Psych OME Notes Flashcards
OSA is diagnosed by polysomnography with what findings?
15+ obstructive apneas/hour OR 5 apneas/hour AND snoring or breathing pauses with daytime somnolence
__________ is the experience of detachment from one’s own thoughts, body, or actions — as if you’re watching a movie about yourself.
________ is the experience of detachment from surroundings, as if living in a dream.
Together, these make up ______ _____ disorder. It’s typically seen in adolescents with a benign stressor (which may be relatively severe). Reality testing is intact!
Depersonalization
Derealization
Depersonalization derealization disorder
Bulimia severity is indicated by how many times per week there is compensatory behavior. What is considered mild, moderate, severe, and extreme?
Mild = 1-3x/week Moderate = 4-7x/week Severe = 8-13x/week Extreme = >14x/week
Treatment for GAD
Psychotherapy is most important
Long term medical therapy includes SSRIs and buspirone
________ is a classic mood stabilizer used to tx bipolar that has narrow therapeutic index, can rapidly become toxic in _______ disease, and has side effect profile including diabetes insipidus, vomiting, abdominal pain, and progresses to encephalopathy, ataxia, and hyperreflexia
Lithium; renal
Postpartum psychiatric condition in which mom fears the baby and is likely to kill it, with onset within 1 month of giving birth, there is no associated depression, and tx is mood stabilizers or antipsychotics
Postpartum psychosis
To qualify for major depressive disorder, there must be at least _____ of the SIGECAPS symptoms which must include _____ or ______ for at least ________
5; depressed mood; anhedonia; 2 weeks
The best thing to do in intellectual disability disorder
Education
Social skills training
In ______ personality disorder, pts are shy, fearing criticism, and saddled with feeling of inadequacy. They desperately want friends but avoid them for fear of rejection. They’ll often pass on promotions or choke during presentations because they’re afraid of failing and/or being judged. They live in cluster ____
Avoidant; C
The best antipsychotic bc it is the most selective for D2C and 5HT1 (treats positive and negative symptoms) so it is the drug of last resort
Clozapine
Extrapyramidal side effect that is a subjective feeling of restlessness. Options are to decrease the dose, use beta blockers or anti-ach medications like benztropine
Akathisia
Schizophrenia symptoms + mood disorder (MDE, mania)
Schizoaffective disorder
Second generation antipsychotic associated with drowsiness (good for mania and psychotic features)
Quetiapine
Pt presents with any complaint — somatic, neurologic, or otherwise. This complaint is self-inflicted. There’s an intention to deceive medical personnel into believing the patient is sick. This can be done by causing injury or disease, contaminating lab tessts, or in any other way manipulating th ediagnosis
Factitious disorder (and factitious disorder by proxy)
Acid base disorder seen in binge/purge eating disorders in which purging is through emesis
Metabolic alkalosis
[also K+ and Mg+ disorders]
If you think disinhibited social engagement disorder, what must be in the vignette?
Neglect or abuse in infancy, too MUCH attachment to others later in life
What constitutes an adequate trial of SSRI for depression prior to adding a second agent?
4-8 weeks at maximal dosing
Panic attacks are anxiety episodes that come on without provocation with symptoms of SOB, trembling, unsteadiness, depersonalization, excessive heart rate, numbness, tingling, sweating, palpitations, abdominal distress, nausea, intense fear of losing control or dying, and/or chest pain.
What is the first line treatment when a patient is in the acute phase of a panic attack?
Benzos
Catatonia is defined by at least 3 of what list of signs/symptoms?
Stupor Cataplexy Waxy flexibility Mutism Negativism Stereotypy Agitation or grimacing Echolalia Echopraxia
________ is associated with OCD and ADHD, having an onset <18. The patient has motor and vocal tics for at least 1 year
Tourette’s
Disorder characterized by deficits in cognitive skills and adaptive functioning. Replaced the term mental retardation which has since been banned by Rosa’s law
Intellectual disability disorder (IDD)
In ______ personality disorder, there is a preoccupation with orderliness and control at the expense of efficiency. These patients have difficulty meeting deadlines and finishing tasks. They’re rigid, but despite their failures are ego-syntonic. They live in cluster ____
Obsessive compulsive; C
________ ________ is defined as the inability to recall or inconsistency in recall ordinary important information. It’s often associated with acute emotional stress or trauma. The loss of memory is usually focused on the event itself, but can also include everyday routines or memories, or even loss of entire autobiographical self. If there’s travel, it’s a subtype that is deemed _______ _______
Dissociative amnesia; dissociative fugue
Best tx for schizophrenia symptoms
Clozapine
To diagnose ADHD, consider the time, inattention symptoms, and impulsivity symptoms. The onset must be before age _____, have a duration of ________, and occur often enough to impair function.
12; >6 months
___________ is a schizophrenia-related disorder in which symptoms last between 1-6 months
Schizophreniform disorder
Bipolar I is mania. Bipolar II is hypomania with depression. ________ is bipolar II, just not as bad. Patients have had at least 2 years of hypomanic and major depressive episode, plus symptoms that fail to meet criteria for bipolar II
Cyclothymia
In _______ personality disorder, the patients teeter on the border of psychosis. This personality disorder has many associations. They often complain of emotional numbness, committing suicidal gestures like cutting. They’re impulsive and often engage in prematurity and drugs. These are pts who attempt suicide to get attention, and if poorly timed, can succeed. They have rapidly changing moods: anger, happiness, sadness, etc. that change on a dime. They frequently exhibit splitting. They live in cluster ____
Borderline; B
Bipolar II is hypomania and major depression. What is hypomania?
Hypomania is defined by all the same symptoms of mania except they are less severe (not as impairing), and for less time (at least 4 days)
Preferred tx for OCD
CBT
Positive and negative symptoms associated with schizophrenia and how they contribute to diagnostic criteria of schizophrenia
Positive symptoms:
- Bizzare delusions
- Hallucinations
- Disorganized speech
- Disorganized or catatonic behavior
Negative symptoms
5. Flat affect, cognitive deficits, poverty of speech, anhedonia
DSM-V says any two symptoms, as long as one of them is from items 1-3
Kubler Ross Stages of Death and Dying
Denial Depression Bargaining Anger Acceptance
[May progress in any order, skip around, or go back and forth between them]
What stressor is associated with reactive attachment disorder?
Neglect or abuse during infancy and childhood — causes inability to pair, bond, or attach to adults
Schizophrenia is a thought process disorder with an unknown etiology. There’s definitely a genetic component, while overload of ________ and probably serotonin contribute to a constellation of thought symptoms culminating in the final diagnosis
Dopamine
T/F: by definition, acute stress disorder cannot be in the setting of bereavement
True
Malignant catatonia, neuroleptic malignant syndrome, and serotonin syndrome are all characterized by rigidity, autonomic instability, increased temp, and possibly increased creatinine kinase. So how do you differentiate these diseases?
By the drug that caused it
Malignant catatonia is non-drug induced
NMS is caused by atypical antipsychotic meds
Serotonin syndrome is caused by SSRIs
Negative symptoms of schizophrenia are caused by activation of what receptor?
5-HT1 serotonin receptorr
T/F: bulimics often have normal or overweight BMI
True
Definitive treatment for PTSD and ASD
Group therapy — if implemented early, can limit the symptoms to ASD without progression to PTSD
Other tx options are SSRIs/SNRIs, CBT, and benzos (if panic attacks)
_______ is the best drug for bipolar/mania but is teratogenic so cannot be used in pregnancy. ________ is also first line but can cause spina bifida so also cannot be used in pregnancy
Lithium; valproic acid
What is most important to assess for in pts presenting with depression?
Suicidal tendency — hospitalize if present, especially if they have a plan
Important to assess for intention, ability, and validity of threat
A pilot develops a fear of flying but wants to keep her job. What type of CBT does she need?
Desensitization
Diagnostic criteria for conduct disorder
At least 3 symptoms in the past 12 months of violating rules, rights of others, or social norms in terms of aggression to people or animals, property destruction, or rule violation
________ _______ occurs almost exclusively in girls who regress after a period of normal development until around 6 months. Over time it progresses to death. Genetically inherited, give genetic counseling to parents.
Rett syndrome
FRAMES motivational interview strategies for substance use disorder
Offer FEEDBACK
Emphasize personal RESPONSIBILITY
Give ADVICE
MENU of options for quitting
EMPATHY
Support SELF-EFFICACY and show them how life is better while clean
Examples of SNRIs
Venlafaxine
Desvenlafaxine
Duloxetine
Name some SSRIs
Escitalopram
Fluoxetine
Paroxetine
Sertraline
_____ _____ is basically antisocial personality disorder as a kid. Patients disregard rights of others. They are bullies who pick fights or destroy property, lie/steal, and/or harm animals. Attempts at correction should be made as soon as possible with juvenile detention, big brother programs, or other behavior modifiers
Conduct disorder
Medical condition to consider ruling out in pt presenting with depression
Hypothyroid
In ______ personality disorder, pts have no regard for rights of others, are impulsive, and lack remorse. They are often criminals and are often preceded by prior conduct disorder. You can’t and shouldn’t treat them, it just makes them better liars. Often incarceration is the only option. They live in cluster _____
Antisocial; B
Pt presents with hair of different lengths with areas of hair loss and a small bowel obstruction, dx?
Trichobezoar
First generation antipsychotics (typical) examples
Haloperidol
Fluphenazine
Thioridazine
Chlorpromazine
What complication is 15x higher in bipolar pts?
Suicide
5 categories of symptoms associated with PTSD
Intrusive — memories, flashbacks, nightmares
Negative mood — depression
Dissociation — depersonalization, amnesia
Avoidance — symbols, locations, memories
Arousal — hypervigilance, irritability, easily started, change in concentration
Criteria for gender dysphoria
Duration >6 months AND and one of the following:
- Incongruence between experienced gender and sex characteristics
- Desire to be, be treated as, or have sex characteristics of another gender
- Wanting to rid self of sex characteristics
- Beliefs that the patient, the self, has typical feelings and reactions of another gender
High-potency typical antipsychotics (haloperidol, fluphenazine) have a stronger effect, but higher incidence of _______ _______.
Low-potency typical antipsychotics (chlorpromazine) have high rates of __________ side effects
Extrapyramidal symptoms
Anticholinergic
Diagnosis requires 2+ distinct identity states. Patient experiences recurrent gaps in memory (“blackouts”) or suffers from inconsistencies in everyday events or important personal information. People around will notice changes in affect and behavior, often completely out of character and manifesting as paradoxical behavior. This commonly arises from periods of intense and prolonged stress
Dissociative identity disorder
Which type of bipolar is mania-predominant?
Bipolar I
Treatment of anorexia nervosa
CBT is critical to control the dysmorphic aspect
Medications are directed at comorbid conditions — SSRI/SNRI for major depression or OCD (fluoxetine), and antipsychotics can be used as primary treatment
In what stage of sleep do night terrors occur?
N3
Examples of MAOIs
Selegiline
Phenelzine
Tranylcypromine
Form of catatonia characterized by rigidity and autonomic instability (hypertension, tachycardia, increased temp)
Malignant catatonia
There are no diagnostic tests for autism spectrum disorder but there must be two characteristics — what are they?
Impaired social communication — manifested as the inability to reciprocate emotionally
Restricted repetitive behaviors — manifested as stereotyped movements, insistance on sameness, and preoccupation with certain objects or interests
Why is the goal to avoid SSRIs in treating bipolar?
Can trigger a manic episode
Schizophrenia symptoms that last >1 day and <1 month
Brief psychotic disorder
GAD diagnostic criteria
Constant state of worry about most things on most days for 6+ months accompanied by 3+ somatic complaints (irritability, somatic pain, weight change, sleep change, concentration, etc)
Theta waves and absent alpha waves are indicative of which sleep stage?
N1 (stage 1, non-REM)
In _______ personality disorder, patients are detached loners who don’t interact and are happy in isolation. They don’t experience emotions like others. They usually don’t need treatment and they avoid everyone, so you won’t see them in clinic. They live in cluster _____
Schizoid; A
In ______ personality disorder, patients are attention-seeking with excessive contrived emotion, over the top action and dress, and hypersexuality. They use their physical appearance to be seductive and behave very theatrically. Those pts do poorly in a mid-life crisis as their looks begin to fade, they’ll feel like no one cares about them anymore. They live in cluster _____
Histrionic; B
Preferred treatment for opioid withdrawal during pregnancy
Methadone
Complications of chronic OSA
Pulmonary HTN that leads to isolated right heart failure
Criteria for premenstrual dysphoric disorder
At least 5 symptoms present in the week before menses onset. Symptoms must be absent in the week post-menses
Look for accompanying mood swings, irritability, depressed mood, anxiety, lacking interest, difficulty concentrating, changes with appetite and sleep, breast tenderness, muscle pain, bloating
Treatment of GAD
Psychotherapy > SSRIs
Mood stabilizer that has adverse effects of teratogenicity, thrombocytopenia, agranulocytosis, and pancreatitis
Valproate
4 characteristics to watch for in substance use disorder
Difficulty controlling use
Adverse social circumstances
Risk-taking
Health effects
Passive resistance to movement during catatonia
Catalepsy
Second generation antipsychotics (atypical) examples
Risperidone Quetiapine Olanzapine Aripiprazole Ziprasidone
Form of catatonia characterized by hyperkinesis, frenzy, combativeness, restlessness
Excited catatonia
K-complexes and sleep spindles are in what stage of sleep?
N2 (stage 2, non-REM)
Schizophrenia symptoms that last >1 month but <6 months
Schizophreniform
Specific phobias that are common include fear of heights, spiders, or flying. The fear comes from somewhere, treatment involves trying to learn serenity in the place of anxiety. This is done in one of two ways:
_____________ which is slower, more effective over time, and has a longer duration of success. It involves stages of anxiety-provoking situations, each of which are conquered sequentially using medications or techniques to control symptoms during the session
__________ which is faster, less effective over time, but can get adequate control quickly. It is performed by overwhelming the pt with a major stimulus while engaging in anxiety reducing behaviors or under medication.
Systemic desensitization (best option for long term tx)
Flooding (best when there is time sensitive need)
What meds come in oral disintigrating tablet form for mild control of combative pts?
Olanzapine
Risperidone
Wetting the bed is normal up until age ____
7
Etiologies of intellectual disability disorder
Chromosomal (Down’s, fragile X, cri-du-chat)
Acquired (maternal substance abuse in utero, maternal hypothyroid in utero, lead poisoning)
Criteria for insomnia
Difficulty falling or staying asleep for more than 6 hours, 3 nights per week for 3 months
Disorder characterized by eating non-food substances for over a month — common examples are soap, paper, paint, air, or chalk. Most often presents with toxicity due to ingested substance
PICA
Treatment of PCP intoxication
Diazepam for chemical sedation (or lorazepam if pre-existing liver damage is a concern)
[urine acidification was used in the past to increase clearance, but now is no longer done d/t risk of metabolic acidosis and renal damage]
Disorder characterized by regurgitation of food for at least a month. It’s mostly in infants or those with developmental problems. It’s related to overfeeding and the inability to cope with the sensation of fullness
Rumination disorder
Impulse control disorders are a subset of anxiety disorders. Impulses are anxiety-inducing needs to do something, actions relieve anxiety (or cause pleasure). These disorders can be associated with crimes. It’s the stressor, action, and response to the action that separates these disorders.
What are some examples of impulse disorders?
Intermittent explosive disorder
Pyromania
Kleptomania
A ________ is a fixed false belief that seems to the patient to be a universal truth. The patient has no insight that the rest of the world would not agree with their thought
Delusion
Treatment for reactive attachment disorder
Coaching the caregiver/parent on good parenting skills
If you think reactive attachment disorder, what must be in vignette?
Neglect or abuse in infancy, too LITTLE attachment to others later in life
With catatonia, fixing the underlying condition is paramount to treatment. When encountered, ________ is the tx of choice. It can be both diagnostic and therapeutic. Refractory cases are treated with _________
Lorazepam; ECT
Postpartum psychiatric condition in which mom doesn’t care about baby or may hurt baby with onset within 1 month of birth, symptoms similar to major depressive episode, and treatment is antidepressants
Post-partum depression
Atypical antidepressant chosen when smoking cessation is also desired
Buproprion
What meds come in a depot form for long-term use in noncompliant pts?
Olanzapine
Risperidone
Haloperidol
Extrapyramidal side effect that comes from inhibition of the nigrostriatal tract. Treat with anticholinergics or specific dopamine agonists like benztropine
Dyskinesia
Enuresis is repeated urination in bed or clothes, either intentional or involuntary and not due to medication, disease, or structural abnormality. The definition is at least ____ times per week for _____ months in a patient that’s at least ____ years old
2; 3 months; 5 years old
Intoxication with ______ causes psychomotor agitation, HTN, tachycardia, dilated pupils, psychosis, angina/HTN crisis
Cocaine
Second line mood stabilizer with side effects of blurred vision and SJS
Lamotrigine
What do alcohol and benzodiazepines do to sleep architecture?
Suppress REM
Treatment of alcohol and benzodiazepine withdrawal starts with long acting benzo like ____ or ______, followed by rapid acting benzos as needed
Chlordiazepoxide; diazepam
Findings in narcolepsy:
______ is the loss of muscle tone while conscious
___________ hallucinations occur while going to sleep
_________ hallucinations occur while waking up
Cataplexy
Hypnagogic
Hypnopompic
If an anorexic pt is less than _____% ideal body weight, or extreme anorexia (BMI less than ______), they should be hospitalized
85%; 15
Diagnostic step for narcolepsy (beyond clinical findings)
CSF Hypocretin-1
Medications to treat depression in a bipolar pt
Quetiapine
Lurasidone
Olanzapine-fluoxetine
Class of medications that are cleaner, better versions of SSRIs but they are more expensive
SNRIs
Blocking dopamine in the _________ tract causes parkinsonism and extrapyramidal symptoms
Blocking dopamine in the _______ tract causes gynecomastia due to disinhibition of prolactin
Nigrostriatal
Tuberoinfundibular
How do you separate pyromania from arson?
Pyromania is fire setting on greater than 1 occasion to decrease anxiety, sexual arousal or pleasure
Arson is done with purpose of monetary gain or to cause harm/destroy
In _______ personality disorder, pts are submissive, clingy, and generally need to be taken care of. They’ll rely on others to make decisions and won’t initiate projects or conversations. Because of their unrealistic fears of isolation, they’ll often go to great lengths to save a relationship. They live in cluster ____
Dependent; C
In _____ personality disorder, pts are all about themselves. They express delusions of their own importance. They also dress over-the-top, but as to draw attention to themselves. They’re often exploitive and self-consumed so they ignore the needs of others. They’re special and demand the best for themselves, carrying a sense of entitlement. Frequently it’s a sign of insecurity as they’re often jealous of others. They live in cluster ____
Narcissistic; B
Valproic acid teratogenicity can lead to?
Spina bifida
What do you treat catatonia with?
Benzos
Overheating (fever, tachycardia), water intoxication, pupillary dilation, psychosis are signs of intoxication with what?
MDMA
Alcohol is zero-order metabolism, so no matter how much you give the liver, it can only process _____/hour which is about the level in one drink
0.03/hr
Adverse effects of TCAs
Cardiac toxicity (widen the QRS complex and lead to arrhythmias)
Convulsions (seizures)
Coma (altered mental status)
Anti-Ach properties (dry mouth, sedation, urinary retention, constipation)
What class of psychiatric drugs is associated with an increased risk for abnormal bleeding?
Serotonin reuptake inhibitors, especially fluoxetine and paroxetine
[thought to be due to 2 mechanisms — they limit uptake of blood serotonin by platelets, which is needed to promote platelet aggregation. They also inhibit CYP450 enzymes, potentially increasing concentration of other anticoagulant agents]
Diagnostic criteria for acute stress disorder vs. PTSD
Acute stress disorder is symptoms >3 days AND <1 month duration
PTSD is symptoms >1 month duration
Mood stabilizers used to treat manic symptoms in bipolar pt
Lithium
Valproate
Carbamazepine
Lamotrigine
Treatment for benzodiazapine withdrawal
Flumazenil
Stages of sleep and their EEG findings
N1 = theta waves, absence of alpha
N2 = K-complexes, sleep spindles
N3 = Delta waves
REM = awake EEG, atony, saccadic eyes, erections
Second generation antipsychotics target the D2C receptor in the ______ tract, which reduces side effects seen with first gen antipsychotics. They also antagonize ________ receptors. They have a lesser risk of EPS side effects
Mesolimbic; 5-HT1 serotonin receptors
Bipolar II is _______ AND _________
Hypomania; major depression
Positive symptoms of schizophrenia are caused by overactivation at what receptor at what location in the brain?
D2C dopamine receptor in mesolimbic tract
A pt is preoccupied with getting sick despite reassurance that they are medically well. Dx?
Illness anxiety disorder
Cluster C personality disorders
Avoidant
Dependent
Obsessive compulsive
The diagnosis of intermittent explosive disorder is dependent on frequency and severity — what are the criteria?
Either 2x/week in 3 months WITHOUT harm
OR
3x (at all) in a year WITH harm
Diagnostic criteria for Bipolar I:
Patient must have ____________ with another ____ symptoms for at least _______
Elevated mood; 3; 1 week
When starting a pt on clozapine, what lab do you need to check and why?
CBC every week
Potential to cause agranulocytosis
Extrapyramidal side effect that is a late onset, irreversible condition of temporarily suppressible oral-facial movements caused by dopamine-receptor sensitization. The only thing to do is stop the drug but symptoms initially worsen
Tardive dyskinesia
Treatment for Tourette’s disorder
Dopamine antagonists (antipsychotics)
Habit reversal therapy (behavioral)
If patient presents with depression but the emphasis is focused on a deceased loved one, or the duration of grief has exceeded 12 months and they don’t meet depression criteria, dx is ___________
Persistent complicated bereavement disorder
[treat with SSRI or SNRI just like depression. It is either persistent (>12 months) or complex (hopelessness, persistent depressed mood), but it’s NOT pervasive into all elements of pts life]
One or more somatic symptoms lasting 6 months or more without medical cause. The disorder is predominated by preoccupation with a somatic complaint that may or may not have a real medical condition behind it. If there is, it’s disproportionate concern to the severity of the illness
Aka preoccupation with a somatic symptom despite the absence of clinical findings
Somatic symptom disorder
2 treatment options for acute dystonia (i.e., oculogyric crisis)
Benztropine
Diphenhydramine
Second generation antipsychotics (atypical antipsychotics like risperidone, quetiapine, olanzapine, ziprasidone, aripiprazole) are first-line in treatment of schizophrenia disorders. They tend to be weaker but have several benefits over the typical antipsychotics. What are the benefits?
Treat both positive and negative symptoms
Less risk of EPS and anticholinergic side effects
__________ is a new lab test used in the diagnosis of narcolepsy
CSF hypocretin-1
A patient has a neurologic complaint (paralysis, sensory deficits) despite no organic cause. Often follows a major emotional stressor, the neurologic complaint often reflects the stressor
Functional neurologic symptom disorder (aka Conversion disorder)
Young patient presents with isolated performance difficulty with reading, spelling, or math. What is the first step you should take?
Hearing or vision exam — rule out organic cause
T/F: in OCD, the patient is painfully aware of the actions/thoughts and how irrational they are and they will often seek help
True
Criteria for adjustment disorder
Mood changes that occur in response to a stressor
Must begin <3 months from stressor, and last <6 months following stressor
Intoxication with _____ causes aggressive psychosis, vertical horizontal nystagmus, impossible strength, and blunted senses
PCP
WHO severity index by BMI for anorexa nervosa
>17 = Mild 16-16.9 = Moderate 15-15.9 = Severe <15 = Extreme
Third line agent for bipolar that is also used in trigeminal neuralgia and absence seizures but it is teratogenic (cleft palate), causes rash, SJS, and AV block
Carbamazepine
You want to start an atypical antipsychotic (second gen).
What do you need first?
ECG for QTc assessment
Impulse control disorders are a subset of anxiety disorders. Impulses are anxiety-inducing needs to do something, actions relieve anxiety (or cause pleasure). These disorders can be associated with crimes. It’s the stressor, action, and response to the action that separates these disorders. Medications, therapy, and combination therapy all work poorly, so consideration for _______ needs to be had
Incarceration
If pt fails to attach to anyone, it is reactive attachment disorder. If they attach to everyone inappropriately, it is ________
Disinhibited Social Engagement Disorder (DSED)
Impulse control disorder in which there’s a stressor (usually physical, violent, or loud) that induces anxiety. The action is some violent act that’s out of proportion to the initial stressor. The violent act is directed at people or property. After the act, the pt is calm, relaxed, and without remorse
Intermittent explosive disorder
How is malingering different from factitious disorder?
In malingering, the motivation is material gain
In factitious disorder, the motivation is to fulfill the sick role
Yawning, lacrimation, N/V, myalgias, sweats, and chills are signs/symptoms of withdrawal from what?
Opioids
Changes in mood (depression), anxiety, or conduct that starts within 3 months of a stressor and duration of less than 6 months after the event
Adjustment disorder
How do you differentiate trichotillomania from alopecia?
Trichotillomania — hair of different lengths
Alopecia — Patchy hair loss
[also rule out fungus causing hair loss or scratching]
5 stages of quitting in substance use disorder
Pre-contemplative (unaware, denial)
Contemplative (admits/accepts there’s a problem)
Preparation (committed, taking steps)
Action (actual changing behavior)
Maintenance (sustained behavior change)
In ________ personality disorder, everything is bizarre. It looks like schizophrenia by their dress, logic process, and actions. They don’t have hallucinations but do have magical thinking (lucky charms, extreme superstition). They live in cluster ____
Schizotypal; A
A woman wants to get pregnant but is bipolar. What med should you use?
Lamotrigine
[other options are quetiapine or carbamazepine]
What therapy works best for OCD?
Psychotherapy (CBT) — often Exposure and Response Prevention (ERP)
Cluster B personality disorders
Borderline
Histrionic
Narcissitic
Antisocial
The neurotransmitters of sleep can be remembered by the mnemonic SAND, they’re the order in which sleep stages occur
Serotonin
ACh
Norepinephrine
Dopamine
Common comorbidities with PTSD and ASD
Mood disorders (depression, anxiety)
Substance abuse
Serotonin modulators are generally not great antidepressants but have benefits in their side effect profiles. _______ can be used as an appetite stimulant for someone malnourished and depressed. ______ is used as a sleep aid, not for depression at all (due to possible AE of priapism)
Mirtazapine; trazodone
Treatment for cocaine withdrawal
Supportive care or benzos
Alpha and then beta blockade
Manic symptoms can be remembered by DIGFASTER mnemonic
Distractability Insomnia Grandiosity Flight of ideas Agitation, activities Sexual exploits Talkative Elevated mood Racing thoughts
Never give ________ in bulimia because there’s an increased risk of seizures
Buproprion
Narcolepsy is a sleep disorder in which patient is plunged directly into REM sleep “sleep attacks” that happen at least _____ times per week for _________
3x/week for 3 months
Side effects of SSRIs
Decreased libido Delayed ejaculation Serotonin syndrome GI effects Insomnia
Cluster A personality disorders
Paranoid
Schizoid
Schizotypal
Specific therapy for borderline personality disorder
Dialectic Behavioral Therapy
Second generation antipsychotic associated with DM and weight gain
Olanzapine
________ is a mood stabilizer that has made headway in the treatment of mania and bipolar. It has sedating side effects, making it ideal for those in mania. It can cause weight gain and QTc prolongation, so ensure an ECG is obtained
Quetiapine
Disorder characterized by confrontation of authority (parents, teachers) by yelling, throwing tantrums, but does NOT break laws, and does NOT hurt others. They interact well with peers but not with figures of authority
Oppositional defiant disorder
Medications sometimes used for public speaking phobia
Beta-blockers (atenolol, nadolol, or propranolol)
What are 2 major types of major depressive episode?
Melancholic depression — pts slow down; sleeping less, eating less, and lose weight (typical features)
Atypical depression — pts sleep more, eat more, and gain weight (atypical symptoms)
What should you rule out in pts presenting with symptoms of panic disorder?
Hyperthyroid
Stimulant drugs
If a pt with major depressive disorder is failing medications and therapy, or if there is catatonia or psychotic features, the ultimate best treatment is _________
ECT
To be dx as bulemic, pt has compensatory behaviors at least once per week for _________. Treatment centers around fluoxetine and CBT
3 months
Acid base disorder seen in binge/purge eating disorders in which purging is through induced diarrhea
Metabolic acidosis
Schizophrenia symptoms that last >6 months
Schizophrenia
First signs of alcohol (or benzo) withdrawal
Diastolic hypertension
Tachycardia
They then progress through tremors, diaphoresis, and anxiety. When they become confused, watch out because seizures (delirium tremens) are coming.
What must be ruled out in order to diagnose reative attachment disorder?
Autism spectrum disorder
Depressed mood for >2 years but without symptoms >2 months at a time
Pt is functioning but will have depressed mood; treated the same as MDD
Dysthymia — persistent depressive disorder
Catatonic pts don’t move or eat so they need help with nutrition and are at increased risk for ______ and ______
DVT; rhabdomyolysis
Extrapyramidal side effect that is a reversible involuntary muscle contraction, typically hand wringing, torticollis, and oculogyric crisis; can be reversed with anticholinergic meds such as benztropine or diphenhydramine
Acute dystonia
T/F: relapse in anorexia nervosa is uncommon
False - most will relapse within 5 years
Rules for trialling antidepressants
> 6 week trial
6 months of treatment
3 weeks washout
Max the dose
Treatment for enuresis begins with nighttime fluid restriction and water alarm blankets. Medications that reduce urinary volume such as ______ can be used (start with this). If that doesn’t work, can try medications that reduce urinary voiding like _________ as an adjunct. Last line therapy is _______
Desmopressin (DDAVP); oxybutynin; TCAs (imipramine)
How do you separate kleptomania from theft?
Kleptomania is stealing for the purpose of reducing anxiety and they are unable to resist. The object is typically something that has no value or something that the pt can afford. It is usually unplanned, not provoked by external stimuli, and the object is usually stashed, gifted, or returned due to remorse/guilt
Theft is stealing for desire of an object that has value of which the pt cannot afford. It is usually planned with help or provoked by external stimuli. The object is used or kept with no remorse or guilt
Encopresis is repeated defecation in inappropriate places, either intentional or involuntary and not secondary to medication or anatomic abnormality. To qualify as a diagnosis, it has to happen how often?
1+ times per month for 3 months
How long must you wait after stopping an MAOI to transition to an SSRI?
14 days
Postpartum psychiatric condition in which mom cares about baby, onset and duration is within 2 weeks of birth, mood is dysthymic, and there is no specific recommended treatment
Baby blues
First generation antipsychotics are second-line treatment for schizophrenia. What is the general MOA for these meds?
Dopamine-receptor antagonists
In ________ personality disorder, patients are mistrustful, suspicious of others, and usually interpret benign behaviors as malevolent. They’ll use _________ as a defense mechanism. They’ll be isolate and may have short-lived delusions of persecution that’ll interrupt their lives, but rarely persist. They live in cluster ____
Paranoid; projection; A
If bedwetting occurs after a dry period, something is wrong. What are some possibilities?
Regression following a stressor
Medical/anatomical problem
[Screen for abuse, educate proper wiping in females, screen for UTI, any STI in a child is confirmation of sexual abuse]
To qualify for major depression, pts must have at least 5 out of what list of symptoms?
SIGECAPS
Sleep changes Interest decrease Guilt Energy diminished Concentration decreased Appetite change/weight gain or loss Psychomotor slowing Suicidal ideation
Pt who has delusions that are fixed, false beliefs but they are non-bizzare (not true, but believable). There’s a logical thought process and there’s no loss of function, but the delusion may cause legal or relationship trouble
Delusional disorder
[tx is gentle confrontation over years of psychotherapy - no drug will do]
Patient presents with signs and symptoms of ADHD but when started on stimulant therapy, their symptoms worsen. What is the most likely dx?
Tourettes
Defined as excessive preoccupation and anxiety directed at acquiring a serious ilness for 6 months, but without somatic symptoms. Will seek multiple providers and undergo unnecessary tests despite reassurance
Illness anxiety disorder
Child having constant irritability with recurring behavioral outbursts disproportionate to situation; happens at least 3x/week and is evident before 10 years old (manifests ages 6-18)
Disruptive mood dysregulation disorder
Tx for dissociative identity disorder
Intense psychotherapy
Hypnosis
MAOIs can cause hypertensive crisis when mixed together, lack of washout, or eating of tyramine containing foods (red wine/cheese). How do you distinguish this hypertensive crisis from other hypertensive-hyperthermia disorders in psych?
Absence of lead-pipe rigidity and fever
Another name for somatic symptom disorder
Briquet’s syndrome
