Psych - morning of exam Flashcards by Giselle McIntyre

How many days does PCP stay in your system

4-7 days urine

Think: opioid = 3 days. P comes right after O and is 3 letters. So 4 + 3 = 7

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How many days do benzos stay in your system

Short acting = 5 days

Long acting = 30 days

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How many days do barbs stay in your system

Short acting = 24 hours

Long acting = 3 weeks

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What psych issues is Propranolol used for

Non-selective beta antagonist
• Useful in treating the autonomic effects of panic attacks or social phobia, such as palpitations, sweating, and tachycardia

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How long do opioids stay in your system

1-3 days urine

think of the 3 vowels in opIOId

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What can be used for tx of heroin withdrawal sx

Clonidine (a2 agonist) to treat autonomic signs and symptoms of withdrawal

Methadone or Buprenoprhine to cause detox

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MOA of PCP

activation of NMDA receptors

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What drugs can be used to treat nicotine dependence

Varenicline
Bupropion
Nicotine replacement therapy

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Give important BAL

20-30 = first signs of intoxication

100-200 = impairment of motor and mental performance

200-300 = blackouts

400+ = respiratory depression, death possible

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Presentation of inhalant intoxication

Perceptual disturbances, paranoia, lethargy, dizziness, N/V, HA nystagmus, tremor, muscle weakness, ataxia, slurred speech

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Describe partial complex seizure

Altered state of consciousness, usually manifested by staring, is accompanied by hallucinations (olfactory are common), automatisms (buttoning and unbuttoning, masticatory movements, speech automatisms), perceptual alterations (objects changing shape or size), complex verbalizations

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Cushing syndrome (from exogenous corticosteroids), often manifests in which psychiatric disorders?

Depression and mixed anxiety and depressive state

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Presentation of temporal lobe epilepsy

Bizarre behavior, often without classic grand mal shaking movements
Characterized by hypo-sexuality, emotional intensity and a perseverative approach to interactions, termed viscosity

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Presentation of Wernicke vs. Korsakoff syndrome

♣ Due to Thiamine deficiency

Wernicke = ataxia, confusion, ocular abnormalities (nystagmus, gaze palsies)

Korsakoff = anterograde and retrograde amnesia, compensatory confabulation

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Drug treatment of akithisia

Beta blockers (Propranolol) are most effective

Benzos and anticholinergics may be somewhat effective

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Tx of shift work sleep disorder

Modafinil is the only approved medication

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Preferred drug to treat psychotic sx in patients with Parkinsons

Quetiapine - due to sedative quality and lack of EPS

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What is the half-life of Lithium / how long does it take to reach steady state

Half life = 20 hours

Takes 5 half-lives to reach steady state. 5 x 20 = 100 hours = about 8 days

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What is clang association

Thoughts that come out in a rhyming pattern, whether or not the verbalized sentence means anything logical

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Time frame and number of symptoms needed for GAD

At least 3 symptoms for at least 6 months

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What is Nihilism

Belief that oneself, other, or the world are either nonexistant or are coming to an end

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What is the primary metabolite of dopamine

Homovanillic acid

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At what stage of sleep does dreaming occur

REM

Most common gene mutation in Alzheimers

Presenilin 1 (70-80%)

Presenilin 2 (20-30%)
APP (2-3%)

Time frame of bulimia

Binge eating and compensatory behaviors occur at least once a week for 3 months

Time frame of binge eating disorder

Binge eating occurs at least once a week for 3 months

DSM criteria and time frame for hypersomnolence disorder

o Excessive sleepiness despite at least 7 hours of sleep, with at least one of the following: ♣ Recurrent periods of sleep within the same day ♣ Prolonged, nonrestorative sleep > 9 hours ♣ Difficulty being fully awake after awakening o Occurs at least 3 times per week for at least 3 months

Tx of hypersomnolence disorder

Modafinil or stimulants Amphetamine-like antidepressants such as atomoxetine are second line

Time frame for narcolepsy

Recurrent lapses into sleep or naps | ♣ Minimum 3x per week for 3 months

What substance can be used to test for narcolepsy

Low CSF levels of hypocretin

2 components of ADHD

Inattention + hyperactivity/impulsivity

Time frame for ADHD

Sx > 6 months in at least 2 settings

2 components of ASD

Impairments in social communication/interaction + restrictive, repetitive behaviors/interests

Diagnostic criteria for Tourette disorder

o Multiple motor tics and at least one vocal tic for > 1 year • Vs. Chronic tic disorder o Either motor or verbal tics (but not both) for > 1 year

• Sexual arousal from touching or rubbing against a nonconsenting person

♣ Frotteuristic disorder

Recurrent defecation into inappropriate places

Encopresis

Tx for Tourette

o Behavioral intervention – habit reversal therapy o Medications: ♣ Alpha-2 agonists – Guanficine, Clonidin ♣ Antipsychotics

Time frame for selective mutism

> 1 month THINK: You SELECT a single (1) choice

Time frame (onset and duration) of Acute Stress Disorder

Trauma occurred < 1 month ago Symptoms last < 1 month

Tx for catatonia

Benzo or ECT

At what time of alcohol withdrawal do seizures occur

12-48 hours

At what time of alcohol withdrawal does delirium tremens occur?

48-96 hours

First line tx for alcohol use disorder

Naltrexone

Dangers of PCP overdose

Seizures, delirium, coma, death

When you think of psych liver enzymes think...

2D6

Smoking is an inducer of what liver enzyme

1A2

Meds that can be used to treat delirium

Avoid unnecessary meds Low dose Haldol (0.25-0.5) if agitated - scheduled BID IV for as short amount of time Make sure to have plan to discontinue

What dementia is characterized by personality changes

FTD

Features of Lewy Body dementia

THINK: Creepy Lewy. Is not right in the head (early dementia). Staring at everyone (visual hallucinations). With darty eyes (rapid eye movement disorders - REM) Core Features: • Waxing and waning of cognition, especially in the areas of attention and alertness o Early onset dementia (vs. Parkinson’s which has later onset) • Visual hallucinations (syntonic – the hallucinations are not disturbing to the patient) • Development of extrapyramidal signs (Parkinsonism) at least one year after cognitive decline becomes evident Suggestive Features: • Rapid eye movement (REM) sleep behavior disorder – violent movements during sleep in response to dreams, often of fighting • Pronounced antipsychotic sensitivity

Tx of akathisia

Lorazepam, Propanolol or Diphenhydramine

Which antipsychotics are available as long acting injectables

THINK: How Ridiculous, Paying For A hOle ``` H = Haloperidol R = Risperidone P = Paliperidole F = Fluphenazine A = Aripiprazole O = Olanzapine ```

Toxicity of what bipolar drug causes tremor, confusion, ataxia, and diarrhea

Lithium

Describe flight of ideas

The patient is not able to answer your original questions, and she switches rapidly from one topic to another. However, there is still a loose connection between sentences.

Describe tangentiality

logical thought | processing that does not answer the original question.

Describe word salad

severe breakdown in thought process in | which no meaning is conveyed and speech consists of a string of words that do not form sentences

Cataplexy vs. Catatonia

Catatonia requires two or more of the following criteria to be met: motor immobility, excessive motor activity, negativism or mutism, odd voluntary movements, and echolalia or echopraxia. This patient exhibits motor immobility with waxy flexibility (maintaining a pose he is placed in), mutism, odd voluntary movements with gegenhalten (increasing resistance through a range of motion), and automatic obedience (obeying your command to allow you to put a pin through his tongue). Cataplexy is sudden loss of muscle tone in response to strong emotion and is seen in narcolepsy