Psychiatry Flashcards
1
Q
how do you tell if a person is in an abuse relationship
A
power and equality
2
Q
akathisia what is it and how do you treat?
A
- restlessness after antipsychotic use
- Tx with stop drug and beta blocker
3
Q
PCP intoxication and how to treat
A
stem will say agitation , nystagmus
Tx benzo
4
Q
Before starting ADHD on amphetamine
A
check
- vitals
- cardiac history (tachycardia)
- weight
5
Q
drugs for ADHD
A
- amphetamine
2. Atomoxine (watch out liver s/e)
6
Q
what s/e do you get with Atomoxine
A
liver side effects
7
Q
patients gets psychosis , female and arthritis what do they have (otherwise healthy no drugs)
A
LUPUS
8
Q
smoking cessation - s/e of varenicline
A
increase risk of cardiac event
PLUS pschy / suicidal risk
9
Q
What drug for smoking cessation is c/i in anorexia and botulm
A
bupropirion
10
Q
c//i to nicotine patch
A
no one its good for everyone
11
Q
treatment of insomnia
A
CBT
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
13
Q
how long do you treat a single episode of MDD
A
6 months
14
Q
all antidepressant meds have an increase risk of what?
A
hypomanic symptoms
15
Q
when to use ECT
A
- acute depressive epidote
resistent to meds
emerge / suicidal
16
Q
Adolescent depression
A
irritability and somatic symptoms
if they begin to completely withdraw - think careful about drug use
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
18
Q
first line treatment of panic disorder
A
SSRI and CBT
19
Q
difference b/w panic disorder or GAD
A
GAD - 6 months
panic disorder - abrupt onset
20
Q
what is interpersonal therapy used for
A
Mostly used for depression
not good for agoraphobia or panic
21
Q
lithium toxicity acute
A
starts off with GI symptoms - N V D
Neuro
22
Q
lithium toxicity chronic
A
confusion , agitation, ataxia, tremors , fasciculation’s , seizure
23
Q
causes of lithium toxicity
A
- overdose
- dehydrated
- Drugs ( thiazide, NSAIDS, ACE inhibitor, tetracycline , metronidazole)
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
25
adjustment disorder
symptoms that develop within 3 months of exposure to an identifiable stressor
26
treatment of choice for adjustment disorder
psychotherapy
| - focuses on improving coping skills and returning to function
27
dx of MDD
> or = to 2 weeks
> or = 5 SIGECAPS
significant impairment
28
treatment of bipolar in renal dysfunction
vampiric acid
29
treatment of performance related anxiety
benzo (more neuro S/e - not good for test)
| propanolol ( less neuro s/e)
30
two mature defence mechanisms
sublimation : channeling impulses into socially acceptable behaviours
Suppression: putting unwanted feelings aside to cope with reality
31
reaction formation
responding to a manner opposite to ones feeling
32
difference b/w depressive disorder with psychotic features and schizoaffective disorder
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
33
hypomanic episode
simp less severe
| , NO PSYCOTIC FEAUTeS , , >/= to 4 consecutive days
34
manic episode duration
1 week unless hospitalized
35
difference b/w BPD 1 and 2
1: manic episode ( don't need depressive episode for Dx)
2: hypomanic episode and at least 1 depressive episode
36
immobility or excessive purposeless activity
catatonia
37
management of catatonia
benzodiazepines
38
treatment of patient who stares blankly and is mute and motionless
think catatonia - benzo
39
dx Neuroleptic malignant syndrome
Fever > 40
confusion
muscle rigidity ( generalized)
Autonomic instability - abnormal vital signs and sweating
40
treatment
stop antipsychotics or restart dopamine agents
41
mode of action for antipsychotic medications
serotonin 2A and dopamine D2 receptor blockade
42
intellectualization
transformation of an emotionally difficult event into a purely intellectual problem to avoid confronting its uncomforabe emotional components
43
giving medical files over to family
its important the patient request a copy of Her medical records ( not just the husband asking)
44
S/e Clonazepine
Neutropenia
45
narcissistic personality disorder
exaggerated sense of SELF IMPORTANCE , need for admiration ,reeling of entitlement and lack of empathy
46
Treatment of sleep terrors
Reassurance
| admin of low bento at bedtime if episodes are frequent persistent and distressing
47
Features of sleep terrors
abrupt arousal from sleep
no dream / little recall
amnesia of episode
48
c/i of lithium
CKD
Heart disease
Hyponatremia or diuretic use
49
Baseline labs before starting patient on lithium
BUN , Cr, Calcium
TFT
ECG - patients with risk factors
urinalysis ( if child bearing age to o.r pregnancy
50
long term s/e of lithium
```
diabetes insipidus
chronic kidney disease
thyroid dysfunction
hypercalemia
hyperparathyroidism
```
51
time for postpartum depression and postpartum blues and postpartum psychosis
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
sexual dysfunction with SSRI
want to switch to bupropion OR Mirtazepine
53
breast feeding - what antidepressants are safe
sertraline and paroxetine
54
Depression treatment
1. SSRI - 6 weeks
| 2. if doesn't work try another SSRI
55
mod to severe alcohol w/d
naltrexone (decreases craving
OR can also give lorazepam
56
who do you not give disulfarim to
avoid in its who live along and at tis of drinking
57
treatment of catatonia
lorazepam
58
patient is on lithium and gets htn - what anti-hypertensive can you use
amlodipine OR loop diuretic
59
what drugs decrease effect of lithium
K+ sparing diuretics
| theophylline
60
patient on antipsychotic drugs and they develop Parkinson's psychosis) what do you do
DECREASE Dose of parkinson meds ( carbiopa, levodopa , mamantine)
61
tourettes at risk of what?
ADHD
| OCD
62
benzo in elderly - risk of?
falls
| cognitive decline
63
chronic benzo - that recently gets stopped - what treatment do you use if patient has bento w/d symp
benzo w/d symptoms - tacycardic, attack attack symptoms, FEVER
Treat with diazepam
64
Opiod w/d
lacrimation, rhinorrhea , yawning, INCREASe Bowl sounds
65
treatment of opiod w/d
methadone , bupranorphine
Non opiod treatment - Clonidine
66
if its has symptoms of 2 weeks of depression - do you treat'?
Yes - SSRI as long as grater than or equal to 2 weeks
67
Bereavement in children (ex: child who looses their dog)
< 7 - they think the dog will come alive again ( temporary death)
>7 - understand god is dead
68
if patient has a history of cutting
do a suicidal and psychiatric history
69
kindly donation c/i in
```
financial issues
legal issues
younger than 18
HTN , DM, HIV uncontrolled
Active / incomplete cancer treatment
```
70
Agitation
always start wit h non pharm first
71
depression on own can increase morbidity and mortality of
cardiovascular disease
72
tourettes vs. tic disorder
tourettes - multiple motor PLUS one or more vocal
Tic - multiple motor OR vocal tic
73
treatment of tourettes
pimozide
Haloperidol
Children with tourettes - can give 2nd generation
74
treatment of acute dystonia
benzotropine
| Diphenyephrine
75
treatment of akathisia
beta blocker or lorazepam
76
treatment of parkinsonism symp
benztrophine
| amantine
77
tardive dyskinesia treatment
clonazipine
78
clitomegly and acne in women
anabolic steroid use
79
veteran who has new onset insomnia
think PTSD
80
treatment of ADHD in adults
atomoxetine
81
best non pharm treatment for depression
CBT
82
sucide risk with antidepressant
yes there is
| but have to outweigh risk and benefits
83
effects on antipsychotic if causing hyperprolactinemia
causes hyperprolactinemia - by blocking dopamine activity in the tubeoinfindibular pathway
84
antipsychotic efficacy
decrease dopamine activity in the mesolimbic pathway
85
what happens to dopamine if patient has tar dive dyskinesia
dopamine receptor supra sensitivity
86
major depressive disorder - what ca happen to your cortisol
MDD - hyperactivity of HPA axis
| INCREASE cortisone level
87
abnormalities in the cortico-striato- thalami cortical circus has been ass /w w
OCD
88
enlarged ventricles has been associated with
schizophrenia
89
how long do you have to stay on lithium
continue longterm
| - DONT STOP
90
first line therapy to help with alcohol abstain
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
when you suspect autism what should your response be
i would like to obtain a more through evaluation now as early interventions may be needed
92
decrease volume of hippocampus ass. w/
schizophrenia
93
best treatment for fear of heights
EXPOSUre therapy
94
second line treatment of MDD after SSRI is tried twice
do a norepinephrine and dopamine reuptake inhibitor - bupropion
95
what antidepressant drug causes no weight gain
bupropion
96
difference b/w factitious and malingering
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
what do you do if elderly is on benzodiazepine for long term
increase risk of adverse effects
therefore you should taper and discontinue
increase risk of falls and confusions, paradoxical agitation
98
narcoses
- 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
hyper somnolence
disorder characterized by persistent daytime sleepiness and is diagnosed only when excessive sleepiness is not better explained by another sleep disorder
100
best treatment for harding disorder
CBT
101
patient has paranoid delusions , tactile hallucinations, aggressive behaviour and severe insomnia with poor dentitions and skin sore on
think methamphetamine abuse
102
most common s/e of ECT
Retrograde and anterograde amnesia
anterograde - last 2 weeks
retrograde - persist longer
permanent memory loss -RARE
103
s/e of valporic acid
liver injury
104
ecstasy intoxication
Amphetamine toxicity - HTN, tachycardia, hyperthermia
serotonin toxicity - serotonin syndrome - fever, autonomic dysfunction , altered mental status, seizures) and hyponatremia
105
what drug can cause hyponatremia
ecstasy
106
what antidepressant is preferred in patients with insomnia
mirtazepine
