Psych Flashcards
Pathology in Korsakoff’s
Hemorrhage + sclerosis in mammillary bodies, thalamic nuclei
Diffuse lesions in brainstem, cerebellum, limbic system
CBT vs SSRI in generalized anxiety discord (effectiveness)
CTB is as effective as SSRI
Rx of generalized anxiety
SSRI: paroxetine, escitalopram
SNRI: duloxetine, venlafaxine
SSRI/SNRI vs Benzo vs Buspirobe for generalized anxiety
SSRI/SNRI more effective
Defense mechanism in borderline personality
Splitting
Alzheimer’s develops psychotic Sx (hallucinations / delusions)
Anti-psychotics
Risperidone
Dx borderline personality
5/8:
- impulsive
- unstable relationships
- anger
- moody
- self-damage act
- can’t accept loss
- emptiness
- Boredom
Cocaine intoxication Sx
Sympathetic (tachycardia, HTN, sweating, mydriasis)
+/- paranoia, psychosis
Freud’s psychosexual development
- Oral phase:
0-18 mo
Stimulating mouth
Put anything in mouth - Anal phase:
18-36 mo
Pleasure in anal area
Control bowels - Phallic phase:
3-6 yr
Manipulation of genitals = 1ry source of pleasure. - Latency phase:
6- puberty
Connections to siblings, other children/adults - Genital phase:
> puberty
Relationship w/ opposite sex
Focused on genital area
SE of haloperidol (48hr)
Rx?
Acute dystonia (torticollis)
It’s reversible EPS
Due to DA blockade at nigrostriatial
Rx with benzotropine
Non-pharm Rx of insomnia
CBT to change believes, techniques, attention shift
Amphetamine toxicity.
High DA + NE Hallucinations + delusions Paranoia Low appetite Activity w/ fatigue
Conversion disorder population
Women
Histrionic personality
Sexual abuse
Conversion disorder
Lack of concern regarding extreme decline in health.
Start suddenly after stress and ends suddenly
Not produced intentionally
Population at risk of suicide
Elderly white men Single Unemployed , low income Mental illness Hx is abuse (sexual / physical) Hx of suicide thoughts FHx of suicide attempts
Schizophrenia Schizophreniform Brief psychotic Schizoid personality Schiozoaffective
Schizophrenia = 6 mo Schizophreform = 1-6 mo Brief psychosis = < 1 mo Schizoaffective = psychosis + mood Schizoid PD = social withdrawal + no desire for relationships
What’s discontinuation syndrome
After stopping SSRI Anxiety Influenza like Diarrhea + GI upset Insomnia, hyperarousal, lightheaded Vertigo, tremor, paresthesia
Lasts 7 days if stop SSRI after 6wk use.
T/F: adults w/ ADHD impulsive + hyperactive as compared to kids
F
Patient w/ anorexia
Sever dehydration + orthostatic hypotension + electrolyte imbalance?
- Would you search pt belongings? Why?
- Confirm she’s on Rx (contact professionals)
Yes!
Pts w/ eating disorders use laxative & diuretics
Facility must be informed to look for contraband.
What’s Cognitive behavioral Rx?
Recognize + correct false self-beliefs
What’s dialectical behavioral Rx?
Part of psychoanalysis/psychodynamic Rx that
Teach patient to analyze what leads up to a problem and identifies alternatives.
Rx of Tourette’s
Anti-DA
Clonidine
Pimozide
Types of delusions
- Nihilism
- Persecutory
- Grandeur
- Somatic
- Reference
- Nihilism = belief that aspects of life are meaningless or non-existing
E.g. Going to work is pointless b/c world is coming to an end
Or no one is real or arm is dead - Persecutory = others trying to harm him
- Grandeur =inflated sense of self
- Somatic = belief they have physical defect / disease.
My brain is melting - Reference = publicly known figures refer to him directly
Percentage of smokers succeed in quitting
2-3%
T/F: genetics influence smoking persistence
T
What neuro system involved in reinforcing effect of nicotine
Mesolimbic
Percentage of population that experiment w/ smoking
55%
Hallmark of PCP (phenocyclidine) intoxication
Rotary nystagmus
Dx psychogenic seizure
Video-electroencephalograph VEEP
Cyclothoymia vs dysthymia
- Cyclo: hypomania + mini depressive Sx for 2 years
2. Dysthymia: persistent mild depression
Hypnagogic vs hypnopompic hallucinations
Hypnoagogic: during sleeep
Hypnopompic: waking up
DOC delirium tremens
IV benzo (lorazepam
Use IM if > 65 YO
DOC panic disorder
SSRI
Involuntary admission?
- Mental illness needs inpatient care
2. Danger to safety of patient or others.
Tourette associated w/?
OCD
ADHD
What’s sublimation
Transform negative emotion to positive action
T/F: imipramine has sigmoidal relationship b/w plasma level and response
T
T/F: nortriptyline has sigmoidal relationship b/w response and level
F = Curvilinear
MOA of MAOi
Stop degradation of monoamine transmitters and increase their levels
(Serotonin, norepi, dopamine)
MOA of typical antipsychotic
Risperdione + clozapine
Dopamine antagonist
SE of clozapine (typical antipsychotic)
Agranulocytosis
Risk for delirium in hospitalized pts
Vision / hearing impairment
Panic disorder associated w/
Depression
Anxiety
Agoraphobia
Asthma + social phobia
SSRI
When to stop antidepressants
3 month for Rx
6 mo after Rx maintenance
Bipolar on lithium develops hypothyroidism
Start replacement
Don’t stop lithium
Limbic system dz
Emotional disturbance
How Dx alcoholism
Ask about problem by alcohol
MAOi
Phenelzine
Tranylcypromine
Serotonin syndrome Sx
Anxiety + agitation + restless
HTN, tachy, fever, sweat, shiver
Hyperreflexia, tremor, rigidity
Rx serotonin syndrome
Stop all med
+/- benzo if anxious and agitated
+/- Cyproheptadine
SSRI + tramadol = ?
SSRI + tramadol = serotonin syndrome
MAOi + tamadol = serotonin syndrome
Maintenance drugs for bipolar
Lithium
Lamotrigine
Aripiprqzole
Olanzapine
Child with ADHD has future risk of
Social withdrawal
Substance abuse
Accident proneness
Normal adult functioning
T/F: D/C SSRIs ass. w/ high rate of relapse
T
Signs of marijuana abuse
Fatigue
Lethargy
Somnolence
What’s reaction formation
Coining extreme opposite
Autism spectrum disorder
Repetitive behavior + normal language
Absolute contraindication to electroconvulsive Rx
None
Relative = recent cerebral hemorrhage, ICP
T/F: 2/3 of suicide death at 1st attempt
T
T/F: risk of suicide is higher in blacks
F: whites
Are SSRIs save in kids?
Yes 8-18 Yrs
SE of long term lithium
Nephrogenic DI
T/F: electroconvulsive therapy causes irreversible memory loss
F: reversible
Depression on SSRI => agitation , insomnia , sexual SE?
Rx with Mitrazpine = helps sleep , no agitation , rarely sexual. Helps appetite
NB: bupropion cause agitation!
Labs w/ lithium
Renal + thyroid
Akathisia
Motor restlessness
SE of anti-psychotics
Rx of neuroleptic syndrome
D/C med
Dantrolene
+/- bromocriptine
+/- amantadine
MOA of resperidone + SE
Dopamine D2 receptor blocker
High prolactin
T/F: phenelzine interacts with st Johns wort and
T
Levels become unpredictable
Anti depressant worsen HTN
Venlafaxine
Damage to parietal lobes (Rt + Lt)
Rt = contralateral hemi-neglect , dent deficit (anosagnosia)
Lt = Gerstmann’s syndrome = Rt-Lt confusion, can’t write, bad math
How to prevent benzo dependence
Use for short time
How are Atypical antipsychotics better than typical?
Cause less tardive dyskinesia
Sx suggestive of major depression
Withdrawal from family
T/F: anorexia nervosa causes: Bradycardia HTN Parotid gland Atropine breast Dental caries
T F T T T
MC SE of TCA?
Dry mouth
What neurotransmitters decreased in depression
Serotonin
NE
Dopamine
Mature defense mechanisms
In healthy adults:
1. Altruism = service to others to experience empathy.
- Anticipation = palming for future discomfort.
- Asceticism = deny pleasure from experience.
- Humor = express feelings in comic way
- Suppression = postpone attention to impulse.
Neurotic defenses
- Control = manage events to reduce inner conflicts.
- Displacement = shift emotions
- Externalizations = attribute personal matters to external world.
- Inhibition = limit function to avoid anxiety.
- Intellectualization = intellectual processing to avoid experiencing affect.
- Isolation = separate Sth from associate affect.
- Rationalization = rational explanation to justify action
- Dissociation = modification of sense of self
- Reaction formation = transforming unacceptable impulse into opposite
- Repression = remove idea from conscious
- Sexualize = bestowing sexual importance to objects
Immature defense
- Acting out = impulsive action.
- Block = block thought / impulse
- Hypochondriasis = exaggerate illness to avoid situations.
- Introjection = victim identity w/ aggressor
- Passive-aggressive
- Regression
- Somatization = unconscious expression is psychotic pain in physical Sx.
Psychotic defense
Denial = replace reality w wishes.
Distortion = reshaping reality
Projection =
Is bupropion used in panic attacks? Why?
No.
stimulating effect
Drugs contraindicated with lithium
Thiazides
ACEI
NSAIDs
Antipsychotic causes high glucose
Olanzapine
Clozapine
What antipsychotic cause withdrawal if stopped abruptly?
Venlafaxine (?) short half life and rapid clearance if D/C
Mood stabilizers used in maniac episodes
Lithium
Valproic acid
Carbamazepine
Monotherpay induces mania in Bipolar
Fluoxetine
What’s Tarasoff decision
Inform authorities when patient show intent towards a person
Keep patient in office till safe disposition is made
Neurotransmitter in OCD?
Serotonin
How to shift safely from MOAi to SSRI
Allow for 2 wk wash out period between stopping MOAi and starting SSRI
T/F: repeated episodes of alcohol withdrawal increase risk of future Sx?
T
Milieu therapy
Inpatient Rx
Use hospital environment as therapeutic intervention.
SE of olanzapine
High TG
Agranulocytosis
Dry mouth (xerostomia)
Tardive dyskinesia
Panic disorder + BPH
No TCA
Use SSRI
Addiction vs pseudo-addiction
Pseudo is how patients behave when pain is under treated and resolve completely when pain is effectively Rx.
What schizophrenic Sx respond well to anti psychotics
Positive Sx
Delusions
Hallucinations
Disorganized speech
T/F: antipsychotic don’t cause urinary incontinence
T
MAOi contraindicated with what food
Aged cheese
Aged wine
High Tyramine
1st line in ADHD
Methylphenidate
Dextroamphetamine
Pemoline
Does ADHD cause intellectual disability
No
Psychotherapy for panic disorder
CBT
Cause of seasonal affective
Serotonin
Melatonin in seasonal affective
Worsens Sx
SE of methylphenidate in ADHD
HTN Tachycardia Insomnia Headache Anxiety Growth suppression
MCC of delirium
Dementia
SE of antipsychotic + Rx
- Parkinsonism
Tremor, Bradykinasia, micrographia
Rx: low dose, shift to atypical, anti-cholinergic
Anticonvulsant for mania
Valproic acid
Carbamazepine
When dose delirium termens start + how long last
Start 3-7 days after stopping
Last 7-10 days
% of alcoholic develop DT
Death from DT
5%
Death 35% if untreated + 5% of Rx
Pacing in Alzheimer’s not Rx with anti cholinesterase
No additional Rx
Deal with paranoid patient
Explain diagnosis + Rx in details
Professional not too friendly
Piaget’s Stage of cognition
- Sensorimotor 0-2 Yrs
Explore via sensation + motor contact
Separation anxiety
2. Pre-operational 2-6 Symbols (words + images) No logics Pretend Egocentric
- Concrete operational 7-12
Logical about concrete objects
Add + subtract
Understand conversation - Formal operational >12
Reason abstractly
Hypothesize
What’s schizophrenia drift
Schizophrenia patient move to cities + become urban poor
It’s not urban poor that cause the disease it’s where patients end up
What’s biopsychosocial
Approach patient in biological psychological social manner
Drugs cause depression (15)
Isotretinoin Alcohol Disulfiram Anticonvulsant: Metho + ethosuximide Barbiturates: phenobarb + secobarb Benzo: BB: metoprolol, atenolol, carvedilol Bromocriptine CCB Estrogen HRT Fluoroquinolones Interferon-alpha Opioids Statins Acyclovir
Triad in Tourette’s
Tourette’s
OCD
ADHD
Tourette’s population
Males (9x more )
Rx Tourette’s
Alpha2-adrenergic = clonidine (less efficacy, less SE)
Dopamine antagonist: Haloperidol + pimozide (more effective, more SE)
Cardiac side effect of anti-psychotic
QT prolongation
Torsades de pointes
Anti-psychotics cause hypertensive encephalopathy
TCA + MAOi
Tyramine + MAOi
How to safely shift from one antipsychotic to another
Gradual reduction in dose of 1st drug then overlap with the 2nd drug before completely stopping the 1st one.
Rx of seasonal effective
early morning light therapy
T/F: Mania could be a Sx of MS
T
Is stammering ass with conversion disorder
No
Premenstrual dysphoric disorder Rx
Mood disorder
Fatigue
Insomnia
During luteal phase lead to missing work.
Rx: SSRI
Trazodone sexual SE
Priapism
Rx of bulimia
SSRI esp. fluoxetine
Tardive dyskinesia high risk population
Females
Older age
Hx or FHx of mood disorders or affective disorders.
Multiple antipsychotics
How to deal with borderline personality clinic setting
Maintain caring but detached stance.
Combine conflict resolution + social learning to minimize aggression
Be constantly available on phone
Frequent visits to monitor and provide support.
When explaining to borderline personality;
- Detailed + technical
- Simple + clear + non technical
Simple
Do you prescribe drugs for borderline? Why?
No
Use it to self-harm themselves.
Drug contraindicated with MAOi (analgesics)
Meperidine
Tramadol
Goal of Rx in anorexia nervosa
Prevent death from malnutrition
DOC in alcohol withdrawal
Short-acting benzo (liver impairment = short)
Smoking withdrawals
Impaired concentration Longing for cigarette Headache Insomnia Irritability Inc. appetite
TCA poisoning
Sx in 2 hrs. Palpitations + chest pain Low BP Altered LOC Resp. depression => acidosis + low O2
Drugs cause mania
Definitive: Levodopa Steroids + anabolic steroids MAOi TCA
Risky: Benzo Amphetamine Cimetidine Captopril Thyroxin Methylphenidate
Psychiatric disease with T1DM?
Adjustment disorder + MDD
Rx of delirium in ICU
IV haloperidol increase dose q3min
Rx of social phobias
SSRIs
Anti depressant doesn’t cause weight gain
Bupropion
Anti depressant cause weight gain
Mirtazapine > SSRIs (paroxetine > fluoxetine)
% of elderly with depression
20% in community
40% in nursing homes
T/F: TCA contraindicated in elderly
True cause postural hypotension + falls.
What’s transvestism
Dressing and acting in manner of opposite sex
When does transvestism start?
Common in M or F?
Do they seek help?
Starts late childhood
M > F
Don’t present for Rx
SE of amphetamine for ADHD
Transient insomnia + weight loss
Bipolar 1 vs 2
1: mania + depression
2: hypomania + depression
What’s not considered conversion according to DSM 5
Sx limited to pain or sexual dysfunction
OCD risk in monozygotic twins?
Negligible
OCD more in M or F?
F (adults + kids)
Shortest half life benzo?
Alprazolam (xanax) 12 hrs.
Body dysmorphic asso
OCD
Social phobia
Delusional disorder
SSRI in elderly
Risk of falls
Activated charcoal helps in 90% of toxins except?
Iron Lithium Fluoride Cyanide Alkali
Sleep terror vs nightmare
Sleep terror = can’t remember nightmares
Nightmare = remember
Anxiety vs OCD
Compulsions in OCD only.
MC neuro SE of SSRI
Insomnia > headache
What personality doesn’t learn form experience + or feel guilt
Antisocial
Atypical depression Sx
Worst in morning and better at evening (diurnal variation in mood)
When is MAOi DOC?
Atypical depression
Rx of serotonin syndrome
Cyrproheptadine
Sleep abnormality in depression
Decreased REM latency
What’s paraphilia? Example
Sexually arousing fantasies
Fetishism
Exhibitionism
Sexual sadism
Transvestism
T/F: Homosexuality is not paraphilia
T
MC endocrine SE of lithium
Hypothyroid > DI
Bupropion is contraindicated in?
Anorexia / bulimia
Seizures
Alcoholism
Hallucinations in narcolepsy
At sleep (hypnogogic) On wakening (hypnopompic)
How to establish rapport?
Ask about feelings
How do disulfiram + Naltrexone work in alcoholism
Disulfiram = accumulates acetaldehyde
Naltrexone = decrease cravings
In bipolar when does mania recur if lithium stopped
6 mo
Most effective mono therapy in alcoholism
Chlordiazepoxide
Risk of schizophrenia in monozygotic
40%
Anti depressant avoid in anorexia nervosa
MAOi (phenelzine)
dietary restrictions
T/F: lanugo hair in anorexia
T
Donepzil SE
Arrhythmia needs pacemaker
Rx of sducidal ideation
Hospital admission
What overdose is more fatal?
Benzo or amitriptyline
TCA > benzo
T/F: opiates cause constricted pupils
True
Opiates: heroine, hydrocodone, oxycodone, hydromorphone, oxymorphone
Atypical cocaine dependence
Mood swings
Snorting (inflamed nares : big turbinates)
Paranoia
Dr reminded of relative by a patient?
Countertransference
Patient sexually attracted to Dr
Transference
T/F: Depression in kids presents as antisocial behaviors
T
T/F: kids with depression will have schizophrenia as adults
F
Psychosis + Parkinson’s Rx
Atypical antipsychotics: queitapine + clozapine
OBGYN SE of antipsychotics
Typical antipsychotic (risperidone) Block dopamine = high prolactin = amenorrhea, infertility, galactorrhea
Criteria for somatic symptom disorder
Somatic Sx Excessive thoughts ass. with the Sx => seriousness of Sx => anxiety about general health => time + energy to figure out Dx
Rx of narcolepsy
Methylphenidate
Childhood gender identity disorder starts at? How?
Age 2
Kids cross-dress + opposite gender games
Hate their genitals
Bupropion in panic disorder
Not effective
Drugs for methamphetamine dependence?
None affective
Cognitive Rx only
School phobia vs truancy
Truancy: leave home but skip school
Phobia: Sx every morning disappear at weekends
Agitated with Hx of dystonia
Benzo vs haloperidol
Benzo
Benzo with shortest elimination half life
Triazolam
Flooding vs grader exposure Rx in phobia
Flooding: exposed and asked to reintegrate the subject, and remain there till anxiety resolve
Exposure: showing picture then going there
Capgras syndrome in psych
Patient thinks person replaced by exact double that acts exactly like original
Rx PTSD (psych)
SSRI
Benzo (acute)
Atypical antipsychotics (quetiapine, olanzapine, risperidone)
To diagnose adult ADHD
When should Sx start?
Since childhood
Earliest SE of lithium
Tremors
Valproic acid vs carbamazepine in bipolar
Valproate for maniac episodes
Carbamazepine if multiple maniac episodes, mixed or rapid cycling
Which SSRI doesn’t cause D/C syndrome
Fluoxetine
Bcz long 1/2 life of 4-6 days
ID, Ego, superego
ID:
Since birth
Unconscious = primitive + instinctive
Ego:
Based on reality
Satisfied ID in realistic ways
Superego:
Morals + standards
Acquired from parents, society and sense of right.
Drug not helpful in tardive dyskinesia
Haloperidol
Vitamin E in tardive dyskinesia
Short duration of benefit
Metabolic SE of valproate
High ammonia due to low carnitine
Dx. Replace carnitine
Insomnia in depression on SSRI
Trazdone or zolpidem
Delirium tremens in >65 Rx
Short acting benzo (lorazepam)
Cough / URTI drug causes serotonin syndrome if used with SSRIs
Dextromethoephan
Level of intellectual disability:
Symbolic communication
Understand gesture + emotions
Express non verbally
Profound