Psychiatry- First Aid

Question 1

Acting Out

Answer 1

Expressing unacceptable feelings and thoughts through actions, eg tantrums

Question 2

Dissociation

Answer 2

Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress

Question 3

Displacement

Answer 3

Transferring avoided ideas and feelings to some neutral person or object, eg mom yells at child because husband yelled at her

Question 4

Identification

Answer 4

Modeling behavior after another person who is more powerful, eg abused child identifies with an abuser

Question 5

Isolation

Answer 5

Separating feelings from ideas and events, eg describing murder in graphic detail with no emotional response

Question 6

Projection

Answer 6

attributing an unacceptable internal impulse to an external source, eg a man who wants another woman thinks that his wife is cheating on him

Question 7

Reaction formation

Answer 7

replacing a warded-off idea or feeling by an emphasis on its opposite, eg a libidinous patient walks into a monastery

Question 8

Repression vs Suppression

Answer 8

Involuntary vs intentional withholding of an idea or feeling from conscious awareness

Question 9

Splitting

Answer 9

Believing that people are either all good or all bad

Question 10

Sublimation

Answer 10

replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with personal ideals, eg teenager’s aggression against father is directed to performing well in sports

Question 11

Neurotransmitter Changes in

1) Alzheimer’s
2) Anxiety
3) Depression
4) Huntington’s
5) Parkinson’s
6) Schizophrenia

Answer 11

1) decreased ACh
2) increased NE, decreased GABA, 5-HT
3) decreased NE, GABA, 5-HT
4) decreased GABA, ACh, increased Dopa
5) decreased Dopa, increased Ach, 5-HT
6) increased Dopa

Question 12

Predisposing factors to delirium (WATCH DEATH)

Answer 12

Withdrawal, Acute metabolic, Trauma, CNS pathology, Hypoxia, Deficiencies, Endocrine, Acute Vascular, Toxins, Heavy metals

Question 13

SIGECAPS (for Major depressive disorder)

Answer 13

Sleep disturbance, Loss of interest, guilt/feelings of worthlessness, energy loss, concentration problems, appetite/weight changes, psychomotor retardation, suicidal ideations

Question 14

Paranoid (Cluster A)

Answer 14

pervasive distrust and suspiciousness, projection is major defense mech.

Question 15

Schizoid (Cluster A)

Answer 15

voluntary social withdrawal, limited emotional expression, content with social isolation

Question 16

Schizotypal (Cluster B)

Answer 16

eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness

Question 17

Antisocial (Cluster B)

Answer 17

disregard for and violation of rights of others, criminality, impulsivity, called conduct disorder for agefemales

Question 18

Borderline (Cluster B)

Answer 18

unstable mood and interpersonal relationships, impulsiveness, self-mutilation, splitting is major defense mech, females>males

Question 19

Histrionic (Cluster B)

Answer 19

excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance

Question 20

Narcissistic (Cluster B)

Answer 20

grandiosity, sense of entitlement, lacks empathy and requires excessive admiration, often demand sand reacts negatively to criticism

Question 21

Avoidant (Cluster C)

Answer 21

hypersensitive to rejection, socially inhibited, desires relationships with others

Question 22

Dependent (Cluster C)

Answer 22

submissive and clinging, excessive need to be taken care of, low self-confidence

Question 23

OCD vs OCPD

Answer 23

OCD- obsessions that are relieved by compulsions, ego dystonic
OCPD- preoccupation with order, prefectionism, control, ego-syntonic

Question 24

Neuroleptic Malignant Syndrome (FEVER)

Answer 24

Fever, Encephalopathy, Vitals Unstable (autonomic instability), Enzymes (myoglobinuria), Ridigity of muscles

Question 25

Side Effects of 1st Generation Anti-Psychotics

Answer 25

Extrapyramidal side effects (dystonia, akathisia, bradykinesia, tardive dyskinesa)
Endocrine side effects (hyperprolactinemia)
Alpha-1 blockade (hypotension)
Muscarinic block (dry mouth, constipation)
Histamine blockade (sedation, weight gain)

Question 26

Side Effects of 2nd Generation Anti-Psychotics

Answer 26

Fewer extrapyramidal and cognitive (negative) side effects because of serotonin blockade
Olanzapine/clozpine- significant weight gain
Clozapine- most efficacious for positive sx, agranulocytosis
Risperidone- increase prolactin
Ziprasidone- prolong QT interval

Question 27

Adverse Events of Lithium Use

Answer 27

Renal (nephrogenic DI, renal insufficiency)
CNS (sedation, impaired cognition, tremor)
CV (sinus bradycardia, SA/AV blockade, Ebstein anomaly in fetus)
GI (increased appetite and weight, n+v, upset stomach)
Note: LI is reabsorbed in proximal tubule with sodium, LI serum levels will increase with low Na intake
Renally excreted

Question 28

Serotonin Syndrome

Answer 28

Occurs with SSRI’s, TCAs, SNRI’s, MAO inhibitors

Hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures

Question 29

Side Effects of TCA’s

Answer 29

Sedation
Alpha-1 Blockade (postural hypotension)
Anti-cholinergic (tachycardia, urinary retention, dry mouth)
Convulsions, Coma, Cardiotoxicity