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Psychiatry Flashcards

0
Q

What is acting out?

A

Immature ego defense in which a patient expresses unacceptable thoughts/feelings through action

Ex: Tantrum

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1
Q

What are the mature ego defenses?

A

SASH

Suppression
Altruism
Sublimation
Humor

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2
Q

What is Dissociation?

A

Immature ego defense in which a patient temporarily drastically changes personality, memory, or behavior to avoid emotional stress.

Extreme form is dissociative identity disorder (split personalities).

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3
Q

What is denial?

A

Immature ego defense in which the patient avoids the awareness of some painful reality.

Ex: AIDS and cancer patients commonly react this way

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4
Q

What is Displacement?

A

Immature ego defense in which the takes emotions toward one thing and directs them toward another.

Ex: My boss yells at me, I’m mad at my boss, I yell at my wife.

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5
Q

What is Projection?

A

Attributing an unacceptable INTERNAL impulse to an external source.

Ex: Patient wants another women, accuses his wife of cheating.

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6
Q

What is Fixation?

A

Immature ego defense in which a patient remains partially at a more childish level of development.

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7
Q

What is Identification?

A

Immature ego defense in which a person will model behavior after another person who is more powerful (even if not admired).

Ex: Abused child identifies with an abuser

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8
Q

What is Isolation?

A

Isolation of affect is an immature ego defense in which a person separates feelings from ideas & events.

Ex: Describes a murder in gory detail without an emotional response.

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9
Q

What is Rationalization?

A

Proclaiming logical reasons for actions performed for other reasons. Usually to avoid self-blame.

Ex: After getting fired, claiming that you didn’t want the job anyway.

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10
Q

What is Reaction Formation?

A

Immature ego defense in which a person replaces a feeling with an emphasis on its opposite.

Ex: A very sexual person joins a monastery.

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11
Q

What is Regression?

A

Immature ego defense in which a person reverses their maturation to go back to an earlier mode of dealing with the world. Seen in children under new stressors (birth of a sibling, hospitalization).

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12
Q

What is Repression?

A

Immature ego defense in which a person INVOLUNTARILY withholds a feeling/idea from conscious thought.

Ex: Not remembering that a traumatic experience happened.

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13
Q

What is Splitting?

A

Immature ego defense in which patients believe that people are either all good or all bad at different times. Commonly seen in borderline personality disorder.

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14
Q

What is Altruism?

A

A mature ego defense in which people alleviate guilty feelings by generosity toward others.

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15
Q

What is Humor?

A

A mature ego defense in which a person can laugh about an adverse or anxious situation.

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16
Q

What is Sublimation?

A

A mature ego defense in which a person replaces an unacceptable wish with an action that is similar but acceptable.

Ex: A teen’s aggression toward his father is channeled into sports

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17
Q

What is Suppression?

A

A mature ego defense in which a person intentionally withholds an idea/feeling from conscious awareness.

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18
Q

What is the treatment for separation anxiety disorder?

A

SSRI’s & behavioral interventions

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19
Q

When must ADHD present to be diagnosable?

A

Before age 12

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20
Q

What is seen with autism spectrum disorder?

A

Poor social interactions
Communication deficits
Repetitive behaviors
Restricted interests

Seen more in boys

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21
Q

What is seen with Rett disorder?

A

X-linked seen only in females (males die in utero)

Symptoms at age 1-4
Regression/loss of development
Loss of speech
Ataxia
Stereotyped hand wringing
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22
Q

What NT changes are seen in Huntinton’s disease?

A

Decreased GABA & ACh

Increased Dopamine

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23
Q

What NT changes are seen in Parkinson’s disease?

A

Decreased Dopamine

Increased 5-HT & ACh

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24
Q

What NT changes are seen in schizophrenia?

A

Increased Dopamine

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25
Q

What is lost first with regard to orientation in a confused patient?

A

1) Time
2) Place
3) Person

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26
Q

What is the treatment for delirium?

A

Identify & address underlying cause
Optimize brain function (O2, etc.)
Haloperidol

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27
Q

What is pseudodementia?

A

Depression in the elderly may present like dementia

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28
Q

What type of hallucinations are usually medical in etiology & what type are psychiatric?

A

Auditory –> psychiatric

Visual –> medical

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29
Q

What are the time cutoffs on the spectrum of schizophrenic disorders?

A

Brief psychotic disorder (stress)

1-6 months –> Schizophreniform disorder

> 6 months –> Schizophrenia

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30
Q

What is seen in schizoaffective disorder?

A

1) At least 2 weeks of psychotic symptoms with stable mood

2) At least 1 episode of major depression or mania or mixed

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31
Q

When does schizophrenia present?

A

~20 in males

~30 in females

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32
Q

What is seen in delusional disorder?

A

Fixed untrue belief for > 1 month

Functioning is otherwise not impaired

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33
Q

What is seen during a manic episode?

A

Lasts > 1 wk. Hospitalization or 3+ of the following (DIG FAST):

Distractibility
Irresponsibility (hedonistic)
Grandiosity
Flight of ideas
Agitation/Activity
Sleep (decreased need)
Talkativeness (pressured speech)
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34
Q

What constitutes bipolar disorder?

A

Bipolar I:
1+ manic episode with or without depression

Bipolar II:
1+ hypomanic & 1+ depressive episode

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35
Q

What is seen with cyclothymic disorder?

A

Dysthymia & hypomania. Milder form of bipolar disorder lasting at least 2 years.

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36
Q

What are the criteria for Major depressive disorder?

A

Depressed mood & 5 of the 9 symptoms for 2+ weeks
(SIG E CAPS)

Sleep Disturbance
Interest (loss of)
Guilt or feelings of worthlessness
Energy loss & fatigue
Concentration problems
Appetite & weight changes
Psychomotor retardation or agitation
Suicidal ideation
37
Q

What is the criteria for persistent depressive disorder?

A

aka Dysthymia

Depression, often mild, lasting at least 2 years

38
Q

What is seen in atypical depression?

A 
Mood reactivity
(mood improvement in response to positive events)
Hypersomnia
Weight gain
Leaden paralysis
Sensitivity to interpersonal rejection
39
Q

How long do postpartum blues last?
Postpartum depression?
Postpartum psychosis?

A

Blues: begin 2-3 weeks postpartum; last <10 days

Depression: Begin within 1 month; lasts 2 weeks to over a year

Psychosis: Lasts a few days to 4-6 weeks

40
Q

What is electroconvulsive therapy used for?

A

Refractory major depression
Major depression in a pregnant patient
Depression with psychotic features
Catatonia

41
Q

What are the risk factors for completion of suicide?

A

SAD PERSONS

Sex (male)
Age (teens or elderly)
Depression
Previous attempt
EtOH or drug use
Rational thinking (loss of)
Sickness (medical illness; 3+ meds)
Organized plan
No spouse
Social support lacking
42
Q

What is seen with agoraphobia?

A

Exaggerated fear of open or enclosed places, public transportation, lines or crowds, or leaving home alone.

43
Q

What is the minimum cutoff in time for generalized anxiety disorder?

A

> 6 months

Must be unrelated to a specific person, situation, or event.

44
Q

What is seen in adjustment disorder?

A

Emotional symptoms causing impairment that follow an identifiable stressor for <6 months.

45
Q

What is the time cutoff for PTSD?

A

> 1 month –> PTSD

< 1 month –> Acute stress disorder

46
Q

What is malingering?
Factitious disorders?
Somatoform disorders?

A

Malingering –> Pt consciously lies to get an external (secondary) gain

Factitious –> Pt consciously lies to get psychological (primary) gain

Somatiform –> Illness production is unconscious drive

47
Q

What are the somatoform disorders?

A

Somatic symptom disorder:
Many complaints in multiple organ systems

Conversion disorder:
Sudden loss of sensory or motor function following acute stressor

Illness anxiety disorder (hypochondriasis)

48
Q

What are the Cluster A personality disorders?

Describe them

A

Paranoid - distrust

Schizoid - voluntary social withdrawal, content with isolation

Schizotypal - eccentric, odd beliefs, awkwardness

49
Q

What are the cluster B personality disorders?

A

Antisocial
Borderline
Histrionic
Narcissistic

50
Q

What is seen in antisocial PD?

A

Disregard for rights of others
Criminality
Males > Females
Must be >18 & have Hx of conduct disorder before 15

51
Q

What are the Cluster C personality disorders?

Describe them

A

Avoidant - Sensitive to rejection, desires relationships w/ others

Obsessive-Compulsive - needs order, perfectionist

Dependent - submissive & clingy, low sel-confidence

52
Q

What is seen with anorexia nervosa?

A

Excessive dieting +/- purging
Body image distortion
Osteoporosis
Amenorrhea

53
Q

What is seen with bulimia nervosa?

A 
Binge eating +/- purging
Normal body weight
Parotitis
Dorsal hand calluses
Enamel erosions
Mallory-Weiss tears
54
Q

What is the treatment for narcolepsy?

A

Daytime stimulants

Nighttime sodium oxybate

55
Q

What are the stages of change in overcoming substance addiction?

A

1) Precontemplation
2) Contemplation
3) Planning
4) Action
5) Maintenance
6) Relapse

56
Q

What is seen with opioid withdrawal?

A 
Sweating
Dilated pupils
Rhinorrhea
Yawning
Stomach cramps
Diarrhea
57
Q

What is the treatment for cocaine intoxication?

A

Benzodiazepines

Do NOT use beta blockers (unopposed alpha –> malignant HTN)

58
Q

What is seen with delirium tremens?

A

1) Autonomic hyperactivity (tachycardia, tremors, anxiety)
2) Seizures
3) Psychotic symptoms
4) Confusion

59
Q

What is the treatment for Tourette syndrome?

A

Antipsychotics

60
Q

What are the high potency neuroleptics?

What toxicities are seen?

A

Neuroleptics = 1st generation antipsychotics
“Try Flying High”

Trifluoperazine
Fluphenazine
Haloperidol

Toxicities:
EPS
Galactorrhea
Neuroleptic malignant syndrome

61
Q

What is the evolution of extrapyramidal side effects of the neuroleptics?

A

4 hour dystonia (stiffness, spasm)

4 day akithisia (restlessness)

4 week bradykinesia (parkinsonism)

4 month tardive dyskinesia (oral-facial movements; can be permanent)

62
Q

What is seen with neuroleptic malignant syndrome?

A 
FEVER:
Fever
Encephalopathy
Vitals unstable
Enzymes^ (CPK)
Rigidity
63
Q

What are the low potency neuroleptics?

A

“LOWlife Cheating Thieves”

Chlorpromazine
Thioridazine

64
Q

What side effects are seen with low-potency neuroleptics?

A 
All:
Dry mouth (M)
Constipation (M)
Hypotension (alpha-1)
Sedation (Histamine)

Chlorpromazine - Corneal deposits
Thioridazine - reTinal deposits

65
Q

What is the mechanism of neuroleptics?

A

Block D2 dopamine receptors in the mesolimbic pathway

66
Q

What are the atypical antipsychotics?

A

“atypical for Old Closets to Quietly Risper from A to Z”

Olanzapine
Clozapine
Quetiapine
Risperidone
Aripiprazole
Ziprasidone
67
Q

What toxicities are seen with Clozapine?

A

Agranulocytosis (weekly WBC counts)
Weight gain
Seizure

68
Q

What toxicities are seen with Risperidone?

A

^Prolactin

Can cause irregular menstruation ^ fertility issues

69
Q

What toxicities are seen with Ziprasidone?

A

Atypical antipsychotic

QT prolongation

70
Q

What are the uses for Lithium?

What toxicities are seen?

A

Mood stabilizer for bipolar disorder
SIADH

Toxicities (STENT):
Sedation
Thyroid dysfunction
Ebstein anomaly
Nephrogenic diabetes insipidus
Tremor
71
Q

What is the mechanism of Buspirone?

A

Stimulates 5-HT(1a) receptors

Used for GAD

72
Q

What side effects are seen with SSRI’s?

A

GI upset
Sexual dysfunction
Serotonin syndrome w/ other drugs that ^5-HT
Suicide during 4-8 wk lag time

73
Q

What is seen in serotonin syndrome?

What is the treatment?

A 
Hyperthermia
Confusion
Diarrhea
Flushing
CV collapse

Tx: Cyproheptadine (5-HT2 antagonist)

74
Q

What are the SNRI’s?

What are their uses?

A

Venlafaxine - Depression & GAD

Duloxetine - Depression & diabetic neuropathy

75
Q

What toxicities are seen with TCA’s?

A

Sedation
Anti-adrenergic –> postural hypotension
Anticholinergic –> dry mouth, tachycardia, urinary retention

76
Q

What are the MAOI’s?

A

“MAO Takes Pride In Shanghai”

Tranylcupromine
Phenelzine
Isocarboxazid
Selegiline (MAO-B only)

77
Q

What are the uses of MAOI’s?

What toxicities are seen?

A

Used for: Atypical depression, Anxiety, Hypochondriasis

Toxicities:
Hypertensive crisis (tyramine found in wine & cheese)
Many drug interactions (SSRI's, TCA's, St. John's wart, meperidine, dextromethorphan)
78
Q

What is bupropion used for?

What side effects are seen?

A

Atypical antidepressant; Smoking cessation

Toxicities:
Stimulant effects
Seizure in bulemic pts
No sexual side effects

79
Q

What is the mechanism of Trazadone?

What toxicities are seen?

A

Blocks 5-HT2 & alpha-1 adrenergic receptors

Toxicities:
Priapism
Postural hypotension
Sedation

80
Q

What drugs are used in the treatment of bipolar disorder?

A

Mood stabilizers: Lithium, Valproic acid, Carbamazepine

Atypical antipsychotics

81
Q

What is seen with serum sickness?

A 
5-10 days after a drug exposure
Fever
Urticaria
Proteinuria
LAD
Vasculitis - fibrinoid necrosis w/ PMN infiltration

It is a Type III hypersensitivity reaction

82
Q

How is acyclovir activated?

A

Viral thymidine kinase

Only present in HSV & VZV

83
Q

What is seen with systemic mastocytosis?

A 
Mast cells in the bone marrow & other organs --> ^^Histamine
Gastric acid secretion --> diarrhea
Syncope
Flushing
Hypotension
Bronchospasm
Urticaria
84
Q

Can Turner syndrome patients become pregnant?

A

Yes, usually only with in vitro fertilization & hormone supplementation.

85
Q

Where in the bone does hematogenous osteomyelitis commonly occur?

A

The metaphysis of long bones

The hematogenous route is seen primarily in children

86
Q

What are the pharmacologic methods of preventing sickle cell crisis?

A

1) Hydroxyurea –> ^HbF

2) Ca2+-dependent K+ channel blockers –> prevent RBC dehydration

87
Q

What is a germinoma?

What is seen?

A

It is a pineal gland germ-cell tumor.

Symptoms:
Precocious puberty (hCG secretion)
Obstructive hydrocephalus
Parinaud syndrome (impaired upward gaze)
88
Q

What antipsychotics can affect the eyes?

A

Chlorpromazine - Corneal deposits

Thioridazine - Retinal deposits (“Thioretazine”)

89
Q

What stain can be used to stain the liver for A1AT deficiency?

A

PAS stain

It shows the A1AT deposits in the liver.

90
Q

What drugs cause gallstones?

A

Bile acid-binding resins (loss of bile acids)
Fibrates (inhibit 7-alpha-hydroxylase)
Octreotide
Ceftriaxone

91
Q

What anti-MTB drug should be used if a patient is on protease inhibitors?

A

Rifabutin

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