Psychiatry Flashcards
1
Q
exhibit disordered thought content and thought process + illusion or hallucination, delusion, impaired reality orientation + impaired social and occupational functioning
A
Schizophrenia
2
Q
positive symptoms for schizophrenia
A
hallucinations, bizarre behavior, delusions
3
Q
negative symptoms for schizophrenia
A
flat affect, apathy, poor grooming, social withdrawal, anhedonia, poor eye contact, poverty of speech
4
Q
Define paranoid schizophrenia
A
most common, characterized by persecutory or grandiose delusions or auditory hallucinations
5
Q
define disorganized schizophrenia
A
characterized by disorganized speech or behavior and flat or inappropriate affect
6
Q
define catatonic schizophrenia
A
include 2: motor immobility, excess motor activity that is w/o purpose, extreme negativism or mutism, peculiarly voluntary movement, echolalia, or echopraxia
7
Q
define delusions
A
erroneous beliefs based on misinterpretation of reality, such as paranoia, ideas of reference, thought broadcasting, delusions of grandeur, delusions of guilt
8
Q
define hallucinations
A
false perceptions in any of the sensory modalities (auditory, tactile, olfactory, visual)
9
Q
define disorganized speech
A
unable to stay on topic, or provide a tangential response
10
Q
Schizophrenia treatment
A
- hospitalization if SI, inability to care for self, or threat to others
- antipsychotics
- psychosocial treatment
11
Q
aripiprazole (abilify)
A
atypical antipsychotic
12
Q
clozapine
A
atypical antipsychotic
ADR: WBC agranulocytosis
13
Q
risperidone
A
atypical antipsychotic
14
Q
olanzapine (zyprexa)
A
atypical antipsychotic
15
Q
quetiapine (seroquel)
A
atypical antipsychotic
16
Q
lurasidone (latuda)
A
atypical antipsychotic
17
Q
Examples of Typical Antipsychotics
A
thioridazine, chlorpromazine, mesoridazine, movindone, perphenazine, loxapine, trifluoperazine, thiothixene, haloperidol, fluphenazine, pimozide
18
Q
Typical Antipsychotics ADR
A
anticholinergic, reduce seizure threshold, hypotension, agranulocytosis, QT prolong, wt gain, extrapyramidal symptoms
19
Q
Describe extrapyramidal symptoms
A
dystonia - muscle spasm Parkinsonian - rest tremor, rigid Akathisia - restlessness tardive dyskinesia - slow movement neuroleptic malignant syndrome = emergency!!
20
Q
why would you choose atypical antipsychotics over typical?
A
fewer extrapyramidal side effects
blocks dopamine and serotonin
21
Q
this disorder meets criteria for major depressive episode, manic episode, or mixed + meets criteria for schizophrenia
A
schizoaffective disorder
22
Q
Schizoaffective disorder
A
mixture of psychotic and mood symptoms
delusions or hallucinations lasting for 2 weeks w/o mood disorder symptoms
23
Q
schizoaffective disorder treatment
A
second-generation antipsychotics
add mood stabilizer or antidepressant
psychosocial suport
24
Q
this disorder is characterized by presence of nonbizarre delusions (situations that occur in real life for 1 month)
A
delusional disorder
25
this disorder has psychotic symptoms present for 1 day to one month, occurs after a catastrophic event
brief psychotic disorder
26
same symptoms as schizophrenia but symptoms last 1-6 months
schizophreniform
27
What are the 5 psychotic disorders?
```
schizophrenia
schizoaffective disorder
delusional disorder
brief psychotic disorder
schizophreniform
```
28
What are the 7 Somatoform disorders?
```
somatization disorder
body dysmorphic disorder
conversion disorder
factitious disorder
malingering
hypochondriasis
pain disorder
```
29
patient presents with vague physical complaints involving many organ systems, numerous visits to health care providers, no medical disorder is found
somatization disorder
30
treatment for somatization disorder?
regularly scheduled visits with health care provider
| group and individual psychotherapy
31
this disorder is characterized by preoccupation with an imagined defect in physical appearance or exaggerated distortion of a minor flaw (often facial)
body dysmorphic disorder
32
this patient often visits dermatologist and not satisfied with physical appearance, age 15-30, female
body dysmorphic disorder
33
treatment for body dysmorphic disorder
```
serotonin drugs (fluoxetine, clomipramine)
10-12 weeks
if depression is associated = treat
```
34
this disorder is characterized by 1+ neurologic complaints that cannot be explained clinically, not intentionally produced, most common = shifting paralysis, blindness, mutism, indifference to symptoms
conversion disorder
35
treatment for conversion disorder?
psychotherapy, hypnosis, anxiolytics (lorazepam), relaxation
36
patients intentionally fake symptoms of medical or psychiatric. motivation is to assume the sick role. seek hospital admission under different names
factitious disorder
37
treatment for factitious disorder
avoid unnecessary procedures
confront in nonthreatening way
psychotherapy
SSRI may reduce impulsive tendencies
38
deliberate production of physical or psychological symptoms, motivated by external gain. express vague, poorly defined symptoms = but say they cause great distress, injuries often self inflicted, uncooperative, symptoms improve when objective is met
malingering
39
preoccupation with the belief of having or fear of contracting a serious illness, no medical cause found, last 6 months and impair function
hypochondriasis
40
treatment for hypochondriasis
psychotherapy
| SSRI
41
pain is reported in 1+ areas w/o any identifiable cause, impair functioning, not intentionally produced, chronic disorder
pain disorder
42
treatment for pain disorder
psychotherapy, behavioral therapy, pain control programs
NO ANALGESICS OR SEDATIVES
SSRI or TCA (may have some benefit)
43
What are the 6 mood disorder?
```
Major Depressive Disorder
Bipolar I
Bipolar II
Dysthymic
Cyclothymic
Adjustment
```
44
What are the 4 mood episodes?
major depressive
manic
hypomanic
mixed
45
What are some depressive signs and symptoms?
depressed mood, anhedonia, excessive feeling of guilt, indecisiveness, lack of self-worth, sleep problems (insomnia/hypersomnia), cognitive problems, changes in appetite, decreased interest in sex, SI, chronic fatigue or decreased energy
46
What are some manic signs and symptoms?
inflated self-esteem or grandiosity, irritability, decreased need for sleep, pressure speech, flight of ideas, distractibility, impaired judgement - resulting in pursuit of pleasurable activities with a high probability of adverse outcomes
47
Major Depressive disorder diagnostic criteria
2 weeks
| 5+ symptoms
48
What are the 7 subtypes of MDD?
```
seasonal affective
melancholia (severe)
atypical (overeating, wt gain)
substance-induced
catatonic (movement)
psychotic (delusions or hallucinations)
postpartum (4 weeks after delivery)
```
49
Treatment options for MDD?
pharmacotherapy
electroconvulsive therapy
psychotherapy
50
how long should antidepressants be used when treating MDD?
4-6 weeks, maintenance should be >6 months (high relapse)
51
First line antidepressants for MDD?
SSRI (fluoxetine, paroxetine, sertraline)
-ADR: GI, HA, sexual dysfunction
do not combine with MAOI
52
SSRI examples
```
fluoxetine
sertraline
paroxetine
fluvoxamine
citalopram
escitalopram
```
53
SNRI examples
venlafaxine (effexor)
| duloxetine (cymbalta)
54
Serotonin receptor agonists and antagonists
trazodone
| nefazodone
55
norepinhephrine-dopamine reuptake inhibitors
bupropion (wellbutrin)
-has low sexual ADR!
helpful for smoking cessation
56
TCA examples
```
block reuptake of serotonin and norepi
doxepin
nortriptyline
imipramine
desipramine
clomipramine
ADR: anticholinergic, orthostatic hypotension, cardiac toxicity, sexual dysfunction, wt gain
```
57
MAOI examples
```
selegiline
tranylcypromine
phenelzine
isocarboxazid
-risk for hyperadrenergic crisis (DIET) = cured meats, fish, beer, red wine, cheese (tyramine-free diet)
```
58
What is a modulator of norepi and serotonin and does not cause sexual dysfunction?
mirtazapine (remeron)
59
this disorder is characterized by the occurrence of 1+ manic episodes, often cycles with depression, manic episodes last 1 week, FHx
Bipolar I
60
Treatment for Bipolar I
mood stabilizers = lithium, valproic acid, olanzapine, carbamazepine
second generation antipsychotics = risperidone, aripiprazole, quetiapine, ziprasidone
61
Are mood stabilizers teratogenic?
yes
62
Lithium uses?
acute mania, bipolar depression, long term bipolar, impulse dyscontrol
63
Lithium MOA?
alters second messenger system, GABA, takes 2-4 weeks, monitor serum levels
64
Lithium ADR?
```
CNS: sedation, cognitive clouding, tremor
ENDO: TSH
Cardiac: sinus arrhythmia
Renal: polyuria
GI
Wt gain
```
65
Valproic Acid Uses?
acute mania, long term bipolar, impulse dyscontrol, seizure disorders
66
Valproic Acid MOA?
increases GABA, takes 2-4 weeks, monitor serum levels, LFT first 6 months = can cause liver hepatotoxicity
67
Valproic Acid major ADR?
neural tube defects = spina bifida
agranulocytosos
pancreatitis
68
Lamotrigine
mood stabilizer
maintenance for bipolar I
Steven Johnson = ADR
other ADR: ataxia, blurred vision, diplopia, dizzy, n/v
69
Carbamazepine
mood stabilizer
| ADR: agranulocytosis, pancytopenia, aplastic anemia
70
Oxcarbazepine
mood stabilizer/anticonvulsant
71
Describe bipolar II?
1+ depressive episode to hypomania (no manic or mixed)
| hypomania = less severe, cause less social impairment, no psychotic symptoms
72
This disorder is chronic, persistent mild depression which is manifested by pessimism, brooding, generalized loss of interest, decreased productivity, feeling inadequate, social withdrawal. No psychotic or manic features.
Dysthymic disorder
73
patient is depressed mood for most of the day, for 2 years (1 year in children or adolescents). has not been without symptoms for >2 months
Dysthymic disorder
74
Treatment for dysthymic disorder?
antidepressants = SSRI
| insight-oriented behavior and cognitive therapy
75
patients are described as moody, erratic, impulsive, somewhat volatile
mild bipolar for 2 years - recurring periods
cyclothymic disorder
76
Treatment for cyclothymic disorder?
mood stabilizers
antimanic drugs
psychotherapy
antidepressants
77
this disorder is characterized by maladaptive behavioral or emotional symptoms that develop within 3 months after a stressful life event. END within 6 months (often after divorce, leaving home)
adjustment disorder
| TX: short-term treatment for insomnia, anxiety, depression
78
Personality Diroder Clusters?
A - mad (odd/eccentric)
B - bad (dramatic/emotional)
C - sad (anxious/fearful)
79
Cluster A example?
| associated with psychotic
Schizoid
Schizotypal
Paranoid
80
Cluster B Examples?
| associated with mood
antisocial
borderline
histrionic
narcissistic
81
Cluster C examples?
| associated with anxiety
avoidant
dependent
obsessive-compulsive
82
This personality disorder is characterized by pervasive distrust and suspicion of others, anticipate harm and betrayal, reluctance to confide in others, quick to counterattack
paranoid personality disorder
Tx: individual psychotherapy, antianxiety med, or antipsychotics to decrease paranoia
83
this personality disorder is characterized by lifelong pattern of voluntary social withdrawal, quiet, have constricted affect, no desire for close relationships, indifferent to praise or criticism
Schizoid personality disorder
(schizoid = avoid)
Tx: group therapy and psychotherapy, low-dose short-term antipsychotics or antidepressants
84
This personality disorder is characterized by a pervasive pattern of eccentric behavior and peculiar thought patterns - viewed as strange and eccentric, magical thinking, not consistent with social norms
Schizotypal personality disorder
(no true psychosis - hallucinations or delusions = but can develop into schizophrenia)
Tx: psychotherapy, low dose antipsychotics (risperidone, olanzapine)
85
This personality disorder is characterized by an inability to conform to social norms, and a strong tendency to commit unlawful acts, 18 years old, disregard to the rules, lye, aggressive, endanger themselves
Antisocial personality disorder
Tx: psychothearpy
Reduce anxiety, impulsivity, aggression (SSRI, lithium, valproate, carbamazepine)
86
This personality disorder is characterized by an unstable and unpredictable mood, affect, and behavior, desperately attempts to avoid abandonment, cannot tolerate being alone but exhibit intense anger toward friends, instability in relationships/self-image/impulse control
Borderline Personality Disorder
Tx: dialectical behavior theraphy
Antipsychotics, SSRI, benzo, lithium
87
This personality disorder has individuals who are overly emotional, dramatic, and seductive, high degree of attention-seeking behavior, flamboyant, easily influenced by others, need to be center of attention
histrionic personality disorder
Tx: psychotherapy
antidepressants
anxiolytics
88
This personality disorder has individuals who have inflated self-image, pattern of grandiosity, need for admiration, and lack of empathy, self-centered, and low-self esteem, arrogant and entitled
Narcissistic personality disorder
Tx: psychotherapy is key
lithium = if mood swings
SSRI = if mood disorder present
89
This personality disorder has individuals who have an extreme sensitivity to rejection (inferior complex), see themselves as unappealing, desire relationships but avoid them b/c of anxiety produced by a sense of inadequacy, very sensitive to criticism, fear of rejection
Avoidant personality disorder
Tx: psychotherapy,
BB, SSRI, benzo
90
This personality disorder has individuals who have an enduring pattern of dependent, clinging, and submissive behavior, extremely needy, rely on others for emotional support and decision making, go to extreme lengths to seek another relationship
dependent personality disorder
Tx: psychotherapy
anxiolytics, antidepressants
91
This personality disorder is characterized by a pervasive pattern of orderliness (rules, lists, details), perfectionism, and inflexibility. tend to be rigid and cold, stubborn, not distressing to the patient (egosyntonic)
obsessive-compulsive personality disorder
Tx: psychotherapy
SSRI
2nd line = clomipramine (TCA)
92
What are the 6 types of anxiety disorder?
```
Generalized Anxiety Disorder
Panic attacks and panic disorder
OCD
PTSD
acute stress disorder
phobias (specific or social)
```
93
This anxiety disorder is characterized by persistent, excessive anxiety regarding general life events that last for 6 months. not situational or episodic. restless, easy fatigability, sleep disturbance, muscle tension, difficulty concentrating, difficulty coping with anxiety
Generalized anxiety disorder
```
Tx: SSRI
SNRI (venlafaxine)
Buspirone (anxiolytic)
Benzo - for short term
behavioral therapy - relaxation techniques
```
94
Define panic attack?
period of extreme anxiety that peaks within 10 minutes, and declines after 30
experience palpitations, sweating, trembling, dyspnea, sense of choking, nausea, fear of losing control, fear of dying, numbness
95
Define panic disorder?
recurrent, unexpected panic attacks that occur abruptly and are accompanied by debilitating fear of having additional attacks
96
Treatment for panic disorder?
acute anxiety = benzo (alprazolam or lorazepam)
maintenance = SSRI (paroxetine) 8-12 months
CBT and exposure therapy
97
define obsessions?
persistent and recurrent thoughts, images, impulses that are intrusive and inappropriate, cause significant anxiety
98
Define compulsions?
ritualistic or repetitive behavior or thoughts that patients feel compelled to engage in to relive the anxiety caused by the obsessions
99
difference between OCD and obsessive-compulsive personality disorder?
OCD = egodystonic = distressing to the patient
personality disorder = not distressing
100
Treatment for OCD?
SSRI (sertraline, paroxetine, fluoxetine, citalopram) at high doses
+ desensitization
101
this anxiety disorder results from exposure or witnessing a traumatic event and is manifested by overwhelming sensations of helplessness, fear, horror, impair occupational or social functioning
sense of reliving the event, avoid talking about event/activities that remind of event, symptoms for >1 month
PTSD
Tx: SSRI (sertraline, paroxetine) x 6 months
insomnia = trazodone
psychotherapy
102
symptoms of this anxiety disorder occur within 1 month and last from 2 days to 1 month. often if victim of violent event, survivor of natural disaster, MVA
excessive anxiety or arousal, distressing event is reexperienced
acute stress disorder
Tx: SSRI
anxiolytics (lorazepam, clonazepam)
103
Define phobia?
irrational fear and persistent excessive anxiety when presented with an object or a situational event
104
What are the 5 types of specific phobias?
animal, natural environment, blood-injection-injury, situational, other
105
fear of social situations in which embarrassment or humiliation in front of other people may occur
public speaking, using public restrooms, eating in public
social phobia
106
intense anxiety about placing oneself into a situation in which an incapacitating problem could occur and no help would be available.
fear of public places, crowded places, bus/train
agoraphobia
107
Treatment for social phobia and agoraphobia?
```
SSRI = paroxetine, fluoxetine, sertraline
SNRI = venlafaxine
```
can add benzo
can add BB (propranolol)
insight-oriented therapy, CBT
108
What are the 3 eating disorder?
Anorexia Nervosa
Bulimia Nervosa
Obesity
109
2 types of anorexia
restricting
| binge eating and purging
110
Treatment of anorexia nervosa
restore nutritional state
behavioral thearpy, supervised weight gain programs
antidepressatns (amitripytyline, paroxetine, mirtazapine)
NO BUPROPRION = lower seizure threshold
111
2 types of bulimia
purging - self induced vomiting
| nonpurging - excessive exercise or fasting
112
Define obesity?
BMI >30
| recurrent episodes of binge eating 2days/week for 6 months
113
Treatment for obesity
behavioral modification therapy, underling depression (SSRI), surgical (gastric bypass, gastroplasty)
114
define substance dependence?
(within 12 months) substance use results in impairment and manifested with either tolerance, withdrawal, use of larger amounts, unsuccessful efforts to stop, more time spent attempting to acquire, impairment
115
define substance abuse
not met criteria for dependence = fail to meet home/school/work obligations, use in hazardous situations (car), legal problems
116
slurred speech, ataxia, facial flushing, erratic behavior, loss of inhibiton, and euphoria, unsteady gait, memory impaired = s/s of what?
alcohol intoxication
117
chronic alcohol abuse s/s?
acne rosacea, palmar erythema, hepatomegaly (fatty liver infiltration), testicular atrophy, gynecomastia
elevated gamma glutamyl transpeptidase, AST/ALT, LDH, MCV
118
alcohol withdrawal symptoms?
tremor/shakes/jitters 6-18 hr after cessation
| tachy, n/v, DT, seizures
119
CAGE?
cut down, annoyed, guilty, eye opener
120
Wernicke-korsakoff syndrome is what?
thiamine deficiency
TRIAD = eye movement abnormalities, ataxia, mental confusion
121
Pharm options for alcohol abuse?
DAN
Disulfiram = cause nausea when etoh consumed
acamprosate = glutamate modulator
Naltrexone = opiate agonist = reduce high
122
Intoxication manifestations of opioid use are??
drowsiness, impaired concentration, bradycardia, hypotension, constricted pupils, slurred speech, flushing
123
withdrawal manifestations of opioid use are??
lacrimation, RHINORRHEA, sweating, awning, anxiety, HTN, DILATED PUPIL
124
Treatment for opioid use/abuse?
Naloxone
Methadone (u agonist)
Clonidine (alpha 2 agonist)
buprenorhpnie (opioid dependence)
125
Examples of stimulants?
caffeine, cocaine, amphetamines, psuedoephedrine, diet pills
126
Stimulant intoxication s/s?
agitation/aggression, impaired judgement, euphoria, eleved bp, DILATED PUPILS, hallucinations, transient psychosis
127
Withdrawal s/s of stimulants?
fatigue, HA, profuse sweating, muscle cramps, hunger
128
Treatment of stimulant abuse/use?
benzo = reduce agitation
129
Treatment for nicotine and tobacco?
bupropion
| varenicline
130
This is a childhood disorder = hyperactivity, impulsivity, inattentiveness resulting in impairment before age 7
occur in 2 settings (home/school)
6 symptoms for 6 months
ADD/ ADHD
131
Treatment for ADD/ADHD?
CNS stimulant + behavioral thearpy
methyphenidate, dexmethypphenidate, emphetamine/dextroamphetamine
ADR: growth retardation, wt loss
132
non stimulant treatment for ADD?
atomoxetine = SNRI
133
This childhood disorder = pattern of behavior that involves violation of basic rights of others or of social norms. 3 of = aggression toward animal/people, destruction of property, deceitfulness, serious violation of rules
Conduct Disorder
| like antisocial in adult
134
Treatment for Conduct Disorder?
environmental and behavioral modifications, family therapy
Stimulants = treat aggressive/assultive behavior
SSRI = reduce impulsivity and mood
135
This childhood disorder = 6 months of negativistic, hostile, defiant beahivor
4 of = frequent loss of temper, arguments with adults, defying adults rules, deliberately annoying others, easily annoyed, anger, resentment, blame others
Oppositional defiant disorder
136
Treatment for oppositional defiant disorder?
family intervention, individual psychotheraphy
137
This disorder is characterized by impaired social interaction, impaired communication, and repetitive stereotyped patterns of behavior and activities BEFORE AGE 3?
Autistic disorder
| no smile or facial expression, fail nonverbal communication
138
This disorder is characterized by decreasing head circumference per height and weight + loss of previously learned behaviors, social interactions, and motor/language development. GIRLS
Rhett disorder
139
This disorder involves multiple motor and 1+ vocal tics for >1 year, common ages 3-8, after group A strept infection (PANDA)
sudden, rapid, recurrent, nonrhythmic (grunt/bark)
Tourette Disorder
140
physical signs of abuse?
any injury that cannot be adequately explained or is not consistent with the hx given
Burns = doughnut shaped, stocking-glove, symmetrically round
Bruise that form regular patterns
Retinal hemorrhage or hyphemia = shaken baby syndrome
141
Forms of Elderly abuse?
physical, sexual, psychological, financial, neglect, violation of basic rights
