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Psychiatry > Psych Lectures (Final Exam) > Flashcards

Psych Lectures (Final Exam) Flashcards

1
Q

definition of psychiatric disorder

A

a syndrome involving defined alteration in cognition, mood, perception and/or behavior

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2
Q

list of DSM 5 mental disorder classifications

A
  1. neurodevelopment disorders (ID, Autism, ADHD)
  2. schizophrenia spectrum and other psychotic disorders.
  3. bipolar and related disorders
  4. depressive disorders
  5. anxiety disorders
  6. Obsessive-Compulsive and related disorders
  7. trauma and stressor assoc. disorders
  8. somatic symptom and related disorders
  9. feeding and eating disorders
  10. substance and addictive disorders
  11. neurocognitive disorders (ie delirium and dementia)
  12. personality disorders
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3
Q

lifetime risk of have a psychiatric disorder?

A

50%

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4
Q

annually how many people are affected by psychiatric disorders

A

25%

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5
Q

prevalence of psychiatric in a clinical setting

A

> 25%

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6
Q

those with severe psychiatric illness most likely have ____ psychiatric diagnoses

A

2 or more

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7
Q

which race and ethnic groups have the highest rates of mental disorders?

A

HA! THEY ARE EQUAL

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8
Q

what percentage of patients that will have a psychiatric disorder are symptomatic by age 24?

A

75%

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9
Q

what percentage of schizophrenic patients receive adequate treatment

A

25%

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10
Q

what percentage of people with current mental disorder receive treatment of any kind

A

fewer than 50%

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11
Q

In 2010 mental disorders accounted for ____ % of years lived with disability?

A

22.7%

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12
Q

life expectancy of patients with chronic mental illness is shortened by an average of __ years

A

25

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13
Q

what percentage of suicides are associated with diagnosable psychiatric disorders`

A

90%

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14
Q

components of mental status

A

general description (appearance, attitude, behavior/motor activity)

mood and affect

speech

thought (form and content)

perception

cognition (alertness, orientation, memory, abstraction, concentration, fund of knowledge)

insight

judgment

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15
Q

cost of schizophrenia to society per year

A

100 billion/year

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16
Q

diagnosis criteria for schizophrenia

A

2 or more for 6 months

1-delusions 
2-hallucinations 
3-disorganized speech
4-disorganized or catatonic behavior
5-negative symptoms
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17
Q

schizophrenia criteria with duration < ONE MONTH

A

brief psychotic disorder

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18
Q

schizophrenia criteria with duration < SIX MONTHS

A

schizophreniform disorder

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19
Q

positive symptoms

A

presence of phenomena not normally present

ex. hallucinations, delusions, disorganization

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20
Q

negative symptoms

A

absence of phenomena normally present

ex. alogia (poverty of speech), affective flattening, anhedonia (inability to experience pleasure), avolition (inability to initiate goal directed behavior)

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21
Q

schizophrenia course

A

prodrome: withdrawal, eccentricity, depression/anxiety

active phase: active psychotic symptoms

residual phase: less intense positive symptoms

exacerbations: occur throughout lifetime

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22
Q

suicide rate in schizophrenia

A

5%

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23
Q

percentage of schizophrenic patients that usually do well at long term follow up

A

20%

zero symptoms is a rarity

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24
Q

lifetime prevalence of schizophrenia

A

1.3%

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25
Q

schizophrenia

monozygotic twins % concordance

A

46%

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26
Q

schizophrenia

dizygotic twins % concordance

A

14%

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27
Q

name two hypotheses for schizophrenia

A

dopamine (strong D2 blockade effacacious drug; drugs that enhance DA transmission worsen)

glutamate

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28
Q

schizophrenia treatment

A

FGAs/typicals: haloperidol

SGAs/atypicals: clozapine, risperidone

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29
Q

adverse effects

FGAs (typicals)

A

extrapyramidal symptoms (dystonia, akathesia, parkinsonian symptoms)

tardive dyskinesia (involuntary movements of tongue, lips, jaw and extremities)

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30
Q

how are SGAs diff’t from FGAs?

A

block 5HT (serotonin receptor)
less strongly D2
more strongly D1, D4

lower incidence of EPS, TD and NMS

more sedating, weight gain, metabolic syndrome

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31
Q

risperidone side effect

A

hyperprolactinema

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32
Q

olanzapine side effect

A

diabetes

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33
Q

ziprasidone side effect

A

QTc prolongation

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34
Q

depressive disorder criteria

A

5 or more of 9 depressive symptoms

2 or more weeks

one of 5 symptoms must be

  • depressed mood
  • marked loss of interest or pleasure
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35
Q

Depressive symptoms

A

Depressed mood +

Sleep
Interest
Guilt
Energy
Concentration 
Appetite 
Psychomotor (slowing or agitation)
Suicide
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36
Q

increased risk of depression for first degree relatives?

A

3x

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37
Q

depression concordance rates in monozygotic twins

A

60%

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38
Q

recurrent depression concordance rates in monozygotic twins

A

33%

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39
Q

MDD lifetime prevalence

A

1/8 or 16-17%

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40
Q

depression accounts for ___ percentage of ALL disability in the world

A

11%

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41
Q

average lost work days/year per employee with MDD

A

27.2days/year

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42
Q

mood disorders account for ___ % of suicides

A

45-75%

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43
Q

lifetime risk of suicide in severe MDD (hospitalized depression)

A

15%

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44
Q

protective factors against completed suicide

A

positive family/social connections

positive treatment connections

spiritual beliefs

sense of responsibility towards others

investment in meaningful goals

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45
Q

which classes of antidepressants are less frequently used

A

TCAs

MAOi

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46
Q

ECT

A

6-12 unilateral or bilateral

response rate 75-85%

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47
Q

complementary and integrative tx for MDD

A 
light therapy 
exercise 
folates 
omega 3 FA 
st. johns wort 
acupuncture 
sleep deprivation 
yoga 
tai chi
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48
Q

when do personality traits become disorders?

A

when traits are so maladaptive that they significantly impair one’s work life and social lifer, or cause major subjective distress

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49
Q

PDs are ego-syntonic or dytonic?

A

ego-syntonic

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50
Q

cluster a

A

accusatory, awkward, aloof

  1. paranoid
  2. schizoid (lack of interest in social relationships)
  3. schizotypal (odd behavior or thinking)
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51
Q

cluster b

A

bad to the bone

  1. antisocial (pervasive disregard for the law and rights of others)
  2. borderline (PRAISE)
paranoid 
relationship inability 
abandonment fears 
impulsive
suicidal gestures, splitting
emptiness
  1. histrionic (attention seeking)
  2. narcissistic (grandiosity, need for admiration, lack of empathy)
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52
Q

cluster c

A

coward, compulsive, clingy

avoidant (social inhibition)
obsessive-compulsive
dependent

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53
Q

prevalence of PD in general population

A

1-5%

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54
Q

prevalence of PD in outpatients mental health facilities

A

10-30%

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55
Q

prevalence of PD in psychiatric inpatients

A

15-30%

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56
Q

antisocial gender prevalence?

A

male

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57
Q

borderline gender preference

A

female

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58
Q

PD onset

A

late adolescence, early adulthood

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59
Q

bipolar lifetime risk

A

3%

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60
Q

bipolar lifetime suicide risk is elevated by ____x

A

20 fold

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61
Q

bipolar episode types

A

manic or hypomanic
depressive
mixed

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62
Q

mania criteria

A

1 week of elevated/irritable mood

at least 3 (4 if only irritable)
DIGFAST 
Distractibility 
Impulsivity/Injudicious behavior 
Grandiosity 
Fast (racing) thoughts
Activity, agitation 
Sleep (decreased need)
Talking rapidly/pressured speech
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63
Q

secondary mania (phenocopies)

A

substance use -alcohol, cocaine, amphetamine, caffeine (stimulants)

Rx: antidepressants, steroids, ACTH

neuro: MS, frontal lobe syndromes, temporal lobe epilepsy, encephalitis, Huntingtons
endocrine: hyperthyroidism, cushings
infectious: HSV or HIV encephalitis, neurosyphillis
autoimmune: SLE

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64
Q

hypomania

A

4 days of elevated/irritable mood

at least 3 (4 if only irritable)
not assoc. w/significant distress/impairment

DIGFAST 
Distractibility 
Impulsivity/Injudicious behavior 
Grandiosity 
Fast (racing) thoughts
Activity, agitation 
Sleep (decreased need)
Talking rapidly/pressured speech
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65
Q

bipolar 1

A

at least one episode of mani

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66
Q

bipolar 2

A

at least one episode of hypomania and one episode of major depression

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67
Q

cyclothymia

A

2+ years of most days with some depressive/hypomanic sx, fewer than 2 month of euthymia, no depressive/manic episode

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68
Q

rapid cycling

A

4+ episodes within a 12-month period

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69
Q

comorbidity in bipolar disorder is common

esp w/ which conditions?

A

substance abuse

anxiety disorders

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70
Q

SSSSSScreening for hypomania

A 
sex 
sleep 
socializing 
speeding 
spending 
special projects
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71
Q

bipolar peak age of onset

A

15-19

small secondary peak ~age 50

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72
Q

1/3 of patients with wait ___ years for correct diagnosis

A

10 years

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73
Q

schizophrenia heritability

A

60-80%

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74
Q

anorexia nervosa

A

restriction of energy intake relative to requirements leading to markedly low body weight

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75
Q

bulimia nervosa

A

recurrent binge eating

recurrent compensatory behaviors to prevent weight gain

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76
Q

binge eating disorder

A

bingeing without compensatory behaviors

assoc. overweight/obesity

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77
Q

mean age onset
AN
BN
BED

A

AN-19
BN-20
BED-25

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78
Q

% of IBW criteria for AN

A

85%

79
Q

% of IBW increased mortality

A

65%

80
Q

% of IBW inpatient level of care

A

75%

81
Q

AN BMI

A

<17.5

82
Q

complication of restricting/malnutrition

A

msk (osteopenia, osteoporosis, fractures)

cardiac (arrhythmias, bradycardia, hypotension, orthostasis, hypothermia, MVP, CHF)

brain (low serotonin)

derm (dry skin)

GI (constipation, motility)

heme (pancytopenia)

endo (hypoglycemia, low LH, FSH, estrogen, testosterone)

83
Q

mortality AN, BN

A

4% AN, 4% BN

84
Q

chronicity AN, BN

A

20% AN, 26% BN

85
Q

improvement

A

34% AN, 26% BN

86
Q

recovery AN, BN

A

47% AN, 47% BN

87
Q

what percentage of Americans have experienced a traumatic event?

how many go on to develop PTSD?

A

70%

20-30%

88
Q

PTSD criteria

A

sx duration more than a month

HARD 
hyperarousal 
avoidance 
reexperience 
distress
89
Q

lifetime PTSD prevalence

A

8%

90
Q

annual PTSD prevalence?

A

4%

91
Q

PTSD gender preference

A

women

though traumatic events are more commonly experienced by men

92
Q

median time to remission from PTSD

A

25months

93
Q

heart rate response to loud tones in PTSD

A

increased

94
Q

what kind of memory is impaired in PTSD

A

declarative (diminished hippocampal volume)

95
Q

predisposed traits (PTSD)

A

hippocampal volume
dorsal ACC activity
neurological soft signs

96
Q

acquired traits (PTSD)

A

rostral ACC activity

heart rate response

97
Q

neurological soft signs abnormalities in PTSD

A

motor sequencing
figure copying
sensory integration

98
Q

PTSD treatment

A

Debriefing may or may not help, may actually worsen symptoms

CBT helps long-term

Can relieve symptoms with anxiolytics + adrenalin block

Meds: cycloserine is NMDA agonist for glutamate, may help together with CBT

99
Q

anterior cingulate

PTSD

A

Dorsal anterior cingulate potentiates response to fear (active in PTSD)

Rostral anterior cingulate calms response to fear (less active in PTSD, smaller)

100
Q

very early onset AD in 30s

A

autosomal dominant

  • APP
  • Presenilin 1
  • Presenilin 2
101
Q

early onset AD in 50s

A

homozygous APOe4 mutations

102
Q

late onset AD beyond 65

A

sporadic

103
Q

types of dementia

A

alzheimers (55%)

vascular

dementia of lewy body

frontotemporal lobar degeneration

104
Q

alzheimers is caused by ____ and ___

A

Amyloid: amyloid bodies build up in neurons

Tau: microtubule component builds up to form neurofibrillary tangles, cognitive disruption

105
Q

Major dementia disorder

A

requires 1 domain affected (memory, language, executive function, attention, social, visuospatial, etc) and significant functional impairment

106
Q

Mild dementia

A

1 domain affected, no significant functional impairment

107
Q

AD costs the US ???

A

200 Billion

108
Q

AD risk factors

A 
age 
family hx 
brain injury 
low education 
APOE4 
cardiovascular risk factors
109
Q

medications shown to slow AD

A

donepezil
galantamine
rivastigmine
memantine

110
Q

ADHD is a syndrome with the following”

A

inattention
hyperactivity (+/-)
impulsivity

111
Q

ADHD prevalence age 8-11

A

10%

112
Q

percentage of children that have ADHD persist into adolescence

A

75%

prevalence 7.5% adolescents

113
Q

percentage of adolescence that have ADHD persist into adulthood

A

50%

prevalence 3-5% adults

114
Q

ADHD TX

A

education

medication

  1. methylphenidate (Ritalin)
  2. amphetamine (adderall)
  3. atomoxetine (strattera) NE reuptake inhibitor
  4. clonidine (alpha 2a receptor agonist)

psychosocial tx

115
Q

comorbid conditions with ADHD

A

Learning Disorders (reading, math, written expression)

116
Q

anxiety, emotion

A

emotion -> motivator, warns of danger, no tx

117
Q

anxiety, symptom

A

symptom-> subjective experience of dread, accompanying somatic symptoms, may or may not require tx

118
Q

anxiety, syndrome

A

syndrome-> accompanies physical illness, precedes performance, assoc. w/self medication, tx short term

119
Q

anxiety disorder

A

SPECTRUM
GAD
panic disorder
Social anxiety disorder

requires long-term tx

120
Q

lifetime prevalence of GAD

A

5%

121
Q

GAD remission rate

A

33%

122
Q

GAD comorbidity rate with other psychiatric disorders

A

65%

123
Q

at any given moment ___% meet criteria for GAD

A

1.6%

124
Q

lifetime prevalence panic disorder

A

3%

125
Q

social anxiety disorder prevalence

A

13%

126
Q

social anxiety disorder gender preference

A

women

127
Q

physical symptoms of social anxiety disorder

A 
blushing 
profuse sweating 
trembling 
difficulty talking 
nausea 
stomach discomfort
128
Q

panic disorder

A

overwhelming experience of apprehension, tear

attacks are time limited but increase in frequency

129
Q

function of amygdala

A

plays a general role in emotion processing

detect and avoid danger

130
Q

percentage of Americans reporting illicit drug use

A

10%

131
Q

percentage of Americans reporting binge drinking

A

25%

132
Q

percentage of Americans reporting tobacco use

A

25%

133
Q

percentage of Americans reporting drinking during first trimester

A

20%

5% -second

5%-third

134
Q

mediators of reward in acute substance abuse

A

dopamine

opioids

135
Q

impulsive substance use for

A

pleasure

136
Q

compulsive substance use for

A

withdrawal avoidance

137
Q

gold standards alcohol screening tools

A

AUDIT/AUDIT-C (10q)
DAST (28 items)
CRAFFT (adolescents)

138
Q

CRAFFT

A

alcohol screening for adolescents

car 
relax 
alone
forget (blackout) 
friends (say cut back) 
trouble (while using)

score of 2 or more positive

prefer paper or computer self-report

139
Q

pregnancy alcohol screening tool

A 
1.TWEAK
tolerance 
worried 
eye-opener 
amnesia 
kut down 
2.T-ACE 
tolerance 
annoyed 
cut down 
eye-opener
140
Q

CAGE

A

not so great

only for severe alcoholism

141
Q

medical management

alcohol use disorder

A

disulfiriam (aldehyde dehydrogenase inhibitor)
naltrexone (MOR antagonist; side effect headaches, nausea)
acamprosate (glutamate neuro-modulator; side effect diarrhea)

142
Q

medical management

opioid use disorder

A 
naltrexone ER (MOR antagonist; side effect headaches, nausea) 
naloxone  (MOR partial antagonist; side effect constipation, sweating) 
methadone (MOR agonist)
143
Q

medical management

nicotine use disorder

A

nicotine replacement therapy (first line)
bupropion (first line except bipolar I DO; warning mania in bipolar I)
varenicline (second line)

144
Q

MOR

A

mu opiod receptor

145
Q

psychological homeostasis

A

bandwidth of nml function
flexibility
resilience
repair

146
Q

defense mechanisms

A

Intellectualization/rationalization: justify doing a or b through logic (may be healthy)

Sublimation: channel one desire into another pursuit (may be healthy)

Projection: believe someone is making you feel a certain way (less health)

Paranoia/psychosis (less healthy)

147
Q

what two principles are mental life governed by

A

1) pleasure principle (primary)

2) reality principle (secondary)

148
Q

Insight oriented psychotherapy

A

start with feelings, go to thoughts originating from it

149
Q

CBT

A

start with thoughts, go to feelings

150
Q

Transference

A

redirection of feelings/desires from the past of patient to the therapist

151
Q

Counter-transference

A

association of feelings to desire from therapist to patient

152
Q

Resistance

A

understand forces that oppose patient’s purpose and goal

153
Q

Free association

A

trying to show unconscious processes

154
Q

Dialectical behavior therapy

A

individual and group therapy for borderline personality to reduce self-harm and hospitalizations

155
Q

% of people use psychotherapy each year,

A

3%

156
Q

% of people receive fewer than 10 sessions

A

70%

157
Q

five class of antidepressants with representative drug from each class

A
  1. SSRIs (sertraline, paroxetine, fluoxentine, citalopram, escitalopram)
  2. SNRIs (venlafaxine, duloxetine)
  3. atypical/NDRIs
    antidepressants (buproprion)
  4. TCAs (amitriptyline, clomipramine)
  5. MAOIs (iproniazid, moclobemide, befloxatone, brofaromine)
158
Q

what are the most common antidepressants

A

atypicals

159
Q

SSRI examples

A

SSRIs ( fluoxentine, paroxetine, sertraline, citalopram, escitalopram)

“Flashbacks paralyze senior citizens.”

160
Q

SNRI examples

A

venlafaxine
desvenlafaxine
duloxetine

161
Q

Non-SRIs/NDPI/atypical

example

A

buproprion

162
Q

5HT2 antagonist

A

antidepressant

trazodone

risk: orthostatic hypotension, insomnia, priapism, hepatoxicity

163
Q

trazodone side effects

A

antidepressant
5HT2 antagonist

risk: orthostatic hypotension, insomnia, priapism, hepatoxicity

164
Q

newest serotonergic agents (antidepressant)

A

SRI + post-synaptic 5HT activity

vilazodone
vortioxetine

165
Q

TCA examples

A

secondary

  • desipramine
  • nortriptyline
  • protripyline

tertiary

  • imipramine
  • amitriptyline
  • clomipramine
166
Q

TCA side effects

A

cardiac arrhythmias with overdose

tertiary > secondary

  • weight gain
  • sedation
  • hypotension
  • dry mouth
  • constipation

anticholinergic sx

167
Q

MAOi examples

A 
iproniazid (first one!) 
selegiline 
phenelzine 
tranylcypromine 
isocarboxazid
168
Q

benzo pros/cons

A

rapid onset
inexpensive

abuse liability
rebound/withdrawal
may hinder learning/CBT

169
Q

SSRIs/SNRIs pros/cons

A

non addictive

delayed onset
sexual dysfunction

170
Q

buspirone pros/cons

A

non-addictive

delayed onset
lower efficacy

171
Q

bupropion pros/cons

A

smoking cessation

lowers seizure threshold

172
Q

additional benefit of TCA and SNRI as compared to SSRI

A

pain reduction

neuropathies
fibromyalgia

173
Q

blood pressure changes and antidepressants

A

increased -SNRIs

orthostatic hypotension-MAOis and TCAs

174
Q

serotonin syndrome

A 
clonus 
tremor 
confusion 
agitation 
diaphoresis 
hyperthermia 
rhabdomylosis 
renal failure

rapid onset
no unique lab findings

175
Q

name 3 classes of anxiolytics and representative drug

A
  1. antidepressants (mainstays for long-term treatment)-> SSRIs, SNRIs
  2. benzodiazepines (diazepam, lorazepam, midazolam, clonazepam -> short term of panic attacks)
  3. buspirone
176
Q

which benzo is preferred for patients with hepatic disorders?

A

LORAZEPAM

think LL
liver lorazepam

177
Q

off label tx for anxiety disorders

A

SGAs
Beta-Blockers (propranolol)
alpha-1 antagonist (prazosin)
anticonvulsants (gabapentin)

178
Q

2 non motor side effects associated with antipsychotics?

A

weight gain
increase blood sugar
increase lipids

179
Q

superior antipsychotic over other?

why not used more often?

A

clozapine (SGA)

side effect agranulocytosis

180
Q

high potency FGA

high risks?

A

haloperidol

extrapyramidal sx

181
Q

intermediate FGA

A

Perphenazine

182
Q

low potency FGA

high risks?

A

chlorpromazine

hypotension
anticholinergic sx
sedation
arrhythmias

183
Q

EPS

A

akathesia
acute dystonic rx
parkinsonism

tx: anticholinergic, b-blockers and benzos

184
Q

clozapine side effects

A

agranulocytosis
lowered sz threshold
myocarditis

185
Q

D1, D2 (essentially all antipsychotics) antagonist

major risk?

A 
neuroleptic malignant syndrome 
FEVER 
Fever 
Encephalopathy 
Vitals unstable 
Elevated enzymes 
Rigidity of muscles
186
Q

3 examples of mood stabilizers

A

lithium
lamotrigine
valproate

187
Q

what mood stabilizer is excreted by the kidneys unchanged?

A

lithium

188
Q

lithium

A

mood stabilizer
low therapeutic index

weight gain 
polyuria 
hypothyroidism 
hyperparathyroidism 
hypercalcemia 
epsteins anomaly
189
Q

factors affecting lithium levels

A

increase

  • thiazide diuretics
  • NSAIDS

decrease

  • methylxanthines
  • mannitol
190
Q

valproate

A

metabolized by liver

GI side effect 
weight 
pancreatitis 
hyperammonemia
platelet dysfunction 
neural tube defects
191
Q

lamotrigine

A

rash (SJS, TEN)
lamest of the options
lithium, valproate and SGAs are best for mania

192
Q

psychopharm emergencies

A 
NMS 
serotonin syndrome 
hypertensive crises 
acute dystonias 
SJS/TEN 
cardiac arrhythmias 
myocarditis 
agranulocytosis 
hepatoxicity 
pancreatitis 
hyperammonemia 
priapism 
seizures
193
Q

MAOi is absolutely contraindicated with what?

A

meperidine

Psychiatry (5 decks)

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