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PANCE > Psychiatry > Flashcards

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

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2
Q

positive symptoms for schizophrenia

A

hallucinations, bizarre behavior, delusions

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3
Q

negative symptoms for schizophrenia

A

flat affect, apathy, poor grooming, social withdrawal, anhedonia, poor eye contact, poverty of speech

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4
Q

Define paranoid schizophrenia

A

most common, characterized by persecutory or grandiose delusions or auditory hallucinations

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5
Q

define disorganized schizophrenia

A

characterized by disorganized speech or behavior and flat or inappropriate affect

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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

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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

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8
Q

define hallucinations

A

false perceptions in any of the sensory modalities (auditory, tactile, olfactory, visual)

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9
Q

define disorganized speech

A

unable to stay on topic, or provide a tangential response

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10
Q

Schizophrenia treatment

A
  • hospitalization if SI, inability to care for self, or threat to others
  • antipsychotics
  • psychosocial treatment
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11
Q

aripiprazole (abilify)

A

atypical antipsychotic

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12
Q

clozapine

A

atypical antipsychotic

ADR: WBC agranulocytosis

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13
Q

risperidone

A

atypical antipsychotic

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14
Q

olanzapine (zyprexa)

A

atypical antipsychotic

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15
Q

quetiapine (seroquel)

A

atypical antipsychotic

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16
Q

lurasidone (latuda)

A

atypical antipsychotic

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17
Q

Examples of Typical Antipsychotics

A

thioridazine, chlorpromazine, mesoridazine, movindone, perphenazine, loxapine, trifluoperazine, thiothixene, haloperidol, fluphenazine, pimozide

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18
Q

Typical Antipsychotics ADR

A

anticholinergic, reduce seizure threshold, hypotension, agranulocytosis, QT prolong, wt gain, extrapyramidal symptoms

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19
Q

Describe extrapyramidal symptoms

A 
dystonia - muscle spasm
Parkinsonian - rest tremor, rigid
Akathisia - restlessness
tardive dyskinesia - slow movement
neuroleptic malignant syndrome = emergency!!
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20
Q

why would you choose atypical antipsychotics over typical?

A

fewer extrapyramidal side effects

blocks dopamine and serotonin

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21
Q

this disorder meets criteria for major depressive episode, manic episode, or mixed + meets criteria for schizophrenia

A

schizoaffective disorder

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22
Q

Schizoaffective disorder

A

mixture of psychotic and mood symptoms

delusions or hallucinations lasting for 2 weeks w/o mood disorder symptoms

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23
Q

schizoaffective disorder treatment

A

second-generation antipsychotics
add mood stabilizer or antidepressant
psychosocial suport

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24
Q

this disorder is characterized by presence of nonbizarre delusions (situations that occur in real life for 1 month)

A

delusional disorder

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25
Q

this disorder has psychotic symptoms present for 1 day to one month, occurs after a catastrophic event

A

brief psychotic disorder

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26
Q

same symptoms as schizophrenia but symptoms last 1-6 months

A

schizophreniform

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27
Q

What are the 5 psychotic disorders?

A 
schizophrenia
schizoaffective disorder
delusional disorder
brief psychotic disorder
schizophreniform
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28
Q

What are the 7 Somatoform disorders?

A 
somatization disorder
body dysmorphic disorder
conversion disorder
factitious disorder
malingering
hypochondriasis
pain disorder
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29
Q

patient presents with vague physical complaints involving many organ systems, numerous visits to health care providers, no medical disorder is found

A

somatization disorder

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30
Q

treatment for somatization disorder?

A

regularly scheduled visits with health care provider

group and individual psychotherapy

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31
Q

this disorder is characterized by preoccupation with an imagined defect in physical appearance or exaggerated distortion of a minor flaw (often facial)

A

body dysmorphic disorder

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32
Q

this patient often visits dermatologist and not satisfied with physical appearance, age 15-30, female

A

body dysmorphic disorder

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33
Q

treatment for body dysmorphic disorder

A 
serotonin drugs (fluoxetine, clomipramine) 
10-12 weeks
if depression is associated = treat
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34
Q

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

A

conversion disorder

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35
Q

treatment for conversion disorder?

A

psychotherapy, hypnosis, anxiolytics (lorazepam), relaxation

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36
Q

patients intentionally fake symptoms of medical or psychiatric. motivation is to assume the sick role. seek hospital admission under different names

A

factitious disorder

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37
Q

treatment for factitious disorder

A

avoid unnecessary procedures
confront in nonthreatening way
psychotherapy
SSRI may reduce impulsive tendencies

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38
Q

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

A

malingering

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39
Q

preoccupation with the belief of having or fear of contracting a serious illness, no medical cause found, last 6 months and impair function

A

hypochondriasis

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40
Q

treatment for hypochondriasis

A

psychotherapy

SSRI

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41
Q

pain is reported in 1+ areas w/o any identifiable cause, impair functioning, not intentionally produced, chronic disorder

A

pain disorder

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42
Q

treatment for pain disorder

A

psychotherapy, behavioral therapy, pain control programs
NO ANALGESICS OR SEDATIVES
SSRI or TCA (may have some benefit)

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43
Q

What are the 6 mood disorder?

A 
Major Depressive Disorder
Bipolar I
Bipolar II
Dysthymic 
Cyclothymic
Adjustment
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44
Q

What are the 4 mood episodes?

A

major depressive
manic
hypomanic
mixed

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45
Q

What are some depressive signs and symptoms?

A

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

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46
Q

What are some manic signs and symptoms?

A

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

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47
Q

Major Depressive disorder diagnostic criteria

A

2 weeks

5+ symptoms

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48
Q

What are the 7 subtypes of MDD?

A 
seasonal affective
melancholia (severe)
atypical (overeating, wt gain)
substance-induced 
catatonic (movement)
psychotic (delusions or hallucinations)
postpartum (4 weeks after delivery)
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49
Q

Treatment options for MDD?

A

pharmacotherapy
electroconvulsive therapy
psychotherapy

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50
Q

how long should antidepressants be used when treating MDD?

A

4-6 weeks, maintenance should be >6 months (high relapse)

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51
Q

First line antidepressants for MDD?

A

SSRI (fluoxetine, paroxetine, sertraline)
-ADR: GI, HA, sexual dysfunction
do not combine with MAOI

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52
Q

SSRI examples

A 
fluoxetine 
sertraline
paroxetine
fluvoxamine
citalopram
escitalopram
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53
Q

SNRI examples

A

venlafaxine (effexor)

duloxetine (cymbalta)

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54
Q

Serotonin receptor agonists and antagonists

A

trazodone

nefazodone

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55
Q

norepinhephrine-dopamine reuptake inhibitors

A

bupropion (wellbutrin)
-has low sexual ADR!
helpful for smoking cessation

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56
Q

TCA examples

A 
block reuptake of serotonin and norepi
doxepin
nortriptyline
imipramine
desipramine
clomipramine
ADR: anticholinergic, orthostatic hypotension, cardiac toxicity, sexual dysfunction, wt gain
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57
Q

MAOI examples

A 
selegiline
tranylcypromine
phenelzine
isocarboxazid
-risk for hyperadrenergic crisis (DIET) = cured meats, fish, beer, red wine, cheese (tyramine-free diet)
58
Q

What is a modulator of norepi and serotonin and does not cause sexual dysfunction?

A

mirtazapine (remeron)

59
Q

this disorder is characterized by the occurrence of 1+ manic episodes, often cycles with depression, manic episodes last 1 week, FHx

A

Bipolar I

60
Q

Treatment for Bipolar I

A

mood stabilizers = lithium, valproic acid, olanzapine, carbamazepine
second generation antipsychotics = risperidone, aripiprazole, quetiapine, ziprasidone

61
Q

Are mood stabilizers teratogenic?

A

yes

62
Q

Lithium uses?

A

acute mania, bipolar depression, long term bipolar, impulse dyscontrol

63
Q

Lithium MOA?

A

alters second messenger system, GABA, takes 2-4 weeks, monitor serum levels

64
Q

Lithium ADR?

A 
CNS: sedation, cognitive clouding, tremor
ENDO: TSH
Cardiac: sinus arrhythmia
Renal: polyuria
GI
Wt gain
65
Q

Valproic Acid Uses?

A

acute mania, long term bipolar, impulse dyscontrol, seizure disorders

66
Q

Valproic Acid MOA?

A

increases GABA, takes 2-4 weeks, monitor serum levels, LFT first 6 months = can cause liver hepatotoxicity

67
Q

Valproic Acid major ADR?

A

neural tube defects = spina bifida
agranulocytosos
pancreatitis

68
Q

Lamotrigine

A

mood stabilizer
maintenance for bipolar I
Steven Johnson = ADR
other ADR: ataxia, blurred vision, diplopia, dizzy, n/v

69
Q

Carbamazepine

A

mood stabilizer

ADR: agranulocytosis, pancytopenia, aplastic anemia

70
Q

Oxcarbazepine

A

mood stabilizer/anticonvulsant

71
Q

Describe bipolar II?

A

1+ depressive episode to hypomania (no manic or mixed)

hypomania = less severe, cause less social impairment, no psychotic symptoms

72
Q

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.

A

Dysthymic disorder

73
Q

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

A

Dysthymic disorder

74
Q

Treatment for dysthymic disorder?

A

antidepressants = SSRI

insight-oriented behavior and cognitive therapy

75
Q

patients are described as moody, erratic, impulsive, somewhat volatile
mild bipolar for 2 years - recurring periods

A

cyclothymic disorder

76
Q

Treatment for cyclothymic disorder?

A

mood stabilizers
antimanic drugs
psychotherapy
antidepressants

77
Q

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)

A

adjustment disorder

TX: short-term treatment for insomnia, anxiety, depression

78
Q

Personality Diroder Clusters?

A

A - mad (odd/eccentric)
B - bad (dramatic/emotional)
C - sad (anxious/fearful)

79
Q

Cluster A example?

associated with psychotic

A

Schizoid
Schizotypal
Paranoid

80
Q

Cluster B Examples?

associated with mood

A

antisocial
borderline
histrionic
narcissistic

81
Q

Cluster C examples?

associated with anxiety

A

avoidant
dependent
obsessive-compulsive

82
Q

This personality disorder is characterized by pervasive distrust and suspicion of others, anticipate harm and betrayal, reluctance to confide in others, quick to counterattack

A

paranoid personality disorder

Tx: individual psychotherapy, antianxiety med, or antipsychotics to decrease paranoia

83
Q

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

A

Schizoid personality disorder
(schizoid = avoid)

Tx: group therapy and psychotherapy, low-dose short-term antipsychotics or antidepressants

84
Q

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

A

Schizotypal personality disorder
(no true psychosis - hallucinations or delusions = but can develop into schizophrenia)

Tx: psychotherapy, low dose antipsychotics (risperidone, olanzapine)

85
Q

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

A

Antisocial personality disorder

Tx: psychothearpy
Reduce anxiety, impulsivity, aggression (SSRI, lithium, valproate, carbamazepine)

86
Q

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

A

Borderline Personality Disorder

Tx: dialectical behavior theraphy
Antipsychotics, SSRI, benzo, lithium

87
Q

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

A

histrionic personality disorder

Tx: psychotherapy
antidepressants
anxiolytics

88
Q

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

A

Narcissistic personality disorder

Tx: psychotherapy is key
lithium = if mood swings
SSRI = if mood disorder present

89
Q

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

A

Avoidant personality disorder

Tx: psychotherapy,
BB, SSRI, benzo

90
Q

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

A

dependent personality disorder

Tx: psychotherapy
anxiolytics, antidepressants

91
Q

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)

A

obsessive-compulsive personality disorder

Tx: psychotherapy
SSRI
2nd line = clomipramine (TCA)

92
Q

What are the 6 types of anxiety disorder?

A 
Generalized Anxiety Disorder
Panic attacks and panic disorder
OCD
PTSD
acute stress disorder
phobias (specific or social)
93
Q

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

A

Generalized anxiety disorder

Tx: SSRI
SNRI (venlafaxine)
Buspirone (anxiolytic) 
Benzo - for short term
behavioral therapy - relaxation techniques
94
Q

Define panic attack?

A

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
Q

Define panic disorder?

A

recurrent, unexpected panic attacks that occur abruptly and are accompanied by debilitating fear of having additional attacks

96
Q

Treatment for panic disorder?

A

acute anxiety = benzo (alprazolam or lorazepam)

maintenance = SSRI (paroxetine) 8-12 months

CBT and exposure therapy

97
Q

define obsessions?

A

persistent and recurrent thoughts, images, impulses that are intrusive and inappropriate, cause significant anxiety

98
Q

Define compulsions?

A

ritualistic or repetitive behavior or thoughts that patients feel compelled to engage in to relive the anxiety caused by the obsessions

99
Q

difference between OCD and obsessive-compulsive personality disorder?

A

OCD = egodystonic = distressing to the patient

personality disorder = not distressing

100
Q

Treatment for OCD?

A

SSRI (sertraline, paroxetine, fluoxetine, citalopram) at high doses

+ desensitization

101
Q

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

A

PTSD

Tx: SSRI (sertraline, paroxetine) x 6 months

insomnia = trazodone

psychotherapy

102
Q

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

A

acute stress disorder

Tx: SSRI
anxiolytics (lorazepam, clonazepam)

103
Q

Define phobia?

A

irrational fear and persistent excessive anxiety when presented with an object or a situational event

104
Q

What are the 5 types of specific phobias?

A

animal, natural environment, blood-injection-injury, situational, other

105
Q

fear of social situations in which embarrassment or humiliation in front of other people may occur

public speaking, using public restrooms, eating in public

A

social phobia

106
Q

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

A

agoraphobia

107
Q

Treatment for social phobia and agoraphobia?

A 
SSRI = paroxetine, fluoxetine, sertraline
SNRI = venlafaxine

can add benzo

can add BB (propranolol)

insight-oriented therapy, CBT

108
Q

What are the 3 eating disorder?

A

Anorexia Nervosa
Bulimia Nervosa
Obesity

109
Q

2 types of anorexia

A

restricting

binge eating and purging

110
Q

Treatment of anorexia nervosa

A

restore nutritional state
behavioral thearpy, supervised weight gain programs
antidepressatns (amitripytyline, paroxetine, mirtazapine)
NO BUPROPRION = lower seizure threshold

111
Q

2 types of bulimia

A

purging - self induced vomiting

nonpurging - excessive exercise or fasting

112
Q

Define obesity?

A

BMI >30

recurrent episodes of binge eating 2days/week for 6 months

113
Q

Treatment for obesity

A

behavioral modification therapy, underling depression (SSRI), surgical (gastric bypass, gastroplasty)

114
Q

define substance dependence?

A

(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
Q

define substance abuse

A

not met criteria for dependence = fail to meet home/school/work obligations, use in hazardous situations (car), legal problems

116
Q

slurred speech, ataxia, facial flushing, erratic behavior, loss of inhibiton, and euphoria, unsteady gait, memory impaired = s/s of what?

A

alcohol intoxication

117
Q

chronic alcohol abuse s/s?

A

acne rosacea, palmar erythema, hepatomegaly (fatty liver infiltration), testicular atrophy, gynecomastia

elevated gamma glutamyl transpeptidase, AST/ALT, LDH, MCV

118
Q

alcohol withdrawal symptoms?

A

tremor/shakes/jitters 6-18 hr after cessation

tachy, n/v, DT, seizures

119
Q

CAGE?

A

cut down, annoyed, guilty, eye opener

120
Q

Wernicke-korsakoff syndrome is what?

A

thiamine deficiency

TRIAD = eye movement abnormalities, ataxia, mental confusion

121
Q

Pharm options for alcohol abuse?

A

DAN
Disulfiram = cause nausea when etoh consumed

acamprosate = glutamate modulator

Naltrexone = opiate agonist = reduce high

122
Q

Intoxication manifestations of opioid use are??

A

drowsiness, impaired concentration, bradycardia, hypotension, constricted pupils, slurred speech, flushing

123
Q

withdrawal manifestations of opioid use are??

A

lacrimation, RHINORRHEA, sweating, awning, anxiety, HTN, DILATED PUPIL

124
Q

Treatment for opioid use/abuse?

A

Naloxone
Methadone (u agonist)
Clonidine (alpha 2 agonist)
buprenorhpnie (opioid dependence)

125
Q

Examples of stimulants?

A

caffeine, cocaine, amphetamines, psuedoephedrine, diet pills

126
Q

Stimulant intoxication s/s?

A

agitation/aggression, impaired judgement, euphoria, eleved bp, DILATED PUPILS, hallucinations, transient psychosis

127
Q

Withdrawal s/s of stimulants?

A

fatigue, HA, profuse sweating, muscle cramps, hunger

128
Q

Treatment of stimulant abuse/use?

A

benzo = reduce agitation

129
Q

Treatment for nicotine and tobacco?

A

bupropion

varenicline

130
Q

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

A

ADD/ ADHD

131
Q

Treatment for ADD/ADHD?

A

CNS stimulant + behavioral thearpy

methyphenidate, dexmethypphenidate, emphetamine/dextroamphetamine

ADR: growth retardation, wt loss

132
Q

non stimulant treatment for ADD?

A

atomoxetine = SNRI

133
Q

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

A

Conduct Disorder

like antisocial in adult

134
Q

Treatment for Conduct Disorder?

A

environmental and behavioral modifications, family therapy
Stimulants = treat aggressive/assultive behavior
SSRI = reduce impulsivity and mood

135
Q

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

A

Oppositional defiant disorder

136
Q

Treatment for oppositional defiant disorder?

A

family intervention, individual psychotheraphy

137
Q

This disorder is characterized by impaired social interaction, impaired communication, and repetitive stereotyped patterns of behavior and activities BEFORE AGE 3?

A

Autistic disorder

no smile or facial expression, fail nonverbal communication

138
Q

This disorder is characterized by decreasing head circumference per height and weight + loss of previously learned behaviors, social interactions, and motor/language development. GIRLS

A

Rhett disorder

139
Q

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)

A

Tourette Disorder

140
Q

physical signs of abuse?

A

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
Q

Forms of Elderly abuse?

A

physical, sexual, psychological, financial, neglect, violation of basic rights

PANCE (16 decks)

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