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uworld > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

how do you tell if a person is in an abuse relationship

A

power and equality

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2
Q

akathisia what is it and how do you treat?

A
  • restlessness after antipsychotic use

- Tx with stop drug and beta blocker

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3
Q

PCP intoxication and how to treat

A

stem will say agitation , nystagmus

Tx benzo

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4
Q

Before starting ADHD on amphetamine

A

check

  • vitals
  • cardiac history (tachycardia)
  • weight
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5
Q

drugs for ADHD

A
  1. amphetamine

2. Atomoxine (watch out liver s/e)

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6
Q

what s/e do you get with Atomoxine

A

liver side effects

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7
Q

patients gets psychosis , female and arthritis what do they have (otherwise healthy no drugs)

A

LUPUS

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8
Q

smoking cessation - s/e of varenicline

A

increase risk of cardiac event

PLUS pschy / suicidal risk

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9
Q

What drug for smoking cessation is c/i in anorexia and botulm

A

bupropirion

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10
Q

c//i to nicotine patch

A

no one its good for everyone

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11
Q

treatment of insomnia

A

CBT

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12
Q

best way to assess drinking problem

A

ask them how many times in past year they had more than 5 drinks at one time

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13
Q

how long do you treat a single episode of MDD

A

6 months

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14
Q

all antidepressant meds have an increase risk of what?

A

hypomanic symptoms

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15
Q

when to use ECT

A
  • acute depressive epidote
    resistent to meds
    emerge / suicidal
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16
Q

Adolescent depression

A

irritability and somatic symptoms

if they begin to completely withdraw - think careful about drug use

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17
Q

patient come to hospital with suicidal attempt , has been drinking - how do you assess suicidal risk

A

observe patient

when sober - address suicidality

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18
Q

first line treatment of panic disorder

A

SSRI and CBT

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19
Q

difference b/w panic disorder or GAD

A

GAD - 6 months

panic disorder - abrupt onset

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20
Q

what is interpersonal therapy used for

A

Mostly used for depression

not good for agoraphobia or panic

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21
Q

lithium toxicity acute

A

starts off with GI symptoms - N V D

Neuro

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22
Q

lithium toxicity chronic

A

confusion , agitation, ataxia, tremors , fasciculation’s , seizure

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23
Q

causes of lithium toxicity

A
  1. overdose
  2. dehydrated
  3. Drugs ( thiazide, NSAIDS, ACE inhibitor, tetracycline , metronidazole)
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24
Q

age seperation anxiety

A

9-18 months

Also okay for when they go to school - but normal response is they are able to calm down and settle into class after you drop them off

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25
Q

adjustment disorder

A

symptoms that develop within 3 months of exposure to an identifiable stressor

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26
Q

treatment of choice for adjustment disorder

A

psychotherapy

- focuses on improving coping skills and returning to function

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27
Q

dx of MDD

A

> or = to 2 weeks
or = 5 SIGECAPS
significant impairment

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28
Q

treatment of bipolar in renal dysfunction

A

vampiric acid

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29
Q

treatment of performance related anxiety

A

benzo (more neuro S/e - not good for test)

propanolol ( less neuro s/e)

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30
Q

two mature defence mechanisms

A

sublimation : channeling impulses into socially acceptable behaviours

Suppression: putting unwanted feelings aside to cope with reality

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31
Q

reaction formation

A

responding to a manner opposite to ones feeling

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32
Q

difference b/w depressive disorder with psychotic features and schizoaffective disorder

A

Depression with psychotic features : the patient will don’t have delusions apart from the episode

Schizoaffective - patient develops disorder that must be evidence of psychotic symptoms for greater than = to 2 weeks in absence of mood

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33
Q

hypomanic episode

A

simp less severe

, NO PSYCOTIC FEAUTeS , , >/= to 4 consecutive days

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34
Q

manic episode duration

A

1 week unless hospitalized

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35
Q

difference b/w BPD 1 and 2

A

1: manic episode ( don’t need depressive episode for Dx)
2: hypomanic episode and at least 1 depressive episode

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36
Q

immobility or excessive purposeless activity

A

catatonia

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37
Q

management of catatonia

A

benzodiazepines

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38
Q

treatment of patient who stares blankly and is mute and motionless

A

think catatonia - benzo

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39
Q

dx Neuroleptic malignant syndrome

A

Fever > 40
confusion
muscle rigidity ( generalized)
Autonomic instability - abnormal vital signs and sweating

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40
Q

treatment

A

stop antipsychotics or restart dopamine agents

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41
Q

mode of action for antipsychotic medications

A

serotonin 2A and dopamine D2 receptor blockade

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42
Q

intellectualization

A

transformation of an emotionally difficult event into a purely intellectual problem to avoid confronting its uncomforabe emotional components

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43
Q

giving medical files over to family

A

its important the patient request a copy of Her medical records ( not just the husband asking)

44
Q

S/e Clonazepine

A

Neutropenia

45
Q

narcissistic personality disorder

A

exaggerated sense of SELF IMPORTANCE , need for admiration ,reeling of entitlement and lack of empathy

46
Q

Treatment of sleep terrors

A

Reassurance

admin of low bento at bedtime if episodes are frequent persistent and distressing

47
Q

Features of sleep terrors

A

abrupt arousal from sleep
no dream / little recall
amnesia of episode

48
Q

c/i of lithium

A

CKD
Heart disease
Hyponatremia or diuretic use

49
Q

Baseline labs before starting patient on lithium

A

BUN , Cr, Calcium
TFT
ECG - patients with risk factors
urinalysis ( if child bearing age to o.r pregnancy

50
Q

long term s/e of lithium

A 
diabetes insipidus 
chronic kidney disease 
thyroid dysfunction 
hypercalemia 
hyperparathyroidism
51
Q

time for postpartum depression and postpartum blues and postpartum psychosis

A

Blues - 2-3 DAYS - reassurance that only last few days - then f/u

Postpartum depression - 4-6 weeks - SSRI

postpartum psychosis - days to weeks - antipsychotics, mode stabilizers

52
Q

sexual dysfunction with SSRI

A

want to switch to bupropion OR Mirtazepine

53
Q

breast feeding - what antidepressants are safe

A

sertraline and paroxetine

54
Q

Depression treatment

A
  1. SSRI - 6 weeks

2. if doesn’t work try another SSRI

55
Q

mod to severe alcohol w/d

A

naltrexone (decreases craving

OR can also give lorazepam

56
Q

who do you not give disulfarim to

A

avoid in its who live along and at tis of drinking

57
Q

treatment of catatonia

A

lorazepam

58
Q

patient is on lithium and gets htn - what anti-hypertensive can you use

A

amlodipine OR loop diuretic

59
Q

what drugs decrease effect of lithium

A

K+ sparing diuretics

theophylline

60
Q

patient on antipsychotic drugs and they develop Parkinson’s psychosis) what do you do

A

DECREASE Dose of parkinson meds ( carbiopa, levodopa , mamantine)

61
Q

tourettes at risk of what?

A

ADHD

OCD

62
Q

benzo in elderly - risk of?

A

falls

cognitive decline

63
Q

chronic benzo - that recently gets stopped - what treatment do you use if patient has bento w/d symp

A

benzo w/d symptoms - tacycardic, attack attack symptoms, FEVER

Treat with diazepam

64
Q

Opiod w/d

A

lacrimation, rhinorrhea , yawning, INCREASe Bowl sounds

65
Q

treatment of opiod w/d

A

methadone , bupranorphine

Non opiod treatment - Clonidine

66
Q

if its has symptoms of 2 weeks of depression - do you treat’?

A

Yes - SSRI as long as grater than or equal to 2 weeks

67
Q

Bereavement in children (ex: child who looses their dog)

A

< 7 - they think the dog will come alive again ( temporary death)

> 7 - understand god is dead

68
Q

if patient has a history of cutting

A

do a suicidal and psychiatric history

69
Q

kindly donation c/i in

A 
financial issues 
legal issues 
younger than 18 
HTN , DM, HIV uncontrolled 
Active / incomplete cancer treatment
70
Q

Agitation

A

always start wit h non pharm first

71
Q

depression on own can increase morbidity and mortality of

A

cardiovascular disease

72
Q

tourettes vs. tic disorder

A

tourettes - multiple motor PLUS one or more vocal

Tic - multiple motor OR vocal tic

73
Q

treatment of tourettes

A

pimozide
Haloperidol

Children with tourettes - can give 2nd generation

74
Q

treatment of acute dystonia

A

benzotropine

Diphenyephrine

75
Q

treatment of akathisia

A

beta blocker or lorazepam

76
Q

treatment of parkinsonism symp

A

benztrophine

amantine

77
Q

tardive dyskinesia treatment

A

clonazipine

78
Q

clitomegly and acne in women

A

anabolic steroid use

79
Q

veteran who has new onset insomnia

A

think PTSD

80
Q

treatment of ADHD in adults

A

atomoxetine

81
Q

best non pharm treatment for depression

A

CBT

82
Q

sucide risk with antidepressant

A

yes there is

but have to outweigh risk and benefits

83
Q

effects on antipsychotic if causing hyperprolactinemia

A

causes hyperprolactinemia - by blocking dopamine activity in the tubeoinfindibular pathway

84
Q

antipsychotic efficacy

A

decrease dopamine activity in the mesolimbic pathway

85
Q

what happens to dopamine if patient has tar dive dyskinesia

A

dopamine receptor supra sensitivity

86
Q

major depressive disorder - what ca happen to your cortisol

A

MDD - hyperactivity of HPA axis

INCREASE cortisone level

87
Q

abnormalities in the cortico-striato- thalami cortical circus has been ass /w w

A

OCD

88
Q

enlarged ventricles has been associated with

A

schizophrenia

89
Q

how long do you have to stay on lithium

A

continue longterm

- DONT STOP

90
Q

first line therapy to help with alcohol abstain

A

Naltrexone (opoid)
or
Acamprosate (glutamate modulator)

Don’t give disulfarim - in a patient who is actively heavily drinking - the patient to get this med must be actively wanting it ( ONLY SECOND LINE )

91
Q

when you suspect autism what should your response be

A

i would like to obtain a more through evaluation now as early interventions may be needed

92
Q

decrease volume of hippocampus ass. w/

A

schizophrenia

93
Q

best treatment for fear of heights

A

EXPOSUre therapy

94
Q

second line treatment of MDD after SSRI is tried twice

A

do a norepinephrine and dopamine reuptake inhibitor - bupropion

95
Q

what antidepressant drug causes no weight gain

A

bupropion

96
Q

difference b/w factitious and malingering

A

Factitious - initial falsification of INDUCed symptoms with goal of assuming sick role

Malingering - falsification or exaggeration of symptoms to obtain external incentives - secondary gain

97
Q

what do you do if elderly is on benzodiazepine for long term

A

increase risk of adverse effects

therefore you should taper and discontinue

increase risk of falls and confusions, paradoxical agitation

98
Q

narcoses

A
  • recurrent lapses into sleep (>3 times week for > 3 months)

> /= 1 of the following:
- cataplexy
- low CSF level of hypocretin 1
Shortened REM sleep latency

Ass. features

  • hypnagogic or hypnopompic hallucination
  • sleep paralysis
99
Q

hyper somnolence

A

disorder characterized by persistent daytime sleepiness and is diagnosed only when excessive sleepiness is not better explained by another sleep disorder

100
Q

best treatment for harding disorder

A

CBT

101
Q

patient has paranoid delusions , tactile hallucinations, aggressive behaviour and severe insomnia with poor dentitions and skin sore on

A

think methamphetamine abuse

102
Q

most common s/e of ECT

A

Retrograde and anterograde amnesia

anterograde - last 2 weeks
retrograde - persist longer
permanent memory loss -RARE

103
Q

s/e of valporic acid

A

liver injury

104
Q

ecstasy intoxication

A

Amphetamine toxicity - HTN, tachycardia, hyperthermia

serotonin toxicity - serotonin syndrome - fever, autonomic dysfunction , altered mental status, seizures) and hyponatremia

105
Q

what drug can cause hyponatremia

A

ecstasy

106
Q

what antidepressant is preferred in patients with insomnia

A

mirtazepine

uworld (11 decks)

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