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Psych HY Flashcards

1
Q

Indication for Haloperidol decanoates (Intra-muscular Depo formulation)

A

Medicine Non-adherence in Schizophrenia
(also for homeless or limited resourced pts due to med costs)

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2
Q

ECT indications and primary complication.

A
  • Psych condition & hemodynamically unstable
    *Acute Psych disorder needing an immediate fix
    (ex: depressed, not eating and actively suicidal)

Complication → Amnesia (anterograde or retrograde) that self-resolves

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3
Q

GABA based agents MOA and their OD tx:
*Barbiturates
*Benzos
*Z-Drugs (Zolpidem, Zaleplon, Ezopiclone) → no OD tx

A

Barbiturates ↑ opening duration of Gabba receptors
OD tx: Sodium Bicarb (alkalinizes urine)

Benzos ↑ opening frequency of Gabba receptors
OD tx: Flumazenil (Gabba antagonist)

Z-Drugs Gabba A receptor agonist

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4
Q

Buspirone Use & MOA?

A

2nd line agent for GAD
Partial agonist at 5HT-1A (Seretonin) receptor

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5
Q

Acute manic episode tx.

A

Anti-psychotic + Lithium

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6
Q

Patient on a mood stabilizer that has to wake up 10x a night to urinate.
dx? ppx?

A

NDI s/t lithium
Amiloride, Triamterene

lithium enters ENAC channels (principal cell of collecting duct) → inhibit ADH function.
Prevent by blocking ENAC Channel w/ K+ sparing diuretics

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7
Q

SSRI uses:
MDD, GAD, PTSD, OCD
(4)

A

Pre-Menstrual Syndrome
Pre-mature ejaculation
Bulimia
Panic disorder

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8
Q

SSRI with the cleanest side effect profile
(still no OK for pregnant pt tho)

A

Citalopram
(lonely in the city)

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9
Q

Bupropion use/MOA/benefits/contraindications

A

MDD, Smoking Cessation
NorEpi Dopamine Reuptake Inhibitor

Weight-loss, No Sexual side effects, Smoking cessation

C/I in bulimia/anorexia or h/o seizure disorder
(Lowers seizure threshold)

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10
Q

Mirtazipine use/MOA/benefits (2)

A

MDD, Anorexia
Alpha 2 blocker releases more Norepinephrine
Helps with sleeping & improves appetite

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11
Q

SSRI that is safe in pregnancy?
Which is contraindicated in pregnancy?

A

Sertraline (Safe)
Paroxetine (c/i)
(parrots picking at baby’s lung - fetal HTN)

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12
Q

What TCA is used in treating OCD?

A

Clomipramine
(2nd line agent to SSRI)

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13
Q

Drug of choice for MDD in a terminally ill patient with a life expectancy of 4 weeks?

A

Methylphenidate
(stimulant)

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14
Q

Pt on SSRIs presents with seizures and hyponatremia
dx?

A

SIADH s/t SSRI

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15
Q

SIADH is most commonly caused by what medication?
(HY)

A

SSRIs

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16
Q

Hyperreflexia + Myoclonus in a pt with hx of MDD
dx/tx?

Classic triad of mental status changes + autonomic dysregulation + neuromuscular hyperactivity (babinski can be +)

A

Serotonin Syndrome
1st line BENZOS
2nd line Cyproheptadine

(technically first is supportive tx, but not on test)

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17
Q

Patient with flu-like symptoms 2 days after stopping paroxetine.
dx/NBSIM?

A

SSRI discontinuation syndrome
Restart old dose of SSRI → Taper off over weeks

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18
Q

CBT for specific phobias.

A

Systematic de-sensatization

(read a book about phobia, see a picture, etc)

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19
Q

CBT for PTSD.

A

Trauma focused Psychotherapy

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20
Q

Female presents with a slashed wrist
dx/tx?

A

Borderline Personality Disorder
Dialectical Behavioral Therapy

(Female+ Slashing wrist= BrPD end of story)

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21
Q

HY HY HY
2 drugs in psychiatry that have mortality benefits?

A

Lithium
Clozapine
(↓ risk of suicide)

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22
Q

HY HY HY
The 4 dopaminergic pathways & how ↓Dopamine levels affects it

Nigro-striatal →

Tubero-infundibular →

Mesolimbic (↑Dopamine) →

Mesocortical →

A

Nigro-striatal → Extrapyramidal sxs (acute dystonia, akathisia, tardive dyskinesia)

Tubero-infundibular → Hyperprolactinemia

Mesolimbic → Positive sxs of schizo
(hallucinations, disorganized speech) Improves w/ anti-psychotics

Mesocortical → Negative sxs of schizo
(social withdrawal, flat faces) Worsen w/ anti-psychotics

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23
Q

Atypical Antipsychotic treat positive sxs really well
and are _________ so they don’t worsen negative sxs as much.

A

serotonin 5HT antagonist

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24
Q

MOA
1st Gen antipsychotics (Typical antipsychotic: haloperidol)

A

1st: D2 antagonist
2nd D2-4 antagonist & 5HT antagonist

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25
Q

Antipsychotic that causes the side effect:
Amenorrhea:
metabolic syndrome (Avoid if DM/Obese pt) :
Neutropenic fever:
Torsades:

A

Amenorrhea: Respiridone
Metabolic syndrome: Olanzapine
Neutropenic fever: Clozapine
TdP: Ziprazidone

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26
Q

AMS, T 105ºF, BP 170/100 in a patient who was recently placed on a drug regimen for diabetic gastroparesis.
± Leukocytosis or Rhabdo
dx/tx?

A

Neuroleptic Malignant Syndrome (s/t Metoclopramide)
tx: Dantrolene (Ryanodine Ca2+ channel blocker)

Exposure is antipsychotic or metoclopramide

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27
Q

Extrapyramidal side effects and treatment:

Sustained abnormal posture few days after starting Antipsychotic:

Motor restlessness:

Cogwheeling:

Stereotypical mouth movements 2 years after starting Fluphenazine typical anti-psychotic:

A

Acute dystonia (weird face, eyes stuck looking up, neck is bent)
Tx: Benztropine or Diphenhydramine

Akathisia (Can’t sit still or stop moving)
Tx: Beta blocker (2nd line is Benzo)

Parkinsonism (EPS: rigidity, shuffling gate, resting tremor)
Tx: Benztropine (parking my Benz)
Bromocriptine, Carbergoline (dopamine agonist)

Tardive Dyskinesia (Weird Mouth movements)
Tx: Valbenazine (V-mat inhibitor)

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28
Q

Angry, irritable, argumentative with instructors, breaks rules.
No criminal behavior/ or violence

A

oppositional defiant d/o

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29
Q

Criminal behavior, forced sex, cruel to neighbor’s dog, stealing,
or fighting in an underaged pt. Dx?
Neuroanatomical association w/ this dx?:
MC Complication when > 18:

A

Conduct d/o
↓ serotonin in CSF
Cx > 18: Antisocial personality d/o

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30
Q

Fidgety, Forgetful 11 yo boy. Dx?
Neuroanatomical association:
Genetic dz association:
First line tx:
2nd line tx:
3rd line tx:

A

ADHD
↓ activity of pre-frontal cortex
Fragile X syndrome
1st → Stimulant (methyl-phenidate, dextroamphetamine)
2nd → non-stimulant (Atomoxetine)
3rd → alpha 2 agonist (Clonidine, Guanfacine)

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31
Q

Does not respond to social interactions (doesn’t respond to name or share), poor eye contact, fixated interests.
Dx?

A

Autism Spectrum d/o

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32
Q

The 2 “egos” & examples
Ego Dystonic:
Ego Syntonic:

A

Dystonic → Knowingly doing something irrational → OCD
(pt is distressed by sxs)

Syntonic → unknowingly doing something irrational → OCPD
(pt is unbothered/proud of sxs)

33
Q

Holds grudges, suspects spousal infidelity,
asks you an enemy or a friend?
Fears exploitation.

A

Paranoid personality d/o

34
Q

Lacks close friends, believes in the occult/conspiracy/magical
Wear yellow pants with red shirt.
Kind of like an odd or weird person

A

Schizotypal personality d/o

35
Q

Emotionally cold, indifferent reaction to praise/criticism
not interested in sex/relationships/friends
Seeks solitude (Loner type)

A

Schizoid personality d/o

36
Q

Impulsive, dysfunctional relationships, radial nerve damage from slashed wrist.
dx/defense mechanism?

A

Boderline Personality d/o
Splitting (black and white thinking)

37
Q

Requires admiration/attention
Lacks empathy (can’t see other’s needs)
Sense of entitlement.

A

Narcissistic

38
Q

Adult who is Remorseless, disobeys the law, lies.
In trouble with the law

A

Anti-Social

(≤18 yo it is called Conduct d/o)

39
Q

Dramatic emotions (cries easily, gets offended easily)
wants to be center of attention
Seductive
Theatrical/Flamboyant behavior
Does not usually lack empathy

A

Histrionic

40
Q

Afraid of social criticism
does not take risks/passes up good opportunities
Always feels inferior to others.

A

avoidant social personality d/o

41
Q

Stubborn, rule oriented, perfectionistic
devoted to the cause/no leisure
Wants everyone to do it their way
Would rather do task alone if others disagree

A

Obsessive Compulsive Personality D/o

(NOT to be confused with real OCD)

42
Q

Needs reassurance for every decision
problems initiating projects
needs urgent companionship.

A

Dependent personality d/o

43
Q

Anorexic pt is hemodynamically unstable
request to leave ED
NBSIM?

A

Admit to hospital
(even if it against their will bc Anorexia is a psychiatric d/o)

44
Q

Chronically Malnourished pt
(Alcoholic, Anorexic/Bulemic, Tea/Toast Diet)
dies while being given IVFs and Nourishment at hospital

A

hypophosphatemia
s/t Re-feeding syndrome

45
Q

How can you differentiate b/w bulimia nervosa and binge eating disorder?

A

Bulimics eat, but have a compensatory behavior (exercise, laxatives)
Binge eaters do NOT have a compensatory behavior

46
Q

ED-Antidepressant to avoid in pts w/ Eating d/o:
Best CBT for anorexia on NBMEs:
Best antidepressant for anorexia:
Best antidepressant for bulimia:

A

Avoid → Bupropion
CBT → Family therapy
Antidepressant Anorexia → Mirtazipine
Antidepressant Bulimia: → SSRI

47
Q

MDD and EEG findings

A

↓ REM sleep Latency/Inhibition
↑ REM Sleep

Same as Narcolepsy.

48
Q

Pt h/o Bulimia presents w/ sudden onset, severe chest pain + pneumomediastinum.
chest palpation/auscultation reveals crepitus
dx/NBSID/tx?

A

Esophageal Perforation
Water soluble contrast (Gastrograffin swallow)
SURGERY

(can be s/t Endoscopy (within 24hrs))

49
Q

Outside observer to one’s thoughts.
No recollection of a traumatic event.

A

depersonalization d/o

50
Q

High anxiety about their leg pain
but w/u is negative.

A

somatic sxs d/o
(have symptom but blown out of proportion)
tx: regular f/u w/same physician

51
Q

Pt preoccupied with the fear of having HTN despite multiple nl BP checks.
dx/tx?

A

illness anxiety disorder
Regular physician visits w/ same clinician

Has no sxs or problems but is worrying about having a dz

52
Q

Neuro sxs like Pain, pinprick, fine touch loss in LLE.
Not worried about sxs/Indifferent attitude during the physical exam.
Neuro sxs are not consistent with a localization

A

Functional Neurologic d/o
aka Conversion disorder

(usually s/t anxiety/stress)

53
Q

Hyperthermia, Rhabdomyolysis, Hyponatremic seizures, Serotonin syndrome due to ____ toxicity.

A

MDMA toxicity (Ecstasy pill)

Takes Ecstasy pill (a seritonergic drug) & dance into hyperthermia and can’t stop so muscle get damaged. Starts drinking alot of water bc feeling hot causing hyponatremia.

54
Q

Pt who is clearly abusing a substance & is difficult to restrain
presents with Nystagmus, Myoclonus and
aggression/violence towards others.
Dx/tx?

A

Phencyclidine (PCP)
NMDA receptor antagonist
tx: Benzos

Nystagmus separates this from cocaine or MDMA use

55
Q

Lethargic pt with
Bradycardia & respiratory rate of 8
Pupils are 2mm (smallest they go)
____ Intoxication
Treating intoxication:
Is withdrawal fatal?
Cogwheeling/akinesia after use → ___ toxicity damaging the substantia nigra

A

Opioid over-dose
Naloxone (if it fails, try again)
Withdrawal is not fatal, but it feels shitty
Parkinsonian sxs→ MPTP toxicity

56
Q

Pressured speech, tachycardia, mydriasis, HTN.
dx/tx?

A

Cocaine intoxication
tx: Benzo

57
Q

Tachycardia, conjunctival injection, increased appetite, reduced rxn time.

A

Marijuana use

58
Q

Tx (3) of terminal cancer pt w/ cachexia.
usually s/t loss of appetite
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Tx of terminal cancer pt w/ depression
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Tx (2) of terminal cancer pt w/ Dyspnea
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Tx of chemo or cancer pt w/ nausea & emesis?
what if pt has ↑ ICP

A

Megestrol (progestin analog), Dronabinol (cannabinoid), Corticosteroids
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Methylphenidate
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Opioids (Morphine) + bowel regimen
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Ondansetron (serotonin receptor antagonist)
Adverse effect? QT prolongation
↑ ICP → Glucocorticoids

59
Q

2 days post-op pt develops diaphoresis, tachycardia &
visual hallucinations + seizures.
Dx/Tx?

A

Alcohol withdrawal
Tx: Benzos

60
Q

Nystagmus, Ataxia (unable to walk right), Confusion:
+ Neuroanatomy:
+ Enzyme association:
Tx:
Irreversible progression:

A

Wernicke encephalopathy (acute, reversible)
+ Neuroanatomy: Mammillary body hemorrhagic infarction
+ Enzyme association: Transketolase does not work
Tx: IV thiamine (B1)
Progresses to Korsakoff’s (Irreversible)
• Amnesia + Confabulation aka makes things up

61
Q

Tx of ETOH use disorder (3)

A

Alcoholic Anonymous
Acomprosate
Naltrexone

62
Q

82F pulling IVs, attempting to get out of bed. ± UTI.
Dx:
Inducing agent:
Acute tx:
What med to avoid:

A

Acute Delirium
Anticholinergic Drugs (diphenhydramine, Scopolamine, TCAs)
Anti-Psychotic (± Sitter)
Avoid: Benzodiazepines (can worsen delirium)

63
Q

Forgetfulness worsening & now impairs performance of activities of daily living
dx/Patho?

A

Alzheimers
↓ AcH s/t destruction of basal nucleus of meynart

64
Q

Alzheimers treatment (3)

A

AchE inhibitors
*Rivastigmine
*Galantamine
*Donepezil

65
Q

Dementia + Constantly “added” neuro deficits:

A

Vascular dementia

66
Q

Rude language, lack of inhibition, sexually suggestive statements.

A

Fronto-temporal dementia
(Pick’s disease)

67
Q

dementia + Abnormal gait + urinary incontinence:

A

NPH

68
Q

What kind of hydrocephalus is seen in NPH
Tx strategies:

A

Non-obstructive/Communicating Hydrocephalus
s/t CSF reabsorption problems in arachnoid granulations
Tx: VP-shunt (reversible cause of dementia)

69
Q

6 weeks of recurrent nightmares after being fired from role as COVID unit nurse.
dx/tx?
Tx of REM sleep problem?

A

PTSD (>1m sxs)
SSRIs + trauma focused psychotherapy
Prazosin for nightmares

70
Q

Checks doors repeatedly to make sure they are locked.
Intrusive unwanted/worrying thoughts requiring a ritual to alleviate.
Dx:
Pharm tx:
CBT:

A

OCD
SSRI + Exposure & response prevention CBT

71
Q

Feels humiliated and is terrified at the thought of giving speeches.
Dx/Tx (1st/2nd line)
When is 1st line tx c/i?

A

Performance Anxiety (subtype of Social anxiety d/o)
1st line: Beta Blocker
2nd line: Benzo
If pt has Asthma treat w/ Benzo

72
Q

9 months of poor sleep, restless, impaired concentration & worrying about “multiple domains in life”
dx/tx?

A

Generalized Anxiety d/o (≥6m sxs)

73
Q

Tx (2) of panic disorder:
Tx of an active panic attack?

A

Panic d/o: → SSRIs + CBT
Panic attack? → Benzos

74
Q

Major Depressive Disorder
≥5/9 on SIGECAPS for ≥ 2 weeks
*Monoamine hypothesis:
*Adrenal axis anomaly:
*Fastest/most effective tx:

A

Monoamine hypothesis: low levels of Serotonin, Norepinephrine, & Dopamine
Adrenal axis: →High cortisol
Fastest/most effective tx: → ECT (ok in pregnancy)

75
Q

Schizophrenia neuroanatomy abnormalities:
SCZ timelines:
(<1m) =
(1-6m) =
(≥6M) =

A

↑ size of lateral & 3rd ventricles

Psychotic sxs
(Hallucinations, bizarre Delusions or disorganized speech/thinking) present for:

(<1m) = Acute psychotic d/o
(1-6m) = Schizophreniform
(>6M) = Schizophrenia

76
Q

Most predictive factor in completing suicide.
Who attempts more, M/F?
Who is more successful?

A

Predictive → h/o prior attempt
Women attempt more
Men succeed more (bc more lethal methods)

77
Q

27M is brought to the ED by his mom with a 2 week history of reduced oral intake. BMI is 16.
PMH: MDD unresponsive to SSRIs, TCAs, & isocarboxazid
Pt is muted and reluctantly responds to questions.
Vitals: BP 60/40s HR 40, RR 7/min
No h/o suicide attempts.
NBSIM?

A

Admit to hospital for ECT

78
Q

72M with 6 wk h/o impaired vision.
Letters and lines appear “more wavy”
Dx:
Visual field lost first:
Fundoscopic exam for Type 1:
Fundoscopic exam for Type 2:
Tx for Type 1:
Tx for Type 2:

A

Macular Degeneration (age related)
HY: Wavy vision = MD
Central vision loss first → then peripheral vision loss last
Fundoscopic Type 1: Dry Type + Yellow deposits (Drussen)
Fundoscopic Type 2: Wet Type + Yellow deposits + Neovascularization
Type 1 Tx: Beta Carotene or Vit.K (Antioxidants)
Type 2 Tx: VEG-F Inhibitor (Bevazizumab or Ranibizumab)

79
Q

Vision loss in a diabetic that is worse at night
(problems reading signs, reading books, etc)
Dx/Tx?
Fundoscopic exam findings:
Most important risk factor:

A

Cataracts
tx: Lens Replacement
Lens Opacification
Age is BRF

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