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Shelf Exams > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Which medication for alcohol use disorder is safe to use in liver disease? Why?

A

Acamprosate

Renally cleared

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2
Q

Treatment of tardive dyskinesia

A

Stop offending medication if possible, if they need to be on an antipsychotic put them on Clozapine

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3
Q

Treatment of parkinsonism

A

Benztropine or amantadine

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4
Q

What neurotransmitter does PCP effect

A

Glutamate (NMDA receptors) antagonist

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5
Q

Triad of ADHD

A

inattentiveness, hyperactivity, and impulsivity IN MULTIPLE SETTINGS (ie school and home)

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6
Q

Cardiac effects of TCA toxicity

What is the treatment

A

Blockade of cardiac sodium channels

QRS and QT prolongation –> Can lead to torsades

Tx with sodium bicarb

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7
Q

Withdrawal: rhinorrhea and lacrimation

A

opioid withdrawal

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8
Q

What drug can be given to reverse the effects of LSD?

A

Atypical antipsychotics

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9
Q

Cyclothymic disorder

A

AT least 2 years of fluctuating, mild hypomanic and depressive symptoms that do not meet criteria for hypomanic episodes or major depressive episodes

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10
Q

What receptors does caffeine work through

A

Adenosine (antagonist)

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11
Q

Wernicke-Korsakoff syndrome:

A

lesion to bilateral mammillary bodies (within temporal lobes) associated with thiamine (B1) deficiency and excessive EtOH use.

Confusion, opthalmoplegia, ataxia, memory loss (retrograde and anterograde amnesia), confabulation and personality changes
o Wernicke problems come in a CAN of beer: Confusion, Ataxia, Nystagmus

Inability to learn new info

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12
Q

What treatment should be used in depressed geriatric patients who are unable to drink or eat, are psychotic, or are actively suicidal in order to achieve a rapid response?

A

ECT

Antidepressants typically take up to 6-8 weeks to be effective

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13
Q

Withdrawal from what drug causes depression?

A

Cocaine

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14
Q

Part of the brain implicated in ADHD

A

Altered activity in the dorsolateral prefrontal cortex

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15
Q

Tic disorder treatment

A 
a1 agonists (clonidine, guanfacine)
or antipsychotics if severe
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16
Q

Psychogenic polydipsia

A

A sensation of unquenchable thirst secondary to mania or psychosis
Dilute urine with normal electrolytes (because the kidneys can compensate just fine)

In DI – there is hypernatremia

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17
Q

Which drugs are the choice for sedation in emergency setting?

A

Lorazepam (Ativan)

Haloperidol (Haldol)

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18
Q

Treatment of catatonia

A

Benzodiazepines and/or ECT

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19
Q

What is required for diagnosis of Neuroleptic malignant syndrome?

A

Diffuse muscle rigidity

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20
Q

Which antipsychotic can cause retinitis?

A

Thioridazine (retinitis pigmentosa)

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21
Q

Dissociative fugue

A

Sudden unplanned travel accompanied by an inability to recall one’s own personal hx. Pts will often assume a new identity in this new location

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22
Q

Connective tissue causes of psychosis

A

SLE, temporal arteritis, porphyria

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23
Q

Medical causes of depression

A

o Thyroid
o Vitamin D
o Folate/B12 (hx of gastric bypass)

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24
Q

Features of MDD with atypical features

Symptoms and treatment

A

o Mood reactivity (feeling better in response to positive events)
o Leaden paralysis (patient’s arms and legs feel very heavy)
o Rejection sensitivity (sensitive to criticism)
o Hypersomnia and hyperphagia
o Treat with SSRIs (MAO inhibitors are not first line due to risk profile)

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25
Q

Scary side effect of Clozapine

When is Clozapine used

A

Leukopenia (agranulocytosis)

Used for treatment resistant schizophrenia and schizoaffective disorder

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26
Q

Schizophrenia vs schizophreniform disorder vs brief psychotic disorder

A

Schizophrenia: present for 6+ months
Schizophreniform disorder: between 1-6 months
Brief psychotic episode: less than 1 month

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27
Q

Medical treatment of binge eating disorder

A

Lisdexamfetamine: (Stimulant)

SSRI

CBT

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28
Q

Treatment of akathisia (Inability to sit still)

A

Propranolol or Benzos

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29
Q

Postpartum depression treatment

A

SSRIs for at least 6 months after resolution of symptoms

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30
Q

TCAs and anticholinergic toxicity symptoms

  • which symptom is most specific
  • which TCA is most notorious for these side effects
  • which population is most often affected
A

Dry mouth, constipation, blurred vision, and **urinary retention

Amitriptyline

Most common in elderly patients

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31
Q

How does smoking affect antipsychotic medications

A

Nicotine increases the metabolism of antipsychotics (decreases their effectiveness)

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32
Q

Which med should you use in MDD with psychotic features?

A

SSRI (like fluoxetine) and Risperidone

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33
Q

1st line treatment for bedwetting in kids

A
  • Limit fluid intake at bedtime
  • Urine alarm
  • Pharmacotherapy if behavioral interventions dont work
    - 1st line = desmopressin
    - Imipramine (TCA) – due to anticholinergic effects (causes urinary retention)
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34
Q

Medical management of fear of public speaking

A

Propranolol (B blockers)

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35
Q

How does tetrabenazine treatment lead to depression in Huntingtons?

A

It depletes dopamine from the synaptic cleft

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36
Q

The effects of what drug is clinically undistinguishable from schizophrenia?

A

PCP

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37
Q

Part of the brain implicated in OCD

A

Caudate nucleus (Basal ganglia)

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38
Q

What drugs act through serotonin

A

Hallucinogens

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39
Q

Which pathway causes hyperprolactinemia?

A

Tuberoinfundibular

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40
Q

Timeline of schizophrenic spectrum disease

A

<1 month: brief psychotic disorder
1-6 months: schizophreniform disorder
>6 months: schizophrenia

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41
Q

First line therapy for bipolar disorder

A

Lithium or Valproic acid plus a second gen antipsychotic (quetiapine) aka seroquel

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42
Q

Elevation of what is seen after a seizure and is used to distinguish between epileptic and psychogenic nonepileptic seizures?

A

Prolactin - elevated after an epileptic seizure

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43
Q

Naltrexone

A

Opioid antagonist
Decreases cravings for alcohol
Can precipitate withdrawal in opioid dependence

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44
Q

What is the preferred treatment of gambling disorder

A

Group therapy: participation in gamblers anonymous

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45
Q

What can benzos in the elderly cause?

A

Delirium

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46
Q

When should you expect to see seizures in alcohol withdrawal?

A

12-48 hours

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47
Q

Schizoaffective disorder

A

Schizophrenia + mood disorder
• Patients meet criteria for either a major depressive episode or manic episode during which psychotic symptoms consistent with schizophrenia are also met

Delusions or hallucinations for 2 weeks in the absence of mood disorder symptoms
• This is necessary in order to differentiate this from mood disorder with psychotic features

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48
Q

Medical management of anorexia nervosa

A

Fluoxetine (SSRI)

Olanzapine

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49
Q

Tyramine Reaction

Symptoms and meds involved
Treatment

A

Hypertensive crisis with HTN, blurred vision, and diaphoresis– due to build up of tyramine

If on MAOIs, need dietary restrictions (no tap beer, aged cheese, dried meat, red wine, avocado, black bananas)

Treat with phentolamine (a1 and a2 blocker)

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50
Q

What vitamin and electrolyte deficiencies can lead to psychosis?

A 
B12
niacin: carcinoid syndrome, pellagra
folate
Calcium
Sodium
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51
Q

When do nightmares occur?

A

During REM sleep, later on in the night

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52
Q

What are contraindications to Buproprion?

A

Anorexics, bulimics, and epileptics –> can cause seizures

Also has stimulant effects so it is not a good choice in people with anxiety

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53
Q

What drugs are used to treat OCD?

A

SSRIs

Clomipramine (TCA) ** technically the gold standard but has side effects

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54
Q

Treatment of akathisia

A

Beta blocker
Benzos

“For treatment of A, give Bs”

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55
Q

What brain changes are seen in schizophrenia

A

Enlargement of the ventricles

56
Q

Acamprosate

A

Mechanism: modulates glutamate and GABA

Can be used in patients with liver disease as it is hepatically cleared

57
Q

Which antipsychotic does not exacerbate symptoms of parkinsons

A

Clozapine

58
Q

Hallucinations act through which neurotransmitter pathway?

A

Serotonin

59
Q

Positive symptoms

A

hallucinations, delusions, bizarre behavior, disorganized speech
• Tend to respond better to antipsychotic medications

60
Q

Acute intoxication with alcohol can cause what type of acid base disturbance

A

Metabolic acidosis with an elevated anion gap

61
Q

Which antipsychotic is most likely to cause long QT

A

Ziprasidone

“Zip on over to get an EKG!”

62
Q

Alcoholic with macrocytosis and peripheral neuropathy

A

B12 deficiency

63
Q

How does the treatment of illness anxiety disorder differ from other somatic symptom disorders?

A

Responsive to CBT AND SSRIs

64
Q

What brain tract is implicated in reward? What neurotransmitter?

A

Mesolimbic tract

Dopamine

65
Q

Opiate withdrawal symptoms

A

Anxiety, N/V/D, insomnia, anorexia, fever, sweating, rhinorrhea, lacrimation, yawning

66
Q

What drug(s) can be used to treat MDD with insomnia?

A

Mirtazapine (Remeron) – has H1 blocking traits, leading to sedation
Trazodone – H1 blockade

TCAs can also do this but they are not first line due to side effects

67
Q

Which SSRI is most associated with sexual dysfunction? What should you switch them to?

A

Paroxetine (due to anticholinergic activity).

Switch to Sertraline

68
Q

Major depressive disorder with psychotic features

A

When a patient presents with MDD with hallucinations and delusions that reinforce the patient’s depressive symptoms

69
Q

What type of therapy is uniquely studied to be beneficial in anorexia?

A

Family based therapy

70
Q

Workup for new onset psychosis

A 
Utox
CBC
Electrolytes
Tsh
Liver panel
CT or MRI
71
Q

Which pathway is responsible for antipsychotic efficacy?

A

Mesolimbic

72
Q

Neurotransmitter implicated in Alzheimer’s disease?

A

Acetylcholine

73
Q

What electrolyte disturbance would you expect in anorexia nervosa

A

Hyponatremia

74
Q

Which benzodiazepine is given to manage withdrawal symptoms from alcohol or other benzos?

A

Chlordiazepoxide (longer half life)

75
Q

what neurotransmitter is implicated in schizophrenia?

A

Inc in dopamine

76
Q

Refeeding syndrome

A

Artificial nutrition causes an increase in insulin
Inc protein synthesis, inc uptake of phosphorous, potassium, magnesium and thiamine

– Causes a dec in serum phosphorous, potassium, magnesium

77
Q

Which pathway can cause extrapyramidal symptoms?

A

Nigrostriatal pathway

78
Q

“Chronically depressed patient with at least one episode of hypomania”

A

Cyclothymic disorder

79
Q

Which SSRI is least likely to cause withdrawal symptoms if stopped abruptly?

A

Fluoxetine

80
Q

Withdrawal of what drugs can cause seizures?

A

Benzos
Booze
Barbs

Due to the upregulation of Glutamate (excitatory) to compensate for increased activation of GABA (inhibitory) by the drugs

81
Q

Factitious disorder: conscious or unconscious

A

Conscious

82
Q

Disulfiram:
Mechanism
Effects
Contraindications

A

inhibits aldehyde dehydrogenase –> causes vomiting, headache, flushing, acts as “punishment” for drinking

Contraindicated in pregnancy, cardiac disease, and psychosis

Issues with adherence

83
Q

Dissociative fugue

A

Sudden unplanned travel accompanied by an inability to recall one’s own personal hx

84
Q

Conversion disorder: conscious or unconscious

A

Unconscious

85
Q

What medication for alcohol use disorder should be used in someone with kidney disease?

A

Naltrexone: hepatically cleared

86
Q

Which second generation antipsychotics are more weight neutral?

A

Ziprasidone
Aripiprazole

(so your ZIPper doesnt RIP)

87
Q

Workup for medical causes of psychosis

A 
CT Head (intracranial process)
HIV and RPR
CBC (some leukemias can present this way)
CMP (electrolytes)
TSH (Thyroid disease)
Utox (drug induced psychosis)
88
Q

Lithium Adverse Effects

A

o Early toxicity = GI symptoms (N/V/D)
o Prolonged toxicity = tremor, confusion, ataxia
o Hypothyroidism: hair loss, weight gain, dry skin, constipation
o Diabetes Insipidus: polyuria, polydipsia (antagonizes ADH in the collecting duct)

89
Q

Why dont you give benzos to older people

A

Can lead to delirium

It is disinhibiting – can cause agitation

90
Q

Treatment of acute dystonia (sustained contraction of the neck, mouth, tongue, eye muscles)

A

Benztropine or Diphenhydramine

91
Q

What illicit drug can lead to serotonin syndrome?

A

Ecstacy

92
Q

What drugs act through GABA

A

Benzos, Booze, and Barbs

93
Q

Time criteria for cyclothymic disorder

A

2 years

94
Q

Agoraphobia vs social anxiety

A
  • Social Phobia: fear of scrutiny by others or fear of acting in a humiliating or embarrassing way
  • Agoraphobia: Severe anxiety that results in response to a situation or place in which a patient is concerned that it might be difficult to escape
95
Q

Lithium toxicity

A

Very narrow therapeutic index
Acute lithium toxicity: GI symptoms (N/V/D)
Prolonged toxicity: tremor, confusion, and hyperreflexia, ataxia and seizures

96
Q

What medication decreases alcohol cravings?

A

Acamprosate for daily drinkers

Naltrexone for binge drinkers

97
Q

A patient with a recent cold presents with serotonin syndrome… what drug most likely precipitated this?

A

Dextromethorphan (cough syrup)

98
Q

When should you expect to see delirium tremens? What is characteristic of this?
What is the treatment of DTs

A

after 2-4 days

*Disorientation, delusions, hallucinations

Treat with benzodiazepines

99
Q

Rapid eye movement sleep behavior disorder is a suggestive feature of what disease?

A

Parkinson disease or Lewy Body Dementia

100
Q

What antidepressant can be used for smoking cessation?

A

Buproprion

101
Q

Treatment of body dysmorphic disorder

A

SSRIs and/or CBT

102
Q

Features of Lewy Body Dementia

A
  1. dementia
  2. hallucinations: usually benign, small animals,
  3. Parkinsonism: masked facies, cogwheel rigidity, shuffling gait, frequent falls
  4. Fluctuating cognition - “sundowning”
103
Q

Acute intermittent porphyria symptoms and treatment

A

Due to a defect in the heme synthesis pathway

o	Precipitator: alcohol, starvation, CYP450 inducers
o	Abdominal pain
o	Port wine urine
o	Psych disturbances
o	Peripheral neuropathy

Treat with dextrose and heme

104
Q

What drug is used for rapid cycling bipolar disorder (at leasr four mood episodes within 12 months)

A

Carbamazepine

105
Q

Hypercalcemia

A

Symptoms: Stones, bones, groans, moans, thrones, and psychiatric overtones
• Stones = kidney stones
• Bones =bone pain
• Groans= lethargy, fatigue
• Moans = constipation, abdominal pain
• Thrones = polyuria and polydipsia
• Psychiatric overtones = mental status change

106
Q

Which antipsychotic can decrease the efficacy of other antipsychotics when used as adjunctive therapy for depression?

A

Aripiprazole (partial dopamine agonist)

107
Q

Why is clonipramine best for OCD compared to other TCA’s?

A

Inc serotonergic activity

108
Q

What drug can be used to treat MDD with hypersomnolence

A

Bupropion (Wellbutrin) – activating, stimulant

109
Q

Meds to treat neuroleptic malignant syndrome

A

Dantrolene- inhibits calcium ion release form the sarcoplasmic reticulum
Bromocriptine- dopamine agonist
Amantadine - an antiviral drug with dopaminergic properties
ECT

110
Q

Negative symptoms

A

flat or blunted affect, anhedonia, apathy, alogia, and lack of interest in socialization
• Often more resistant to treatment

111
Q

Which SSRI should not be started in patients with a hx of medication noncompliance? Why?

A

Paroxetine
Can cause severe SSRI discontinuation syndrome - dizziness, nausea, fatigue, muscle aches, electric shock sensations, anxiety

(Usually avoid this with slow tapering off of the drug)

112
Q

Sleep changes in MDD

A

Inc in REM

Dec in slow wave “deep sleep”

113
Q

Drug intoxication: nystagmus

A

PCP Phencyclidine

114
Q

Treatment of enuresis

A 
Desmopression
Imipramine (TCA) for refractory cases
115
Q

Difference in mechanism of action of barbs vs benzos

A

Both are GABA-A agonists

Barbs; increase DURATION of chloride channel opening
Benzos; increase FREQUENCY of chloride channel opening

116
Q

fregoli syndrome

A

when multiple people are believed to be one person that can change appearance

117
Q

Adverse effect of B blockers in elderly

A

centrally-acting beta blockers (carvedilol, propranolol, nadolol) can cause cognitive suppression – patients with dementia are at higher risk of this

118
Q

Which anticonvulsant is safe in pregnancy?

A

Lamotrigine

119
Q

capgras syndrome

A

belief that someone you know well has been replaced by an imposter

120
Q

Mechanism of tardive dyskinesia

A

When you block dopamine receptors with antipsychotics, the brain makes more receptors are made that are more sensitive to dopamine → leads to excess movement (dopamine receptor hypersensitivity)

121
Q

Hyperreflexia and myoclonus suggests what? What is the treatment?

A

Serotonin syndrome – treat with cyproheptadine

In NMS, you would see hyporeflexia

122
Q

What receptors do opioids work through

A

Mu opioid receptors

123
Q

Fear of crowds

A

Agoraphobia

124
Q

What effect can alcohol have on red blood cells?

A

Macrocytosis

125
Q

Which medication can be used in PTSD to decrease nightmares and hypervigilance

A

Prazosin (a1 blocker)

126
Q

EKG findings in anorexia

A

ST dep
T wave flattening
low voltage
long QT

127
Q

If a patient presents with depressive symptoms and admits to heavy alcohol use, what is the diagnosis?

A

Substance induced mood disorder

128
Q

Kluver Bucy Syndrome

A

disinhibited behavior (hyperphagia, hypersexuality, hyperorality) caused by a lesion to the bilateral amygdala (within the temporal lobe)
o Can be due to ischemic stroke or trauma
o Often asociated with HSV-1

129
Q

Treatment of acute mania in bipolar?

Treatment of acute depressive episodes of bipolar?

A

Mania: Lithium and valproic acid
Depression: Lithium and lamotrigine

130
Q

Patient hospitalized for an MS flare is appropriately treated. However she then develops delusions and hallucinations. What is the likely diagnosis?

A

Substance induced psychosis: 2/2 steroids!

131
Q

What neurotransmitter is found to be lower in the CSF of people with impulsivity/violence when compared to the general population?

A

Serotonin

132
Q

anti-HAM effects of antipsychotics

A

anti-Histamine: sedation, weight gain
anti-Alpha adrenergic: orthostatic hypotension
anti-Muscarinic: dry mouth, constipation

133
Q

NSAID effects on lithium levels?

A

NSAIDs increase lithium levels, better to use Aspirin

134
Q

What antidepressant should not be started in a patient with HTN?

A

SNRI – can inc blood pressure

135
Q

Which antipsychotic causes the most weight gain

A

Olanzapine

136
Q

How long should a patient be treated with SSRI for depression

A

About 8-10 months after resolution of symptoms

Shelf Exams (8 decks)

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