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[2a] A ⼀ Step 2 OD USLME > psYchiatry > Flashcards

psYchiatry Flashcards

1
Q

What is the CAM score and describe its criteria

A

CAM score = Diagnosis Delirium and differentiates it from Dementia/Depression

AIDA: Requires A and I, but only either D or A

Acute onset and fluctuating

Inattention (spell “world” backwards & forward)

Disorganized thinking (rambling/illogical)

Altered level of consciousness (intermittently not alert?)

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2
Q

S/S of Alcohol Withdrawal -8

these sx PEAK 2nd day of abstinence and resolve by day 5

A

PAST NITE

Psychomotor agitation

Anxious Irritability

Seizures

Tremor

NV

Insomnia

Transient Hallcuinations

[Excitable autonomics (⬆︎HR, BP) ➜ DELIRIUM TREMENS]

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3
Q

Describe Delirium Tremens-5

________________

when does DT onset?

A

Further progression of Excitable autnomics =

  1. ⬆︎ HR
  2. ⬆︎ BP
  3. Fever
  4. Hallucinations
  5. Tremulousness –> Death

________________

Onsets 2 days after last EtOH (when withdrawal sx peak)

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4
Q

lab w/u for suspected substance abuse-5

A
  • UA
  • Urine Drug Screen
  • Serum Drug Screen
  • Serum AAA (APAP/ASA/Alcohol)
  • ABG
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5
Q

Name 5 major Risk Factors for Altered Mental Status

A
  1. Dementia
  2. Age
  3. Substance Abuse
  4. Physical issues (Sleep loss/Immobility/Dehydration/Pain)
  5. ICU
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6
Q

Main cause of Delirium in Hospitalized Elderly

A

MULTIFACTORIAL

(Urinary Catheters/Restraints/Poor Sleep/Constipation/Malnutrition)

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7
Q

What are Non-Rx ways to ⬇︎Agitation in Delirius pts -5

A
  1. DC Delirum-causing meds (Benzo, Benadryl)
  2. No restraints
  3. Normalize Sleep
  4. Reorientation (Write Date on message board)
  5. Correct Derangements (dehydration, metabolic)
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8
Q

Developmental Milestones for a 1 Year Old

GROSS MOTOR -3

A

[1G: STANDS]

[1G: WALKS INDEPENDENTLY]

[1G: THROWS BALL]

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9
Q

Developmental Milestones for a 1 Year Old:

fine motor

A

[1f: two finger pincer grasp]

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10
Q

Developmental Milestones for a 1 Year Old

Language

A

[1L: says 1st real words]

________________

that are not “mama” or “dada”

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11
Q

Developmental Milestones for a 1 Year Old

Social -2

A

[1S: separation anxiety]

[1S: follows 1 step commands]

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12
Q

Developmental Milestones for a 18 Month Old

GROSS MOTOR -2

A

[18mG: RUNS]

[18mG: KICKS BALL]

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13
Q

Developmental Milestones for a 18 Month Old

fine motor -2

A

[18mf: 2-4 cube tower]

[18mf: removes clothing]

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14
Q

Developmental Milestones for a 18 Month Old

Language - 2

A

[18mL: (10-25 words)]

[18mL: identifies ≥1 body part]

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15
Q

Developmental Milestones for a 18 Month Old

Social - 2

A

[18mS: Understands “mine”]

[18mS: Begins Pretend Play]

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16
Q

Developmental Milestones for a 2 Year Old

GROSS MOTOR -2

A

[2G: NON-ALTERNATING WALK UP/DOWN STAIRS]

[2G: JUMPS]

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17
Q

Developmental Milestones for a 2 Year Old

fine motor - 2

A

[2f: 6 cube tower]

[2f: copies line]

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18
Q

Developmental Milestones for a 2 Year Old

Language - 2

A

[2L: (50 words)]

[2L: 2-word phrases]

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19
Q

Developmental Milestones for a 2 Year Old

Social - 3

A

[2S: 2 step commands followed]

[2S: Parallel Play]

[2S:starts Toilet Training]

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20
Q

Developmental Milestones for a 3 Year Old

GROSS MOTOR -2

A

[3G: TRICYCLE]

[3G: ALTERNATES FOOT-BY-FOOT UP/DOWN STAIRS]

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21
Q

Developmental Milestones for a 3 Year Old

fine motor -2

A

[3f: copies Circle]

[3f: uses utensils]

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22
Q

Developmental Milestones for a 3 Year Old

Language - 2

A

[3L: 3 word sentences]

[3L: 75% intelligible speech]

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23
Q

Developmental Milestones for a 3 Year Old

Social - 3

A

[3S: knows AGE]

[3S: knows GENDER]

[3S: Imaginary play]

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24
Q

Developmental Milestones for a 4 Year Old

GROSS MOTOR -2

A

[4G: HOPS ON 1 FOOT]

[4G: BALANCES ON 1 FOOT]

________________

Get Audiologic testing in kids with Language Delay!

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25
Q

Developmental Milestones for a 4 Year Old

fine motor -1

A

[4f: copies square]

_________________

Get Audiologic testing in kids with Language Delay!

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26
Q

Developmental Milestones for a 4 Year Old

Language - 2

A

[4L: Identifies Colors]

[4L: 100% intelligible]

________________

Get Audiologic testing in kids with Language Delay!

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27
Q

Developmental Milestones for a 4 Year Old

Social - 1

A

[4S: Cooperative Play]

________________

Get Audiologic testing in kids with Language Delay!

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28
Q

Developmental Milestones for a 5 Year Old

GROSS MOTOR -2

A

[5G: SKIPS]

[5G: WALKS BACKWARDS]

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29
Q

Developmental Milestones for a 5 Year Old

fine motor -5

A

[5f: triangle]

[5f: shoelaces]

[5f: dresses alone]

[5f: bathes alone]

[5f: prints letters]

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30
Q

Developmental Milestones for a 5 Year Old

Language - 2

A

[5L: 5 word sentences]

[5L: counts to 10]

________________

Get Audiologic testing in Kids with Language Delay!

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31
Q

Developmental Milestones for a 5 Year Old

Social - 2

A

[5S: has friends]

[5S: finishes toilet training]

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32
Q

Autism usually presents by age ⬜

________________

What is the CP?-3

EAAARRRLY intervention for Autism is the KEY!

A

Presents by age 2

_________________

  1. Reciprocal Social Communication & Interaction deficit (limited language/eye contact, plays alone, poor pickup of social cues/metaphors/humor/NONverbals)
  2. Repetitive Behavior (rocking, hand flipping, phrases)
  3. Fixated Interest (insist on same routines, 1-sided convos on fixated topics)

_________________

  • Autism is +/- language or intellectual impairment*
  • Also, consider Fragile X syndrome testing*
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33
Q

How do Older Adults typically present with Depression?

A

With c/o somatic complaints (i.e. sleeping problems) instead of mood changes

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34
Q

For Bipolar I dx, you need at least [__ mania sx +/- ___] that last for ___ duration.

________________

What are the mania sx? (7)

A

[3 sx +/- major depression]; 1 week duration;

BIPOLAR

Buying excessively (⬆︎ in pleasurable activity)

Inflated self-esteem

Psychomotor agitation (pacing)

awOke - won’t sleep

Lots of Language

ADD distractability

Racing thoughts

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35
Q

Rx for Delirium in Elderly - 3

A

Haloperidol vs Risperidone vs Quetiapine

Note: Do NOT use Haloperidol in DLB (Dementia with Lewy Bodies)

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36
Q

What is the diagnositic criteria for Major Depression DO? - 3

A
  1. At least 5 out of 9 of [SIG E CAPSS] for
  2. ≥2 weeks
  3. At least 1 must be Sadness or Interest loss anhedonia
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37
Q

The diagnositic criteria for Major Depression DO assess for 9 major sx

What are they?

A

SIG E CAPSS

Sadness most day/everyday

Interest loss anhedonia most day/everyday

Guilt & worthlessness

Energy ⬇︎

Concentration ⬇︎

Appetite ⬇︎

Psychomotor ∆ observable by others

Sleep ∆

Suicidal ideation (but no attempt)

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38
Q

Clinical criteria for diagnosing PMS

________________

PreMenstrualSyndrome

A

≥5 sx (from Group A and B) that =

([begins 1 week pre menses]➜[improves during menses]➜[resolves 1 week post menses])

________________

If sx occur irregularly or throughout menses = mood or personality DO

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39
Q

Clinical criteria for diagnosing PMS (PreMenstrualSyndrome) relies on sx from Group A and Group B

Describe sx for Group A - 6

A

At least 5 sx (from Group A and B) began 1 week before menses, improve during menses and resolve during week after menses

A: (at least one)

  1. Mood lability
  2. irritability
  3. depression
  4. hopelessness
  5. anxiety
  6. ⬇︎libido
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40
Q

Clinical criteria for diagnosing PMS (PreMenstrualSyndrome) relies on sx from Group A and Group B

Describe Group B sx - 6

A

At least 5 sx (from Group A and B) began 1 week before menses, improve during menses and resolve during week after menses

B: (at least one)

  1. Food cravings
  2. sleep change
  3. feeling “out of control”
  4. ⬇︎energy
  5. Anhedonia
  6. Physical sx (constipation/diarrhea/breast TTP/HA)
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41
Q

Tx for Premenstrual syndrome - 4

A
  1. Menstrual Diary (determines relationship of sx to menses)
  2. Exercise
  3. Stress Reduction
  4. SSRIs **if severe**
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42
Q

Why should Haloperidol be CAUTIOUSLY given to Alcoholics

A

Haloperidol ⬇︎Seizure threshold and alcoholics going thru withdrawal may already be at risk for seizures!

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43
Q

Describe the clinical features of OCD - 2

A
  1. Obsessions (w/symmetry, contamination, taboo urges like killing, fear of arm)
  2. Compulsions (rituals-that may be used to help combat obsessions)

tx = high dose SSRIs + exposure CBT

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44
Q

OCD tx - 2

A

[High Dose SSRIs] + [exposure CBT]

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45
Q

Indication for Deep Brain stimulation ; what part of the brain is targeted

A

[SEVERE, tx-refractory OCD]; nucleus accumbens

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46
Q

Ebstein’s anomaly etx

A

Maternal lithium use during [1st trimester pregnancy] –> malformation and displacement of tricuspid valve into R Vt –> Tricuspid Regurgitation –> R Atrial Enlargement and R Axis deviation –> HEART FAILURE

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47
Q

What kinds of teratogenic effects are you concerned about if Lithium is taken during 2nd and 3rd trimester pregnancy? -2

A
  1. Goiter formation
  2. Transient Neonatal Neuromuscular dysfunction

Ebsteins anomaly is concern for 1st trimester only

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48
Q

Diagnostic criteria for Nightmare Disorder - 3

A
  1. Recurrently wakes from sleep reMember the nightmare
  2. Child is fully alert on awakening
  3. Child can be consoled

NightMares occur during REM and is developmentally normal for kids

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49
Q

What is the difference between Sleep Terrors and Nightmare Disorder? - 4

A

Sleep terrors are :

  1. NON-REM disorder
  2. with incomplete awakenings
  3. and can NOT be consoled
  4. and pt Seems to forget the dream
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50
Q

What is REM sleep behavior disorder?

A

Complex motor behaviors or vocalization during REM

________________

(sleep walking or sleep talking during REM)

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51
Q

Diagnostic criteria for Schizoaffective Disorder - 2

A

{ [(Schizo Criteria A)-ALONE x 2 wks] + [Major Mood Episode] }

________________

  • Major Mood = Depression v Bipolar*
  • ________________*
  • “I’m not feeling depressed for the first time in years, but the voices just won’t go away”*
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52
Q

Key features for Schizoid personality disorder - 4

A

SchiZOID are DULL

  1. Detached
  2. Unemotional
  3. LONERS that
  4. LOVE being alone
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53
Q

Key features for SchizoTypal personality disorder

A

SchizoTypal have magical Thinking

magial Thinking / eccentric / odd behavior

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54
Q

Difference between Avoidant disorder and SchizoiD disorder

A

Avoidant DO = PERVASIVELY avoids people only due to fears of REJECTION or scrutiny (pts don’t want or like this = egoDystonic)

vs.

SchizoiD DO = avoidance that these pts are perfectly content with = egoSyntonic

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55
Q

Delusional PD involves ≥ __ delusion for ≥ ___ months, with no other sx

Describe the subtype Erotomaniac delusional PD

A

≥1 delusion for ≥1 month

Erotomaniac = pt attempts to contact the object of delusion (usually –> legal problems)

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56
Q

Function of the [MesocorticalLimbic dopaminergic system]

A

Regulates Behavior

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57
Q

Diesease associated with dysfunctional

[MesocorticalLimbic dopaminergic system]

A

Schizophrenia

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58
Q

Function of [Nigrostriatal dopaminergic system]

A

coordinates Voluntary mvmt

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59
Q

Dz associated with the [Nigrostriatal dopaminergic system]

A

Parkinsonism

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60
Q

Function of [Tuberoinfundibular dopaminergic system]?

A

INHIBITS Prolactin Secretion

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61
Q

what happens when [Tuberoinfundibular dopaminergic system] is blocked by antipsychotics?

A

Hyperprolactinemia–> infertility

occurs mostly with FIRST generation antipsychotics

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62
Q

Serotonin Syndrome Clinical Presentation (8)

A

“Serotonin gave me the SHIVERS!”

Shivering

[Hyperreflexia & Myoclonus]

INC Temp

[Vital sign instability] (tachycardia vs. tachypnea vs. HTN)

Encephalopathy (Confusion vs. Agitation)

Restlessness

Sweating

Italicized = Triad Sx

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63
Q

How do you treat Refractory Serotonin Syndrome

A

Cyproheptadine

(antihistamine with anti-serotonergic properties)

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64
Q

Describe Neuroleptic Malignant Syndrome

A

RARE SE of Any Dopamine Blocker (Antipsychotics vs. GI meds) that –> FEVER

  • [Fever > 40C]
  • Encephalopathy (Confusion)
  • Vitals unstable (INC HR / RR / BP from autonomic dysfunction)
  • Enzymes CreaTine and WBC ⬆︎
  • Rigitidy ⬆︎ (Tremor)

Tx = supportive, dantrolene, [dopamine agonist if refractory]

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65
Q

What’s the best way to approach treatment for [Neuroleptic Malignant Syndrome] - 3

A

Treat Rigiditiy with Dantrolene (inhibits Ca+ release from sk. muscle sarcoplasmic reticulum)

+

supportive care

followed by [Bromocriptine or Amantadine] dopamine agonist if refractory

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66
Q

What is the diagnostic criteria for ADHD? - 3

A
  1. Sx present for at least 6 mo. AND inappropriate for dvpmental age
  2. Sx start between 6-12 yo and not after 12 yo
  3. Evident in 2 or more settings (school/work/home)

And Obvi, ALL psych disorders MUST be NOT 2/2 medical condition and be functionally impairing and/or cause significant distress

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67
Q

Diagnostic criteria for Cyclothymic disorder - 3

A
  1. Chronic flutuating mood (depression vs bipolar) disturbance
  2. lasting ≥ 2 years
  3. and does not meet full criteria for hypomanic or depressive episodes
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68
Q

What is the clinical criteria for hypOmania -2

A
  1. ≥3 [BIPOLAR] sx PLUS
  2. Elevated or irritable mood 4< x <7 days
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69
Q

What is the clinical criteria for Mania-2

A
  1. ≥3 [BIPOLAR] sx PLUS
  2. Elevated or irritable mood > 7 days
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70
Q

Diagnostic criteria for Bipolar II ? - 3

A
  1. Major Depressive Episodes +
  2. hypOmanic episode +
  3. NOT functionally impaired
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71
Q

Diagnostic criteria for Bipolar I ? - 3

A
  1. Major Depressive Episodes +
  2. Manic episode +
  3. Functionally impairing
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72
Q

What is the difference between Acute Stress Disorder and PTSD?

A

ASD is ACUTE! which = [3 days ≤ sx ≤ 1 month] post exposure

vs

PTSD = sx > 1 month

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73
Q

Diagnostic criteria for Panic disorder - 2

A
  1. Panic attacks +
  2. Persistent concern about additional attacks and +/- attempts to avoid them

Be sure to r/u medical conditions that mimic them

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74
Q

Describe Advanced sleep phase syndrome

This is a Circadian rhythm disorder

A

circadian rhythm DO in which you can not stay awake past 7 pm –> early morning insomnia

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75
Q

Diagnostic criteria for Delayed sleep phase syndrome - 4

This is a Circadian rhythm disorder

A

AKA “The Night Owls”

  1. inability to fall asleep at “normal” bedtimes
  2. Difficulty waking in morning
  3. Excessive early daytime sleepiness
  4. Normal sleep ONLY WHEN ALLOWED TO SET OWN UR SLEEP SCHEDULE with later bedtimes
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76
Q

Diagnostic criteria for Persistent Depressive Dysthymia disorder - 3

A
  1. at least 2 / 6 of sigeca
  2. CONSTANT for ≥ 2 years (or 1 year in kids)
  3. No relief > 2 mo

Major Depressive Episodes may also occur with this

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77
Q

Clozapine’s SE is agranulocytosis

Name the Granulocytes - 3

A

BEN

Basophils

Eosinophils

Neutrophils

Clozapine also causes Metabolic Syndrome X, Seizures and Myocarditis

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78
Q

Which test are routinely (q3-6 mo) done in Lithium patients?-2 why?

A

Thyroid function test: monitor for hypothyroidism

Creatinine: monitor renal function

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79
Q

Diagnostic criteria for Adjustment disorder with depressed mood - 3

A
  1. [≤ 4 SIGeCAPSS s/s] within 3 mo. of acute stressor that –>
  2. functionally impairing
  3. NOT 2/2 an other more specific disorder

Tx = CBT

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80
Q

Postpartum depression affects women during what time periods? What 2 methods are used to screen for this?

A

within 1st year > first 3 mo ;

  1. [PHQ2 –(if both +)–> PHQ9]
  2. Edinburgh Postnatal Depression Scale

Screen prenatal, postnatal and well child

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81
Q

Give brief descriptions that differentiate Postpartum

Blues vs Depression vs Psychosis

A
  • Blues = onsets right after birth, peaking at postpartum day 5 and subsiding PPD14, worst w/lactation
  • Depression = onset right after birth - 12 months later. Traditional s/s. Previous Depression hx is RF
  • Psychosis = RARE but onsets IMMEDIATELY after birth
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82
Q

Tx for Delirium

A

Short course of PO haloperidol

alternatives: Aripiprazole/Olanzapine/Risperidone

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83
Q

What would you expect diagnostic appearance of a Major Depression pt to be - 3

A
  1. ⬇︎Body wt
  2. poor grooming
  3. poor hygiene
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84
Q

What would you expect diagnostic appearance of an Anorexia Nervosa pt to be - 3

A
  1. ⬇︎Body wt
  2. baggy clothes
  3. Lanugo -image
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86
Q

What is echopraxia

A

repetitive imitation of mvmnts of another person

EchoLALIA = repetitve imitation of verbiage of another person

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87
Q

What is sterotyping

A

isolated purposeless mvmnt performed reptitively

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88
Q

What is alexithymia

A

Pt can NOT describe their mood

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90
Q

What is pressured speech?

________________

Which pt mental illness exhibit this?

A

ABC (S)TAMP LICKER

rapid and difficult to interrupt (verbally runs you over!)

________________

Mania

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92
Q

Describe referential delusions

A

random events are of some special significance

“the Cubs won, so that’s a signal the alien invasion is coming!”

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93
Q

What is the diagnostic clinical criteria for Panic Disorder? - 4

________________

DSM5 no longer considers this its own DO but now as a Specifier for other conditions

A
  1. Recurrent Panic Attacks
  2. Unexpected Panic Attacks
  3. ≥1 attack is followed by ≥1 mo. of [anticipatory anxiety and/or behavior ∆] (details below)

  • anticipatory anxiety = persistent worry of having another panic attack
  • behavior ∆ to try and avoid future panic attacks
    4. ≥ 4 Panic Attack Specifier symptoms - image
  • And obvs can’t be 2/2 drugs or other condition*
94
Q

What is formication

A

feeling bugs crawling under skin

common in Cocaine and Meth users!! lol

95
Q

What is hallucinosis

A

pt knows their hallucinations aren’t real

Common in Alcoholics

96
Q

What is the diagnostic clinical criteria for Agoraphobia? - 3

A
  1. Fear & Avoidance OOP of ≥ 2 / 5 agora situations - image
  2. Fear & Avoidance OOP are > 6 months
  3. Fear & Avoidance OOP –> distress and functional impairment

OOP = Out Of Proportion

97
Q

What is the diagnostic clinical criteria for Generalized Anxiety Disorder? - 2

A
  1. Excessive anxiety includes ≥ 3 / 6 of anxiety sx - WATCHERS
  2. Sx ≥ 6 months

  • Excessive anxiety –> distress and functional impairment*
  • OOP = Out Of Proportion*
100
Q

What is the diagnostic clinical criteria for PTSD? - 3

Lifetime prevalence = 8% and more common in Women

A
  1. All 4 sx categorymet - image
  2. sx > 1 month
  3. Exposure done via Direct (single or repeated), Witnessed, occurred to close fam/friend
101
Q

What is the diagnostic clinical criteria for Acute Stress Disorder? - 3

A

image

102
Q

Risk factors for developing PTSD? - 7

Lifetime prevalence = 8% and more common in Women

A
  1. Substance abuse
  2. Violence, Mood or Anxiety med hx (self or family)
  3. Suicidal Ideation/attempts
  4. Work or Marriage problems
  5. Homelessness
  6. Prior trauma
  7. Female
104
Q

Demographic for Panic Disorder - 2 ; What is this group at risk for?

A

Women in the late teens/early 20s ; Death from Stroke vs MI

Usually Occurs with MDD/GAD/OCD

105
Q

Tx for Panic Disorder - 6

A

CBT (can be used alone)(breathing technique, exposure therapy) +/-

  1. SSRI (1st line rx)
  2. SNRIs
  3. [Benzo or BBlocker for situational]
  4. TCA
  5. MAOi
    * Similar to Social Phobic Anxiety Disorder tx*
108
Q

Diagnostic clinical criteria for Specific Phobia - 2 ; Tx?

A
  1. Specific things (objects/locations/events) provoke IMMEDIATE fear/anxiety OOP –> active avoidance
  2. sx ≥ 6 mo

Tx = CBT Exposure Therapy (ONLY USE BENZOS IF CBT IS UNAVAILABLE)

109
Q

What are the ⬜ causes of Anxiety

Endocrine - 5

A

Substances can also induce Anxiety

110
Q

What are the ⬜ causes of Anxiety

Cardiovascular - 5

A

Substances can also induce Anxiety

111
Q

What are the ⬜ causes of Anxiety

Metabolic - 5

A
  • Metabolic includes the “Zebras”*
  • Substances can also induce Anxiety*
112
Q

What are the ⬜ causes of Anxiety

Neurological - 7

A

Substances can also induce Anxiety

113
Q

How is GAD associated with pharmacotherapy cessation?

A

60-80% of GAD pts relapse within 1st year after stopping pharmacotherapy

114
Q

Tx for Generalized Anxiety Disorder -9

A
  1. CBT
  2. SSRI (1st line rx)
  3. SNRI (1st line rx)
  4. TCA (2nd line rx)
  5. Benzo
  6. Buspirone
  7. Lyrica
  8. Mirtazpine
  9. Trazodone
119
Q

Tx for PTSD -7

A
  1. SSRI (1st line rx)
  2. Prazosin (nightmare sx)
  3. Clonidine (hyperarousal sx)
  4. Propranolol (hyperarousal sx)
  5. CBT
  6. Exposure therapy
  7. EMDR (Eye Mvmnt Desensitization and Reprocessing)
120
Q

What is the diagnostic clinical criteria for Obsessive Compulsive Disorder? - 2

A
  1. Intrusive Obessions, Compulsions or both that > 1 hr/day AND/OR
  2. Intrusive Obessions, Compulsions or both that–> distress or functional impairment

Obessesion=Contamination, Symmetry, Somatic, Violence, Sex, Religion

122
Q

OCD tx - 6

A
  1. CBT
  2. Exposure & Response prevention
  3. SSRIs-higher doses than anxiety tx (1st line rx)
  4. Clomipramine TCA (2nd line rx) - consider after 2 failed trials of SSRI
  5. SNRI (2nd line rx)
  6. Atypical antipsychotics (augmenting agent)
123
Q

In Hoarding Disorder, pts accumulate possessions and cause functionally impairing clutter

When in untreated pts are these areas typically cleaned?

A

ONLY when CBT intervention by 3rd parties is made

Medical causes and other disorders should ALWAYS be ruled out before diagnosing psych conditions

124
Q

Diagnostic clinical criteria for Social Phobic Anxiety Disorder - 2

A
  1. OOP Fear/Anxiety with Social interactions which could –> humiliation or scrutiny by others (giving speech/meeting new peeps/eating/drinking)
  2. Fear/Anxiety ≥ 6 mo

Tx similar to Panic Disorder tx

131
Q

Which substances are known for inducing Anxiety - 8

A
  1. Cocaine
  2. Amphetamines
  3. Caffeine
  4. CTS (CorTicoSteroids)
  5. Hallucinogens (Cannabis, PCP)
  6. Inhalants
  7. Theophylline
  8. Thyroid hormones
132
Q

Common side effects of SSRI - 7

A
  1. GI distress
  2. SIADH –> Wt Gain
  3. ⬇︎Libido
  4. Sedation
  5. Dry Mouth
  6. HA
  7. induces mania/hypomania in Bipolar pts!

​SSRI DC –> Nausea/HA/Dizziness/Lethargy/FluLikeSx/Zapping

133
Q

What are 3 major precautions to remember with SSRIs?

A
  1. induces mania/hypomania in Bipolar pts! (THIS IS FOR ANY ANTIDEPRESSANT)
  2. ⬆︎suicidality within first 2 weeks in young adults
  3. ​SSRI Discontinuance –> Nausea/HA/Dizziness/Lethargy/FluLikeSx/Zapping
134
Q

Hoarding disorder tx

A

CBT targeting hoarding behaviors

Consider adding SSRI only if there’s also depression / anxiety

135
Q

How should you manage Autism? - 3

A
  1. Early dx & tx
  2. Multimodal tx (speechTherapy/CBT/education)
  3. pharm adjunct
136
Q

What are the signs of Cocaine intoxication? - 4

A
  1. MyDriasis (Pupils Wide Open on coke!)
  2. Chest Pain –> Arrhythmia and MI
  3. Seizures
  4. Hyperthermia
137
Q

What are the signs of Amphetamine intoxication? - 6

A
  1. Psychosis +/- delirium
  2. Combative Agitation
  3. Myoclonus
  4. MyDriasis
  5. Tachycardia
  6. HTN

These effects last a long time when from bath salts!

138
Q

Which rx agents cause false positive amphetamine results on urine tox? - 3

A
  1. pseudophedrine
  2. Buproprion
  3. Selegiline
139
Q

How long does opioid withdrawal typically last?

A

3-5 days

Sweating/Lacrimation/Rhinorrhea/Myalgia/Diarrhea

140
Q

Phencyclidine (AKA ___) is a __(MOA)___ and main intoxication signs are what?-4

A

PCP (Hallucinogenic dissociative anesthetic = [NMDA Glutamate R Blocker])! ;

  1. Multidirectional Nystagmus
  2. Violence w/⬇︎pain perception
  3. HTN
  4. Hyperthermia
141
Q

LSD main toxication sign is _____

A

Visual Hallucinations

142
Q

[Phencyclidine PCP] and Ketamine are both _____ with similar effects. What’s the main differences?-2

A

Hallucinogenic Dissociative anesthetics

  1. Ketamine is short lived
  2. Keamine causes blunted behavior (i.e.impaired consciousness) while PCP causes violent behavior
143
Q

What is Eye movement desensitization and reprocessing treatment?

________________

What is it indicated for?

A

Integration of eye mvmnts with therapy

________________

PTSD

144
Q

Tx for Acute Bipolar Mania -3

A

ALV

[Antipsychotics (1st or 2nd gen)] > Lithium > Valproate

NO ANTIDEPRESSANTS

145
Q

Tx for Bipolar I and II - 6

A

Treat Bipolar pts b4 they go BALLD!

-Benzos adjunct prn

-AntiPsychotics (Only use 2nd gen for Depressive phase)

-Lamotrigine (depression phase only)

-Lithium or Valproate **

-DepakOte **

146
Q

Buspirone

MOA

________________

indication

A

Buspirone = [5HT1α R partial agonist]

________________

GAD

________________

[slow onset] and [lacks muscle relaxant/anticonvulsant properties]

147
Q

What are the cons of Buspirone? - 3

A
  1. slow onset
  2. lacks muscle relaxant properties
  3. lacks anticonvulsant properties
148
Q

Describe Shift work sleep disorder

A

Recurrent sleep interruption 2/2 shift work –> daytime sleepiness, difficulty initiating sleep, difficulty maintaining sleep

149
Q

Describe Trichotillomania is

________________

what’s a serious complication of this?

A

compulsive Hair pulling DO in which pt attempts to stop pulling hair out of scalp, eyebrows and eyelashes BUT CAN’T!

________________

Possibly ➜ trichophagia (swallowing hair) which ➜ bowel obstruction

Related to OCD and has ⬆︎morbidity in those with hx or fam hx of OCD

150
Q

Trichotillomania tx

A

CBT - habit reversal training

151
Q

MDMA MOA

A

synthetic amphetamine that ⬆︎ synpatic “Dick N’ Sweat”

[Dopamine / NorEpi / Serotonin]

________________

Can cause Serotonin Syndrome when taken with SSRI!! MDMA may also cause hypOnatremia

152
Q

In pts with TCA overdose, what’s the most important objective to monitor?

________________

why?

A

QRS duration

________________

TCA OD ➜ QRS > 100 msec ➜ [⬆︎Vt arrhythmias and seizures (tx: NaHO3)]

153
Q

PCP and Amphetamine intoxication presentations may be similar

How can you tell them apart? - 2

A
  1. PCP will show up in UDS
  2. PCP has multidirectional nystagmus
154
Q

Signs and symptoms of MDMA intoxication - 3

A
  1. Hyperthermia
  2. Seizures
  3. Delirium
155
Q

Teens who develop significant acute changes in behavior should be assessed for what potential factors? - 4

A
  1. Psychosocial stressors
  2. Trauma (physical or sexual)
  3. Substance use
  4. Psych disorders

Don’t just throw drugs at them! Do detailed eval

156
Q

Borderline personality disorder pt typically have a remote hx of what?

A

PESSP

CHILD ABUSE

157
Q

When is it ok for Bipolar pts to discontinue their Rx therapy?

________________

Explain

A

NEVER!!

________________

It is a lifelong illness requiring maintenance tx for years (and forever in severe bipolar pts)

158
Q

In addition to TSH, BUN/Creatinine and urinalysis labs…

What other test should be ordered before starting pts needing Lithium if they have CAD risk?

A

EKG (Lithium causes dysrhythmias in CAD pts)

159
Q

Tx for Somatic Symptom disorder

A

Regularly scheduled Med visits (Goal: Improve functionality)

DO = preocupation with unexplained (but proven to be benign) medical sx

160
Q

Somatic Symptom disorder clinical presentation

A

preocupation with unexplained (but proven to be benign) medical sx

161
Q

What is Functional Neurological Symptom Disorder?

________________

tx?

A

unexplained neurological deficits 2/2 emotional stressors

________________

EDUCATION about the Disorder!

AKA CONVERSION DISORDER

162
Q

Jimson Weed Poisoning clinical presentation - 7

A

Jimson Weed = AntiCholinergic

“Blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone, the bowel & bladder lose their tone, and the heart runs alone…..”

  1. Blind as a bat = [Mydriasis and [cycloplegia (blurry vision especially when focusing on near objects)]
  2. Mad as a hatter= Agitation & Hallucinations
  3. Red as a Beet = Cutaneous flushing despite vasoconstriction
  4. Hot as a hare = Hyperthermia from DEC ability to sweat
  5. Dry as a bone= DEC Secretions (including sweat)
  6. Bladder & Bowel lose tone
  7. Heart runs alone = No vagal tone at SA –> Tachycardia
163
Q

Malignant Hyperthermia etx

A

After giving [inhaled anesthestics vs succinylcholine] to genetically predisposed pts (AUTO DOM) pts develop ➜

Malignant = Muscle Rigiditiy

Malignant = Malignant Unstable Vitals

Hyperthermia = Fever

164
Q

Malignant Hyperthermia Tx

A

Dantrolene

TREAT PROMPTLY! AS THIS IS LIFE THREATENING CONDITION!

165
Q

Malignant Hyperthermia clinical presentation - 3

A
  1. Malignant = Muscle Rigidity
  2. Malignant = Malignant Unstable Vitals
  3. Hyperthermia = Fever
166
Q

Disulfiram

MOA

________________

indication

A

inhibits aldehyde dehydrogenase ➜ horrible rxn when EtOH is consumed!

________________

Alcoholism

ONLY give to pts who will be abstinent and HIGHLY motivated

167
Q

Naltrexone is 1st line tx for alcohol use disorder and can be taken while pt is still drinking

When is Naltrexone contraindicated? - 3

A
  1. Liver Failure
  2. Acute Hepatitis
  3. Pt currently uses opioids

It CAN be used in mild liver dysfunction

168
Q

Acamprosate MOA ; indication

A

GABA analog ; Maintains Alcohol abstinence once its reached by ⬇︎ cravings (1st line rx)

Renal excreted so Be sure to monitor renal function and SE = Diarrhea

169
Q

What behaviors from a toddler regarding sex are medically concerning? - 4

A
  1. precocious sexual knowledge
  2. preoccupation with masturbating
  3. excessive talk about sexuality
  4. simulating oral/anal/genital2genital contact

curiousity with their own or other children’s genitals is normal

170
Q

Which rx is most optimal for Bulimia Nervosa

A

Fluoxetine

is also helpful in Anorexia Nervosa if its refractory to therapy

171
Q

Difference between Tourette and [Chronic Tic DO]

A

Tourette = [Motor AND Vocal Tics BOTH] for ≥ 1 year

These sx must occur before 18 yo and tx = Antipsychotics vs Alpha 2 R agonist vs CBT

172
Q

Tx for Tourette’s and Chronic Tic Disorder - 6

A
  1. CBT Habit Reversal Training
  2. Clonidine - alpha 2 R agonist
  3. Guanfacine - alpha 2 R agonist
  4. Risperidone
  5. Haloperidol
  6. Pimozide antipsychotic

Antipsychotics are more effective

173
Q

Side effects of ADHD stimulants - 4

A
  1. ⬇︎Appetite –> Wt loss
  2. Insomnia
  3. Tachycardia
  4. Tics (in children AND RARE)
174
Q

Buproprion MOA - 2

A

NorEpi and Dopamine reuptake inhibitor

175
Q

Mirtazapine

SE -2

A

[appetite ⬆︎]

somnolence

176
Q

There are 3 Dopamine D2 pathways in the brain

Name the pathways ; what overall effect do they have when activated?

A

Stimulation of….

Mesolimbic = Psychosis

Nigrostriatal = Mvmnt Coordination

Tuberoinfundibular = INHIBITS Prolactin when activated (if blocked –> infertility from hyperprolactinemia)

177
Q

Which antipsychotic actually has a dual blockade effect?

________________

Which 2 receptors does it block?

A

Risperidone

________________

  1. D2 R blocker
  2. Serotonin 2A R blocker (helps to ⬇︎EPS side effects)
178
Q

S/S of Opioid withdrawal - 7

A
  1. Sweating
  2. Lacrimation
  3. Rhinorrhea
  4. Myalgia
  5. Diarrhea
  6. Yawning
  7. MyDriasis

These last for 3-5 Days

179
Q

S/S of Amphetamine and Cocaine withdrawal - 4

A

Coke/Meth withdrawal hits HARD

  1. Hungry
  2. Angry irritable
  3. Rest a lot w/unpleasant dreams
  4. Depressed (can mimic MDD vs Bipolar)

can last several days

180
Q

Which comorbidities is Tourette’s associated with?

A
  1. OCD (develops within ~5 years of tic onset)
  2. ADHD
181
Q

Describe the clinical tool used to assess whether a pt is seriously contemplating suicide

A

SAD PERSONS

Each is worth 1 point and [normal 4–(outpt tx)–7 –> Hospitalize now!]​

Sex Male

Age external to 19-45

Depression diagnosis

Previous attempt hx (STRONG RISK FACTOR!)

EtOH/substance abuse

Rational thinking impaired (psychosis, delusions, hallucinations)

Social support lacking

Organized plan

No significant Other

Sickness physically (i.e. chronic pain)

182
Q

What is the strongest single risk factor for suicide

A

previous suicide attempt

183
Q

Diagnostic clinical criteria for Disruptive Mood Dysregulation disorder - 3

A
  1. Frequent Temper Outburst
  2. Severe irritability
  3. Poor Frustration tolerance
184
Q

What type of psychiatric side effects does CTS (CorTicoSteroids) have? - 4

A

Steroids Make People Depressed!

  1. Suicidality
  2. Mania
  3. Psychosis
  4. Depression
185
Q

AntiSocial Personality disorder is essentially Charlie Sheen

What is the nuance for diagnosing this disorder in regards to age of onset?

A

ASPD pts must have had conduct DO before 15 yo, with a continuance into adulthood

186
Q

What regimen, for maintenance therapy, is considered in Bipolar pts who DON’T respond to monotherapy maintenace?

A

Treat Bipolar pts b4 they go B(AL)D!

A + L

[Antipsychotic 2ND GEN] + [Lithium or Valproate]

187
Q

Tx for Major Depression with psychotic features - 2

A
  1. ECT > antipsychotic ➕
  2. Antidepressant

​Use ECT in elderly as it is more rapid acting

188
Q

A pt has a single episode of major depression but responds well to antidepressant SSRI tx

What do you do when he asked to stop the SSRI since he’s now feeling “great”?

A

Cont Antidepressant rx for additional 4-9 months once remission is reached and then d/c

  • This is called continuation phase tx*
  • Pt with multiple episodes of MDD should cont SSRI for additional 1-3 years after reaching remission and indefinitely if their depression is SEVERE*
189
Q

[T or F] Pt confidentiality shuld be maintained even when a pt is having Active suicidal ideation

A

FALLLSEE!!!!

Active (i.e. plans to hang themself) suicidal or homocideal ideation warrants breaking confidentiality and informing parents or whomever

190
Q

Is Parental consent required for hospitalization? ; what about psychotropic medications?

A

NO, not required for hospitalization if pt is harm to self or others ; YES required for psych meds

191
Q

Which Antipsychotics can be administered as Long acting injectables

________________

Which of these are excreted via RENAL

A

“OPRAH has long shows”

  1. Olanzapine
  2. Paliperidone (Metabolite of Risperidone)
  3. Risperidone
  4. Aripiprazole
  5. Haloperidone

________________

B: Paliperidone = DO NOT USE IN RENAL FAILURE PTS

192
Q

3 SGAs that cause the greatest weight gain

A

“i Cause Obesity”

iLoperidone / Clozapine / Olanzapine

Clozapine & Olanzapine cause [Metabolic Syndrome X] as well so monitor Fasting glucose and lipids!

193
Q

Which antipsychotic DOES NOT cause EPS

A

Clozapine

This also treats Tardive Dyskinesia!

194
Q

A: High binding SEs of Olanzapine (2)

B: Which Receptors are blocked (2)

A

A:

  1. Wt. Gain
  2. Metabolic Syndrome

B: [A1 adrenergic] / H1

195
Q

Which antipsychotic is the most associated with prolonged QT?

A

Ziprasidone

196
Q

Tx for Kleptomania - 5

A
  1. CBT
  2. SSRI
  3. Opioid R Blockers
  4. Lithium
  5. Anticonvulsants
197
Q

[MAOI]

MOA

________________

indications-2

A

inhibit metabolism of SED (Serotonin/Epi/Dopamine)

  1. refractory depression
  2. atypical depression
198
Q

Foods containing ⬜ can have a dangerous interaction with MAOIs

What is the rxn when these two mix?

A

Tyramine

________________

HYPERTENSIVE CRISIS 2/2 sympathetic activation!

This will first present as a HA

199
Q

Explain what Cognitive Behavioral Therapy is

A

Therapy that changes cognitive distortions (i.e. overgeneralization, catastrophizing, minimalizing positive events)

200
Q

Explain what Biofeedback therapy is

A

Uses signals from body (HR, temperature, BP) as indicators of emotional distress and teaches this to pts to control their responses

201
Q

Explain what Dialectical behavioral therapy is - 3 ; What disorder is this specifically used for?

A

Targets

  1. emotional dysregulation
  2. self-destructive
  3. suicidal behaviors

Borderline Personality DO

202
Q

In Motivational Interviewing, therapist focus on pt’s motivation for change and ambivalence

What illness is this usually used to treat?

A

Substance Abuse DO

203
Q

Diagnostic clinical criteria for Generalized Anxiety Disorder consist of a ≥6 month time period of ≥3 out of 6 major sx

What are the 6 GAD major sx?

A

waTCHERS

Worry / Anxiety that –>

  1. Tension in muscles
  2. Concentration ⬇︎
  3. Hyperarousal IRRITABILITY
  4. Energy ⬇︎
  5. Restlessness/on edge
  6. Sleep ∆
204
Q

Contraindications for Buproprion - 4

A
  1. Seizure hx
  2. Bulimia nervosa
  3. Anorexia Nervosa
  4. Use of MAOI within prior 2 weeks
205
Q

Tx for Anorexia Nervosa - 5

A
  1. Nutritional rehab
  2. CBT
  3. Hospitalization if vitals unstable
  4. Fluoxetine if refractory to #1-3
  5. Olanzapine if refractory to #1-3 (⬇︎obsessive thoughts and ⬆︎ wt)
206
Q

How is Anorexia Nervosa associated with thyroid dysfunction? ; Should this be medically addresed with supplement?

A

pts with anorexia nervosa naturally have ⬇︎levels of T3 and T4 2/2 body’s adaption to chronic nutritional depletion ; T3 and T4 will return ON THEIR OWN with refeeding so DO NOT REPLACE

207
Q

Clinical presentation of [REM sleep behavior disorder]

________________

What could this indicate if it occurs reoccurs frequently?-2

A

Physical Dream Enactment during REM sleep (latter part of the night)

________________

Parkinson’s or DLB

Pt kicking, talking and pushing you off the bed while they’re dreaming

208
Q

Describe Sleep terrors and sleepwalking

A

non-REM sleep arousal disorder that occurs in younger pts during first trimester of sleep period with NO MEMORY of dreams

In Sleep terrors/walking, you Seem to forget the dream…

209
Q

What is the difference between Sleep Terror and Nightmare disorder? - 2

A
  1. in nightMares, you reMember the dream!
  2. Nighmares = REM (occurs in mid night) / Sleep Terrors-Walking = NonREM (occurs 1st trimester)
210
Q

Depressed pt has been on an SSRI “for a while” and doesn’t see much improvement

What constitutes an adequate “trial” of SSRI before switchin to SNRI?

A

≥ 6 weeks

211
Q

Most common side effect of ElectroConvulsive Therapy (ECT)

A

Transient Amnesia

212
Q

What are the primary electrolyte disturbances seen in Anorexia or Bulimia Nervosa - 3

A
  1. ⬆︎Amylase
  2. ⬇︎K+
  3. ⬇︎Cl
213
Q

Antipsychotics (___ generation) can be used to treat the depressive phase of Bipolar disorder

Which 2 are the best to be used?

A

Treat Bipolar pts b4 they go BALLD!

2nd generation Antipsychotics for Bipolar Depression =

Quetiapine and Lurasidone

214
Q

Clinical presentation for Illness Anxiety disorder

A

Anxiety over the possibility of having a specific Illness even though there are little to no symptoms

In Somatic symptom disorder….Somatic symptoms ARE present!

215
Q

What are the triggers of Sleep Terrors/Walking - 4

A
  1. Sleep Deprivation
  2. Stress
  3. illness
  4. meds affecting CNS
216
Q

What’s the most common neurostructural findings for OCD - 2

A
  1. OrbitoFrontal Cortex structural ∆
  2. Basal Ganglia structural ∆
217
Q

Name the main signs and symptoms of Methamphetamine abuse - 4

A
  1. Paranoid delusions
  2. Formication tactile hallucinations (bugs crawling under skin)
  3. Poor Dentition 2/2 clenching & decay
  4. Excoriations 2/2 skin picking

These pts will still need Antipsychotics and CBT

218
Q

Pts with chronic alcohol use commonly present with what subacute sx? - 2 ; why is this?

A
  1. Insomnia
  2. Anxiety

Pt use EtOH to fall asleep but when EtOH levels drop during mid-night –> CNS hyperarousal –> sleep awakenings and mild withdrawal

219
Q

In which conditions do you see Catatonia? - 4

A

syndrome of marked psychomotor disturbance occuring in severe

  1. mood disorders w/psychotic features (Depression,Bipolar)
  2. psychotic DO
  3. Autism
  4. Med conditions (infection/metabolic/neuro/rheum)

Tx = Lorazepam vs ECT

220
Q

clinical presentation of Catatonia - 5

A
  1. EchoLalia/praxia
  2. Mutism
  3. Waxy flexibility (resistance to repositioning)
  4. Catalepsy (limbs remain fixed and immobile)
  5. negativism

  • Possibly* Catatonic Agitation
  • Tx = Lorazepam vs ECT*
221
Q

Dx for Catatonia?

A

Give 1-2 mg Lorazepam IV –> wait 10 min –> if pt improves = Catatonia

222
Q

Tx for Catatonia?-2

A
  1. Lorazepam
  2. ECT
223
Q

What is the irony of short acting benzos (i.e. Alprazolam) and seizures?

A

Benzos treat seizures BUT short acting benzos can –> seizures (along with anxiety and psychosis) if there is abrupt d/c

224
Q

How long should a Doc wait to start an SSRI after discontinuing a MAOI?

This is to avoid Serotonin Syndrome SHIVERS

A

2 weeks

225
Q

What 3 elements should all Depressed pts be initially evaluated for?

A

SUICIDE via suicide risk assessment!

  1. Ideation
  2. Intent
  3. Plan

If 2 and 3 present –> hospitalization

226
Q

Selective Mutism cp

A

verbal and talkative at home but refuse to speak in specific social settings (like school)

Refusal to speak at school should not be considered normal shyness

227
Q

When does Stranger Anxiety onset and subside

A

starts 6-9 mo and ends 3 yo

anxiety/distress when encountering unfamiliar people, even when parent is around

228
Q

Phencyclidine (AKA ___) is a __(MOA)___ and main toxication sign is _____

A

PCP (Hallucinogen = [NMDA Glutamate R Blocker])!

________________

[Vertical Nystagmus]

229
Q

Tx for Acute Stress Disorder

A

Trauma focused CBT

230
Q

Cocaine MOA

A

[Reuptake inhibitor] of Do Not Snort

[Dopamine / NorEpi/ Serotonin]

231
Q

Cocaine toxicity signs (4)

________________

Reuptake inhibitor of Do Not Snort

A
  1. myDriasis responsive to light
  2. Tachycardia
  3. Agitation
  4. Vasoconstriction –> Myocardial ischemia (cp)
232
Q

In Psychiatry, what is Displacement

A

Displacing feelings meant for one person toward a “safer” person

233
Q

In Psychiatry, what is Transference

A

Transfering unconscious emotions associated with a person in the past –> person in present

Pts abused as kids have difficult time seeking care in the future since they associate it with poor caretaking

234
Q

In Psychiatry, what is Projection

A

Projecting your unacceptable feelings of something into someone else (and treating them as if they have those feelings) so u don’t have to acknowledge ur own feelings

235
Q

What biochemical changes are associated with Major Depression Disorder?

A

hyperactivity of hypothalamic-pituitary-adrenal axis –> Cortisol⇪

236
Q

Side effects of Lithium - 4

A

If not careful, Lithium TANS you!

  1. Tremors - late
  2. Ataxia - late
  3. NVD early on
  4. Seizures - late

precipitants: NSAIDs, thiazides, tetracyclines, metronidazole

237
Q

Which drugs have an interaction with Lithium - 5

A
  1. Thiazide
  2. NSAIDs
  3. ACE inhibitors
  4. Tetracyclines
  5. Metronidazole
238
Q

What is the best way to prevent schizophrenia relapse

A

Minimize conflict and stress, especially with family

239
Q

In psychiatry, what is sublimation

A

chanelling unacceptable thoughts or impulses into something socially acceptable (channeling anger into running)

240
Q

What is the difference between a child with Separation Anxiety Disorder and a normal child who has reluctance to be separated?

A

Separation Anxiety Disorder kids will have physical sx (abd pain, HA, nightmares, sleep⬇︎)

241
Q

When treating the Depression/Anxiety in Alzheimer’s pts, which SSRI should you avoid?

A

paroxetine

if sx persist, use ACEI

242
Q

SSRIs with short half lives need to be tapered

Which 2 SSRIs are in this group?

A

Paroxetine and FluVoxamine

[2a] A ⼀ Step 2 OD USLME (21 decks)

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