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PANCE REVIEW > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is anhedonia?

A

Loss of pleasure

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2
Q

How long should you wait for antidepressants to work?

A

minimum of 3-6 weeks

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3
Q

Order of treatment for depression

A

1) SSRI, possibly SNRI
2) Bupropion
3) TCA, MAOi

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4
Q

List of SSRI medications

A 
Sertraline (Zoloft) 
Paroxetine (Paxil) 
Fluoxetine (prozac)
Citalopram (Celexa) 
Escitalopram (Lexapro)
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5
Q

Presentation of Serotonin Syndrome

A
  • AMS, seizure, coma
  • Restless, diaphoretic, tremor, n/v, hyperthermia

-Increased risk with St. Johns Wart and SNRI mixing

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6
Q

List of SNRI medications

A

Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)

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7
Q

What receptors to SNRI medications work on?

A

Serotonin, dopamine, norepinephrine

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8
Q

Indications for SNRI

A

2nd line in depression

-Works well for patients with significant fatigue or pain syndromes in association with depression

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9
Q

MOA of tricyclic antidepressants

A

Inhibits repute of serotonin and norepinephrine

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10
Q

What is the definition of Bipolar 1 disorder?

A

At least 1 manic or mixed episode which cycles with occasional depressive episodes, major depression is not required

-Manic episode= persistantly elevated expansive or irritable mood at least 1 week with marked impairment of social function

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11
Q

Management of Bipolar I disorder

A

-MOOD STABILIZERS: LIthium 1st line, benzos 2nd line

**you can try antidepressants but they tend to precipitate mania

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12
Q

Definition of Bipolar II disorder

A

-At least one hypomanic episode with at least one major depressive episode

Hypomania=manic features that last about 4 days that DOES NOT CAUSE marked impairment in social or occupational function

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13
Q

Definition of panic disorder

A

Multiple panic attacks with the additional criteria:

  • Panic attacks followed by concern about future attacks, worry about implication of attacks, or significant change in behavior from attacks
  • at least 4 of 13 typical symptoms of panic attack
  • S/s not due to substance use
  • May have agoraphobia : anxiety about being in places where an escape may be difficult
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14
Q

Treatment of an Acute Panic Attack

A

Benzos

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15
Q

Treatment of panic disorder

A

SSRI, cognitive behavioral therapy

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16
Q

13 symptoms of panic attacks

A
  1. dizziness
  2. trembling
  3. Choking feeling
  4. Parasthesias
  5. Sweating
  6. SOB
  7. Chest pain
  8. Chills or hot flashes
  9. Fear of losing control
  10. Fear of dying
  11. Palpations
  12. Nausea
  13. Depersonalization
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17
Q

What is buspirone (buspar)?

A

It is an anti anxiety agent which stimulates serotonin receptors and blocks dopamine receptors. IT DOES NOT CAUSE SEDATION

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18
Q

ADHD Treatment options

A

1) Behavior Modification

2) Stimulant medications: Adderall, Ritalin
- central nervous stimulator of norepinephrine and dopamine
- High potential for abuse

3) Non-stimulant medication: Atomoxetine (Strattera):
- SNRI, less addictive

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19
Q

Methylphenidate

A

Ritalin

-stimulant used in ADHD

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20
Q

Amphetamine/dextroamphetamine

A

Adderoll

-stimulant used in ADHD

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21
Q

Hallmarks of ADHD

A

Must present before the age of 12, and be present for at least 6 months.
-The patient must demonstrate symptoms in 2 different settings, and the patient must demonstrate symptoms of Inattentiveness AS WELL AS hyperactivity

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22
Q

Criteria to diagnose PTSD

A

1) Exposure to actual or threatened death

2) At least 1 intrusion symptom:
- Re-experiencing
- Avoidance
- Negative alterations in mood
- Arousal and reactivity

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23
Q

Treatment of PTSD

A
  1. SSRI
  2. TCA
  3. Cognitive behavioral therapy
    * May use trazadone to help insomnia
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24
Q

What is trazadone?

A

This is an antidepressant that acts as a serotonin antagonist AND reuptake inhibitor

-is a good anti anxiety, hypnotic, and helps in insomnia

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25
Q

What is acute stress disorder?

A

Similar to PTSD but it is only in the 1st month following the traumatic event and does not effect that patient chronically

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26
Q

Criteria for a specific phobia

A

Persistant fear lasting at least 6 months that is out of proportion to any real danger and everyday activities must be impaired

-Exposure therapy is the TOC

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27
Q

Diagnosis of anorexia

A

BMI under 17.5

Body weight <85% of ideal

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28
Q

Additional PE findings on an anorexic patient

A

Lanugo, dry skin, hypotension, bradycardia, amenorrhea, arrhythmias, ostoporosis

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29
Q

Bulimia Nervosa

A

Normal or overweight patient that engages in binge eating and compensatory behavior such as starvation or purging emesis

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30
Q

What will the pupils look like in opioid intoxication vs withdrawl?

A

Intoxication= constricted (narcotics are miotics) , you will also see respiratory depression

Withdrawl: dilated (mydriasis) , you will also see flu like symptoms of rhinorrhea

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31
Q

Medications used for tobacco dependence and their MOAs

A
  1. Nicotine tapering
  2. Buproprion (Zyban) antidepressant
  3. Varenicline (Chantix) : blocks the nicotine receptors
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32
Q

4 stages of alcohol withdrawl

A
  1. Increased CNS activity (6-24hrs)
  2. Withdrawl seizures (6-48 hrs) usually isolated event
  3. Alcoholic halucinosis (12-48hrs) ; NML vitals, clear sensorium
    4) Dilerium Tremens (2-5 days) ; abnormal vitals, dilerious with altered sensorium
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33
Q

Treatment of alcohol withdrawl

A

1) Benzodiazepines: these potentiate GABA inhibition
2) Fluids and supplementation: Thiamine, magnesium, glucose

**be sure to replace glucose last to make sure you don’t precipitate Korsakoff syndrome

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34
Q

Supplementation needed for chronic alcoholics

A

1) IVF
2) Mg and Thiamine
3) Glucose (give after #2)
4) Multivitamins, B12, folate

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35
Q

Disulfiram

A

Antabuse

Inhibits aldehyde dehydrogenase, so the patient can’t metabolize the alcohol

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36
Q

What is the strongest predictive factor for committing suicide?

A

A previous attempt

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37
Q

What population has the highest suicide rate?

A

Elderly white males

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38
Q

Definition of delusional disorder

A

at least 1 delusion lasting at least one month in the absence of any other psychiatric symptoms

39
Q

Definition of schizophreniform disorder:

A

schizophrenia criteria only lasting LESS THAN 6 MONTHS

40
Q

Positive symptoms of Schizophrenia

A

Hallucinations, delusions, disorganized speech, abnormal behavior

41
Q

Different types of hallucinations found in Schizophrenia

A
  • Auditory (MC)
  • Visual
  • Olfactory
  • Tactile ( insects on skin)
  • Somatic (sensation arising form in body)
  • Gustatory (tasting poisin in food)
42
Q

Different types of delusions found in Schizophrenia

A
  • Persecutory
  • Reference (random events pertain to them)
  • COntrol (someone else took control of them)
  • Grandiose (unrealistic beliefs about oneself and abilities)
  • Nihilism (exagerated belief in futility & catastrophic events
  • Erotomanic (another person is in love with them)
  • Jealousy (suspecting being unfaithful)
  • Doubles ( a close person has been replaced by a double)
43
Q

Negative symptoms of schizophrenia

A

Flat emotional affect, social withdrawal, lack of emotion, avolition (lack of self motivation) , lack of communication

44
Q

Management of Schizophrenia

A

1) Antipsychotics: dopamine receptor antagonists
- 2ND GEN is best first line agent
- Risperidone, olanzapine, Quetipine

45
Q

First Generation antipsychotics

A

Butyrophenones: Haloperidol, Droperidol

Phenothiazines: Fluphenazine (Prolixin), Perphenazine, Chlorpromazine (Thorazine), Thioridazine

46
Q

1st gen antipsychotics MOA and SE

A

MOA: Dopamine antagonists

SE:

  • Extrapyramidal s/s:
    1) Dystonic reactions aka dyskinesia -Give benadryl to prevent

2) Tardive Dyskinesia: repetitive and involuntary movements
3) Parkinsonism: rigidity, tremor
- Neuroleptic Malignant Syndrome

47
Q

What is neuroleptic malignant syndrome?

A

Life threatening disorder due to dopamine inhibition in the basal ganglia

-AMS, muscle rigidity, tremor, autonomic instability, tachycardia, hyperthermia, fever

48
Q

Atypical (2nd gen) antipsychotics:

A

Quetiapine (seroquel)
Olanzapine (zyprexa)
Clozapine (Clozaril)
Loxapine (Loxatane)

49
Q

2nd gen antipsychotics MOA, SE

A

MOA: Dopamine AND serotonin antagonists

SE

  • less extrapyramidal s/s than first generation
  • QT prolongation, weight gain
  • olanzipine causes DM
  • Clozapine causes agranulocytosis and myocarditis
50
Q

Benzisoxazoles

A

Risperidone (Risperdol)

Ziprasidone (Geodon)

51
Q

Benzisoxazoles MOA, SE:

A

MOA: partial dopamine and serotonin antagonist

SE: these increase prolactin

52
Q

Quinolinones

A

Aripiprazole (Abilify)

53
Q

Quinolinones MOA

A

Dopamine and serotonin receptor antagonist

54
Q

Lithium MOA, SE

A

MOA: increases norepinephrine and serotonin receptor sensitivity

SE: HYPOTHYROID, decrease Na, increased urination and thirst, diabetes insipidus, hyperparathyroidism, arrhythmias

55
Q

What is persistent depressive disorder?

A

chronic depressed mood for greater than 2 years

  • There is no symptoms of mania, only depression
  • MC in younger females
  • SSRI treatment
56
Q

What is cyclothymic disorder?

A

Less severe form of bipolar II disorder

-recurrent hypomanic s/s that don’t meet criteria for hypomania with mild depressive episodes FOR AT LEAST 2 years

57
Q

What is adjustment disorder?

A

Emotional or behavioral response to identifiable stressor that causes a disproportionate response within 3 months and goes away around 6 months of experience

-treat with psychotherapy

58
Q

What is dissociative identity disorder?

A

Presence of at least 2 distinct identities

  • MC in women with a history of sexual abuse
  • Mange with psychotherapy
59
Q

What is dissociative amnesia?

A

Inability to recall personal information often secondary to abuse or stress

60
Q

What is dissociative fugue?

A

Abrupt change in geographical location with loss of identity

61
Q

4 major patterns of compulsions is OCD

A

1) Contamination
2) Pathologic doubt (forgetting to unplug iron)
3) Symmetry/precision
4) Intrusive obsessive thoughts (without compulsion)

62
Q

What is the treatment for OCD ?

A

SSRI

63
Q

What is Somatic Symptom Disorder?

A

Chronic condition where the patient exhibits at least 1 physical symptoms with no medical evidence for a cause

  • normally present at least 6 months
  • Treat with regular doctors appointments
64
Q

Common presenting symptoms in somatic symptom disorder

A
  • SOB
  • Dysmenorrhea
  • Burning in sexual organ
  • Dysphagia
  • Amnesia
  • Vomiting
  • Painful extremity
65
Q

Illness anxiety disorder

A
  • Formerly known as hypochondriasis
  • Preoccupation with the fear that one has or will get a serious undiagnosed disease.
  • Usually there are not symptoms present
66
Q

What is functional neurological symptoms disorder?

A
  • AKA conversion d/o
  • neurological dysfunction suggestive of physical disorder that can’t be explained clinically and is not a result of malingering (the patient actually is experiencing)
  • Motor: paralysis, aphonia, mutism, seizures
  • Sensory: blindness, anesthesia, paresthesias

-Treat with psychotherapy

67
Q

What is factitious disorder?

A

Intentional falsification of an illness on oneself or another for primary gain (sympathy) *this is a mental illness unlike malingering

  • willing to undergo multiple surgeries and painful tests
  • Nonspecific treatment
68
Q

What is Munchausen syndrome?

A

old term referring to a severe form of factitious disorder

69
Q

What is malingering and how does it differ from factitious disorder?

A

Intentional falsification of s/s for SECONDARY GAIN (finances, lawsuit, food, shelter)

*this is not a mental illness, the patient is not trying to be viewed as sick, but rather using sickness to create an advantage

70
Q

Sexual abuse on a child is MC inflicted by what sex?

A

Male

71
Q

Physical abuse on a child is MC inflicted by what sex?

A

Female

72
Q

At what BMI is the clinical definition of obesity

A

30 (or weight 20% over their ideal weight)

73
Q

What kind of acid/base disturbance is seen in a patient with bulimia?

A

Hypochloremic Metabolic alkalosis

74
Q

What makes up the Cluster A personality disorders?

A

1) Schizoid personality d/o
2) Schizotypal personality d/o
3) Paranoid personality d/o
* These are SOCIAL detachments; weird, odd, eccentric

75
Q

Schizoid personality disorder

A

Social withdrawal and anhedonia

MC in males

No pleasure or enjoyment from relationships or sex

Psychotherapy

76
Q

Schizotypal personality disorder

A

Odd, eccentric, peculiar thought patterns

  • Magical thinking, NO DELUSIONS (separation from schizophrenia) believes in telepathy, superstition
  • Uncomfortable with close relationships
77
Q

Paranoid personality disorder

A

Distrust and suspicion of others

78
Q

What personality disorders make up cluster B?

A

1) Antisocial personality d/o
2) Borderline personality d/o
3) Histrionic personality d/o
4) Narcissistic personality d/o
* Wild, dramatic, impulsive, emotional

79
Q

Antisocial personality d/o

A

Deviate from the norms or society
-MUST BE 18 to diagnose, in children this is conduct d/o

-disregard the rights of others as well as the law (often DUI)

80
Q

Borderline personality d/o

A

Unstable, unpredictable mood and affect

  • MC in females
  • Mood swings, black and white thinking, impulsive self damaging behaviors
81
Q

Histrionic personality d/o

A

overly emotional, dramatic, seductive, attention seeking behavior

-self absorbed temper tantrums

82
Q

Narcissistic personality disorder

A

Grandiose sense of self importance but needs praise and admiration

  • fragile self esteem
  • considers themself special, entitled, requires extra special attention
83
Q

What personality disorders are in cluster C?

A

1) Avoidant personality d/o
2) Dependent personality disorder
3) Obsessive compulsive personality d/o
* Anxious, worried, fearful

84
Q

Avoidant personality disorder

A
  • Desires relationships but avoids them do an inferiority complex
  • Timid, shy, no self confidence
85
Q

Dependent personality disorder

A

Dependent , submissive behacior

-constant need for reassurance, will not initiate things

86
Q

Obsessive compulsive personality disorder

A
  • Perfectionist with the need for order and control

- preoccupied with minute details

87
Q

Primary signs of autism spectrum disorder

A

1) Social interaction difficulties (no eye contact, affection)
2) Impaired communication
3) Repetitive behaviors

88
Q

Oppositional defiant disorder

A

-Persistant negative behavior of a child towards adults

6 months of angry mood, argumentative behaviors, and vindictiveness

89
Q

Conduct disorder

A

Persisent pattern of behavior in a child that deviate sharply from age appropriate norms and violate the rights of others

  • Violate laws, animal cruelty, deceitfulness, destruction of property
  • 40% go on to develop antisocial personality disorder
90
Q

Benzodiazapines used in alcohol withdrawl

A
  • Diazepam (Valium)
  • Lorazepam (Ativan)
  • Chlordiazepoxide (Librium)
91
Q

What must you give thiamine before glucose in alcohol withdrawal patients?

A

It may induce korsakoff’s syndrome (memory disorder due to lack of B1)

92
Q

CAGE criteria

A

C-need to Cut down
A-Annoyed at you when you drink
G-Guilt about drinking
E-need for eye opener?

*at least 2 is a positive screening

93
Q

Treatment options for alcohol dependence?

A
  1. Supportive
  2. Disulfram (Antabuse)
  3. Naltrexone: opiod antagonist that reduces craving and euphoria
  4. Gabapentin, topiramate
94
Q

How long is the normal period of grief?

A

1 year

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