Psych Shelf Flashcards
Screening tool for dementia
Folstein MMSE
Test that acts friends and relatives to report individual’s function
Blessed rating scale
Test to assess executive function
WCST (wisc card sorting test)
Executive functions are localized to this lobe in the brain and are often affected in individuals with —
Frontal, schizophrenia
IQ calcuation
mental age/chronological age x100
test to assess visual nonverbal memory
rey-osterrieth test that asks pt to copy complex figure with it in front of them and then from memory
rey-osterrieth test result: pt can’t copy figure correctly
R parietal lobe lesion – L visual field neglect
rey-osterrieth test result: pt can’t copy figure from memory
R temporal lobe lesion
Transference vs countertrans
Transferring emotions from one’s past onto another. For trans it’s patient onto therapist and other way around for counter
akathisia
motor and mental restlessness; SE of FGA
dystonia
musc rigidity and spasticity; SE of FGA
tests for concentration
serial 7s, spelling world backwards, random letter test
Repetition of obscene words sometimes in Tourette
coprolalia
What’s most common psych emergency in kids and adolescents?
suicidal behavior
What’s most common way kids/teens attempt suicide?
drug OD
What’s most common way kids/teens commit suicide?
firearms
What med is used to treat enuresis?
DDVAP
Side effects of DDVAP
HA and nausea
SEs of fluoxetine
GI, insomnia, agitation, HAs
Condition with deceleration of head growth, loss of coordination, and developmental delay starting after 5 months
Rett’s
First line medication for tourette
Alpha 2 agonist: guanfacine, clonidine
Most common initial sx’s for tourettes
Eye tics
type of tics in tourettes
Must have motor and verbal although not necessarily simultaneously
What’s most common predisposing factor for mental retardation?
Early alterations in embyronic development (can be due to chrom changes or toxins)
Axis I
psych disorders exc Axis II ones
Axis II
intellec disab and personality do’s
Axis III
medical dos
Axis IV
psychosocial and envi probs
Axis V
global assessment functioning
What meds can increase risk of tics?
stimulants
Enuresis is more common
in boys than girls that are otherwise healthy
At what age can normal child copy circle?
2
At what age can normal child copy square?
5
At what age can normal child tell you age and gender?
3
At what age can normal child ride tricycle?
3
At what age can normal child ID left hand?
5
Treatment for NMS
Dantrolene and bromocriptine or amantadine
Catatonia sx’s
stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerism stereotypy, agitation, grimacing, echolalia (repeats words), echopraxia (repeats behavior)
delusion that familiar ppl have been replaced by impostors
capgras
antipsychotics available in long acting injectable form
haloperidol and fluphenazine
Factors favoring good outcome in schizophrenia
Age onset 20-25, married, good premorbid social and work hx, triggering event, rapid onset
Factors favoring poor outcome in schizophrena
Age<20, insidious onset, lack of precipt factors, poor premorbid hx, negative sx’s, social isolation, fam hx of schizophrenia
Drugs that induce psychosis
amphetamines, PCP, LSD
Prevalence of schizophrenia
0.3-0.7%
Malingering
feigning sx’s for personal gain with external motivation (like avoiding legal issues, getting room and board, receiving monetary compensation)
Factitious disorder
feigning sx’s for personal gain with internal motivation to assume sick role
hallucination of transparent phantom of one’s body
autoscopic psychosis
delusion that you’re a werewolf or other animal
lycanthropy
false perception of having lost everything ie money, strength, health, organs
cotard syndrome
one person develops psychotic sx’s similar to one that partner has
folie a deux
First line med for mania
valproic acid
In what time range does pt develop depression after stroke?
Usually within 6 mos
cyclothymic disorder
recurrent periods of mild depression and hypomania present for at least 2 years
Tests to monitor lithium
plasma levels, thyroid, creatinine, urinalysis, CBC, electrolytes
Treatment for premenstrual dysphoric disorder
SSRIs and OCPs
phobia desensitization by pairing feared stimulus with anti-anxiety behavior
reciprocal inhibition
operant conditioning
learning through rewards and punishments (Skinner)
polysymptomatic syndrome in which pts are chronically sick and get several surgeries but no organic cause
somatic sx disorder
interpretation, clarification, and confrontation are used in what type of therapy
psychoanalytic psychother
patient presents acutely with blindness with no explainable cause
conversion disorder
pt is intensely afraid of getting sick and has distorted interpretation of sx
illness anxiety disorder
med to treat narcoplepsy
modafinil
pt has lots of time and memory gaps including autobio details
dissociative identity
pharm treatment for OCD
clomipramine (TCA), SSRIs (high dose)–fluvoxamine
treatment for PTSD
CBT, SSRIs, prazosin for nightmares
pharm for panic do
SSRI + benzo initially until SSRI effect sets in
sudden onset of REM sleep
narcolepsy
REM sleep behavior disorder vs narcolepsy
pts act out dreams as opposed to paralysis in narc
med to treat narcoplepsy
modafinil
patient is unaware that they move legs at night
periodic limb movement disorder
patient feels pain and need to move legs
restless leg syndrome
treatment for PTSD
CBT, SSRIs, prazosin for nightmares
Pharm to treat tardive dyskin
valbenazine
drugs abused that lead to brief euphoria, loss of consciousness, perioral skin changes
inhalants
treatment for GAD
CBT and SSRIs (buspirone is also an option)
EPS: dyskinesia of mouth, tongue, extremities that develops months after starting meds
tardive dyskinesia
antidepressant assoc with dose depend HTN
venlafaxine
Pharm to treat akathisia
beta block (propanolol), benzo, benztropine
narcolepsy sx’s
cataplexy (loss of musc tone), shortened REM phases, hypnagogic (falling asleep) and pompic (waking up) halluc
Pharm to treat tardive dyskin
valbenazine
drugs abused that lead to brief euphoria, loss of consciousness, perioral skin changes
inhalants
withdrawal sx’s of irritability and incr appetite
nicotine
drug intox that presents with agitation, aggression, psychosis, nystagmus, ataxia
PCP
antidepressant assoc with dose depend HTN
venlafaxine
long term treatment for panic disorder
CBT and SSRIs
narcolepsy sx’s
cataplexy (loss of musc tone), shortened REM phases, hypnagogic and pompic halluc
withdrawal sx’s incl seizure
alc and benzos
withdrawal sx’s of pyschomotor retardation and severe depr
stimulants
withdrawal sx’s of irritability and incr appetite
nicotine
abnormal cortico-striato-thalamo-cortical circuits in which disorder
OCD
hypercortisol seen in
MDD (hyperact of HPA axis)
pharm for panic d/o
SSRI + benzo (use initially until SSRI kicks in)
decreased hippocampal and frontal lobe volumes seen in
MDD
patient presents acutely with blindness with no explainable cause
conversion d/o
pt is intensely afraid of getting sick and has distorted interpretation of sx
illness anxiety d/o
polysymptomatic syndrome in which pts are chronically sick and get several surgeries but no organic cause
somatic symptom d/o
pt has lots of time and memory gaps including autobio details
dissociative identity
lithium toxicity
GI, confusion, ataxia, tremor
pharm for panic d/o
SSRI + benzo (use initially until SSRI kicks in)
NMS
fever, musc rigidity, autonom instability, delirium
antichol effects
dilated pupils, hyperthermia, flushed, dry skin, intestinal ileus
new onset neuropsych sx’s and unexplained ab pain
acute intermittent porphyria
effect of tuberoinfundibular
control of prolactin; antag leads to galac and sex dysfunc
length of time for major depr episode
> 2 weeksli
cocaine withdrawal
depression, hypersomnia, hyperphagia, fatigue, impaired conc, incr dreaming
lithium clearance
renal
NMS
fever, musc rigidity, autonom instability, delirium
effect of mesolimbic pathway
psychosis
effect of nigostriatal pathway
movement; antag leads to EPS
effect of tuberoinfundibular
control of prolactin; antag leads to galac and sex dysfunc
risk factors for suicide
SAD PERSONS: sex, age, depr, previous attempt, EtOH, rational thought loss, social support lack, organized plan, no spouse, sickness
cocaine withdrawal
depression, hypersomnia, hyperphagia, fatigue, impaired conc, incr dreaming
nightmare d/o vs sleep terrors
nightmare: recurrent awakenings from REM with alertness and recall; terror: non-REM with partial arousal, unresponsiveness and no recall
meds to treat NMS
dantrolene, dopa agonists (bromocriptine, amantadine) and benzos
first line treatment for atypical depr
MAOIs
Long acting BDZ
diazepam (valium) and clonazepam
Intermed acting BDZ
alprazolam (xanax), lorazepam, oxazepam, temazepam
Short acting BDZ
triazolam, midazolam
BDZs not met’d by liver
LOT: loraz, oxaze, temaze
sexual se of SSRIs in women
anorgasmia
first and second line treat for tourette’s
1) haloperidol 2) alpha2ag
pharm for bulimia
fluoxetine
ECG changes with lithium
flattening or inversion of T wave
class of antidepressant that has orthostat hypotens as SE
TCAs
antidepressant that can cause withdrawal symptom in 2 days
paroxetine
antipsych available in depot form
haloperidol and risperidone
amantadine can be used to treat
NMS and parkinsonism
relative contrainds for ECT
MI within 6 months and intracranial space occupying lesion
What drug reduces suicidality in pts with schiz?
clozapine
What drug reduces suicidality in pts with bipolar?
lithium
spasm of neck and back that causes pt to arch
opisthotonos
neck spasm that brings neck to one side
torticollis
feeling of bugs crawling on your skin
formication
drugs that cause agranulocytosis
clozapine and chlorpromazine
side effect assoc with thioridizaine
pigmented retinopathy
del tremens occurs within how many hours
96
mental status changes, autonomic dysreg, neuromusc hyperactivity
serotonin syndrome
Management of serotonin syndrome
Supportive care, sedation with benzos, serotonin antag (cyproheptadine)
What’s the time frame for post partum blues?
Onset 2-3 days and resolves within 14
Symptoms of post partum depression
At least 2 weeks of mod to severe depr
First line treatment for ADHD
stims: methylphenidate and amphet
Second line treat for ADHD
atomoxetine (NE reuptake inhib) or alpha 2 ags (guanfacine, clonidine)
persistent complex bereavement syndrome
persistent yearning for deceases and prolonged emotional pain with ruminative thoughts and dysfunc behavior
brain changes in schizophrenia
lat ventricle enlargement, decr volume of hippocampus and amygdala
struc abnormalities in orbitofrontal cortex and basal ganglia assoc with
OCD
personality changes, disinhibition, apathy, compulsions
frontotemporal dementia
memory, executive, and visuospatial deficits
alzheimers
dementia with parkinsonism and hallucinations
dementia with lewy bodies
wet, wacky, wobbly
NPH
mild memory impairment, major exec dysfunc and focal neuro deficits
vasc dementia
treatment for major depression with psychotic features
ECT
treatment for severely depressed elderly patients
ECT
meds for social anxiety
SSRI and SNRI
treatment for ADHD in someone with substance abuse
atomoxetine (nonaddictive)
most common sleep disturbance in MDD
early morning awakening
double depression
MDD imposed on dysthymia
anorexia lab findings
Incr BUN, cortisol, growth hormone, anemia, leukopenia, reduced gonadotropins
% of pts with messed up cortisol response in MDD
50% ; incr cortisol
full list of Li SEs
weight gain, tremor, GI probs, fatigue, cardiac arrhyth, seizures, goiter/hypothyr, coma, polyuria and dipsia, alopecia
Risk of schizophrenia in 1) child, 2) identical twin, 3) frat twin, 4) sibling of pt with it
1) 12%; 2) 50%; 3) 12%; 4) 8%
loss of motor tone in narcolepsy
cataplexy (catalepsy is in catatonia)
anterograde amnesia
loss of short term memory
retrograde amnesia
loss of remote or previously formed memories
subbing a word or descr for a word that can’t be found/spoken
circumlocution
can’t perform previously learned motor skills
apraxia
prodromal schizophrenia
incr negative sx’s without pos sx’s
general psych d/o that carries greatest risk of suicide
mood disorder
What’s the most predictive variable for suicide?
Older age >45
iatrogenic cause of psych sx’s like depr or psychosis
glucocorticoids
treatment for pt with bipolar and kidney probs
valproate
med that can result in liver failure
valproate
med that can cause renal disease
lithium
spasm of extraoc muscles as dystonic reac
oculogyric crisis
spasm of jaw musc as dystonic reac
trismus
physio effects of bulimia
hypokal, hypochloremic alkalosis, hypomag, high serum amylase, enlargement of salivary and parotid glands and pancreas, Normal thyroid func
Why the concern for discontinuing antianxiolytic (benzo or barb)
Risk of seizures
Drug used to manage agitated or confused patient with delirium
haloperidol
Tourette often co-occurs with
OCD and ADD
Withdrawal sx’s severe with drugs with what?
short half lives
What makes drugs of abuse more addictive?
short onset of action
Wernicke triad
ataxia, confusion, eye movement (nystagmus)
What’s deficient in Wernike
B1, thiamine
Korsakoff lesions found
mamillary bodies and thalamus
Korsakoff sx’s
memory impairment, confusion, confabulation, personlaity changes
What meds are good for depressed phase of bipolar?
atypical antipsych (quetiapine, lurasidone)
pharm to treat acute dystonia EPS
diphenhydramine, benztropine (have antichol effects)
pharm to parkinsonism EPS
benztropine, amantadine
treatment for moderate to severe premenstrual dysphoric
SSRIs
MDMA intoxication
HTN, tachycardia, hyperthermia, serotonin syndrome, hyponatremia
BMI cutoff for anorexia
18.5
erythema of nasal mucosa
cocaine abuse –> also see weight loss and behav changes
meds that cause hyperprolactinemia
typical antipsych (haloperidol, fluphenazine), risperidone
treatment for anorexia
nutritional rehab and CBT (or other therapy)
Domains of ASD
social communication and stereotyped, repetitive behavs
drug intox that can cause psychosis
amphetamine
physical findings of amphet intox
tooth decay, acne, skin excoriations
drug for schizophrenia with sucidality
clozapine
AEs of clozapine
agranulocytosis, myocarditis, seizures, metab syndrome
drug to treat tyramine crisis
alpha blocker phentolamine
medical causes of mania
thyrotoxicosis, Cushing, hypoglycemia, substance use and withdrawal, steroids, antichol
depression with atypical features
mood reactivity, rejection sensitivity, leaden paralysis, hypersomnia, weight gain
depression with melancholic features
loss of interest and pleasure in all activities or lack of reactivity to pleasurable stimuli
antidepressant that can be used in pregnancy
fluoxetine
Risk of lith in pregnancy
Ebstein’s anomaly
Meds assoc with neural tube defects
valproic acid and carbamazepine
drugs to use in alc withdrawal for those with liver disease
loraz, oxaz, temaz
What pain med has dangerous interactions with MAO-I?
meperidine (demerol)
score on MMSE indicative of dementia
<24
NMS vs serotonin syndrome
rigidity in NMS vs hyperreflexia/tremor in SS
normal MOCA score
> =26/30
seizures, QRS prolong, and antichol effects are OD of what type drug
TCAs (triptyline)
pathophys of tardive dyskinesia
dopamine recep supersens/upreg
first line med for alc use disorder
naltrexone
real scary SE of lamotrigine
Stevens-Johnson or toxic epidermal necrolysis
low levels of hypocretin
narcolepsy
tooth decay and skin excoriations can be sign of chronic use of what drug
meth
propanolol used for what type anxiety disorder
performance anxiety
first line treatment for MDD with psychotic features (2 options)
1) antidep + antipsych 2) ECT if need results faster
illicits assoc with serotonin syndrome
ecstasy and bath salts
antipsych w/ highest risk of metab syndrome
clozapine and olanzapine
fevers higher in SS or NMS?
NMS
time frame for dysthymia
depressed mood >2 years w/o 2 mo symptom free