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EOR - Emergency Medicine > Psych/Behavioral Med > Flashcards

Psych/Behavioral Med Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

anxiety d.o to know

A

GAD: 6 mos
panic d.o: >/= 1 mo
phobias

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2
Q

-recurrent, unexpeted panic attacks with at least 1 month or more of worry or avoidant behavior
+/- agorahobia
-sx develop abruptly and reach a peak w.in 10 min

A

panic disorder

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3
Q

tx for agoraphobia

A

SSRI
CBT

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4
Q

bipolar related disorders

A

bipolar I: mostly mania
bipolar II: mostly dpn, hypomania
cyclothymic

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5
Q

hypomania alternating w. long standing dysthymia x 2 years

A

cyclothymic d.o

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6
Q

squandering savings
destroying relationships
neglecting work

A

bipolar I

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7
Q

first line tx for bipolar I

A

lithium

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8
Q

tx for bipolar I

A

acute mania: lithium, valproate, SGAs
mania maintenance: SGAs, gabapentin, lamotrigine
agitation: haldol, risperidone, benzo

fam/group/CBT

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9
Q

hypomania is defined as

A

-not severe enough to cause marked impairment in social/occupational functioning
-no hospitalization
-no psychotic features

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10
Q

tx for bipolar II

A

quetiapine vs olanzapine + fluoxetine
fam/group therapy/CBT

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11
Q

less intense, longer acting form of bipolar

A

cyclothymia

highs and lows, but never as severe as mania or major dpn

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12
Q

4 types of depressive disorders

A

mdd
persistent depressive d.o (dysthymia)
premenstrual dysphoric d.o
suicidal/homicidal behaviors

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13
Q

mdd is _ or more of significantly depressed moods

A

2 weeks

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14
Q

persistently depressed mood w. low self esteem, withdrawal, pessimism, or despair x at least 2 years w. no absence for more than 2 months

A

persistent depressive d.o (dysthymia)

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15
Q

significant dpn and related sx during the week before menstruation

A

premenstrual dysphoric d.o

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16
Q

mood d.o, somatic complaints, feeling hopelessness, worthlessness, helplessness

A

suicidal/homicidal, behaviors

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17
Q

dsm 5 for mdd

A

5 or more sigecaps >/= 2 weeks, nearly every day - at least one sx is depressed mood or anhedonia

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18
Q

what does sigecaps stand for

A

sadness
interest/anhedonia
guilt
energy
concentration
appetite
psychomotor activity
suicidality

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19
Q

how do you uptitrate SSRIs

A

increase dose q 3-4 weeks until sx are in remission

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20
Q

30 yo M feeling down most of the time x 3 years - frequent intruisive thoughts of inadequacy despite success - he tries to overcompensate by taking on more than he can handle, which leads to failure and furthers feelings of inadequacy

A

persistent depressive d.o (dysthymia)

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21
Q

with dysthymia, the pt never experiences

A

mania/hypomania

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22
Q

dsm 5 premenstrual dysphoric d.o

A

-at least 5 sx the final week before onset of menses
-improve w.in a few days after onset of menses -
-resolve in the week post menses

one or more must be present:
-affective lability
-interpersonal conflicts
depressed mood
-anxiety
-decreased interest
PLUS
one or more:
-difficulty concentrating
-lethargy
-change in appetite
-insomina
-overwhelmed
-physical (bloating, breast tenderness etc)

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23
Q

tx for premenstrual dysphoric d.o

A

-SSRIs continuously vs week prior to menses
-OCP
-diuretics
-SNRI
-GnRH

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24
Q

SNRIs are esp useful for premenstrual dysphoric syndrome when symptoms are mostly

A

psychological

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25
Q

2 sx of GnRH

A

bone loss
vasomotor sx

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26
Q

6 rf for suicide

A

male
older
mdd
active SUD
chronic conditions
recent loss (employment, relationships, death)

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27
Q

acute cognitive dysfxn 2/2 underlying medical condition - reversible

A

delirium

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28
Q

mc type of hallucination associated w. delirium

A

visual

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29
Q

pt’s esp high risk for delirium

A

post surgery w. heart disease or DM

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30
Q

mc presentation of AMS in inpt setting

A

delirium

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31
Q

mc cause of delirium

A

etoh abuse

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32
Q

delirium is a common s.e of _

A

hyperthyroidism

thyroid storm

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33
Q

causes of delirium (7)

A

UTI
PNA
metabolic changes
CVA
MI
TBI
meds

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34
Q

3 meds associated w. delirium

A

anticholinergics
benzos
opioids

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35
Q

don’t forget to order this in a febrile pt w. delirium

A

LP

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36
Q

pharm for agitatiion/psychosis w. delirium

A

haldol

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37
Q

disorders w. a significant or moderate impairment of cognition or memory that represents a marked deterioration from a previous level of fxn

A

neurocognitive d.o

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38
Q

mild/moderate neurocognitive d.o are same same

A

dementia

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39
Q

causes of dementia

A

alzheimer’s
frontotemporal lobar degeneration
lewy body dz
vascular dz
TBI
SUD
meds
HIV
prion dz
parkinson’s
huntington’s

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40
Q

what are the 2 cognitive exams

A

MMSE
MoCA

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41
Q

what class of drug may temporarily improve cognitive fxn

A

cholinesterase inhibitors:
donepezil
galantamine
rivastigmine

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42
Q

2 hallmark bx findings in alzheimer’s

A

bate amyloid plaquees
neurofibrillary tangles

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43
Q

what type of dementia is characterized by personality changes preceding memory changes

A

frontotemporal lobar degeneration

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44
Q

what type of dementia is characterized by parkinsonian sx

A

lewy body

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45
Q

2 mc types of dementia

A
  1. alzheimer’s
  2. vascular dementia
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46
Q

what type of dementia is associated w. arteriosclerotic dz and may involve a sudden decline in mental status

A

vascular dementia

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47
Q

what dementia is associated w. hallucinations, delusions, gait difficulties, and falls

A

lewy body

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48
Q

what dementia is associated w. language difficulties, personality changes, and behavioral disturbance

A

frontotemporal lobar

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49
Q

what type of dementia has a rapid onset and is very rare

A

creutzfeldt jakob

50
Q

bx finding of HIV associated dementia

A

cerebral atrophy

51
Q

dsm 5 for panic d.o

A

-3 panic attacks in 3 weeks
-at least one has been followed by at least one month of one or both:
-worry about additional attacks
-maladaptive change in behavior related to attacks

52
Q

diagnostic criteria for for ptsd

A

-traumatic event -> acute stress rxn
-sx persist past one month

53
Q

tx for ptsd

A

ssri’s
prazosin for nightmares

54
Q

schizophrenia spectrum

A

delusional d.o
schizoaffective d.o
schizophrenia
schizophreniform d.o

55
Q

normally functioning person w. a belief in something that does not exist

A

delusional d.o

56
Q

-psychotic d.o characterized by BOTH schizophrenia and a major mood d.o (dpn, bipolar)
-sx may occur at the same time

A

schizoaffective d.o

57
Q

psychotic d.o associated w. delusions, hallucinations, disoganized speech, and/or diminished inappropriate emotional expression > 6 months
PLUS
difficulty functioning

A

schizophrenia

58
Q

-psychotic d.o involving the sx of schizophrenia > 1 week, < 6 months
-no social/occupational impairment

A

schizophreniform d.o

59
Q

common delusions associated w. delusional d.o

A

non bizarre delusions - beliefs that occur in real life
-poisoning
-stalking
-being loved or deceived
-having an illness

beliefs last > 1 month

60
Q

tx for delusional d.o

A

atypical antipsychotics
-olanzapine
-risperidone

61
Q

45 yo M - hearing things that aren’t there x 2 weeks, severely depressed - hearing things - life is not impaired by hallucinations at this time

A

schizoaffective d.o

62
Q

dsm 5 for schizoaffetive d.o

A

schizophrenia PLUS mood d.0 x 2 or more weeks

63
Q

tx for schizoaffective d.o

A

atypical antipsychotics
SSRIs

64
Q

26 yo M - hearing voices of ppl plotting to kill him - has missed multiple days of work and was recently fired - he is dishevled, incoherent, and has disorganized speech - was normal until 8 months ago

A

schizophrenia

65
Q

major psychosis x 6 months or more + difficulty functioning

A

schizophrenia

66
Q

dsm 5 for schizophrenia

A

2 or more of the following x 6 months:
-delusions
-hallucinations
-disorganized speech/thought/behavior
-impaired ADLs
-negative sx
-inability to maintain job/relationships

67
Q

what are negative sx

A

blunted affect
poor posture
lack of goal-direct activities/initiatives

68
Q

tx for schizophrenia

A

SGAs
clozapine
FGAs

69
Q

what drugs are most effective for positive sx

A

FGAs:
haldol
chlorpromazine
thioridazine
loxapine
fluphenazine

70
Q

what SGA is not first line due to risk for agranulocytosis

A

clozapine

71
Q

pharm for tx resistant schizophrenia

A

clozapine OR SGA
PLUS
benzo/carbamazepine/valproate/lithium

72
Q

3 s.e of antipsychotics

A

parkinsonism
neuroleptic malignant syndrome
TD

73
Q

mc type of hallucination w. schizophrenia

A

auditory

74
Q

23 yo M grad student - visual and auditory hallucinations x 2 months - he is able to attend classes but having difficulty focusing - dad has schizophrenia - takes no meds - labs/imaging nl

A

schizophreniform d.o

75
Q

dsm 5 for schizophreniform d.o

A

-major psychosis > 1 week but < 6 mos
-no social/occupational impairment

76
Q

schizophrenia and schizophreniform are basically same-same, what differentiates them

A

schizophreniform d.o: > 1 week, < 6 mos
schizophrenia: > 6 mos, social/occupational impairment

77
Q

tx for schizophreniform d.o

A

SGAs
resistant: consider lithium, anticonvulsants

78
Q

types of abuse/neglect

A

child abuse
domestic violence
elder abuse
sexual abuse
spouse/partner neglect/violence

79
Q

what type of fx makes you concerned for child abuse

A

spiral fx

80
Q

2 types of burns that make you suspect child abuse

A

doughnut shaped
stocking-glove

81
Q

child abuse may manifest as

A

anxiety
aggression
PTSD
dpn/suicide
SUD
poor self esteen
dissociative d.o
paranoid
FTT

82
Q

t/f: neglect can be considered if a minor is allowed to engage in etoh

A

t!

83
Q

definition for domestic violence

A

any act of violence against family members

84
Q

child sexual abuse is mc in ages _
and is often done by _

A

9-12
male known to child

85
Q

moa for etoh

A

-increases GABA channel opening
-longterm: downregulation of GABA channels -> inhibitory
-upregulation of NMDA -> excitatory

86
Q

tx for etoh withdrawal (5)

A

thiamine
folate
MVI
IVF w. dex
benzos

87
Q

delirium tremens happens w.in _ hr of etoh withdrawal onset

A

48-96

88
Q

4 sx of delirium tremens

A

autonomic instability
disorientation
hallucinations
agitation

89
Q

5 addiction medications

A

disulfram (antabuse)
naltrexone: oral vs extended release
acamprosate
topiramate
gabapentin

90
Q

what 3 addiction meds decrease desire to drink

A

naltrexone
topiramate
gabapentin

91
Q

what addiction med inhibits acetaldehyde dehydrogenase and leads to aversive conditioning

A

disulfram (antabuse)

92
Q

what addiction med changes brain chemistry to reduce anxiety, irritability, and restlessness - leads to early sobriety

A

acamprosate

93
Q

etoh withdrawal timeline

A
94
Q

moa for anxiolytics

A

increase frequency of GABA channel opening

95
Q

intoxication vs withdrawal sx of benzos

A

intoxication: respiratory dpn, hypotn, amnesia, ataxia, stupor/somnolence, coma, death
withdrawal: rebound anxiety, tremor, sz

96
Q

tx for benzo intoxication vs withdrawal

A

intoxication: flumazenil (GABA antagonist)
withdrawal: clonazepam (long acting benzo)

97
Q

moa for cannabis

A

binds to CB1/CB2 receptors

98
Q

what drugs are associatd w. simulant related d.o (3)

A

cocaine
amphetamines

99
Q

moa for cocaine vs amphetamines

A

cocaine: block reuptake of DA, NE, 5HT
amphetamines: stimulates DA, NE, 5HT release PLUS decrease reuptake

100
Q

what are the biogenic amines (3)

A

dopamine (DA)
norepinephrine (NE)
serotonin (5HT)

101
Q

tx for stimulant intoxication

A

antipsychotics
benzos
labetalol
alpha 1 blockers
vitamin C

102
Q

what pharm promotes excretion of cocaine

A

vitamin C

103
Q

never _ a pt w. cocaine intoxication

A

restrain

risk for rhabdo

104
Q

pharm for stimulant withdrawal

A

bupropion
bormocriptine
SSRIs

105
Q

what 2 drugs are associated w. hallucinogen related d.o

A

PCP
LSD

106
Q

pt is extremely aggressive and becomes enraged w. sudden movements or w. loud sounds

A

PCP

107
Q

moa for PCP

A

NMDA antagonist

like ketamine

108
Q

6 PE findings of PCP intoxication

A

belligerence
fear
homicidality
psychosis
vertical AND horizontal nystagmus
tachycardia

109
Q

tx for PCP intoxication (4)

A

haldol
benzos
low stimulatn environment
restraints

110
Q

tx for PCP withdrawal

A

symptomatic

111
Q

pt wants to hurt himself - freaking out and hallucinating

A

LSD

112
Q

moa for LSD

A

5HT agonist

113
Q

tx for acute LSD intoxication

A

haldol
benzos
talk down/supportive counseling

114
Q

why isn’t LSD associated w. withdrawal

A

does not affect DA

115
Q

leading cause of preventable death in US

A

tobacco

116
Q

3 meds or tobacco cessation

A

bupropion
varenicline (chantix)
NRT

117
Q

which tobacco cessation med has highest success rates

A

varenicline

esp when used w. NRT

118
Q

4 sx of inhalant intoxication

A

belligerence/assault
apathy
blurred vision
coma

119
Q

tx for inhalant intoxication

A

supportive
+/- haldol

120
Q

tx for opioid withdrawal

A

clonidine
methadone
suboxone - withdrawal if given too early

EOR - Emergency Medicine (13 decks)

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