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PANCE Prep Pearls > Psych > Flashcards

Psych Flashcards

1
Q

schizophreniform disorder

A

schizophrenia sxs < 6 months

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2
Q

schizoaffective disorder

A

schizophrenia + mood disturbance (mania or depression)

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3
Q

schizophrenia symptoms

A

positive - hallucinations, delusions, disorganized speech & thinkings, abnormal behavior

negative - flat affect, avolition, social withdrawal, poor eye contact

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4
Q

schizophrenia treatment

A

1st line - 2nd gen antipsychotics (risperidone, olanzapine, quetiapine); dopamine and serotonin antagonists

2nd line - 1st gen antipsychotics (haloperidol, chlorpromazine)

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5
Q

“typical” 1st gen antipsychotics (names, MOA, s/e)

A

haloperidol, droperidol, fluphenazine, perphenazine, chlorpromazine, thioridazine

MOA - dopamine antagonists

S/E - extrapyramidal symptoms (rigidity, bradykinesia, tremor, akathisia; dystonic reactions (dyskinesia), tardive dyskinesia, parkinsonism)

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6
Q

“atypical” 2nd gen antipsychotics (names, MOA, s/e)

A

clozapine, quetiapine, olanzapine, loxapine

MOA - dopamine and serotonin antagonists

S/E - clozapine = agranulocytosis; lower incidence of EPS than 1st gen because their bind to dopamine receptors is weaker

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7
Q

risperidone (class, MOA, s/e)

A

class - benzisoxazoles

MOA - partial dopamine and serotonin receptor antagonist

s/e - EPS, increased prolactin

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8
Q

lithium (MOA, s/e)

A

MOA - increases NE and serotonin receptor sensitivity

s/e - hypothyroidism, hyperparathyroidism, increased urination and thirst, arrhythmias

**narrow therapeutic index; monitor level q 4-8wks

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9
Q

major depressive disorder

A

depressed mood or anhedonia w/ >= 5 associated symptoms almost every day for most of the days for at least 2 weeks with the symptoms causing clinical distress or impairment

tx - psychotherapy, meds (SSRIs 1st line - continue 3-6 wks to determine efficacy; SNRIs, bupropion)

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10
Q

seasonal affective disorder

A

presence of depressive symptoms at the same time each year

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11
Q

atypical depression

A

typical symptoms of major depression but patients experience mood reactivity (improved mood in response to positive events)

tx - MAOI

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12
Q

SSRIs (names, MOA, s/e)

A

names - citalopram (celexa), escitalopram (lexapro), paroxetine (paxil), fluoxetine (prozac), sertraline (zoloft), fluvoxamine (zyvox)

MOA - serotonin reuptake inhibitor

s/e - GI upset, sexual dysfunction, headache, serotonin syndrome

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13
Q

serotonin syndrome symptoms

A

neuro sxs - acute AMS seizure, coma, death

autonomic - restlessness, diaphoresis, tremor, hyperthermia, nausea, vomiting, abdominal pain, mydriasis, tachycardia

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14
Q

SNRIs (names, MOA, s/e)

A

names - venlafaxine (effexor), desvenlafaxine (pristiq), duloxetine (cymbalta)

MOA - serotonin, NE, and dopamine reuptake inhibitors

s/e - similar to SSRI, HTN

**useful in patients w/ significant fatigue or pain syndromes in association with depression

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15
Q

TCAs (names, MOA, s/e)

A

names - amitriptyline (elavil), clomipramine (anafranil), desipramine (norpramin), doxepin (sinequan), imipramine (tofranil), nortriptyline (pamelor)

MOA - serotonin and NE reuptake inhibitors

s/e - anticholinergic effects, severe toxicity w/ overdose, prolonged QT interval

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16
Q

bupropion (Wellbutrin) MOA, s/e

A

MOA - inhibits neuronal uptake of dopamine and NE

s/e - weight loss, agitation

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17
Q

MAOIs (names, MOA, s/e)

A

nonselective (MAO A & B) - phenelzine (nardil), tranylcypromine (parnate), isocarboxazid (marplan)

selective (MAO B) - selegiline (eldepryl); less chance of HTN crisis

MOA - inhibits monoamine oxidase, blocking the breakdown of neurotransmitters (serotonin, dopamine, EPI, and NE)

s/e - HTN crisis (must avoid tyramine-containing foods), serotonin syndrome

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18
Q

bipolar I disorder

A

> = 1 manic or mixed episode, often cycling with occasional depressive episodes

mania - abnormal and persistently elevated, expansive, or irritable mood at least 1 week (or requiring hospitalization) WITH MARKED IMPAIRMENT of social/occupational function (mood, thinking, behavior)

management - mood stabilizers (lithium 1st line; 2nd gen antipsychotics, 1st gen antipsychotics, benzos)

**antidepressants may precipitate mania

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19
Q

bipolar II disorder

A

> = 1 hypomanic episode + >= 1 major depressive episode

hypomania - period of elevated, expansive, or irritably mood at least 4 days which DOES NOT cause marked impairment, no psychotic features, and does not require hospitalization usually

management - antipsychotics, mood stabilizers (lithium), and benzos

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20
Q

persistent depressive disorder

A

chronic depressed mood > 2 years in adults (1 yr in children) that is usually milder than major depression (patients usually able to function); patient not symptom free for > 2 months at a time)

mgmt - psychotherapy, SSRIs

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21
Q

cyclothymic disorder

A

recurrent episodes of hypomanic symptoms cycling with relatively mild depressive episodes for at least a 2-year period in adults (1 yr in children); similar to bipolar II but less severe

mgmt - mood stabilizers and neuroleptics (similar to bipolar I)

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22
Q

panic attacks

A

not a disorder in and of itself but a feature of many different anxiety disorders

episode of intense fear or discomfort that develops abruptly, usually peaks w/in 10 minutes, and usually lasts < 60 minutes

mgmt - benzos

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23
Q

panic disorder

A

recurrent, unexpected panic attacks (>=2) with at least one of the following occurring for at least one month: attack followed by concern about future attacks, worry about the implication of attacks (losing control), or significant change in behavior related to the attacks

mgmt - SSRI, CBT, benzos for acute attacks

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24
Q

generalized anxiety disorder

A

GAD - excessive anxiety or worry a majority of days >6 month period about various aspects of life

mgmt - SSRIs, psychotherapy

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25
Q

social anxiety disorder

A

persistent (>6 mo) intense fear of social or performance situations in which the person is exposed to scrutiny of others for fear of embarrassment

mgmt - SSRI, BB for performance anxiety, psychotherapy

26
Q

specific phobias

A

persistent (>6mo), intense fear/anxiety of a specific situation, object, or place in which the phobic object or situation is actively avoided or endured with intense fear or anxiety so as to impair everyday activities with distress or avoidance

mgmt - exposure/desensitization therapy

27
Q

PTSD

A

> =1 (lasting >1mo) re-experiencing event (>1mo as repetitive recollections and dissociative reactions), avoidance of stimuli associate w/ the traumatic event, negative alterations in cognitions and mood, arousal & reactivity

mgmt - SSRIs, CBT

28
Q

acute stress disorder

A

similar to PTSD but sxs lasting <1mo

mgmt - couseling/psychotherapy; treat as PTSD if persistent

29
Q

adjustment disorder

A

emotional or behavioral reaction to an identifiable stressor (job loss, physical illness, leaving home, divorce, etc.); marked distress out of proportion to the severity of stressor and/or significant impairment in areas of functioning

mgmt - psychotherapy; meds not preferred

30
Q

dissociative identity disorder

A

presence of >= 2 distinct identities or states of personalities

mgmt - psychotherapy

31
Q

depersonalization/derealization disorder

A

persistent feelings of detachment or estrangement from oneself and/or surrounding environment

reality testing is intact and symptoms cause distress

mgmt - psychotherapy

32
Q

dissociative amnesia

A

inability to recall personal/autobiographical information; causes significant impairment in functioning

mgmt - psychotherapy

33
Q

obsessive compulsive disorder

A

combination of thoughts (obsessions) that are inappropriate, intrusive, and unwanted and behaviors (compulsions) that often interfere with patient’s lifestyle and are time consuming

major patterns - contamination, pathologic doubt, symmetry/precision, intrusive obsessive thoughts

mgmt - SSRIs, CBT

34
Q

body dysmorphic disorder

A

excessive preoccupation that >1 body part is deformed or an over-exaggerations of a minor flaw, often causing patient to have functional impairment

mgmt - SSRI, psychotherapy

35
Q

somatic symptom disorder

A

(formerly somatization disorder)

one or more vague somatic symptoms that are distressing or result in significant disruption of daily life, with symptoms not explained by a physical or medical cause

mgmt - regularly scheduled visits to a healthcare provider

36
Q

illness anxiety disorder

A

(formerly hypochondriasis)

preoccupation with the fear or belief one has or will contract a serious, undiagnosed disease; somatic symptoms not usually present

mgmt - regularly scheduled visits to healthcare provider

37
Q

functional neurological symptom disorder

A

(conversion disorder)

neurological dysfunction (motor or sensory) suggestive of a physical disorder that cannot be explained clinically; symptoms cause significant distress or impairment and tend to be episodic, recurring during times of stress

mgmt - psychotherapy

38
Q

factitious disorder

A

intentional falsification or exaggeration of signs and symptoms of medical or psychiatric illness for primary gain (assuming the sick role to get SYMPATHY)

mgmt - nonspecific treatment

39
Q

malingering

A

intentional falsification or exaggeration of s/s of medical or psychiatric illness for secondary gain (financial, food, shelter, avoidance of prison/school/work, to obtain drugs, etc.)

40
Q

obesity

A

BMI >30kg/m2 or body weight >=20% over ideal weight

mgmt - behavior modification, meds (orlistat, lorcaserin)

41
Q

anorexia nervosa

A

refusal to maintain a minimally normal body weight (patient is UNDERWEIGHT; BMI <17.5) and has a morbid fear of fatness or gaining weight; restrictive type or purging type

mgmt - medical stabilization, psychotherapy, pharmacotherapy if depressed

**refeeding syndrome - watch for hypophosphatemia which occurs if refed too quickly (phos driven into cells)

42
Q

bulimia nervosa

A

binge eating (at least weekly x 3mo) with compensatory behavior (purging or non-purging); patients have NORMAL weight or are overweight

mgmt - psychotherapy, pharmacotherapy (fluoxetine has been shown to reduce binge-purge cycle)

43
Q

schizoid personality disorder

A

voluntary social withdraw, anhedonic introversion, hermit-like behavior, inability to form relationships, prefers to be alone

mgmt - psychotherapy

44
Q

schizotypal personality disorder

A

odd, eccentric behavior and peculiar thought patterns (magical thinking but without psychosis (delusions)); pervasive discomfort with close relationships

mgmt - psychotherapy

45
Q

paranoid personality disorder

A

pervasive pattern of distrust and suspiciousness of others; preoccupation with doubt regarding the loyalty of others

mgmt - psychotherapy

46
Q

antisocial personality disorder

A

inability to conform to social norms with disregard and violation of the right of others; pattern of criminal behavior

may begin in childhood as conduct disorders but must be >=18 to diagnose

mgmt - psychotherapy

47
Q

borderline personality disorder

A

unstable, unpredictable mood and affect; extreme pattern of instability in relationships, fear of abandonment, black and white thinking, impulsivity in self-damaging behaviors

mgmt - psychotherapy

48
Q

histrionic personality disorder

A

overly emotional, dramatic, seductive, attention-seeking; need to be the center of attention; often inappropriate, sexually provocative, seductive

mgmt - psychotherapy

49
Q

narcissistic personality disorder

A

grandiose, often excessive sense of self-importance but needs praise and admiration (fragile self-esteem)

mgmt - psychotherapy

50
Q

avoidant personality disorder

A

desires relationships but avoids them due to inferiority complex (timid, shy, lacks confidence)

mgmt - psychotherapy

51
Q

dependent personality disorder

A

dependent, submissive behavior; constantly needs to be reassured, relies on others, will not initiate things

mgmt - psychotherapy

52
Q

obsessive-compulsive personality disorder

A

perfectionists who require a great deal of order and control, preoccupied with minute details

mgmt - psychotherapy

53
Q

autism spectrum disorder

A

social interaction difficulties, impaired communication, and restricted/repetitive/stereotyped behaviors

54
Q

oppositional defiant disorder

A

persistent pattern of negative, hostile, and defiant behavior towards adults

at least 6 months of angry/irritable mood, argumentative/defiant behavior, and vindictiveness

mgmt - psychotherapy

55
Q

conduct disorder

A

persistent pattern of behaviors that deviate sharply from the age-appropriate norms and violate the rights of others; social and academic difficult

4 main areas - serious violations of laws, aggressive/cruel to animals, deceitfulness, and destruction of property

**40% develop antisocial personality disorder

56
Q

ADD and ADHD

A

hyperactivity, impulsivity, and/or inattentiveness leading to impairment; must have onset before 12 y/o, be present for at least 6 months, and symptoms must occur in at least two settings

mgmt - behavior modification, sympathomimetic meds (stimulants; ritalin, adderall), non-stimulants (atomoxetine)

57
Q

sympathomimetic medications (names, MOA, s/e)

A

methylphenidate (ritalin), amphetamine/dextroamphetamine (adderall)

block NE and dopamine reuptake, increase release of NE and dopamine in extraneuronal space

s/e - anxiety, HTN, tachycardia, weight loss, addiction

58
Q

alcohol dependence (CAGE questions, treatment)

A

CAGE - cutdown, annoyed, guilt, eye opener

tx - psychotherapy, disulfiram (antabuse; produces uncomfortable symptoms when couples with alcohol intake)

59
Q

strongest predictive factor of suicide

A

previous attempt or threat

60
Q

population with highest suicide rate in US

A

elderly white men

61
Q

normal grief reaction

A

DABDA - denial, anger, bargaining, depression, acceptance

resolves w/in 1 year

patient may have illusions/hallucinations but perceives these as not being real

62
Q

abnormal grief

A

severe symptoms, continued symptoms after 1 year, positive suicide ideation

illusions/hallucinations that patient perceives as being real

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