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Psychiatry Flashcards

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USMLE® Step 1 flashcards
1
Q

4 P’s of the biopsychosocial model

A
  • Predisposing
  • Precipitating
  • Perpetuating
  • Protective
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2
Q

Suicide Risk Factors

A

SAD PERSONS

  1. Sex: male
  2. Age: >60
  3. Depression
  4. Previous attempts
  5. Ethanol abuse
  6. Rational thinking lost (i.e. Delusions, hallucinations, hopelessness)
  7. Suicide in family
  8. Organized plan
  9. No spouse
  10. Serious illness

(Think of the young 29y/o punk in PICU)

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3
Q

Important elements (4) to a safety plan

A
  1. Not harm themselves
  2. Avoid drugs, EtOH, and triggers
  3. Follow up at designated time
  4. Go to Emerg, call HCP, or call someone
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4
Q

Important elements (3) to a safety plan

A
  1. Not harm themselves
  2. Avoid drugs, EtOH, and triggers
  3. Follow up at designated time
  4. Go to Emerg, call HCP, or call someone
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5
Q

Time line for:

  1. Brief psychotic disorder
  2. Schizophreniform disorder
  3. Schizophrenia
A
  1. Brief psychotic disorder
  2. Schizophreniform disorder 1-6 months
  3. Schizophrenia > 6 months
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6
Q

Schizoaffective Disorder: DSM 5 Criteria

A

2 weeks or more with no mood symptoms

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7
Q

DSM 5 criteria for Schizophrenia

A

6 months of disturbanc, with at least 1 month of continuous symptoms (min 1 from each list) + _>_3 of the following:

Positive symptoms:

  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Disorganized or catatonic behaviors

Negative symptoms

  1. Anhedonia, avolition, alogia, affective blunting Think of ‘Robert’
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8
Q

Basic activities of daily living

A

DEATH

  1. Dressing
  2. Eating
  3. Ambulating
  4. Toileting
  5. Hygiene
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9
Q

Instrumental activities of daily living

A

SHAFT

  1. Shopping
  2. Housekeeping
  3. Accounting
  4. Food-preparation
  5. Transportation
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10
Q

Types of Dementia

A
  1. Alzheimer’s (60-70%)
  2. Vascualar (10-20%)
  3. Lewey body (10-20%)
  4. Frontatemporal/Pick’s (5-15%)
  5. Parkinson’s Disease
  6. Hungtington’s Disease
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11
Q

CAM

Confusion Assessment Method

A

Guideline taught to nurses to assess baseline cognition for every patient over 65 years of age.

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12
Q

Delerium Accronym

A

DIMS-O

  1. Drugs/Drug withdrawal
  2. Infection
  3. Metabolic
  4. Structural
  5. Organ System
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13
Q

PRISME

Identify and addresses factors contributing to delerium

A
  • P: pain, poor nutrition
  • R: retention, restraints
  • I: infection, inmobility
  • S: skin, sleep, sensory deficits
  • M: mental status, metabollic, medications
  • E: environment
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14
Q

4 Traditional Anti-Psychotics

A
  1. Haloperidol
  2. Loxapine
  3. Chlorpromazine
  4. Perphenazine
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15
Q

5 Atypical Antipsychotics

A
  1. Aripiprazole (AbilifyTM)
  2. Clozapine (ClozarilTM)
  3. Olanzapine (ZyprexaTM)
  4. Risperidone (ResperidolTM)
  5. Quitiapine (SeroquelTM)
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16
Q

Benzodiazapine list

A
  1. Lorazipam is Ativan
  2. Diazepam is Valium
  3. Oxazepam is Serax
  4. Clonazepam
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17
Q

Venlafazine (EffexorTM)

  • Drug class
A
  • SNRI
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18
Q

Extra Pyramidal Symptoms

A

TAP’D

  1. Tardive Dyskinesia - abnormal involuntary movement disorder (SSRI’s & antipsycotics)
  2. Akathesia
  3. Pseudoparkinsonianism
  4. Akinesia/Bradykinesia
  5. Rigidity
  6. Rabbit Tremor
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19
Q

Tardive Dyskinesia

A
  • Involuntary muscle movement
  • Starts months after meditcation
  • Often permanent; non-treatable with benztropine
  • Generally starts around mounth and tongues
  • Can get grinding teeth (can lose teeth)
  • Can spread to other parts of the body
  • Tx: ween the patient off the offender
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20
Q

Akathisia

A
  • The preception of restlessness
  • Onset weeks after offender
  • Tx: beta-blockers
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21
Q

General anti-psychotic side effects

A
  • EPS (risperidone)
  • Sedation (quitiapine)
  • Dizziness/Orthostatic Hypotension (quitiapine)
  • Anti-cholinergic effects (olanzapine)
  • Metabollic syndrome (olanzapine!)
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22
Q

Symptoms treated by Anti-Psychotics

A
  • Delusions
  • Hallucinations
  • Physical/verbal aggression
  • Manic-like
  • Sexually inappropriate behaviour
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23
Q

Major Neurodegnerative

A
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24
Q

6 Common SSRI’s

A
  1. Sertraline (ZoloftTM)
  2. Escitalopram (CipralexTM)
  3. Citalopram (CelexaTM)
  4. Paroxetine (PaxilTM)
  5. Fluoxetine (ProzacTM)
  6. Fluvoxamine
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25
Q

Common Anti-cholinergic Side-effects

A
  • Confusion
  • Dry mouth
  • Urinary retention
  • Constipation
  • Exacerbation of closed angle glaucoma
  • Delirium
  • Tachycardia
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26
Q

Define: Countertransference

A

The therapists emotional response to the patient

  • Can be related to therapist’s past relationships
  • Can be in response to unconscious pressure from patient to behave in a certain way
  • Two types
    • Concordant CT: therapist experiences patient’s emotions
    • Complementary CT: therapist experiences the emotions of patient’s hisotircal caregiver
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27
Q

Three types of Defense Mechanisms

A
  1. Primitive (i.e. splitting, projection, denial)
  2. Neurotic (i.e. intellectualisation, repression)
  3. Mature (i.e. alturism, humour)
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28
Q

Explain Projection and Projective Identification

A

Patient will internalize aspects of absuer, but cannot accept the feelings and impulses and project them to others, making the others be abusive.

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29
Q

Define: Splitting

A

Splitting (also called black and white thinking or all-or-nothing thinking) is the failure in a person’s thinking to bring together both positive and negative qualities of the self and others into a cohesive, realistic whole. It is a common defense mechanism used by many people.

i.e. “You’re the best psychiatrist. The other ones were wrong about everything.”

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30
Q

Psychodynamic Psychotherapy Techniques

A
  1. Uncover unconscious thoughts
    1. Pay attention to Freudian slips/parapraxes
    2. Free associations
    3. Dreams
  2. Observe defense mechanisms as they happen
  3. Monitor transferDence/counter transference
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31
Q

Psychodynamic Psycotherapy Applications

A

Neurotic level disorders

  1. Anxiety disorders
  2. Conversion disorders
  3. Dysthymic disorder
  4. Mood disorders (mild-moderate)
  5. Personality disorders (mild-moderate)
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32
Q

The 4 Hateful Paitents
+ Solutions

A
  1. DEPENDENT CLINGERS: needy, seductive, grateful; early on say “I’m ony human” and set boundaries
  2. ENTITLED DEMANDERS: hostile, narsisstic; say “you are entitled to the very best medical care, but you must help us.”
  3. MANIPULATIVE HELP-REJECTERS: moms, needy; share pessimism/warn medications often fail
  4. SELF-DESTRUCTIVE DENIERS: help them anyway. That’s all.
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33
Q

Define: CBT

A
  • Aaron Beck (father of CBT) - relautionship between thought, emotions, and behviours; emotions are hard to change, so target the other two
  • Judith Beck (daughter) - focus on here and now (next week)
    *
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34
Q

Dysfunctional Congntions

A
  1. Automatic thoughts (rapid responses
  2. Maladaptive schemas (i.e. “I will never succeed”)
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35
Q

10 Common Automatic Cognitive Distortions

A

Jammed Slop

  1. Jumping to conclusions
  2. All or nothing thinking
  3. Magnifying/minimising
  4. Mental filter
  5. Emotional reasoning
  6. Discounting the positive
  7. ‘Shoulds’
  8. Labeling
  9. Overgeneralization
  10. Personalisation
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36
Q

Formula for Anxiety

A

(Perceived probability of event X Perceieved severity of event) / Perceived ability to cope

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37
Q

DBT Skill Modultes

A
  1. Mindfulness
  2. Interpersonal effectiveness
  3. Distress tolerance
  4. Emotion regulation
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38
Q

IPT Uses

A

Adjunctive treatment in Bipolar disorder (combine with social rhythm therapy)

Treatment for MDD, bulimia, and dysthymia

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39
Q

Define: pseudocyesis

A

Patient who is not pregnant shows signs and symptoms of pregnancy, including abdominal distension, breast enlargement, pigmentation, cessation of menses, and morning sickness.

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40
Q

Define: Adynamia

A

Weakness and fatigability

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41
Q

Define: acathexis

A

lack of feeling associated with an ordinarily emotionally charged subject

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42
Q

Define: alexithymia

A

Inability/difficulty describing or being aware of emotions/mood

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43
Q

Define: sundowning

A

Syndrome in older people, often at night, characterized by drowsiness, confusion, ataxia, and falling; overly sedated with medications

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44
Q

Define: coprophagia

A

eating of feces

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45
Q

Define: polyphagia

A

pathological overeating

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46
Q

Differentiate between:

  1. Circumstantiality
  2. Tangentiality
  3. Flight of Ideas
  4. Loosening of associations
  5. Pressure of speech
A
  1. Circumstantiality -indirect, but reaches the point
  2. Tangentiality - indirect, but never reaches point
  3. Flight of Ideas - constant shifting between ideas, sometimes able to follow
  4. Loosening of associations - unrelated shifting between ideas, can reach incoherence
  5. Pressure of speech - rapid speech and difficult to interrupt
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47
Q

Differentiate between:

  1. Tactile Hallucination
  2. Somatic Hallucination
A
  1. Tactile: False perception of touch or surface sensation (i.e. phantom limb, formication)
  2. Somatic: false sensation of thins in or to the body (usually visceral in origin)
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48
Q

Differentiate between:

  1. Depersonalization
  2. Derealization
A
  1. A person’s subjective sense of being unreal, strange, or unfamiliar
  2. A subjective sense that the environment is strange or unreal; a feeling of changed reality
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49
Q

Differentiate between:

  1. Thought broadcasting
  2. Throughs of inference
A
  1. Thought broadcasting:
  2. Throughs of inference
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50
Q

DSM 5 Criteria for Depressive Episode

A

5 of the following, including at least one of the first two, for at least 2 weeks and cause FUNCTIONAL IMPAIRMENT

  1. Depressed mood
  2. Anhedonia
  3. Sleep distrubances
  4. Feelings of guilt/worthlessness
  5. Energy low
  6. Poor concentration
  7. Increased/decreased appetite/weight
  8. Psychomotor slowing
  9. Suicide ideation
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51
Q

DSM 5 criteria for manic episode

A

At least 1 week of 3 the following, plus the first 1 (or 4 plus the first one, if mood is irritible); and cause FUNCTIONAL IMPAIRMENT:

  1. Abnormally persistent expansive, elevated or irritible mood
  2. Distractibility
  3. Insomnia
  4. Grandiose delusion
  5. Flight of ideas
  6. Activity focused/goal oriented
  7. Speech pressured
  8. Thoughtlessness (high risk activities with consequences)
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52
Q

DSM 5 criteria for mixed episode

A

Criteria is fully met for manic and depressive episode, minimum 1 week.

NOTE: like mania, a psychiatric emergency

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53
Q

Differences between Manic and Hypomanic Episodes

A

Mania

  • _>_7 days
  • Functional impairment
  • Requires hospitalization
  • Possible psychosis

Hypomania

  • > 4 days
  • No functional impairment
  • Does not require hospitalization
  • No psychosis
54
Q

Medical causes of mania (5)

A
  1. MS
  2. Temporal lobe seizures
  3. Hyperthyroidism
  4. Neoplasms
  5. HIV Infections

MoNaSH - T

55
Q

DSM IV diagnostic criteria for Major Depressive Disorder

A

_>_1 depressive episode and no history of manic or hypomanic episodes

56
Q

Serotonin Syndrome Symptoms (3)

A
  1. autonomic instability
  2. hyperthermia
  3. seizures/confusion
  4. muscle rigidity

Too much serotonin… I think… fml.

57
Q

SSRI Side Effect Profile

A

Mostly mild:

  1. Headache
  2. GI intolerance
  3. Sexual dysfunction
  4. Rebound anxiety
58
Q

Psychotherapies

A
  1. CBT
  2. DBT
  3. IPT
  4. Dynamic psychotherarpy
  5. Family therapy
  6. Group therapy
59
Q

What is ECT?

A
  • A unilateral or bilateral induction of a generalized seizure lasting less than 1 minute
  • Atropine, followed by a muscle relaxant
  • About 8 treatments over 2-3 weeks, typical
  • Retrograde amnesia, gone after 6 months
  • Stimulants lower threshold for seizure, incase max dose given
60
Q

DSM IV Bipolar 1 Criteria

A

One bipolar or mixed episode +/- depressive episodes, hypomanic episodes, etc.

61
Q

Treatment for Bipolar Disorder

A
  1. Lithium
  2. Anti-convulsants (valporic acid, carbamazepine)
  3. Olanzapine (anti-psychotic)
62
Q

DSM IV criteria for Bipolar 2

A

No manic episode ever, but at least one hypomanic episode PLUS _>_1 depressive episodes

63
Q

Side effects of Lithium (13)

A
  1. Weight gain
  2. Tremor
  3. GI disturbances
  4. Fatigue
  5. Arrhythmias
  6. Seizures
  7. Goiter/hypothyroidism
  8. Leukocytosis (benign)
  9. Coma
  10. Polyuria
  11. Polydipsia
  12. Alopecia
  13. Metallic taste
64
Q

Dysthimic Disorder Diagnosis

A

Dysthymic disorder (DD) = 2 Ds

  • 2 years of depression
  • 2 listed criteria:
  1. Sleep disturbances
  2. Hopelessness
  3. Energy low
  4. Concentration low/difficulty deciding
  5. Appetite high or low
  6. Self-esteem low
  • Never asymptomatic for > 2 months
65
Q

DSM IV criteria for Cyclothymic Disorder

A
  1. Numerous episodes of hypomania and/or mild-moderate depressive episodes over 2 years
  2. Never symptom free for >2 months in 2 years
  3. No reported manic or depressive episodes
66
Q

General definition of a personality disorder

A

Pattern of behaviours that differ from one’s culture plus:

  1. Cognition
  2. Affect
  3. Personal Relations
  4. Impulse Control

(CAPRI)

67
Q

Classify the clusters of personality disorders

A
  1. Cluster A: Mad/Psychotic
    • Schizoid
    • Schizotypal
    • Paranoid
  2. Cluster B: Bad/Mood
    • ​​Borderline Personality
    • Anti-social
    • Histrionic
    • Narcissitic
  3. Cluster C: Sad/Anxiety
  • Avoidant
  • Dependent
  • Obsessive Compulsant
68
Q

DSM IV Criteria for Paranoid Personality Disorder

A

A general distrust beginning by early adulthood
and present in different contexts + > 4 of the following:
1. Suspicion (without evidence) that others are exploiting or deceiving him or her
2. Preoccupation with doubts of loyalty or trustworthiness of acquaintances
3. Reluctance to confide in others
4. Interpretation of benign remarks as threatening or demeaning
5. Persistence of grudges
6. Perception of attacks on his or her character that are not apparent to others; quick to counterattack
7. Recurrence of suspicions regarding fidelity of spouse or lover

69
Q

Differentiate between paranoid personality disorder and paranoid schizophrenia

A

PPD do not have fixed delusions and psychosis is only transient and under stress

70
Q

DSM IV criteria for Schizoid Personality Disorder

A

Voluntary social withdrawal, restricted affect. + _>_4 of the following

  1. Not enjoying family or friend
  2. Solitary activities
  3. LIttle to no sex drive
  4. Anhedonia
  5. Few friends/if any
  6. Indifference to praise or criticism
  7. Emotional coldness, detachment, or flattened affect
71
Q

Differentiate between schizoid and avoidant personality disorders.

A

Schizoid PREFERS to be alone.

72
Q

DSM IV Schizotypal Personality Disorder

A

Social deficits related to magical thinking and eccentric behaviour + > 5 of the following:

  1. Ideas of reference (excluding delusions of reference)
  2. Odd beliefs or magical thinking, inconsistent with cultural norms
  3. Unusual perceptual experiences (such as bodily illusions)
  4. Suspiciousness
  5. Inappropriate or restricted affect
    * *6. Odd or eccentric appearance or behavior**
    * *7. Few close friends or confidants**
  6. Odd thinking or speech (vague, stereotyped, etc.)
  7. Excessive social anxiety
73
Q

Early signs of Anti-Social Personality Disorder

A
    1. Conduct disorder in childhood
  2. History of abuse (physical/sexual)
  3. History of hurting animals
  4. History of starting fires
  5. Violations of the law
74
Q

DSM IV criteria for Antisocial Personality Disorder

A
  • Disregard for others/rights since age 15, but diagnosis after age 18.
  • History consistent with conduct disorder
  • + _>_3 of the following:

  1. Unlawful non-conforming acts
  2. Deceitfulness/repeated lying/manipulating others for personal gain
  3. Impulsivity/failure to plan ahead
  4. Irritability and aggressiveness/repeated fights or assaults
  5. Recklessness and disregard for safety of self or others
  6. Irresponsibility/failure to sustain work or honor financial obligations
  7. Lack of remorse for actions
75
Q

DSM IV criteria for Borderline Personality Disorder

A
  • Impulsive or unstable relastionships/affect/self-image/behaviours
  • + _>_5 of the following:

(IMPULSIVE)

  1. I - impulsive x 2
  2. M- moody
  3. P - paranoid under stress
  4. U - unstable self image
  5. L - Labile relationships
  6. S - suicidal/self harm
  7. I - inappropriate anger
  8. V - vulnerable to abandonment
  9. E - emptiness
76
Q

DSM IV criteria for Histrionic

A
  • *Excessive emotionality and attention seeking + _>_5 of the following**
    1. Uncomfortable w/o attention
    2. Inappropriately seductive or provocative behavior
    3. Uses physical appearance to draw attention to self
    4. Has speech that is impressionistic and lacking in detail
    5. Theatrical and exaggerated expression of emotion
    6. Easily influenced by others or situation
    7. Perceives relationships as more intimate than they actually are

More functional and less depressed than BPD

77
Q

DSM IV criteria for Narcissistic Personality Disorder

A

_>_5 of the following

  1. Grandiosity
  2. Grandiose fantasies
  3. Can only associate with high-status individuals
  4. Needs excessive admiration
  5. Has sense of entitlement
  6. Takes advantage of others for self-gain
  7. Lack Empathy
  8. Envious or believes others are envious
  9. Arrogant or haughty
78
Q

DSM IV criteria for avoidant personality disorder

A
  • Avoidant, but desires relationships, absolute fear of rejection
  1. Avoids work with interpersonal contact
  2. Avoid uncertain interactions
  3. Cautious of intrapersonal relationships
  4. Preoccupied with social rejection
  5. Inhibited in new social situations
  6. Believes they are socially inferior/inept
  7. Reluctant in new activities due to embarrassment
79
Q

DSM 5 criteria for Delerium

A
  1. Change from baseline
  2. Short time line +/- prodromal
  3. Disturbance in cognitive
  4. Not from pre-existing neurocognitive disorder
  5. Not due to other medical

INCLUDE SPECIFIERS: hyperactive (agiation) or hypoactive

80
Q

Vascular Dimentia features

A
  1. stepwise decline in cognition (multpile infarcts) or more gradual (small vessel ischemia)
  2. Frontal lobe = emotional lability
81
Q

2 variants of Fronto-Temporal Dementia & features

A
  1. Behavioural variant
      1. Language variants
    • i.e. Difficulty remebering words, but remember function
82
Q

The most affected neurotransmitter deficiency in Alzheimer’s Disease

A

Acetylcholine

83
Q

If patient is not oriented, which is better: MMSE or MOCA?

A

MMSE

The MOCA is more complicated, but the MMSE does not test executive function (have them do a clock)

84
Q

Give me the profile for one atypical anti-psychotic

A

Risperidone

  • Initial dose 1-2 mg PO daily
  • Titrate up 1-2 mg PO per day
  • Maximum dose 6 mg PO daily
  • Thereapeutic dose
85
Q

Treatment for Alzhimer’s

A
  • Rivastigmine
  • Donepezil
  • Galantamine (contraindicated with asthma, bradycardia, active ulcers)
86
Q

DSM 5 criteria for Dependent Personality Disorder

A
  • Submissive, clingy, desperately relationship seeking
  • 5 of the following:
  1. Difficulty deciding without reassurance
  2. Needs others to take responsibility for Pt
  3. Fear prevents disagreement
  4. Difficulty initiating projects, because of lack of confidence
  5. Excessively seeks support
  6. Helpless when alone
  7. Serial approach to relationships
  8. Fear of taking care of self
87
Q

DSM 5 criteria for OCPD

A
  • Patient is inflexible, focused, and detail oriented, preventing task performance in time
  • FOUR or more of the following
  1. Detail/rule focused
  2. Detrimental perfectionism
  3. Excessive devotion to work
  4. Excessive attention to ethics
  5. Inability to delegate
  6. Unable to discard worthless objects
  7. Miserly (selfish with objects)
  8. Rigid and stubborn

Lambert

88
Q

Types of Anxiety Disorders

A
  1. Generalized Anxiety Disorder
  2. Social Anxiety Disorder
  3. Separation Anxiety Disorder
  4. Selective Mutism
  5. Post Traumatic Stress Disorder
  6. Specific Phobia
  7. Panic Disorder
  8. Agoraphobia
    9.
89
Q

Define: Panic Attack

A

Intense fear & discomfort + _>_4 of the following:

  • Palpitations
  • Abdominal distress
  • Numbness, nausea
  • Intense fear of death
  • Choking, chills, chest pain,
  • Sweating, shaking, shortness of breath
90
Q

DSM IV criteria for Panic Disorder

A
  • Attack with no obvious trigger + minimum 1 month of _>_1 of the following
  1. Persistent concern of next attack
  2. Worry about the implications of attacks (“Am I out of control?”)
  3. Change in behaviour because of attacks
91
Q

DSM IV criteria for Agoraphobia

A
  1. Anxiety for situations difficult to escape or will be without help for a panic attack
  2. Avoid, endure with severe distress, or bring a companion to these situations
  3. Not better explained by another mental disorder
92
Q

DSM IV criteria for Specific Phobias

A
  1. ​Persistent excessive fear of specific
  2. Anxiety with exposure
  3. Patient recognizes that the fear is excessive
  4. Avoidance or tolerance with intense anxiety
  5. Under 18, duration must be at least 6 months
93
Q

DSM IV criteria for PTSD

A

1 month or more of all of the following:

  1. Trauma (potentially harmful + intense fear)
  2. Persistent reexperiencing of the event
  3. Avoidance of triggers or difficulting recalling event
  4. Decreased affect/feeling detached
  5. Persistent increased arousal
94
Q

DSM IV criteria for GAD

A

Persisten worry about normal daily stuff, for more than 6 months, plus _>_3 of the following:

  1. Concentration poor
  2. Restlessness
  3. Irritable mood
  4. Muscle tension
  5. Energy low
  6. Insomnia
95
Q

DSM IV criteria for Adjustment Disorder

A
  1. Sx’s within 3 months of stress and resolved within 6 months of resolution of stressor
  2. Either excess distress or significant loss of function
  3. Sx’s are not bereavement
96
Q

DSM IV criteria for substance abuse

A

(using substances badly) A pattern leading to impairment or distress for _>_1 year with _>_1 of the following:

  1. Unmet obligations
  2. Dangerous use
  3. Related legal problems
  4. Continued use despite problems
97
Q

DSM IV criteria for dependence

A
  • Impairment or distress manifested for _>_1 year with _>_3 of the following:
  1. Tolerance
  2. Withdrawal
  3. Using more than intended
  4. Desire or unsuccess to cut back
  5. Time spent using/recovering
  6. Use despite problems
98
Q

CAGE Questions

A
  1. Have you ever felt the need to cut back your drinking?
  2. Have you ever felt annoyed by criticism about your drinking?
  3. Have you ever felt guilty about your drinking?
  4. Have you ever had a drink as an ‘eye opener’?
99
Q

Blood Alcohol of a drunk person

A

>150mg/dL or 0.15mg% causes obvious signs of intoxication in 50% of adults

100
Q

What does Thiamine prevent?

A

Wernickles’

101
Q

Time line of Alcohol withdrawal

A
  • Onset 6-24 hours
  • Lasts 2-7 days
    *
102
Q

Severity of Alcohol Withdrawal

A
  1. Mild: Irritability, tremor, insomnia
  2. Moderate: Diaphoresis, fever, disorientation
  3. Severe: Grand mal seizures, DTs
103
Q

Wernickle’s Encephalopathy

A
  1. Ataxia
  2. Confusion
  3. Ocular abnormalities (nystagmus, gaze palsies)
104
Q

Korsakoff’s Syndrome

A
  1. Impaired recent memory
  2. Anterograde amnesia
  3. +/− Confabulation
105
Q

Effects of Cocaine Intoxication

A
  1. Death (2nd to arrhythmia, seizure, or respiratory depression)
  2. Euphoria
  3. Hallucinations (tactile)
  4. Hyper or hypotension
  5. Brady or tachycardia
  6. Nausea
  7. Dilated pupils
  8. Weight loss
  9. Agitation/Depression
  10. Chills/sweating
106
Q

Cocaine Intoxication & Dependence & Withdrawal Treatment

A

Intoxication
1. Mild-Mod: Benzodiazepines
2. Severe: Haliperidol
+ Symptomatic support

  • *Dependence:**
    1. Psychotherapy, group therapy
    2. Tricyclic antidepressants (TCAs)
    3. Dopamine agonists (amantadine, bromocriptine)

Withdrawal

… just let them sleep it off, since they’re crashing…

107
Q

PCP intoxication symtoms

A
  1. Rotary nystagmus
  2. Impulsivity
  3. Hypertension/tachycardia
  4. Muscle rigidity
  5. Pain tolerance
108
Q

Gamma-hydroxybutyrate

A

(GHB, “Grievous Bodily Harm”)

  • Dose specific CNS depressant
  • Memory loss
  • Respiratory distress
  • Coma

Treat with activated charcol (prvent more GI absorption)

109
Q

Opioid Overdose

A
  1. Respiratory depression
  2. Altered mental status
  3. Miosis

“Rebels Admire Morphine”

110
Q

Opiate Withdrawal Symptoms

A
  1. Dysphoria
  2. Insomnia,
  3. Lacrimation, rhinorrhea
  4. Yawning
  5. Weakness
  6. Sweating, piloerection,
  7. Nausea/vomiting
  8. Fever
  9. Dilated pupils
  10. Muscle pain
111
Q

DSM IV criteria for Binge Eating Disorder

A
  • Excessive eating within a 2 hour time at least 2/week for at least 6 months
  • Done without compensatory behaviour (i.e. purge)
  • Severe stress with over-eating
  • Must have 3 of the following:
    1. Eating very rapidly
    2. Eating to be uncomfortable full
    3. Eat when not hungry
    4. Eating in insolation out of embarassment
    5. Guilt, depressed, or disgusted about overeating
      6.
112
Q

DSM IV criteria for Bulimia Nervosa

A
  • Over eating with compensation (i.e. purge, exercise, laxatives)
  • 2/week for at least 3 months
  • Perception of self-worth is heavily influenced by body weight
113
Q

DSM IV criteria for Anorexia Nervosa

A

Acutally requires low body weight. Criteria:

  1. 15% below average body weight
  2. Amenorrhea
  3. Intnese fear of gaining weight/fat
  4. Disturbed body image
114
Q

What are the major risks of Clozapine?

A
  • 2-3% risk of seizures
  • 0.5-2% risk of agranulocytosis
115
Q

When should blood work be taken for a patient taking clozapine?

A

CBC diff

  • 1/week for 6 stable months
  • 1/2 weeks for 6 stable months
  • Monthly therafter
116
Q

Bio-psycho-social considerations for Schizophrenia

A
  1. Bio
    1. Continue antipsychotic for 1-2 years
    2. Monitor AIMS (EPS symptoms)
    3. Monitor Metabollic sypmtoms
    4. Monitor CBC-Diff
  2. Plan G
    1. Family Doctor
  3. Psycho
    1. CBT when not acute
    2. Family education, support, and involvement
  4. Social
    1. Housing
    2. Independent living strategies (OT)
    3. Substance avoidance
117
Q

Drugs for Opiate Withdrawal

A
  1. Clonidine
  2. and/or Buprenorphine
  3. Severe cases: taper with methadone 7 days
118
Q

Lithium Toxicity

A

4 days of nausea, vomiting, and diarrhea. On examination she is tremulous and weak. She seems somewhat confused and cannot recall what medication she is on.

Activated charcol not helpful.

119
Q

L

A
120
Q

Lithium has a narrow therapeutic range with a target serum concentration between __ and __. GI side effects and tremor start at __, while seizure, coma, and death can occur with concentrations greater than __.

A

0.6 and 1.2; 1.5; 2.5.

121
Q

Which of the atypical antipsychotics has the lowest associated risk of inducing EPS?

A

clozapine

122
Q

What percentage of patients with schizophreniform disorder go on to develop schizophrenia or schizoaffective disorder?

A

66%

123
Q

Depressive symptoms are present in what percentage of the older adult community?

A

15%

124
Q

A patient with dementia who presents with memory impairment, executive dysfunction, visual hallucinations and Parkinsonian symptoms is most likely to have which type of dementia?

A

Lewey body dimentia

125
Q

Some TCA side effects

A

Blurred vision, dry mouth and sedation

126
Q

Some SNRI side effects

A

Increased blood pressure, increased heart rate, irritability

127
Q

The amino acid, L-tryptophan, is the precursor to which neurotransmitters?

A

Serotonin

128
Q

A 19 year old male is brought to the emergency by his distraught parents for vomiting and profuse diarrhea. On arrival, his pupils are dilated. He has cold and sweaty extremities with goose flesh. His BP is 175/ 105 and his muscles are twitching. His parents report that these symptoms started 2 hours earlier. For the past two days, he has been house bound due to a fractured ankle. He has become increasingly anxious and agitated during the period. He is constantly yawning and has a runny nose. What is the most likely drug that this man is withdrawing from?

A

Heroine

129
Q

A 25 year old male is brought to the emergency by his distraught parents because they found their son on the floor with an assortment of pills and bottles around him. The patient is stuporous and his eyes are constricted. His breathing is slow, shallow and infrequent. While on the way to the emergency, he had a grand mal seizure. What drug did he most likely overdosed on?

A

An opiate (merpidine..?)

130
Q

A 13-year-old girl was brought into the emergency department for bizarre behaviour by the police. She complains of “hearing colours and seeing sounds.” She feels that she is going “crazy.” On examination she has tachycardia, hypertension and has mydriasis. She thinks it might be due to the white tabs her boyfriend gave her 1 hour ago at a rave party. Which of the following substances did she most likely consume?

A

LSD

Peaks at 4 hours, clears in 12 hours

Medical School (12 decks)

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