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PANCE prep JQ > Psychiatry/behavioral > Flashcards

Psychiatry/behavioral Flashcards

1
Q

Delusional disorder

A

1 or more delusions lasting more than a month without other psychotic symptoms

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2
Q

Brief psychotic disorder

A

1 or more psychotic symptoms with onset and remission <1month

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3
Q

Schizophreniform disorder

A

Meets criteria for schizophrenia but duration <6month

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4
Q

Schizoaffective disorder

A

Schizophrenia with a mood disturbance

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5
Q

Schizophrenia

A

2 or more of the following:
Positive sx-hallucinations, delusions, disorganized speech/thinking, abnormal behavior
Negative sx-flat affect, social withdrawal, avolition

For 6 months or more with at least 1 month acute symptoms

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6
Q

Who gets schizophrenia?

A

MC in males with family hx, presents in early 20s

Presents in late 20s in women

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7
Q

1st line treatment for schizophrenia

A

2nd gen antipsychotics: risperidone, olanzapine, quetiapine

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8
Q

Typical 1st gen antipsychotics

A

BUTYROPHENONES: haloperidol and droperidol

PHENOTHIAZINES: fluphenazine, perphenazine, chlorpromazine, thioridazine

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9
Q

Side effects of antipsychotics

A

Extrapyramidal sx, neuroleptic malignant syndrome, QT prolongation, arrhythmias, sedation, anticholinergic sx, dermatitis, increased prolactin, weight gain

EPS and increased prolactin worse in 1st gen/typical antipsychotics

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10
Q

Chlorpromazine and thioridazine have less __________ symptoms but more ___________ symptoms

A

Extrapyramidal

Anticholinergic

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11
Q

Describe extrapyramidal symptoms

A
  1. dystonic reaction (intermittent spasms with sustained involuntary muscle contraction) occurs hours to days after initiating antipsychotics
  2. Tardive dyskinesia (akathisia) seen with long term use of antipsychotics
  3. Parkinsonism (rigidity, tremor, Bradykinesia)
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12
Q

Akathisia

A

Restlessness

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13
Q

Tx for dystonic reaction

A

IV diphenhydramine

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14
Q

Describe neuroleptic malignant syndrome (NMS)

A

D2 inhibition leads to mental status change, muscle rigidity, tremor, autonomic instability-tachycardia, tachypnea, hyperthermia

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15
Q

Tx for NMS

A

Stop offending agent

lower temp with cooling blankets

dopamine agonist: bromocriptine, amantadine, levodopa/carbidopa, dantrolene

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16
Q

When does NMS usually occur?

A

In young adults within 90d of antipsychotic initiation/dose increase

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17
Q

C/I-cautions for Haldol

A

Parkinson’s disease, anticoagulant use, severe cardiac disease

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18
Q

Describe anticholinergic symptoms

A

Dry mouth, blurred vision(dilated pupils), urinary retention, constipation, dry skin, flushing, tachycardia, fever, htn, and delirium

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19
Q

Atypical 2nd generation antipsychotics

A

Quetapine (Seroquel)
Olanzapine (zyprexa)
Clozapine
Loxapine

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20
Q

Unique side effects of clozapine

A

Agranulocytosis (CBC monitored weekly)

Myocarditis, QT prolongation

Seizures

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21
Q

Unique side effects of olanzapine

A

Weight gain and diabetes mellitus

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22
Q

Benzioxazoles

A

Risperidone (Risperdal)

Ziprasidond (Geodon)

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23
Q

Indications for benzisoxazoles

A

Schizophrenia, bipolar, psychosis

*Risperdal also used in Tourette’s

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24
Q

Indication for Abilify

A

Psychotic disorders

*sometimes called a 3rd generation antipsychotic

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25
Indication for lithium
Bipolar disorder -acute mania
26
SE of lithium
``` Hypothyroidism Diabetes insipidus Hyperparathyroidism Seizures HA Tremor Sedation Arrhythmia N&V Diarrhea Weight gain ``` *narrow therapeutic index. Monitor q 4-8wk
27
Anticonvulsants used to suppress impulsive or aggressive behavior
Valproate and carbamazepine
28
How long must you have depressed mood/anhedonia/loss of interest in activities to be dx with MDD?
2wks *symptoms must cause distress or impairment and mania or hyponania must be absent
29
Key symptom in atypical depression
Mood reactivity
30
Tx of atypical depression
MAO inhibitors
31
How prevalent is suicide in depression?
15% of pts commit suicide Especially men 25-30 and women 40-50 Higher rates in pts with detailed plan, White males >45, and concurrent substance abuse
32
PHQ 2
1. Little interest/enjoyment of things | 2. Feeling down, depressed, or hopeless
33
PHQ 9
1. Little interest 2. Feeling down/hopeless 3. Difficulty sleeping/hypersomnia 4. Fatigue/low energy 5. Appetite or weight changes 6. Self disappointment 7. Trouble concentrating 8. Psychomotor changes (slow movement or speech, irritability, restlessness) 9. Passive or active suicidal thoughts
34
Tx of MDD
1st line: SSRI or SNRI 2nd line: Bupropion or mirtazapine 3rd line: TCAs or MAO inhibitors Continue for a minimum 3-6wk to determine efficacy
35
Selective serotonin reuptake inhibitors(SSRIs)
``` Citalopram (Celexa) Ecitalopram (Lexapro) Paroxetine (Paxil) Fluoxetine (Prozac) Sertraline (Zoloft) Fluvoxamine (Zyvox) ``` *1st line for depression and anxiety
36
SE of SSRIs
GI upset, sexual dysfunction, HA, changes in energy, anxiety, insomnia, weight changes, SIADH
37
Avoid using citalopram in pts with ___________.
Long QT syndrome
38
SSRI + MAO inhibitor =
Serotonin syndrome
39
SNRI + St. John’s Wart=
Serotonin syndrome
40
MAOI + TCA=
Delirium and hypertension
41
Sx of serotonin syndrome
``` Acute AMS seizures Restlessness Diaphoresis Tremor Hyperthermia N&V Abd pain Mydriasis Tachycardia ```
42
Serotonin Norepinephrine Reuptake inhibitors (SNRIs)
Venlafaxine (Effexor) Desvenlafaxine (Pristiq) Duloxetine (cymbalta)
43
SNRIs are particularly good first line agents for MDD in patients with ______________ or ______________
Significant fatigue Pain syndromes
44
SE of SNRIs
Same as SSRIs plus htn and dizziness
45
Mirtazapine (Remeron)
Antidepressant with less sexual dysfunction
46
SE of Mirtazapine
``` Sedation Dry mouth Constipation Weight gain Agranulocytosis ```
47
Bupropion indication
Wellbutrin for depression *less GI distress and sexual dysfunction than SSRIs Zyban for smoking cessation
48
SE of bupropion
``` Seizures Agitation Anxiety Restlessness Weight loss HTN HA ```
49
Bupropion C/I
Seizure disorders Eating disorders MAOI use ETOH/drug detox
50
Tricyclics antidepressants (TCAs)
``` Amitriptyline Clomipramine Desipramine Doxepin Imipramine Nortriptyline ```
51
SE of TCAs
Anticholinergic, sedation, weight gain, prolonged QT
52
TCA overdose
Wide complex tachycardia Neurological symptoms ARDS SIADH
53
MAO inhibitors
Non selective: phenelzine, tranylcypromine, isocarboxazid Selective: selegiline
54
SE of MAOI
``` Insomnia Anxiety Orthostatic hypotension Weight gain Sexual dysfunction Hypertensive crisis ```
55
Pts on MAOIs must avoid these foods or it may lead to hypertensive crisis
Tyramine-containing foods
56
Bipolar I disorder
1 or more manic or mixed episode which often cycles with occasional depressive episodes
57
Strongest risk factor for bipolar I
Family history/1st degree relative *the earlier the onset the poorer the prognosis and more likely to develops psychotic features
58
Mania
Abnormal & persistently elevated, expansive or irritable mood for at least 1wk with impaired function
59
Pharmaceutical treatment of bipolar I
1st line Mood stabilizers: LITHIUM, vampiric acid, carbamazepine 2nd line antipsychotics Benzodiazepines can be added if psychosis or agitation develops *antidepressants may precipitate mania
60
Bipolar II disorder
1 or more hypomanic disorder and 1 or more major depressive episode Without mania or mixed episodes
61
Hypomania
Sx are similar to mania but no marked impairment in function
62
Persistent depressive disorder (dysthymia)
Chronic depressed mood in adults >2yr. Usually milder than MDD and pt is able to function *may progress to MDD or bipolar in time. Tx same as MDD
63
Cyclothymic disorder
Similar to bipolar II but less severe, at least 2yr duration
64
Tx for acute panic attack
Benzodiazepines: lorazepam and alprazolam are 1st line
65
Panic disorder
Recurrent unexpected panic attacks with worry/concerns about future attacks
66
Symptoms of panic attack
``` Dizziness Trembling Choking feeling Paresthesias Sweating SOB chest pain Chills/hot flashes Fear of loading control or dying Palpitations/tachycardia Nausea or abd distress Depersonalization/derealization ```
67
Agoraphobia
Anxiety about being in places or situations from which you cannot escape
68
Management of panic disorder
Long term:SSRIs or SNRIs CBT Acute attack: benzo
69
Generalized anxiety disorder
Excessive anxiety about various aspects of life for >6m
70
Management of GAD
1st line: SSRI or SNRI 2nd: buspirone (Buspar) -May take several weeks for improvement. Does not cause sedation 3rd: Ben is, BB, TCAs * psychotherapy
71
Social anxiety disorder
Persistent fear of social or performance situations that can cause panic attacks (>6m)
72
Tx of SAD
Antidepressants (SSRIs or SNRI) BB (propranolol or atenolol) for performance anxiety Benzos if treatment very infrequent Psychotherapy
73
Tx of specific phobias
Exposure/desensitization therapy *benzos or BB can be used short term in some pts
74
PTSD
Exposure to an inciting event and 1 or more of the following: 1. Re-experiencing for >1m 2. Avoidance of associated stimuli 3. Negative alternations in cognition or mood 4. Arousal/reactivity
75
Tx of PTSD
SSRIs are 1st line 2nd line: TCAs it MAOIs Trazodone may be helpful in insomnia CBT
76
Acute stress disorder
Similar to PSTD but <1m
77
Adjustment disorder
Disproportionate emotional or behavioral response to an identified stressor causing significant impairment in functioning Begins w/i 3mo stressor and resolves w/i 6mo of stressor
78
Tx of adjustment disorder
Psychotherapy
79
Rule these 2 things out before dx a dissociative disorder
Seizures and brain tumors
80
Tx of dissociative disorders
Psychotherapy
81
Dissociative identity disorder
Presence of 2 or more distinct identities or states of personalities Pts often have gaps in recall *maybe associated with hx of sexual abuse, PTSD, or substance use
82
Depersonalization/derealization disorder
Persistent feelings of detachment or estrangement that cause distress
83
Dissociated amnesia
Inability to recall personal/autobiographical information that causes impairment in functioning *often secondary to sexual abuse, stress or trauma
84
Dissociative fugue
Abrupt change in geographical location with loss of identity or inability to recall past
85
Obsessive-compulsive disorders
OCD, body dysmorphic disorder, hoarding, tichotillomania( hair-pulling), and excoriation disorder
86
OCD
Anxiety disorder characterized by obsessions (recurrent or persistent thoughts/images) and compulsions (repetitive behaviors the person feels driven to perform)
87
4 major OCD patterns
1. Contamination 2. Pathological doubt 3. Symmetry/precision 4. Intrusive obsessive thoughts without compulsions
88
Tx of OCD
Antidepressants (SSRI, TCA, or SNRI) CBT
89
Body dysmorphic disorder
Preoccupation that 1 or more body parts is deformed or over exaggeration of a minor flaw Causes shame and functional impairment May commit repetitive acts in response *may also have anxiety or depression
90
Tx of body dysmorphic disorder
Antidepressants(SSRI or TCA) Psychotherapy
91
Somatic symptom disorder
Physical symptom without physical cause. Excessive thoughts, feelings, or behaviors related to somatic sxs are distressing and can result in significant disruption. *aka hypochondiasis and somatization disorder
92
Management of somatic symptom disorder
Regular visits to healthcare provider
93
Illness anxiety disorder
Preoccupation with fear or belief one has or will contract serious illness. Somatic sxs usually not present *aka hypochondriac
94
Management of illness anxiety disorder
Regular healthcare visits
95
Functional neurological symptom disorder
Neurological dysfunction (motor or sensory) that can’t clinically be explained Tends to be episodic and rescuers during times of stress *aka conversion disorder
96
Tx of functional neurological symptom disorder
Physchotherapy
97
Pts with functional neurological symptom disorder often have...
Depression, anxiety, schizophrenia, or a personality disorder
98
Factitious disorder
Intentional falsification or exaggeration of signs and symptoms with motivation to assume the sick role and get sympathy Can be self imposed or imposed on another *considered a form of premeditated abuse if imposed on another
99
Things that would make you concerned that pt has factitious disorder or is malingering
- willingness or eagerness to undergo surgery or painful tests repeatedly - extensive knowledge about medical terminology
100
Tx of factitious disorder
None
101
Münchausen syndrome
Severe factitious disorder characterized by predominance of physical symptoms, use of aliases and habitual lying
102
Unlike factitious disorder which is done to assume sick role and for sympathy, malingering is done with the motivation of....
Secondary gain, wether it be financial, food, shelter, avoidance of responsibility, or drug attainment *not a mental illness
103
Perpetrator of child sexual abuse is often...
Male and known to pt
104
Perpetrator of physical child abuse is often...
Primary female caregiver
105
Signs of physical child abuse (7)
``` Cigarette burns Burns in a stocking glove distribution Lacerations Healed fxs on X-ray Subdues hematoma Multiple bruises Retinal hemorrhages ```
106
Signs of shaken baby syndrome
Retinal hemorrhages and hyphema
107
Signs of child neglect (4)
Malnutrition Withdrawal Poor hygiene Failure to thrive
108
Obesity
BMI>30 or >20% over ideal weight *50%associated with binge eating
109
Tx of obesity
1. lifestyle modification (diet and exercise) and group therapy 2. Antidepressant if underlying depression 3. anti-obesity meds 4. bariatric surgery
110
Anti obesity meds and MOA
Orlistat decreases GI fat digestion Lorcaserin is a serotonin agonist
111
Anorexia nervosa
Refusal to maintain minimal normal body weight due to morbid fear of fatness *restrictive and purging types
112
Anorexia is common in this population
Girls age 15-24 who are athletes or dancers
113
Signs of anorexia nervosa
``` BMI<17.5 or <85% expected body weight Hypotension Bradycardia Lanugo Dry skin Amenorrhea Arrhythmias Osteoporosis ```
114
Labs in pts with anorexia nervosa may show this
``` Leukocytosis Leukopenia Anemia Hypokalemia Increased BUN from dehydration Hypothyroidism ```
115
Management of anorexia nervosa
Hospitalize if <75% expected body weight CBT with supervised meals and weight monitoring SSRI if depressed and maybe atypical antipsychotics to cause weight gain
116
The major difference between anorexia nervosa and bulimia nervosa is
pts with bulimia often have a normal body weight or are overweight
117
Signs of self induced vomiting
Teeth putting or enamel erosion Russell’s sign (calluses on dorsum of hand from inducing vomiting) Parotid hypertrophy
118
This medication has been shown to reduce the binge-purge cycle
Fluoxetine
119
Cluster A personality disorders
Characterized by social detachment with weird, odd eccentric behavior Includes: schizoid, schizotypal, and paranoid
120
Cluster B personality disorders
Dramatic, wild, erratic, impulsive, and emotional Includes: antisocial, borderline, histrionic, narcissistic
121
Cluster C personality disorders
Anxious worried and fearful Includes: avoidant, defendant, and obsessive-compulsive
122
Who has cluster A personality disorders?
They are MC in men Schizotypal and paranoid onset is usually early adulthood Schizoid onset is usually early childhood
123
Conduct disorder in childhood may progress to...
Antisocial personality disorder in adulthood *3xMC in males
124
Management of cluster A personality disorders
1st line: psychotherapy Short term low dose use of antipsychotics, antidepressants, or benzos
125
Describe schizoid personality disorder
Voluntary social withdrawal and anhedonic introversion “Hermit-like behavior”/prefers to be alone Little enjoyment if close relationships or intimacy
126
Describe schizotypal personality disorder
Odd, eccentric and peculiar thought patterns without psychosis/delusions “Magical thinking” May talk to self in public
127
Describe paranoid personality disorder
Pervasive pattern of distrust and suspicious of others Bears grudges, doesn’t forgive and blames others for problems
128
Describe antisocial personality disorder
Deviates sharply from social norms, values, and laws Disregard and violation of rights of others Criminal acts, promiscuous, extremely manipulative and lacks remorse
129
Describe borderline personality disorder
Unstable unpredictable mood, affect, self image, and relationships Cannot tolerate being alone/fear of abandonment Black& white/all-or-nothing thinking Self-damaging behaviors
130
Borderline personality amity disorder is MC in
Women
131
Describe histrionic personality disorder
Overly emotional, dramatic and seductive Attention seeking/needs to be center of attention Self absorbed temper tantrums
132
Describe narcissistic personality disorder
Grandiose excessive sense of self-importance but fragile self-esteem Needs praise and admiration Reacts to criticism/rejection with rage May become depressed Lacks empathy for others
133
Narcissistic personality disorder is MC in
Men
134
Management of cluster C personality disorders
1st line: paychotherapy BB, anxiolytics, and antidepressants as needed
135
Describe avoidant personality disorder
Desires relationships but avoids them due to inferiority complex Lacks confidence
136
Describe dependent personality disorder
Very needy/clingy submissive behavior Needs constant reassurance Will not initiate things and may volunteer for unpleasant tasks
137
Describe obsessive-compulsive personality disorder
Perfectionist who require great deal of control and order Change in routine may lead to anxiety Preoccupation with minute details May avoid intimacy
138
Is autisim more common in boys or good?
Boys 4:1
139
Clinical manifestation of Autisim
Social interaction difficulties Impaired communication Restrictive, repetitive, stereotypes behaviors
140
Describe oppositional defiant disorder
Defiant behavior to adults characterized by irritable mood, defiant behavior and vindictiveness for at least 6m *may progress to conduct disorder
141
Describe conduct disorder
Sharper deviation form age-appropriate Norns and violation of the rights of others Social and academic difficulty *may violate laws, be cruel to animals, destroy property, and lie
142
How many pts with conduct disorder eventually develop antisocial personality disorder?
40%
143
Onset of ADD or ADHD usually occurs when?
Before the age of 12
144
Tx of ADD or ADHD
Behavior modification with Sympathomimetics/stimulants: (Methylphenidate, amphetamine/deztroamphetamine, or dexmethylpgenidate) OR No stimulants: (atomoxetine)
145
Clinical manifestations of nicotine withdrawal
Restlessness, anxiety, irritability, withdrawal, sleep abnormalities, desperation, cravings
146
Tx of nicotine dependence
1. nicotine tapered therapy 2. bupropion (zyban) 3. Varenicline (Chantix)
147
Signs and symptoms of opioid intoxication
``` Euphoria Sedation Pupillary constriction Resp depression Biot’s breathing Bradycardia Hypotension ```
148
Signs of opioid withdrawal
``` Lacrimation N&V Hypertensioa Abd cramps Sweating Diarrhea Piloerections Pupil dilation Rhinorrgea Myalgia/joint pain ```
149
Tx for acute opioid intoxication
Naloxone (Narcan) *IM onset of action 5min. 30-60min duration
150
Management of opioid withdrawal
Clinicians to decrease sympathetic symptoms Loperamide first diarrhea NSAIDs for joint and muscle cramps
151
Long term management options for opioid dependence
Methadone Suboxone (buprenorphine and naloxone)
152
Tx for benzodiazepine intoxication
Flumazenil
153
Wernick’s encephalopathy
Triad: ataxia, confusion, oculomotor palsy Due to thiamine/B1 deficiency caused by chronic alcohol consumption
154
Korsakoff syndrome
Retrograde and antegrade amnesia due to alcohol
155
Signs of cocaine/stimulant intoxication
Euphoric mood and psychosis
156
Treatment of cocaine intoxication
Benzodiazepines
157
When do alcohol withdrawal seizures occur?
6-48hr after last drink *MC occurs as a single episode
158
When do alcoholic withdrawal hallucinations occur?
12-48hrs after last drink *pt has clear sensorium and normal vitals
159
When do delirium tremendous occur?
2-5d after last drink *altered sensorium/delirium and abn vitals(tachycardia, hypertension, and fever)
160
Management of alcohol withdrawal
IV benzodiazepines IV thiamine and Mg before glucose administration
161
Management of alcohol intoxication
Acute intoxication - observation IV thiamine and magnesium prior to glucose administration Haloperidol of psychosis or severe aggression
162
Alcohol dependence screening
CAGE Cutdown Annoyed Guilt Eye opener *2 or mire considered positive
163
Normal grief reaction
Resolved within 1yr and does not have psychosis or suicidal ideation
164
Types of delusions
``` Bizarre Non-bizarre Paranoid/persecutory Grandiose Reference (high power communication) Somatic Erotomanic (celebrity loves them) Jealous ```
165
Types of hallucinations
``` Auditory (commands?) Visual Tactile Olfactory Gustatory ```
166
Types of disorganized speech
``` Derailment Tangential Incoherent/word salad Neologism (combining words) Echolalia (repaying you back) Blocking/paucity ```
167
Psychosis differential
``` Substance intoxication/withdraw Meds (steroids, stimulants, anticholinergic) Delirium Dementia Hyperthyroidism CNS infection Epilepsy B12 deficiency Lupus Huntington’s Wilson’s Psychiatric disorders ```
168
DTS
Danger to self
169
DTO
Danger to others
170
MC type of elder abuse
Neglect
171
SSRIs with low CYP450 interactions
Sertraline and escitalopram
172
Pharmaceutical Tx for male hypoactive sexual desire disorder
Testosterone or bupropion
173
Tx for female sexual interest/arousal disorder
Lubricants Flibanserin Therapy
174
Exhibitionism
Indecent exposure/flashing
175
Voyeurism
Observing unsuspecting person get undressed or engage in sexual behavior
176
Frotteurism
Rubbing against or touching a non-consenting person
177
Fetishism
Sexual arousal/fantasies involving non-living objects or non-genital body parts
178
Masochism
Sexual arousal from being humiliated, beaten, bound, or otherwise made to suffer
179
Sadism
Sexual arousal from causing a non-consenting person physical or psychological harm **associated with ASPD

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