Psychiatry Flashcards
Cluster A personality disorders include :
Paranoid
Schizoid
Schizotypal
Cluster B personality disorders include:
Histronic
Borderline
Narcissistic
Antisocial
Cluster C personality disorders include:
Avoidant
Obsessive-compulsive
Dependent
What substances can produce psychosis
Cocaine, heroin, marijuana, LSD, K2
What if the patient is only psychotic when he is sad?
Major depression with psychotic features
Excessive anxiety and worry about most things, most days for more than 6 months accompanied by restlessness and concentration difficulties. Diagnosis
Generalized anxiety disorder
Excessive anxiety and worry about most things, most days for more than 6 months accompanied by restlessness and concentration difficulties. Treatment?
Psychotherapy
SSRIs
Venlafaxine and buspirone
GAD + severe and explosive anxiety. Treatment?
Lorazepam
4 Autonomic hyperactivity symptoms seen in panic attack
Shortness of breath Trembling Dissociative symptoms Paresthesias Diaphoresis Palpitations Chills Nausea Dizziness Fear of dying Chest pain
Three attacks in 3 week period and worry about more. Diagnosis?
Panic disorder
Can induce panic attack by ____, ______, ______, ____, and _____
Hyperventilation Carbon dioxide Yohimbine Sodium lactate Epinephrine
Acute treatment for panic attack
Benzodiazepines: Alprazolam, lorazepam, clonazepam and diazepam
Maintenance treatment for the prevention of the next panic attack…..
SSRI
Duration to keep on medication in panic disorder
6-12months
Treatment for performance anxiety and when should it be administered
Betablocker- atenolol or propranolol
30-60 mins before performance
Intrusive thoughts that increases anxiety+ time consuming ritual that reduces anxiety. Diagnosis
Obsessive-Compulsive disorder.
Intrusive thoughts that increases anxiety+ time consuming ritual that reduces anxiety. Managements
SSRI
Supportive therapy
Exposure
Motivational interviewing
Persistent difficulties with parting with one’s possessions regardless of their value. Diagnosis?
Hoarding disorder
Persistent difficulties with parting with one’s possessions regardless of their value. Treatment?
SSRI
Believes body part is abnormal, misshapen or defective when it is normal in appearance. Diagnosis?
Body dysmorphic disorder
After traumatic exposure, symptoms last for >2days - <1 month. Diagnosis?
Acute stress disorder
After traumatic exposure, symptoms last for > 1 month
Post traumatic stress disorder
What hormones are increased in ASD/PTSD?
Norepinephrine and Epinephrine
What hormones are decreased in ASD/PTSD?
Cortisol
First line treatment of ASD/PTSD
Paroxetine and sertraline
__________ is used to reduce the incidence of nightmares
Prazosin
Identifiable stressor and symptoms must occur within 3 months of onset lasting < 6 months after end of stressor
Adjustment disorder
Person attributes his or her own wishes, desires, thoughts or emotions to someone else. Defense mechanism?
Projection
Not allowing reality to penetrate. Asserting that so e clear features of external reality just isn’t true. Defense mechanism?
Denial
People and things in the world are perceived as all bad or all good. Defense mechanism?
Seen in what personality disorder
Splitting
Borderline
Temporary or transient block in thinking or an inability to remember. Defense mechanism?
Blocking
Returning to an earlier stage of development. Defense mechanism?
Regression
Psychic derivatives are converted into bodily symptoms. Feelings are manifest as physical symptoms rather than psychological distress. Defense mechanism?
Somatization
A resident dresses and acts like the attending physician. Defense mechanism?
Introjection/ identification
An attending physician scolds a resident who later expresses his anger by yelling at a medical student. Defense mechanism?
Displacement
An idea or feeling is eliminated from consciousness. You forget, and then forget that you forgot. Defense mechanism?
Repression
Reality is accepted, but without the expected human emotional response to that reality. Facts without feelings. Defense mechanism?
Isolation of affect
Affect us stripped away and replaced by an excessive use of intellectual processes. Cognition replaces affect. Defense mechanism?
Intellectualization
Temper tantrum is thrown by an abandoned child to cover the depression he really feels.
Massive emotional or behavioral outburst to cover up underlying feeling or idea.
Defense mechanism?
Acting out
Rational explanation are used to justify attitudes, beliefs, or behaviors that are unacceptable. Defense mechanism?
Rationalization
An unacceptable impulse is transformed into its opposite. Defense mechanism?
Reaction formation
Acting out the reverse of unacceptable behavior. Repairs or fixed the impulse. Defense mechanism?
Undoing
Non-performance or poor performance after setting up the expectation of performance. Defense mechanism?
Passive-aggressive
Separates self from one’s experience.
The facts of the events are accepted, but the self is protected from the full impact of the experience.
Defense mechanism?
Dissociation
Permits the overt expression of feelings and thoughts without personal discomfort.
Laughter covers the pain and anxiety.
Defense mechanism?
Humor
Impulse- gratification is achieved by channeling the unacceptable or unattainable impulse into a socially acceptable direction.
Defense mechanism?
Sublimation
Conscious decision to postpone attention to an impulse or conflict.
Forget, but remember that you forgot.
Defense mechanism?
Suppression
The patient unconsciously transfers thoughts and feelings about a parent or significant other person onto his physician.
Diagnosis?
Transference
The physician unconsciously transfers thoughts and feelings about a parent or significant other person onto his patient.
Counter transference
Problems in social interaction, poor eye contact, stereotyped or repetitive movements seen in a child less than 3 years. Diagnosis?
Autism spectrum disorder
Autism spectrum disorders is linked to chromosome ___ and _____
Chromosome 15&11
Risk factors of autism spectrum disorder
Prenatal or perinatal injury eg, rubella in first trimester
Mother has allergies, asthma or psoriasis during pregnancy
Treatment of Autism
Applied behavioral analysis
Behavioral techniques
Risperidone and aripiprazole
Inattention, short attention span or hyperactivity for more than 6 months in a child less than 7 years
Attention deficit hyperactivity disorder
First line treatment of ADHD
Methylphenidate and dextroamphetamine
Second line treatment of ADHD and class of medication?
Atomoxetine ( norepinephrine reuptake inhibitor)
What can be used to enhance cognition and attention in the prefrontal cortex and reduce distractibility?
Clonidine and guanfacine
Psychotic symptoms > 1 day and < 30 days.
Diagnosis?
Brief psychotic disorder
Psychotic symptoms > 1 month to < 6 months.
Diagnosis?
Schizophreniform
Psychotic symptoms >6 months.
Diagnosis?
Schizophrenia
Diagnostic criteria symptoms for schizophrenia and the like
Delusions Hallucinations Disorganized speech Abnormal psychomotor activity Negative symptoms
Negativism, echopraxia, automatic obedience. Rigidity of posture.
Diagnosis?
Catatonia
Predictors for Good prognosis of schizophrenia
- paranoid symptoms
- quick onset
- late onset (female)
- positive symptoms
- no family history of schizophrenia
- family history of mood disorder
- absence of structural brain abnormalities
Brain structural and anatomic abnormalities seen in schizophrenia
- Large ventricular size and ventricular brain ratio
- cortical atrophy
- smaller frontal lobes
- atrophy of temporal lobe
Which antipsychotic is safer for use in pregnant patients and for bipolar depression?
Lurasidone
Most effective antipsychotic?
Clozapine
High risk of agranulocytosis; monitor CBC on regular basis?
Clozapine
Increased risk of prolongation of QT interval; avoid in conduction defects?
Ziprasidone
Antipsychotic that is more sedating, orthostasis, cataract surgery? Less EPS
Quetiepine
Hours to days after antipsychotic:
- muscle spasms
- torticollis
- laryngeal spasm
- oculogyric crisis
Diagnosis?
Acute dystonic reaction
Hours to days after antipsychotic:
- muscle spasms
- torticollis
- laryngeal spasm
- oculogyric crisis
Treatment?
Benztropine
Trihexyphenidyl
Diphenhydramine
Generalized restlessness
Pacing
Rocking
Inability to relax after a few weeks after antipsychotic use
Diagnosis?
Akathisia
Generalized restlessness
Pacing
Rocking
Inability to relax after a few weeks after antipsychotic use
Treatment?
Reduce dose
Beta blockers
Switch to atypical
Abnormal involuntary movements of head, limb, trunk, perioral, most common
Diagnosis?
Tardive dyskinesia
Abnormal involuntary movements of head, limb, trunk, perioral, most common
Treatment?
Valbenazine, deutetrabenazine
Clozapine has least risk
Muscular rigidity, fever, autonomic changes, agitation on antipsychotics?
Diagnosis ?
Neuroleptic malignant syndrome
Muscular rigidity, fever, autonomic changes, agitation on antipsychotics?
Treatment?
Dantrolene or bromocriptine
Mood disorder present with at least a 2 wk course of symptoms include a change from the previous level of functioning.
Major depressive disorder
SIGECAPS symptoms ?
Sleep Interest Guilt Energy Concentration Appetite Psychomotor retardation/agitation Suicidal ideation
What is the single most effective treatment for depression?
Electroconvulsive therapy
Depressed mood on most days for greater than 2 years. Functional but at a suboptimal level.
Diagnosis and treatment?
Persistent depressive disorder
SSRI/SNRI
Depression with seasonal pattern.
Diagnosis?
Treatment?
Seasonal affective disorder
Bright light therapy
After death of loved one + SIGECAP symptoms
Treatment?
SSRI / SNRI
History of Symptoms of major depression + symptoms of mania / symptoms of hypomania
Bipolar disorder
DIGFAST of manic symptoms
Distractibility Insomnia / impulsive behavior Grandiosity Flight of ideas/thoughts Agitation Speech (pressured) Thoughtlessness ( risk taking behavior)
What is the treatment for an acute manic episode seen in the emergency room?
Lithium
Valproic acid
Olanzapine
First line maintenance therapy for bipolar disorder?
Lithium
What should be monitored with the use of lithium?
Kidney function
Thyroid function
Therapy for bipolar depression
Lamotrigine, Lurasidone
Presence of hypomania and mild depression for more than 2 years.
Diagnosis?
Cyclothymia
Compulsive, rapid ingestion of food followed by compensatory behavior such as self-induced vomiting, use of laxatives or exercise.
Diagnosis?
Bulimia nervosa
Compulsive, rapid ingestion of food followed by compensatory behavior such as self-induced vomiting, use of laxatives or exercise.
Treatment?
SSRIs
Insight
Group therapy
Hypotension, bradycardia, lanugo hair, underweight and edema seen in a teenage girl with fear of being fat.
Diagnosis?
Anorexia nervosa
Hypotension, bradycardia, lanugo hair, underweight and edema seen in a teenage girl with fear of being fat.
Most common cause of death?
Arrhythmia
______ are the most likely method by which either men or women commit suicide
Firearms
What is the most commonly abused substance in the US?
Alcohol
Seizures in alcohol withdrawal is generally seen when
24-48 hours
Altered mental status, hallucinations (tactile at times), autonomic instability 48-72 after last drink.
Diagnosis?
Delirium tremens
Most successful alcohol treatment?
Alcoholic Anonymous
Pinpoint pupils, sedation, constipation, bradycardia, respiratory depression.
Substance intoxication?
Opioids
Pinpoint pupils, sedation, constipation, bradycardia, respiratory depression.
Intoxication treatment?
Naloxone
Medications for opiate use disorder?
Methadone- mu agonist
Naltrexone- opiate antagonist
Buprenorphine- partial mu agonist
Pupillary dilation, restlessness, anxiety, confusion with risk of arrhythmia, seizures, coma
Substance intoxication
Stimulants
Treatment of withdrawal from tobacco
Bupropion
Varenicline
Replacement- gum, patch
Psychosis, illusions, hyperacusis, sensitivity of touch, taste/smell altered
Substance intoxication?
MDMA ( XTC or Ecstacy)
Insomnia, irritability, anxiety, poor appetite, depression, physical discomfort.
Substance withdrawal?
Cannabis
Severe agitation, dissociative symptoms, paranoid delusions, hallucinations, violent with decreased awareness of pain; ataxia, dysarthria, vertical and horizontal nystagmus.
Substance Intoxication ?
Phencyclidine - Angel dust
Severe agitation, dissociative symptoms, paranoid delusions, hallucinations, violent with decreased awareness of pain; ataxia, dysarthria, vertical and horizontal nystagmus.
Treatment?
Antipsychotics for agitation or benzodiazepines
Low stimulation environment
A patient with bipolar disorder presents to the ER with slurred speech, tremors and ataxia.
Lithium toxicity
Therapeutic level of lithium?
0.5-1.5
Treatment or TCA intoxication
Stop TCA
Sodium bicarbonate, activated charcoal
