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2019 RC Specialties > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Which psych med causes sexual dysfunction:

A

Antidepressant (SSRI)

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2
Q

Risperidone with frequent syncopal episode. What is the cause?

A

Prolonged QT

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3
Q

List 3 AE of risperidone:

A
  • **Metabolic syn (wt gain, DM, dyslipidemia)
  • **Hyperprolactinemia (gynecomastia, sexual dysfunction)
  • Anticholinergic (dry mouth, constipation)
  • **Cardio (QTc)
  • ** Agranulocytosis (neutropenia, leukopenia)
  • Sedation
  • ** Hepatotoxicity
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4
Q

Recurrence of depression once off:

A

50%

btwn 30-50% within first year and 50-70% in next 8yrs

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5
Q 
Teen has change in behaviour. Drop in grades. Not interested in sport. Divorced 2 years ago. Picks on sister. 
Likely:
- adjustment
- substance
- MDD
- ADHD
A

MDD (mood dx)

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6
Q

Kid w/ in change w/ behaviour.

Psychology assessment, TSH or Tox?

A

Tox screen

If occasional smoke but no other drug use in hx- then think psych.

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7
Q

List DDX for Depression:

A

Medical

  • **Neuro
  • **Endo (DM, thyroid)
  • ** Eating Dx
  • Infection (**Mono)
  • CA
  • Anemia
  • ** HIV
  • Chronic pain

Meds

  • Narcotics
  • Chemo
  • Beta blocker
  • Steroid**
  • ** Substance Abuse

Psychiatry

  • **Anxiety
  • ADHD
  • ODD
  • CD
  • Adjustment Disorder
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8
Q

List the DSM criteria for Major Depressive Episode:

A

“SIGECAPS”

Depressed or anhedonia x 2 weeks + 4 of:

  • sad
  • no interested
  • guilt or worthlessness
  • energy low
  • low concentration
  • appetite/wt (up or down 5% in one month)
  • psychomotor agitation or retardation
  • insomnia or hypersomnia
  • death or SI

+ cause distress or f’n issue
+ not due to substance or medical condition
+ never been manic or hypomanic

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9
Q

How do you treat depression:

A
  • psychoeducation
  • CBT or interpersonal therapy
  • Antidepressant if severe
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10
Q

Girl referred for possible ADHD. Agitated, irtaible, only sleep 4 hour a night. Mom bipolar. Likely:

  • drug
  • bipolar
  • ADHD
A

Bipolar

HIGHLY HERITABLE

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11
Q

F irritable, low sleep, provocative clothing. FHX suicide. Likely tx:

  • TCA
  • Paroxetine
  • Lithium
  • Fluoxetine
A

Lithium or antipsychotic (risperidone, aripiprazole, olanzapine)

OR VPA or carbamazepine.

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12
Q

T or F: Medication is the only treatment of manic stage of bipolar.

A

True

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13
Q

What med do you use for bipolar depression?

A

Lamotrigine (mono therapy or adjunct)

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14
Q

Manic Episode DSM5 Criteria?

A

“DIGFAST”

Elation or irritable x 1 week
\+ min. 3-4 symptoms
D- distractibility
I- Irresponsible (risk behaviour)
G- grandiosity (high SE)
F- flight of ideas
A- activity goal directed or agitated
Sleep down
Talkative

+ cause impairment
+ not due to substance of medical condition

Versus hypomanic: last 4d instead

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15
Q

What is bipolar 1 versus 2 disorder?

A

Bipolar 1= Manic

Bipolar II= hypomanic + 1 major depressive

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16
Q

T or F: Homosexuality is NOT a RF for increased suicide?

A

False.

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17
Q

List RF for suicide in teens:

A 
> Non Modifiable:
*Male
*Teens
*Aboriginal
*LGBQT
History of Abuse
FHX Suicide
*Pre-exsting psych (esp depression)
Chronic pain
>Modifiable
*hopelessness/ (-) self attribution
loss of reality
severe agitation
lack social support
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18
Q

What is the suicide pattern with M and F?

A 
F= ideation
M= completion
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19
Q

T or F: safety contract help avoid suicide.

A

False.

Safety planning helps

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20
Q

What can you recommend for suicidal teen in remote community over next two days.

A
  • use coping skills
  • (+) focus on leverage (Something to live for)
  • recognize personal warning signs
  • name people to support
  • ID close friend or adult to resolve conflict
  • know mental health to contact (helpline, local ED)
  • ensure safe environment (fire arm, locked meds)
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21
Q

Attempting suicide teen. Troubled violent thoughts. Thoughts to hurt others. Likely psych dx?

A

Schizophrenia

(+ symptoms like hallucination, psychotic thought to harm others versus “I’m bad” psychosis in depression, high risk suicide (20%))

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22
Q

How does anxiety present in kids at school?

A

Non specific symptom (intermittent abdo pain, daily h/a in healthy pt, chest feel tight in morn)

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23
Q

What is the most common psychiatric disorder of childhood?

A

Anxiety Disorders

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24
Q

List the diagnostic criteria for GAD:

A

Excessive anxiety + worry most days x 6 month.

AND hard to control

AND associated w/ 1 of: BE SKIM

  • Blank mind, [hard]
  • Easy fatigue
  • Sleep disturb (insomnia, wake from sleep)
  • Keyed up or on edge
  • Irritable
  • Muscle tension

And cause impairment. And not due to drug. And not due to med condition.

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25
Q

What are keys to separation anxiety versus social anxiety.

A

Separation: worry about self or caregiver (avoid school, nightmare)

Social: diffuse nature + 1 other complaint

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26
Q

Separation Anxiety Disorder DSM 5 Criteria:

Name 3…

A

Developmentally inappropriate + excessive anxiety re: separate with min. 3 of x 4 week:

    • ++ distress if separated
  • excessive worry about event that could lead to separation
    • refusal to go to school
    • fear to be alone
    • refusal to sleep without attachment near by
  • nightmare about separation
    • physical (h/a, abdo pain, N/V)
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27
Q

T or F: separation anxiety commonly present with somatic symptom like stomachaches, h/a to avoid leaving home. School refusal common

A

True.

3/4 show school avoidance.

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28
Q

What is the most common childhood anxiety disorder?

A

Separation anxiety

5%

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29
Q

What is separation anxiety associated with:

A 
Tics
Panic disorder (3x more likely)
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30
Q

Best Tx for separation anxiety?

A

CBT +/- SSRI

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31
Q

7 y.o. w/ separation anxiety refusing to go to school? What to do?

  • Send back asap
  • Send back to school gradual
  • SSRI and back to school
A

Send back to school immediately

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32
Q

7 y.o. w/ separation anxiety. Refuse to go to school. Four things in management:

A
  1. ** Psychoeducation (ID signs of fright)
  2. ***Psychotherapy= CBT, coping, (+) reinforcement)
  3. **Immediate return to school (graded exposure doesn’t work)
  4. ***Pharma (SSRI if severe)
  5. Screen for comorbid (tic, panic, anxiety)
  6. R/O medical (thyroid, meds, substance abuse)
  7. Referral to psych
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33
Q

Panic Attack Disorder:

A

“Students Fear the 3 C’s”

Abrupt intense fear within 1 mon. and include min. 4 of:

Sweating
Trembling/shake
Unsteady/Dizzy
Derealization
Excess HR
Nausea
Tingling/Paresthesia
SOB/smothering
Fear of Death

Choking (feeling)
Chills/Flush
Chest Pain

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34
Q

Panic Disorder:

A

Recurrent panic attack

followed by 1 mon of:

  • worry about more
  • change behaviour related to attack (avoid unfamiliar situation)

Not due to psych or med dx

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35
Q

What helps with panic attacks:

A
  • CBT
  • SSRI
  • Short term benzo
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36
Q

Teen. Violent thoughts overwhelm him. Frequent and not hurt anyone yet but fears will. Likely dx:

  • behav issue
  • OCD
  • schizo
  • antisocial
A

OCD

schizophrenia usually lack insight into dx

Antisocial min. 18 y.o.

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37
Q

6 y.o. with 2 week new onset OCD. What infectious agent we worry about?

A

Controversial= Group A Strep
= PANDAS

Tx:

  • If (+)= Abx (penicillin)
  • Behavioural therapy
  • SSRI for OCD +/- clonidine for tics

***Unproven theory= routine lab GAS, ASOT, long term Abx, IVIG NOT recommended.

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38
Q

OCD DSM5 Criteria:

A

Obsession and/or compulsion
+ Time consuming (>1hr/day) or cause distress/impairment
+ Not due to substance or medical condition
+ not due to Psych dx

Obsessions - recurrent thoughts/urges/impulses that are unwanted and intrusive and cause distress. Attempts to ignore or suppress or neutralize by doing some thought or action.

Compulsions - repetitive behaviours or mental acts driven to do in response to obsessions or rules. Aimed at reducing stress or prevent event but are not realistically connected or are clearly excessive.

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39
Q

Common comorbidities with OCD:

A

Tic
LD or DD
Depression

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40
Q

How to treat OCD

A

CBT (including desensitization) +/- SSRI

41
Q

Tourette Criteria

A

2 motor + 1 vocal
x 1 year
started before 18 y.o.
Not due to medication or other medical condition

Tx: Clonidine

42
Q

Tourette comorbidies

A

ADHD
OCD
LD

43
Q

Give two traits of “obsession” in OCD Criteria

A
  • **recurrent + persistent thoughts, urge, image
  • **intrusive and unwanted
  • cause **distress
  • try to **neutralize (compulsion) or ignore
44
Q

Given two traits of “Compulsions” in OCD criteria

A
  • **Repetitive behave or mental act
  • **To respond to obsession
  • Goal to reduce anxiety but **not logically connected to obsession
  • **Time consuming
45
Q

Which is true about trichotillomania:

  • assoc. w/ OCD
  • self-limiting
  • rare
A

Associated with OCD

Trichotillomania
= visible hair loss due to recurrent pull
- common cause of alopecia
- usually teen
- associated w/ OCD in older kids
- irregular area of incomplete hair loss; often crown
- behavioural -> SSRI (fluoxetine)
- often remit
46
Q

List 4 traits of PTSD:

A

TTRAUMA

Traumatic event= Exposed to actual or life threatening dead, injury, sexual violence.

  1. (-) Thought/ feeling of trauma
    (amnesia, self-image, blame)
  2. Re-experiences (intrusive thought, nightmare, flashback)
  3. Arousal (Hyperarousal- irritable, aggression, self-destructive)
  4. Unable to Function
  5. Month (min.)
  6. Avoidance
    (of trauma related stimuli)
47
Q

5 y.o. with single mom. Hyperactive, hoarding food, not remorseful for inappropriate behaviour. No contact w/ mom but runs and hugs you. Likely dx?

  • ADHD
  • Autism
  • Attachment Disorder
A

Attachment Disorder

48
Q

What is diecenphalic syndrome?

A

Severe FTT or emaciation

DESPITE norm/ or ++ appetite

Preserved Ht.

Association w/ hypothal neoplasm

49
Q

What are the DSM5 ADHD criteria

A

Symptom prior to 12 y.o.
@ 2 settings
W/ functional impairment

6 symp x 6 month

Inattention:

  • *lack attn/ careless mistake
  • can’t sustain attain
  • *no listening
  • d.n. follow through
  • *poor organization
  • *avoid task if need effort
  • *lose imp things
  • *easily distracted
  • *forgetful

H/I:

  • *fidget
  • *leaves seat
  • run/climbs
  • can’t play quietly
  • *“on the go”
  • talks +++
  • *blurt answer
  • *can’t wait turn
  • interrupt other
50
Q

What are 4 things you must investigate for ADHD

A
  1. Symptoms
    > Report Cards
    > SNAP scales (parents + teacher)
  2. Hx and P/E to R/O medical dx and consider BW (thyroid, lead level, CBC anemia)
  3. Vision and Hearing
  4. Psycho educational testing (LD)
  5. +/- OT evaluation for sensory impairments
  6. if concerns for genetics (Fragile X)
51
Q

T or F: ADHD is highly heritable.

A

True.

60-80%

52
Q

State two RF for ADHD:

A

Male
BW < 1500g
In utero smoke
FHX

53
Q

List DDX for ADHD

A

Med/Neuro

    • Thyroid
    • Hearing or vision deficit
  • Auditory or visual processing disorder
    • Absence sz
  • Migraine H/a
    • OSA
  • Lead poisoning

Psychosocial

  • poor parenting
    • LD/ Intellectual disability
    • Mood disorder (depression)
  • Bipolar dx (OCD)
    • ASD
    • Substance Abuse
    • child abuse or neglect
  • *Dx Associated
  • Fragile X
  • FASD
  • Tourette
  • Attachment Dx
54
Q

What are common co-existing dx with ADHD:

A
  1. Learning Dx
  2. ODD
  3. CD
  4. Depression
  5. Anxiety
55
Q

List ADHD stimulant AE:

A
  • h/a
  • reduced appetite
  • delayed sleep phase
  • wt loss
  • tachycardia
  • HTN
  • “rebound effect”
  • psychotic (e.g. halluincation) effect
56
Q

When is straterra particularly helpful:

A

ADHD + tic or anxiety or resistance or high AE to stimulants

57
Q

Name two meds in dextroamphetamine and methylphenidate group.

A 
Dextroamphetamine:
= DAV
- Dexedrine
- Adderall
- Vyvanse
Methylphenidate
= RBC
- Ritalin
- Biphentin
- Concerta
58
Q

Name two non stimulant medication for ADHD:

A

> Atomoxetine (Straterra)
- (+): tics, anxiety, AE from stimulant
(-) may increase SI

> Guanfacine (Intuniv)

  • (+): tics, aggression
  • (-): somnolence, sedation
  • rebound tachy HR and BP if stop abruptly
59
Q

Contraindication to Stimulants:

A
  • symptomatic cardiac dx
  • mod/severe HTN
  • hyperthyroidism
  • fhx long QT
60
Q

T or F: you must do routine ECG prior to stimulant

A

FALSE.

Unless hx of palpitation, pre-syncope, or syncope, or strong fhx cardiac dx.

61
Q

7 y.o. with normal IQ. Can’t read out-loud and doesn’t understand material but can learn when read to. Likely dx:

  • ADHD
  • Expressive aphasia
  • Global delay
  • Reading Disorder
A

Reading disorder

  • expressive aphasia = oral and can’t understand when read to

Global delay= < 5 y.o., developmental delay + IQ issue

ADHD= not skill performance but LEARNING

62
Q

List 3 RF for learning disability:

A
  • IUGR
  • HIE
  • FAS
  • Meningitis
  • Traumatic brain injury
63
Q

Math LD called

A

Dyscalculia

64
Q

Written expression disorder called

A

Dysgraphia

65
Q

Reading disorder called

A

Dyslexia

66
Q

T or F: in LD IQ is fine.

A

True.

67
Q

How can you tell ADHD versus LD

A

ADHD= issue performing academic skill NOT learning it.

68
Q

How do you treat LD

A
  1. demystify (highlight strength, educate)
  2. accommodate
  3. remediate skill
  4. curriculum modify
69
Q

List three things if loss of language skills:

A

< 3 y.o.
= Autism Spectrum Disorder
= Landau-Kleffner syn

> 3 y.o.
= Sz

70
Q

How many kids with initial speech delay “catch up” by 3?

A

50%

71
Q

T or F: isolated expressive speech delay more common in F.

A

False.

MALE more common.

72
Q

T or F: early language disorder strongly related to reading disorder.

A

True (50%)

73
Q

4 y.o. M with trouble expressing lang. Receptive fine. Development fine. At risk for:

  • DD
  • Reading difficulty
  • ASD
  • ADHD
A

Reading difficulty

74
Q

10 y.o. steal, kills pet, lights fire. Dx?

A

Conduct disorder

75
Q

Two treatment modality for ODD

A
  • Anger management for youth
  • Parent and family skills(Triple P = (+) parenting program)
  • Medications:
    > stimulants
    > risperidone
76
Q

List 4 behaviours in Conduct disorder

A
  1. Aggression to ppl or animal
  2. Destruction of property
  3. Deceitful or theft
  4. Serious violation of rules
77
Q

List ODD DSM 5 criteria:

A

min. 6 mon
4 of following:

> angry (lose temper, annoyed easily, resentful)
defiant (argue, won’t comply w/ rule, annoy, blame others)
vindictive (x 2 within last 6 mo.)

78
Q

How can you tell ODD versus CD

A

ODD = NO PHYSICAL aggression

79
Q

List Conduct disorder DSM5 criteria.

A

Min. 3 of x 12 month and 1 for 6 mo.:

“TV AD”

  • Theft/ deceitfulness
  • Violation of rules (run away, stay out)
  • Aggression (people and animal)
  • Destruction of property (fire setting, damage property)
80
Q

17 y.o. teen with persistent issue with (-) evaluation, fear of social situation. Likely?

  • avoidant PD
  • social phobia
  • depression
A

Avoidant personality disorder

*feel inadequate, avoid work that could be criticized, *hypersensitive to (-) eval, *social inhibition w/ new relationships

81
Q

T or F: FHX of tics would support dx of Tourette’s in pt with facial tics.

A

True. Usually (+) FHX.

82
Q

List 3 things on Chorea ddx:

A
  • *Genetic (rare juvenile Huntington)
  • Rare structural (vascular chorea in stroke or mass)
  • Parainfectious and AI (*Sydenham Chorea, *SLE)
  • Infectious (HIV)
  • metabolic or Toxic (acute porphyria, Na)
83
Q

List the most common acquired chorea

A

Sydenham chorea

  • neuro manifestation due to rheumatic fever (GAS)
  • long term Abx for rheumatic heart dx
  • if chorea impairing= VPA
  • resolve on own within 6-9 mo.
84
Q

What are the hallmark of Sydenham chorea:

A

Chorea
+ Emotional Lability
+ Hypotonia

85
Q

List for things on ddx for teen with weird statements and personality change.

A

> Medical

  • Brain tumour
  • Head trauma
  • antiNMDA
  • Low BG
  • high thyroid
  • adrenal dysfunction
  • Wilson’s
  • IEM
  • Seizures

> Drugs

  • steroid, stimulant
  • hallucinogen, LSD

> Mood Disorder
- depression w/ psychotic features

> Psychotic Disorder

86
Q

List the psychotic disorder and how to tell the diff

A
  • Brief psychotic (<1 mo.)
  • Delusional Dx (1 mo.; nothing odd)
  • Schizo phreniform (< 6 mo.)
  • Schizophrenia (6 mo. x 2 symptoms) (2 of- delusion, halluincation, disorganized speech and behav, (-) symp)
  • Schizoaffective (mood + symp but ALSO delusion/ halluincation for min. 2 wk w/out mood)
87
Q

List 4 non -psychiatric dx for psychosis/delirium:

A

DIMS (extended)

> Drugs

  • withdrawal: alcohol, benzo
  • substance use
  • steroids AE
  • heavy metal (lead)

> Infection

  • encephalitis
  • meningitis

> Metabolic

  • acute: BG, lyte
  • low B12
  • thyroid
  • adrenal HTN crisis

> Structural/ Sz/ Syncope

  • trauma: injury, bleed
  • brain tumour
  • sz disorder
88
Q

What is the difference between sleep terror and nightmares:

A

Nightmare

    • child to young adult
    • REM
    • last 1/3 of night
    • no autonomic or confusion

Sleep terror:

  • preschool
  • FHX (+)
  • slow wave sleep (early in)
  • agitation w/ comforting
  • amnesia
  • educate
  • sched awakening 30 min. prior to expected episode
89
Q

5 things to tell boy to improve sleep hygiene

A
  1. increase physical activity in day but not within 2h of bed
  2. quiet, dark, comfortable
  3. consistent wake and sleep time
  4. avoid screen
  5. read until fatigued
90
Q

Divorcing parents. Best for kids?

  • joint custody asap
  • see both parent even if fighting
  • parents settle differences and not fight in front of kids
A

Settle differences and not fight in front of kids.

91
Q

T or F: best predictor of child’s response is post-separation parental conflict and depression rather than custody issue.

A

True.

92
Q

List key 3 factors for child morbidity after family going through divorce.

A
  1. Degree of inter parental conflict
  2. Quality of parenting (love + discipline)
  3. Parent-child interaction (supportive, communicate, low conflict)
93
Q

List 3 protective factors for child is parents divorcing

A
  • quality authoritative parenting
  • healthy parent-child relationship
  • protection from conflict
  • psychologically well child
  • household stability
  • economic stability
94
Q

T or F: best adjusted kids after divorce have one parent.

A

False.

Best if 2 psychologically healthy parents who minimize conflict and have sibling and other who are support network.

95
Q

What is adjustment disorder

A

Emotional or behav symp within 3 month of stressor that are:
- distress > than what is expected
and/or cause significant impairment

96
Q

List 3 reasons you can breach confidentiality

A
  • Self Risk (form)
  • Risk to other (police report)
  • Risk to other kids (CYPT)
  • Reportable infection (public health)
97
Q

Depression RF (increases with):

A
  • FHX depression
  • Hx of lang disorder, ADHD
  • (-) life events
  • Family conflict
98
Q

Poor prognostic factors for mood dx:

A
  • long duration or severe episodes
  • psychotic features
  • EtOH/ substance use
  • anxiety dx
  • > 1 previous episode
  • poor premorbid functioning
99
Q

Indication for hospitalization if mood dx:

A
  • threat to self/ others
  • severe symptom without support
  • failed output management
  • significant co-morbidities needing intervention

2019 RC Specialties (31 decks)

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