Psychiatric/Behavioral & Substance Abuse Flashcards
not thinking about behavior modification =
thinking about it =
planning behavior modification =
putting plan into action =
maintaining new behavior
Precontemplation
contemplation
preparation
action
maintenance
recurrent episodes of binge eating, followed by compensatory behavior, excessive preoccupation with body weight and shape, normal weight weight or above normal =
treatment with nutritional rehab, CBT, and ________
bulimia nervosa
SSRI fluoxetine
_______ blocks the ________ receptor and blocks the rewarding and reinforcing effects of alcohol to reduce CRAVING
naltrexone
mu opioid
evaluation of a patients access to _____ is a key part of suicide risk assessment
guns
depressed mood, low energy, loss of interest, insomina, weight loss, poor concentration almost every day for >2 weeks =
even if hypothyroidism diagnosed, TSH is _______, so not a consequence of this
Major Depressive Disorder
normal
_______ is a pure opioid Receptor antagonist and used to treat opioid intox and OD. It has the greatest affinity for ____ receptor
Naloxone
Mu
acute onset of tremulousness, agitation, elevated pulse and BP 48hrs following admission is suggestive of _______. FIrst line therapy is _______ such ________ in order to prevent progression to seizure and delrium. Long acting agents are preferred unless the patient has liver disease, then shorter acting agents like lorazepam and oxazepam are preferred
alcohol withdrawal
benzos
chlordiazepoxide or diazepam
based on the principle of _____ the prescription of medications likely to do more harm than good should be avoided, even if requested by patients (stimulants for ADHD in patient with many risk factors)
nonmaleficence
_______ for Bipolar Disorder has a very narrow therapuetic index and presents toxicity as gradual worsening confusion, agitation, ataxia, tremors/fasciculations. This toxicity can be precipitaed by volume depletion and drug interactions with _______, ACEI, and NSAIDs
Lithium
thiazide diuretics
_____________ in college student preparing for finals can present with paranoid ideation and must be differentiated from primary psychiatric disorders. Physical signs of stimulant intoxication include tachycardia, HTN, hyperthermia, diaphoresis, and mydriasis
Stimulant intoxication
_______ medications are the first line treatment for ADHD. They work by increasing the availability of _______ and _____ in the PFC
Stimulant
NE and DA
Key defense mechanisms:
expressing unacceptable feelings through actions =
behaving as if an aspect of reality does not exist =
transferring feelings to a more acceptable object =
using intellect to avoid uncomfortable feelings =
avoiding conflict by expressing hositility convertly =
attributing ones own feelings to others =
justifying behavior to avoid difficult truths =
responding to a manner opposite to one’s actual feelings
reverting to earlier developmental stage =
seeing others as all good or all bad =
channeling impulses into socially acceptable behaviors =
putting unwanted feelings aside to cope with reality =
acting out
denial
displacement
intellectualization
passive aggression
projection
rationalization
reaction formation
regression
splitting
sublimation
suppression
depression, suicidal ideation, impulsivity in women in the setting of feeling rejected; persistent pattern of unstable and intense relationships, substance abuse, unsafe sex, recurrent suicidal behaviors or threats, inappropriate or intense anger, chronic feelings of emptiness =
Borderline personality disorder
pervasive pattern of distrust and suspiciousness beginning in early adulthood and occurring in a variety of settings
paranoid personality disorder
intentional falsification or inducement of symptoms (induction of infection in the absence of obvious rewards)
Factitious disorder
_________ involves a neutral stimulus being repeatedly paired with non neutral stimulus that elicits an unconditioned response. Over time the neutral stimulus (stethoscope) is able to evoke a conditioned response (sweating, anxiety) in absence of non neutral stimulus (physician girl is scared of)
Classical conditioning
the new onset of anxiety in a patient with no prior psychiatric history and prominent physical findings on examination suggest that the anxiety is more likely due to a _______ such as ________
medical condition
hyperthyroidism
patient initially presents with depression and insomnia, given a medication, then comes back 3 weeks later in a full blown manic episode, with a family history of bipolar disorder. Disorder?
induced by __________ such as ________
Bipolar disorder
antidepressants, sertraline
buspirone is a _________ used in the treatment of GAD. It is not useful in the treatment of acute anxiety due to its ________, lacks muscle relaxant or anticonvulsant properties, and carries no risk of dependence
nonbenzodiazepine anxiolytic
slow onset of action
treatment resistant schizophrenia or schizophrenia assoicatied with suicidality =
adverse effects =
clozapine
agranulocytosis (monitor neutrophil count)
_______ is characterized by psychotic symptoms (delusions, hallucinations, disorganized speech, behavior, negative symptoms) lasting greater than 1 month and less than 6 months
greater than 6 months =
less than 1 month =
Schizophreniform disorder
Schizophrenia
Brief Psychotic disorder
recurrent, unexpected panic attacks and avoidance of potential triggers =
Panic disorder
in order to manage somatic symptom disorder, physicians should __________, limit unnecessary workout and referrals, reassure the patient that a serious illness has been ruled out, legitimize symptoms, decrease stress, improve coping strategies, and only refer to mental health once a physician/patient relationship is well established
schedule regular visits with the same provider
smoked drug, uncoordinated, jerky movements, assaults bouncer, fights off 4 officers, immune to pain, visual hallucinations, agitation and sedation altering states, HTN, tachycardic, vertical nystagmus =
works primarily as a n
PCP induced psychosis
NMDA receptor antagonist
acute treatment of agitation, psychosis in the presence of delirium in an elderly patient with UTI =
haloperidol
sexual dysfunction is seen in up to 50% of patients treated with ______. Bupropion, a _____________ is a first line treatment for MDD that does not cause this side effect
SSRIs
NDRI
mature defense mechanism involving the conscious choice not to dwell on a particular thought or feeling =
suppression
___________ are the most common adverse effects of psychostimulate medications used to treat ADHD such as methylphenidate
decreased appetite and insomnia
acute panic disorder treatment =
acts by positive allosteric modulation of the ____ receptor
Benzodiazepine
GABAa
multiple persistent deficits in social communication and interactions currently or history involving lack of social engagement, repetitive play, insistence on sameness =
Autism spectrum disorder
reversible, acute confusional state in the presence of a likely bacterial infection =
gradual progressive irreversible confused state with remote memory sparing =
delirium
dementia
recurrent episodes of chest pain, tachycardia, SOB, sweating, and tremulousness in a young, otherwise healthy patient with normal ECG are consistent with _______
administration of _______ results in rapid relief
panic disorder
benzos
_________ consists of anxiety >4 weeks in children and >6months in adults due to separation from those to whom the patient is attached. Physical symptoms and nightmares may accompany anxiety
Separation anxiety disorder
in the US, the majority of OD deaths are caused by
opioids
distracted, impulsive, grandiosity, flight of ideas, increased activity, decreased need for sleep, talkativeness (DIGFAST) is most likely _______ and can occur with or without psychotic features. _______ involves hypomanic episodes and major depressive episodes
BPDI
BPDII
replacing unacceptable feelings and impulses with their extreme opoosites =
reaction formation
______ acts by inhibiting the presynaptic reuptake of NE, DA, and 5HTP. Intoxicated patients develop agitation, tachycardia, HTN, and light responsive mydriasis due to increase ______ activity. It is also a potent vasoconstrictor and can cause myocardial ischemia and atrophy of nasal mucosa and septum
Cocaine
sympathetic
chlorpromazie and thioridazine are ______ first generation anti-psychotics, while haloperidol and fluphenazine are _______ first generation anti-psychotics. Fluphenazine will have a higher chance of ________ symptoms as an adverse effect
low potency
high potency
extrapyramidal
______ is typically the first symptom of alcohol withdrawal
tremulousness
treatment for _______ includes scheduled daytime naps and psychostimulants such as ________ for daytime sleepiness
nacrolepsy
modafinil
at age 2, a child should have a vocabulary of ______ and be using 2 word phrases. Parents concerns about delayed milestones should be validated, and that further assessment and regular monitoring are essential
50-200 words
all patients experiencing a major depressive episode should be carefully screened for __________ to rule out bipolar disorder
past manic episodes
nausea, vomiting, abdominal pain, muscle aches, dilated pupils, yawning, lacrimation are _______ withdrawal symptoms
heroin
PTSD (symptoms longer than 1 month) =
SSRI, SNRI
__________ is characterized by recurrent intrusive thoughts (obsessions) and repetitive time consuming rituals (compulsions) that the individual feels driven to perform
Obsessive-compulsive disorder
______ is a sedating antidepressant often used as a hypnotic to treat insomnia associated with depression. It has been associated with the rare but serious side effect of priapism
Trazodone
long term panic disorder treatment =
immediate
SSRI/SNRI and CBT
Benzo
subjective restlessness with inability to sit still in a patient being treated for schizophrenia successfully is due to =
called
antipsychotic treatments
akathisia
Clozapine and olanzabine can cause ________ syndrome, so fasting glucose and lipids should be measured regularly
metabolic
the most common causes of death with TCA OD are ______ and refractory hypotension due to the ______ of fast sodium channels in cardiac myocytes
cardiac arrhythmias
inhibition
___________ side effects include DI, hypothyroidism, tremor, ebstein anomaly
Lithium
preoccupation with >1 perceived physical defects, appear slight to others, repetitive behavior or mental acts performed in response, significant distress or impairment, specific insight
body dysmorphic disorder
peer behavior has a strong influence on adherence in ______ due to desire to fit in
teens
not excessive or out of proportion to severity of stressor, no significant functional impairment, just sad =
normal stress response
drug induced parkinsonism is a type of extrapyramidal symptom caused by medications that block _______ such as ________
D2 receptors
Benztropine
patients who experience major depressive and hypomanic episodes are diagnosed with _________
BPD2
young kid, new friends, inappropriate laughter, increased appetitie, slowed reaction time, tachycardia and conjunctival injection =
marijuana
methadone is a drug of choice for maintenance treatment of opioid use because it is potent and
long acting
involuntary movments after chronic use of antipsychotics such as lip smacking, choreoathetoid movements =
tardive dyskinesia
hallucinations of recently deceased relatives in children are part of the -________
normal grief reaction
Risperidone and other antipsychotics cause _________ by blocking D2 receptors on lactotrophs leading to elevated prolactin levels, amenorrhea, galactorrhea, and breast soreness
hyperprolactinemia
________ is characterized by loss of speech and motor skills, deceleration of head growth, sterotypic hand movements after a period of normal development. It mainly affects girls and is associated with mutations in _______
Rett syndrome
MECP2
the anticonvulsant ______ also has mood stabilizing properties and is an effective maintenance therapy for Bipolar disorder
valproate
by age ____ a child is expected to play imaginateively in parallel, speak in simple sentences, copy a circle, use utensils, and ride a tricycle
3
short term acting benzos or intermediate term acting benzos such as _____ or _______ are preferred as a temporary treatment during the initiation period for SSRIs in anxiety treatment
triazolam
lorazepam
patient develops hyperthermia, HTN, tachycardia, agitation, confusion, tremor, hyperreflexia, myoclonus, GI symptoms, diaphoresis after a round of antibiotics in the hospital =
due to _______ which has some MAOI activity combined with patients current SSRI/SNRI/TCA
serotonin syndrome
linezolid
to avoid serotonin syndrome, patients must wait at least 2 weeks after discontinuing an MAOI (phenyelzine) before initiating SSRI therapy (Sertraline) allowing time for ______
MAO regeneration
patients showing drug seeking behavior should, physician should obtain ________
confirmation of the patients prescription history
patient experiencing a manic episode, receives multiple doses of antipsychotic medication to control him, develops hyperthermia, muscle rigidity, and confusion =
contrast to serotonin syndrome, these patients do not exhibit ______ and clonus
Neuroleptic malignant syndrome
hyperreflexia
a ________ is characterized by difficulties with learning key academic skills like reading, writing, or mathematics. Kids will display symptoms of anxiety, inattention, or hyperactivity when under stress
learning disorder
specific phobias are best treated with
behavioral therapy
child aggressive toward people and animals, destruction of property, serious violation of rules, deceitfulness or theft =
if adult =
conduct disorder
antisocial disorder
eccentric, odd thoughts, perceptions and behavior =
preferes to be a loner, detached, unemotional =
Schizotypal
Schizoid
patient overdose with cutaneous flushing, dry oral mucosa, dilated poorly reactive pupils, confusion, which drug?
why?
TCAs (amitriptyline)
strong anticholinergic adverse effects)
____________ is the strongest single risk factor for suicide
previous suicide attempt
mania, delusions, hallucinations in the absence of any other mood episode over lifetime =
schizoaffective
_________ is characterized one more more delusions in the absence of other psychotic symptoms. Behavior is not obviously bizarre and functioning is not significantly impaired apart from the direct impact of the delusions
delusional disorder
misattribution of one’s unacceptable feelings or thoughts to another person who does not actually have them
projection
multiple motor and vocal tics for >1 year with no obvious cause =
treatment with antipsychotics, alpha 2 adrenergic agonists, and behavioral therapy
Tourette disorder
persistent or recurrent feelings of detachment from or being outside ones self, derealization, but intact reality testing
depersonalization/derealization disorder
_______ is an eating disorder characterized by low body weight, intense fear of becoming fat, and distorted body image, bradycardia, hypotension, osteoporosis, amenorrhea, and cardiac atrophy as a result of malnutriton and starvation
anorexia nervosa
GAD should be treated long term with SSRIS or SNRIs like
citalopram
patients with _________ often experience executive dysfunction and personality changes secondary to impairment of the organizational, restraint, and motivational symptoms. Changes in social behavior can manifest in variable ways. _______ lesions more often associated with apathy and ________ lesions with disinhibition
front lobe injury
left sided
right sided
increased appetite and sleep, leaden paralysis, rejection sensitivity, and mood reactivity are hallmarks of _________ can respond well to MAOI like ________
atypical depression
phenelzine
depression, fatigue, hypersomnia, hyperphagia, vivid dreams, history of drug use, due to withdrawla of
cocaine
______ is the unconscious shifting of emotions associated with signfiicant from ones past to a person in the present
Transference
bilateral parotid gland enlargement, erosion of tooth enamel, irregular menses, abnormal electrolytes
bulimia nervosa
____________ is a severe subtype of unipolar major depression characterized by symptoms meeting criteria for a major depressive episode and the presence of delusions or hallucinations
major depressive disorder with psychotic features
_______ involves excessive fears of scrutiny or embarrassment in social or performance situations, resulting in significant distress and functional impairment
social anxiety disorder
nonpharmacologi treatments for insomnia include sleep hygiene, stimulus control, relaxation, sleep restriction, and cognitive behavioral therapy. stimulus control focuses on eliminating stimulating bedroom activities and ____________
getting into bed only when sleepy
MDD treatment
SSRIs or TCAs
_______ is characterized by chronic depressed mood and at least 2 other depressive symptoms lasting for at least 2 years
persistent depressive disorder (dysthymia)
________ is maladaptive pattern of behavior characterized by social inhibition, feelings of inadequacy and fear of embarrassment and rejection. Patients have the desire for social interaction unlike _____
Avoidant personality disorder
Schizoid
___________ are the treatment of choice for OCD
SSRIs
______ is the compulsive consumption of a nonfood or nonstaple food source for >1month
common in
pica (ice eating)
pregnancy
recurrent episodes of early ejaculation accompanied by a sense of lack of control
premature ejaculation
________ is a behavioral disorder of childhood characterized by argumentative and defiant behavior toward authority figures. It does not involve the more severe violations of the basic rights of others seen in conduct disorder
Oppositional defiant disorder
________ is a first line antidepressant with amphetamine like properties, it is not associated with sexual side effects or weight gain, however, it is associated with an increased _____ risk at high doses.
Bupropion
Seizure
