Psych - morning of exam Flashcards
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
How many days do benzos stay in your system
Short acting = 5 days
Long acting = 30 days
How many days do barbs stay in your system
Short acting = 24 hours
Long acting = 3 weeks
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
How long do opioids stay in your system
1-3 days urine
think of the 3 vowels in opIOId
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
MOA of PCP
activation of NMDA receptors
What drugs can be used to treat nicotine dependence
Varenicline
Bupropion
Nicotine replacement therapy
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
Presentation of inhalant intoxication
Perceptual disturbances, paranoia, lethargy, dizziness, N/V, HA nystagmus, tremor, muscle weakness, ataxia, slurred speech
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
Cushing syndrome (from exogenous corticosteroids), often manifests in which psychiatric disorders?
Depression and mixed anxiety and depressive state
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
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
Drug treatment of akithisia
Beta blockers (Propranolol) are most effective
Benzos and anticholinergics may be somewhat effective
Tx of shift work sleep disorder
Modafinil is the only approved medication
Preferred drug to treat psychotic sx in patients with Parkinsons
Quetiapine - due to sedative quality and lack of EPS
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
What is clang association
Thoughts that come out in a rhyming pattern, whether or not the verbalized sentence means anything logical
Time frame and number of symptoms needed for GAD
At least 3 symptoms for at least 6 months
What is Nihilism
Belief that oneself, other, or the world are either nonexistant or are coming to an end
What is the primary metabolite of dopamine
Homovanillic acid
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
