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
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
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
4
Q
What is the DOC for acute treament of panic disorder?
A
Benzos
5
Q
Benzodiazepine used most often to induce conscious sedation during medical procedures
A
Midazolam
- No role in treating anxiety disorders
6
Q
Irritable, drowsy, fatigued, and hungry
Psychomotor agitation or retardation may also present
A
Cocaine withdrawal
Amphetamine withdrawal- May also have depression
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
8
Q
Irritability, anxiety, depression, insomina, restlessness, poor concentration, increased appetite, weight gain, and bradycardia
A
Nicotine withdrawal
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
10
Q
Behaving as if an aspect of reality does not exist
A
Denial
11
Q
Transferring feelings to a more acceptable object
A
Displacement
12
Q
Alterin perception of upsetting reality to be more acceptabe
A
Distortion
13
Q
Separating a thought from its emotional components
A
Isolation of affect
14
Q
Attributing one’s own feelings to others
A
projection
15
Q
Responding in a manner opposite to one’s actual feelings
A
Reaction formation
16
Q
Channeling impulses into socially acceptable behavior
A
Sublimation
17
Q
Putting unwanted feelings aside to cope with reality
A
Suppression
18
Q
Mature defense mechanisms
A
Altruism
Humor
Sublimation
Suppresion
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
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
21
Q
What types of medications cause neuroleptic malignant syndrome?
A
Medications that block dopamine transmission
- Most common with high-potency antipsychotics
22
Q
What is the appropriate way to manage a patient with neuroleptic malignant syndrome?
A
- Stop the medication
- Monitor in ICU
- Control temperature
- Watch electrolytes
- Dantrolene- if severe
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
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
25
How do you manage suicidal patients who are high-risk, but have no plan to act in the near future?
1. Treat modifiable risk factors
2. Recruit social support
3. Reduce access to means
26
Which serotonin receptor is antagonized by atypical antipsychotics to help allevaite negative symptoms and decrease risk of EPS?
5-HT2A
27
What receptors does risperidone bind to?
Alpha-1 - No theraputic effect
Dopa-2 - Antipschotic
5-HT2A - Treats negative symptoms and decreases risk of EPS
28
What are the 4 broad categories of conduct disorder?
1. Aggression toward people and animals
2. Destruction of property
3. Serious violation of rules
4. Deceitfulness or theft
29
How many symptoms must be present in conduct disorder? How many months?
1. 3+
2. Last 12
*At least 1 must have been present in the last month
30
What are indications for ECT?
```
Severe depression
Depression in pregnancy
Refractory mania
NMS
Catatonic schizophrenia
```
31
What are the side effects of ECT?
```
Amnesia
Prolonged seizures
Delirium
Headache
Nausea
Skin burns
```
32
What is the BMI critera for anorexia nervosa?
33
What is the recommended treatment for anorexia?
CBT
Nutritional rehab
Olanzapine- if unresponsive
34
What is the recommended treatment for bulimia?
CBT
Nurtitional rehab
SSRI- Given as adjunct
35
What are is the recommneded treatment for binge eating disorder?
CBT
Behavioral weight loss therapy
SSRI
Lisdexamfetamine, topiramate
36
What are the risk factors for homicide?
```
Young male
Unemployed
Impoverished
Access for firearms
Substance abuse
Antisocial personality disorder
History of violence
History of childhood absue
Impulsive
```
37
What lab value is elevated during NMS?
CPK- Rhabdomyolysis
38
What is a common complication of NMS?
Acute kidney failure- Rhabdomyolysis -> Myoglobinuria
39
What are the basic critera for pathologic gambling?
Persisten and maladaptive gambling behavior
| Often dishoneset and evasice when confronted
40
What are the FDA approved first-line treatments for OCD?
CBT is also recommended
```
Clomipramine
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
```
SSRI first, then another SSRI or Clomipramine
41
Increased risk of jaundice
Chlopromazine
42
Pigmentary retinopaty
Thioridazine
43
Cataracts
Quetiapine
44
What is a major mental health risk for someone who has been sexually assaulted?
Suicidal ideation and attempts
45
Physical aggression, severe agitation, impulsivity, impaired judgement, psychosis, paranoia, or hallucinations.
Ataxia, nystagmus, & muscle rigidity
Phencyclidine (PCP)- Intoxication
46
What other intoxication presents with ataxia, nystagmus, aggression, and impaired judgement?
EtOH
47
Pinpoint pupils, drowsiness, CNS deprssion, and constipation
Heroin intoxication
| - Opiods
48
Mood impairment, hallucinations, subjective perceptual intesification, depersonalization, and illusions
2+
Sweating, tachycardia, pupillary dialation, palpitations, tremors, and poor concentration
Lysergic acid (LSD) intoxication
49
Anxiety, aggression, psychosis, formication, or delirum
High BP, tachycardia or bradycardia, sweating, pupillary dilation, nausea or vomiting, or insomnia
Nose bleed or septal perforation
Cocaine intoxication
50
What is the effect of ODing on cocaine?
Think heart and brain
Cardiac arrhythmias
MIs
Seizures
Stroke
51
Which drug is most commonly associated with agitation and aggresion?
PCP
52
```
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
```
Signs and symptoms of tardive dyskinesia
53
What is the most likely atypical antipsychotic to cause TD? Lest likely?
Risperdone
Clozapine
54
Subjective feeling of restlessness that compels to not sit still and cosntantly move around
Akathisia
| - Treat with beta-blocker
55
Muslce spasms or stiffness, tongue protrusion or twisting, opisthotonus, and oculogyric crisis
Dystonias
- Treat with antihistamines or anticholinergics
4 hrs to 4 days after medication
56
Cogwheel rigidity, masked facies, bradykinesis, pill-rolling finger tremors, and shuffling gait
Parkinsonism
| - Treat with anticholinergics (Benzotropine)
57
What is the time requirement for delusional disorder?
1+ month
58
What is a major key difference between delusion disorder and other psychosis?
Ability to function is minimally impaired
59
What is the chance of a person developing bipolar disorder in their lifetime if they have a first degree realtive with bipolar disorder?
5-10%
- 60% if both parents suffer from it
- 70% if a monozygotic twin has it
60
Mania/Hypomania is characterized by elevated/irritable mood and increased energy. What other symptoms are needed? How many are needed?
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
How does hypomania differ from mania?
Symptoms last 4+ days (instead of 1+ week)
No marked impairment
No psychosis
62
Bipolar I vs Bipolar II
Bipolar 1
- Mania
- Does not need depression
Bipolar 2
- Hypomania
- 1+ Episode of major deprssion
63
Cyclothymia critera
2+ years
Fluctuating hypomania and depressive symptoms
Does not meet critera for hypomania or major depression
64
How many SiG E CAPS symptoms are required for MDD?
4+
| Also depressed mood or anhedonia
65
What is the most effective strategy to address MDD? What if the patient has a short life expectancy?
SSRI
Psychostimulant- Methylphenidate or Modafinil
*Supportive thearpy is good, but does not shorten MDD episodes
66
What is the appropriate approach to treating a patient with hypochondriasis?
1. Evaluate for psychological stressors
| 2. Follow-up with psychotherapy
67
How many symptoms from PANICS need to be present to make a panic disorder dx?
4+
68
What is the most effective treatment for panic disorder?
Immediate: Benzos
| Long-term: SSRI or SNRI or CBT
69
What are common comorbidities of panic disorder?
MDD: 60%
Bioplar disorder
Agoraphobia: 40%
Substance abuse
70
What is the recommneded duration of lithium treatment based on number of manic episodes?
1 episode: 1 year from time of remission
2 episodes: years to lifetime
3 episodes: Lifetime
71
Indications for clozapine
Treatment-resistant schizophrenia
| Schizophrenia associated with suicidality
72
Adverse effects of clozapine
Agranulocytosis
Seizures
Myocarditis
Metabolic syndrome
73
What is the time requirement to dx social anxiety disorder?
> 6 months
74
When should perforamnce-only anxiety be made?
Public speaking or presentations and performers
75
What is the treatment for performance-only anxiety?
Benzo or beta blocker 30 to 60 min prior to situation
| CBT
76
What is the treatment for GAD and Social?
SSRI or SNRI
| CBT
77
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Violent behavior
Dissociation
Hallucination
Amnesia
Nystagmus- CLUE CLUE CLUE
Ataxia
```
PCP intoxication
78
Visual hallucinations- CLUE CLUE CLUE
Euphoria
Dysphoric/panic
Tachycardia/Hypertension
LSD intoxication
79
```
Euphoria
Agitation
Chest pain- CLUE CLUE CLUE
Seizures- CLUE CLUE CLUE
Tachycardia/Hypertension
Mydriasis
```
Cocaine intoxication
80
```
Violent behavior, psychosis
Diaphoresis
Tachycardia/Hypertension
Choreiform movements
Tooth decay
```
Methamphetamine intoxication
81
```
Increased appetite- CLUE CLUE CLUE
Euphoria
Dysphoria/panic
Impaired time perception- CLUE CLUE CLUE
Dry mouth
Conjunctivale injection- CLUE CLUE CLUE
```
Marijuana intoxication
82
```
Euphoria
Depressed mental status- CLUE CLUE CLUE
Miosis- CLUE CLUE CLUE
Respiratory distress- CLUE CLUE CLUE
Constipation
```
Heroin intoxication
83
Highest risk second generation antipsychotics?
Olanzapine
| Clozapine
84
Lowest risk second generation antipsychotics?
Aripiprazole
| Ziprasidone
85
Monitoring guidelines for second generation antipsychotics?
BMI: Baseline the monthly
| Metabolic profile, waist, & blood pressure: Baseline, 3 months, then annually
86
Antagnosit of what receptor causes EPS?
D2
Antipsychotics
(Typicals, quetiapine, and clozapine)
87
Treatment for acute dystonic reactions?
Benzotropine or diphenhydramine
88
Treatment for akathisia?
Benzos (Lorazepam)
89
EPS that have no known treatment?
Parkinsonism
| Tardive dyskinesia
90
What kind of behavior accompanies body dysmorphic disorder?
Repetitive behavior or mental acts
| - Response to preoccupation
91
What is the treatment approach for a patient with body dysmorphic disorder?
1. Establish theraputic alliance
2. Explore thoughts and educate patient about options
- Psychotherapy
- SSRI
92
Alcohol withdrawal syndrome:
6 to 24 hrs
12 to 48 hrs
48 to 96 hrs
6 to 24 hrs: Mild withdrawal
12 to 48 hrs: Seizures & Alcholic hallucinosis
48 to 96 hrs: DTs
93
```
Anxiety
Insomnia
Tremors
Diaphoresis
Palpitations
GI distress
Intact orientation
```
Mild EtOH withdrawal
94
Visual, auditory, or tactile hallucinations
Intact orientation
Stable vital signs
Alcohol hallucinosis
95
```
Confusion
Agitation
Fever
Tachycardia/HTN
Diaphoresis
```
DTs
96
Peak of alcohol withdrawal?
Day 2
97
What is the treatment for EtOH withdrawal?
Benzos
- Lorazepam: DOC if liver disease is present (no active mets.)
- Diazepam
- Chlordiazepoxide
98
Aside from the time critera, what is another difference between schizophreniform and schizophrenia?
Do not need functional decline
99
What is the treatment appraoch to depression in a cancer patient?
1. Pain control
2. Psychotherapy and SSRI: Low threshold for SSRI therapy
- SUPPORT groups will not decrease duration of depressive episode.
100
What is the appropriate approach to a patient with hypochondriasis?
Hypochondriasis is worse during times of emotional stress, inquire about emotional stressors.
101
What are the major comorbidities associated with panic disorder?
Major depression
- Higher risk of SI and SA
Agoraphobia
Substance abuse
102
What is the difference between generalized social anxiety disorder and performance-only socail anxiety disorder?
Performance only is related only to public speaking, presentations, or performers
103
How does the treatment differ between generalized social anxiety and performance only?
Generalized needs to be treatment with SSRIs and CBT, while performance only can be treated with Benzos or Beta blockers
104
What is a key symptoms of body dysmorphic disorder?
Repetitive behavior or mental acts performed in response to preoccupation.
105
What is the preferred monotherapy for mild to moderate bipolar disorder?
Atypical antipsychotics
| Lithium or valproic acid may also be used
106
What is the preferred treatment protocol for severe episodes of bipolar disorder?
Combonation therapy with lithium or valproic acid plus an atypical antipsychotic
107
What disorders can be treated with CBT?
```
Anxiety
Mood
Personality
Somatic symptoms
Eating disorder
```
108
What distortions can be treated with CBT?
Overgeneralization of negative events
Catastrophizing
Minimizing positive events
109
What type of psychotherapy would you use to treat a patient with relationship conflicts, life role transitions, or grief?
Interpersonal
| - Current relationships and conflicts
110
What type of psychotherapy would you use to treat a patient with low functioning, in crisis, psychotic, or cognitively impaired?
Supportive threapy
| - Coping skills (Adaptive defense mechanisms)
111
What type of psychotherapy would you use to treat a patient with high function, persistent patterns of dysfunction, or more neurotic?
Psychodynamic
- Past relationships/conflicts
- Uses treansference
- Break down defense mechanisms
112
What type of psychotherapy would you use to treat a patient with substance abuse disroder?
Motivational interview
- Address ambivalence to change
- Enhance motivaiton to changes
- Acknowledge resistance
113
What type of psychotherapy would you use to treat a patient with persistent maladaptive thoughts, avoidance behavior, or ability to participated in homework?
CBT
- ID and change maladaptive behavior
- Change emotions and behavior caused by thoughts
- Behavioral techniques (breathing, exposure, goal-setting, visualization)
114
What type of psychotherapy would you use to treat a patient with borderline personality disorder or self injurious behavior?
Dialectical behavior therapy
- Acceptance and change
- Improve emotion regulation, mindful awareness, disress tolerance
- Manage self harm
- Group therapy component
115
What type of psychotherapy would you use to treat a patient when prominent physical response accompany psychiatirc symtpoms?
Biofeedback
- Improve awareness and control over physiological reactins
- Lower stress levels
- Integrate mind and body
116
What is the most effective line of treatment for a manic patient presenting with acute agitation?
Antipsychotics
| - Atypical first then typical
117
What are lithium, valproate, and carbamazepine not as effective at treating acute agitation in acute mania?
They require titration
118
In which medical condition should lithium be avoided?
Patients with renal disease
119
In which medical condition should valproate be avoided?
Liver disease
120
What is the main concern with using carbamazepine?
CYP induction
121
What is the time requirement for GAD/
6+ months
122
What are the symptoms associated with GAD?
MS. FRIC
Muscle tension
Sleep disturbances
Fatigue
Restlessness
Irritability
Concentration
123
How many symptoms are needed to meet critera for GAD?
3+
124
Excessive anxiety and preoccupation with 1+ unexplained symp
Somatic symptoms disorder
125
Fear of having a serious illness despite few or no symptoms & consistently negative evaluations
Illness anxiety disorder
126
Neurologic symptoms incompatible with any known neurologic disease; often acute onset associated with stress
Conversion disorder (functional neurologic symptoms disorder)
127
Intentional falsificataion or inducement of symptoms with goal to assume sick role
Factitious disorder
128
Falsification or exaggeration of symptoms to obtain external incentives (secondary gain)
Malingering
