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STEP > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

operant conditioning

A

Learning in which a particular action is elicited because it produces a punishment or reward. Usually deals with VOLUNTARY responses.

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2
Q

mature defense mechanisms

A

SASH - sublimation, altruism, suppression, humor

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3
Q

schizophrenia risk - 1) general population 2) parent or sibling of someone affected 3) monozygotic twin

A

1%,10%,50%

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4
Q

Infant deprivation effects

A

1) FTV
2) poor language/socialization skills
3) lack of basic trust
4) reactive attachment disorder (infant withdrawn/unresponsive to comfort)
The 4 W’s: Weak, wordless, waning, wary.

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5
Q

epidemiology of physical abuse in kids

A

40% of deaths in children

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6
Q

peak incidence of sexual abuse in kids

A

9-12 years old

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7
Q

ADHD onset

A

Before age 12.

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8
Q

ADHD treatment and alternatives

A

1) stimulants (methylphenidate)
2) +/- CBT
3) atomoxetine, guanfacine, clonidine

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9
Q

ASD association

A

increased head/brain size

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10
Q

ASD presentation

A

Usually in early childhood.

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11
Q

percent of patients with ADHD that go on to adult ADHD

A

50%

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12
Q

ADHD physical association

A

decreased frontal lobe volume/metabolism

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13
Q

conduct disorder treatment

A

CBT

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14
Q

antisocial personality disorder treatment

A

CBT

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15
Q

oppositional defiant disorder treatment

A

CBT

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16
Q

separation anxiety disorder treatment

A

CBT, play therapy, family therapy

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17
Q

common onset of separation anxiety disorder

A

7-9 years

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18
Q

Tourette’s onset

A

Before age 18.

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19
Q

magic number for tourette’s

A

symptoms longer than 1 year

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20
Q

incidence of coprolalia in tourette’s

A

10-20%

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21
Q

tourettes associations

A

OCD + ADHD

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22
Q

Tourette’s treatment

A

psychoeducation + behavioral therapy

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23
Q

Treatment for intractable tics

A

low-dose high-potency antipsychotics (e.g, fluphenazine, pimozide) + tetrabenazine + clonidine

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24
Q

rett syndrome presentation

A

loss of development + loss of verbal abilities + ID + ataxia + stereotyped hand-wringing

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25
Q

neurotransmitter changes in Anxiety

A

increase in NE, decrease in GABA + 5-HT

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26
Q

neurotransmitter changes in depression

A

decrease in NE + dopamine + 5-HT

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27
Q

order of orientation loss

A

1st–time
2nd–place
3rd–person

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28
Q

dissociative amnesia

A

memory problems following severe trauma or stress

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29
Q

Findings in delirium

A

EEG abnormalities (as opposed to dementia, in which EEG is usually normal)

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30
Q

pseudodementia

A

depression + hypothyroidism. This is why you need to measure TSH + B12 levels.

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31
Q

dementia presentation

A

apraxia + aphasia + agnosia + loss of abstract thought + behavioral/personality chagnes + impaired judgment.

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32
Q

olfactory hallucinations. when do they happen?

A

usually in epileptics + brain tumors

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33
Q

gustatory hallucinations. when do they happen?

A

epileptics

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34
Q

formication

A

sensation of bugs crawling on one’s skin

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35
Q

schizophrenia magic number

A

6 months

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36
Q

schizophrenia diagnosis

A

requires at least 2 of following:

1) delusions
2) hallucinations
3) disorganized speech
4) disorganized or catatonic behavior
5) negative symptoms (flat affect, social withdrawal, lack of motivation, lack of speech or thought)

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37
Q

brief pyschotic disorder magic number

A

less than 1 month

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38
Q

schizophreniform disorder magic number

A

1-6 months

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39
Q

schizoaffective disorder magic number

A

> 2 weeks

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40
Q

lifetime prevalence of schizophrenia

A

1.5%

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41
Q

delusional disorder magic number

A

> 1 month

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42
Q

manic episode magic number

A

> 1 week

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43
Q

manic episode diagnosis

A

3 of DIGFAAST (FA 510)

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44
Q

hypomanic episode magic number + diagnostic criterion

A

4 consecutive days. No impairment in functioning.

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45
Q

cyclothymic disorder magic number

A

2 years

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46
Q

MDD magic number

A

6-12 months

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47
Q

MDD diagnosis caveat

A

Must include depressed mood or anhedonia

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48
Q

MDD treatment alternatives

A

SNRIs + mirtazapine + bupropion. ECT.

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49
Q

Peresistent depressive disorder (dysthymia) magic number

A

at least 2 years

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50
Q

changes in sleep stages during depression

A

decreased slow-wave sleep + decreased REM latency + increased REM early in sleep + increased Total REM sleep + repeated nighttime awakenings + early-morning awakening

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51
Q

terminal insomnia

A

early morning awakening

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52
Q

treatment for atypical depression

A

CBT and SSRIs are first line

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53
Q

most common form of depression

A

atypical

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54
Q

other features of atypical depression

A

long-standing interpersonal rejection sensitivity + mood reactivity (being able to experience improved mood in response to positive events, albeit briefly).

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55
Q

postpartum blues incidence

A

50-85%

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56
Q

postpartum blues onset

A

2-3 days after delivery

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57
Q

postpartum blues treatment

A

supportive + followup to assess for depression

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58
Q

postpartum depression incidence

A

10-15%

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59
Q

postpartum depression timeframe

A

within 4 weeks after delivery

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60
Q

postpartum psychosis incidence

A

0.1-0.2%

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61
Q

nonintuitive RF’s for postpartum psychosis

A

First pregnancy

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62
Q

postpartum psychosis treatment

A

Hospitalization + initiation of atypical antipsychotic. ECT if refractory.

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63
Q

Pathologic grief diagnosis + caveat

A

> 6 months + satisfies major depressive criteria. Hallucinations NOT pathologic grief.

64
Q

ECT indications

A

treatment-refractory depression + depression with psychotic symptoms + acutely suicidal patients.

65
Q

ECT contraindications

A

Grand-mal seizures in anesthetized patients.

66
Q

ECT AE’s

A

disorientation + headache + partial anterograde/retrograde amnesia usually resolving in 6 months.

67
Q

Panic attack diagnosis + Panic disorder diagnosis

A

at least 4 of PPANIICCCCSSS for attack + 1 month of at least 1 of following (persistent concern of additional attacks, worrying about consequences of attack, behavioral change related to attcks)

68
Q

Agoraphobia treatment

A

CBT + SSRIs + MAO inhibitors

69
Q

GAD magic number

A

at least 6 months

70
Q

adjustment disorder treatment

A

CBT + SSRIs

71
Q

adjustment disorder magic numbr

A

impairment in function + less than 6 months

72
Q

ego-dystonic

A

Feature of OCD. Behavior inconsistent with one’s own beliefs and attitudes.

73
Q

treatment for body dysmorphic disorder

A

CBT.

74
Q

Acute stress disorder magic number

A

Between 3 days and 1 month.

75
Q

Acute stress disorder treatment

A

CBT. Pharmacotherapy usually NOT indicated.

76
Q

malingering vs. somatic symptom disorder vs. factitious disorder

A

somatic – no conscious attempt to deceive.
factitious – chief goal is psychological (primary gain)
malingering – chief goal is external (secondary gain).

77
Q

munchausen syndrome

A

CHRONIC factitious disorder with predominately physical signs/symptoms. History of hospitalization and willingness to undergo invasive procedures.

78
Q

illness anxiety disorder

A

hypochondriasis

79
Q

personality disorders – A,B,C

A

“Weird, wild, worried”

80
Q

major defense mechanism in paranoid personality disorder

A

projection

81
Q

conduct disorder vs. antisocial personality disorder

A

conduct is if 18 years old.

82
Q

treatment for BPD

A

dialectical behavior therapy

83
Q

schizoid vs. avoidant

A

avoidant people desire relationships with people, unlike schizoid people.

84
Q

Obsessive-compulsive personality disorder vs. OCD

A

obsessive-compulsive is ego-syntonic (behavior consistent with one’s own beliefs and attitudes). OCD is ego-dystonic.

85
Q

anorexia magic number

A

less than 18.5

86
Q

Refeeding syndrome

A

Fluid and electrolyte disturbances following feeding, especially hypophosphatemia. Can occur in malnourished patients, such as anorexics.

87
Q

anorexia nervosa treatment

A

psychotherapy + nutritional rehabilitation are first line.

88
Q

bulimia nervosa magic number

A

3 months

89
Q

Russell sign

A

dorsal hand calluses from induced vomiting (seen in bulimia nervosa).

90
Q

paraphilia

A

intense sexual arousal to atypical objects, situations, or individuals. characteristic of transvestism.

91
Q

vaginismus

A

Discomfort resulting from involuntary vaginal muscle spasm, making penetration painful or impossible.

92
Q

drugs associated with sexual dysfunction

A

antihypertensives + neuroleptics + SSRIs + ethanol

93
Q

sleep phase in which sleep terror disorder occurs

A

slow-wave sleep

94
Q

hypocretin produced in

A

lateral hypothalamus (low in narcolepsy)

95
Q

cataplexy

A

loss of muscle tone (narcolepsy)

96
Q

sleep physiology in narcolepsy

A

episodes start with REM sleep

97
Q

narcolepsy treatment

A

Daytime – stimulants (amphetamines, modafinil).

Nighttime – sodium oxybate (GHB).

98
Q

substance abuse disorders caveat

A

at least 2

99
Q

opioid intoxication presentation

A

euphoria + respiratory/CNS depression + decreased GAG reflex + pupillary constriction

100
Q

benzo intoxication presentation

A

ataxia + minor respiratory depression

101
Q

amphetamines intoxication presentation

A

pupillary dilation + paranoia + fever

102
Q

cocaine intoxication presentation

A

pupillary dilation + hallucinations (including tactile) + paranoid ideations + angina + sudden cardiac death

103
Q

cocaine intoxication treatment

A

alpha-blockers + benzodiazepines

104
Q

DT mortality rate

A

5-15%

105
Q

opioid withdrawal presentation

A

sweating + dilated pupils + piloerection (“cold turkey”) + fever + rhinorrhea + yawning + nausea + stomach cramps + diarrhea (“flu-like” symptoms”)

106
Q

barbiturate withdrawal presentation

A

delirium + life-threatening cardiovascular collapse

107
Q

benzo withdrawal presentation

A

sleep disturbance + depression + rebound anxiety + seizures

108
Q

amphetamine withdrawal presentation

A

anhedonia + increased appetite + hypersomnolence + existential crisis

109
Q

cocaine withdrawal

A

hypersomnolence + malaise + severe psychological craving + depression/suicidality

110
Q

nicotine withdrawal treatment

A

bupropion + varenicline

111
Q

time frame of marijuana detection in urine

A

1 month

112
Q

marijuana withdrawal

A

irritability + depression + insomnia + nausea + anorexia.

113
Q

timeframe for marijuana withdrawal

A

Most symptoms peak in 48 hours and last for 5-7 days.

114
Q

when do you use naltrexone for opioid rehab?

A

relapse prevention once detoxified (it is long-acting).

115
Q

why does naloxone/buprenorphine have low abuse potential?

A

if injected, naloxone will precipitate withdrawal because of antagonism. When taken orally, naloxone isn’t orally bioavailable, so doesn’t have any antagonism.

116
Q

approach to management of alcoholism

A

1) naltrexone is first line and can be initiated while the individual is still drinking. It blocks rewarding and reinforcing effects of alcohol.
2) disulfiram only used in abstinent patients with strong motivation to maintain abstinence.

117
Q

ethyl glucuronide (EtG)

A

Commonly used biomarker to detect recent alcohol ingestion (metabolite of ethanol).

118
Q

onset of withdrawal in alcoholism

A

6-12 hours after individuals top or dramatically decrease alcohol intake

119
Q

DT timeframe, peaking…

A

2-4 days after last drink

120
Q

DT presentation

A

presentation = HTN (can be severe) + profound agitation + global confusion + disorientation + hallucinations + fever + diaphoresis + tachycardia

121
Q

alcoholic hallucinosis + timeframe

A

distinct condition from DT. visual hallucinations 12-48 hours after last drink.

122
Q

first-line for social phobias

A

SSRIs + beta-blockers

123
Q

high-potency antipsychotics + SE profile

A

(Try to Fly High P) –> Trifluoperazine, Fluphenazine, Haloperidol + pimozide
- neurologic side effects

124
Q

typical antipsychotics treat…

A

positive symptoms

125
Q

treatment for extrapyramidal side effects of typical antipsychotics

A

benztropine + diphenhydramine

126
Q

typical antipsychotics side effects (other than endocrine)

A
  • muscarinic blockade (dry mouth + constipation)
  • alpha 1 blockade (hypotension)
  • histamine blockade (sedation)
    QT prolongation
127
Q

NMS treatment

A

dantrolene + D2 agonists (bromocriptine)

128
Q

Low potency antipsychotics + SE profile

A

(Cheating Thieves) Chlorpromazine, thioridazine

- non-neurologic side effects (anticholinergic, antihistamine, alpha1 blockade)

129
Q

chlorpromazine unique side effects

A

corneal deposits

130
Q

thioridazine unique side effect

A

retinal deposits

131
Q

evolution of EPS side effects

A

4 hr –> acute dystonia (muscle spasm, stiffness, oculogyric crisis)
4 day –> akathisia (restlessness)
4 week –> bradykinesia (parkinsonism)
4 month –> tardive dyskinesia

132
Q

atypiacl antipsychotics

A

olanzapine + clozapine + quietiapine + risperidone + aripiprazole + ziprasidone

133
Q

clozapine SEs

A

agranulocytosis + seizure

134
Q

risperidone SE’s

A

may increase prolactin (causing lactation and gynecomastia, leading to decreased GnRH, LH, and FSH, causing irregular menstruation and fertility issues.

135
Q

lithium MOA

A

not established; maybe inhibition of phosphoinositol cascade.

136
Q

Lithium pharmacologic notes

A

1) narrow therapeutic window
2) almost exclusively excreted by kidneys
3) most reabsobred at PCT with Na+

137
Q

SSRIs

A

fluoxetine + paroxetine + sertraline + citalopram

138
Q

delay before SSRIs take effect

A

4-8 weeks

139
Q

serotonin syndrome presentation

A

hyperthermia + confusion + myoclonus + cardiovascular instability + flushing + diarrhea + seizures.

140
Q

drugs that cause serotonin syndrome

A

Anything that increases serotonin. MAOIs + SNRIs + TCAs + SSRIs

141
Q

diabetic peripheral neuropathy treatment

A

duloxetine

142
Q

imipramine

A

TCA

143
Q

doxepin

A

TCA

144
Q

amoxapine

A

TCA

145
Q

desipramine

A

TCA

146
Q

TCA mechanism

A

block reuptake of norepinephrine + 5-HT

147
Q

other indications for TCA’s

A

peripheral neuropathy + chronic pain

148
Q

amitriptyline

A

tertiary TCA (more anticholinergic side effects than secondary TCA’s)

149
Q

nortriptyline

A

secondary TCA

150
Q

TCA side-effects

A

convulsions + coma + cardiotoxicity + respiratory depression + hyperpyrexia + confusions and hallucinations in elderly (due to anticholinergic side effects)

151
Q

TCA to use in old people

A

nortriptyline

152
Q

MAOIs

A

tranylcypromine + phenelzine + isocarboxazid + selegeline

153
Q

MAOIs mechanism

A

MAO inhibition leads to inceased levels of amine neurotransmitters (NE + 5-HT + dopamine)

154
Q

MAOI contraindications

A

SSRIs + TCAs + St. John’s wort + meperidine + dextromethorphan (to prevent serotonin syndrome)

155
Q

trazodone indication

A

insomnia

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