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Psychiatry Flashcards

1
Q

Schizoaffective vs schizophrenia

A

Schizoaffective: depression or mania + psychosis, then 2 weeks minimum psychosis only Schizophrenia: psychosis symptom greater 6 months, no mood symptoms

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2
Q

Someone starts off depressed and then develops psychosis symptoms has…

A

A mood disorder

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3
Q

Someone is depressed with psychosis symptoms, then has an episode with only psychosis symptoms has…

A

Schizoaffective

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4
Q

Delusional disorder

A

Doesn’t meet schizophrenia criteria, but has one or more delusions for one month or longer. Functioning not significantly impaired

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5
Q

Bipolar I disorder

A

Mania for 7+ days-weeks, + major depressive disorder Symptoms of mania

  • psychosis possible

DIG FAST

D = Distractibility and easy frustration I = Irresponsibility and erratic uninhibited behavior G = Grandiosity F = Flight of ideas A = Activity increased with weight loss and increased libido S = Sleep is decreased T = Talkativeness

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6
Q

Bipolar II disorder

A

Hypomania (no psychosis) 4 days, never psychotic symptoms, + major depressive disorder, no hospitalizations

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7
Q

Cyclothymia types

A

Subsyndromal hypomania Subsyndromal major depression *dont meet criteria for hypomania or major depressive disorder

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8
Q

A patient is going crazy, what drugs can you give to calm them down?

A

Benzodiazepines or sedating antipsychotics (chlorpromazine/Thorazine) Sometimes change environment or physical restraints to protect people

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9
Q

Dopamine pathways

A
  1. Mesolimbic: delusions and hallucinations (target with med) (+ symptoms)
  2. Mesocortical: cognition and motivation, affective symptoms in schizo (exacerbated by med)(- symptoms)
  3. Nigrostriatal: extra-pyramidal movements (dystonic reaction, Parkinsonism)
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10
Q

Atypical antipsychotics partial D2 agonism

A

Aripiprazole, cariprasine

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11
Q

Atypical Antipsychotic that cause weight gain

A

Clozapine and olanzapine

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12
Q

Atypical Antipsychotic cause dyslipidemia

A

Cardiometabolic, diabetes: olanzapine, clozapine

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13
Q

Atypical Antipsychotic that causes EPS/hyperprolactinemia

A

Risperidone

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14
Q

Atypical Antipsychotic that causes akathisia

A

Aripiprazole

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15
Q

Atypical Antipsychotic that cause agranulocytosis so need check CBC

A

Clozapine

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16
Q

Side effects antipsychotics

A

Dystonia (muscle contraction, tx IV Benadryl), Parkinsonism, akathisia (feeling worms under skin, tx propanonol)

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17
Q

Which psychiatric disorder has equal diagnosis for men and females

A

OCD equal diagnosis

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18
Q

Patient presents with problems concentrating at school and increased irritability. She seems to not be able to stop worrying about issues in her life. She also says she has trouble falling to sleep at night and is easily fatigued. She also has problems of feeling restless. What is her likely diagnosis?

A

General anxiety disorder

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19
Q

Psychodynamic modality

A

Relationship most important

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20
Q

CBT

A

Pick problem and actively try fix, focus on behavior

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21
Q

Dialectical behavioral therapy

A

Mindfulness, emotional regulation, distress tolerance, interpersonal effectiveness

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22
Q

Motivational interviewing

A

Use for substance abuse, patient come up with solution

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23
Q
  • •Young age of onset
  • •Early changes are personality and behavior changes not memory deficits •
  • Memory loss is a late finding •
  • MCC of dementia in patients <60 •
  • Poor prognosis: Onset to death is about 4-6 years
A
  • Frontotemporal dementia, atrophy brain
  • •Treatment: symptomatic •SSRIs for impulsivity or sexually inappropriate behavior
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24
Q
  • • a slow and progressive
  • •development of apathy
  • • lack of insight
  • •prominent language and memory deficits, early presentation.
A

Alzheimer’s disease

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25
Waxing and waning forgetfulness with hallucinations
Levy body dementia
26
Schizophrenia diagnosis criteria
TWO or more of the following: 1. Delusions 2. Hallucinations 3. Disorganized speech (e.g., frequent derailment or incoherence). 4. Grossly disorganized or catatonic behavior 5. Negative symptoms (i.e. diminished emotional expression or avolition) * Must impact level of function * Must last for 6+ months
27
Substance-Induced Psychotic Disorder
Delusions or hallucinations within one month of acute intoxication or withdrawal.
28
Delirium
* Global, diffuse disturbance of CNS functioning that affects attention, consciousness and other areas of cognition (memory, orientation, language, and perceptions) * Develops rapidly, over hours-days
29
DementI occurs over a course of ?
months to years
30
Panic disorder treatment
* CBT * SSRIs, SNRIs,TCAs * hydroxyzine (antihistamine) * benzodiazepines (enhance GABA)
31
When use benzodiazepines
1. Acute alcohol withdrawal: oxazepam, (propranolol if drinking) 2. short term management anxiety: clonazepam (don't give for PTSD!) 3. sleep aids: temazepam
32
Which benzodiazepines are not metabolized by liver?
LOT = lorazepam, oxazepam, temazepam
33
Agoraphobia=fear unable to escape or be helped and avoid public places; treatment?
* CBT * benzos (short term) * hydroxyzine * SSRIs (long term) * Higher doses than mood disorder
34
Specific phobia
Fear specific object or situation, avoid single object or situation
35
Social anxiety disorder
Fear humiliation, scrutiny/rejection. Avoid social/performance situations
36
PTSD
1. Traumatic event exposure 2. symptoms \> or equal to 1 month (less=acute stress disorder) 3. symptom clusters * intrusive (1 sx required) * memories, nightmares, flashbacks, * avoidance (1) * internal, external * negative mood/cognition (2) * distored blame, negative beliefs and expectations, diminished interest, detachment, inability to recall * reactivity/arousal (2) * Irritability, hypervigilance, exaggerated startle, concentration difficulty, sleep disturbance, self destructive
37
Someone with PTSD is struggling falling asleep at night what medication can you give them?
Prazosin
38
Treatment for PTSD
1. Couple and/or family therapy 2. individual and/or group therapy * PE (prolonged exposure), CPT, CBT, ACT, DBT 3. medications * SSRIs (sertraline +paroxetine) * mirtazapine * TCAs and MAOIs
39
OCD vs. OCPD
OCD - ego dystonic=know problem OCPD- ego syntonic=think perfect
40
OCD treatment
* Exposure and Response Prevention * SSRI, fluvoxamine * Clomipramine * meds: higher doses,longer duration
41
Hoarding treatment
CBT, SSRI only help if also OCD
42
Trichotillomania
Pull hair out
43
Excoriation disorder
* recurrent skin picking result in lesions * treatment: CBT, SSRI
44
The key factor that helps to distinguish delirium from dementia is:
## Footnote Fluctuation in level of consciousness, dementia patients do not have
45
dementia - Alzheimer type ct scan shows what of brain
* demonstrates diffuse cortical atrophy. Most common kind * memory impairment, word finding difficulty, apraxia, and executive functioning deficits * insidious onset, gradual progression impairment
46
Frontotemporal dementia head Ct shows what? PE findings
* **earlier onset**; it is characterized by preferential **atrophy** of **frontal** and **temporal** lobes, as well as appearance of **primitive** **reflexes** and **behavioral** **changes**. * **personality** **changes** * **Misdiagnose bipolar**
47
Lewy body disease- dementia characteristics
**hallucinations**, **parkinsonian** features and extrapyramidal signs (involuntary movements). REM sleep behavior disorder
48
Vascular dementia
* widespread **lacunar infarcts** (people with hypertension or other cardiovascular disease) * symptoms progress stepwise fashion with focal neurological deficits
49
Psychoanalysis therapy
**verbalize** all their **thoughts**, including free associations, **fantasies** and dreams, and the **analyst** attempts to **formulate** the **unconscious conflicts** giving rise to the patient's symptoms or character problems.
50
Psychodynamic therapy
**uncover** the **unconscious content** of a client's psyche and then work on those issues in therapy; it has its roots in **psychoanalysis**.
51
Transference
individual **unconsciously transfers feelings and desires** relating to important individuals **from** their **past** (ie parent daughter or authority figure) onto their relationship and feelings **towards their provider.**
52
Lamotrigine
Na+ channel blocker, Partial Epilepsy and generalized epilepsy. Use for bipolar depression. Safety issue: rash/Steven Johnson syndrome
53
Phenobarbital
Increases GABA activity, often used to control seizures in Pediatric Population
54
Increases GABA activity, often used to control seizures in Pediatric Population
Phenobarbital
55
partial agonist of nAChR, Used for treatment of Tobacco cessation along with CBT
Varenicline
56
Potentiates GABA activity, Has active metabolites – long half life; may be used in anxiety treatment and alcohol withdrawal
Chlordiazepoxide
57
Blocks breakdown of ethanol by blocking aldehyde dehydrogenase
Disulfiram
58
partial agonist at nAChR and inhibitor of dopamine reuptake, Use for MDD, ADHD, narcolepsy, smoking cessation. Less sexual side effects; lowers seizure threshold
Bupropion
59
**Lead pipe rigidity**, HTN, Hyperthermia, Tachycardia, Tachypnea. Reaction to antipsychotic or neuroleptic drugs
Neuroleptic malignant syndrome
60
Serotonin-Norepinephrine reuptake inhibitor (SNRI). Used for major depression, GAD, social anxiety, pain disorder, neuropathic pain
Venlafaxine
61
beta-adrenergic receptor antagonist. Used for performance anxiety; contraindicated in COPD
Propranolol
62
increases release of NE and 5-HT, Alpha2 adrenergic receptor antagonist. Used in Major Depressive Disorder
Mirtazapine
63
serotonin receptor antagonist and reuptake inhibitor. Risk for priapism (painful erection that won't leave)
Trazodone
64
Tricyclic serotonin/NE reuptake inhibitor; Used for chronic pain; Overdose deadly
Amitriptyline
65
SSRI use for MDD, GAD. Safety issue: Dose dependent QTC prolongation
Citalopram
66
SSRI-use for MDD, GAD, OCD Long ½ life; good for tapering this class of drugs
Fluoxetine
67
MAO inhibitor. Risk of hypertensive crisis, Tyramine containing foods should be avoided
Phenelzine
68
MOA unknown/inhibits PI turnover. Mood stabilizer. Decreases suicidality. Risk for Ebstein’s anomaly.
Lithium
69
S is a 65 y/o M with Schizophrenia admitted to inpatient psychiatry unit due to heightened symptoms in the setting of medication non-adherence. His symptoms worsen over the first few days of the hospitalization as he continues to decline medications. On day three, he is noted to be **standing next to his bed for hours**. Upon exam, **you can place his arms into unusual positions which he then maintains**; you also notice muscle **rigidity**. He does not respond to questions, but he occasionally **repeats a word or phrase you say**. What is the most appropriate pharmacological intervention for him? What going on?
Catatonia- treatment= lorazepam IM
70
Conduct disorder is likely to progress to what?
Antisocial disorder
71
Panic disorder
Has 4 or more symptoms and anticipate next attack or change behavior to avoid
72
LT is a 19 y/o female is seeking evaluation for anxiety which began two months ago. She reports that several times a day she experiences abrupt onset of **shortness of breath, nausea, tingling in her fingers, diaphoresis, and the sense that she is outside of her bod**y. She is unable to identify any triggers or precipitants for these episodes. She now shops **only online and avoids leaving her house**, going to concerts, and both driving and public transportation. PMH is insignificant, and she denies substance use or current medications. What is the most likely diagnosis? long term Treatment?
* Panic Disorder with Agoraphobia * treatment: sertraline and CBT
73
Panic Disorder
* Recurrent, unexpected panic attacks x 1 month with anticipatory anxiety and/or avoidance * treatment: benzos (short-term), SSRIs and SNRIs (long-term)
74
Social Anxiety Disorder
* Anxiety with exposure to social situations in which you may be judged or evaluated by others * treatment: propranolol (PRN, test/performance anxiety), SSRIs and SNRIs (long term)
75
Excoriation Disorder
Recurrent skin picking resulting in skin lesions accompanied by repeated attempts to decrease or stop the behavior
76
Flooding treats what?
Specific phobia
77
PTSD treatment
Prolonged exposure, prazosin, SSRI or SNRI

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