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Clinical Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

In-class material

1
Q 
What are the various tx availble for Insomnia based on the categories below?
→ Non-pharm 
→ Antidepressant (2) 
→ Anticonvulsant (1)
→ Non benzos (2) 
→ Melatonin receptor agonist (1)
→ Benzo (2)
A 
→ Non-pharm 
     Sleep hygiene
→ Antidepressant (2) 
     Trazodone 
     Mirtazapine 
→ Anticonvulsant (1)
     Quetiapine
→ Non benzos (2) 
      Zolpidem ("z-solid sleep")
      Eszopiclone
→ Melatonin receptor agonist (1)
     Ramelteon
→ Benzo (2) → "L & T" 
     Lorazepam 
     Temazepam
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2
Q 
Parasomnias, which ones do you tx? 
How? + Which ones are REM vs NREM?
Options: 
Sleepwalking
REM Behavior Disorder 
Nightmare Disorder 
Sleep Terror Disorder 
Enuresis
A

Sleepwalking → nope, just education (NREM)
REM Behavior Disorder → Clonazepam (REM)
Nightmare Disorder → avoid meds (bb, TCA, etoh, clozapine, L-dopa, nicotine) (REM)
Sleep Terror Disorder → Diazepam (NREM)
Enuresis → Desmopressin (?)

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3
Q 
Characterized by: 
-Sleep attacks 
-Cataplexy
-Sleep paralysis 
-Hypnagogic hallucination
\+
Tx?
A

Narcolepsy

Tx:
→Stimulant: Dextromethamphetamine
→Modafinil
→Armodafinil

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4
Q

Manifestation of intrusion sx (flashbacks, nightmares), avoidance sx, negative cognitive/mood alterations, hyper-arousal sx (irritability etc) w/ complete resolution in 3 weeks is categorized as what?

A

Acute Stress Disorder

→ PTSD sx that last < 4 weeks

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5
Q 
Characterized by: 
→ Perceived or actual event
→Intrusion sx
→Avoidance sx
→ Negative alteration
→ Hyeperarousal
→ Duration of sx 
Dx? 
How many under the criteria? 
Tx?
A 
PTSD: 
→ Perceived or actual event (*necessary) 
→Intrusion sx (> 1)
→Avoidance sx (> 1)
→ Negative alteration (> 2) 
→ Hyeperarousal (> 1) 
→ Duration of sx (3 options)

Tx:
1st line Psychotherapy like TF- CBT
+
SSRI (sertraline)

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6
Q

ID the timelines for the 3 subtypes of PTSD?

A

Acute: resolution in < 3 mo
Chronic: resolution in > 3 mo
Delayed onset: > 6 mo

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7
Q

Russel’s Sign

Duration of sx to be diagnostic?
https://www.brainscape.com/decks/8022609/cards/quick_new_card
L/T results?

Tx?

A

Bulimia

Calloused knuckles

2 binge/purge per week x 3 mo

Metabolic alkalosis, ↓ K, ↓ Mg, ↓ Cl

Tx:
SSRI: Fluvoxamine or fluoxitine

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8
Q

Risk Factors of Substance Use Disorder

A

Psych disorders, PTSD, childhood trauma

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9
Q

Leading cause of preventable disease, disability, death
vs
3rd leading cause of preventable death in US

A

Tobacco

ETOH

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10
Q

Addiction starts with deficits in ________ & progresses into deficit in _________.

-What reinforcement is associated to each?

A

Impulsivity (positive/pleasure) → Compulsivity (negative/relieve an anxiety)

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11
Q

Characterized by the following large categories for DSM-5 criteria:
→Impaired control over use of a substance
→Social impairment
→Risky use of the substance
→Pharmacologic criteria (tolerance & withdrawal)

A

Substance Use Disorder

*10 possible categories of substances

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12
Q

of criteria needed to ID the degree of severity in SUD
→Mild
→Moderate
→Severe

A

Mild: 2-3
Moderate: 3-5
Severe: > 6

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13
Q

3 FDA approved tx for ETOH use disorder?

3 non-FDA approved tx?

A

Naltrexone, acamprosate, disuliram

Non-FDA:
Gabapentin, topiramate

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14
Q

3 tx for for Tobacco use disorder?

A

NRT, Varenicline, Wellbutrin

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15
Q 
Autonomic hyperactivity (sweating, ↑ HR) 
Hand tremor, insomnia, anxiety
N/V
Transient hallucinations or illusions 
Seizures 
....
Sx of?
Tx?
A

Alcohol use Withdrawal

Tx:
→ Thiamine, dextrose
→ Benzo vs seizures

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16
Q

Grades:
0: craving & anxiety
1: yawning, lacrimation, rhinorrhea, perspiration
2: previous sx + midrasis, piloerection, anorexia, tremors, hot/cold flashes, generalized aching
3/4: high intensity sx, ↑ body temp, ↑ BP, ↑ pulse, ↑ RR (resp depression)

A

Opioid Withdrawal

Overdose:
→resp depression, peripheral vasodilation, pinpoint pupils, pulm edema, coma, death

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17
Q

Risk factors for major depression

A

FHx of psych disorders

PMHx

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18
Q

Major depression diagnosis criteria

A

5 SIGECAPS sx
+
> 2 weeks duration

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19
Q

PHQ2 quesitons?

-what is PHQ9

A

PHQ2:

  1. Feeling down, depressed, hopeless?
  2. Little interest or pleasure?
    * You can do this in a primary care setting as the 1st screening then if (+) do the PHQ9
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20
Q

If I have the following…
→prior attempt, plan, etoh abuse, firearms, psych dz, sudden lift in mood/antidepressant
…what am i at risk for?

A

HIGHEST risk of suicide

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21
Q

Progression of prescribing SSRIs for Major Depression

A
  1. F/u in 1-2 weeks
  2. If better → F/u in 6 mo → 9 mo can revaluate need
  3. If NOT better → change dose or med → F/u in 1-2 weeks → keep trying to change
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22
Q

1st line SSRI in child (2)

A

Fluoxetine & Escitalopram

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23
Q

4 Steps to do Prior to Discharging an Adolescent Who Attempted Suicide

A
  1. Caution family about drugs/etoh
  2. Firearms or OD drugs?
  3. Need a SUPPORTIVE person
  4. NEED a F/U apt
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24
Q

MC psych disorder in children

A

Anxiety

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25
Q

Mnemonic:
STUDENTS PANIC
→ How many needed to diagnose?
→Tx

A 
Panic Attack
SOB
Trembling
Unsteady 
Depersonalization
Excessive HR
Numb
Tingling
Sweating
Palpitation
Abd pain
Nausea
Intense fear
Chest pain

NEED: 4
Tx: Acute attack → Benzo

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26
Q

Panic Disorder
→Duration of sx to diagnose
→1st line tx

A

> 1 mo of concern/fear of recurrent panic attacks
1st line tx:
SSRI: sertraline, fluoxetine, paroxetine

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27
Q

MC co-current diagnosis w/ anxiety

A

Major depression (50-60% of time)

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28
Q

Generalized Anxiety Disorder
→Duration of sx to diagnose
→1st line tx

A

> 6 mo + impairment of life moments
1st line tx:
SSRI (Escitalopram, paroxetine)
→others, SNRI (venlafaxine, duloxetine) or buspirone

29
Q

2 categories of sx in DSM-5 criteria for ADHD
→ID the quantity of each necessary for dx
→In what settings?
→What screening tool can be used in variable settings?
→1st line tx
→ADHD + tics
→CI of stimulants

A

INATTENTIVE sx (>5 adult; >6 child)

HYPERACTIVITY/IMPULSIVITY sx (>5 adult; >6 child)

Settings: > 2 
Vanderbilt screening (parent, teacher etc)

Tx: Stimulants (Methylphenidate, amphetamine)
ADHD + tics: Amoxetine
CI of stimulants: Bupropion

30
Q

2 categories of sx for Autism Spectrum Disorders
→How many total sx necessary for dx?
→Gold standard screening?
→GS tx?

A
  1. Social communication & interaction deficit
  2. Restricted & repetitive behavior, interest, activity
    NEED: > 6 sx
    ADOS(autism diagnostic observation schedule) + Hearing & visual screening
    GS Tx:
    Applied Behavioral Analysis

+/- other meds like riseperidone or aripiprazole or SSRIs

31
Q

MC comorbid disorder along w/ bipolar

A

Anxiety (75%)

Other: ADHD, substance use disorder, eating disorders

32
Q

Which meds cause the following series of SE:
A) TREMOR, weight gain, HYPOthyroidism, arrhythmia, many DDI
B) NEURAL TUBE DEFECTS, cleft lip/palate, hepatotoxic, pancreatitis
What do they tx?

A

A) Lithium
B) Valproate

Usually used to tx Bipolar 1/2

33
Q 
ID the details of the DSM-5 criteria for Bipolar 1 Disorder: 
→Types of episode &amp; quantity?
→Duration
→Effect on life
→Additional criteria &amp; quantity?
A 
→Types of episode &amp; quantity?
    MANIC episode (> 1) 
→Duration
    > 1 week
→Effect on life
    Impairs function
→Additional criteria &amp; quantity?
    3 of the DIGFAST criteria
34
Q

DIGFAST → what are they?

A 
D: distractibility
I: irritability
G: grandiose
F: flight of ideas 
A: activity ↑
S: sleep deficit/less need (*Usually the 1st sx)
T: talkative/fast talking
35
Q

Bipolar 1 vs. Bipolar 2

Tx

A

Mood Stabilizers: (for BP1 & hypomania in BP2)
1st line: Lithium
Other: Valproic acid, carbamazepine

Antipsychotics: (for BP1 & hypomania in BP2)
2nd generation like olanzapine

Only to subdue pt:
Haloperidol or benzodiazepine

BP2 depression: Lithium, valproate, carbamazepine, lamotrigine, atypical antipsych

BP2 mixed hypomania & depression: atypical antipsych, valproate

36
Q 
ID the details of the DSM-5 criteria for Bipolar 2 Disorder: 
→Types of episode &amp; quantity?
→Duration
→Effect on life
→Additional criteria &amp; quantity?
A 
→Types of episode &amp; quantity?
    Hypomania 
    Major depression 
    >1 episodes of each/both!
→Duration
    Hypomania > 4 days
    Major depression > 2 weeks 
→Effect on life
    Impairs function
→Additional criteria &amp; quantity?
    3 of the DIGFAST criteria
37
Q

Bipolar 1 vs Bipolar 2, how do they compare in terms of suicide?

A

Bipolar 2 has high suicide attempts but both have suicidality as a risk

38
Q

Diagnostic duration for Cyclothymic Bipolar disorder?

A

2 years of not extremely severe depression/hypomania

39
Q

Diagnostic duration of sx/presentation to diagnose either Anorexia or Bulimia?

A

3 months

40
Q

Lanugo

A

Anorexia

41
Q

Anorexia:
→Diagnostic weight must by _____% below expected which is about _____ standard deviations from this value
→Amenorrhea can be diagnostic at _____ months

A

15%
1.5
3 mo

42
Q

Pharm 1st line in anorexia

A

Olanzapine (low dose)

43
Q

Deadly complication of restoring normal weight in anorexia

A

Refeeding syndrome → characerized by HYPOphosphatemia & volume overload → can result in death

Solution: feeding must be slow/in small amts

44
Q

Screening for anorexia

A

EAT 26 (96% accurate)

45
Q

Types of INAPPROPRIATE COMPENSATION in bulimia (5)

A
  1. Self-induced vomiting
  2. Laxatives
  3. Diuretics
  4. Fasting
  5. Excessive exercise
46
Q

Parotid swelling

A

Bulimia

47
Q

Russel’s sign

A

Bulimia (calloused knuckles)

48
Q

Metabolic alkalosis values form bulimia

A

↓ K+
↓ Mg+
↓ Cl-
*can progress to cardiac abnormalities (T-wave flattening/inversion, ST depression, QTc lengthening)

49
Q

Bulimia & Binge Eating Disorder common tx?

A

Psychotherpay CBT

SSRI → Fluvoxamine

50
Q

What risk factor makes child abuse 5 x’s more likely?

What are the other risk factors?

A

Poverty (5x’s greater than general pop)

Other: SUD, FHs, divorce, parental mental illness, foxter care

51
Q

MC type of child abuse

A

Neglect

52
Q

Retinal hemorrages of hyphema in baby

A

Shaken Baby Syndrome

Child Abuse

53
Q

The general long term impact of child abuse on the victim

A

Overall ↓ lifespan

54
Q

When is it more likely for domestic violence or a severe assault in this context to occur?

A

When the victim is attempting to escape their relationship

55
Q

When discussing elder abuse, what age is “elder”?

A

> 60 yo

*A breech in the trusted relationship with the elder

56
Q

During what time period is forensic evidence able to be collected from the victim?

A

24 hrs

“rape kit”

57
Q

Sexual Abuse child victim, do you give them all abx prophylaxis?

A

PREpubertal + no sx → no
POSTpubertal + no sx → yes
Symptomatic → YES!

58
Q

Dialectical Personality Tx

A

1st line tx in borderline personality disorder

59
Q

CC of pt is “Aggression” what do you think of as possible causes

A 
ADHD
DMDD
Intermittent Explosive Disorder 
TBI
Seizures 
Autism
60
Q

ODD, Conduct Disorder & Intermittent Explosive Disorder

…are all?

A

Impulse Control Disorders

61
Q

ODD vs conduct disorder

A

ODD is > 6 mo of > 4 sx BUT no harming of property or ppl
Conduct disorder is > 12 mo of 3 or > 6 mo of 1 sx + YES harming in 4 categories (Aggression, destruction, deceit, serious rule violation)

62
Q

ODD vs DMDD (Disrupted Mood Dysregulation Disorder)

A

ODD is > 6 mo of > 4 sx BUT no harming of property or ppl

DMDD is out of proportion temper tantrums > 12 mo > 3 times per week (not the pts baseline)

63
Q

Intermittent Explosive Disorder vs ODD vs DMDD

A

Intermittent Explosive is verbal aggression OR damaging behavioral outbursts (not the pts baseline)
ODD is > 6 mo of > 4 sx BUT no harming of property or ppl
DMDD is out of proportion temper tantrums > 12 mo > 3 times per week (not the pts baseline)

64
Q

Mainstay of care for somatic symptom disorders? What are they?

A

Psychotherapy + SINGLE provider f/u + Socialization

Illness Anxiety Disorder
Conversion Disorder
Somatization Disorder

Others that are for the pt’s personal gain: Factitious Disorder & Malingering

65
Q

2 types of Illness Anxiety Disorder
→Duration of sx?
→How can it present?

A
  1. Care seeking
  2. Care avoidant
    > 6 mo
    Presents: highly focused on the idea of a sx or dx
66
Q

Neurologic presentation + La belle differance

A

Conversion disorder

→often presents as paralysis, pseudosizure, aphonia, blindness, sensory deficit, neuro/ortho complaint

67
Q

Pt complains of pain, fatigue & is preoccupied excessively w/ this sx (disproportionately) in the past 6 mo

A

Somatic Sx Disorder

68
Q

Personality disorder MC associated w/ malingering

A

Antisocial personality disorder

Clinical Medicine (6 decks)

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