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Master the Boards > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

HY symptoms of depression

A

anhedonia
weight changes
sleep changes
poor concentration

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2
Q

first line agent in depression

A

SSRI ALONE (without any other antidepressants)

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3
Q

2 exceptions to SSRI use in depression

A
  1. depression + NEUROPATHIC PAIN
  2. depression +….
    - fearful of weight gain
    - sexual SE’s
    - smoker trying to quit
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4
Q

tx depression + NEUROPATHIC PAIN

A

DULOXETINE

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5
Q

tx depression +….

  • fearful of weight gain
  • sexual SE’s
  • smoker trying to quit
A

BUPROPION

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6
Q

choice of SSRI + antidepressant in depression

A

WRONGGGGGGG!!!!!

choose the cleanest= SSRI on its own

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7
Q

tx mild depression + sleep problems

A

MIRTAZAPINE,

since= antidepressant + sedative

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8
Q

what to exclude with presentation of mania

A

COCAINE and AMPHETAMINE use….

thus hx and toxicology

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9
Q

first line tx acute mania

A

LITHIUM

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10
Q

PC: 33yo man, brought to emergency room, bipolar, recently started on lithium, combative and punches nurse on the mouth. what’s the next best mgmt

A

ADEQUATE TX> admission to psychiatric unit;

ANTIPSYCHOTICS= first line tx

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11
Q

tx acute mania with severe symptoms

A

atypical antipsychotics

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12
Q

tx dysthymia

A

antidepressant meds + psychotherapy

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13
Q

tx atypical depression

A

MAOIs = usually the correct answer

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14
Q

seasonal affective disorder

A

phototherapy– 12-18 inches from source of 10,000 lux of white fluorescent light without UV wavelengths for 30 minutes each morning; eyes open, but don’t necessarily stare at the light

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15
Q

tx of normal bereavement

A

PSYHCOTHERAPY

never never never pharmacology

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16
Q

exception to strict diagnosis of major depressive disorder (5/9 for >6months, for 2 weeks)

A

if the symptoms are SEVERE ENOUGH

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17
Q

emergency situation of psychosis tx

A

IM atypical antipsychotic> haloperidol

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18
Q

tx of schizophrenia with psychotic episode, that is unresponsive to typical ro atypical antipsychotics

A

CLOZAPINE

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19
Q

avoid olanzapine in…

A

diabetics

obese patients

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20
Q

big SE of risperidone

A

MOVEMENT disorders

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21
Q

benefit of quetiapine

A

lower incised of movement disorders; thus ok to use in pots with movement disorders

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22
Q

avoid ziprasidone in patients with…

A

conduction defects since prolongs QT interval

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23
Q

clozapine monitor

A

CBC, since high risk of agranulocytosis

NEVER THE FIRST LINE TREATMENT

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24
Q

ariprazole use

A

ADJUNCT+ for major depressive disorer

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25
Q

only antipsychotic that can be used in pregnancy

A

lurasidone

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26
Q

LEAST likely drug to cause weight gain and diabetes in schizophrenia

A
  1. ARIPRAZOLE

2. ZIPRASIDONE

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27
Q

timing of movement side effects with antipsychotics…

HOURS–DAYS

A

ACUTE dystonia

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28
Q

tx of acute dystonia

A

benztropine
trihexyphenidyl
diphenhydramine

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29
Q

timing of movement side effects with antipsychotics…

WEEKS

A

AKATHASIA

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30
Q

tx of akathasia

A

DECREASE dose
beta blockers
switch to atypical antipsychotics
benzodiazepine

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31
Q

timing of movement side effects with antipsychotics…

GREATER THAN 6 MONTHS

A

tardive dyskinesia

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32
Q

tx of tardive dyskineasia

A

switch to atypical antipsychotics

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33
Q

LOWEST RISK OF tadive dyskinesia

A

CLOZAPINE

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34
Q

PC delusional disorder

A 
NON-bizarre delusions
NO impairment of functioning
- still obeys law
- goes to work
- pays bills

> 1 month

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35
Q

tx of manic disorder– PSYCHOTIC FEATURES and AGITATION

A

ANTIpsychotics> lithium;

because RAPID action

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36
Q

PC panic attack

A

patient is presenting with autonomic hyperactivity

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37
Q

Tx panic attack

A

benzodiazepines: lorazepam, clonazepam, aprazolam

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38
Q

PC pain disorder

A

patient is giving you STORY/HISTORY of these symptoms

4+ autonomic hyperactivity,

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39
Q

Tx panic disorder

A

SSRI’s

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40
Q

tx of phobias

A

behavioural modification

and relaxation techniques

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41
Q

tx of performance anxiety– stage fright

A

BETA BLOCKERS; 30-60minutes before performance

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42
Q

tx of OCD

A

SSRIs

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43
Q

tx of OCD, when all the options are TCAs

A

CLOMIPRAMINE

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44
Q

tx of hoarding disorders

A

1: SSR’s

can also do behavioural mod or psychotherapy–CBT

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45
Q

what to exclude in diagnosis of PTSD

A

substance abuse— since will worsen the diagnosis

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46
Q

first line treatment for PTSD

A

paroxetine and sertraline

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47
Q

other tx options for PTSD

A

relaxation techniques

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48
Q

tx of GAD

A

1st line: SSRs

  1. venlafaxine
  2. buspirone
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49
Q

panic disorder vs. GAD

A

panic disorder: 30 minutes of symptoms

GAD: chronicity of symptoms >6months; constantly worried

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50
Q

lorazepam use

A

IM injection, thus EMERGENCY situations

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51
Q

clonazepam use

A

LONG HALF LIFE– if worried about addiction–

LOW addiction

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52
Q

chlordiazepoxide use

A

alcohol withdrawal

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53
Q

oxazepam use

A

alcohol withdrawal a/w LIVER problems

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54
Q

lorazepam non-emergency use

A

alcohol withdrawal a/w LIVER problems

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55
Q

alprazolam use

A

panic disorder and panic attack

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56
Q

flurazepam use

A

hypnotic (rarely used)

57
Q

temazepam use

A

hypnotic (rarely used)

58
Q

triazolam use

A

hypnotic (rarely used)

59
Q

tx of somatic symptom disorders=

somatoform disorders

A

PSYCHOTHERAPY

60
Q

PC: patient inflicts life-threatening injury on themselves

A

in order to get attention… thus FACTITIOUS DISORDER

61
Q

caretaker fakes signs and symptoms on another person (usually a child)

A

= factitious disorder IMPOSED on others

62
Q

signs and symptoms fakes on oneself

A

= factitious disorder IMPOSED on self

63
Q

how does a man with factitious disorder present

A

PHYSICAL symptoms

64
Q

typical PC of factitious disorder

A

WOMAN

hx of working in HEALTHCARE

65
Q

dx of factitious disorder

A

MUST confirm by excluding legitimate medical illness

66
Q

tx of factious disorder

A

NO TREATMENT proven to bed effective

- with child–> child protective services

67
Q

malingering

A

DOES NOT = MENTAL ILLNESS
PRISONERS/ MILITARY
typically when DISCREPANCY between patients complaints and physical/lab findings
DO NOT COOPERATE

68
Q

tx of acute alcohol intoxication thats severe

A

mechanical ventilation

69
Q

tx of alcohol withdrawal

A

long acting benzos
B1
folate

70
Q

PC: drugs- constricted pupils

A

opiod intoxication

71
Q

PC: drugs- dilated pupils, lacrimation, yawning

A

opiod withdrawal

72
Q

mgmt opiod withdrawal

A

methadone
buprenorphine
clonidine

73
Q

PC: drugs- seizures

A

bento’s OR cocaine or PCP

74
Q

PC: drugs- poor sleep and depression and anxious

A

withdrawal from benzo’s

75
Q

PC: drugs- dilated pupils and sweating, and hypertensive

A

amphetamines intoxication

76
Q

PC: drugs- increase appetite and sedated

A

amphetamines withdrawal

77
Q

tx of amphetamines and cocaine withdrawal

A

bupropion and bromocriptin

78
Q

tx of amphetamines and cocaine intoxaication

A

benzo’s
blood pressure mgmt– ALPHA blockers
antipsychotics

79
Q

withdrawal mgmt of nicotine

A

buproprion

varenciline

80
Q

PC: drugs- nystagmus and ataxia

A

PCP intoxication

81
Q

PC: drugs- VIOLENT behaviour

A

PCP intoxication

82
Q

tx of PCP intoxication

A

bento’s and antisychotics (rapid)

83
Q

PC: drugs- angry, tired, depressed

A

PCP withdrawal

84
Q

PC: drugs- euphoria and hallucinations

A

LSD intoxication

85
Q

any withdrawal from LSD or marijuana or inhalants

86
Q

PC: drugs- conjunctival injection

87
Q

2 synthetic cannabis

A
  1. K2

2. spice

88
Q

PC: drugs- irritable, signs of psychosis, and mania

A

ANABOLIC STEROIDS

89
Q

withdrawal from anabolic steroids

A

depression/anxious/headache/

concern over physical appearance

90
Q

PC: drugs- belligerent, apathetic, aggressive, STUPOR–>COMA

91
Q

tx of inhalant use

A

antipsychotics

92
Q

similarities in anorexia and bulimia

A

purging
fasting
laxative and diuretic abuse
XS exercise

93
Q

age of anorexia vs. bulimia

A

younger in anorexics

94
Q

premorbid hx for bulimia

A

obesity before

95
Q

mgmt of anorexia

A
  1. hospitalization for dehydration/electro disturbances
  2. psychotherapy
  3. SSRI’s
96
Q

mgmt of bulimia– need hospitalization

A

NOOOOOO
psychotherapy
SSRI’s

97
Q

tx of binge eating disorder

A

topiramate

psychotherapy: CBT, DBT, interpersonal

98
Q

eating disorder not other wise specified

A

anorexia criteria– BUT PERIOD NORMAL
anorexia criteria– BUT WEIGHT NORMAL
compensatory behaviour– BUT NORMAL AMOUNTS FOOD

99
Q

step 1 drug choice for anorexia

A

mirtazapine– since cures depression, and makes them gain weight

100
Q

tx of choice in narcolepsy

A

modafinil

and forced naps during the day

101
Q

specific features of narcolepsy

A
  1. sleep attacks
  2. cataplexy
  3. hypnogogic and hypnopompic hallucinations
  4. sleep paralysis
102
Q

sleep attacks

A

episodes of IRRESISTIBLE sleepiness and feeling refreshed upon awakening

103
Q

caaplexy

A

sudden loss of muscle tone

104
Q

sleep paralysis

A

patient is AWAKE but unable to move– typically occurs upon wakening

105
Q

tx of sleep apnea

A

nasal CPAP
weight loss
corrective surgery
AVOID– sedatives and alcohol which WORSEN condition

106
Q

tx of insomnia

A

sleep hygiene techniques

non-benzo’s

107
Q

sexual identity

A

based on persons secondary SEXUAL characteristics

108
Q

gender identity

A

sense of maleness or femaleness– established by 3yo

109
Q

gender role

A

based on EXTERNAL patterns of behaviour that reflect inner sense of gender identity

110
Q

sexual orientation

A

choice of love

111
Q

nb thing about patient with SUICIDAL IDEATION

A

take them all seriously and HOSPITALIZE the patient

112
Q

impotence tx

A

EXCLUDE medical or medication causes
psychotherapy
couples sexual therapy

113
Q

premature ejaculation

A
  1. psychotherapy
  2. behavioural modification– stop and go, squeeze
  3. SSRI’s
114
Q

genitopelvic pain disorder

A

= dyspareunia,

tx- psychotherapy

115
Q

penetration disorder

A

= vagnismus– involuntary constriction of outer third of vagina preventing penile insertion

116
Q

paraphilic disorders

A

RECURRENT sexual arousing, mc in men, focusing on HUMILIATION, nonconsenting partners or use f non living objects, must occur for GREATER than 6 months and cause distress and poor level functioning

117
Q

exhibitionism

A

recurrent urge to expose oneself to strangers

118
Q

fetishism

A

recurrent use of non living objects to achieve sexual pleasure

119
Q

masochism

A

recurrent urge or behaviour in HUMILIATING acts

120
Q

sadism

A

recurrent urge or behaviour involving physical or psychological suffering of victim is exciting

121
Q

transvestic fetishism

A

recurrent urge or behaviour in cross dressing

122
Q

frotteurism

A

rubbing, usually ones pelvis or erect penis against a nonconsenting person for sexual gratification

123
Q

tx of paraphilias

A

psychotherapy
behavioural modification
antiandrogens or SSRIs to decrease sexual drive

124
Q

gender dysphoria

A

gender identity disorder– persistent discomfort and sense of inappropriateness regarding patients assigned sex

125
Q

mental retardation = intellectual disability

A

DEFECTIVE intellectural function AND SOCIAL adaptive functioning

126
Q

tx for intellectual disability

A

GENETIC COUNSELING

127
Q

autism spectrum disorders has replaced

A

autim, retts, aspergers

128
Q

age of autism

129
Q

timing with ADHD

A

GREATER than 6 months before the age of 7

130
Q

2 areas dx of ADHD

A

HOME and SCHOOL

131
Q

FIRST LINE TX ADHD– STEP 2CK

A

atomoxetine (since side effects of other tx)

132
Q

oppositional defiant

A

argue and lose temper
problems with AUTHORITY
DO NOT BREAK RULES

133
Q

tx oppositional defiant

A

less oppositional behaviour and clinical mgmt. skills for parents

134
Q

conduct disorder

A

less than 18yo,

persistently break rules, bully, cruelty, crimes, vandalism

135
Q

tx conduct disorder

A

behavioural intervention– rewards for prosocial and nonaggressive behaviour

aggression–> antipsychotic

136
Q

DMDD= disruptive mood dysregulation disorder AGE

A

boys 6-10yo, NOT BEFORE 6 or AFTER 10yo

137
Q

more likely to develop with DMDD…

A

bipolar
depression
anxiety

138
Q

DMDD symptoms

A

OUTBURSTS of anger
SADNESS in between,
occurring every day–noticeable to others, out of proportion; NEVER SYMPTOM FREE FOR >3MONTHS

139
Q

tx DMDD

A

individual therapy

may need meds for specific symptoms

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