Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

STEP2 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

General anxiety disorder dx, tx

A

6+ months
3+ somatic signs
Worry about multiple entities
Causes dysfunction

Benzos ==> eventually taper

  1. SSRI’s
  2. Buspirone
  3. SNRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Benzo overdose tx w/ mechanism

A

Flumazenil

Competitive GABA antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Obsessive compulsive disorder dx, tx*

A

Obsessions: persistent, unwanted ideas
Compulsions: repeated acts to relieve anxiety
Ego-dystonic (aware of absurdity)

  1. SSRI
  2. CBT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Panic disorder dx, associations, tx

A

Discrete moment of fear
4+ signs: tachypnea, palpitations, sweating, chest pain, nausea, fear of dying, depersonalization
1+ month of fear over recurrence causing behavior change
*Must screen for agoraphobia

*Depression, bipolar, substance abuse

  • Acute: Benzo (taper if needed)
    1. SSRI
    1. CBT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Phobia disorders dx, tx*

A

Excessive fear leading to dysfunctional avoidance
Ego-dystonic

*1. CBT ==> first-line for SINGLE phobia like flying!
*2. Beta blocker or benzo if situational
Rarely SSRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Post-traumatic stress disorder dx, subtype*, tx

A

s/p threatening event
Avoidance, hypervigilance, numbed responsiveness
sx for 1+ month

*Acute-stress disorder: PTSD lasting < 1 month

Short term:
Beta-blockers
Alpha-agonists

Long-term:
SSRI
Support groups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dementia dx, tx

A 
Memory impairment plus 1+ sx:
[4A's]
Amnesia
Aphasia (language impairment)
Apraxia (motor impairment)
Agnosia (recognition impairment)
Executive dysfunction
Personality change
STABLE CONSCIOUSNESS (unlike delirium)

Cholinesterase inhibitors
Antipsychotics
Environmental cues
AVOID benzodiazepines!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Delirium dx, tx

A

Waxing/waning consciousness (unlike dementia)
Altered cognition
Perceptual disturbances
Worsening at night
2/2 underlying medical cause!!! ==> find it!

Environmental cues
Antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Major depressive disorder dx, subtypes*, tx** including refractory cases

A 
2+ weeks
Depressed mood or anhedonia and...
4+ SIGECAPS 
Sleep change
Interest loss
Guilt/worthlessness
Energy loss
Concentration loss
Appetite increase/decrease
Psychomotor agitation/retardation
Suicidality

Psychotic
Post-partum (within 1 month)
Seasonal
*Dysthymia: milder but 2+ years
Bereavement: gradually waning with time, generally less severe, less self-loathing
*Persistent complex bereavement: 1+ year of depression with symptoms ALL focused on deceased
Adjustment disorder: 2/2 event, doesn’t meet MDD criteria, impairs functioning, lasts >1 month but > 6 months ==> psychotherapy instead of SSRI

  1. SSRI ==> expect 4-6 weeks for change; continue minimum 6 months if effective without severe side effects ==> switch class after 2 refractory attempts*
  2. ECT if refractory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ECT s/e*

A

*Anterograde amnesia

Headache, nausea, skin burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Bipolar disorder dx, relevant features, subtypes, tx

A 
1+ week of elevated, irritable mood plus 3+ DIGFAST mania criteria: 
Distractibility
Irresponsibility
Grandiosity
Flight of ideas
Agitation (psychomotor)
Sleep decrease
Talkative (pressured speech)
SSRI's may trigger
Psychotic episodes common
Suicide risk! 
Rule out substance abuse
10% risk if parent or sibling has it*

1: manic episode
2: depressive episode + hypomanic episode
Rapid cycling: 4+ episodes of any in one year
Cyclothymic: alternating episodes for 2+ years

*Acute mania:
antipsychotics [haloperidol] & hospitalize
*Long-term:
Mild bipolar: mood stabilizer or atypical antipsychotic mono therapy
Severe bipolar: mood stabilizer [lithium] + antipsychotic
Bipolar II:
Mood stabilizer first, then possibly antidepressant (afterward to prevent inducing mania)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Antipsychotics mechanism, names, side-effects*

A

Typicals: BLOCK D-2 receptor
Haloperidol, fluphenazine, chlorpromazine
Extrapyramidal (see flashcard)
Anticholinergic (dry mouth, urinary retention, constipation)
NMS (fever, rigidity, CK elevation) ==> dantrolene or bromocriptine
Prolacinemia 2/2 dopamine blockade*
Seizures
QT prolongation

Atypicals: D-2* and serotonin receptor blockage
Ziprazidone, quetipine, risperidone, olanzipine, aripiprazole, clozapine, fluphenazine (depot…for non-compliant)
Prolactinemia 2/2 dopamine blockade*
Weight gain* (especially olanzipine and clozapine ==> monitor glucose and lipids)
QT prolongation
Risperidone: most likely to cause extrapyramidal sx
**Clozapine only: tardive dyskinesia, agranulocytosis (weekly CBC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Antidepressant names, s/e*, contraindications

A

SSRIs-
Fluoxetine, citalopram etc.
Sexual, GI etc.
MAO-i ==> serotonin syndrome; pregnancy

Atypicals-
*Bupropion: seizures ==> contraindicated in epileptics and anorexia
Mirtazipine: sedation
Trazodone: sedation, priapism

SNRIs-
Venlafaxine, duloxetine
Hypertension

TCAs-
Nortriptyline, amitryptiline, desipramine
“Tri-C”: seizure, coma, dry mouth, dilated pupils, widened QRS ==> reverse with sodium bicarb**

MAO-i-
Selegiline, tranylcypromine, isocarboxazid
Hypertensive* crisis 2/2 tyramines (wine, cheese)
SSRI’s ==> serotonin syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mood stabilizer names, s/e, contrandications

A

Lithium
DI, hypothyroid* (test thyroid function before initiating)
Fetal: ASD & Ebstein’s tricuspid anomaly
Toxicity > 1.5 ==> ataxia, renal failure (always see Cr if stem gives CBC)

Carbamazepine
SJS, aplastic anemia

Valproic acid
Agranulocytosis, pancreatitis, hepatotoxicity

Lamotrigine
SJS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Post-partum disorder ddx

A

“Blues”:
Within 2 weeks
Sadness
No harm thoughts

Psychosis: 
2-3 weeks post-delivery
Depression
Delusions
Possible harm thoughts

Depression:
1-3 months post-delivery
Psychosis
+ harm thoughts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Personality disorders general characteristics, clusters with subtypes*, tx

A 
"MEDIC" 
Maladaptive
Enduring
Deviant
Inflexible
Causing social impairment

“Weird, Wild, Worried Wimp”

CLUSTER A
Paranoid
Schizoid: isolated loners
Schizotypal: magical thinking, ideas of reference (seeing reference in everyday media)

CLUSTER B
Borderline: unstable relationships, self-harm history, manipulative, splitting*
Histrionic: excessively emotional, sexual
Narcissistic: entitled, lacking empathy
Antisocial: violates others without remorse; conduct disorder as child

CLUSTER C*
OCD:  perfectionist, ego-syntonic
Avoidant*:  fear of rejection, inadequacy, isolation DESPITE desire for friendship (unlike schizoid*)
Dependent*:  submissive, clingy
----
Psychotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Schizophrenia age, dx*, subtypes** with prognosis, ddx, tx

A

Males: 18-25
Females: up to 35

*6+ months
2+ of following:
Positive symptoms: hallucinations, delusions (fixed, false belief), disorganized speech, bizarre behavior ==> more treatment sensitive
Negative symptoms: flat affect, poverty of speech, anhedonia

Paranoid: delusions, hallucinations, intact cognition ==> best prognosis
Disorganized: flat affect, disordered speech and behavior ==> worst prognosis
Catatonic: motor defects, echolalia, echopraxia, mutism

  • Brief pyschotic < 1 month
  • Schizophreniform < 6 months
  • Schizoaffective = schizophrenia plus mood disorder features (i.e. mania, depression*)

Antipsychotics: atypicals are first line due to fewer side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Extrapyramidal side-effect symptoms, tx

A

DYSTONIA
Immediate onset tonic muscle contraction
Anticholinergics: benztropine*, diphenhydramine

DYSKINESIA
Days-later onset of pseudoparkinsonism (bradykinesia, masked facies, tremor)
Anticholinergic: benztropine*
Dopaminergic: amantadine

AKATHISIA
Weeks-later restlessness
Beta blockers or anticholinergic

TARDIVE DYSKINESIA*
Months-later stereotypical hyperkinetic oral-facial movement 2/2 dopamine blockade
Anticholinergics or decreasing dose may worsen
Often irreversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ADHD dx, tx

A

6+ months
2+ settings
6+ symptoms of inattention and/or hyperactivity

Methylphenidate (ritalin)
Amphetamines
Antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Rett disorder presentation

A

Females only

Progressive impairment after 5 months of normal development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Childhood disintegrative disorder presentation

A

Regression after 2 years of normal development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Conduct disorder dx

A

1+ year
Violating rights of others
Progresses to antisocial disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Oppositional defiant dx

A

6+ months
Negative, defiant behavior towards authority
May progress to conduct disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Retardation IQ scores

A

Mild: 50-70
Moderate: 35-50
Severe: 20-34
Profound: <20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Tourette’s dx, associations, tx

A

< 18 y/o
1+ year
Motor tics
Vocal tics (coprolalia = obscene word repetition)

ADHD
OCD*

Antipsychotic*

26
Q

Substance abuse dx

A 
1+ year of 1 or more: 
Failure to fulfill responsibilities 
Use in hazardous situations
Legal problems
Recurrent use despite social problems
27
Q

Substance dependence dx

A 
1+ year of 3+ of following: 
Tolerance (more to obtain desired effect)
Withdrawal sx
Failed attempts to cut down
Significant time spent obtaining
Isolation
Consumption of greater amounts than intended
Continued use despite problems 2/2 drug
28
Q

Alcoholism dx, withdrawal signs*, tx hospital and long-term

A 
2+ "CAGE"
Cutting back need
Annoyed when criticized
Guilty 
Eye opener

6 hrs: anxiety, palpitations ==> 1-2 days: seizures, hallucinations ==> 2-4 days: DT’s fever, hypertension, tachycardia, hallucinations

HOSPITAL
Benzo taper
Multivitamins w/ folic acid
Thiamine before glucose (glucose depletes thiamine, thus prevents Wernicke’s)

LONG-TERM
Disulfiram or naltrexone

29
Q

Signs of substance abuse* and withdrawal* with reversal agents

A

OPIOIDS
Pupil constriction, respiratory depression
Dilated pupils, pain, sweating, GI upset* ==> no seizures & not life-threatening
Naloxone or naltrexone

AMPHETAMINES
Pupil dilation, agitation, seizures
Anxiety, lethargy
Haloperidol

COCAINE
Pupil dilation, cardiac ischemia, agitation
Lethargy, anxiety
Haloperidol

PHENCYCLIDINE (PCP)*
Combativeness*, vertical/horizontal/rolling nystagmus
None
Benzo or haloperidol

LSD*
Anxiety, delusion, hallucination, pupil dilation
Less aggression and more pronounced hallucinations than PCP*

30
Q

Anorexia vs bulimia dx, complications**, pill to avoid, when to hospitalize*

A

< 85% expected body weight
Ego-syntonic (delusion as fat)
Dental erosions, enlarged parotids, dorsal scars
Bradycardia, hypotension, lanugo (fine, soft hair)
Subtypes: restrictive or binge & purge

Osteoporosis*
Elevated cholesterol
Amenorrhea
Mitral valve prolapse
Stress fractures
Arrhythmia
Mortality > 10% 2/2 suicide or medical complications
**Small for gestational age...even if only formerly anorexic!

Normal - overweight
3+ months of 2x/week of binging ==> purge/fasting
Ego-dystonic (aware of problem)
Dental enamel erosions, enlarged parotids, dorsal scars

Lower mortality
More easily treatable
Similar complications
—-

Bupropion decreases seizure threshold
----
Hypokalemia
Bradycardia
BMI < 18
31
Q

Sexual interest change with age:

A

None

32
Q

Primary insomnia dx, tx

A

1+ month
3x / week
Unrestful sleep
NOT caused by medical or psychiatric condition

  1. good sleep hygiene (limit caffeine, sleep schedule, am exercise, nighttime bath etc)
  2. <2 week of sleep aids: diphenhydramine, zoldipem, trazadone
33
Q

Narcolepsy dx, features, tx

A

> 3 months
Decreased REM
Sleep attacks

Cataplexy loss of muscle tone
Hypnogogic/pompic hallucination
Sleep paralysis

Scheduled naps
Stimulants

34
Q

Sleep apnea types, tx

A

Central: both airflow and respiratory effort cease
Peripheral: obstruction 2/2 obesity, tongue, etc

Central: bipap
Peripheral: cpap

35
Q

Somatoform disorder definition, types, tx

A

Unconscious production of sx

  1. Somatization
    Female&raquo_space;> male
    Chronic complaints of multiple organs: GI, neurologic, pain, sexual
    Frequent physician visits*

1.5 Somatic symptom disorder (maybe different than above?)
1+ somatic complaints, including pain
>6 months
Causing severe impairment

  1. Conversion
    Usually 2/2 stressful event
    Implausible severe sensory/motor dysfunction (blind, seizure, paralysis)…often indifferent to them “la belle indiference”
    Self-resolving
  2. Hypochdriac/”illness anxiety disorder”
    Male = female
    Debilitating concern despite NO REAL SYMPTOMS* and REASSURANCE
    Frequent apt
  3. Body dysmorphic
    Female slightly more
    Debilitating self image concern
    SSRI may help; repeat appointments; reassurance doesn’t help*
36
Q

Fictitious disorder definition, types*

A

Cognizant fabrication of sx

  1. Munchausen*: for primary gain of sick role; often health workers
  2. Munchausen by proxy: fabricating sx in another person also for primary gain
  3. Malingering*: fabrication for secondary gain (pain seeking, $$)
37
Q

Abuse signs, sequelae, tx

A

Late-presentation of illness
Frequent ER visits
Shifty behavior or partner

PTSD
Suicide attempt

Document everything!!

38
Q

Suicide risks, dx, tx

A 
SAD PERSONS
Sex (males complete; females attempt more)
Age (>45!!!)
Depression / mental disorder
Previous attempt
Ethanol/substance 
Rational thought 
Sickness (chronic)
Organized plan / access
No spouse
Social support dirth

Ask DIRECTLY

If endorsing ==> immediate hospitalization (even against will)
SSRI increase risk early by increasing energy…observe

39
Q

Trichtillomania dx, tx

A

Pulling hair to relieve anxiety

No underlying derm condition

40
Q

Delusional disorder dx*

A

1+ month
1+ delusion
No other psychotic symptoms
Otherwise well-functioning

41
Q

Normal ages for imaginary friends*

A

2-6

42
Q

Folie a deux dx, tx

A

One person’s delusion becomes shared by another close relation

Interview separately

43
Q

Defense mechanisms

A

Do them once finished

44
Q

Defiant teenager workup*

A

Interview together and separately with parents

*Toxicology screen

45
Q

HIPAA stuff to know*

A

Information may be released by verbal or written consent

Information may be released over the phone without proof of identity

46
Q

Neuroimaging findings in psychiatric disorders*

A 
Autism:  increased total volume
Schizophrenia:  enlarged ventricles
PTSD:  smaller hippocampus
Panic disorder:  smaller amygdala
OCD:  orbitofrontal cortex changes
47
Q

Kleptomania dx, tx

A

Anxiety-induced urge to steal
Often small value
Regret post-stealing

*CBT

48
Q

Best option for patients refusing treatment*

A

Ask why!!

49
Q

Hospice referral criteria*

A

<6 month prognosis

50
Q

Vaginismus/pelvic pain/penetration disorder dx*

A

6+ months
Pain or tenseness with penetration
Causing significant impairment

51
Q

Buproprion indications, s/e

A

Atypical antidepressant
Smoking cessation aid
==> if patient is depressed and wants to quit, this may be best option*

Decreases seizure threshold!
Contraindicated with MAO-i

52
Q

When its okay to proceed with emergency procedure without consent*

A

No living will or advanced directives
Patient is not able to provide consent
*Even if Jehova’s witness, according to family

53
Q

Dissociative fugue vs dissociative amnesia*

A

Fugue: TRAVEL, amnesia, unable to identify self
Amnesia: forgetting important life events usually 2/2 stressor

54
Q

When minors can receive confidential, parental consent-free care*

A

STD
Pregnancy
Mental illness
Emancipated minor 13+: armed services, marriage, a parent*, living alone or financial independence

55
Q

Pediatric sexual abuse signs*

A

TRIAD:
Sudden behavioral change
Unstable economic background
Parent with substance abuse

56
Q

Breaking bad news approach*

A

SPIKES
Setting up: privacy, ask if family are desired
Perception: assess understanding of medical situation
Invitation: how much they want to know
Knowledge: warn of bad news and drop the bomb
Empathy
Strategy

57
Q

Reporting HIV or other STD to cuckolded partner*

A

Encourage partner to do it… but explain that health department will notify the partner if not

58
Q

When to discontinue lithium in bipolar patients*

A

1 episode: after 2 stable years

2 episodes: many years, if not lifetime

59
Q

Circumstantiality vs. tangentiality*

A

Circumstantial: eventually returns to topic
Tangential: deviates totally

60
Q

Mother vs fetus ethics*

A

Mother has autonomy over fetus as long as she has capacity

STEP2 (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions