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EOR Psych > Psych rotation 3 > Flashcards

Psych rotation 3 Flashcards

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1
Q

Delusional disorder

A

otherwise normally functioning person with a belief in something that does not exist but no other sx of schizophrenia

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2
Q

how long do you have to have sx to be diagnosed with delusional disorder

A

at least 1 month

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3
Q

do you have impaired fx if you have delusional disorder

A

no impaired functioning

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4
Q

what is a delusion

A

a fixed belief of an external reality despite evidence to the contrary

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5
Q

what is a non bizarre delusion

A

false belief that is plausible but highly unlikely

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6
Q

average age of onset for delusional disorder

A

40 yo

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7
Q

most commonly observed co-occuring condition with delusional disorder

A

depression

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8
Q

tx for delusional disorder

A

psychotherapy
atypical antipsychotics

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9
Q

schizoaffective disorder

A

psychotic disorder featuring sx of BOTH schizophrenia and a major mood disorder (like MDD and bipolar)

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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

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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

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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

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13
Q

tx for schizoaffective disorder

A

psychotherapy
atypical antipsychotics, anticonvulsants, SSRIs

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14
Q

schizophrenia

A

psychotic disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression

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15
Q

how long do sx have to occur to be diagnosed with schizophrenia

A

at least 6 months

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16
Q

is there impaired functioning in schizophrenia

A

yes

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17
Q

who is affected more in schizophrenia

A

men = women

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18
Q

is there a genetic predisposition to schizophrenia

A

yes - strong genetic predisposition – 50% concordance among monozygotic twins

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19
Q

what other disorder is common is schizophrenia

A

substance use
nicotine (50%)
alcohol
cannabis
cocaine

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20
Q

better prognosis for schizophrenia

A

later age of onset
acute onset
positive sx

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21
Q

worse prognosis for schizophrenia

A

early age of onset
gradual onset
negative sx

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22
Q

positive sx in schizophrenia are thought to be due to

A

excess dopamine in mesolimbic pathway

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23
Q

negative sx in schizophrenia are thought to be due to

A

dopamine imbalance (decreased) in mesocortical pathway

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24
Q

what should you check before starting antipsychotic

A

QT interval - EKG

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25
Q

how long do you have to have sx to be diagnosed with schizophrenia

A

at least 6 mos

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26
Q

how many sx to be diagnosed w schizophrenia

A

2 of 5
hallucinations
delusions
disorganized speech
grossly disorganized or catatonic behavior
negative sx

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27
Q

at least 1 sx for schizophrenia must be

A

hallucinations, delusions, or disorganized speech

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28
Q

what are the most common type of hallucinations in schizophrenia

A

auditory

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29
Q

examples of positive sx

A

hallucinations
delusions
disorganized speech
behavior disturbances

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30
Q

examples of negative sx

A

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

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31
Q

what might you see on CT scan in someone with schizophrenia

A

ventricular enlargement
decreased cortical volume
decreased grey matter

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32
Q

what is the most effective med for treatment resistant schizophrenia

A

clozapine

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33
Q

most effective drug for positive sx

A

first generation antipsychotics

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34
Q

which type of antipsychotics have increased risk of extrapyramidal sx

A

first generation antipsychotics

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35
Q

schizophreniform disorder

A

psychotic disorder involving the sx of schizophrenia for > 1 week but less than 6 months

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36
Q

brief psychotic disorder duration

A

at least 1 psychotic sx w onset and remission < 1 month

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37
Q

acute dystonia

A

muscle spasms of the face, neck, tongue, and other muscles

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38
Q

onset of acute dystonia

A

hours to days

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39
Q

management for acute dystonia

A

benztropine
diphenhydramine

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40
Q

akathisia

A

compulsive, repetitive motions
agitation

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41
Q

onset of akathisia

A

hours to days

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42
Q

management fo akathisia

A

benzodiazepines and/or beta blockers

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43
Q

parkinsonism

A

tremor
shuffling gait
drooling
stooped posture
instability

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44
Q

onset of parkinsonism

A

5-30 days

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45
Q

treatment for parkinsonism

A

benztropine
diphenhydramine

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46
Q

tardive dyskinesia

A

lip smacking
worm-like tongue movements
“fly catching”

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47
Q

treatment for tardive dyskinesia

A

D.C med and switch to atypicals (Clozapine preferred - suppresses tardive dyskinesia)
Vitamine E can prevent further deterioration
Valbenazine and Deutetrabenazine may help

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48
Q

when is NMS suspected

A

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

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49
Q

NMS mnemonic

A

FALTERED
Fever
Autonomic instability (tachycardia, tachypnea, hyperthermia, incontinence)
Lead-pipe muscle rigidity
Tremor
Elevated WBC
Regular sized pupils
Excessive sweating
Delirium, decreased DTR

50
Q

Tx for NMS

A

DC med
Benzodiazepines with Dantroline (muscle relaxant)
can also use dopamine agonists (Bromocriptine or Amantadine)

51
Q

ADHD definition

A

a psychological disorder marked by the appearance of sx by age 12 of 1 or more of 3 sx: extreme inattention, hyperactivity, impulsivity

52
Q

how many settings must sx for ADHD occur

A

more than 1

53
Q

who is more commonly affected in ADHD

A

Males

54
Q

In regards to ADHD, what type of sx do females usually have

A

inattentive sx

55
Q

67% of pts w ADHD have comorbidiities of

A

Conduct and oppositional defiant disorders

56
Q

how many inattentive sx need to be met to be diagnosed with ADHD predominately inattentive in a child

A

6 or more

57
Q

how many inattentive sx need to be met to be diagnosed with ADHD predominately inattentive in an adult

A

5 or more

58
Q

how many hyperactive/impulsive sx need to be met to be diagnosed w ADHD predominantly hyperactive/impulsive type in a child

A

6 or more

59
Q

how many hyperactive/impulsive sx need to be met to be diagnosed w ADHD predominantly hyperactive/impulsive type in an adult

A

5 or more

60
Q

what is first-line and mainstay medical treatment of choice for ADHD

A

Stimulants

61
Q

Examples of stimulants

A

Methylphenidate
Dexmethylphenidate
Amphetamine
Dextroamphetamine

62
Q

MOA of amphetamines and methylphenidate

A

block the reuptake of dopamine and NE

63
Q

ADE stimulants

A

decreased appetite
poor growth
changes in BP
dizziness
insomnia
nightmares
tics
psychosis
risk of dependency

64
Q

non stimulants for ADHD

A

Atomoxetine
Viloxazine
Guanfacine
Clonidine

65
Q

MOA Atomoxetine and Viloxazine

A

block reuptake or serotonin and NE

66
Q

when are Atomoxetine and VIloxazine appropriate choices for ADHD treatment

A

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
Q

ADE Atomoxetine and Viloxazine

A

Dry mouth
Decreased appetite
Insomnia
Hepatotoxicity
Xerostomia
Hyperhidrosis
Erectile dysfunction
Priapism
Cardiac issues –

68
Q

what dietary deficiencies are linked to ADHD

A

zinc
iron
omega 3

69
Q

prenatal exposure to what substances are linked to ADHD

A

tobacco
Acetaminophen
Antidepressants

70
Q

is low birth weight or high birth weight linked to ADHD

A

low birth weight/prematurity is linked to ADHD

71
Q

MOA Guanfacine and Clonidine

A

alpha 2 agonists

72
Q

Common ADE of guanfacine and clonidine

A

hypotension
dizziness
sedation
weight gain

73
Q

at what age is pharmacotherapy first line for people with ADHD

A

6 or older
if younger, behavioral therapy

74
Q

what is the most common known single gene to cause autism spectrum disorder

A

fragile x syndrome

75
Q

when do sx usually present for autism

A

12-24 months

76
Q

who is more likely to develop autism between males and females

A

males (4:1)

77
Q

when does the American Academy of Pediatricians recommend screening for autism

A

18-24 months

78
Q

how many deficits in social communication to be diagnosed with autism

A

3 (all of them)
social-emotional reciprocity
nonverbal communicative behaviors for social interaction
deficits in developing, maintaining, and understanding relationships

79
Q

how many restricted, repetitive behaviors to be diagnosed with autism

A

2 of 4

80
Q

do people with autism experience significant impairment

A

yes

81
Q

conduct disorder

A

a pattern of behavior in which the rights of others or social norms are violated

82
Q

how many sx to be diagnosed with conduct disorder

A

at least 3 sx over the last 12 months and at least 1 sx in the last 6 mos

83
Q

conduct disorder is often a precursor to

A

antisocial personality disorder

84
Q

how old do you have to be to be diagnosed with conduct disorder

A

younger than 18

85
Q

patients with conduct disorder often have comorbid

A

ADHD, oppositional defiant disorder, or substance abuse disorder

86
Q

oppositional defiant disorder

A

childhood disruptive behavior characterized by a persistent pattern of negative, angry or hittable mood, argumentative or defiant behavior, and intentional vindictiveness or spitefulness

87
Q

is oppositional defiant disorder associated with physical aggression, violating other’s rights or breaking laws

A

no

88
Q

oppositional defiant disorder may progress to

A

conduct disorder

89
Q

oppositional defiant disorder is associated with comorbid

A

ADHD and substance abuse (just like conduct disorder)

90
Q

how many sx to be diagnosed with oppositional defiant disorder

A

at least 4 over a period of 6 months (with at least 1 individual that is not a sibling)

91
Q

is obsessive compulsive personality disorder more common in men or women

A

men

92
Q

what core features describe cluster B personality disorders

A

dramatic, emotional, erratic

93
Q

what core features describe cluster C personality disorders

A

anxious and fearful

94
Q

in which type of personality disorder are people more likely to hold grudges

A

paranoid personality disordeer

95
Q

in which personality disorder are people more likely to have cognitive-perceptual disturbances

A

schizotypal personality disorder

96
Q

in which personality disorder are people more likely to have suicidal behaviors

A

borderline personality disorder

97
Q

which personality disorder is marked by interpersonal submissiveness

A

dependent personality disorder

98
Q

what personality disorder may be confused with autism

A

schizoid personality disorder

99
Q

what pharmacologic therapy can be used in people with schizotypal personality disorder

A

atypical antipsychotics

100
Q

initial treatment for somatic sx disorder

A

regularly scheduled visits with a healthcare provider

101
Q

can somatic sx disorder be diagnosed even if the sx are explained by another diagnosis

A

yes

102
Q

atypical antipsychotics can cause what illness

A

type 2 diabetes

103
Q

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

A

serum glucose level

104
Q

neurologic sx disorder is also called

A

conversion disorder

105
Q

what is neurologic sx disorder

A

significant distress caused by neurologic sx that are not consistent with known general or neurologic medical conditions

106
Q

common sx in neurologic sx disorder

A

nonepileptic seizures
weakness
paralysis
sensory sx
visual sx
speech disturbances
globus sensation (sensation of something being stuck in throat)
abnormal movement
cognitive disturbances

107
Q

malingering

A

an individual creating false medical or psychiatric symptoms for external reward (money, meds, time off work, etc)

deception is intentional!!!

108
Q

are sx intentionally produced in somatic sx disorder or in neurologic sx disorder

A

no they are not intentionally produced

109
Q

treatment for malingering

A

subtle confrontation

110
Q

inpatient weight gain goals for anorexia

A

2-3 pounds per week

111
Q

partial hospital treatment weight gain goals for anorexia

A

1-2 pounds per week

112
Q

outpatient weight gain goals for anorexia

A

0.5-1 pounds per week

113
Q

when should someone with anorexia be referred for hospital admission

A

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
Q

people with anorexia who do not gain weight despite adherence to nutritional program can be prescribed what medication

A

atypical antipsychotic (Olanzapine)

115
Q

mild anorexia

A

BMI > 17

116
Q

moderate anorexia

A

BMI between 16 and 16.99

117
Q

severe anorexia

A

BMI between 15 and 15.99

118
Q

extreme anorexia

A

BMI < 15

119
Q

what electrolyte abnormality can cause tissue hypoxia in refeeding syndrome

A

hypophosphatemia

120
Q

blood abnormality common in anorexia

A

leukopenia due to bone marrow atrophy

EOR Psych (8 decks)

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