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.
2
Q
mature defense mechanisms
A
SASH - sublimation, altruism, suppression, humor
3
Q
schizophrenia risk - 1) general population 2) parent or sibling of someone affected 3) monozygotic twin
A
1%,10%,50%
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4) reactive attachment disorder (infant withdrawn/unresponsive to comfort)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.
5
Q
epidemiology of physical abuse in kids
A
40% of deaths in children
6
Q
peak incidence of sexual abuse in kids
A
9-12 years old
7
Q
ADHD onset
A
Before age 12.
8
Q
ADHD treatment and alternatives
A
1) stimulants (methylphenidate)
2) +/- CBT
3) atomoxetine, guanfacine, clonidine
9
Q
ASD association
A
increased head/brain size
10
Q
ASD presentation
A
Usually in early childhood.
11
Q
percent of patients with ADHD that go on to adult ADHD
A
50%
12
Q
ADHD physical association
A
decreased frontal lobe volume/metabolism
13
Q
conduct disorder treatment
A
CBT
14
Q
antisocial personality disorder treatment
A
CBT
15
Q
oppositional defiant disorder treatment
A
CBT
16
Q
separation anxiety disorder treatment
A
CBT, play therapy, family therapy
17
Q
common onset of separation anxiety disorder
A
7-9 years
18
Q
Tourette’s onset
A
Before age 18.
19
Q
magic number for tourette’s
A
symptoms longer than 1 year
20
Q
incidence of coprolalia in tourette’s
A
10-20%
21
Q
tourettes associations
A
OCD + ADHD
22
Q
Tourette’s treatment
A
psychoeducation + behavioral therapy
23
Q
Treatment for intractable tics
A
low-dose high-potency antipsychotics (e.g, fluphenazine, pimozide) + tetrabenazine + clonidine
24
Q
rett syndrome presentation
A
loss of development + loss of verbal abilities + ID + ataxia + stereotyped hand-wringing
25
neurotransmitter changes in Anxiety
increase in NE, decrease in GABA + 5-HT
26
neurotransmitter changes in depression
decrease in NE + dopamine + 5-HT
27
order of orientation loss
1st--time
2nd--place
3rd--person
28
dissociative amnesia
memory problems following severe trauma or stress
29
Findings in delirium
EEG abnormalities (as opposed to dementia, in which EEG is usually normal)
30
pseudodementia
depression + hypothyroidism. This is why you need to measure TSH + B12 levels.
31
dementia presentation
apraxia + aphasia + agnosia + loss of abstract thought + behavioral/personality chagnes + impaired judgment.
32
olfactory hallucinations. when do they happen?
usually in epileptics + brain tumors
33
gustatory hallucinations. when do they happen?
epileptics
34
formication
sensation of bugs crawling on one's skin
35
schizophrenia magic number
6 months
36
schizophrenia diagnosis
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)
37
brief pyschotic disorder magic number
less than 1 month
38
schizophreniform disorder magic number
1-6 months
39
schizoaffective disorder magic number
>2 weeks
40
lifetime prevalence of schizophrenia
1.5%
41
delusional disorder magic number
>1 month
42
manic episode magic number
>1 week
43
manic episode diagnosis
3 of DIGFAAST (FA 510)
44
hypomanic episode magic number + diagnostic criterion
4 consecutive days. No impairment in functioning.
45
cyclothymic disorder magic number
2 years
46
MDD magic number
6-12 months
47
MDD diagnosis caveat
Must include depressed mood or anhedonia
48
MDD treatment alternatives
SNRIs + mirtazapine + bupropion. ECT.
49
Peresistent depressive disorder (dysthymia) magic number
at least 2 years
50
changes in sleep stages during depression
decreased slow-wave sleep + decreased REM latency + increased REM early in sleep + increased Total REM sleep + repeated nighttime awakenings + early-morning awakening
51
terminal insomnia
early morning awakening
52
treatment for atypical depression
CBT and SSRIs are first line
53
most common form of depression
atypical
54
other features of atypical depression
long-standing interpersonal rejection sensitivity + mood reactivity (being able to experience improved mood in response to positive events, albeit briefly).
55
postpartum blues incidence
50-85%
56
postpartum blues onset
2-3 days after delivery
57
postpartum blues treatment
supportive + followup to assess for depression
58
postpartum depression incidence
10-15%
59
postpartum depression timeframe
within 4 weeks after delivery
60
postpartum psychosis incidence
0.1-0.2%
61
nonintuitive RF's for postpartum psychosis
First pregnancy
62
postpartum psychosis treatment
Hospitalization + initiation of atypical antipsychotic. ECT if refractory.
63
Pathologic grief diagnosis + caveat
>6 months + satisfies major depressive criteria. Hallucinations NOT pathologic grief.
64
ECT indications
treatment-refractory depression + depression with psychotic symptoms + acutely suicidal patients.
65
ECT contraindications
Grand-mal seizures in anesthetized patients.
66
ECT AE's
disorientation + headache + partial anterograde/retrograde amnesia usually resolving in 6 months.
67
Panic attack diagnosis + Panic disorder diagnosis
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
Agoraphobia treatment
CBT + SSRIs + MAO inhibitors
69
GAD magic number
at least 6 months
70
adjustment disorder treatment
CBT + SSRIs
71
adjustment disorder magic numbr
impairment in function + less than 6 months
72
ego-dystonic
Feature of OCD. Behavior inconsistent with one's own beliefs and attitudes.
73
treatment for body dysmorphic disorder
CBT.
74
Acute stress disorder magic number
Between 3 days and 1 month.
75
Acute stress disorder treatment
CBT. Pharmacotherapy usually NOT indicated.
76
malingering vs. somatic symptom disorder vs. factitious disorder
somatic -- no conscious attempt to deceive.
factitious -- chief goal is psychological (primary gain)
malingering -- chief goal is external (secondary gain).
77
munchausen syndrome
CHRONIC factitious disorder with predominately physical signs/symptoms. History of hospitalization and willingness to undergo invasive procedures.
78
illness anxiety disorder
hypochondriasis
79
personality disorders -- A,B,C
"Weird, wild, worried"
80
major defense mechanism in paranoid personality disorder
projection
81
conduct disorder vs. antisocial personality disorder
conduct is if 18 years old.
82
treatment for BPD
dialectical behavior therapy
83
schizoid vs. avoidant
avoidant people desire relationships with people, unlike schizoid people.
84
Obsessive-compulsive personality disorder vs. OCD
obsessive-compulsive is ego-syntonic (behavior consistent with one's own beliefs and attitudes). OCD is ego-dystonic.
85
anorexia magic number
less than 18.5
86
Refeeding syndrome
Fluid and electrolyte disturbances following feeding, especially hypophosphatemia. Can occur in malnourished patients, such as anorexics.
87
anorexia nervosa treatment
psychotherapy + nutritional rehabilitation are first line.
88
bulimia nervosa magic number
3 months
89
Russell sign
dorsal hand calluses from induced vomiting (seen in bulimia nervosa).
90
paraphilia
intense sexual arousal to atypical objects, situations, or individuals. characteristic of transvestism.
91
vaginismus
Discomfort resulting from involuntary vaginal muscle spasm, making penetration painful or impossible.
92
drugs associated with sexual dysfunction
antihypertensives + neuroleptics + SSRIs + ethanol
93
sleep phase in which sleep terror disorder occurs
slow-wave sleep
94
hypocretin produced in
lateral hypothalamus (low in narcolepsy)
95
cataplexy
loss of muscle tone (narcolepsy)
96
sleep physiology in narcolepsy
episodes start with REM sleep
97
narcolepsy treatment
Daytime -- stimulants (amphetamines, modafinil).
| Nighttime -- sodium oxybate (GHB).
98
substance abuse disorders caveat
at least 2
99
opioid intoxication presentation
euphoria + respiratory/CNS depression + decreased GAG reflex + pupillary constriction
100
benzo intoxication presentation
ataxia + minor respiratory depression
101
amphetamines intoxication presentation
pupillary dilation + paranoia + fever
102
cocaine intoxication presentation
pupillary dilation + hallucinations (including tactile) + paranoid ideations + angina + sudden cardiac death
103
cocaine intoxication treatment
alpha-blockers + benzodiazepines
104
DT mortality rate
5-15%
105
opioid withdrawal presentation
sweating + dilated pupils + piloerection ("cold turkey") + fever + rhinorrhea + yawning + nausea + stomach cramps + diarrhea ("flu-like" symptoms")
106
barbiturate withdrawal presentation
delirium + life-threatening cardiovascular collapse
107
benzo withdrawal presentation
sleep disturbance + depression + rebound anxiety + seizures
108
amphetamine withdrawal presentation
anhedonia + increased appetite + hypersomnolence + existential crisis
109
cocaine withdrawal
hypersomnolence + malaise + severe psychological craving + depression/suicidality
110
nicotine withdrawal treatment
bupropion + varenicline
111
time frame of marijuana detection in urine
1 month
112
marijuana withdrawal
irritability + depression + insomnia + nausea + anorexia.
113
timeframe for marijuana withdrawal
Most symptoms peak in 48 hours and last for 5-7 days.
114
when do you use naltrexone for opioid rehab?
relapse prevention once detoxified (it is long-acting).
115
why does naloxone/buprenorphine have low abuse potential?
if injected, naloxone will precipitate withdrawal because of antagonism. When taken orally, naloxone isn't orally bioavailable, so doesn't have any antagonism.
116
approach to management of alcoholism
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
ethyl glucuronide (EtG)
Commonly used biomarker to detect recent alcohol ingestion (metabolite of ethanol).
118
onset of withdrawal in alcoholism
6-12 hours after individuals top or dramatically decrease alcohol intake
119
DT timeframe, peaking...
2-4 days after last drink
120
DT presentation
presentation = HTN (can be severe) + profound agitation + global confusion + disorientation + hallucinations + fever + diaphoresis + tachycardia
121
alcoholic hallucinosis + timeframe
distinct condition from DT. visual hallucinations 12-48 hours after last drink.
122
first-line for social phobias
SSRIs + beta-blockers
123
high-potency antipsychotics + SE profile
(Try to Fly High P) --> Trifluoperazine, Fluphenazine, Haloperidol + pimozide
- neurologic side effects
124
typical antipsychotics treat...
positive symptoms
125
treatment for extrapyramidal side effects of typical antipsychotics
benztropine + diphenhydramine
126
typical antipsychotics side effects (other than endocrine)
- muscarinic blockade (dry mouth + constipation)
- alpha 1 blockade (hypotension)
- histamine blockade (sedation)
QT prolongation
127
NMS treatment
dantrolene + D2 agonists (bromocriptine)
128
Low potency antipsychotics + SE profile
(Cheating Thieves) Chlorpromazine, thioridazine
| - non-neurologic side effects (anticholinergic, antihistamine, alpha1 blockade)
129
chlorpromazine unique side effects
corneal deposits
130
thioridazine unique side effect
retinal deposits
131
evolution of EPS side effects
4 hr --> acute dystonia (muscle spasm, stiffness, oculogyric crisis)
4 day --> akathisia (restlessness)
4 week --> bradykinesia (parkinsonism)
4 month --> tardive dyskinesia
132
atypiacl antipsychotics
olanzapine + clozapine + quietiapine + risperidone + aripiprazole + ziprasidone
133
clozapine SEs
agranulocytosis + seizure
134
risperidone SE's
may increase prolactin (causing lactation and gynecomastia, leading to decreased GnRH, LH, and FSH, causing irregular menstruation and fertility issues.
135
lithium MOA
not established; maybe inhibition of phosphoinositol cascade.
136
Lithium pharmacologic notes
1) narrow therapeutic window
2) almost exclusively excreted by kidneys
3) most reabsobred at PCT with Na+
137
SSRIs
fluoxetine + paroxetine + sertraline + citalopram
138
delay before SSRIs take effect
4-8 weeks
139
serotonin syndrome presentation
hyperthermia + confusion + myoclonus + cardiovascular instability + flushing + diarrhea + seizures.
140
drugs that cause serotonin syndrome
Anything that increases serotonin. MAOIs + SNRIs + TCAs + SSRIs
141
diabetic peripheral neuropathy treatment
duloxetine
142
imipramine
TCA
143
doxepin
TCA
144
amoxapine
TCA
145
desipramine
TCA
146
TCA mechanism
block reuptake of norepinephrine + 5-HT
147
other indications for TCA's
peripheral neuropathy + chronic pain
148
amitriptyline
tertiary TCA (more anticholinergic side effects than secondary TCA's)
149
nortriptyline
secondary TCA
150
TCA side-effects
convulsions + coma + cardiotoxicity + respiratory depression + hyperpyrexia + confusions and hallucinations in elderly (due to anticholinergic side effects)
151
TCA to use in old people
nortriptyline
152
MAOIs
tranylcypromine + phenelzine + isocarboxazid + selegeline
153
MAOIs mechanism
MAO inhibition leads to inceased levels of amine neurotransmitters (NE + 5-HT + dopamine)
154
MAOI contraindications
SSRIs + TCAs + St. John's wort + meperidine + dextromethorphan (to prevent serotonin syndrome)
155
trazodone indication
insomnia
