Psych rotation 3 Flashcards
1
Q
Delusional disorder
A
otherwise normally functioning person with a belief in something that does not exist but no other sx of schizophrenia
2
Q
how long do you have to have sx to be diagnosed with delusional disorder
A
at least 1 month
3
Q
do you have impaired fx if you have delusional disorder
A
no impaired functioning
4
Q
what is a delusion
A
a fixed belief of an external reality despite evidence to the contrary
5
Q
what is a non bizarre delusion
A
false belief that is plausible but highly unlikely
6
Q
average age of onset for delusional disorder
A
40 yo
7
Q
most commonly observed co-occuring condition with delusional disorder
A
depression
8
Q
tx for delusional disorder
A
psychotherapy
atypical antipsychotics
9
Q
schizoaffective disorder
A
psychotic disorder featuring sx of BOTH schizophrenia and a major mood disorder (like MDD and bipolar)
10
Q
when do sx of major mood disorder and schizophrenia occur in schizoaffective disorder
A
they can occur at the same or separate times
11
Q
how long do delusions or hallucinations have to occur in schizoaffective disorder
A
2 weeks or more in the absence of major mood disorder
12
Q
duration of sx for major mood disorder in schizoaffective disorder
A
they are present for majority of the total duration of the active and residual portions of the illness
13
Q
tx for schizoaffective disorder
A
psychotherapy
atypical antipsychotics, anticonvulsants, SSRIs
14
Q
schizophrenia
A
psychotic disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression
15
Q
how long do sx have to occur to be diagnosed with schizophrenia
A
at least 6 months
16
Q
is there impaired functioning in schizophrenia
A
yes
17
Q
who is affected more in schizophrenia
A
men = women
18
Q
is there a genetic predisposition to schizophrenia
A
yes - strong genetic predisposition – 50% concordance among monozygotic twins
19
Q
what other disorder is common is schizophrenia
A
substance use
nicotine (50%)
alcohol
cannabis
cocaine
20
Q
better prognosis for schizophrenia
A
later age of onset
acute onset
positive sx
21
Q
worse prognosis for schizophrenia
A
early age of onset
gradual onset
negative sx
22
Q
positive sx in schizophrenia are thought to be due to
A
excess dopamine in mesolimbic pathway
23
Q
negative sx in schizophrenia are thought to be due to
A
dopamine imbalance (decreased) in mesocortical pathway
24
Q
what should you check before starting antipsychotic
A
QT interval - EKG
25
how long do you have to have sx to be diagnosed with schizophrenia
at least 6 mos
26
how many sx to be diagnosed w schizophrenia
2 of 5
hallucinations
delusions
disorganized speech
grossly disorganized or catatonic behavior
negative sx
27
at least 1 sx for schizophrenia must be
hallucinations, delusions, or disorganized speech
28
what are the most common type of hallucinations in schizophrenia
auditory
29
examples of positive sx
hallucinations
delusions
disorganized speech
behavior disturbances
30
examples of negative sx
absence of normal cognition (impairment in attention, working memory, and executive function)
affect flattening
alogia (poverty of speech, latency in response)
avolition (lack of will - poor grooming, anergy, failure of proper responsibility)
anhedonia (lack of interest)
sociality
31
what might you see on CT scan in someone with schizophrenia
ventricular enlargement
decreased cortical volume
decreased grey matter
32
what is the most effective med for treatment resistant schizophrenia
clozapine
33
most effective drug for positive sx
first generation antipsychotics
34
which type of antipsychotics have increased risk of extrapyramidal sx
first generation antipsychotics
35
schizophreniform disorder
psychotic disorder involving the sx of schizophrenia for > 1 week but less than 6 months
36
brief psychotic disorder duration
at least 1 psychotic sx w onset and remission < 1 month
37
acute dystonia
muscle spasms of the face, neck, tongue, and other muscles
38
onset of acute dystonia
hours to days
39
management for acute dystonia
benztropine
diphenhydramine
40
akathisia
compulsive, repetitive motions
agitation
41
onset of akathisia
hours to days
42
management fo akathisia
benzodiazepines and/or beta blockers
43
parkinsonism
tremor
shuffling gait
drooling
stooped posture
instability
44
onset of parkinsonism
5-30 days
45
treatment for parkinsonism
benztropine
diphenhydramine
46
tardive dyskinesia
lip smacking
worm-like tongue movements
"fly catching"
47
treatment for tardive dyskinesia
D.C med and switch to atypicals (Clozapine preferred - suppresses tardive dyskinesia)
Vitamine E can prevent further deterioration
Valbenazine and Deutetrabenazine may help
48
when is NMS suspected
when any 2 of the 4 cardinal features 1) mental status change, 2) rigidity, 3) fever, 4) dysautonomia appear in the setting of antipsychotic use of dopamine w/d
49
NMS mnemonic
FALTERED
Fever
Autonomic instability (tachycardia, tachypnea, hyperthermia, incontinence)
Lead-pipe muscle rigidity
Tremor
Elevated WBC
Regular sized pupils
Excessive sweating
Delirium, decreased DTR
50
Tx for NMS
DC med
Benzodiazepines with Dantroline (muscle relaxant)
can also use dopamine agonists (Bromocriptine or Amantadine)
51
ADHD definition
a psychological disorder marked by the appearance of sx by age 12 of 1 or more of 3 sx: extreme inattention, hyperactivity, impulsivity
52
how many settings must sx for ADHD occur
more than 1
53
who is more commonly affected in ADHD
Males
54
In regards to ADHD, what type of sx do females usually have
inattentive sx
55
67% of pts w ADHD have comorbidiities of
Conduct and oppositional defiant disorders
56
how many inattentive sx need to be met to be diagnosed with ADHD predominately inattentive in a child
6 or more
57
how many inattentive sx need to be met to be diagnosed with ADHD predominately inattentive in an adult
5 or more
58
how many hyperactive/impulsive sx need to be met to be diagnosed w ADHD predominantly hyperactive/impulsive type in a child
6 or more
59
how many hyperactive/impulsive sx need to be met to be diagnosed w ADHD predominantly hyperactive/impulsive type in an adult
5 or more
60
what is first-line and mainstay medical treatment of choice for ADHD
Stimulants
61
Examples of stimulants
Methylphenidate
Dexmethylphenidate
Amphetamine
Dextroamphetamine
62
MOA of amphetamines and methylphenidate
block the reuptake of dopamine and NE
63
ADE stimulants
decreased appetite
poor growth
changes in BP
dizziness
insomnia
nightmares
tics
psychosis
risk of dependency
64
non stimulants for ADHD
Atomoxetine
Viloxazine
Guanfacine
Clonidine
65
MOA Atomoxetine and Viloxazine
block reuptake or serotonin and NE
66
when are Atomoxetine and VIloxazine appropriate choices for ADHD treatment
appropriate for pts w a history of illicit substance use or household members w a history or illicit substance use, concern about abuse or diversion, or a strong caregiver preference against stimulant medication
67
ADE Atomoxetine and Viloxazine
Dry mouth
Decreased appetite
Insomnia
Hepatotoxicity
Xerostomia
Hyperhidrosis
Erectile dysfunction
Priapism
Cardiac issues --
68
what dietary deficiencies are linked to ADHD
zinc
iron
omega 3
69
prenatal exposure to what substances are linked to ADHD
tobacco
Acetaminophen
Antidepressants
70
is low birth weight or high birth weight linked to ADHD
low birth weight/prematurity is linked to ADHD
71
MOA Guanfacine and Clonidine
alpha 2 agonists
72
Common ADE of guanfacine and clonidine
hypotension
dizziness
sedation
weight gain
73
at what age is pharmacotherapy first line for people with ADHD
6 or older
if younger, behavioral therapy
74
what is the most common known single gene to cause autism spectrum disorder
fragile x syndrome
75
when do sx usually present for autism
12-24 months
76
who is more likely to develop autism between males and females
males (4:1)
77
when does the American Academy of Pediatricians recommend screening for autism
18-24 months
78
how many deficits in social communication to be diagnosed with autism
3 (all of them)
social-emotional reciprocity
nonverbal communicative behaviors for social interaction
deficits in developing, maintaining, and understanding relationships
79
how many restricted, repetitive behaviors to be diagnosed with autism
2 of 4
80
do people with autism experience significant impairment
yes
81
conduct disorder
a pattern of behavior in which the rights of others or social norms are violated
82
how many sx to be diagnosed with conduct disorder
at least 3 sx over the last 12 months and at least 1 sx in the last 6 mos
83
conduct disorder is often a precursor to
antisocial personality disorder
84
how old do you have to be to be diagnosed with conduct disorder
younger than 18
85
patients with conduct disorder often have comorbid
ADHD, oppositional defiant disorder, or substance abuse disorder
86
oppositional defiant disorder
childhood disruptive behavior characterized by a persistent pattern of negative, angry or hittable mood, argumentative or defiant behavior, and intentional vindictiveness or spitefulness
87
is oppositional defiant disorder associated with physical aggression, violating other's rights or breaking laws
no
88
oppositional defiant disorder may progress to
conduct disorder
89
oppositional defiant disorder is associated with comorbid
ADHD and substance abuse (just like conduct disorder)
90
how many sx to be diagnosed with oppositional defiant disorder
at least 4 over a period of 6 months (with at least 1 individual that is not a sibling)
91
is obsessive compulsive personality disorder more common in men or women
men
92
what core features describe cluster B personality disorders
dramatic, emotional, erratic
93
what core features describe cluster C personality disorders
anxious and fearful
94
in which type of personality disorder are people more likely to hold grudges
paranoid personality disordeer
95
in which personality disorder are people more likely to have cognitive-perceptual disturbances
schizotypal personality disorder
96
in which personality disorder are people more likely to have suicidal behaviors
borderline personality disorder
97
which personality disorder is marked by interpersonal submissiveness
dependent personality disorder
98
what personality disorder may be confused with autism
schizoid personality disorder
99
what pharmacologic therapy can be used in people with schizotypal personality disorder
atypical antipsychotics
100
initial treatment for somatic sx disorder
regularly scheduled visits with a healthcare provider
101
can somatic sx disorder be diagnosed even if the sx are explained by another diagnosis
yes
102
atypical antipsychotics can cause what illness
type 2 diabetes
103
if someone is taking antipsychotics and presents with rapid onset of polyuria, polydipsia, N/V, weight loss, dehydration, rapid respiration, weakness, clouding of sensorium, and even coma, what should you check
serum glucose level
104
neurologic sx disorder is also called
conversion disorder
105
what is neurologic sx disorder
significant distress caused by neurologic sx that are not consistent with known general or neurologic medical conditions
106
common sx in neurologic sx disorder
nonepileptic seizures
weakness
paralysis
sensory sx
visual sx
speech disturbances
globus sensation (sensation of something being stuck in throat)
abnormal movement
cognitive disturbances
107
malingering
an individual creating false medical or psychiatric symptoms for external reward (money, meds, time off work, etc)
deception is intentional!!!
108
are sx intentionally produced in somatic sx disorder or in neurologic sx disorder
no they are not intentionally produced
109
treatment for malingering
subtle confrontation
110
inpatient weight gain goals for anorexia
2-3 pounds per week
111
partial hospital treatment weight gain goals for anorexia
1-2 pounds per week
112
outpatient weight gain goals for anorexia
0.5-1 pounds per week
113
when should someone with anorexia be referred for hospital admission
HR < 40 bpm
BP < 80/60
orthostatic increase in pulse or decrease in systolic BP
cardiac dysrhythmia
BMI < 15
<75% ideal body weight
hypoglycemia
electrolyte imbalance
syncope
114
people with anorexia who do not gain weight despite adherence to nutritional program can be prescribed what medication
atypical antipsychotic (Olanzapine)
115
mild anorexia
BMI > 17
116
moderate anorexia
BMI between 16 and 16.99
117
severe anorexia
BMI between 15 and 15.99
118
extreme anorexia
BMI < 15
119
what electrolyte abnormality can cause tissue hypoxia in refeeding syndrome
hypophosphatemia
120
blood abnormality common in anorexia
leukopenia due to bone marrow atrophy
