Psychiatry Flashcards
What are the three core features of anorexia nervosa as highlighted in the DSM?
- Restriction of energy intake relative to requirements leads to significantly low body weight
- Intense fear of gaining weight or persistent behavior interfering with weight gain
- Disturbance in body image
What are the two types of anorexia nervosa?
- Restricting
- Binge eating and purging
What medication is contraindicated in a patient with a history of anorexia nervosa?
Bupropion
Antipsychotic medications are associated with extrapyramidal symptoms. Describe akathisia associated with antipsychotic medications?
- Onset within hours to days of starting medication
- Compulsive, repetitive motions or agitations
What extrapyramidal symptom associated with antipsychotic medications is the last to develop?
Tardive Dyskinesia as it takes months to years to present
Which common extrapyramidal symptom is irreversible?
Tardive dyskinesia
Which personality disorder in adults is associated with the individual having evidence of conduct disorder onset before the age of 15?
What cluster is it in?
Antisocial personality disorder
Cluster B
What are some contraindations to buproprion?
- Known seizure disorder (lowers seizure threshold)
- Past eating disorder or anorexia nervosa
- Abrupt discontinuation of alcohol, benzos, barbituates or antiepileptic drugs due to lowered seizure threshold
What is the treatment of choice for fentanyl intoxication?
What are symptoms of opioid overdose?
Naloxone
Hypoventilation, respiratory depression, CNS depression, miosis, slow HR
How do you treat alcohol withdrawal?
Benzodiazepines
An 18-month-old is not yet speaking. He does not point to objects. He does not make eye contact with others. What diagnosis should you be thinking of?
Autism
List four symptoms of serotonin syndrome?
- Hyperthermia
- Seizure
- Altered Mental Status
- Tremor
Preoccupation with having or acquiring a specific serious illness despite negative exams and test findings defines what disorder?
Illness Anxiety Disorder
Which psychiatric disorder is characterized by episodes of hypomania and depression for greater than 2 years?
Cyclothymia
A patient exhibits all of the characteristics of antisocial personality disorder, but he is only 14 years old. What diagnosis does he have?
Conduct disorder
A patient complains of actue paralysis in his left arm. This does not seem to bother him, but his wife made him come in. There was no traumatic event. A complete neuro work-up is negative. What diagnosis should you be considering?
Functional neurological symptom disorder
What is the term for being afraid of being out in a terrible situation with no help available?
Agoraphobia
How long does a panic attach typically last?
10-20 minutes
What are the 2 subcategories of hypochondriasis?
Illness anxiety disorder and somatic symptom disorder
A patient of yours always craves attention, often using sex as a tool to gain it. She often acts like a child when she does not get her way. What is the most likely diagnosis?
Histrionic Personality Disorder
What SSRI is commonly used to treat Bulimia Nervosa and is considered 1st line therapy?
Fluoxetine (Prozac) - helps reduce the binge-purge cycle
A patient is arrogant with an inflated self-image. He feels he is special and should be treated that way. What is the most likely diagnosis?
Narcissistic Personality Disorder
A patient has very strange magical thinking. What is the most likely diagnosis?
Schizotypal Personality Disorder
What labs should you check prior to starting lithium?
Creatinine (renal failure, hyponatremia, and dehydration all increase the likelihood of lithium toxicity)
What medication class would be considered first-line therapy for a patient with bipolar I or II and renal dysfunction?
Valproate or Carbamazepine
Borderline personality disorder is on the border of what two psychological disorders?
Neurosis and psychosis
How does a patient with narcolepsy present?
Excessive sleepiness throughout the day or uncontrollable “sleep attacks”
What two things are needed to make a diagnosis of bipolar 2?
One major depressive episode and one hypomanic episode
A patient exhibits splitting, seeing others as all good or all bad. What diagnosis should you be thinking of?
Borderline Personality Disorder
At what age is screening for autism recommended?
18-24 months
To be diagnosed with ADD patients must exhibit symptoms before what age?
12 years old
List the three cluster A personality disorders?
Cluster A = Mad
* Schizoid
* Schizotypal
* Paranoid
What is the most common precipitating event for PTSD in women?
What about in men?
Rape
Combat exposure
What is the term for a chronic mild depression which has lasted greater than two years?
Persistent Depressive Disorder (formally known as Dysthymia)
What is the difference from schizophrenia and schizophreniform disorder?
Schizophreniform has symptoms from 1-6 months. Schizophrenia has symptoms for greater than 6 months.
Are hallucinations normal during a normal grieving period?
Yes, as long as they are not persistent or intrusive
What is necessary to diagnose a patient with Bipolar I?
One manic episode. They do not have to have a depressive episode for the diagnosis.
After stopping alcohol, when do the first symptoms of withdrawal typically occur?
6-12 hours
What class of medication is used during an acute panic attack?
Benzodiazepines
How long before normal grief resolves?
About 1 year
A child with recurrent disruptive behavior and violation of human or animal rights without remorse shold make you think of what diagnosis?
Conduct Disorder
List the four cluster B personality disorders?
Cluster B = “Bad”
* Antisocial
* Borderline
* Histrionic
* Narcissistic
A psychiatric patient presents with confusion, fever, and lead pipe rigidity. What diagnosis should you be thinking of?
Neuroleptic Malignant Syndrome; this can occur with high dose antipsychotics
What is Russell’s sign?
Abraded knuckles from forcing onself to vomit
What is the treatment for a patient who presents within one hour of ingesting 30 tablets of diazepam (Valium)?
Gastric lavage with administration of activated charcoal
A spiral fracture should make you think of what diagnosis?
Abuse, either child or elderly
What are the 3 components of the female athlete triad?
Disordered eating, amenorrhea, and osteopenia
What is the difference betwen ego-syntonic and ego-dystonic?
Is bulima ego-syntonic or ego-dystonic?
Ego-syntonic denies having a problem ego-dystonic KNOWS they have a problem
Ego-dystonic
When is the typical onset of Tourette’s syndrome?
3-8 years old
Wht type of person is at the highest risk for committing suicide?
People with prior suicide attempts
How do you diagnose premenstrual dysphoric disorder?
Mood changes occur < 1 week before menses, must affect daily life and must resolve within 1-week post menses
You have a patient with major depressive disorder. Once his symptoms have completely resolved how long should you continue with treatment?
Six months minimum
What are the typical first symptoms of alcohol withdrawal?
Trembling, irritability, anxiety, headache and insomnia
What medication is often used to treat postpartum depression in a woman who is breastfeeding?
Sertraline (Zoloft)
A 16 year old has just moved schools. He is quiet, moody and not like himself at all. Within six months he seems to have completely changed back to his previous personality. What is the most likely diagnosis?
Adjustment disorder
A patient was sent in by his mother. He lives on his own and is a computer programmer. He works from home. He has no friends and no past sexual relationships. His mom is concerned he expresses no interest in meeting people and is happy alone. What is the most likely diagnosis?
Schizoid Personality Disorder
A patient complains of developing stage fright. What medication might you give him?
Beta-blocker: propranolol
A patient is very concerned that she has breast cancer. In order to reassure her you perform a full work-up which is negative. She is still unsatisfied and convinced that she has breast cancer. What diagnosis should you be considering?
Illness anxiety disorder (formally hypochondriasis)
A patient expresses concern that he can’t trust anyone. That everyone is out to get him, and his problems are all the faults of others. He has held very long grudges due to perceived past wrongs. What is the most likely diagnosis?
Paranoid Personality Disorder
What type of hallucinations are most common in schizophrenia
Auditory - hearing voices
Antisocial personality disorder may not be diagnosed until what age?
18 years of age
What type of behavioral therapy works best for borderline patients?
Dialectical Behavior Therapy
At what BMI should a patient be hospitalized for anorexia?
BMI of < 16 or 20% below appropriate body weight
What is the new term for Munchausen syndrome?
Factitious Disorder
Neuroleptic malignant syndrome is a life-threatening condition that is due to the adjustment or initiation of what drug class?
Dopaminergics
What causes anorexic patients to have osteopenia?
A decrease in estrogen
List some positive symptoms associated with schizophrenia?
Hallucinations, delusions, movement disorders
What are the early side-effects of SSRI’s?
What is the black box warning associated with SSRIs?
- Headache
- Insomnia
- Anxiety
Increased suicidality in children and young adults
What is the first-line treatment for a patient with depression and neuropathic pain?
Duloxetine
What is the only approved treatment for Bulimia?
Fluoxetine
What is the treatment for a suspected cocaine intoxication?
What are some of the sx associated with cocaine intoxication?
- Benzodiazepines
- Sodium bicarbonate for wide-complex dysrhythmias
- Avoid beta-blockers
HTN, diaphoresis, dialted pupils (mydriasis), hyperthermia, tachycardia
A patient exhibits splitting, seeing others as all good or all bad. What diagnosis should you be thinking of?
Borderline Personality Disorder
Can the onset of symptoms of PTSD begin > 6 months after the inciting trauma?
How long do symptoms need to be present in order to diagnose PTSD?
Yes, up to 25% of patients develop symptoms greater than 6 months after the inciting trauma
At least one month
What is the first-line treatment for PTSD?
Trauma-focused cognitive behavioral therapy
What is the preferred treatment for trauma-related nightmares?
Prazosin
