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Step 2 Study > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Boys>girls
lack peer relationships, poor eye contact, & social smile.
Absent or bizarre speech, repetitive behaviors (stacking) , injurious behavior to self or others.

A

Autistic

Tx: Improve ability to develop relationships, attend schools, & achieve independent living.
Behavioral modifications, ANTIPSYCHOTIC Meds if aggressive.
Disorder

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2
Q

Girls> Boys;

Progressive encephalopathy, microcephaly, hand-wringing, loss of speech, ataxia, psychomotor retardation.

A

Rett Disorder

Tx: symptomatic, behavior therapy for self injurious behavior, physiotherapy for muscular def.

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3
Q

Boys> girls
Normal development for 2 yrs & then regressions.
Loss of language, social interaction, motor, bladder function. Repetitive/stereotyped behaviors.
r/o infection then r/in CDD.

A

Childhood Disintegrative Disorder

Tx: behavioral modification, develop relationships, attend school, achieve independent living

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4
Q

Boys> Girls.

Social problems. No intellectual deficits. Preoccupied with rules.

A

Asperger Disorder

Tx: Improve social relationships with others

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5
Q

Inattention, short attention span or hyperactivity that interferes with daily functioning
Usually appears before age 7, must be present for > 6 mos. May persist in adulthood
Must be in 2 areas (home &outside of home)
Comorbid w/learning disability.

A

ADHD

Tx: Methlyphenidate & dextroamphetamine
SE: insomnia, decreased appetite and headache
2nd line: atomoxetine (norepinephrine reuptake inhibitor)

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6
Q

Argues often, loses temper, easily annoyed, blames other for their mistakes, tends to have problems with authority figures. Justifies behavior as response to others actions

A

Oppositional Defiant disorder

Tx: Teach child management skills . No pharmacological treatment.

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7
Q

Leads to Anti-social Personality disorder
Persistent behaviors where rules are broken, cruelty to animals, bullying, fighting, using weapons.
Vandalize and destroy property, set fires, steal items from others or lie to obtain good from others.

A

Conduct Disorder

Tx: behavior with giving rewards for normal behaviors
Aggressive? Give antipsychotic meds.

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8
Q

Characterized by onset of multiple tics. Lasting > 1 yr.
Facial and neck muscles most commonly involved.
Vocal tics include grunting, coughing, &throat clearing.
Boys> girls; begins at age 7

A

Tourette Disorder

Tx: Dopamine antagonists- antipsychotics medications (Risperidone)

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9
Q

At least 2 wks of symptoms.
Depressed mood/Anhedonia + 4 of the following
Depressed mood most of the day, weight changes, sleep changes, fatigue, poor concentration, thoughts of death and worthlessness and psychomotor disturbance.
r/o medical causes: Thyroid hormone,Parkinson and dementia

A

Major Depression

Tx: SSRI (Fluoxetine, paroxetine, sertraline, citalopram, escitalopram)
Increase the dose of SSRI
Psychotherapy: w/goal of teaching patients to identify negative thoughts

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10
Q

SSRI +MAOI

A

Serotonin Syndrome

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11
Q

Depression + Neuropathic Pain

A

Desvenlafaxine

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12
Q

Depressed + fears weight gain

A

buproprion

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13
Q

Manic symptoms that last at least 1 week. Cause significant distress in level of functioning.
Elevated mood, increased self-esteem, distractability, pressured speech, decreased need for speech.
Increase in goal directed behavior, racing thoughts, excessive involvement in pleasurable activities.

A

Bipolar Disorder
Tx:
Acute Mania: Lithium, Valproic Acid, Atypical Antipsychotics
Severe symptoms consider: atypical antipsychotics: shorter onset of action
Bipolar Depression: Lithium, Lamotrigine
Compromised Kidneys? DON’T USE LITHIUM!

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14
Q

Depressed mood for most of the day.

Symtoms must be present for > 2yrs.

A

Dysthymia

Tx: antidepressant medications and psychotherapy

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15
Q

Hypomanic episodes & mild depression. Symptoms present for > 2 yrs.

A

Cyclothymia

Tx: Lithium, valproic acid, carbamazepine, Psychotherapy

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16
Q

Increased sleep, weight, and appetite.

Moods tend to be worse in evenings & pts may complain of extremities feeling heavy

A

Atypical Depression

Tx: SSRI or MAOI

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17
Q

Weight gain, increased sleep, lethargy

A

Seasonal Affective Disorder

Tx: Phototherapy, and bupropion

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18
Q

Onset : immediate birth up to 2 wks. Sadness, labile mood, tearfulness. Love baby lots.

A

Baby Blues

Tx: supportive

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19
Q

Onset 1- 3 mos after birth.

Depressed mood, weight changes, sleep disturbances, & excessive anxiety, may have neg feelings toward baby.

A

Depression

Tx: Antidepressant

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20
Q

Onset 2-3 wks after birth.
Wants to harm baby.
Depression, delusions, and thoughts of harm.

A

Psychosis

Tx: antipsychotic med, lithium, possibly antidepressant

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21
Q

No functional impairment then don’t treat.
Begins after the death of loved one
Sadness, worrying, irritability, sleep difficulties, poor concentration, tearfulness

A

Bereavement

Tx: supportive psychothearpy

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22
Q

TCA (-triptyline)

Side Effects

A

Hypotension, Dry mouth, Constipation, Confusion, Arrhythmia, Sex SE, Weight gain, GI disturbance

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23
Q

MAOI Side effects

Phenelizine, Isocaboxiazid, tranylcypromine

A

Monitor diet

Causes HTN

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24
Q

SSRI Side effects

Fluoxetine, paroxetine, sertraline, citalopram, Escitalopram, Fluvoxamine

A

Headaches, weight changes, sexual SE, GI disturbances

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25
Q

SNRI Side Effect

Venlafaxine, Duloxetine, Desvenlafaxine

A

HTN, Blurry vision, weight changes, sexual side effects, GI

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26
Q

Bupropion Side Effect

A

Seizures

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27
Q

Trazadone Side Effect

A

Priapism

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28
Q

Mitrazapine Side Effect

A

Weight gain and sedation

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29
Q

Lithium Side Effect

A

Tremors, weight gain, GI, nephrotoxic, diabetes, leukocytosis, teratogenic

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30
Q

Lithium Toxicity

A

Confusion, ataxia, lethargy, abnormal reflexes

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31
Q

Valproic Acid SE

A

Tremors, weight gain, GI, alopecia, teratogic, hepatotoxic

Toxicity: hyponatremia, coma death

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32
Q

Lamotrigine SE

A

Stevens-Johnson Syndrome

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33
Q

ECT SE

A

Headaches, transient memory loss, single most effective treatment

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34
Q

Agitation confusion, hallucination, hypomania. Sweating, hyperthermia, tachycardia, nausea, diarrhea, shivering, tremors, myoclonus.

A

Serotonin Syndrome

Tx: STOP THE MEDICATION. Symptomatic treatment of fever, nausea, vomiting. Cyproheptadine (serotonin antagonist)

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35
Q

Schizophrenia Treatment

A

Acutely psychotic- hospitalize-
Emergency situation give olanazpine and ziprazidone. Haloperidol was worse SE
Atypical antipsychotics
Noncomplaint with meds give long acting risperidone.
No response to trial of typical or atypical medications: Clozapine

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36
Q

Acute Dystonia

A

Hours to days
Muscle Spasms
Tx: Benztrophine, trihexphenidyl, diphehydramine

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37
Q

Akathesia

A

Weeks
Inability to relax, restless
Tx: reduce the dose, give beta blockers, switch to atypical antipsychotics

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38
Q

Tardive Diskinesia

A

Rare before 6 months
Abnormal involuntary movement esp perioral
Tx: Atypical antipsychotic, clozapine least risk

39
Q

Neuroleptic Malignant Syndrome

A

Not time limited, muscular rigidity, fever, autonomic changes
Tx: Dantrolene or bromocriptine

40
Q

Nonbizarre delusion >1 month, & no impairment in level of functioning
Hallucinations are not present

A

Delusional Disorder
Tx: Atypical Antipsychotics: First line
Psychotherapy can help pts feel things are safer than they believe

41
Q

Dread and Doom
Diaphoresis, SOB, nausea, dizziness, trembling, chest pain, fear of dying, chills, dissociative symptoms, palpitations, paresthesias
r/o MI, thyroid, hypoglycemia, cardiac disease
Lasts

A

Panic Disorder
Tx: SSRI, typically (Fluoxetine, paroxetine, sertraline)
Benozdiazepine- taper the dose down to monitor
Behavioral therapy

42
Q

GAD Treatment

A

Busiprone

43
Q

Panic Attack

A

Alprazolam

44
Q

Specific or Social Phobia Treatment

A 
Tx: behavioral modification techniques, Systematic desensitization. 
Relaxation techniques (breathing guided imagery)
45
Q

Performance anxiety

A

beta-blockers.

Given 30 mins to hr before performance.

46
Q

Affect the pts level of functioning.
Obsessions: thoughts that are intrusive, senseless, & distressing, thus increasing anxiety.
Compulsions: neutralize the thoughts they are rituals
Young pts; men=women, coexist w/tourette disorder

A

OCD

Tx: SSRI: treatment of choice (Fluoxetine, paroxetine, sertraline, citalopram, or fluvoxamine)
Behavioral therapy –exposure therapy

47
Q

Symptoms: Increased startle, hypervigilance, sleep disturbances, concentration issues, anger outbursts.
Symptoms last > 1 mon

A

PTSD

48
Q

Symptoms: Increased startle, hypervigilance, sleep disturbances, concentration issues, anger outbursts.
> 2 days

A

Acute Stress Disorder

49
Q

PTSD/Acute Stress Disorder

A

Tx: First-line: Paroxetine & sertraline
Relaxation
Psychotherapy to get coping techniques

50
Q

Excessive anxiety or worry lasting greater than 6 months. Anxiety out for proportion to event.
symptoms: fatigue, concentration difficulty, sleep problems, muscle tension, restlessness.
Usually women

A

Tx: SSRI (Fluoxetine, paroxetine, sertraline, citalopram)
Venlafaxine and busiprone

Psychotherapy and behavioral therapy—not first line

51
Q

Diazepam, lorazepam, clonazepam, alprazolam, oxazepam, chlordiazepoxide, temazepam, flurazepam

A

Benozodiazepines

SE: sedation, confusion, memory deficits, respiratory depression, addiction potential

52
Q

Busiprone SE

A

SE: Headaches, nausea, dizziness

53
Q

Lorazepam

A

given IM in emergencies

54
Q

Clonazepam

A

longer half live- give if addiction is a concern

55
Q

Chlordiazepoxide, oxazepam-

A

used frequently in treatment of alcohol withdrawal

56
Q

Flurazepam, temazepam, triazolam

A

approved for hypotics

57
Q

Flumazenil is a

A

benzodiazepine antagonist

58
Q

Flumazenil indications

A

the overdose is acute & you are certain that there is no chronic dependence

59
Q

Flumazenil SE

A

seizures in benzodiazepine-dependent patients.

causes acute withdrawal: tremor or seizures similar to delirium tremens

60
Q

talkative, sullen, disinhibited, moody, gregarious

A

Alcohol Intoxication

Tx: mechanical ventilation if severe

61
Q

tremors hallucinations, seizures, delirium tremens,

A

Alcohol withdrawal

Tx: benzodiazepine, thiamine, multivitamins, folic acid

62
Q

Euphoria, hypervigilance, autonomic hyperactivity, weight loss, papillary dilation, perceptual disturbances

A

Cocaine/Amphetamine Intoxication

Tx: Antipsychotics and/or benzodiazepine and/or antihypertensives

63
Q

anxiety, tremulousness, headache, increased appetite, depression, risk of suicide

A

Cocaine/Amphetamine Withdrawal

Tx: Bupropion and/or bromocriptine

64
Q

Intoxication: Ideas of reference, perceptual disturbances, impaired judgment, tremors, incoordination, dissociative symptoms

A

Hallucinogen Intoxication

Antipsychotics and/or benzodiazepines and/ or talking down.

65
Q

belligerence, apathy, aggression, impaired judgement, stupor, coma

A

Inhalant Intoxication

Tx: Antipsychotics

66
Q

apathy, dysphoria, papillary constriction, drowsiness, slurred speech, coma, death

A

Opiates Intoxication

Naloxone

67
Q

Fever, chills, lacrimation, abdominal cramps, muscle spasms, diarrhea

A

Opiates Withdrawal

Tx: clonodine, methadone, buprenorphine

68
Q

belligerence, psychomotor agitation, violence, nystagmus, HTN, seizures

A

PCP Intoxication

Tx: antipsychotics and/or benzodiazepines and/or talking down

69
Q

young, irritability, aggression, mania, psychosis

A

Anabolic steroid intoxication

Tx: antipsychotics

70
Q

depression, headaches, anxiety, increased concern over body’s physical state

A

Anabolic Steroid withdrawal

Tx: SSRI

71
Q

Somatoform disorder

Tx: Psychotherapy

A

Young women, unaware of psychological problems

Symptoms: 4 pain, 2 GI, 1 sexual, 1 pseudoneurological symptoms

72
Q

Hypochondriasis:

A

Patients believe that they have some specific disease despite constant reassurance.

73
Q

Conversion Disorder

A

voluntary motor or sensory functions, indicative of a medical condition
Unconcerned about impairment in the associated La Bell Indifferance

74
Q

Body Dysmorphic Disorder

A

Patients believe that some part of the body is abnormal, defective, or misshapen

75
Q

Pain Disorder

A

Pesence of pain, psychological factors associated with pain.

76
Q

Facitious disorder
(Munchausen)
Tx: no specific therapy

A

Individual fakes an illness to get attention &emotional support in pt role
Either psychological or physical illness
Hx of being employed by healthcare
Rule out medical disorder Peptide c- levels. Call child protective services.

77
Q

Malingering

Tx: Confront the pt

A

Conscious production of signs and symptoms for an OBVIOUS gain
Not a mental disorder
Patient: Prisoners and military personnel
Typically diagnosed when there is a discrepancy between the complaints and the physical/lab findings

78
Q

Adjustment disorder

Tx: psychotherapy, individual and group

A

Characterized by maladaptive reaction to an identifiable stressor.
Loss of job, divorce or failure in school. If seeing murder or POW that would be PTSD
Usually occur w/in 3 mos of stressor &must remit w/in 6 months of removal of stressor.
Symptoms: Anxiety, depression, disturbances of conduct
Severe enough to cause impairment in functioning.

79
Q

Suspicious, mistrustful, secretive, isolated and questioning the loyalty of family and friends

A

Paranoid

80
Q

Loners, choice of solitary activities, lack close friends, emotional coldness, no desire for or enjoyment of close relationships. Content alone

A

Schizoid

81
Q

Ideas of reference, magical thinking, odd thinking, eccentric behavior, increased social anxiety, brief psychotic episodes. Dragon statues, magic 8 ball in the room, dolls are magical and can talk

A

Schixotypal

82
Q

Must be center of attention, inappropriate sexual behavior, self-dramatization
Use physical appearance to draw attention to self

A

Histrionic

83
Q

Failure to conform to social rules, deceitful, lack of remorse, impulsive,
aggression towards others, Irresponsible, must be 18 years older

A

Antisocial

Conduct disorder usually leads to this

84
Q

Unstable relationships, impulsive, recurrent suicidal behaviors, chronic feelings of emptiness,
inappropriate anger, dissociative symptoms when severely stressed, brief psychotic episodes

A

Borderline

85
Q

Grandiose sense of self, belief that they are special, lack of empathy, sense of entitlement,
Require excessive admiration

A

Narcissistic

86
Q

Unwilling to get involved with people, views self as socially inept, reluctant to take risks
Feelings of inadequacy. Want friends but unwilling to make risks.

A

Avoidant

87
Q

Difficulty making day to day decisions, unable to assume responsibility, unable to express disagreement, fear of being alone, seeks relationships as source of care.

A

Dependent

88
Q

Preoccupied with details, rigid, orderly, perfectionists, excessively devoted to work, inflexible

A

Obsessive Compulsive

89
Q

Anorexia Nervosa
Tx:
Electrolytes

A

SSRI
High Bicarb, carotene, LFTs, amylase, cholesterol, cortisol
Low K, Cl, LH/FSH, estrogen

90
Q

Re-feeding syndrome

A

Low PO4, Mg, Ca, and fluid retention

91
Q

Bulimia Nervosa

A

SSRI

Don’t give bupropion

92
Q

Narcolepsy

A

Sleep paralysis: awake but unable to move
Cataplexy: sudden loss of muscle tone, occurs with loud noises and sounds
Lack of REM sleep
Tx: modafinil, naps

93
Q

Insomnia

A

Tx: Sleep hygiene, avoid naps, zolpidem, eszopiclone, zaleplon

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