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Step 1 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Negative reinforcement vs Positive punishment

Note - Used in operant conditioning (voluntary responses)

A

Negative reinforcement - Removal of aversive stimuli with target behavior

Positive punishment - Application of aversive stimulus

Negative punishment - Removal of a desired reward

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2
Q

Displacement vs Projection

A

Displacement - Transferring avoided ideas and feelings to a neural person or object (e.g. doing to others what someone did to you)

Projection - Attributing an unacceptable internal impulse to an external source (e.g. accusing someone of your impulse)

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3
Q

Regression vs Fixation

A

Fixation - Partially remaining at a childish level of development

Regression - Involuntarily turning back maturational clock to deal with the world

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4
Q

Sublimation vs Reaction formation

A

Reaction formation - Replacing warded-off feeling with unconsciously derived emphasis on opposite

Sublimation (mature) - Replacing an unacceptable wish with a similar wish that does not conflict with value system

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5
Q

Supression vs Repression

A

Repression - Involuntary

Suppression (mature) - Voluntary and temporary

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6
Q

Infant withdrawn or unresponsive to comfort

A

Reactive attachment disorder

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7
Q

Girl toddler with…
Developmental regression
Ataxia
Stereotyped-hand wringing

A

RETT SYNDROME

X-linked dominant

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8
Q

Treatment of ADHD

Note - Must be diagnosed before age 12 and involve more than one setting

A

Methylphenidate
Atomoxetine
Guanfacine
Clonidine

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9
Q

Treatment of Tourette’s

Note - Must be diagnosed before age 18 and persist for >1 year

A 
Fluphenazine
Pimozide
Tetrabenazine
Guanfacine 
Clonidine
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10
Q 
Neurotransmitters affected in...
Alzheimers
Anxiety
Depression
Huntington's
Parkinson's
Schizophrenia
A

Decreased Ach
Increased Glutamate

Increased NE
Decreased GABA, Serotonin

Decreased NE, Serotonin, Dopamine

Decreased Ach, GABA
Increased Dopamine

Decreased Dopamine
Increased Ach

Increased Dopamine

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11
Q

Diffuse slowing on EEG

A

Delerium

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12
Q

Reversible causes of dementia

A 
Hypothyroidism
Depression (pseudodementia)
Vitamin B12 deficiency
NPH
Neurosyphilis
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13
Q

Hypnagogic vs Hypnopompic

A

Hypnagogic - Going to sleep

Hypnopompic - Waking from sleep

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14
Q

Timeframe for…
Brief psychotic disorder
Schizophreniform disorder
Schizophrenia

Note - Ventriculomegaly on MRI

A

< 1 month
1 - 6 months
> 6 months

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15
Q

Criteria for schizoaffective disorder

A

2 weeks of hallucinations or delusions without mood disorder

Also periods of concurrent mood disorder with symptoms of schizophrenia

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16
Q

Folie a deux

A

Shared delusion - Must not impair functioning and last > 1 month

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17
Q

Criteria for manic episode - must last > 1 week

A

At least 3 of…

Distractibility
Impulsivity
Grandiosity
Flight of ideas
Agitation
Sleep decreased
Talkativeness or pressured speech

Note - If lasts > 4 days but does not impair functioning, require hospitalization, or come with psychosis then hypomania instead

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18
Q

Cyclothymic disorder

A

At least 2 years of hypomania and mild depression

Note - Bipolar II requires MDD instead

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19
Q

Sleep pattern changes in MDD…

Slow-wave sleep
REM latency
REM timing
Total REM

Note - Requires 5 out of 9 criteria for > 2 weeks

A

Decreased
Decreased
Earlier
Increased

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20
Q 
Mood reactivity to positive event
Hypersomnia
Hyperphagia
Leaden paralysis
Rejection sensitivity
A

Atypical depression

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21
Q

Presentation of…
Postpartum blues
Postpartum depression
Postpartum psychosis

Note - Must present within a month of delivery

A

Depressed affect, tearfulness, and fatigue resolving usually within 10 days

Depressed affect, anxiety, and poor concentration

Mood-congruent delusions

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22
Q

Criteria for GAD

A

Lasting > 6 months unrelated to specific person, situation, or event

Note - Treat with SSRI or SNRI (Buspirone is second line)

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23
Q

Timeline for adjustment disorder

A

Lasting < 6 months after stressor is removed

24
Q

Timeline for PTSD

A

Lasting > 1 month

Note - 3 days - 1 month is acute stress disorder

25
Q

Cluster A personality disorders

A

Paranoid - Pervasive distrust and projection

Schizoid - Voluntary social withdrawal

Schizotypal - Eccentric, odd, magical thinking, awkward

26
Q

Cluster C personality disorders

A

Avoidant - Hypersensitive but desires relationships

Obsessive-Compulsive - Ego-syntonic perfectionism

Dependent - Submissive and clingy

27
Q

Mechanism of re-feeding syndrome

A

Increased insulin
Hyperphosphatemia
Arrhythmias

28
Q

Timeline for bulimia

Note - Binge eating disorder does not have inappropriate compensatory behavior

A

Occurring weekly for > 3 months

Note - Response to Fluoxetine unlike Anorexia

29
Q

Transsexualism vs Transvestism

A

Transexualism - Desire to live as opposite sex

Transvestism - Desire to wear paraphilia of opposite se (not gender dysphoria)

30
Q

Difference between sleep terror and nightmare

A

Sleep terror - Non-REM sleep (slow-wave/deep) so no recollection

Nightmare - REM sleep so recollection

31
Q

Mechanism and treatment of narcolepsy

Note - Narcoleptic episodes start with REM sleep

A

Decreased Hypocretin (Orexin) production in lateral hypothalamus

Treat with…
Day - Amphetamines, Modafinil
Night - Sodium oxybate (GHB)

32
Q

Stages (6) of overcoming substance addiction

A

Precontemplation - there is no problem
Contemplation - there is a problem
Preparation/Determination - ready to change behavior
Action/willpower - changing behavior
Maintenance - maintaining changed behavior
Relapse - return to old behavior and abandoning new changes

33
Q

Sensitive serum marker indicative of alcohol use

A

y-glutamyltransferase (GGT)

34
Q

Symptoms of barbiturate vs benzodiazepine withdrawal

A

Barbiturates - Delirium, CV collapse

Benzodiazepines - Sleep disturbance, depression, rebound anxiety, seizure

35
Q

Mechanism of Naloxone + Buprenorphine

A

Buprenorphine is a partial agonist

Naloxone is not orally bioavailable so withdrawl symptoms only develop with IV use

Note - Naltrexone is long-acting opioid antagonist used for relapse prevention once detoxified

36
Q

Treatment of alcoholism

A

Naltrexone - Prevent cravings

Disulfiram - Condition abstinence

Acamprosate (modulates Glutamate at NDMA) - Prevent relapse

37
Q

Treatment of OCD

A

SSRI
Venlafaxine
Clomipramine

38
Q

Treatment of panic disorder

A

SSRI
Venlafaxine
Benzodiazepines

39
Q

Treatment of PTSD

A

SSRI

Venalfaxine

40
Q

Treatment of social anxiety disorder

A

SSRI
Venlafaxine

Note - If performance only then b-blockers or Benzodiazepines

41
Q

High and low potency typical antipsychotics, and their side effects

Note - All block dopamine D2 receptors increasing cAMP

A

High potency:
Trifluoperazine, Fluphenazine, Haloperidol
May cause EPS symptoms, hyperprolactinemia, prolonged QT

Low potency:
Chlorpromazine, Thioridazine
May cause HAM side effects, corneal deposits (Chlorpromazine), or retinal deposits (Thioridazine)

Note - Treat EPS with Benztropine/Diphenhydramine

42
Q

Mechanism and side effects of atypical antipsychotics

Includes...
Aripiprazole
Clozapine
Olanzapine
Quetiapine
Risperidone
ZIprasidone
Lurasidone
Paliperidone
Iloperidone

Note - Can treat positive and negative symptoms of schizophrenia

A

5HT2 Antagonists
Weaker D2 Antagonist

HAM side effects (less EPS)
QT prolongation
Weight gain ("-pines")
Hyperprolactinemia (Risperidone)
43
Q

Side effects of Lithium

A 
Tremor
Ataxia
Hypothyroidism
Nephrogenic DI
Teratogen

Almost exclusively excreted by kidneys and most is resorbed at PCT - Anything increasing Na resorption (e.g. Thiazides, ACEi, NSAIDs) also increases Li resorption

Note - Acutely mostly GI distress

44
Q

Mechanism of Buspirone

A

Stimulates 5-HT1A receptors

45
Q

Mechanism of SSRIs

Includes...
Fluoxetine
Paroxetine
Sertraline
Citalopram
A

5-HT specific reuptake inhibitors

May cause…
GI distress
SIADH
Sexual dysfunction

46
Q

Mechanism of SNRIs

Includes...
Venlafaxine
Desvenlafaxine
Duloxetine
Levomilnacipran
Milnacipran
A

5-HT and NE reuptake inhibitors

May cause...
Hypertension
Stimulation
Sedation
Nausea

Note - can also be used for diabetic neuropathy

47
Q

Treatment of serotonin syndrome

A

Cyproheptadine

48
Q

Mechanism of TCAs

Includes...
Amitriptyline
Nortriptyline
Imipramine
Desipramine
Clomipramine
Doxepin
Amoxapine
A

5-HT and NE reuptake inhibitors

Major depression
OCD (Clomipramine)
Peripheral neuropathy
Chronic pain
Migraine prophylaxis
May cause...
Sedation
Orthostatic hypotension (a1-blocking)
Anticholinergic (tertiary; Amitriptyline)
Prolonged QT
Delerium (use Nortriptyline in elderly)
Hyperpyrexia
Convulsions, Coma, Arrhythmia
49
Q

Mechanism of MAOi

Includes...
Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline (MAO-B selective)
A

Non-selective MAO inhibition increases 5-HT, NE, and Dopamine

Refractory atypical depression
Anxiety

May cause…
Hypertensive crisis
CNS stimulation
Serotonin syndrome if taken with SSRIs, TCAs, St. John’s wort, Meperidine, Dextromethorphan

Note - Wait 2 weeks after stopping drug to take other serotonergic drug or stop dietary (Tyramine) restrictions

50
Q

Mechanism of Buproprion

A

Increased NE and Dopamine

Depression
Smoking cessation

May cause…
Simulation/Anxiety
Headache
Seizures in anorexia/bulimia

Note - No sexual side effects

51
Q

Mechanism of Mirtazipine

A

a2-antagonist increases NE and 5-HT
5-HT2, 5-HT3 antagonist
H1 antagonist

Depression
Insomnia

May cause...
Sedation
Increased appetite
Weight gain
Dry mouth

Note - No sexual side effects

52
Q

Mechanism of Trazodone

Note - Not used in depression as high doses are needed

A

5-HT2 antagonist
a1 antagonist
H1 antagonist

Insomnia

May cause...
Sedation
Nausea
Orthostatic hypotension
Priapism
53
Q

Mechanism of Varenicline

A

Nicotinic ACh receptor partial agonist

Smoking cessation

May cause…
Sleep disturbance

54
Q

Presence of multiple motor or multiple vocal tics but not both

A

CHRONIC TIC DISORDER

Note - Tourettes requires multiple motor and at least 1 vocal tic >1 year

55
Q

Mechanism of Dantrolene

A

Stops Ca release from SR (RYR antagonist) - Prevents consumption of excess ATP (generates heat) to move Ca back into SR

Note - Also used in malignant hyperthermia

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