Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clerkship decks > Psych rotation > Flashcards

Psych rotation Flashcards

1
Q

Class and mechanism of mirtazapine? Uses?

A

Tetracyclic antidepressant
Noradrenergic and serotonergic mechanisms; NOT A REUPTAKE INHIBITOR

Depression
Anxiety disorders
Induce sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is ideas of reference?

A

False beliefs that, for example, TV, radio, performer, song, or newspaper article refers to oneself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pt started on lithium. You might see a benign increase in ________. They also have a tremor. How can you help the tremor?

A

Benign increase in WBC

Propanolol can may help with tremor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Normal grief feelings of guilt, sadness, appetite changes, illusions usually abate after _______ (time)

A

Usually abate after 6 months of the loss

Pt’s ability to function appropriately in their life is preserved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is complicated grief?

A

Complicated/prolonged grief:

  • Persists for at least 6 months + 4/8 symptoms:
  • Difficulty moving on with life
  • Numbness/detachment
  • Bitterness
  • Agitation
  • Feeling that life is empty without deceased
  • Trouble accepting loss
  • Feeling the future holds no meaning without deceased
  • Difficulty trusting others since loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Age related effects of alcohol?

A

Decreased alcohol dehydrogenase –> increased BAL with less drinks compared to younger adults

Increased CNS sensitivity to alcohols

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Isoniazid + alcohol use can lead to increased risk of _____

A

Increased risk of hepatotoxicity

Alcohol + acetaminophen, isoniazid, or phenylbutazone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Antihistamines + alcohol use can lead to increased _____

A

Sedation

Alcohol with these can cause sedation:
Antihistamine
Benzos
TCAs
Narcotics
Barbiturates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Drinking alcohol with what other drug can lead to higher BALs?

A

Alcohol + H2 blockers –> Higher BALs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Alcohol + long acting hypoglycemics –> ?

A

Nausea/vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Most common psych disorder in elderly?

A

MDD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Most Alzheimers patients experience delusions. T/F?

A

True

Delusions are reported in up to 70% of Alzheimers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Most dementia patients experience hallucinations. T/F? Are they mostly auditory or visual?

A

False
Hallucinations can be seen in up to 33% of dementia pts
Mostly VISUAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Visual hallucinations early in dementia suggest a dx of _____

A

Lewy body dementia

DO NOT GIVE ANTIPSYCHOTICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If you have to use antipsychotics in elderly, which meds?

A

Quetiapine or olanzapine with severe symptoms

Short term haloperidol or risperidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If sedative hypnotics are used in the elderly, what drugs are used?

A

Trazodone
Hydroxyzine
(safer than the more sedating benzos)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is K-ABC? WISC-R?

A

K-ABC: intelligence test for children 2-12

WISC-R: Determines IQ for ages 6-16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What defines intellectual disability/mental retardation?

A
  • Significantly subaverage IQ of
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Mental retardation affects males more than females. T/F?

A

True
Men are affected 1.5x as often as females
*85% of MR are mild cases (IQ 55-70)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the different categories of MR?

A

1-2% Profound / IQ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are prenatal causes of MR?

A

TORCH infections

Toxo, other (syphilis, AIDS, alcohol/drugs), rubella, CMV, herpes simplex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Perinatal causes of MR?

A 
Anorexia
Prematurity
Birth trauma
Meningitis
Hyperbilirubinemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Postnatal causes of MR?

A 
Hypothyroidism
Malnutrition 
Toxin exposure
Trauma
Psychosocial causes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Genetic causes of MR?

A 
Down syndrome
Fragile X syndrome (2nd most common cause of MR)
PKU
Prader Willi
Angelman
Williams syndrome
Tuberous sclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Most common inherited form of mental retardation?

A

Fragile X

FMR1 gene defect on X chromosome, M>F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Most common of learning disorders?

A

Reading, boys may be more affected than girls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is ADHD? What are the types?

A

Inattention and/or hyperactivity and impulsivity greater than expected for age

Three types:
Predominantly inattentive
Predominantly hyperactive-impulsive
Combined

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How do you dx ADHD?

A

At least 6 sx of either inattentiveness, hyperactivity, or both

  • Persisted for at least 6 months
  • Sx present to a degree that is maladaptive
  • Onset prior to age 7
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

ADHD is more prevalent in boys. Does it go into adulthood?

A

Up to 60% of childhood cases will have sx into adulthood (impulsivity > hyperactivity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

First line treatment for ADHD?

A

CNS Stimulants

  • Methylphendiate (Ritalin, Concerta, Focalin, Metadate)
  • Dextroamphetamine (Dexedrine, DextroStat)
  • Amphetamine salts (Adderall)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

First line for ADHD cant be used. What else can you use?

A

If first line cant be used, use ALPHA-2 AGONISTS

  • Clonidine
  • Guanfacine
  • can be used at adjuvant therapy to stimulants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What disorder can atomoxetine used for?

A

ADHD; non stimulant that is FDA approved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

CNS stimulants are good long term options for ADHD. T/F?

A

False; long term efficacy is controversial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Boys > Females in autistic disorder, T/F?

A

True

Boys are 3-4x more likely than girls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Autism is associated with ______

A

Mental retardation (70% meet criteria of

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Autism phenotypic findings? Genetic component?

A

May have higher peripheral serotonin levels
Increased head size
Persistent primitive reflexes
Abnormalities in EEG findings

YES genetic component; siblings have 22x risk vs general population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Two most important predictors of adult outcome in those with autism?

A

Level of intellectual functioning AND communicative competence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Childhood disintegrative disorder is associated with:

A
  • Abnormal EEG findings
  • Seizure disorder
  • Various medical conditions like Landau-Kleffner, neurolipidoses, mitochondrial deficits, metachromatic leukodystrophy, CNS infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is tourettes?

A

Most severe tic disorder

  • Multiple daily motor tics
  • One or more vocal tics
  • Onset before 18
  • **Vocal tics may appear many YEARS after motor tic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the types of vocal tics seen in Tourettes?

A

Coprolalia - repetitive speaking of obscene words

Echolalia - exact repetition of words

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How do you dx tourettes?

A
  • Onset before 18
  • Motor and vocal tics both present at some point, not attributable to CNS disease
  • Tics occur many times a day, almost every day for >1 year
  • No tic free period >3 months
  • Change in anatomic location and character of tics over time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Describe course of sx of someone with Tourettes?

A

Sx peak in severity between 8-12 years old, decrease with puberty

Decrease sx/asymptomatic by adulthood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Tourettes has a high comorbidity with ______

A

OCD (40%)

ADHD (50%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Neurochemical factors that contribute to Tourettes?

A

Impaired regulation of dopamine in caudate nucleus

and possibly impaired regulation of endogenous opiates and the noradrenergic system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Tx of Tourettes?

A

When tics become a source of impairment:

  • Atypicals (e.g. risperidone)
  • Alpha-2-agonists (e.g. clonidine, guanfacine)
  • SEVERE? Use typicals (e.g. haloperidol, pimozide)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Do you have to be worried about withdrawal with antidepressants?

A 
YES
Most antidepressants have a withdrawal phenomenon 
- Dizziness
- Headaches
- Nausea
- Insomnia
- Fatigue
TAPER, depending on dose and half life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Regarding SSRIs there is no relationship between plasma levels and efficacy or side effects.

A

TRUE

No relationship!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Why are SSRIs the most commonly prescribed antidepressant?

A
  • Low incidence of side effects, resolve with time
  • No food restrictions
  • Much safer in OD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Which SSRI do you give to a pregnant women?

A

Fluoxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Which SSRI is also approved for use in children?

A

Fluoxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Schizophrenia prevalence in men vs women?

A

Men and women similarly affected
Men present around 20 and have more negative sx and more social impairment
Women present around 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How does season affect schizophrenia?

A

People born in winter or early spring have a higher incidence of schizophrenia for unknown reasons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Should you screen for substance abuse in those with schizophrenia? If so, what?

A

Yes, substance abuse comorbid
Alcohol (most common)
Cannabis
Cocaine (least)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the downward drift hypothesis?

A

People with schizophrenia are unable to function well in society –> enter lower socioeconomic groups –> lower socioeconomic groups have higher rates of schizophrenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What would you expect to see on CT of schizophrenia pt?

A

Enlarged ventricles

Diffuse cortical atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Ketamine mechanism? How does it relate to those with schizophrenia?

A

NMDA antagonist (glutamate receptor)

In schizophrenics, they have lower # of NMDA receptors; correlates with psychotic symptoms observed with ketamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

NE, Serotonin, dopamine, GABA levels in schizophrenics?

A

Dopamine: increased
Serotonin: increased
NE: increased
GABA: decreased (decreased expression of the enzyme necessary to create GABA in the hippocampus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

How does onset of schizophrenia relate to prognosis?

A

Earlier onset and gradual onset = poor prognosis

Later onset and acute onset = better prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

How do positive or negative sx relate to prognosis?

A

Positive sx = better prognosis

Negative sx = poor prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Mood symptoms in people with schizophrenia is associated with better or worse prognosis?

A

Mood sx associated with BETTER prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Mechanism of typical and atypical neuroleptics?

A

Typical: D2 antagonist
Atypical: 5-HT2 and dopamine receptor antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What kind of lab tests would you order for someone on atypical antipsychotics?

A

FBG
Lipids
BP, waist circumference, BMI
–> METABOLIC SYNDROME (increased risk with atypicals)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Beta blockers and _____ are known to exacerbate psychosis in predisposed patients

A

Beta blockers and digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Prognosis of schizophreniform disorder?

A

Remember 1-6 months; >6mo is schizophrenia

1/3 recover completely
2/3 progress to schizoaffective or schizophrenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Prognosis for schizoaffective disorder?

A

60% progress to schizophrenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is a brief psychotic disorder?

A

Psychotic sx just like in schizophrenia

Sx last from 1 DAY to 1 MONTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Delusional disorder occurs more in _____ population

A

Older (>40)
Immigrants
Hearing impaired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Bizarre or nonbizarre delusions in delusional disorder?

A

NONbizarre delusions for at least 1 month (bizarre delusions are found in schizophrenia)

(cant meet criteria for schizophrenia, functioning in life not significantly impaired)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Folie a deux is also known as _______ and it’s characterized by:

A

Induced Psychotic Disorder

- Pt develops same delusional sx as someone he or she is in a close relationship with

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Can someone have a manic episode for less than a week?

A

Yes if they are hospitalized, it can be any length of time
Otherwise, at least for one week

Persistently elevated, expansive, or irritable mood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Mixed manic/depressive episode is a psychiatry emergency. T/F?

A

True; same with manic episode

- Severely impaired judgement makes patient dangerous to self and others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

MDD prevalence in men vs women?

A

Equal before menses and after menopause

Women 2x likely in reproductive years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Sleep changes in MDD?

A
  • REM shifted to earlier in night
  • Decreased stage 3/4 sleep
  • Hypersomnia
  • Multiple awakenings
  • Initial and terminal insomnia (hard to fall asleep and wake up)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

How does dexamethasone relate to MDD?

A

High cortisol is associated with MDD

- Hyperactivity of HPA axis as shown by failure to suppress cortisol by dexamethasone suppression test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Death of a parent before age 11 is associated with later development of ______.

A

MDD

So is pancreatic cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Neurotransmitter change in MDD?

A

Decreased brain and CSF 5-HT and 5-HIAA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

How long do depressive episodes last if untreated in MDD?

A

Usually self limited

last 6-13 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Which class of antidepressants is most lethal in OD?

A

TCAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Side effects of SSRIs?

A

GI disturbances
Sexual dysfunction
Headache
Rebound anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

TCA side effects?

A 
Orthostasis
Weight gain
Sedation
Anticholinergic effects
Can aggravate QTc prolongation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

MAOI is used for _______ and has a major side effect of _____

A

Refractory depression

Orthostasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Postpartum depression usually resolves without medication. T/F?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

When is ECT used?

A

Unresponsive to pharmaco
Can’t tolerate pharmaco (pregnant, elderly)
Desire rapid reduction in sx (e.g. suicide risk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

During ECT, premedication with ______, then give ____ and ____

A

Premed with atropine, give anesthesia (propofol, ketamine, etc), muscle relaxant (succinylcholine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Side effects of ECT

A

Retrograde and anterograde amnesia (usually disappears within 6 mo)

Headache, nausea, muscle soreness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Pharmacotherapy and psychotherapy is more effective in treating depression than either treatment alone. T/F?

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Atypical features of depression? Tx?

A

Mood reactivity (mood brightens in response to positive events)
Leaden paralysis (legs feel heavy)
Hypersomnia
Hyperphagia
Hypersensitivity to interpersonal rejection

If atypical depression? Use MAOI!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Dysthymia can never have psychotic features. T/F?

A

TRUE

If they have delusions or hallucinations with “depression” consider another dx like MDD or schizoaffective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

High potency antipsychotic associated with heart block, ventricular tachycardia, etc?

A

Pimozide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Low potency antipsychotic that can cause bluish skin discoloration?

A

Chlorpromazine

  • can also cause photosensitivity
  • used to treat N/V and intractable hiccups
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Mechanism for how antipsychotics cause hyperprolactinemia?

A

Blocks dopamine activity in tuberoinfundibular pathway –> prolactinemia –> galactorrhea, gynecomastia, amenorrhea, sexual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Adjustment disorder prevalence in men vs women

A

Occurs 2x more in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

When should you think adjustment disorder?

A

Stressful life event –> maladaptive behavior/emotional sx that begin within 3 months, resolve by 6 months

–> causes significant impairment in daily functioning and interpersonal relationships

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Tx of adjustment d/o?

A

Supportive psychotherapy!!!!!
Group therapy
Meds for symptoms like insomnia, anxiety, depression, etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Common comorbidities of panic attacks?

A 
MDD
Bipolar
Agoraphobia
Substance abuse 
*Also linked to a higher rate of suicide attempts or ideation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

How long does bereavement last?

A

Sx usually last up to 2 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Hoarding disorder is treated with cognitive behavioral therapy and ____

A

SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What is panic disorder? Acute treatment? Long term?

A

Recurrent and unexpected panic attacks with 4 or more of things like palpitations, sweating, sob, chest pain, dizziness, fear of dying, etc

Immediate: benzos
Long term: SSRIs, SNRI, and/or cognitive behavioral therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

First line treatment for specific phobia?

A

Specific phobia: fears specific object or situation

First line: BEHAVIORAL THERAPY (via exposure therapy)

*short acting benzos like lorazepam or alprazolam are effective in alleviating anxiety acutely but not first line for phobia because outweighed by rebound anxiety, dependence and cognitive impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

How do you treat anorexia?

A

FOOD
Behavioral therapy, family therapy, weight gain programs

Low dose 2nd gen antipsychotics (e.g. olanzapine) may treat preoccupation with weight gain and food, can help cause weight gain

Benzos before meals for preprandial anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

How do you treat bulimia?

A

Antidepressants + therapy

  • SSRIs are FIRST LINE; Fluoxetine is the only FDA approved one
  • Therapy: CBT, interpersonal psychotherapy, family therapy, group therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

First line for OCD?

A

SSRIs (high doses)

TCAs (clomipramine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Functional neuroimaging of pts with social phobia (social anxiety disorder) shows MORE activity in ______

A

Amygdala

Insula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Performance anxiety is often successfully treated with:

A

beta blockers

atenolo, propanolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

How to treat social phobia?

A

Psychotherapy/desensitization

Severe? Some pharmacological:

  • SSRIs
  • Benzos
  • Venlafaxine
  • Buspirone (can augment treatment when used adjunctively with SSRIs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Specific phobias are more common than social phobias. T/F? Specific phobias are more common in men vs women? T/F?

A

True, specific > social

False, women > men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

PCP intoxication physical findings?

A 
Nystagmus
Dysarthria
Hyperacusis
Hypertension or tachycardia
Muscle rigidity 
Ataxia
Seizures or coma
Numbness

Behavioral manifestations are very UNPREDICTABLE; can be sociable one minute and extremely violent the next.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

PCP intoxication tx?

A

If nonpsychotic:
- Benzos for muscle spasms, seizures, sedation, agitation, anxiety

If agitated or psychotic:

  • Antipsychotics (haldol is popular, or atypical antipsychotics)
  • AVOID typical low potency antipsychotics because can increased PCP-induced hyperthermia, dystonia, anticholinergic effects and lower seizure threshold
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Non pharm intervention for PCP intoxication?

A

Place in room away from stimulation, dark room

Avoid physical restraints because risk of muscle breakdown (but might need restraints initially)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What other drug is commonly used with PCP?

A

Marijuana; PCP often added to marijuana cigarettes; do UDS!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Chances of getting bipolar disorder is a first degree relative has it? What if both parents have it? What if your monozygotic twin has it? Dizygotic twin? General population?

A 
1st degree: 5-10%
Both parents: 60%
Mono twin: 70%
Dizygotic twin (same as 1st degree): 5-10%
General population: 1%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

First line for acute mania?

A

Antipsychotics
or Mood stabilizers (Lithium, Valproate, Carbamazepine)

**But mood stabilizers need gradual titration over several days for therapeutic blood levels so it would be less effective in controlling pts acute agitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

When should you think somatization disorder?

A

Multiple organ systems
Chronic
Onset BEFORE age 30
Seen multiple doctors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Tx of somatization disorder?

A

Regularly scheduled PCP visits with limited medical workup

Be slow with psychology, will likely refuse MH referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Somatization disorder, conversion disorder, hypochondriasis are all more common in women vs men. T/F?

A

False; somatization and conversion are more in WOMEN

Hypochondriasis MEN = WOMEN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

When would you see la belle indifference?

A

See it in conversion disorder where patients are calm and unconcerned when describing their symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Common symptoms of conversion disorder?

A 
Shifting paralysis
Blindness
Paralysis
Paresthesia
Mutism
Seizures
Globus hystericus (sensation of lump in throat)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Most patients with conversion disorder resolve spontaneously. T/F?

A 
True
Tx may include
- Insight oriented psychotherapy
- Hypnosis
- Relaxation therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Hypochondriasis has to last for _____ (time)

A

At least 6 months; preoccupation with fear of having or contracting serious disease, based on misinterpreting bodily symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Good prognostic factors for someone with hypochondriasis?

A

Higher SES
Treatment responsive anxiety or depression
Absence of comorbid medical conditions and personality disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

How do you treat hypochondriasis?

A

Regularly scheduled visits to PCP
Comorbid anxiety or depression? Treat with SSRI or other psychotropic
CBT is the most useful of psychotherapies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Body dysmorphic disorder; seen in what kind of patient? onset?

A

Women > men
Unmarried > married
Onset between 15-20yo; usually gradual onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Surgical/dermatological interventions are often successful in body dysmorphic disorder. T/F?

A

False!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

How do you treat body dysmoprhic d/o?

A

NOT surgical/dermatological

SSRI’s helpful in 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

How do you define acute vs chronic pain disorder?

A

6 month

Pain often coexists with medical condition but is not directly caused by it or not FULLY accounted for by it

126
Q

Tx for pain disorder?

A 
SSRIs
Biofeedback
Hypnosis
Psychotherapy
***DO NOT USE ANALGESICS; not helpful and pts become dependent on them
127
Q

_____ can exacerbate the sx of pain disorder

A

MDD

128
Q

What is primary gain?

A

Sx as an unconscious defense against unacceptable INTERNAL conflicts
- Self justification for various actions or lack of action

129
Q

What is secondary gain?

A

Sx that provide unconscious external benefits (attention from others, decreased responsibilities, avoidance of law)

Malingering is NOT secondary gain because its CONSCIOUS external benefit

130
Q

Munchhausen syndrome is also known as _____ and is:

A

Aka factitious disorder

- Predominantly physical complaints

131
Q

Factitious disorder is higher in _____ (population)

A 
Hospital/health care workers
Higher intelligence
Poor sense of identity
Poor sexual adjustment
Many pts have history of child abuse or neglect
132
Q

How do you treat factitious disorder?

A

Collect collateral
Collab with PCP to avoid unnecessary procedures
Avoid early confrontation (will leave AMA and get hospitalized elsewhere)
*Repeated and long term hospitalization is common

133
Q

Intermittent explosive disorder tx?

A 
SSRI- esp fluoxetine
Anticonvulsants
Mood stabilizers - lithium
Antipsychotics
Propanolol

Individual psychotherapy is INEFFECTIVE and DIFFICULT

134
Q

Low levels of _____ have been associated with impulsiveness and aggression

A

Serotonin

135
Q

1/4 of bulimia patients have comorbid _____

A

Kleptomania

136
Q

Majority of shoplifters have kleptomania. T/F?

A

False; less than 5% of shoplifters have kleptomania

137
Q

How do you treat kleptomania?

A

Insight-oriented psychotherapy
Behavior therapy such as desensitization, aversive conditioning
SSRIs

maybe naltrexone

138
Q

People with kleptomania experience guilt when they steal. T/F

A

True

Pleasure is from stealing; often report intense guilt and shame

139
Q

Comorbid conditions of those with klepto?

A

Mood disorders
Eating disorders
OCD
*Klepto more in women, but severity of sx equal in men vs women

140
Q

Pt has pathological gambling; what other disorders might they have?

A

Increased incidence of:

  • Mood disorders
  • Anxiety disorders
  • OCD
141
Q

Most people with pathological gambling recover without treatment. T/F?

A

False; 1/3 recover without treatment

142
Q

Predisposing factors to pathological gambling?

A

Loss of a parent during childhood
Inappropriate discipline from parent in childhood
ADHD
Lack of family emphasis on budgeting

143
Q

Most effective treatment for pathological gambling?

A

Participating in gamblers anonymous (12-step)

After 3 months of abstinence from gambling, insight-oriented psychotherapy may be attempted

144
Q

Trichotillomania is more common in men vs women. T/F?

A

False; more in women

145
Q

Trigger for trichotillomania behavior?

A

TEXTURE of the hair

146
Q

Pts with trichotillomania have an increased incidence of comorbid:

A

Borderline personality disorder
OCD
OCDP
Mood disorders

147
Q

Tx for trichotillomania?

A

SSRIs
Antipsychotics
Lithium

148
Q

Onset and prognosis of pyromania?

A

Onset is late adolescence
Prognosis better in children vs adults
*w/ tx, children recover completely

149
Q

Tx of pyromania?

A

Behavior therapy
Supervision
SSRI

150
Q

____ (hormone) is often increased in anorexia

A

Cortisol

151
Q

Bulimia patient with laxative abuse…alkalosis or acidosis?

A

Metabolic acidosis

152
Q

Lab findings in bulimia to look for?

A 
Increased BUN, amylase
Hypernatremia
Hypochloremia hypokalemic alkalosis 
Altered thyroid hormone and cortisol homeostasis
*Metabolic acidosis (laxative abuse)
153
Q

Physical findings in bulimia?

A 
Russell's sign
Sialadenosis (enlarged parotid glands)
Dental erosions
Petechiae
Peripheral edema
Aspiration
154
Q

Comorbid disorders associated with bulimia?

A

Mood disorders
Anxiety disorders
Impulse control disorders
Prevalence of cluster B and C personality disorders!

155
Q

Bulimia has a better prognosis compared to anorexia. T/F?

A

True

156
Q

Most people with bulimia fully recover with treatment. T/F?

A

1/2 recover fully with treatment

1/2 have chronic course with fluctuating sx

157
Q

Tx for binge eating?

A

Individual psychotherapy and behavioral therapy + strict diet and exercise

Pharmacotherapy can be used adjunctively to promote weight loss:

  • Stimulants to suppress appetite (phentermine, amphetamine)
  • Orlistat (inhibits pancreatic lipase)
  • Sibutramine (inhibits reuptake of NE, serotonin, dopamine)
158
Q

Pathophysiology of narcolepsy?

A

Linked to loss of hypothalamic neurons that contain hypocretin

May have autoimmune component

159
Q

Kleine-Levin syndrome?

A

Rare; recurrent hypersomnia with episodes of daytime sleepiness + hyperphagia, hypersexuality, aggression

Sx:

  • Insomnia
  • waking up at inappropriate times
  • headaches, difficulty concentration, frequent performance errors, increased reaction times
160
Q

Nightmare disorder?

A

Recurring nightmares, awakens with vivid recall, NO confusion or disorientation with wakening

Higher in women

161
Q

Tx of nightmare disorder?

A

IRT; imagery rehearsal therapy

  • mental imagery to modify the outcome of of a recurrent nightmare; writing down improved outcome then mentally rehearsing it in a relaxed state
  • severe? may use antidepressants
162
Q

GAD first line tx?

A

SSRI, SNRI

Tx for GAD includes CBT, meds, or both.

163
Q

First line for generalized social anxiety disorder? Performance social anxiety?

A

(Marked anxiety about 1 or more social situations for >6mos, fear of scrutiny, humiliation, embarrassment, avoid social situations, marked impairments)

Generalized:

  • SSRI/SNRI first line
  • CBT first line

Performance only:

  • Benzo or propanolol 30-60min before
  • CBT
  • *Avoid benzos if substance abuse or sedation is not desired
164
Q

Difference between risperidone and aripiprazole?

A

Risperidone is a dopamine and serotonin antagonist –> can cause weight gain and hyperprolactinemia (amenorrhea, galactorrhea)

Aripiprazole is a PARTIAL AGONIST of D2 receptors so no galactorrhea

165
Q

Youth presents to pediatrician with complaints of sudden onset of anger and irritability, sudden poor grades, lack of interest in fun activities and decreased energy. Dx?

A

Depression

- Pt might stay up late by wanting to watch TV but actually has trouble falling asleep

166
Q

MAO-A and MAO-B deactivates?

A

MAO-A: Serotonin
MAO-B: NE, Epi
Both: Dopamine and tyramine

167
Q

MAOI?

A

Phenelzine
Isocarboxazid
Tranylcypromine

168
Q

ODD vs CD?

A

ODD: negative behavior pattern

but offenses do NOT typically cause significant harm to others or involve violations of major societal norms

169
Q

How to treat CD?

A

Multisystemic treatment approach
- combines well-coordinated plan to help parents develop new skills at home like parent-child interaction training, to help the relationship between parents/caregivers and the child

Also

  • Teach classroom social skills
  • Encourage communication between teachers and parents

Meds:

  • stimulants (–> leads to less aggression and impulsiveness)
  • atypicals may be helpful in controlling aggression
170
Q

Many children with CD have a comorbid dx of ____

A

ADHD

171
Q

CD sx categories?

A 
Aggression toward people or animals
Destruction of property
Deceitfulness or theft
Serious rule violation
*At least 3 of the sx in the last 12 months with at least one occurring the last 6 months
172
Q

Definition of antisocial personality disorder?

A

Pervasive disregard for and violation of rights of others starting by age 15

Dx if the sx appear AFTER THE AGE OF 18

173
Q

Conduct disorder is more common in children of parents with ______

A

Antisocial personality disorder

Alcohol dependence

174
Q

Side effects of tertiary amine TCAs vs secondary amine TCAs?

A

Tertiary amine TCAs:

  • Highly anticholinergic
  • More sedating
  • More lethal in OD

Secondary amine TCAs:

  • Less anticholinergic
  • Less sedating
175
Q

Name the tertiary amine TCAs and uses of each

A

CAID
Clomipramine - OCD (most serotonin specific)
Amitriptyline - Migraines, chronic pain, insomnia
Imipramine - Enuresis, panic disorder (IM form available)
Doxepin - Chronic pain, sleep aid in low doses

176
Q

Name the secondary amine TCAs and uses of each

A

Nortriptyline - chronic pain (less like to cause orthostasis)
Desipramine - more activating, least sedating, least anticholinergic

177
Q

TCA OD treatment?

A

Sodium Bicarbonate

178
Q

Name the tetracycline antidepressants

A

Amoxapine - metabolite of loxapine (antipsychotic), similar side effect profile to typical antipsychotics
Maprotiline - higher rates of seizures, arrhythmia, fatality in OD

179
Q

How much TCA can cause an overdose?

A

As little as a 1 week supply (1-2g)

180
Q

Three C’s (complications) of TCAs?

A

Cardiotoxicity
Convulsions
Coma

181
Q

Side effects of TCAs?

A

HAM, weight gain, sex problems

    • anti-Histaminic: sedation
    • anti-Adrenergic: CV side effects, orthostasis, arrhythmias, ECG changes, seizures (avoid in pts with preexisting conduction problems or recent MI)
    • anti-Muscarinic: exacerbation of narrow angle glaucoma, dry mouth, urinary retention, tachycardia, blurred vision, constipation
    • Weight Gain
    • Serotonergic effects: ED problems in men, anorgasmia in women
182
Q

TCAs are highly protein bound and lipid soluble. T/F?

A

True; thus can interact with other meds that are highly protein bound

Also, side effects of TCAs are due to TCAs lack of receptor specificity and interaction with other receptors

183
Q

Pt has atypical depression but does not want to be put on a dietary restriction if put on an MAOI. What do you use?

A

Selegiline (Emsam patch)

*MAOI that does not require dietary restrictions when used in low dosages

184
Q

Describe the course of serotonin syndrome

A

Initially:

  • Lethargy
  • Restlessness
  • Confusing
  • Flushing/diaphoresis
  • Tremor
  • Myotonic jerks

May progress to:
- hyperthermia, hypertonicity, rhabdomyolysis, renal failure, convulsions, coma, death

185
Q

How do you treat serotonin syndrome?

A

Discontinue meds
CCB (oral nifedipine)
If carefully monitored, can try chlorpromazine or phentolamine

186
Q

Pt needs to be switched from an SSRI to MAOI. How do you approach this

A

Wait at least 2 weeks before switching

If switching from fluoxetine, wait at least 5-6 weeks

187
Q

Side effects of MAOI other than possible serotonin syndrome? Which is most common?

A

Most common - orthostasis

  • Drowsiness
  • Weight gain
  • Dry mouth
  • Sleep dysfunction, sex dysfunction
  • Paresthesias (in people with pyridoxine deficiency, tx with B6)
188
Q

Pts on clozapine should get ____ tests at a frequency of ____ for risk of _____

A

WBC tests
Weekly for first 6 months of treatment, can decrease in frequency after that
Risk of agranulocytosis

189
Q

Tests to order when prescribing/monitoring someone on lithium?

A

Lithium levels
Thyroid
Creatinine

190
Q

Studies show an increased risk of ____ and ____ when atypical antipsychotics are used in the eldery

A

All cause mortality

Stroke

191
Q

Mesolimbic pathway includes which structures? How does this relate to antipsychotics?

A

Nucleus accumbens
Fornix
Amygdala
Hippocampus

Antipsychotics target mesolimbic dopamine pathway to treat the positive sx of schizophrenia

192
Q

Antipsychotic thats less likely to cause tardive dyskinesia?

A

Clozapine

193
Q

Neuroleptic malignant syndrome is characterized by ? Seen mostly in ?

A 
FALTERED
Fever
Autonomic instability (tachy, labile htn, diaphoresis)
Leukocytosis
Tremor
Elevated CPK
Rigidity (lead pipe)
Excessive sweating
Delirium

Young males early in treatment with either typicals or atypicals

194
Q

NMS is treated with things like amantadine or bromocriptine. T/F?

A

False
Discontinue meds, supportive therapy

Amantadine, bromocriptine, dantrolene are infrequently used because of side effects and unclear efficacy

195
Q

Pt is on a haldol for 5 years. What are the pts chances of getting tardive dyskinesia?

A

5%

- 1% per year they are on typical antipsychotics

196
Q

Lab tests to order if you suspect NMS?

A

Liver enzymes (elevated), jaundice

197
Q

If patient develops NMS from a certain antipsychotic, they can no longer use that drug at a later date. T/F?

A

False, doesnt prevent pt from restarting the same neuroleptic later

198
Q

Low potency antipsychotics are more likely to lower seizure thresholds. T/F

A

True

199
Q

In general, how do side effects of atypicals compare to typical antipsychotics?

A

Atypicals have a less chance of causing EPS, NMS, Tardive dyskinesia

200
Q

Atypicals are used to treat:

A 
Schizophrenia (negative sx)
Acute mania
Bipolar
Adjunctive for unipolar depression
Sometimes for personality disorders
201
Q

Ziprasidone is an atypical used when you want to avoid _____ (side effect)

A

Weight gain

- less likely to cause weight gain

202
Q

Side effects of aripiprazole?

A

D2 partial agonist so it can be more activating (akathisia)

  • also less sedating
  • less potential for weight gain
203
Q

What drug is a metabolite of risperidone?

A

Paliperidone

204
Q

Side effects of risperidone?

A

Can cause increased prolactin
Orthostasis, reflex tachycardia
Consta = long acting injectable form

205
Q

____ is the only antipsychotic to decrease risk of suicide

A

Clozapine

206
Q

When MUST you stop clozapine use in a pt?

A

When absolute neutrophil count drops below 1500/ul

207
Q

____ (antipsychotic) is associated with hypersalivation and can develop myocarditis

A

Clozapine

  • Associated with hypersalivation
  • Myocarditis can develop
  • ONLY antipsychotic to be more efficacious, decrease risk of suicide
  • LESS likely to cause tardive dyskinesia
  • MORE anticholinergic effects than other typicals or high potency typicals
208
Q

Side effects of seroquel?

A

Sedation

Orthostasis

209
Q

Labs to order with atypical antipsychotic use?

A

Think metabolic syndrome
- lipids, glucose, BMI, etc
LFT - monitor yearly for elevation and ammonia
QTc prolongation

210
Q

_____ is the only mood stabilizer shown to decrease suicidality

A

Lithium

211
Q

Prior to initiating someone on lithium, what tests do you want?

A 
Basic chemistries
CBC
ECG
Thyroid
Pregnancy test
*Lithium is metabolized by kidney so adjust and monitor if pt has renal dysfunction
212
Q

Onset of action of lithium?

A

5-7 days

213
Q

Normal, toxic, and lethal range of lithium?

A

.6-1.2 normal
>1.5 toxic
>2 lethal

214
Q

Factors/meds that affect lithium levels?

A 
NSAIDs - decrease
Dehydration - increase
Salt loss/sweating - increase
Salt deprivation - increase
Impaired renal function - increase
Aspirin
Diuretics, esp thiazides
215
Q

Before starting pt on carbamazepine, what tests should you order? Onset of action?

A

CBC and LFT, monitor regularly

Onset: 5-7 days

216
Q

Carbamazepine use?

A

Mixed episodes and rapid-cycling bipolar disorder
*Less effective for depressed phase

Management of trigeminal neuralgia

217
Q

Carbamazepine mechanism?

A

Blocks Na+ channels, inhibits AP

218
Q

Side effects of carbamazepine?

A

GI and CNS are most common (ataxia, sedation, confusion)
SJS
Leukopenia, aplastic anemia, agranulocytosis, etc
Teratogenic (neural tube)

P450 interactions; causes AUTOINDUCTION (inducing its own metabolism) so requires increasing doses

219
Q

Valproic acid tests? Normal range?

A

CBC and LFT monitor regularly
50-150 micrograms/mL
Check levels after 3-5 days

220
Q

Lamotrigine mechanism? How does it relate to valproate?

A

Works on sodium channels that modulate glutamate and aspartate

Valproate will increase lamotrigine levels
Lamotrigine will decrease valproate levels

221
Q

Pregabalin and gabapentin have little efficacy in bipolar disorder. T/F?

A

True
Gabapentin: adjunctively used for sleep, anxiety
Pregabalin: GAD, fibromyalgia

222
Q

Oxcarbazepine vs carbamazepine?

A

Oxcarazepine is as effective for mood disorders

  • better tolerated
  • less risk of rash and hepatic toxicity
223
Q

Topiramate use? Side effects?

A

Use: Impulse control disorder and anxiety
Side effects:
- Weight loss (beneficial)
- Kidney stones
- Hypochloremic, non-anion gap metabolic acidosis
- limited use because of cognitive slowing

224
Q

Main side effects of valproate

A

Hepatotoxicity or benign liver enzyme elevations
Increased ammonia
Teratogen
Pancreatitis
—–
GI side effects, weight gain, sedation, alopecia, thrombocytopenia

225
Q

Benzos are relatively safer in OD than barbiturates. T/F?

A

True

226
Q

Short acting benzos? (half life

A

Triazolam - for insomnia

Midazolam

227
Q

Intermediate acting benzos (half life 6-20hrs)

A

A LOT
Alprazolam - for anxiety, panic attacks (SHORT onset of action –> euphoria, high abuse potential)

Lorazepam - for panic attacks, agitation, alcohol detox, sedative-hypnotic-anxiolytic detox

Oxazepam - for alcohol detox, sedative-hypnotic-anxiolytic detox

Temazepam - decreasingly used for insomnia due to dependence

228
Q

Long acting benzos (half life >20hrs)

A

Diazepam (has rapid onset) - for alcohol detox, sedative-hypnotic-anxiolytic detox, seizures
Clonazepam - for anxiety, panic attacks; AVOID WITH RENAL DYSFUNCTION

229
Q

Side effects of benzos

A

Impairment of intellectual functioning
Reduced motor coordination (CAREFUL WITH ELDERLY)
Anterograde amnesia
Drowsiness

230
Q

When is informed consent NOT required?

A

Lifesaving medical emergency
Prevention of suicidal or homicidal behavior
UNemancipated minors receiving obstetric care, STD treatment, or substance abuse tx

231
Q

Minors are considered emanicipated if they are:

A

Married
In the military
Have children
Self supporting

232
Q

What is police power?

A

Protecting citizens from each other (supports involuntary commitment)

233
Q

What is parens patriae?

A

Protecting citizens who can’t care for themselves (supports involuntary commitment)

234
Q

Lawyers are not required to report child abuse. T/F?

A

True

Doctors ARE required

235
Q

What is tenting and how does it relate to the sexual response cycle?

A

Desire
Excitement - tenting (elevation of uterus in pelvis); increase in BP, pulse, nipple erection
Plateau - contraction of outer 1/3 of vagina, enlargement of upper 1/3 vagina
Orgasm
Resolution

236
Q

Being male is a risk factor for developing PTSD. T/F?

A 
False;
Risk factors:
- Female
- Low SES
- Low education
- Previous psych illness
237
Q

Treatment of PTSD?

A

Multimodal (pharm + psychotherapy + social interventions)
SSRIs or SNRIs
- Paroxetine, sertraline (reduces the sx clusters of reexperience, avoidance hyperarousal in esp noncombat related PTSD)

TCAs and MAOIs for treating the reexperiencing sx

*SSRis are usually first adminsitered at a low dose and titrated up to max dose as tolerated

238
Q

How to determine patient for decisionality?

A

Understand relevant information regarding treatment (purpose, risk, benefits)

Appreciate appropriate weight of and impact of the decision

Logically manipulate the information to make a decision

Communicate a choice or preference

239
Q

What is the 6th amendment? 14th amendment?

A

6th: Right the counsel and to confront witnesses
14th: Right to due process of law

240
Q

Which mental illness/disorder has the highest risk of violence towards self/others?

A

Other substance abuse/dependence other than alcohol - 16x risk

Alcohol abuse/dependence 12x
Bipolar 5x
Depression 5x
Schizophrenia  2-5x (controversial) 
Mental illness increased risk of violence
241
Q

Expert witness standards; Daubert? Frye?

A

Daubert: Judge decides if evidence is based on relevant and reliable science

Frye: Evidence must be generally accepted by the appropriate scientific community

242
Q

Signs for detecting malingering?

A 
Antisocial personality disorder
Substance abuse
Hx of working in medical field 
Atypical presentation
"textbook" description of the illness
Sx only present when patient knows they are being observed
243
Q

How does alcohol, marijuana, cocaine, amphetamines, narcotics affect libido?

A

Alcohol and marijuana: increase by suppressing inhibitions
Cocaine and amphetamines: increase by stimulating dopamine receptors
Narcotics: inhibit

***Alcohol long term DECREASES libido

244
Q

Testosterone increases libido in women. T/F?

A

True; in both men and women

245
Q

How does serotonin affect sexual function? Progesterone?

A

Serotonin INHIBITS sexual function

Progesterone INHIBITS sexual function in men and women by blocking androgen receptors

246
Q

Most common sexual disorders in women? Men?

A

Women:

  • Sexual desire disorder
  • Orgasmic disorder

Men:

  • Secondary erectile disorder
  • Premature ejaculation
247
Q

What is hypoactive sexual desire disorder?

A

Absence or deficiency of sexual desire/fantasies (more common in women)
*No problem having or sustaining erection, no problem reaching orgasm

248
Q

Male erectile disorder? Female sexual arousal disorder?

A

Male erectile disorder:

  • Impotence; primary (never had one) or secondary (previously able to)
  • Psychological etiology if they have erections in the morning, during masturbation or with sexual partners

Female sexual arousal disorder:
- Inability to maintain lubrication until completion of sex act ( high prevalence, 33% of women)

249
Q

Male orgasmic disorder?

A

MUCH LESS COMMON than impotence or premature ejaculation

  • Achieves orgasm with great difficulty, if at all
250
Q

Female orgasmic disorder?

A

Inability to have an orgasm after a normal excitement phase (30% of women)

251
Q

Sexual aversion disorder?

A

Avoidance of genital contact with a sexual partner

252
Q

Vaginismus?

A

Involuntary contractions of outer 1/3 of vagina upon insertion of penis, object

Higher incidence in high SES, strict religious upbringing

253
Q

Dyspareunia? Associated with?

A

Genital pain BEFORE, DURING, or AFTER sexual intercourse

Much higher incidence in women; associated with vaginismus

254
Q

What is dual sex therapy and what are its goals?

A

Marital unit meets with male and female therapist for a 4-way session to identify sexual problems

Goals:

  • Sexual at-home exercises
  • Heightening sensory awareness
  • Increase levels of sexual contact

SHORT TERM therapy

255
Q

Hypnosis is most useful as primary treatment. T/F?

A

False; most often used as adjunct with other therapies

Most useful is anxiety also present

256
Q

____ is injected into the penis (which location?) and causes an erection in 2-3 minutes. Does this drug require sexual stimulation to achieve erection?

A

Alprostadil
Injected into corpus cavernosa or transurethral
No sexual stimulation needed

257
Q

How to treat premature ejaculation?

A

SSRIs and TCAs

Increases time between stimulation and orgasm

258
Q

Hypoactive sexual desire disorder, how do you treat? Men vs women?

A

Testosterone in men to replace low levels of T

Low doses in women may increase libido

259
Q

How do you treat vaginal dryness?

A

Estrogen replacement may improve vaginal dryness and atrophy in hypoestrogenemic women

260
Q

Tx for end-stage impotence?

A

Surgical insertion of semirigid or inflatable tubes into corpus cavernosa

261
Q

Mechanical tx of male orgasmic disorder? Female orgasmic disorder?

A

Male orgasmic disorder: gradual progression for extra to intravaginal ejaculation

Female orgasmic disorder: masturbation, sometimes with vibrator

262
Q

Vaginismus tx?

A

Regular dilation of vagina with fingers or dildo

263
Q

What are paraphilias?

A

Sexual disorders of engagement of unusual sexual activities and/or preoccupation with unsual sexual

264
Q

Paraphilia tx?

A

Aversion therapy

265
Q

Sadism vs masochism?

A

Sadism - humiliating others

Masochism - being humiliated

266
Q

Three most common types of paraphilia?

A

Pedophilia
Voyeurism
Exhibitionism

267
Q

Of all major psych disorders, which has highest genetic link?

A

Bipolar I

  • Concordance of monozygotic twins with bipolar is 40-70%; for dizygotic 5-25%
  • First degree relatives of bipolar are 8-18x more likely to develop illness
268
Q

Best treatment for manic pregnant women?

A

ECT

269
Q

Long term treatment of lithium increases suicide risk. T/F?

A

FALSE
Long term lithium use DECREASES suicide risk
*Note: other mood stabilizers like carbamazepine or valproic acid are associated with INCREASED suicide risk

270
Q

Two most commonly used substances in terms of substance abuse?

A

Alcohol and nicotine

271
Q

Abuse vs Dependence?

A 
Abuse --> think WILD
Work, school, home role obligation failure
Interpersonal or social consequences
Legal troubles
Dangerous use

Dependence –> impairment/distress within a 12 month period of things like
- tolerance, withdrawal, using more than intended, persistent desire to quit, failed attempts to quit, continued use despite physical/psychological problems

272
Q

Is it possible to have substance dependence without physiological dependence?

A

YES

Meaning without withdrawal or tolerance

273
Q 
How long is each present in urine (i.e. produce a positive UDS)?
Cocaine
Amphetamine
PCP
Barbiturate (short and long acting)
Benzos (short and long acting) 
Opioids
Marijuana (heavy and single use)
A

Cocaine: 2-4 days
Amphetamine: 1-3 days
PCP: 3-8 days; CPK and AST are often elevated
Barbiturate/short like pentobarbital: 24 hours
Barbiturate/long like phenobarbital: 3 weeks
Benzo/short like lorazepam: 3 days
Benzo/long like diazepam: 30 days
Opioids: 2-3 days (methadone and oxycodone will be negative on general screen so order a separate panel!)
Marijuana/heavy use: 4 weeks
Marijuana/single use: 3 days

274
Q

Alcohol mechanism of action?

A

Activates GABA receptors
Activates serotonin receptors
Inhibits glutamate receptors
Inhibits voltage gated calcium channels

275
Q

Alcohol, methanol and ethylene glycol can cause what metabolic disturbances?

A

Metabolic acidosis with increased anion gap

276
Q

How to do you treat alcohol intoxication?

A

ABCs, glucose, electrolytes, acid base status
Thiamine to prevent/treat Wernickes Encephalopathy
Folate
CT to r/o subdural hematoma or other brain injury

277
Q

Attempted suicided is associated with:

A

Mental illness
Young females
Alcoholism

278
Q

Gi evacuation is NOT indicated in alcohol overdose. T/F?

A

Can be done if significant amount of EtOH was consumed in the preceding 30-60 minutes

279
Q

Anorexia can be a s/s of alcohol withdrawal syndrome. T/F?

A

True

280
Q

Seizures can happen in alcohol withdrawal. When do they occur and peak?

A

Generalized tonic clonic seizures occur at 6-48 hours after cessation

Peak 13-24hours

281
Q

Hypo/hypermagnesemia can predispose to seizures.

A

HYPOmagnesemia

282
Q

When do etoh withdrawal sx begin and how long do they last?

A

Begin 6-24 hours

Last 2-7 days

283
Q

Only 5% of hospitalized etoh withdrawal pts develop DTs and if left untreated has a 15-25% mortality rate. T/F

A

True

284
Q

DTs occur equally in men and women. T/F

A

False

DTs 4-5x higher in men

285
Q

DT sx? Tx? When does it start?

A

delirium
hallucinations (often visual, can be tactile)
gross tremor
autonomic instability
fluctuating levels of psychomotor activity

Tx? Phenytoin or Benzo; use antipsychotics and temporary restraints for severe agitation
Start: usually 24-72hrs, usually within a week

286
Q

_____ is associated with Korsakoff’s psychosis

A

Confabulation

Pt is unaware they are making this up

287
Q

Disulfuram is contraindicated in

A

Severe cardiac disease
Pregnant
Psychosis

288
Q

AST:ALT >2 suggests excessive alcohol use. T/F?

A

True

289
Q

Naltrexone mechanism?

A

Opioid receptor blocker, reduces craving/desire

Greater benefit seen in those with family hx of alcoholism

290
Q

Acamprosate mechanism?

A

Structurally similar to GABA (thought to inhibit glutaminergic system)

Should be started POST-detox for relapse preventionin patients who have stopped drinking

291
Q

Glucose before thiamine or thiamine before glucose in alcoholics?

A

Thiamine before glucose, otherwise wernicke korsakoff syndrome may be precipitated

292
Q

Major benefit of using acamprosate? Contraindication?

A

Can be used in those with liver disease

Contraindicated in severe renal disease

293
Q

Topiramate mechanism and use?

A

Anticonvulsant that potentiates GABA and inhibits glutamate receptors

Reduces cravings for alcohol

294
Q

Wernickes encephalopathy?

A

Long term complication of alcohol intake
Caused by B1/thiamine deficiency from poor nutrition

Sx:

  • Ataxia, broad based
  • Confusion
  • Eye abnormalities (nystagmus, gaze palsies)

Untreated? Can progress to Korsakoff syndrome

295
Q

What is korsakoff syndrome?

A 
Chronic amnestic state
- Impaired recent memory
- anterograde amnesia
- compensatory confabulation (memory fails so you lie)
only reversible in 20%
296
Q

What does cocaine intoxication look like?

A
  • euphoria, heightened self esteem
  • dilated pupils,
  • nausea, weight loss, chills, sweating
  • tachy or brady, hyper or hypotension, psychomotor agitation or depression
  • hallucinations (esp. tactile), paranoia
  • respiratory depression
  • seizures, arrhythmia
  • vasoconstrictive may result in MI or stroke
297
Q

Signs of cocaine withdrawal? Can you abruptly stop using?

A

Abrupt abstinence is NOT life threatening

  • post-intoxication crash!
  • malaise, fatigue, depression, somnolence
  • psychomotor agitation or depression
  • hunger
  • constricted pupils
  • vivid dreams
298
Q

How long does cocaine withdrawal last? Tx?

A

Mild-moderate use: resolve within 18 hours
Heavy chronic use: weeks, peak in several days
***Heavy use may cause AMPHETAMINE PSYCHOSIS that mimics schizophrenia

Tx: supportive

299
Q

Amphetamine mechanism?

A

Blocks reuptake and facilitates release of dopamine and NE –> stimulant effect

Substituted/designer amphetamines: release dopamine, NE and serotonin from nerve endings –> stimulant and hallucinogenic effect
***Serotonin syndrome possible if combined with SSRI

300
Q

Physical findings of chronic amphetamine use?

A

Tooth decay

Acne

301
Q

Sx of amphetamine abuse?

A 
Dilated pupils 
Increased libido
Perspiration
Respiratory depression
Chest pain
302
Q

Rotary nystagmus is pathognomonic for?

A

PCP intoxication

303
Q

PCP intoxication sx?

A 
RED DANES
Rage
Erythema (skin)
Dilated pupils
Delusions
Amnesia
Nystagmus
Excitation
Skin dryness
304
Q

OD of amphetamine sx? Tx?

A

Hyperthermia
Dehydration
Rhabomyolysis –> renal failure

Tx: rehydrate, correct electrolytes, treat hyperthermia

305
Q

Amphetamine withdrawal sx?

A

Prolonged depression

Possible psychosis

306
Q

PCP mechanism? Relationship to ketamine?

A 
NMDA antagonist (glutamate receptors)
Activates dopaminergic neurons

Ketamine is less potent; used as date rape as its tasteless and odorless

307
Q

Cocaine and PCP are similar in that they both can cause _____ hallucinations

A

Tactile and visual hallucinations

308
Q

Withdrawal sx of PCP?

A

None

Might get “flashbacks” of sx from lipid stores releasing drug

309
Q

What is meperidine and its unique properties?

A

Meperidine = Demerol = synthetic opioid analgesic
Dilates pupils, does NOT constrict pupils like other opioids

Meperidine + SSRI –> Serotonin syndrome

310
Q

Tx of opioid withdrawal?

A

Moderate sx:

  • Clonidine for autonomic s/s of withdrawal
  • NSAIDs for pain
  • Dicyclomine for ab pain

Severe sx:
- Detox with buprenorphine or methadone

Clerkship decks (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions