of: appetite change, sleep change, low energy, low self-esteem, poor concentration, hopelessness

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25
Q

diagnostic criteria of adjustment disorder with depressed mood

A

onset within 3 months of identifiable stressor

marked distress and/or functional impairment

does not meet criteria for another DSM-5 disorder

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26
Q

diagnostic criteria borderline

A

pervasive pattern of unstable relationships, self image and affects, marked impulsivity with at least 5 of:

  • frantic efforts to avoid abandonment
  • unstable and intense interpersonal relationships
  • markedly and persistently unstable self image
  • impulsivity in at least two areas that are potentially self damaging
  • recurrent suicidal behaviors or threats of self mutilation
  • mood instability
  • chronic feelings of emptiness
  • inappropriate and intense anger
  • transient stress-related paranoia or dissociation
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27
Q

what second gen antipsychotics have the greatest risk of metabolic side effects?

A

clozapine, olanzapine

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28
Q

which second gen AP have the lowest risk of metabolic side effects?

A
  • aripiprazole
  • lurasidone
  • ziprasidone
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29
Q

TSH should be measured before and while taking __ (drug)

A

Lithium

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30
Q

structural abnormalities of orbitofrontal cortex and basal ganglia are a/w ___

A

OCD

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31
Q

features of cocaine withdrawal

A

minor physical sxs

  • depression, SI
  • fatigue, hypersomnia, hyperphagia
  • increased dreaming
  • impaired concentration
  • intense drug craving
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32
Q

firstline maintenance treatments for bipolar disorder

A
  • lithium
  • valproate
  • quetiapine
  • lamotrigine
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33
Q

drugs that can be used to suppress REM sleep (for significant cateplexy)

A

antidepressants

sodium oxybate

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34
Q

long term side effects of Li

A
  • hyperparathyroidism
  • nephrogenic DI
  • CKD
  • thyroid dysfunction
  • Ebstein anomaly
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35
Q

baseline labs before prescribing Li?

A
  • BMP (Cr, BUN)
  • UA
  • calcium (Li can cause hyperparathyroidism)
  • thyroid function tests
  • pregnancy test
  • ECG if risk factors for CAD (can cause dysrhythmias)
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36
Q

valproate side effect

A

neural tube defect

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37
Q

what mood stabilizers can cause stevens johnson syndrome

A

carbamazepine

lamotrigine

38
Q

what can cause Li toxicity

A

(decr renal perfusion = decr clearance)

  • dehydration
  • thiazides, ACEi
  • NSAIDs
  • tetracyclines
  • metronidazole
39
Q

bupropion is contraindicated in

A

bulimia

h/o seizures

40
Q

medical causes of psychosis to r/o in child or adolescent

A
  • SLE
  • metabolic or electrolyte disorder
  • thyroiditis
  • CNS infection
  • epilepsy
41
Q

how long should treatment be continued in remitted single episode of major depression?

A

6 months

if maintain complete remission at end of continuation phase, can gradually taper and discontinue the antidepressant

42
Q

When should you maintain 1-3 years of antidepressants?

A

pts w/ high risk of recurrence:

  • 2 or more episodes
  • persistent residual depressive symptoms
43
Q

when should antidepressant maintenance therapy be continue indefinitely?

A

pts w/

highly recurrent major depressive disorder
-3 or more depressive episodes

chronic episodes
-at least 2 years

severe episodes

strong family history

44
Q

switching SSRI to or from MAOI requires washout period of _

A

2 weeks

fluoxetine needs 5 weeks

45
Q

endocrine causes of anxiety

A
  • hyperthyroid, thyrotoxicosis
  • hypoglycemia
  • pheo
  • carcinoid syndrome
46
Q

neuro causes of anxiety

A 
epilepsy
migraines
brain tumors
MS
Huntington's
47
Q

metabolic causes of anxiety?

A

vit B12 deficiency
electrolyte abnormalities
porphyria

48
Q

respiratory causes of anxiety

A 
asthma, COPD
hypoxia
PE
PNA
PTX
49
Q

cardiac causes of anxiety

A

CHF
angina
arrhythmia
MI

50
Q

mnemonic to assess of anxiety is pathologic

A

SOD: Social or Occupational Dysfunction

51
Q

features suggestive of psychogenic non-epileptiform seizures

A
  • forceful eye closure
  • side-to-side head or body movements
  • rapid alerting and reorienting
  • memory recall of event

typically occur in front of witnesses
pt ma model behavior after a friend or relative w/ epilepsy

52
Q

which SSRI can cause dose dependent QTc prolongation?

A

citalopram (avoid post MI)

53
Q

what is Trazadone and what is it used for

A

antidepressant that is extremely sedating, used at low dose for sleep induction

can cause orthostatic HTN, problematic in elderly

54
Q

what tests should be monitored in pts taking Lithium

A

kidney and thyroid tests

55
Q

which second-gen antipsychotic a/w prolonged QTc at higher doses?

A

Ziprasidone

56
Q

NMS caused by

A

antipsychotics

57
Q

which is reversible, wernicke or korsakoff?

A

wernicke

58
Q

cause of Wernicke encephalopathy and symptoms

A

alcohol use disorder –> thiamine deficiency

classic triad: ataxia, confusion, oculomotor dysfunction

59
Q

neuropathologic findings in wernicke

A

mamillary body atrophy

dorsomedial thalamic neuron loss

60
Q

neuropathologic findings in korsakoff

A

lesions in anterior and medial thalami and corpus callosum

61
Q

most common psychiatric complication of MS?

A

depression

  • inflamm changes in brain
  • immune system changes
  • psychologic reactios to neuro deficits and challenges of living with MS
62
Q

differentiating parkinson’s disease dementia from lewy body dementia

A

parkinson’s symptoms predate cognitive impairment by > 1 year

63
Q

when are benzos less preferred in treating GAD tha persists despite SSRI

A

h/o using alcohol to self medicate

64
Q

CJD is aossicated w/ high ___ in CSF

A

14-3-3 protein

65
Q

high anti-Hu antibodies are seen in __

A

paraneoplastic encephalomyelitis (a syndrome a/w small cell lung cancer)

66
Q

when are high anti-NMDA receptor antibody titers seen

A

anti-NMDA receptor encephalitis

67
Q

substances that can induce depression

A

L-ABC

Levodopa
Alcohol
Beta blockers (esp propranolol)
Corticosteroids

68
Q

tx options for OCD

A

CBT

meds:

  • first line: SSRI
  • can also use Clomipramine (the most serotonin selective TCA)
69
Q

brain imaging changes in Huntington’s

A

caudate atrophy

70
Q

red flags for child abuse

A
  • delayed medical care for injury
  • inconsistent explanation of injury
  • mult injuries in various stages of healing

-spiral bone fx

  • bruising c/w with hand or belt
  • cigarette burns
  • head injuries
71
Q

what lab value abnormalities can be seen in NMS

A

leukocytosis

elevated CK

72
Q

probable diagnosis of CJD requires

A
  1. rapid progression of cognitive decline
  2. at least two of:
    - myoclonus! (often startle)
    - visual or cerebellar signs
    - pyramidal or extrapyramidal signs
    - akinetic mutism
  3. supportive findings from at least 1 diagnostic modaliy
    - periodic sharp waves on EEG
    - CSF with 14-3-3
    - lesions on putamen or caudate nucleus on MRI
73
Q

tourette’s first line tx? second line?

A

first line: alpha 2 agonists - guanfacine; clonidine (more sedating)

second line: antipsychotics

74
Q

normal QT interval

A

0.4 - 0.44 sec

75
Q

alzheimer’s affects what region of brain

A

nucleus basalis of meynert

76
Q

hemiballismus affects what region of brain

A

subthalamic nucleus

77
Q

auditor pathways are in what region of brain

A

medial geniculate nucleus

78
Q

kluver-bucy affects what region of brain

A

amygdaloid nucleus

79
Q

GAD symptom mnemonic

A

worry WARTS

worried
wound up (irritable), worn out
absent minded (concentration)
restless
tense
sleepless
80
Q

normal QRS interval

A

80-100 ms

81
Q

tx acute dystonia

A

benztropine

diphenhydramine

82
Q

tx akathisia

A

benztropine
benzodiazepine
beta blocker (propranolol) (likely works by blocking noradrenergic and serotonergic inputs on dpamine pathways)

83
Q

tx Parkinsonism

A

benztropine

amantadine

84
Q

tx Tardive dyskinesia

A

valbenazine

deutetrabenazine

85
Q

REM sleep behavior disorder is highly associated with __

A

underlying neurodegenerative disorders (parkinson’s, mult system atrophy, dementia with lewy bodies)

86
Q

___ is effective in treating most REM sleep disorders

A

clonazepam

87
Q

Risk factors for restless leg syndrome

A
  • Fe deficiency
  • other med comorbidities
  • meds (antidepr, antispych, dopamine blocking antiemetics, antihistamines)
88
Q

what can differentiate between depression vs pseudodementia

A

depressed pts are aware of their cognitive impairment

89
Q

essenial components of borderline that differentiate it from histrionic

A

negative self image

self-destructive behavior (self harm, suicide attempts)

90
Q

when should you try clozapine for schizophrenia

A

failed adequaet trials (6 weeks each) of two different antipsychotics

91
Q

firstline tx schizophrenia

A

SGA such as quetiapine, risperidone

Uworld/shelf (5 decks)

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