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Psychiatry Flashcards

1
Q

who is a candidate for lifelong antidepressant treatment

A

patient with more than 3 lifetime depressive episodes, suicide attempts, or episodes lasting more than 2 years

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2
Q

blockage of what receptor causes extrapyramidal symptoms

A

D2 (antipsychotics and metoclopramide)

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3
Q

what is not detected by a standard urine drug screen

A

semisynthetic opioids

  • hydrocodone
  • hydromorphone
  • oxycodone

synthetic opioids

  • fentanyl
  • meperidine
  • methadone
  • tramadol
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4
Q

man with bipolar comes in with fatigue, myalgias, constipation, and bradycardia … what do you think

A

lithium induced hypothyroidism (this happens in 25% of pts on lithium)

  • all pts on lithium need TSH monitoring every 6-12 months
  • treat with T4 supplementation (dont discontinue lithium)
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5
Q

if ssri doesnt work for a pt who is suffering from weight gain and sexual side effects, what do you give them?

A

bupropion (NDRI)

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6
Q

what do you give to someone who has an addictive past but is diagnosed with ADHD

A

Atomoxetine, nonstimulant norepinephrine reuptake inhibitor

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7
Q

TCA overdose

A

convulsions
coma
cardiotoxicity

-respiratory depression, hyperpyrexia, prolonged QT

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8
Q

neuroimaging in a pt with schizophrenia

A

larger lateral ventricles

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9
Q

what is the first line treatment for narcolepsy

A

modafinil

  • nonamphetamine
  • promotes wakefulness
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10
Q

MAOI and you drink or eat cheese

A

hypertensive crisis due to excess tyramine

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11
Q

preferred treatment for adjustment disorder (symptoms develop w/i 3 months of major stressor and cause significant impairment) and borderline personality disorder

A

psychotherapy

-specifically dialectical behavioral therapy for borderline personality disorder

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12
Q

how long do postpartum blues last

A

usually 2 weeks

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13
Q

how to treat acute opioid intoxication

A

naloxone

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14
Q

unstable mood, recurrent suicidal behavior, impulsivity, intense anger, chaotic interpersonal relationships

A

borderline personality disorder

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15
Q

what CSF findings are associated with increased risk of suicidal behavior

A

low concentrations of 5-HIAA in CSF

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16
Q

valproate side effect

A

hepatotoxicity

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17
Q

irritability, agitation, psychosis, tachycardia, hypertension, hyperthermia, diaphoresis, mydriasis

A

amphetamine toxicity

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18
Q

how to treat catatonia (when pt doesnt move even if you move their arm against gravity they will just leave it there)

A

benzodiazepine and/or ECT

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19
Q

signs of and how to treat lithium toxicity

A

signs –> neurologic (altered mental status, seizure, fasciculations, tremor) and gi (vomiting and diarrhea) symptoms

mild –> hydration and monitoring
prominent –> hemodyalsis

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20
Q

what do you think of in a pt with hand abrasions and parotid gland enlargement

A

bulemia nervosa

  • expect to see metabolic alkalosis with hypokalemia
  • also hypochloremia
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21
Q

3 FDA-approved first line treatments for smoking cessation

A
  1. nicotine replacement therapy
  2. varenicline
  3. bupropion
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22
Q

second generation antipsychotics that cause metabolic side effects

A

olanzapine and clozapine

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23
Q

what medication at high doses can cause psychosis

A

glucocorticoids

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24
Q

first line treatment for alcohol use disorders

A

naltrexone –> mu opioid receptor antagonist

acamprostate –> glutamate modulator

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25
Q

what are three chemical differences in someone with MDD

A
  1. hyperactivity of hypothalamic-pituitary-adrenal axis causing increased cortisol levels
  2. decreased REM latency
  3. decreased slow wave sleep
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26
Q

mirtazapine

A

atypical antidepressant

  • a2 antagonist
  • increases NE and serotonin
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27
Q

if pt on antipsychotic starts experiencing tardive dyskinesia refractory to valbenazine and deutetrabenazine then what do you do…

A
  • discontinue causative medication if feasible

- switch to either quetiapine or clozapine if continued antipsychotic is required

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28
Q

what type of therapy has been shown to decrease relapse in pts with schizophrenia

A

family therapy

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29
Q

first line treatments for acute mania

A
  1. antipsychotics (1st and 2nd generation)
  2. lithium
  3. anticonvulsant mood stabilizers (valproate)
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30
Q

dhat syndrome

A
  • somatic symptoms (fatigue, weight loss), anxiety, cultural background, and belief of losing semen during urination
  • usually in south asian men
  • pt mentions any type of concern of losing semen

-use a pt centered approach and ask open ended questions about what they think is going on

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31
Q

seizure with these factors lead to what likely diagnosis

  • forced eye closure
  • side-to-side head or body movements
  • memory recall of the event
  • lack of postictal confusion
A

psychogenic nonepileptic seizure (PNES)

-gold standard for dx: video electro-encephalogram of an event demonstrating lack of epileptiform activity

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32
Q

which antidepressant has mild stimulant effects and when would you give it

A

bupropion

  • give to depressed pts with low energy, impaired concentration, hypersominia, and weight gain
  • it can also be used to help with smoking cessation
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33
Q

what is the most common psychiatric complication in patients with multiple sclerosis

A

depression

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34
Q

REM sleep behavior disorder

A

sleep behavior disorder that involves dream enactment that occurs during REM sleep due to absence of muscle atonia

  • if awakened pt becomes fully alert and recall their dreams
  • in older pts this can be a sign of neurodegeneration
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35
Q

pt has fever, lead-pipe rigidity, mental status changes, and autonomic instability (hypertension, tachycardia, diaphoresis)

A

neuroleptic malignant syndrome

  • can be caused by every class of antipsychotics
  • creatinine kinase and WBC count may be elevated

-if supportive measures aren’t enough then use D2 blockers like bromocriptine or amantadine

36
Q

macrocytosis in a pt who cant sleep and has ast:alt > 2

A

alcohol use disorder

37
Q

once a pt with single-episode unipolar major depression has been brought back to baseline… how do you change their meds?

A

continuation-phase treatment

-continue their treatment for 6 months at same dose and if remission is maintained then taper gradually and discontinue

38
Q

how to treat a pt with recurrent, chronic, severe episodes of depression once they finally are stable?

A

keep them on medication for 1-3 years or indefinitely if they have more than 3 episodes

39
Q

excessive anxiety and preoccupation with 1 or more unexplained symptoms lasting at least 6 months

A

somatic symptom disorder

40
Q

what is this pt withdrawing from…

  • nausea, vomiting, abdominal cramping, diarrhea, muscle aches
  • dilated pupils, yawning, piloerection, lacrimation, hyperactive bowel sounds
A

heroin

-pts may also have rhinorhea

41
Q

if a pt has a history of bulemia or anorexia nervosa what medication is absolutely contraindicated and why

A

bupropion is contraindicated due to the increased risk of seizures from the electrolyte disturbances they may have

42
Q

treatments for eating disorders

A

anorexia –> cbt, nutritional rehab, olanzapine if nothing else worked
bulemia –> cbt, nutritional rehab, ssri (fluoxetine) added
binge-eating –> cbt, behavioral weight loss therapy, ssri, lisdexamfetamine

43
Q

what type of medication is contraindicated in someone taking an SSRI

A

monoamine oxidase inhibitor due to possible serotonin syndrome (3 As –> increased Activity, Autonomic instability, Altered mental status)

44
Q

pt has depression then ends up losing a little weight and becoming hypertensive… what do you think?

A

SNRI, venlafaxine

-blood pressure should be monitored regularly for these pts

45
Q

manic behavior (agitation, grandiosity, loud/pressured speech) + sympathetic stimulation (diaphoresis, tachycardia, hypertension, mydriasis)

A

cocaine intoxication

46
Q

what do you give to a pt in alcohol withdrawal

A

lorazepam
oxazepam
temazepam

*note: you cant give chlordiazepoxide or diazepam b/c they have long half lives and build up to cause toxicity in pts with liver dysfunction

47
Q

if a pt with cancer or some disorder seems depressed from it what do you do

A

GIVE MEDS FOR IT

-pts with medical problems have a lower threshold for when you wanna treat them for depression

48
Q

preferred treatment of PCP induced agitation

A

benzos

49
Q

what is akathesia, when do you expect to see it, and how do you treat it

A

akathesia –> subjective restlessness and inability to sit still

  • try to keep a lookout for this if a pts psychosis gets worse or if they cant sit still after being placed on an antipsychotic
  • treat by reducing antipsychotic dosage and adding propranolol, benztropine, OR a benzo
50
Q

older thin pt presents with depression, anxiety, smoking history, weight loss, and recent diagnosis with DMT2… what do you think

A

pancreatic cancer

-get CT of abdomen

51
Q

how to diagnose absence seizure

A

classic 3-hz spike and wave pattern on electroencephalogram

52
Q

false positive UDS for amphetamines

A 
NAP-B
Nasal decongestant 
Atenolol 
Propranolol
Bupropion
53
Q

false positive UDS for PCP

A 
DDD-TV-K
dextromethorphan 
diphenhydramine 
doxylamine 
ketamine
tramadol
venlafaxine
54
Q

at what age roughly should imaginary friends be considered abnormal

A

around 6 or 7, before that they are normal and a form of creative play for a child

55
Q

how to tell the difference b/w risperidone or a prolactinoma in pts with history of psychosis

A 
risperidone = prolactin level around 70-100
prolactinoma = prolactin level above 200
56
Q

what other medications besides lithium can be used for bipolar disorder as mood stabilizers

A

valproic acid
carbamazepine
lamotrigine (titrate slowly –> can cause SJS or TEN if severe)

2nd gen antipsychotics (quetiapine and lurasidone)

57
Q

wernicke-korsakoff syndrome

A

Wernicke encephalitis = confusion, opthalmoplegia, ataxia (classic triad)
Korsakoff syndrome = confabulation, personality change,, memory loss

*occurs in pts with alcoholism and/or thiamine (B1) deficiency

58
Q

atypical features of MDD

A

hyperphagia, heavy feeling in limbs, hypersensitivity to rejection, and mood reactivity (ability to respond to positive events)

59
Q

how can PTSD present in children

A

distressing dreams with vague content, traumatic themes during play, emotional dysregulation, and behavioral difficulties

60
Q

explain tardive dyskinesia at a molecular level

A

D2 receptor upregulation and supersensitivity

61
Q

when is ECT indicated for depression

A

treatment resistance, psychotic features, emergency conditions (pregnancy, refusal to eat/drink, imminent risk for suicide)

62
Q

symptoms of cocaine w/d

A

depression, increased dreaming, hyperphagia, drug cravings

63
Q

how to differentiate naricisstic personality from OC personality

A

N –> order and rigid to be perfect FOR PRAISE

OC –> order and rigid to be perfect for self

64
Q

what two parkinson meds are associated with psychosis

A 
levodopa (dopamine precursor)
dopamine agonist (pramipexol)
-if pt starts having psychotic symptoms then put decrease the dosage of these meds
65
Q

At what CD4+ T cell count should you be concerned about HIV-associated dementia

A

< 200

-subcortical symptoms in early course of disease

66
Q

pt presents with depressed mood, weight loss, salt cravings, and reduced body hair…. what is it and how do you diagnose it

A

primary adrenal insufficiency (addisons disease)
-autoimmune destruction of bilateral adrenal cortex

mineralocorticoid deficiency –> salt cravings
glucocorticoid deficiency –> psych problems (depressed mood and irritability)
androgen deficiency –> loss of libido and 2ndary sex characteristics (reduced pubic hair)

dx via cosyntropin stimulation test

67
Q

clozapine side effects

A

agranulocytosis (neutropenia)

-only consider clozapine if the pt had 2 failed drug trials for treatment resistant schizophrenia

68
Q

how to differentiate acute stress disorder from PTSD

A

acute stress disorder –> 3days to 1 month

PTSD –> more than 1 month

69
Q

psychotic symptoms and tactile hallucinations like bugs crawling under skin

A

methamphetamine use disorder

70
Q

pt starts fasting or taking carbamazepine, phenytoin, or rifampin then has intermittent neurovisceral attacks and abdominal pain….

A

acute intermittent porphyria

-dx via elevated urinary porphobilinogen

71
Q

what are the negative symptoms of schizophrenia

A

apathy, avolition, lack of facial expression, alogia, social withdrawal, and diminished interest in relationships

72
Q

how to diagnose schizophrenia

A

more than 2 of the following for more than 6 months

  • delusions*
  • hallucinations*
  • disorganized speech*
  • disorganized behavior
  • negative symptoms

*at least one of these is required

73
Q

narcolepsy and cataplexy

A

narcolepsy –> recurrent lapses into sleep or naps ( >3x/week for 3 months)
WITH more than 1 of the following….
1. cataplexy –> brief loss of muscle tone precipitated by strong emotion (laughter/excitement)
2. low CSF fluid levels of hypocretin-1
3. shortened REM sleep latency

Associated features

  • hypnogogic or hypnopompic hallucinations
  • sleep paralysis
74
Q

how long after discontinuing an SSRI can you start someone on an MAOI… what happens if you dont wait long enough?

A

2 weeks, serotonin syndrome (3 As –> activity, autonomic, and altered mental status)

*except fluoxetine because it has a longer t1/2 you have to wait 5 weeks

75
Q

what mini-mental status exam is associated with dementia

A

23 or lower

76
Q

diagnostic criteria and treatment for dementia with lewy bodies

A

dx via dementia + 2 of the following features

  • visual hallucinations
  • parkinsonism
  • fluctuating cognition
  • REM sleep behavior disorder

treat with carbidopa-levodopa (parkinsonism), rivastigmine (cognitive impairment), melatonin (REM sleep behavior disorder)
—-trial of antipsychotic (risperidone) can be used for hallucinations or delusions BUT WITH CAUTION because it can cause extreme antipsychotic hypersensitivity

77
Q

how to treat sleep terrors

A
  • reassurance (usually resolve w/i 1-2 years)

- low-dose benzo if frequent, persistent, and distressing

78
Q

What do you have to watch out for when giving a patient acamprostate

A

It’s tough on the kidneys

79
Q

what type of medication is citalopram

A

ssri

80
Q

cyclothymic disorder

A

chronic, fluctuating mood disturbances for many years

  • more than 2 years in adults, 1 year in children
  • less severe bipolar syndrome
81
Q

what meds to give for premature ejacuation

A 
SSRI
topical anesthetics (lidocaine)
psychotherapy/joint couples therapy
82
Q

patient with schizophrenia… what should you lookout for

A

up to 50% of pts also have a coexisting substance use disorder so if they are in the hospital and start to have a tremor then give benzos for alcohol w/d

83
Q

what are the three most serious side effects of clozapine

A

agranulocytosis/neutropenia
seizures
myocarditis

84
Q

how to treat body dysmorphia

A

ssri or other antidepressants

cbt

85
Q

what is chlordiazepoxide

A

benzo

86
Q

when to wean someone off schizophrenia meds

A

never! maintained indefinitely including those with one 1 episode of psychosis

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