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Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

mneumonic for mania

A

DIG FAST Distractability, Irritable mood/insomnia, Gradiosity, Flight of ideas, Agitation/incr in goal-directed activity, Speedy thoughts/speech, Thoughtlessness (seek pleasure w/out thought of consequences)

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2
Q

Suicide risk mnemonic

A

SAD PERSON Sex-male Age > 60 Depression Previous attempt Ethanol/drug abuse Rational thinking loss Suicide in family Organized plan/access No support Sickness

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3
Q

Depression mneumonic

A

Sleep Interest Guilt Energy Concentration Appetite Psychomotor slowing Suicidal idation

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4
Q

Tx of serotonin syndrome

A

removal of offending agents consider cyproheptadine

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5
Q

Sx of tyramine Rxn? Tx?

A

HTN, heacache, neck stiffness, sweating, n/v, visual problems. Can -> stroke Tx w/ phentolamine

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6
Q

Tx of acute dystonia

A

benztropine (cogentin) or diphenhydramine (benadryl)

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7
Q

timeline for Dx of schizo disorders

A

6 mons - schizophrenia

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8
Q

neurological pathways affected in schizophrenia

A

prefrontal cortical - low dopamine -> neg Sx mesolimbic - high dopamine -> pos Sx tuberoinfundibular - antipsychotics -> hyperprolactinemia -> gynecomastia, galactorrhea, menstrual changes nigrostriatal - antipsychotics -> EPS

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9
Q

List the typical antipsychotics. MOA?

A

chlorpromazine, thioridazine, trifluoperazine, haloperidol MOA-D2 antagonists

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10
Q

List the atypical antipsychotics. MOA?

A

risperidone, clozapine, olanzapine, quetiapine, aripiprazole, ziprosidone MOA-D2 and 5HT-2 antagonists

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11
Q

Concern with use of clozapine

A

high risk of agranulocytosis. Used if multiple other med trials have failed

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12
Q

AE of typical antipsychotics

A

EPS NMS anticholinergic Sx prolonged QT tardive dyskinesia thioridazine - irreversible retinal pigmentation chlorpromazine - corena/lens deposits

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13
Q

Examples of EPS

A

Dystonia, parkinsonism, akathisia(restlessness)

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14
Q

Tx of EPS

A

benztropine, diphenydramine, benzos, b-blockers(for akathisia)

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15
Q

atypical antipsychotics that are more “weight neutral”

A

aripiprazole and ziprasidone

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16
Q

AE of atypical antipsychotics

A

metabolic syndrome olanzapine/clozapine - weight gain ziprasidone - prolonged QT can cause same AE as typicals, but less likely to do so

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17
Q

drugs known to exacerbate psychotic Sx

A

b-blockers and digoxin

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18
Q

Dx of pt who meets criteria for major depressive disorder, manic, or mixed + delusions/hallucinations for 2 weeks in the absence of mood disorder Sx

A

schizoaffective disorder

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19
Q

Dx of delusional disorder

A

non bizarre, fixed delusions for at least 1 month functioning in life not significantly impaired doesnt meet criteria for schizophrenia

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20
Q

Tx of delusional disorder

A

trial of antipsychotics should be tried tho often unsuccessful. hard to treat

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21
Q

describe koro

A

Pt believes penis is shrinking and will -> death. Seen in Asia

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22
Q

describe amok

A

sudden unprovoked outbursts of violence which pt doesnt recollect. Often commits suicide afterwards. Seen in malaysia & SE asia

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23
Q

describe brain fag

A

HA, fatigue, visual changes in male students. seen in africa

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24
Q

difference between manic and hypomanic episode

A

manic - lasts at least 7 days, causes severe impairment in social/occupational functioning, requires hospitalization hypomanic - at least 4 days, no s/o impairment, does not require hospitalization

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25
Q

high potency typical antipsychotics

A

Trifluoperazine, Fluphenazine, Haloperiod (Try to Fly High)

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26
Q

low potency typical antipsychotics

A

Chlorpromazine, thioridazine

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27
Q

AE of SSRIs

A

sexual dysfunction, GI distress, HA, rebound anxiety, serotonin syndrome

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28
Q

AE of TCAs

A

sedation, anticholinergic, alpha-blocking (orthostatic hypotension), weight gain

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29
Q

TCA toxicity Sx

A

Convulsions, Coma, Cardiotoxicity (arrythymias, prolonged QT). also: respiratory depression, hyperpyrexia, anticholinergic Sx.

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30
Q

AE of SNRIs (venlafaxine, duloxetine)

A

incr BP is most common

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31
Q

AE of MAO-I’s

A

orthostatic hypotension is most common. hypertensive crisis with tyramine ingestion (wine/cheese). Serotonin syndrome w/ SSRIs. usually reserved for atypical depression

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32
Q

AE of electroconvulsive therapy

A

retro/anterograde amnesia, HA, nausea, muscle soreness

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33
Q

list the MAO-I’s

A

Tranylcypromine, phenelzine, isocarboxazid, selegiline(MAO-B selective)

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34
Q

features of atypical depression

A

hypersomnia, hyperphagia, reactive mood, leaden paralysis, hypersensitivity to interpersonal rejection

35
Q

normal grief

A

<2 months. can have illusions, crying spells, problems sleeping, and trouble concentration, but not gross disorganization or suicidality

36
Q

psych disorder with highest genetic link

A

bipolar I

37
Q

AE of lithium

A

Movement(tremor Nephrogenic DI hypOthyroid Pregnancy problems-ebstein cardiac defect others: weight gain, GI, fatigue, arrhythmias, seizures, alopecia, metallic taste

38
Q

anticonvulsants used in bipolar

A

carbemazepine and valproic acid. especially useful in rapid cycling (>4 mood episodes per year)

39
Q

Tx of mania in pregnancy

A

ECT

40
Q

panic attack criteria

A

four of: Palpiations Abd distress Numbness, nausea Intense fear of death Choking, chills, chest pain Sweating, shaking, SOB

41
Q

Tx of panic disorder

A

in acute setting, benzos SSRIs are best long term Tx

42
Q

PTSD vs acute stress disorder

A

PTSD is >1 month, and Sx could’ve occurred any time in past. In ASD event occurred <1 month

43
Q

Dx of generalized anxiety disorder

A

> 6 months of excessive anxiety/worry + 3/6 of: restlessness, fatigue, decr concentration, irritability, muscle tension, sleep disturbance

44
Q

mnemonic for personality disorder

A

pattern manifested in 2 or more of CAPRI: Cognition Affect Personal Relations Impulse control

45
Q

cluster A personality disorders

A

schizoid(prefer isolation), schizotypal, paranoid a/w psychotic disorders

46
Q

cluster B personality disorders

A

antisocial, borderline, histrionic, narcissistic a/w mood disorders

47
Q

cluster C personality disorders

A

avoidant, dependent, obsessive compulsive a/w anxiety disorders

48
Q

antisocial personality disorder vs conduct disorder

A

conduct is <18 y/o

49
Q

Tx of antisocial personality disorder

A

psychotherapy generally ineffective. dialectical behavior therapy and behavioral therapy best choice. pharm for anxiety/depression used w/ caution due to high addiction rates in this population

50
Q

defense mechanism seen in borderline PD

A

splitting

51
Q

defense mechanism seen in histrionic PD

A

regression (revert to childlike behaviors)

52
Q

What is acamprosate(campral) used for?

A

Post detox alcohol relapse prevention. Can be used in liver disease.

53
Q

Contraindications of Antabuse

A

Severe cardiac disease, preg, psychosis. Must monitor LFTs

54
Q

Rotatory nystagmus is ? Intoxication

A

Pcp

55
Q

opioid that -> mydriasis

A

meperidine (demerol dilates)

56
Q

symptomatic Tx of opioid withdrawal? Tx for severe withdrawal?

A

clonidine for autonomic instability, nsaids for pain, dicyclomine for abd cramps severe - detox w/ buprenorphine or methadone

57
Q

Tx of pregnant opioid dependent woman

A

methadone

58
Q

MOA of caffeine

A

adenosine antagonist, causing incr cAMP and a stimulant effect via dopaminergic system

59
Q

core features of lewy body dementia

A

waxing and waning cognition, visual hallucinations, parkinsonism, sensitivity to neuroleptics. REM sleep behavior disorder is also common

60
Q

Dx of mental retardation

A

IQ<18

61
Q

age for ADHD

A

onset before age 7

62
Q

aspergers vs autism

A

in aspergers, children have normal language acquisition and cognitive development

63
Q

congenital abnormalities a/w lithium

A

1st trimester - ebstein anomaly (atrialized R ventricle) 2nd/3rd - goiter, transient neonatal neuromuscular dysfunction

64
Q

contraindication for lithium use

A

renal dysfunction

65
Q

AE of methylphenidate

A

decr appetite -> wt loss, nervousness, insomnia, tachycardia, abd pain, nausea

66
Q

Tx of social phobia

A

assertiveness training (subtype of CBT) and SSRI

67
Q

Tx of akathisia 2/2 antipsychotics

A

b blockers

68
Q

Tx of anorexia nervosa

A

behavioral therapy, family therapy (maudsley approach) low dose atypical antipsychotics benzos prior to meals lower anxiety SSRIs not effective (lack of tryptophan in diet - precursor to serotonin)

69
Q

Tx of bulemia

A

SSRIs - fluoxetine CBT, group/family terapy, Avoid buprorion - lowers seizure threshold

70
Q

contraindications to buproprion

A

epilepsy, or things that may precipitate seizures - alcohol/benzo abuse, eating disorders

71
Q

describe kleptomania. a/w?

A

compulsion to steal items not needed for personal use. more common in females. a/w bulemia

72
Q

If giving lamotrigine, what drug should you know if they are on?

A

Valproic acid increases conc -> incr incidence of Steven Johnson seen with lamotrigine. If on VPA, titration schedule is slower

73
Q

time cutoff for Dx of primary insomnia

A

at least 1 month

74
Q

time cutoff for Dx of narcolepsy

A

irresistible attacks of refreshing sleep that occur daily for at least 3 months.

75
Q

DOC for narcolepsy with cataplexy? Other Tx of narcolepsy?

A

cataplexy - sodium oxybate other options: amphetamines, non-amphetamine stimulants (methylphenidate, modafinil, sodium oxybate), TCAs, SSRIs, SNRIs

76
Q

Kleine-Levin Syndrome

A

rare disorder characterized by recurrent hypersomnia w/ episodes of daytime sleepiness with hyperphagia, hypersexuality, aggression

77
Q

Tx of nightmares in PTSD

A

imagery rehearsal therapy

78
Q

Medications a/w REM sleep behavior disorder

A

SSRIs, TCAs, MAOIs

79
Q

indications for ECT

A

refractory depression, depression in pregnancy, refractory mania, NMS, catatonic schizophrenia

80
Q

Dx of enuresis (Bed wetting)

A

must be >5 w/ occurrence twice per week for >3 months. Tx with ADH (desmopresin). 2nd line is imipramine

81
Q

Tx of tourette’s

A

typical antipsychotics (haloperidol or pimozide)

82
Q

sleep meds assoc w/ sleep walking, sleep driving, and other dissociative events

A

zolpidem, zaleplon

83
Q

anesthetic agent used prior to ECT

A

methohxital

Medicine (6 decks)

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