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Psychiatric/Behavioral & Substance Abuse Flashcards

1
Q

When could you suspect Lamotrigine as the cause of a seizure?

A

If the patient has seizure hx and stops taking their medication
- Insert any anticonvulsant into this catagory

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2
Q

What is considered a normal response to stress?

A

Not excessive or out of proportion
No significant functional impairment
- Social and occupational
- Key diagnostic criteria

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3
Q

Everyday occurrences have a special implication

  • TVs or radio speaking directly to them
  • Articles have special messages
A

Ideas of reference

Common with schizophrenia

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4
Q

What is the DOC for acute treament of panic disorder?

A

Benzos

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5
Q

Benzodiazepine used most often to induce conscious sedation during medical procedures

A

Midazolam

- No role in treating anxiety disorders

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6
Q

Irritable, drowsy, fatigued, and hungry

Psychomotor agitation or retardation may also present

A

Cocaine withdrawal

Amphetamine withdrawal- May also have depression

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7
Q

Onset 12 to 48 hrs after last dose
Sweating, hyperreflexia, tremors, and seizures
Acute hallucinosis without autonomic symtpoms
Altered sensorium, hallucinations, and autonamic instability
Death

A

Alcohol withdrawal

Benzodiazepine withdrawal

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8
Q

Irritability, anxiety, depression, insomina, restlessness, poor concentration, increased appetite, weight gain, and bradycardia

A

Nicotine withdrawal

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9
Q

When should you suspect Alpazolam instead of bupropion in a patient experiencing seizures?

A

When the patient abruptly stops the medication

i.e. withdrawal type picture

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10
Q

Behaving as if an aspect of reality does not exist

A

Denial

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11
Q

Transferring feelings to a more acceptable object

A

Displacement

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12
Q

Alterin perception of upsetting reality to be more acceptabe

A

Distortion

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13
Q

Separating a thought from its emotional components

A

Isolation of affect

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14
Q

Attributing one’s own feelings to others

A

projection

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15
Q

Responding in a manner opposite to one’s actual feelings

A

Reaction formation

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16
Q

Channeling impulses into socially acceptable behavior

A

Sublimation

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17
Q

Putting unwanted feelings aside to cope with reality

A

Suppression

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18
Q

Mature defense mechanisms

A

Altruism
Humor
Sublimation
Suppresion

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19
Q

What would a prolactin level be if the cause of the hyperprolactinema was a prolactinoma and not an antipsychotic?

A

> 200 ng/mL

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20
Q

Patient has fever, rigidity, mental status changes, and autonomic instability. They have a history of antipsychotic use. What is the condition?

A

Neuroleptic malignant syndrome

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21
Q

What types of medications cause neuroleptic malignant syndrome?

A

Medications that block dopamine transmission

- Most common with high-potency antipsychotics

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22
Q

What is the appropriate way to manage a patient with neuroleptic malignant syndrome?

A
  1. Stop the medication
  2. Monitor in ICU
  3. Control temperature
  4. Watch electrolytes
  5. Dantrolene- if severe
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23
Q

What are the risk factors for suicide?

A

SAD PERSONS

Sex- Male
Age- Young and Old
Depression

Previous attempt
EtOH
Rational thought loss (Psychosis)
Social support- Lack of
Organized plan
No spouse or significant other
Sickness or injury
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24
Q

Which suicidal patients are considered high-risk and should be admitted?

A

Those with intent and a plan

  • Admit
  • Remove items that can be used for harm
  • Constant observation
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25
Q

How do you manage suicidal patients who are high-risk, but have no plan to act in the near future?

A
  1. Treat modifiable risk factors
  2. Recruit social support
  3. Reduce access to means
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26
Q

Which serotonin receptor is antagonized by atypical antipsychotics to help allevaite negative symptoms and decrease risk of EPS?

A

5-HT2A

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27
Q

What receptors does risperidone bind to?

A

Alpha-1 - No theraputic effect
Dopa-2 - Antipschotic
5-HT2A - Treats negative symptoms and decreases risk of EPS

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28
Q

What are the 4 broad categories of conduct disorder?

A
  1. Aggression toward people and animals
  2. Destruction of property
  3. Serious violation of rules
  4. Deceitfulness or theft
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29
Q

How many symptoms must be present in conduct disorder? How many months?

A
  1. 3+
  2. Last 12

*At least 1 must have been present in the last month

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30
Q

What are indications for ECT?

A 
Severe depression
Depression in pregnancy
Refractory mania
NMS
Catatonic schizophrenia
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31
Q

What are the side effects of ECT?

A 
Amnesia
Prolonged seizures
Delirium
Headache
Nausea 
Skin burns
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32
Q

What is the BMI critera for anorexia nervosa?

A
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33
Q

What is the recommended treatment for anorexia?

A

CBT
Nutritional rehab
Olanzapine- if unresponsive

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34
Q

What is the recommended treatment for bulimia?

A

CBT
Nurtitional rehab
SSRI- Given as adjunct

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35
Q

What are is the recommneded treatment for binge eating disorder?

A

CBT
Behavioral weight loss therapy
SSRI
Lisdexamfetamine, topiramate

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36
Q

What are the risk factors for homicide?

A 
Young male
Unemployed
Impoverished
Access for firearms
Substance abuse
Antisocial personality disorder
History of violence
History of childhood absue
Impulsive
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37
Q

What lab value is elevated during NMS?

A

CPK- Rhabdomyolysis

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38
Q

What is a common complication of NMS?

A

Acute kidney failure- Rhabdomyolysis -> Myoglobinuria

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39
Q

What are the basic critera for pathologic gambling?

A

Persisten and maladaptive gambling behavior

Often dishoneset and evasice when confronted

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40
Q

What are the FDA approved first-line treatments for OCD?

A

CBT is also recommended

Clomipramine
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline

SSRI first, then another SSRI or Clomipramine

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41
Q

Increased risk of jaundice

A

Chlopromazine

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42
Q

Pigmentary retinopaty

A

Thioridazine

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43
Q

Cataracts

A

Quetiapine

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44
Q

What is a major mental health risk for someone who has been sexually assaulted?

A

Suicidal ideation and attempts

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45
Q

Physical aggression, severe agitation, impulsivity, impaired judgement, psychosis, paranoia, or hallucinations.

Ataxia, nystagmus, & muscle rigidity

A

Phencyclidine (PCP)- Intoxication

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46
Q

What other intoxication presents with ataxia, nystagmus, aggression, and impaired judgement?

A

EtOH

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47
Q

Pinpoint pupils, drowsiness, CNS deprssion, and constipation

A

Heroin intoxication

- Opiods

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48
Q

Mood impairment, hallucinations, subjective perceptual intesification, depersonalization, and illusions

2+
Sweating, tachycardia, pupillary dialation, palpitations, tremors, and poor concentration

A

Lysergic acid (LSD) intoxication

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49
Q

Anxiety, aggression, psychosis, formication, or delirum

High BP, tachycardia or bradycardia, sweating, pupillary dilation, nausea or vomiting, or insomnia

Nose bleed or septal perforation

A

Cocaine intoxication

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50
Q

What is the effect of ODing on cocaine?

A

Think heart and brain

Cardiac arrhythmias
MIs
Seizures
Stroke

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51
Q

Which drug is most commonly associated with agitation and aggresion?

A

PCP

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52
Q 
Tongue protrusion and twisting
Lip smaking, puting, and puckering
Retraction of the cornters of the mouth
Chewing movements
Limb twisting and spreading
Piano-playing finger movements
Foot tapping
Dystonic extension of the toes
Torticollis
Shoulder shrugging
Rocking or swaying
Rotary hip movements
Grunting noies
A

Signs and symptoms of tardive dyskinesia

53
Q

What is the most likely atypical antipsychotic to cause TD? Lest likely?

A

Risperdone

Clozapine

54
Q

Subjective feeling of restlessness that compels to not sit still and cosntantly move around

A

Akathisia

- Treat with beta-blocker

55
Q

Muslce spasms or stiffness, tongue protrusion or twisting, opisthotonus, and oculogyric crisis

A

Dystonias
- Treat with antihistamines or anticholinergics

4 hrs to 4 days after medication

56
Q

Cogwheel rigidity, masked facies, bradykinesis, pill-rolling finger tremors, and shuffling gait

A

Parkinsonism

- Treat with anticholinergics (Benzotropine)

57
Q

What is the time requirement for delusional disorder?

58
Q

What is a major key difference between delusion disorder and other psychosis?

A

Ability to function is minimally impaired

59
Q

What is the chance of a person developing bipolar disorder in their lifetime if they have a first degree realtive with bipolar disorder?

A

5-10%

  • 60% if both parents suffer from it
  • 70% if a monozygotic twin has it
60
Q

Mania/Hypomania is characterized by elevated/irritable mood and increased energy. What other symptoms are needed? How many are needed?

A

DIG FAST

Distractability
Impulsivity- High-risk behavior
Grandiosity

Flight of ideas or racing thoughts
Activity- Increased goal directed activity
Sleep- Decreased
Talkativeness- Increased

3 with elevated mood; 4 if only irritable

61
Q

How does hypomania differ from mania?

A

Symptoms last 4+ days (instead of 1+ week)
No marked impairment
No psychosis

62
Q

Bipolar I vs Bipolar II

A

Bipolar 1

  • Mania
  • Does not need depression

Bipolar 2

  • Hypomania
  • 1+ Episode of major deprssion
63
Q

Cyclothymia critera

A

2+ years
Fluctuating hypomania and depressive symptoms
Does not meet critera for hypomania or major depression

64
Q

How many SiG E CAPS symptoms are required for MDD?

A

4+

Also depressed mood or anhedonia

65
Q

What is the most effective strategy to address MDD? What if the patient has a short life expectancy?

A

SSRI
Psychostimulant- Methylphenidate or Modafinil

*Supportive thearpy is good, but does not shorten MDD episodes

66
Q

What is the appropriate approach to treating a patient with hypochondriasis?

A
  1. Evaluate for psychological stressors

2. Follow-up with psychotherapy

67
Q

How many symptoms from PANICS need to be present to make a panic disorder dx?

68
Q

What is the most effective treatment for panic disorder?

A

Immediate: Benzos

Long-term: SSRI or SNRI or CBT

69
Q

What are common comorbidities of panic disorder?

A

MDD: 60%
Bioplar disorder
Agoraphobia: 40%
Substance abuse

70
Q

What is the recommneded duration of lithium treatment based on number of manic episodes?

A

1 episode: 1 year from time of remission
2 episodes: years to lifetime
3 episodes: Lifetime

71
Q

Indications for clozapine

A

Treatment-resistant schizophrenia

Schizophrenia associated with suicidality

72
Q

Adverse effects of clozapine

A

Agranulocytosis
Seizures
Myocarditis
Metabolic syndrome

73
Q

What is the time requirement to dx social anxiety disorder?

A

> 6 months

74
Q

When should perforamnce-only anxiety be made?

A

Public speaking or presentations and performers

75
Q

What is the treatment for performance-only anxiety?

A

Benzo or beta blocker 30 to 60 min prior to situation

CBT

76
Q

What is the treatment for GAD and Social?

A

SSRI or SNRI

CBT

77
Q 
Violent behavior
Dissociation
Hallucination
Amnesia
Nystagmus- CLUE CLUE CLUE
Ataxia
A

PCP intoxication

78
Q

Visual hallucinations- CLUE CLUE CLUE
Euphoria
Dysphoric/panic
Tachycardia/Hypertension

A

LSD intoxication

79
Q 
Euphoria
Agitation
Chest pain- CLUE CLUE CLUE
Seizures- CLUE CLUE CLUE
Tachycardia/Hypertension
Mydriasis
A

Cocaine intoxication

80
Q 
Violent behavior, psychosis
Diaphoresis
Tachycardia/Hypertension
Choreiform movements 
Tooth decay
A

Methamphetamine intoxication

81
Q 
Increased appetite- CLUE CLUE CLUE
Euphoria 
Dysphoria/panic
Impaired time perception- CLUE CLUE CLUE
Dry mouth
Conjunctivale injection- CLUE CLUE CLUE
A

Marijuana intoxication

82
Q 
Euphoria
Depressed mental status- CLUE CLUE CLUE
Miosis- CLUE CLUE CLUE
Respiratory distress- CLUE CLUE CLUE
Constipation
A

Heroin intoxication

83
Q

Highest risk second generation antipsychotics?

A

Olanzapine

Clozapine

84
Q

Lowest risk second generation antipsychotics?

A

Aripiprazole

Ziprasidone

85
Q

Monitoring guidelines for second generation antipsychotics?

A

BMI: Baseline the monthly

Metabolic profile, waist, & blood pressure: Baseline, 3 months, then annually

86
Q

Antagnosit of what receptor causes EPS?

A

D2
Antipsychotics
(Typicals, quetiapine, and clozapine)

87
Q

Treatment for acute dystonic reactions?

A

Benzotropine or diphenhydramine

88
Q

Treatment for akathisia?

A

Benzos (Lorazepam)

89
Q

EPS that have no known treatment?

A

Parkinsonism

Tardive dyskinesia

90
Q

What kind of behavior accompanies body dysmorphic disorder?

A

Repetitive behavior or mental acts

- Response to preoccupation

91
Q

What is the treatment approach for a patient with body dysmorphic disorder?

A
  1. Establish theraputic alliance
  2. Explore thoughts and educate patient about options
    - Psychotherapy
    - SSRI
92
Q

Alcohol withdrawal syndrome:
6 to 24 hrs
12 to 48 hrs
48 to 96 hrs

A

6 to 24 hrs: Mild withdrawal
12 to 48 hrs: Seizures & Alcholic hallucinosis
48 to 96 hrs: DTs

93
Q 
Anxiety
Insomnia
Tremors
Diaphoresis
Palpitations
GI distress
Intact orientation
A

Mild EtOH withdrawal

94
Q

Visual, auditory, or tactile hallucinations
Intact orientation
Stable vital signs

A

Alcohol hallucinosis

95
Q 
Confusion
Agitation
Fever
Tachycardia/HTN
Diaphoresis
96
Q

Peak of alcohol withdrawal?

97
Q

What is the treatment for EtOH withdrawal?

A

Benzos

  • Lorazepam: DOC if liver disease is present (no active mets.)
  • Diazepam
  • Chlordiazepoxide
98
Q

Aside from the time critera, what is another difference between schizophreniform and schizophrenia?

A

Do not need functional decline

99
Q

What is the treatment appraoch to depression in a cancer patient?

A
  1. Pain control
  2. Psychotherapy and SSRI: Low threshold for SSRI therapy
    - SUPPORT groups will not decrease duration of depressive episode.
100
Q

What is the appropriate approach to a patient with hypochondriasis?

A

Hypochondriasis is worse during times of emotional stress, inquire about emotional stressors.

101
Q

What are the major comorbidities associated with panic disorder?

A

Major depression
- Higher risk of SI and SA
Agoraphobia
Substance abuse

102
Q

What is the difference between generalized social anxiety disorder and performance-only socail anxiety disorder?

A

Performance only is related only to public speaking, presentations, or performers

103
Q

How does the treatment differ between generalized social anxiety and performance only?

A

Generalized needs to be treatment with SSRIs and CBT, while performance only can be treated with Benzos or Beta blockers

104
Q

What is a key symptoms of body dysmorphic disorder?

A

Repetitive behavior or mental acts performed in response to preoccupation.

105
Q

What is the preferred monotherapy for mild to moderate bipolar disorder?

A

Atypical antipsychotics

Lithium or valproic acid may also be used

106
Q

What is the preferred treatment protocol for severe episodes of bipolar disorder?

A

Combonation therapy with lithium or valproic acid plus an atypical antipsychotic

107
Q

What disorders can be treated with CBT?

A 
Anxiety
Mood
Personality
Somatic symptoms
Eating disorder
108
Q

What distortions can be treated with CBT?

A

Overgeneralization of negative events
Catastrophizing
Minimizing positive events

109
Q

What type of psychotherapy would you use to treat a patient with relationship conflicts, life role transitions, or grief?

A

Interpersonal

- Current relationships and conflicts

110
Q

What type of psychotherapy would you use to treat a patient with low functioning, in crisis, psychotic, or cognitively impaired?

A

Supportive threapy

- Coping skills (Adaptive defense mechanisms)

111
Q

What type of psychotherapy would you use to treat a patient with high function, persistent patterns of dysfunction, or more neurotic?

A

Psychodynamic

  • Past relationships/conflicts
  • Uses treansference
  • Break down defense mechanisms
112
Q

What type of psychotherapy would you use to treat a patient with substance abuse disroder?

A

Motivational interview

  • Address ambivalence to change
  • Enhance motivaiton to changes
  • Acknowledge resistance
113
Q

What type of psychotherapy would you use to treat a patient with persistent maladaptive thoughts, avoidance behavior, or ability to participated in homework?

A

CBT

  • ID and change maladaptive behavior
  • Change emotions and behavior caused by thoughts
  • Behavioral techniques (breathing, exposure, goal-setting, visualization)
114
Q

What type of psychotherapy would you use to treat a patient with borderline personality disorder or self injurious behavior?

A

Dialectical behavior therapy

  • Acceptance and change
  • Improve emotion regulation, mindful awareness, disress tolerance
  • Manage self harm
  • Group therapy component
115
Q

What type of psychotherapy would you use to treat a patient when prominent physical response accompany psychiatirc symtpoms?

A

Biofeedback

  • Improve awareness and control over physiological reactins
  • Lower stress levels
  • Integrate mind and body
116
Q

What is the most effective line of treatment for a manic patient presenting with acute agitation?

A

Antipsychotics

- Atypical first then typical

117
Q

What are lithium, valproate, and carbamazepine not as effective at treating acute agitation in acute mania?

A

They require titration

118
Q

In which medical condition should lithium be avoided?

A

Patients with renal disease

119
Q

In which medical condition should valproate be avoided?

A

Liver disease

120
Q

What is the main concern with using carbamazepine?

A

CYP induction

121
Q

What is the time requirement for GAD/

122
Q

What are the symptoms associated with GAD?

A

MS. FRIC

Muscle tension
Sleep disturbances

Fatigue
Restlessness
Irritability
Concentration

123
Q

How many symptoms are needed to meet critera for GAD?

124
Q

Excessive anxiety and preoccupation with 1+ unexplained symp

A

Somatic symptoms disorder

125
Q

Fear of having a serious illness despite few or no symptoms & consistently negative evaluations

A

Illness anxiety disorder

126
Q

Neurologic symptoms incompatible with any known neurologic disease; often acute onset associated with stress

A

Conversion disorder (functional neurologic symptoms disorder)

127
Q

Intentional falsificataion or inducement of symptoms with goal to assume sick role

A

Factitious disorder

128
Q

Falsification or exaggeration of symptoms to obtain external incentives (secondary gain)

A

Malingering

Uworld- Psych (1 decks)

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