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psych clin Flashcards

1
Q

trx of SAD

A

light therapy and bupropion

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2
Q

which drugs are specific for premenstrual dysphoric disorder

A

sertraline
perioxitine
fluoxetine

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3
Q

trx for bipolar (and their AEs)

A

lithium, valproic acid, carbamezapine (check blood levels)

second gen antipsychotics to calm mania

lamotrigine for bipolar w depression
can cause STEVEN-JOHNSON SYNDROME= rare but deadly allergic rash from neck up

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4
Q

criterion for social anxiety disorder/social phobia

A

persistent fear of social performance/exposure to unfamiliar ppl

may have panic attacks
person recognizes their fear is unreasonable/excessive

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5
Q

social anxiety disorder has increased risk of what

A

alc dependence, severe depression

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6
Q

most often medical ds causes psych sx

A 
UTI
pnuemonia
electrolyte abn
sepsis
thyroid
hypoxia
hypoglycemia
hyponatremia (elderly w ssris)
stroke, CNS lesion
MI
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7
Q

trx for delerium in ER

A

sedative: haloperidol +lorazepam (IM 15-30 min)
only haloperidol in elderly

keep pt safe, in quiet room

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8
Q

describe labs for alc withdrawal

A 
low platelets on CBC
MCV>100
hypoNa on BMP
dec hepatic function
blood alc level
drug urine screen
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9
Q

trx for alc withdrawal in the ER

A

IV fluids
thiamine
glucose

meds= IV lorazepam (if liver impaired)
IV diazepam/chlordiazepoxide (if liver good)

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10
Q

meds to give violent pts in the ER

A

haloperidol, lorazepam, olanzapine, ketamine

get full labs and consults

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11
Q

trx for PTSD

A 
SSRi
therapy
prazosen for nightmares
EMDR (REM to desensitize)
NO GIVE BENZOS bc of increased risk of addiction
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12
Q

acute stress disorder vs PTSD

A

ASD= 3 days 1 month

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13
Q

criterion for adjustment disorder

A

emotional/behavior changes associated witha stressor within 3 months but no longer than 6 months

=not proportionate disress and decreased functioning

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14
Q

sx associated with conversion disorder=

A

unexplained neural deficits w change in voluntary movement, initiated or worsened by a stressor

~pseudo-seizures (normal EEG), numbness, paralysis, tremor

NOT fake
associated with sexual and physical abuse as a child

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15
Q

what is factitious disoder

red flad?

A

munchausen
munchausen by proxy
red flag= lots of allergies

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16
Q

risk factors for alzheimers

A

(progressive and irreversible)
female, FH, head trauma, down’s syndrome
=50-60% of dementia

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17
Q

risk factors for vascular dementia

A

male, old, HTN, CV ds

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18
Q

what is pick’s ds

A

a type of progressive dementia
associated with frontotemporal lobe atrophy
=young, volatile, and violent

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19
Q

describe lewy body dementia

A

memory loss, parkinsonian sx, frank visual hallucinations

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20
Q

what are some reversible causes of dementia

A 
drugs
hypothyroid
metabolic ds
hematomas
normal P hydrocephalus
inc ICP
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21
Q

what labs are important when you suspect dementia

A

thyroid, glucose, vitamines
b12 (<400 means need trx)
kidney function, A1c

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22
Q

what imaging test can diagnose Alzheimer

A

pet scan

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23
Q

causes of delirium w psychosis in elderly

A 
drugs
infection
retention/constipation
hypoxemia
stroke/seizure
lack of sleep
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24
Q

what can happen if you give elderly diphenhydramine

A

seretonin syndrome and psychosis

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25
Q

explain the domains of adaptive functioning in intellectual disability

A

conceptual= school for that age (preschool=language, school=reading and regulate emotions, adults= stuck at school level)

social domain= v gullible and easily manipulated by peers

practical domain= personal care and daily living tasks

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26
Q

what is the difference between intellectual disability and global developmental delay

A

GDD is just the dx for people who can’t be tested, i.e. kids too young, post severe head injury

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27
Q

define language disorder

A

persistent difficulty of acquisition and use of language across modality

= x comprehesion (less vocab, sentence structure, impaired discourse)

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28
Q

define speech sound disorder

A

diff PRODUCTION of speech

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29
Q

define childhood onset fluency disorder

A

stuttering (time patterning)

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30
Q

define social (pragmatic) communication disorder

A

diff w social use of verbal and nonverbal communication

inappropriate greeting and info sharing, can’t understand the rules of language, diff w sarcasm

=”autism of language”, associated w the delay of reaching milestones

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31
Q

what must be present for dx of autism spectrum

A

all 3 deficits

  1. in social-emotional reciprocity
  2. nonverbal communication
  3. in making, maintaining, and understanding relationships

+ 2+ of below

  • repetitive motor movements, use of objects, speech
  • insistence of sameness, inflexibility
  • highly restricted, fixated interests
  • hyper/hypo sensitivity to sensory input
32
Q

trx for autism spectrum

A

most consistently useful= education and support for pt, parents, family, teachers
parallel process
FDA approved meds= risperidone, aripriprazole (for agitation)
off label= valproic acid, gabapentin, stimulants, alpha agonists, anti-depressants

33
Q

what specifiers are needed dx of autism spectrum disorder

A

w or w/o accompanying intellectual repair
w or w/o accompanying language repair
associated w neurodev/mental/behav disorder
associated w catatonia
associated a med/gen/env factor

34
Q

with the tourrette’s triad, which sx are more associated w males and females

A 
males= tics, ADHD
females= OCD sx
35
Q

ADHD is associated with what parts of the brain

A

prefrontal cortex and dorsal anterior midcingulate cortex

DA and NE

36
Q

which tests can be used to dx for ADHD

A

TOVA (variables for attention)

Conner’s continuous performance tasks

37
Q

med trx for ADHD

A

alpha 2 adrenergic agonists= guanfacine and clonidine

bupropion (antidepress w mixed catechol effect)

atomexatine (not first line bc CV AR)

modafanil= adults only= inhibit DA uptake= can cause DRESS syndrome, steven-johnson syndrome, epidermal
necrolysis

methylphenidate= increase extracell DA

38
Q

define developmental coordination disorder

A

-acquire and execute coordinated motor skills way behind expected age
v clumsy

39
Q

define stereotypic movement disorder

specificities?

A

repetitive, pointless motor behavior

specific= w self-injurious behavior, w known med/gen/neurodev/env factor

severity= mild= easily suppressed 
mod= require explicit protective measure
severe= continuous monitoring
40
Q

meds for tourrettes

A

ONLY FDA: haloperidol, pimozide, aripriprazol (antiDA)
fluphenazine, risperidone
guanfacine, clonidine
VMAT2 inhibitor (-benazine)
botulin-toxin injections
anticonvulsants= topiramate, gabapentin, valproic acid

41
Q

what is the reward deficiency syndrome

A

DA malfunction–> vulnerability to addiction

associated w hippocampus and amygdala

42
Q

what blood alcohol level does intoxication start at

A

0.08 g/dL

43
Q

med trx for alcohol withdrawal

A

benzos (makre sure no alc in blood–> resp suppression)

anticonvulsants= carbomezapine, gabapentin, valproic acid
disulfiram (=more harm than good)
naltrexon
acamprosate (3x a day)

44
Q

to taper off benzos, which long eliminating drugs can you switch them to

A

clonazepam, chlordiazepoxide, diazepam

45
Q

what drugs can you give if you need to taper off benzos or barbs quickly

A

best= gabapentin, tizanidine

also carbamezapine and valproic acid

46
Q

which benzos are not effected by age or hepatic insufficiency (bc only glucoronidation)

A

oxazepam, lorazepam, temazepam

can use w cirrhosis

47
Q

trx for opioid withdrawal

A

antiemetics, antacids, anti-diarrhea, M relaxant, NSAIDs, clonidine,

methadone–> high risk qtc prolongation
naltrexone
buprenorphine= highly motivated patients

48
Q

cocaine use can have what medical effects

A

risk of MI, CVA (get EKG)
rhabdomyolysis–> compartment syndrome
psychosis bc of xneuroadaptation

49
Q

SEs of chronic amphetamine use

A

neurotoxicity from glutamate, axonal degeneration, permanent psychosis

50
Q

how does tobacco change drug metabolism

neuroadaptation?

A

induce cyp1a2 (i.e. olanzapine)

DA release from ventral tegmental area to nucleus accumbens

51
Q

med trx for tobacco use

A

bupropion

varenicline

52
Q

trx of PCP intoxication

A

antipsychotics and benzos, less stimulating environment

53
Q

terms for classical conditioning

A

(simultaneous)
condition, unconditioned response and stimulus
extinction

54
Q

terms for operant conditioning

A

(in order)

positive/negative reinforcement/punishment

55
Q

phases of sexual response cycle

A
  1. desire= drive (bio) + motivation (willing)+ wish fullfilment (cultural hope)
  2. excitement= arousal phase (erection, vaginal lubrication, nipples hard) vasodilation of genitals and M in body contractions
  3. orgasm = rhythmic contractions of perineal Ms
  4. resolution (rapid if orgasmed, hours if didnt’)
    Ms have refractory period and fast resolution
    Fs have no refractory period, long resultion
56
Q

define female sexual interest/arousal disorder

A

decreased sexual interest for 6+ months for 3+..

less interset, thoughts, receptiveness, pleausre, sensations

57
Q

define male hypoactive sexual desire

A

persistent deficient sexual fantasies/desire for 6+ months

58
Q

define erectile disorder

A

at least 6+ months of

cant get erection, keep it, or is less rigid

59
Q

define female orgasmic disorder

A

delay/no orgasm for 6+ months

60
Q

define delayed ejaculation disorder

A

6+ months almost always can’t ejaculate

61
Q

define premature ejaculation disorder

A

6+ months of ejaculation within 1 min of penetration

62
Q

define genito-pelvic pain penetration disorder

A

6+ months of 1+

pain w penetration, tensing/tightened of floor Ms w penetration, fear of pain

63
Q

define voyeurism

A

peeping tom, 18+ yo

64
Q

define fetishistic disorder

A

arousal from nonliving objects, not focused on genital parts

65
Q

define pedophilia

A

attracted to kids <13,
must be 16+ and 5+ years older than kid
can be exclusive or nonexclusive

66
Q

define frotteuristic disorder

A

touching/rubbing against nonconsenting individuals

male 15-25

67
Q

risk factors of child abuse

A 
child
what makes taking care more diff
colicky infant
<1 year
nonbio parent
parent
criminla hx
substance abuse
hx of mental health
teen parents

social
isolation, poverty

68
Q

most common type of child abuse, most commonly causes death

A

neglect

69
Q

response to suspected emotional abuse

A

if isolated w no immediate harm: refer to family therapy and parenting classes

if recurrent w immediate harm: call CPS

70
Q

response to neglectful child abuse

A

call CPS, send social worker to home

71
Q

response to physical or sexual child abuse

A

call CPS

72
Q

increased risk of sexual abuse in what population of children

A

deaf children
trans kids
intellectually disabled

73
Q

risk factors for elder abuse

A

elders- dementia, psych dx, physical dependence, incontinence

perpetrator- substance abuse, male, financial dependence on victim

74
Q

pharm trx for anorexia

A

not first line, only use if resistant
NO USE BUPROPION or TCA
only give SSRIs if anxiety/depression is bad enough to interfere w care

olanzopine= for help w weight gain
lorazepam= decrease anxiety associated w eating
75
Q

trx for bulimia

A

gold standard = CBT
give CBT+pharm+nutritional rehab

meds= 1st line= fluoxetine
2nd line= sertralin/fluvoxamine
3rd= TCA

76
Q

trx for binge eating disorder

A

1st line= CBT+interpersonal therapy

77
Q

describe stress theory

A

sympathetic response to stress

= increase catechol release, serotonin turnover, DA transmision
=increase CRH–>ACTH
decrease growth, immunity

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