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Boards Step/Level 2 > Psych OME Notes > Flashcards

Psych OME Notes Flashcards

1
Q

OSA is diagnosed by polysomnography with what findings?

A

15+ obstructive apneas/hour OR 5 apneas/hour AND snoring or breathing pauses with daytime somnolence

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2
Q

__________ 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!

A

Depersonalization

Derealization

Depersonalization derealization disorder

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3
Q

Bulimia severity is indicated by how many times per week there is compensatory behavior. What is considered mild, moderate, severe, and extreme?

A 
Mild = 1-3x/week
Moderate = 4-7x/week
Severe = 8-13x/week
Extreme = >14x/week
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4
Q

Treatment for GAD

A

Psychotherapy is most important

Long term medical therapy includes SSRIs and buspirone

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5
Q

________ 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

A

Lithium; renal

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6
Q

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

A

Postpartum psychosis

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7
Q

To qualify for major depressive disorder, there must be at least _____ of the SIGECAPS symptoms which must include _____ or ______ for at least ________

A

5; depressed mood; anhedonia; 2 weeks

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8
Q

The best thing to do in intellectual disability disorder

A

Education

Social skills training

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9
Q

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 ____

A

Avoidant; C

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10
Q

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

A

Clozapine

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11
Q

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

A

Akathisia

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12
Q

Schizophrenia symptoms + mood disorder (MDE, mania)

A

Schizoaffective disorder

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13
Q

Second generation antipsychotic associated with drowsiness (good for mania and psychotic features)

A

Quetiapine

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14
Q

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

A

Factitious disorder (and factitious disorder by proxy)

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15
Q

Acid base disorder seen in binge/purge eating disorders in which purging is through emesis

A

Metabolic alkalosis

[also K+ and Mg+ disorders]

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16
Q

If you think disinhibited social engagement disorder, what must be in the vignette?

A

Neglect or abuse in infancy, too MUCH attachment to others later in life

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17
Q

What constitutes an adequate trial of SSRI for depression prior to adding a second agent?

A

4-8 weeks at maximal dosing

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18
Q

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?

A

Benzos

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19
Q

Catatonia is defined by at least 3 of what list of signs/symptoms?

A 
Stupor
Cataplexy
Waxy flexibility
Mutism
Negativism
Stereotypy
Agitation or grimacing
Echolalia
Echopraxia
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20
Q

________ is associated with OCD and ADHD, having an onset <18. The patient has motor and vocal tics for at least 1 year

A

Tourette’s

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21
Q

Disorder characterized by deficits in cognitive skills and adaptive functioning. Replaced the term mental retardation which has since been banned by Rosa’s law

A

Intellectual disability disorder (IDD)

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22
Q

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 ____

A

Obsessive compulsive; C

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23
Q

________ ________ 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 _______ _______

A

Dissociative amnesia; dissociative fugue

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24
Q

Best tx for schizophrenia symptoms

A

Clozapine

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25
Q

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.

A

12; >6 months

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26
Q

___________ is a schizophrenia-related disorder in which symptoms last between 1-6 months

A

Schizophreniform disorder

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27
Q

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

A

Cyclothymia

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28
Q

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 ____

A

Borderline; B

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29
Q

Bipolar II is hypomania and major depression. What is hypomania?

A

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)

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30
Q

Preferred tx for OCD

A

CBT

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31
Q

Positive and negative symptoms associated with schizophrenia and how they contribute to diagnostic criteria of schizophrenia

A

Positive symptoms:

  1. Bizzare delusions
  2. Hallucinations
  3. Disorganized speech
  4. 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

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32
Q

Kubler Ross Stages of Death and Dying

A 
Denial
Depression
Bargaining
Anger
Acceptance

[May progress in any order, skip around, or go back and forth between them]

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33
Q

What stressor is associated with reactive attachment disorder?

A

Neglect or abuse during infancy and childhood — causes inability to pair, bond, or attach to adults

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34
Q

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

A

Dopamine

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35
Q

T/F: by definition, acute stress disorder cannot be in the setting of bereavement

A

True

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36
Q

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?

A

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

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37
Q

Negative symptoms of schizophrenia are caused by activation of what receptor?

A

5-HT1 serotonin receptorr

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38
Q

T/F: bulimics often have normal or overweight BMI

A

True

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39
Q

Definitive treatment for PTSD and ASD

A

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)

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40
Q

_______ 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

A

Lithium; valproic acid

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41
Q

What is most important to assess for in pts presenting with depression?

A

Suicidal tendency — hospitalize if present, especially if they have a plan

Important to assess for intention, ability, and validity of threat

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42
Q

A pilot develops a fear of flying but wants to keep her job. What type of CBT does she need?

A

Desensitization

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43
Q

Diagnostic criteria for conduct disorder

A

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

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44
Q

________ _______ 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.

A

Rett syndrome

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45
Q

FRAMES motivational interview strategies for substance use disorder

A

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

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46
Q

Examples of SNRIs

A

Venlafaxine
Desvenlafaxine
Duloxetine

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47
Q

Name some SSRIs

A

Escitalopram
Fluoxetine
Paroxetine
Sertraline

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48
Q

_____ _____ 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

A

Conduct disorder

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49
Q

Medical condition to consider ruling out in pt presenting with depression

A

Hypothyroid

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50
Q

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 _____

A

Antisocial; B

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51
Q

Pt presents with hair of different lengths with areas of hair loss and a small bowel obstruction, dx?

A

Trichobezoar

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52
Q

First generation antipsychotics (typical) examples

A

Haloperidol
Fluphenazine
Thioridazine
Chlorpromazine

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53
Q

What complication is 15x higher in bipolar pts?

A

Suicide

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54
Q

5 categories of symptoms associated with PTSD

A

Intrusive — memories, flashbacks, nightmares

Negative mood — depression

Dissociation — depersonalization, amnesia

Avoidance — symbols, locations, memories

Arousal — hypervigilance, irritability, easily started, change in concentration

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55
Q

Criteria for gender dysphoria

A

Duration >6 months AND and one of the following:

  1. Incongruence between experienced gender and sex characteristics
  2. Desire to be, be treated as, or have sex characteristics of another gender
  3. Wanting to rid self of sex characteristics
  4. Beliefs that the patient, the self, has typical feelings and reactions of another gender
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56
Q

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

A

Extrapyramidal symptoms

Anticholinergic

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57
Q

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

A

Dissociative identity disorder

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58
Q

Which type of bipolar is mania-predominant?

A

Bipolar I

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59
Q

Treatment of anorexia nervosa

A

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

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60
Q

In what stage of sleep do night terrors occur?

A

N3

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61
Q

Examples of MAOIs

A

Selegiline
Phenelzine
Tranylcypromine

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62
Q

Form of catatonia characterized by rigidity and autonomic instability (hypertension, tachycardia, increased temp)

A

Malignant catatonia

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63
Q

There are no diagnostic tests for autism spectrum disorder but there must be two characteristics — what are they?

A

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

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64
Q

Why is the goal to avoid SSRIs in treating bipolar?

A

Can trigger a manic episode

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65
Q

Schizophrenia symptoms that last >1 day and <1 month

A

Brief psychotic disorder

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66
Q

GAD diagnostic criteria

A

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)

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67
Q

Theta waves and absent alpha waves are indicative of which sleep stage?

A

N1 (stage 1, non-REM)

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68
Q

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 _____

A

Schizoid; A

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69
Q

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 _____

A

Histrionic; B

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70
Q

Preferred treatment for opioid withdrawal during pregnancy

A

Methadone

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71
Q

Complications of chronic OSA

A

Pulmonary HTN that leads to isolated right heart failure

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72
Q

Criteria for premenstrual dysphoric disorder

A

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

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73
Q

Treatment of GAD

A

Psychotherapy > SSRIs

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74
Q

Mood stabilizer that has adverse effects of teratogenicity, thrombocytopenia, agranulocytosis, and pancreatitis

A

Valproate

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75
Q

4 characteristics to watch for in substance use disorder

A

Difficulty controlling use

Adverse social circumstances

Risk-taking

Health effects

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76
Q

Passive resistance to movement during catatonia

A

Catalepsy

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77
Q

Second generation antipsychotics (atypical) examples

A 
Risperidone
Quetiapine
Olanzapine
Aripiprazole
Ziprasidone
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78
Q

Form of catatonia characterized by hyperkinesis, frenzy, combativeness, restlessness

A

Excited catatonia

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79
Q

K-complexes and sleep spindles are in what stage of sleep?

A

N2 (stage 2, non-REM)

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80
Q

Schizophrenia symptoms that last >1 month but <6 months

A

Schizophreniform

81
Q

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.

A

Systemic desensitization (best option for long term tx)

Flooding (best when there is time sensitive need)

82
Q

What meds come in oral disintigrating tablet form for mild control of combative pts?

A

Olanzapine

Risperidone

83
Q

Wetting the bed is normal up until age ____

A

7

84
Q

Etiologies of intellectual disability disorder

A

Chromosomal (Down’s, fragile X, cri-du-chat)

Acquired (maternal substance abuse in utero, maternal hypothyroid in utero, lead poisoning)

85
Q

Criteria for insomnia

A

Difficulty falling or staying asleep for more than 6 hours, 3 nights per week for 3 months

86
Q

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

A

PICA

87
Q

Treatment of PCP intoxication

A

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]

88
Q

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

A

Rumination disorder

89
Q

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?

A

Intermittent explosive disorder

Pyromania

Kleptomania

90
Q

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

A

Delusion

91
Q

Treatment for reactive attachment disorder

A

Coaching the caregiver/parent on good parenting skills

92
Q

If you think reactive attachment disorder, what must be in vignette?

A

Neglect or abuse in infancy, too LITTLE attachment to others later in life

93
Q

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 _________

A

Lorazepam; ECT

94
Q

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

A

Post-partum depression

95
Q

Atypical antidepressant chosen when smoking cessation is also desired

A

Buproprion

96
Q

What meds come in a depot form for long-term use in noncompliant pts?

A

Olanzapine
Risperidone
Haloperidol

97
Q

Extrapyramidal side effect that comes from inhibition of the nigrostriatal tract. Treat with anticholinergics or specific dopamine agonists like benztropine

A

Dyskinesia

98
Q

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

A

2; 3 months; 5 years old

99
Q

Intoxication with ______ causes psychomotor agitation, HTN, tachycardia, dilated pupils, psychosis, angina/HTN crisis

A

Cocaine

100
Q

Second line mood stabilizer with side effects of blurred vision and SJS

A

Lamotrigine

101
Q

What do alcohol and benzodiazepines do to sleep architecture?

A

Suppress REM

102
Q

Treatment of alcohol and benzodiazepine withdrawal starts with long acting benzo like ____ or ______, followed by rapid acting benzos as needed

A

Chlordiazepoxide; diazepam

103
Q

Findings in narcolepsy:

______ is the loss of muscle tone while conscious

___________ hallucinations occur while going to sleep

_________ hallucinations occur while waking up

A

Cataplexy

Hypnagogic

Hypnopompic

104
Q

If an anorexic pt is less than _____% ideal body weight, or extreme anorexia (BMI less than ______), they should be hospitalized

A

85%; 15

105
Q

Diagnostic step for narcolepsy (beyond clinical findings)

A

CSF Hypocretin-1

106
Q

Medications to treat depression in a bipolar pt

A

Quetiapine
Lurasidone
Olanzapine-fluoxetine

107
Q

Class of medications that are cleaner, better versions of SSRIs but they are more expensive

A

SNRIs

108
Q

Blocking dopamine in the _________ tract causes parkinsonism and extrapyramidal symptoms

Blocking dopamine in the _______ tract causes gynecomastia due to disinhibition of prolactin

A

Nigrostriatal

Tuberoinfundibular

109
Q

How do you separate pyromania from arson?

A

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

110
Q

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 ____

A

Dependent; C

111
Q

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 ____

A

Narcissistic; B

112
Q

Valproic acid teratogenicity can lead to?

A

Spina bifida

113
Q

What do you treat catatonia with?

A

Benzos

114
Q

Overheating (fever, tachycardia), water intoxication, pupillary dilation, psychosis are signs of intoxication with what?

A

MDMA

115
Q

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

A

0.03/hr

116
Q

Adverse effects of TCAs

A

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)

117
Q

What class of psychiatric drugs is associated with an increased risk for abnormal bleeding?

A

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]

118
Q

Diagnostic criteria for acute stress disorder vs. PTSD

A

Acute stress disorder is symptoms >3 days AND <1 month duration

PTSD is symptoms >1 month duration

119
Q

Mood stabilizers used to treat manic symptoms in bipolar pt

A

Lithium
Valproate
Carbamazepine
Lamotrigine

120
Q

Treatment for benzodiazapine withdrawal

A

Flumazenil

121
Q

Stages of sleep and their EEG findings

A

N1 = theta waves, absence of alpha

N2 = K-complexes, sleep spindles

N3 = Delta waves

REM = awake EEG, atony, saccadic eyes, erections

122
Q

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

A

Mesolimbic; 5-HT1 serotonin receptors

123
Q

Bipolar II is _______ AND _________

A

Hypomania; major depression

124
Q

Positive symptoms of schizophrenia are caused by overactivation at what receptor at what location in the brain?

A

D2C dopamine receptor in mesolimbic tract

125
Q

A pt is preoccupied with getting sick despite reassurance that they are medically well. Dx?

A

Illness anxiety disorder

126
Q

Cluster C personality disorders

A

Avoidant
Dependent
Obsessive compulsive

127
Q

The diagnosis of intermittent explosive disorder is dependent on frequency and severity — what are the criteria?

A

Either 2x/week in 3 months WITHOUT harm

OR

3x (at all) in a year WITH harm

128
Q

Diagnostic criteria for Bipolar I:

Patient must have ____________ with another ____ symptoms for at least _______

A

Elevated mood; 3; 1 week

129
Q

When starting a pt on clozapine, what lab do you need to check and why?

A

CBC every week

Potential to cause agranulocytosis

130
Q

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

A

Tardive dyskinesia

131
Q

Treatment for Tourette’s disorder

A

Dopamine antagonists (antipsychotics)

Habit reversal therapy (behavioral)

132
Q

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 ___________

A

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]

133
Q

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

A

Somatic symptom disorder

134
Q

2 treatment options for acute dystonia (i.e., oculogyric crisis)

A

Benztropine

Diphenhydramine

135
Q

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?

A

Treat both positive and negative symptoms

Less risk of EPS and anticholinergic side effects

136
Q

__________ is a new lab test used in the diagnosis of narcolepsy

A

CSF hypocretin-1

137
Q

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

A

Functional neurologic symptom disorder (aka Conversion disorder)

138
Q

Young patient presents with isolated performance difficulty with reading, spelling, or math. What is the first step you should take?

A

Hearing or vision exam — rule out organic cause

139
Q

T/F: in OCD, the patient is painfully aware of the actions/thoughts and how irrational they are and they will often seek help

A

True

140
Q

Criteria for adjustment disorder

A

Mood changes that occur in response to a stressor

Must begin <3 months from stressor, and last <6 months following stressor

141
Q

Intoxication with _____ causes aggressive psychosis, vertical horizontal nystagmus, impossible strength, and blunted senses

A

PCP

142
Q

WHO severity index by BMI for anorexa nervosa

A 
>17 = Mild
16-16.9 = Moderate
15-15.9 = Severe
<15 = Extreme
143
Q

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

A

Carbamazepine

144
Q

You want to start an atypical antipsychotic (second gen).

What do you need first?

A

ECG for QTc assessment

145
Q

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

A

Incarceration

146
Q

If pt fails to attach to anyone, it is reactive attachment disorder. If they attach to everyone inappropriately, it is ________

A

Disinhibited Social Engagement Disorder (DSED)

147
Q

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

A

Intermittent explosive disorder

148
Q

How is malingering different from factitious disorder?

A

In malingering, the motivation is material gain

In factitious disorder, the motivation is to fulfill the sick role

149
Q

Yawning, lacrimation, N/V, myalgias, sweats, and chills are signs/symptoms of withdrawal from what?

A

Opioids

150
Q

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

A

Adjustment disorder

151
Q

How do you differentiate trichotillomania from alopecia?

A

Trichotillomania — hair of different lengths

Alopecia — Patchy hair loss

[also rule out fungus causing hair loss or scratching]

152
Q

5 stages of quitting in substance use disorder

A

Pre-contemplative (unaware, denial)

Contemplative (admits/accepts there’s a problem)

Preparation (committed, taking steps)

Action (actual changing behavior)

Maintenance (sustained behavior change)

153
Q

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 ____

A

Schizotypal; A

154
Q

A woman wants to get pregnant but is bipolar. What med should you use?

A

Lamotrigine

[other options are quetiapine or carbamazepine]

155
Q

What therapy works best for OCD?

A

Psychotherapy (CBT) — often Exposure and Response Prevention (ERP)

156
Q

Cluster B personality disorders

A

Borderline
Histrionic
Narcissitic
Antisocial

157
Q

The neurotransmitters of sleep can be remembered by the mnemonic SAND, they’re the order in which sleep stages occur

A

Serotonin

ACh

Norepinephrine

Dopamine

158
Q

Common comorbidities with PTSD and ASD

A

Mood disorders (depression, anxiety)

Substance abuse

159
Q

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)

A

Mirtazapine; trazodone

160
Q

Treatment for cocaine withdrawal

A

Supportive care or benzos

Alpha and then beta blockade

161
Q

Manic symptoms can be remembered by DIGFASTER mnemonic

A 
Distractability
Insomnia
Grandiosity
Flight of ideas
Agitation, activities
Sexual exploits
Talkative
Elevated mood
Racing thoughts
162
Q

Never give ________ in bulimia because there’s an increased risk of seizures

A

Buproprion

163
Q

Narcolepsy is a sleep disorder in which patient is plunged directly into REM sleep “sleep attacks” that happen at least _____ times per week for _________

A

3x/week for 3 months

164
Q

Side effects of SSRIs

A 
Decreased libido
Delayed ejaculation
Serotonin syndrome
GI effects
Insomnia
165
Q

Cluster A personality disorders

A

Paranoid
Schizoid
Schizotypal

166
Q

Specific therapy for borderline personality disorder

A

Dialectic Behavioral Therapy

167
Q

Second generation antipsychotic associated with DM and weight gain

A

Olanzapine

168
Q

________ 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

A

Quetiapine

169
Q

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

A

Oppositional defiant disorder

170
Q

Medications sometimes used for public speaking phobia

A

Beta-blockers (atenolol, nadolol, or propranolol)

171
Q

What are 2 major types of major depressive episode?

A

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)

172
Q

What should you rule out in pts presenting with symptoms of panic disorder?

A

Hyperthyroid

Stimulant drugs

173
Q

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 _________

A

ECT

174
Q

To be dx as bulemic, pt has compensatory behaviors at least once per week for _________. Treatment centers around fluoxetine and CBT

A

3 months

175
Q

Acid base disorder seen in binge/purge eating disorders in which purging is through induced diarrhea

A

Metabolic acidosis

176
Q

Schizophrenia symptoms that last >6 months

A

Schizophrenia

177
Q

First signs of alcohol (or benzo) withdrawal

A

Diastolic hypertension
Tachycardia

They then progress through tremors, diaphoresis, and anxiety. When they become confused, watch out because seizures (delirium tremens) are coming.

178
Q

What must be ruled out in order to diagnose reative attachment disorder?

A

Autism spectrum disorder

179
Q

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

A

Dysthymia — persistent depressive disorder

180
Q

Catatonic pts don’t move or eat so they need help with nutrition and are at increased risk for ______ and ______

A

DVT; rhabdomyolysis

181
Q

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

A

Acute dystonia

182
Q

T/F: relapse in anorexia nervosa is uncommon

A

False - most will relapse within 5 years

183
Q

Rules for trialling antidepressants

A

> 6 week trial
6 months of treatment
3 weeks washout
Max the dose

184
Q

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 _______

A

Desmopressin (DDAVP); oxybutynin; TCAs (imipramine)

185
Q

How do you separate kleptomania from theft?

A

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

186
Q

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?

A

1+ times per month for 3 months

187
Q

How long must you wait after stopping an MAOI to transition to an SSRI?

A

14 days

188
Q

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

A

Baby blues

189
Q

First generation antipsychotics are second-line treatment for schizophrenia. What is the general MOA for these meds?

A

Dopamine-receptor antagonists

190
Q

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 ____

A

Paranoid; projection; A

191
Q

If bedwetting occurs after a dry period, something is wrong. What are some possibilities?

A

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]

192
Q

To qualify for major depression, pts must have at least 5 out of what list of symptoms?

A

SIGECAPS

Sleep changes
Interest decrease
Guilt
Energy diminished
Concentration decreased
Appetite change/weight gain or loss
Psychomotor slowing
Suicidal ideation
193
Q

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

A

Delusional disorder

[tx is gentle confrontation over years of psychotherapy - no drug will do]

194
Q

Patient presents with signs and symptoms of ADHD but when started on stimulant therapy, their symptoms worsen. What is the most likely dx?

A

Tourettes

195
Q

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

A

Illness anxiety disorder

196
Q

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)

A

Disruptive mood dysregulation disorder

197
Q

Tx for dissociative identity disorder

A

Intense psychotherapy

Hypnosis

198
Q

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?

A

Absence of lead-pipe rigidity and fever

199
Q

Another name for somatic symptom disorder

A

Briquet’s syndrome

Boards Step/Level 2 (15 decks)

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