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Psychiatry Flashcards

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1
Q

Attention-Deficit Hyperactivity Disorder (ADHD) (dg)

A

Before 12yo has ≥5 sympt from each category for ≥6mo in ≥2 settings (home/school/…) lead to signif social + academ impair

  • Inatt: poor att span, poor att to details/careless mistakes, diff follow instruc/finish task, forgetful, easy distract*
  • Hyperactiv/Impulsiv: fidget, leave seat in class, run around, cant play quiet, talk excess, dont wait his turn, interrupt others
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2
Q

ADHD (PE, ttt)

A

Persistent excessive inatt (esp girls) +/or hyperactiv/impulsiv (esp boys)
Betw/ 3-13yo; often familial

ttt: #1 behav modif, then pharmaco
- Psychostimulant: methylphenidate, dextroamphetamine; (side eff: insomn, irritab, ↓appetite, tic↑, ↓growth)
- Nonstimulant (SSRI, nortriptyline, bupropion) and alpha2-agonist (clonidine) and atomoxetine

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3
Q

Autism Spectrum Disorder (PE)

A

Esp boys; before 3yo
Wide variat* in IQ and severity (based on level of support needed)

AbNl/impair social interact* + communic + restrict activities/interests
Spoken language delay/absent
Stereotyp speech+behavior

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4
Q

Autism Spectrum Disorder (ttt)

A

Intensive special educat*
Behav manag
Symptom-targeted meds: neuroleptic if aggressive, SSRI for stereotyp behav
Family counseling!!!

Ass w/ Rett sd, fragile X sd, tuberous sclerosis

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5
Q

Disruptive behavioral disorders

A

Esp men/boys; Hx of abuse; ttt ptt and family

-Oppositional defiant disorder: negativistic defiant disobedient hostile behavior tow/ authority; ≥6mo
May progr to conduct dso

-Conduct disorder: persist violating basic rights of others, societal norms/rules; ≥1y. May be aggress (rape, cruelty) or nonaggress (steal, lie, annoy)
May progr to antisocial personality dso in adult

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6
Q

Intellectual developmental disorder

A

At <18yo; IQ<70 w/ def in adaptive fct* (hygiene, social skills)
Ass w/ male, chrom abNl, congen inf, teratogens, alcoh/drugs, inborn metab errors

Mild (IQ 50-70); mod (35-49); sev (20-34); profound (<20)
ttt: 1* prevent* (educat public + prenatal screen)
Family counseling/support, speech/lang therapy, physical therapy, behav interv, assist, social skills training

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7
Q

Tourette syndrome

A

Esp boys/men, starts <18yo; genetic predispo
Ass w/ ADHD, learning dso, OCD
Multiple motor tics + vocal tics, recurr for >1y
+ social/occupational impairment

ttt: dopamine recept antag (haloperidol) or clonidine
Behav therapy + counseling
CI stimulants

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8
Q

Schizophrenia (epidemiology, ttt)

A

Psychotic sympt + disorganizat* + negative sympt
1% pop; M=W; peak at 18-25yo in M and 25-35 in W
↑R if 1st relative also
Suicide: 50% attempt; 10% successful

ttt: antipsychotics + long-term follow-up
Supportive psychottt, train social skills, illness educat*
Atyp antipsy esp for negative sympt

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9
Q

Schizophrenia (PE)

A

≥2 sympt for ≥6mo w/ social/occupat dysfct*

  • Positive sympt: hallucin, delus*, disorg speech, bizarre behav, thought dso
  • Negative sympt: flat affect, ↓emotion, poor speech, lack of purposeful act*, anhedonia
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10
Q

Differential diagnosis of psychosis

A
  • Brief psychotic disorder: >1d and <1mo
  • Schizophreniform disorder: >1mo and <6mo
  • Schizophrenia: >6mo
  • Schizoaffective disorder: schizo + major affective dso (major depr dso or bipol dso)
  • Schizotypal perso dso: magical thinking
  • Schizoid perso dso: loner
  • Delusional dso: persist nonbizarre fixed delus, unaffected fct
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11
Q

Typical antipsychotics

A

For psychotic disorders, acute agitat*, acute mania, Tourette, esp positive sympt of schizo

  • High potency (haloperidol, fluphenazine): EPS > anticholinergic sympt; ↑QTc; TdP; neuroleptic malignant sd
  • Low potency (thioridazine, chlorpromazine): anticholinergic sympt > EPS; orthostatic hypoTN; retinal pigm (thiorid)
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12
Q

Atypical antipsychotics

A 
Risperidone, quetiapine, olanzapine, ziprasidone, aripiprazole, clozapine
#1 ttt for schizo (↓side eff)
Clozapine: sev ttt resistance

↑weight, DM2, somnolence, ↑QTc
Clozapine: agranulocytosis (CBC/wk for 6mo)

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13
Q

Extrapyramidal syndrome

A
  • 4h: acute dystonia (ttt: anticholinergic)
  • 4d: dyskinesia (ttt: anticholinergic or dopamine agonist; ↓or stop neuroleptic)
  • 4wks: akathisia (ttt: ↓neuroleptic, give B⊖; +/- benzo or anticholin)
  • 4mo: tardive dyskinesia (ttt: ↓/stop neuroleptic; clozapine; other meds)
  • Anytime: neuroleptic malignant syndrome (ttt: stop med; support in ICU; dantrolene or bromocriptine)
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14
Q

Generalized anxiety disorder

A

Uncontrol excessive anxiety; multiple activities
Signif impairment/distress; M/F=1:2; early 20s

Anx most days for ≥6mo + ≥3 somatic sympt
ttt: short-term (benzo immed then taper bcz !tolerance)
Long-term: lifestyle, psychotherapy, meds (SSRI #1, venlafaxine, buspirone)

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15
Q

Panic disorder (PE)

A

Recurr unexpect panic attacks; W>M; ~25yo
+/- agoraphobia
≥1mo concern of having attacks

Intense fear/discomf + ≥4 sympt abrupt/peak in 10min (tachypn, palpit, chest pain, diaphor, N, trembl, dizzy, going crazy, deperson, hot flashes)

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16
Q

Panic disorder (ttt)

A

Short-term: benzo (immed) then taper bcz tolerance
Long-term: CBT, meds (SSRI #1, TCAs)
If ass w/ agoraphobia: ttt it also

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17
Q

SSRIs

A

Fluoxetine, sertraline, paroxetine, citalopram, escitalopram
GAD, OCD, panic disorder, depress*, anxiety

Side eff: N, GI, somnol, sex dysfct, agitat*, insomn, tremor
!!!Not w/ MAOIs (dev serotonin sd)

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18
Q

Buspirone and B⊖

A

-Buspirone: GAD, social phobia
No tolerance, dependance or withdrawal
Side eff: seizures if chronic; !!!Not w/ MAOIs

-B⊖: prior to phobic disorder
Side eff: bradycardia, hypoTN

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19
Q

Benzodiazepines

A

Anxiety, insomnia, alcohol withdrawal, M spasm, night terrors, sleepwalking

Side eff: ↓sleep durat; abuse/tolerance/dependence; disinhibit in young/old; confus*

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20
Q

Phobias (social and specific)

A

-Social: specific (speaking, urinating) or general (interact*)
Often ado

-Specific: feared object/situat*
Often childhood

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21
Q

Phobias (PE, ttt)

A

Excessive fear + avoidance
Signif distress/impairment and ⊕insight

ttt: social ph (CBT, SSRI, low-dose benzo, B⊖)
Specific ph (CBT+desensitizat*, support, family psychottt)
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22
Q

Obsessive-compulsive disorder (OCD)

A

Obsess* and/or compuls; signif distress/dysfct
Late ado or early adult; W=M

Obsess: persist unwant intrusive idea/impulse: marked anxiety/distress
Compuls: repeat mental act/behav to neutralize

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23
Q

OCD (#dg, ttt)

A 
OCD: ⊕insight + wants to be ttt
#OCPD = personality dso: do not recognize the prob

ttt: SSRIs #1, CBT (desensitizat), educat

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24
Q

Body dysmorphic disorder

A 
Preoccupat* w/ imagined or slight physical defects
Imperceptible to others
Signif distress/impairment
Obsess* + repetitive behav
ttt: SSRIs
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25
Q

Post-Traumatic Stress Disorder (PTSD)

A

Signif distress/impairment
Extreme life-threat traumatic event: direct expo, witnessing, indirect in close friend

4 sympt clusters for >1mo
Intrus* (reexperience), avoidance, negative alterat* in mood/cognit*, changes in arousal/reactivity
If >3d to <1mo: acute stress dso

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26
Q

PTSD (ttt)

A

Short-term: B⊖, alpha2-agonists (for anxiety)

Long-term: meds (SSRIs #1, … Avoid benzo), psychotherapy, support groups

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27
Q

Adjustment disorder

A

Signif distress after profound life change
But r/o other mental dso
3mo after stressor; resolv in 6mo

Anxiety, depressed mood, conduct; ↑R suicid
ttt: supportive counsel

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28
Q

Dementia (Major neurocognitive disorder) (PE)

A

Progress ↓cognit* w/ global deficits; Nl conscious
Esp Alzheimer or vascular dem

Impaired cognit* in order: Amnesia, Aphasia, Apraxia, Agnosia
Impaired executive fct*: plan, organize, abstract
+/- personality, mood, behav changes

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29
Q

Dementia (dg, ttt)

A

Dg: Hx+PE, serial MMSE
R/o treatable causes (labs, vitB12/B9, LFTs, UA, CT/MRI,…)

ttt: environmental cues for daily life
Cholinesterase inhib, family/ptt educat* + support
Low-dose antipsychotics (if aggress)
Avoid benzo

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30
Q

Delirium (PE)

A

Acute disturb conscious + altered cognit*
Hours to days; esp child/elder/hospit ptt

Wax/wane conscious + perceptual disturb (halluc, illus, delus); +/- anxiety, paranoid, stupor

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31
Q

Delirium (dg, ttt)

A

Dg: vitals, oximetry, glu, PE, neuro exam, labs, imagery
Recent meds/drugs, prior episodes, organ failure, inf

ttt: underl cause (often reversible), optimize environment, low-dose antipsychotics (agitat*/hall)
+/- physical restraint

32
Q

Major depressive disorder (dg)

A

≥1 episodes; M/F=1:2; esp mid-20s but in elder ↑w/ age
Esp if stress or chronic illness; !!!suicide
5 subtypes: psychotic features, postpartum, atypical, seasonal, double depress*

Dg: ≥2 weeks of depressed mood or anhedonia + ≥5 signs/sympt (sleep, interest, guilt, energy, concentrat, appetite, psychomotor agitat, suicidal)

33
Q

Major depressive disorder (ttt)

A
  • Meds: 2-6wks for effect; ttt for ≥6mo
  • Psychotherapy w/ meds
  • Phototherapy: seasonal depress*
  • Transcranial magnetic stimulation

-ECT: if refractory, psychotic depress*, sev mania or suicidality
2-3/wks for 6-12ttt
Relative CI: recent stroke/MI, intracranial mass, anesth R

34
Q

Major depressive disorder (#dg)

A
  • Mood dso due to a medical condition
  • Substance-induced mood disorder
  • Adjustment disorder w/ depressed mood (in 3mo of a stressor)
  • Normal bereavement (<6mo, max 1y)
  • Dysthymia (mild chronic depress* most of time for ≥2y)
35
Q

Postpartum disorders

A
  • PP blues: in 2wks pp; sad, moody, emot* lability; No thoughts ag bb
  • PP psychosis: 2-3wks pp; delus* + depress*; may have thoughts to hurt bb
  • PP depress: 1-3mo pp; depress, sleep disturb, anxiety; thoughts to hurt bb
36
Q

Atypical antidepressants

A

Bupropion, mirtazapine, trazodone
Depress*, anxiety

Bup: seiz; so CI if seiz Hx or eating dso
Mirta: ↑weight, sedat*
Traz: sedat*, priapism

37
Q

SNRIs

A

Venlafaxine, duloxetine
Depress*, anxiety, chronic pain

Venlaf: diastolic HTN

38
Q

Tricyclic antidepressants

A

Nortriptylline, desipramine, amitriptylline, imipramine
Depress*, anxiety, chronic pain, migraine, enuresis (imipr)

Side eff: lethal if overdose (arrhyth) so monitor ICU x3-4d
Anticholinergic eff

39
Q

MAOIs

A

Phenelzine, tranylcypromine, selegiline
Depress*, esp atypical

HTN crisis if taken w/ ↑tyramine food
Sexual dysfct*, orthostatic hypoTN, ↑weight

40
Q

Bipolar disorder (types)

A 
Types I (1%) and II (4%); M=W; ↑R if fam Hx
~20yo; ↑episodes w/ ↑age; !!! suicide
  • BP I: ≥1 manic or mixed episode (+/- hospit)
  • BP II: ≥1 MDE and ≥1 hypomanic episode
  • Rapid cycling: ≥4 episodes (MDE/manic/mixed/hypomanic) in 1y
  • Cyclothymic: chronic less sev, alternate hypomania and moderate depress* for >2y
41
Q

Bipolar disorder (PE, dg)

A

Distractibility, insomnia, grandiosity, flight of ideas, psychomotor agitat*, sexual indiscretions, talkativeness
+/- psychotic features

-Manic: ≥1wk persistent elevated expansive mood + 3 sympt; signif impairment
R/o substance or medical condit*
-Hypomanic: same but no impairment, no psychotic sympt, no hospit

42
Q

Bipolar disorder (ttt)

A

BP mania: emergency (↑R for ptt and others)
Acute ttt: antipsychotics, lithium, valproate
Mainten ttt: mood stabilizers
Benzo if refractory agitat*

BP depress*: mood stabil first +/- antidepr
!!! CI antidepr w/o mood stabilizer
ECT if refractory

43
Q

Lithium

A 
#1 for acute mania
Prophylaxis in BPD, ↓R suicide

Side eff: diabetes insipidus, tremor, ↑weight, hypothyr, GI, seiz, teratogen, acne
Narrow therapeutic window
Toxicity (>1.5mEq/L): ataxia, dysarthria, delirium, acute renal failure

44
Q

Carbamazepine

A

2 mood stabil; anticonvulsant; trigeminal neuralgia

Side eff: N, rash, leukopenia, AV block, teratogen
Rare: aplastic anemia, SJS

45
Q

Valproic acid

A

Bipolar, anticonvulsant

Side eff: GI, tremor, sedat*, alopecia, ↑weight, teratogen
Rare: pancreatitis, thrombocytopenia, fatal hepatotoxicity, agranulocytosis

46
Q

Lamotrigine

A

2 mood stabil; anticonvulsant

Side eff: blurred vis*, GI distress, SJS (so slowly ↑dose)

47
Q

Personality disorders

A

Emotional + behavioral traits chronically rigid and maladaptive + social/occup impairment
Stable + predictable

Early adult
Dg: ask abt attitudes, mood variability, activities, react* to stress; deny/diff changing behavior; refuse ttt
ttt: psychotherapy (#1); meds if comorbid psychiatric ds

48
Q

Cluster A (Weird)

A
  • Paranoid: distrustful, suspicious, see other’s motives as evil
  • Schizoid: isolated, detached, restricted emotional express*
  • Schizotypal: odd behavior/perceptions/appearance, magical thinking
49
Q

Cluster B (Wild)

A
  • Borderline: unstable mood/relationships/self-image, feel emptiness, impulsive, suicidal ideat*/self harm
  • Histrionic: excess emotional/attention seeking, sexual provocative, theatrical
  • Narcissistic: grandiose, need admirat*, lack empathy
  • Antisocial: violate others’ rights/social norms/law, impulsive, lack remorse (must have Hx of conduct dso)
50
Q

Cluster C (Worried)

A
  • Obsessive-compulsive: preoccupied w/ perfectionism + order + control at expense of efficiency, doesnt feel probl
  • Avoidant: socially inhibited, rejection sensitive, fear of being disliked/ridiculed but desires friends/social interact*
  • Dependent: submissive, clingy, need to be taken care of, feel helpless, difficulty making decisions
51
Q

Substance use disorders

A 
Most subst (except caffeine); signif impairment
Dg: 2 of 11 criteria in 1y
Criteria grouped into: impaired control, social impairment, risky use, pharmacologic

Tolerance and withdrawal: not needed to make dg
Severity of abuse: mild (2-3/11), mod (4-5/11), sev (>6)
Check: urine+bld toxico screen, LFTs, serum EtOH

52
Q

Alcohol use disorder (dg, complications)

A 
Esp men (4:1); 21-34yo; ⊕fam Hx
Dg: screen w/ CAGE (Cut down, Annoyed by criticism, Guilty, Eye opener); monitor vitals; LFTs, LDH, MCV

Compl: pancreatitis, liver ds, DT, hallucinosis, periph neurop, Wernicke/Korsakoff, FAS, aspirat* pneumonia, trauma, ……….

53
Q

Alcohol use disorder (ttt)

A 
R/o compl, correct e-
Benzo taper (withdrawal sympt)
Haloperidol (psychotic sympt)
Multivitamins + B9 + B1 before glucose
Anticonv (if seiz Hx)

For dependence: group therapy, disulfiram, naltrexone
Long-term rehab therapy (AA)

54
Q

Anorexia nervosa (RF, PE)

A

RF: female, ↓self-esteem, ↑socio-eco status
Ass w/ OCD, MDD, anxiety, modeling, gymnastics, ballet, running

Sev restrict KCal (fast or ↑exo) or binge+purge (vomit, laxat, diuret)
Cachexia, BMI<18, lanugo, dry skin, bradyc, lethargy, hypoTN, cold intol, hypothermia

55
Q

Anorexia nervosa (dg, ttt)

A

Dg: BMI, CBC, e-, endocrino, ECG, intense fear of ↑weight, psychiatric eval (comorbid)

ttt: monitor KCal, hospit if necess
Psychotherapy; ttt comorbid
Ptt may resist ttt (not distressed by ds)

56
Q

Medical complications of eating disorders

A 
Constitutinal: cachexia, hypothermia, fatigue, e-
Cardiac: arrhyth, sudden death, ...
GI: dental eros*, abdo pain, ...
GU: amenorrhea, nephrolithiasis
Dermato: lanugo
Hemato: leukopenia
Neuro: seiz
MSK: osteoporosis, stress fx
57
Q

Bulimia nervosa

A

Esp women; ass w/ ↓self-esteem, mood dso, OCD
Dg: ≥1wk for ≥3mo of episodes (binge eat + compensatory behav of purge or fast); Nl or overweight

Dental enamel eros*, larg parotid, scars on dorsal hand
Ptt distressed so easily ttt
ttt: psychotherapy +/- antidepressants

58
Q

Sexual changes with aging

A

Same interest in sex

Men: need ↑stimulat* for longer period to reach orgasm, ↓intensity of orgasm, ↑refractory period

Women: ↓estro, dry/thin vag, discomfort; ttt w/ HRT, estro vag suppo, vag creams

59
Q

Paraphilic disorders

A

Preoccup w/ unusual sex fantasies/urges/behav for >6mo
Signif impairment

8 disorders characterized by: disordered courtship, disordered preferences, pleasure in inflicting/receiving pain
ttt: insight-oriented psychotherapy + behavioral therapy

60
Q

Gender dysphoria (dg)

A

Strong persistent cross-gender identificat*
Discomfort w/ assigned sex/gender role
No intersexual disorders

Men > Women; Hx of dressing like opposite sex, taking sex hormones, surg to reassign sex
Psychiatric comorbidities

61
Q

Gender dysphoria (ttt)

A

Educat* (culturally acceptable behav pattern)
ttt comorbid
Sex-reassign surg or hormonal ttt
Psychotherapy

62
Q

Sexual dysfunction

A

Prob in arousal, desire, orgasm, pain
30% of pop
1/3 biological; 1/3 psycholog

ttt: dep on cause; sildenafil, bupropion; psychotherapy

63
Q

Sleep disorders

A

1/3 of US adults; dyssomnia, insomnia
RF: female, mental/medical dso, substance abuse, adv age

Sleep hygiene: regular schedule, ↓caffeine, avoid naps, evening warm bath, bedroom (sleep/sex), exo early, relaxat*, avoid large meals

64
Q

1* insomnia

A

30% pop; R/O physical/mental dso
Nonrestorative sleep, diff initiate/maintain sleep; ≥3 times/wk for 1 month

ttt: sleep hygiene (#1); meds (#2; for short period <2wks; diphenhydramine, zolpidem, zaleplon, trazodone)

65
Q

1* hypersomnia

A

Excessive daytime sleepiness or nighttime sleep
For >1mo
R/O medical/mental dso, meds, poor sleep hygiene, insufficient sleep, narcolepsy

ttt: stimulant meds (#1; amphetamines)

66
Q

Narcolepsy

A

Young adult, <30yo; may be genetic
Excess daytime somnol + ↓REM latency on daily basis for ≥3mo; sleep attacks

Ass w/ cataplexy, hypnagogic or hypnopompic hallucinations, sleep paralysis
ttt: scheduled daily naps + stimulant (amphet); SSRI (for cataplexy)

67
Q

Sleep apnea (2 types)

A

2* to disturb breathing → excess daytime somnol + sleep disrupt* (arousal stops apnea)

  • Central: airflow + resp effort cease; morning headaches, mood chang, repeat awaken at night
  • Obstructive: airflow cease; snoring+++; RF (male, obes, airway surg, anatomic abNl)
68
Q

Sleep apnea (dg, ttt)

A

Dg: polysomnography, OSA/CSA, mvt dso, seiz, other sleep dso

ttt: OSA (CPAP, ↓weight, surg in child if tonsil/adenoid hypertrophy)
CSA (BiPAP)

69
Q

Circadian rhythm sleep disorder

A

Misalignment betw/ desired and actual sleep
Types: jet-lag, shift-work, delayed sleep, unspecified

ttt: jet-lag (self-resolut* 2-7d); shift-work (light therapy); oral melatonin if 5.5h before desired bedtime

70
Q

Somatic symptom disorder

A

Excess thoughts/anxiety/behav by presence of somatic sympt; distress daily life +/- medical ds
High health care utilizat*

ttt: regular appointments w/ 1 Dr; psychotherapy

71
Q

Conversion disorder

A 
Def of voluntary motor/sensory fct* incompatible w/ medical ds; close time relation to sev stress/emot*
Hoover sign (r/o leg paralysis); eye resist to opening in seiz; ⊖EEG; tremor disappear w/ distract*

ttt: psychotherapy

72
Q

Factitious disorders and malingering

A

Factit: fabrication of sympt or self-injury, assume sick role (1* gain)
Factit imposed on another: caregiver makes other ill

Maling: intentionally cause sympt (2* gain), financial/housing

ttt: psychotherapy, minimal dg/ttt to avoid reinforc behav

73
Q

Sexual and physical abuse (PE)

A

Esp women <35yo w/ marital discord, subst abuse (ptt or partner), pgnt, ↓socio-eco
Victims of childhood abuse: ↑R become adult victims

Multiple somatic complaints, fqt ER visits, unexplained injuries w/ delayed ttt, avoid eye contact, genital/anal trauma, STDs, UTIs, psychiatric prob
!!partner answers or refuses to leave room

74
Q

Sexual and physical abuse (ttt)

A 
Screen of ptt's safety
Medical care
Emotional support
Counseling
Educate abt support services + refer
!!! documentation
75
Q

Suicidality (RF)

A

30K deaths/y in US; #8 cause of death in US

RF: male, >45yo, psychiatric dso, previous attempt, Hx of psy admiss*, subst abuse, recent sev stress, fam Hx, chronic ds, no spouse/support, organized plan, weapons

76
Q

Suicidality (dg, ttt)

A

Dg: comprehensive eval, ask directly abt suicidal ideat*/plan/weapons

ttt: emergent hospit even against ptt’s will
!!! R may ↑ after antidepr bcz ↑ energy

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