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Step 2 > Psychiatry 4 > Flashcards

Psychiatry 4 Flashcards

1
Q

When does NMS happen after beginning an antipsychotic?

A

May occur at any time, but usually develops within the first 2 weeks of treatment

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2
Q

What are the cardinal features of NMS?

A

Severe hyperthermia
Autonomic instability
Muscular (lead-pipe) rigidity
Altered sensorium

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3
Q

Lab findings in NMS?

A

Elevated creatinine phosphokinase level and WBC count

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4
Q

Known complication of NMS?

A

Rhabdomyolysis, followed by myoglobinuria that can cause acute renal failure

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5
Q

What medication can be used to treat severe cases of serotonin syndrome?

A

Cyproheptadine (5-HT antagonist)

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6
Q

Clinical features of ADHD?

A

Inattentive and/or hyperactive/impulsive symptoms for 6+ months
-Inattentive: difficulty focusing, distractible, does not listen or follow instructions, disorganized, forgetful, loses/misplaces objects
-Hyperactive/impulsive symptoms: fidgety, unable to sit still, “driven by a motor,” hyper-talkative, interrupts, blurts out answers
Several symptoms present before age 12
Symptoms occur in at least 2 settings and cause functional impairment

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7
Q

Treatment of ADHD?

A
  1. Stimulants - methylphenidate, amphetamines
  2. Non-stimulants - atomoxetine, alpha-2 adrenergic agonists
  3. Behavioral therapy
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8
Q

Although ADHD is more common in boys, girls are more likely to present with predominantly ___ features.

A

Inattentive

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9
Q

When is atomoxetine indicated in treating ADHD?

A

History of illicit substance use

Strong family preference against stimulant medication

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10
Q

When are alpha-2 adrenergic agonists indicated in treating ADHD?

A

Poor response to/intolerable side effects from stimulants

Coexisting conditions like tic disorders

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11
Q

List the 4 manifestations of alcohol withdrawal syndrome and the onset since last drink (hours).

A
  1. Mild withdrawal - 6-24 hours
  2. Seizures - 12-48 hours
  3. Alcoholic hallucinosis - 12-48 hours
  4. Delirium tremens - 48-96 hours
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12
Q

Symptoms/signs of mild alcohol withdrawal?

A

Anxiety, insomnia, tremors, diaphoresis, palpitations, GI upset, intact orientation

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13
Q

Symptoms/signs of seizures from alcohol withdrawal?

A

Single or multiple generalized tonic-clonic

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14
Q

Symptoms/signs of alcoholic hallucinosis?

A

Visual (predominant), auditory, or tactile hallucinations
Intact orientation
Alert sensorium
Relatively stable vital signs

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15
Q

Symptoms/signs of DT?

A

Confusion, agitation, fever, tachycardia, HTN, diaphoresis, hallucinations

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16
Q

Hallmark of delirium tremens?

A

Disorientation and global confusion

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17
Q

Metabolic effects of SGAs?

A

Metabolic syndrome - weight gain, dyslipidemia, hyperglycemia (including new-onset diabetes)

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18
Q

Highest risk SGAs for metabolic effects?

A

Clozapine

Olanzapine

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19
Q

Monitoring guidelines for SGAs with metabolic effects?

A

Baseline and regular follow-up of BMI, fasting glucose and lipids, blood pressure, and waist circumference

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20
Q

Features of antidepressant discontinuation syndrome?

A

Sudden onset dysphoria, fatigue, insomnia, myalgias

Dizziness, flu-like and GI symptoms, tremor, neurosensory disturbances (electric shock and rushing sensations in the head, paresthesias, hyper-responsivitiy to light and noise, vivid dreams)

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21
Q

What is the best approach to manage discontinuation syndrome from antidepressants?

A

Restart the same antidepressant and taper the dose gradually over 2-4 weeks or longer in severe cases

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22
Q

Indications for clozapine?

A

Treatment-resistant schizophrenia

Schizophrenia associated with suicidality

23
Q

Clinical features of antisocial personality disorder?

A

Violates rights of others, social norms, laws
Impulsive, irritable, aggressive (fights, assaults)
Consistently irresponsible, lies, is deceitful
Lack of remorse
Age 18+
Evidence of conduct disorder before age 15

24
Q

Management of antisocial personality disorder?

A

Psychotherapy for milder forms (monitor for manipulation of therapeutic relationship)
Treat comorbid psychiatric disorders

25
Q

Although NMS is not fully understood and the involvement of multiple NT has been proposed, it is thought to be primarily due to dysregulation of ___ caused by ___.

A

Dopamine; D2 receptor antagonism

26
Q

Dopamine antagonism in the ___ pathway may lead to the diffuse “lead-pipe” rigidity seen in NMS.

A

Nigrostriatal

27
Q

What antipsychotics are available in LAI formulations?

A

FGA - haloperidol, fluphenazine

SGAs - risperidone, paliperidone, olanzapine, aripiprazole

28
Q

Features of a grief reaction (vs. MDD)?

A

Normal reaction to loss (bereavement)
Sadness more specific to thoughts of the deceased
“Waves” of grief at reminders
Worthlessness, self-loathing, guilt less common
Functional decline less severe
Thoughts of dying involve wish to join the deceased; active suicidality uncommon
Intensity decreases over time

29
Q

True or false - a major depressive episodes is diagnosed regardless of an existing precipitant, including bereavement.

A

True

30
Q

Although it is rare in comparison with postpartum blues and depression, postpartum psychosis is a medical emergency, with an increased risk of both ___ and ___.

A

Suicide; infanticide

31
Q

Pediatric depression often presents with symptoms of ___ rather than depressed mood.

A

Irritability

32
Q

Evidence shows that SSRIs are most effective for pediatric depression; among them, ___ is considered the medication of choice based on several meta-analyses.

A

Fluoxetine (least potential to cause weight gain)

33
Q

Many OTC cold preparations contain antihistamines (eg, diphenhydramine, doxylamine) that decrease nasal discharge but also have ___ properties that can cause confusion and hallucinations. Alpha-adrenergic agents (eg, phenylephrine, pseudoephedrine) constricts blood vessels, decreasing nasal congestion, but can result in agitation and psychosis via their ___ properties. The cough suppressant dextromethorphan, which is an ___ antagonist, can result in dissociative symptoms and halluciations.

A

Anticholinergic; sympathomimetic; NMDA

34
Q

Hepatoxicity is most commonly associated with what mood stabilize?

A

Valproate

35
Q

AE - valproate?

A

Hepatotoxicity
Tremor
Thrombocytopenia
Alopecia

36
Q

Which low-potency antipsychotic has been associated with cholestatic jaundice?

A

Chlorpromazine

37
Q

Which psychotropic medication has been associated with the rare adverse effect of priapism?

A

Trazodone

38
Q

Clinical features of conversion disorder (functional neurological symptom disorder)?

A

Neurological symptoms (eg, weakness/paralysis, nonepileptic seizures, sensory disturbances)
Not intentionally produced (vs . factitious disorder or malingering)
Findings incompatible with recognized neurological conditions
Symptoms cause significant functional impairment
Often precipitated by psychological stressor

39
Q

Rx for conversion disorder?

A

Education about the disorder
CBT
Physical therapy for motor symptoms

40
Q

Signs and symptoms of a sedative-hypnotic overdose (benzos alone vs. co-ingestion)?

A

Benzodiazepines (isolated): altered level of consciousness, ataxia, slurred speech, arousable, normal vitals

Co-ingestion: bradycardia, hypotension, respiratory depression, hyporeflexia

41
Q

Clinical features of intermittent explosive disorder?

A

Recurrent episodes of impulsive verbal or physical aggression; behaviors are unplanned and out of proportion to the provocation

42
Q

Rx - intermittent explosive disorder?

A

CBT and SSRIs

43
Q

Clinical features of disruptive mood dysregulation disorder?

A

Disproportionate verbal or physical outbursts, persistent irritability or anger between episodes, onset before age 10, not diagnosed after age 18

44
Q

Medications used to treat psychosis?

A
  1. SGAs
  2. FGAs
  3. Adjunctive benzos for agitation
45
Q

Most common physical manifestations of PMS?

A

Bloating, fatigue, headaches, breast tenderness

46
Q

Common psychological symptoms of PMS?

A

Mood swings, anxiety, difficulty concentrating, decreased libido, and irritability

47
Q

Timing of symptoms in PMS?

A

Usually begin a week prior to menses and resolve within a few days after menses start; symptom free during the follicular phase

48
Q

What is PMDD?

A

Severe variant of PMS with prominent irritability, hopelessness, depressed mood, self-critical thoughts, anger, and greater psychosocial impairment

49
Q

First-line Rx for moderate to severe PMS/PMDD?

A

SSRIs

50
Q

Clinical features of OCD?

A 
Obsessions (recurrent, intrusive, anxiety-provoking thoughts, urges, or images)
Compulsions (response to obsessions with repeated behaviors or mental acts, behaviors not connected realistically with preventing feared event)
Time consuming (>1 hr/day) or causing significant distress or impairment
51
Q

Rx - OCD?

A

SSRIs

CBT (ERP)

52
Q

Some medications used to treat dementia target this NT, involved in attention, memory, and executive functions

A

ACh (via acetylcholinesterase inhibitors)

53
Q

Primary NT targeted by benzos?

A

GABA

54
Q

Although antipsychotic medication is the primary treatment for schizophrenia, integrating ___ into a broader treatment program can improve outcomes.

A

Psychosocial interventions (specifically family therapy and psychoeducation)

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