Psychiatry Shelf Flashcards
A young boy wakes up at night, sits up and screams unconsolably on several nights. He is eventually able to fall back to sleep. He has:
Sleep terror disorder - repeated episodes of sudden awakening from sleep followed by panic symptoms that begin with a scream and is associated with unreponsiveness to comfort or attempts to awaken. Usually lasts a few mins.
The risk factors for completed suicide are:
Male gender, prior suicide attempt, history of psychiatric illness, family history, substance abuse.
For youth: one of the biggest risk factors is a co-morbid psychiatric illness.
What is the triad of narcolepsy?
Cataplexy, sleep attacks, hypnopompic/hypnagogic hallucinations or sleep paralysis
When in the sleep cycle do nightmare disorders occur?
In the latter third of the night or during REM sleep. In addition, when awakened, the individual becomes quickly oriented.
In dementia, people tend to have confabulation which you would not see in pseudodementia
Repeat
Quetiapine does not cause as many EPS symptoms because it binds and dissociates with the dopamine receptor.
Repeat
Personality disorders burnout with age
Repeat
Complicated grief lasts at least 6 months vs normal grief.
Repeat
Elevated p-tau CSF of patients with Alzheimer’s. Amyloid beta aggregates in plaques extracellularly.
Repeat
Avoid lorazepam in elderly patients.
Repeat.
Boy has markedly limited vocabulary, makes errors in tense, has difficulty recalling/producing developmentally appropriate words and sentences but his speech is fine and written expression is fine. Diagnosis:
Expressive language disorder
At age 2, you should produce 200 words. Failure to do so by age ____ would constitute a developmental delay.
Age 3
Social phobia is defined as…
Marked and persistent fear of social or performance situations w/exposure causing intense anxiety.
An 8 year old boy who complains of stomachache every day at school and wants to head straight home afterschool and sleeps in parents’ bed is concerning for… _________.
This child’s parent is most likely to suffer from __________
Separation anxiety disorder.
Parent: anxiety disorder.
Other risk factors include: over controlling or rejecting parenting style insecure attachment with primary caregiver, inhibited or shy temperament.
Schizophrenia is not usually associated with grandiose delusions. Grandiose delusions are more consistent with: ___________
Bipolar disorder, manic phase.
The classic illicit drug that produce mania in addition to psychosis is _________.
What other drugs could induce psychosis including hallucinations?
Mania + psychosis: cocaine
Psychosis: heroin, alcohol, cannabis, PCP
Conduct disorder is distinguished from oppositional defiant disorder by _______
How long must the behavior have been present for oppositional defiant disorder to be diagnosed?
Conduct disorder vs oppositional defiant disorder: In conduct disorder, acts of aggression are committed whereas in oppositional defiant disorder, the person is just angry, argumentative and easily annoyed by others.
Duration of behavior required for diagnosis in oppositional defiant disorder: 6 months.
A patient with bulimia is most likely to have which acid-base derangement?
Hypokalemic-hypochloremic metabolic alkalosis.
What form of therapy has been demonstrated to be the most effective for treating bulimia nervosa?
Cognitive behavioral therapy.
What depressive symptoms of MDD are more likely to be present depending on a child’s age:
Younger children: psychomotor agitation; anxious, irritable
Adolescents: Hypersomnia, hopelessness, weight change
The most common method that children attempting to commit suicide use is…
Substance ingestion
Common effects of intranasal DDAVP (desmopressin) that can be prescribe for enuresis are…
Headache, nausea
What is the comorbidity of childhood anxiety disorders (overanxious disorder, separation anxiety disorder, panic disorder) and MDD?
50%
Tangientiality refers to a thought process in which there is an abrupt, _________ (permanent or transient) deviation from the current subject. The person speaking _____ (does/does not) return to the original subject.
Permanent.
Does not return.
A schizophrenic patient who deviates from the topic of discussion but eventually returns to it is demonstrating __________
Circumstantially
Flight of ideas refers to loosely associated thoughts that rapidly move from topic to topic while loose associations are the lack of a logical connection between thoughts or ideas of an individual.
Repeat
A patient experiencing command auditory hallucinations that is acutely psychotic is a candidate for …
Immediate hospitalization including involuntary commitment because of the concern that the auditory stimuli could instruct patient to harm self or others.
An individual over the age of 18 who engages in illegal activities (theft, assault) and disregards the rights of others. Diagnosis:
Antisocial personality disorder. These individuals often suffered from conduct disorder as children.
A 24 month old girl is brought to clinic by mom. Mom tells you she has not spoken her first clear word and at times she seems to understand what people say to her but does not play with her 4yr old brother. She has odd, clumsy, repetitive movements with her hands. According to her growth chart, her head circumference at birth, 6 months, 12 months seemed to be developing normally but now the growth of her head has slowed. Diagnosis:
An identical twin has a ____% chance of getting the disease.
Rett disorder - appearance of poorly coordinated gait or trunk movements, severely impaired expressive/receptive language development w/severe psychomotor retardation in addition. RETT disorder is ONLY seen IN GIRLS.
Identical twin: 100% chance
What are some of the risk factors for a child with conduct disorder?
Absent biological father,
having a mother with somatization or alcohol abuse, having a large family, having aggressive, unsupportive, and conflict-ridden parents.
How can you distinguish MDD from adjustment disorder?
Symptoms of adjustment disorder do not last longer than 6 months after a stressor or termination of its consequences. Both disorder are marked by symptoms that may develop within 3 months of the onset of a stressor.
Up to 1/3 of kids diagnosed with Type I DM develop adjustment disorder following the diagnosis.
Repeat
What is the first-line treatment for Tourette disorder?
What co-morbid disorder is most commonly associated with Tourette disorder?
Clonidine (catapres). It is also good for treating co-morbid ADHD.
Most commonly Tourette’s is associated with OCD.
What is one of the major adverse effects of stimulants, a class of drugs often prescribed for ADHD?
What is the treatment for this side effect?
Tics
Treatment: atypical antipsychotic
Approximately 50% of kids with a learning disorder have a co-morbid psych disorder.
Repeat
20% of boys with enuresis have a co-morbid mental disorder.
Repeat
Aromoxetine is a NRI used to treat ADHD.
Repeat
A 3 year old girl should be able to state her age and gender and be involved in or completing potty training.
Repeat
Part of the required criteria for diagnosing autistic disorder is _________ disorder.
Language disorder is one of the required criteria for diagnosing autistic disorder. Could be delay in speech, difficulty beginning or sustaining speech, or stereotyped use of language.
3 Common lab abnormalities in anorexia nervosa are:
Hypercholesterolemia, Normocytic anemia, leukopenia
Stranger anxiety usually happens at what age?
At 7-8 months is when babies experience stranger anxiety
Drugs
Intoxication/Withdrawal
Alcohol & Benzos
Intoxication: Disinhibition, mood lability, incoordination, slurred speech, ataxia, blackouts, respiratory depression.
Withdrawal: tremulousness, HTN, tachycardia, anxiety, psychomotor agitation, diaphoretic, seizures, hallucinations, DT (EtOH)
Drugs
Intoxication/Withdrawal:
Barbiturates
Intoxication: Respiratory depression
Withdrawal: anxiety, seizures, delirium, life-threatening CV collapse
Opioids
Intoxication/Withdrawal:
Intoxication: CNS depression, n/v, sedation, decreased pain perception, decr GI motility, pinpoint pupils, respiratory depression
Withdrawal: Incr sympathetic activity, n/v, diarrhea, diaphoretic, rhinnorhea, piloerection, yawning, stomach cramps, myalgias, arthralgias, restlessness, anxiety, anorexia
Drugs
Amphetamines/Cocaine:
Intoxication/Withdrawal:
Intoxication: Pupil dilatation, euphoria, increased attention span, aggressiveness, psychomotor agitation, HTN, tachycardia, cardiac arrhythmias, psychosis
Withdrawal: Post-use crash, restlessness, headache, hunger, severe depression, insomnia/Hypersomnia, strong psychological craving.
What is the DSM-IV criteria for psychosis secondary to a general medical condition?
Prominent hallucinations or delusions
Symptoms persist even when the pt is not delirious
Lab data, H&P data to support it
What is duloxetine?
An SNRI which is effective both as an anti-depressant and as control for diabetic polyneuropathy.
What are some of the side effects of Lithium?
Tremor, diabetes insipidus, weight gain, edema, leukocytosis.
Diarrhea, restlessness, extreme agitatition, Hyperreflexia, AUTONOMIC INSTABILITY, myoclonus, seizures, hyperthermia, rigidity, delirium, coma and death are concerning for _________ especially in the s/o a patient who just started an SSRI or SNRI after recently being on an MAOI.
Serotonin syndrome
Which anti-psychotic is associated loss of night vision?
Thioridazine
In a pt who has experienced priapism for >18hours, check the med list for this likely offending anti-depressant _________ and one option is to give an injection of _________ to the penis.
Trazodone (anti-depressant)
Epinephrine injection
Pts on MAOIs cannot have wine, all cheese, and all fermented or aged food because tyramine. The risk if they consume it is ___________ (medical scenario).
Hypertensive crisis
To revert toxicity or overdose on benzodiazepines, administer what benzo antagonist? __________]
Flumazenil
How is lithium toxicity that causes seizures and coma treated?
Dialysis
How long should you maintain anti-depressant therapy once someone begins to feel well?
Additional 6-9 months at same dose.
Bizarre delusions are most specific to schizophrenia, auditory hallucinations can be seen in other conditions.
Repeat
If mood symptoms precede psychotic symptoms, then a mood disorder w/psychotic component is likely.
Repeat.
The hallmark of panic disorder is …
Recurrent, UNEXPECTED panic attacks associated with worry about having additional attacks, the consequences of attacks, or a change in behavior as a result of attacks. Usually not provoked by any stimulus.
R/o medical conditions, medications, substance abuse
Treatment of panic disorder: SSRI + CBT. Benzo (low-dose) acutely.
In a child with bipolar disorder without psychosis, appropriate treatment is ________
With psychosis: ______
Without psychosis: mood stabilizer like Lithium, valproic acid, or carbamezepine OR atypical anti-psychotic like olanzapine, Quetiapine, or risperidone.
Bipolar w/psychosis: mood stabilizer + atypical antipsychotic
Bipolar disorder:
Type I:
Type II:
Rapid-cycling:
Type I: Mania
Type II: Hypomania (do not usually exhibit psychotic symptoms, racing thoughts, marked psychomotor agitation, less social impairment)
Rapid cycling bipolar: At least 4 episodes - both depression and Hypomania/mania in a year
Pts on lithium for bipolar need to have what lab tests?
Thyroid and kidney function
A pregnancy test should be performed in all women of child-bearing age before prescribing mood stabilizers.
Repeat
Indications for ECT are:
Rapid response necessary, major depressive disorder + psychotic symptoms, catatonic patient, imminently suicidal patient, patient not ingesting food or fluid
What is rationalization?
An immature defense mechanism where you excuse an unacceptable behavior in a false but logically rational way to avoid true reasons for the behavior.
The mature defense mechanisms are:
Altruism, humor, suppression, sublimation
Criteria for mania:
DIG FAST: Distractibility, Indiscretion, Grandiosity. Flight of ideas, activity, sleep, talkativeness.
The stages of grief:
Death Always Brings Great Acceptance
Denial, Anger, Bargaining, Grieving, Acceptance
Beta-blockers are great for treating social anxiety subtype.
Repeat
6 months of worry, anxiety, restlessness, irritability, difficulty concentrating, muscle tension, and sleep disturbance is concerning for…
Treatment:
Generalized anxiety disorder
Treatment: SSRI, SNRI, or CBT. Can consider benzo if intractable to SSRI.
A man who forgets his identity and travels unexpectedly is concerning for…
Dissociative fugue
Multiple personality disorder is now known as…
Dissociative identity disorder
What anatomical brain changes are associated with common psychiatric conditions:
Autism: increased total brain volume
OCD: abnormalities in the orbitofrontal cortex and striatum
Schizophrenia: enlarged lateral cerebral ventricles
Panic disorder: decr amygdala volume
PTSD: decr hippocampal volume
ADHD occurs before the age of ____
12
Repetitive, stereotyped behavior and abnormal reactivity to sensory input in the setting of a child is concerning for …
Autism spectrum disorder
A patient who experiences overwhelming sense of anxiety to steals things of minimal value and feels guilty afterwards and may even return should be diagnosed with __________ (diagnosis), a ___________ (type of disorder). Onset is usually in adolescence. Appropriate treatment:
Kleptomania
Impulse control disorder
Treatment: psychotherapy - CBT
The treatment of choice for anorexia is _______. If pharmacotherapy is added, then _______ should be added.
CBT. Olanzapine. Nutritional rehab is a staple treatment for anorexia or bulimia.
The treatment of choice for bulimia nervosa is _______
There are 2 types:
CBT + SSRI, nutritional rehab
2 types: purging and non-purging
A patient with bipolar disorder who has experienced one episode of acute mania can stay on lithium for a year. Once they have experienced 2 episodes, they need years long or lifetime maintenance. Once they have 3 episodes, lifetime. If pt keeps relapsing on lithium monotherapy, Lithium + atypical antipsychotic should be considered.
Repeat
A persistent fear of fatal illness despite negative medical workups is concerning for: _________. Often times, this disease is exacerbated in the setting of ________.
Hypochondriasis. Criteria: 6 months duration.
Exacerbated by: current emotional stressors
Treatment: brief psychotherapy (e.g. Freq appointments with primary care)
Anti-psychotic medication effects:
Mesolimbic - antipsychotic efficacy
Nigrostriatal - EPS, Parkinsonism, TD
Tuberoinfundibular - hyperprolactinemia - sexual dysfunction, gynecomastia
Body dysmorphic disorder:
Treatment:
Definition: preoccupation with 1 or more physical defects, defects are not observable or are slight to others, repetitive behavior or mental acts performed in response to preoccupation, significant distress or impairment, specify insight
Best treated with medication or psychotherapy
Acute stress disorder with anxiety symptoms is characterized by:
Treatment:
PTSD-like symptoms that do not persist for more than 1 month. There has to have been an event where fatality or threat of serious injury was experienced by patient.
Once symptoms last over 1 month, they are characterized as PTSD.
Treatment: supportive intervention in the community - includes spiritual or religious, social support
Children with ___________ are talkative at home but not at school.
Selective mutism. Symptoms must be present for at least 1 month for diagnosis.
There has been a link between PANDAS and the development of ________ disorder
OCD
The treatment of choice for OCD in a child is…
Individual and family CBT and treatment with SSRIs or clomipramine
The triad of ataxia, delirium, and ophthalmoplegia are concerning for::
Wernicke’s syndrome. It is a reversible encephalopathy.
What are the criteria for a substance dependence disorder:
3 or more
Tolerance, withdrawal symptoms, substance taken in larger amounts or over longer time than intended, unsuccessful efforts to cut down, large of time spent obtaining substance or recovering from its effects, important social or occupational activities given up or reduced, continued use despite known effects on physical or psychological problems
Substance abuse:
Failure to fulfill obligations at work, school, or home
Continued use in dangerous situations (DWI, machinery)
Alcohol related legal problems
Social or interpersonal problems
Treatment of alcohol dependence:
Antabuse (disulfiram) - inhibits alcohol dehydrogenase
Naltrexone - decreases craving for alcohol
Acamprosate - shows promise when used in conjunction with psychological or behavioral treatment
Cocaine withdrawal lasts _______days
2 to 4 days. Could be longer in heavy users. 3 days for urine to clear.
Give ppl with bereavement 2 months post-death before considering depressive diagnosis.
Repeat
A child suffering from major depression with psychotic features should be treated with an anti-depressant and atypical antipsychotic. The atypical antipsychotic should be continued for ___ months and then tapered. The anti-depressant for ___ months and then tapered every 2-3 months.
Helpful hint: children with depression often report their mood as angry or mad
3 months (anti-psychotic) 6-9 months (anti-depressant)
Conduct disorder criteria:
Conduct disorder treatment:
There is a high co-morbidity with ______ disorder.
3 of the following in the last 12 months with at least one in the last 6 months:
Aggression towards people or animals
Destruction of property
Deceitfulness or theft
A serious rule violation
Treatment of CD: multi systemic treatment (wraparound services)
High co-morbidity with ADHD.
In OCPD vs OCD, the main differences are that:
In OCPD, there are no obsessions (repetitive, INTRUSIVE thoughts) or compulsions (ritualistic behaviors) and the illness is ego-syntonic in OCPD.
Treatment of OCPD: Long-term, insight-oriented psychotherapy
PTSD criteria:
PTSD treatment:
Criteria: re-experiencing, hyperarousal, avoidance
Treatment: SSRIs to address re-experiencing symptoms, prasozin and Clonidine (alpha-2 adrenergic agonists), CBT
Diagnosis of bulimia nervosa criteria:
Recurrent episodes of binge eating followed by feelings of extreme disgust/guilt
Repeated compensatory behavior to prevent weight gain after binging
Binging episodes that occur at least 2x/wk over a 3-month period
Normal or above slightly normal BMI
Dissatisfaction with body weight/shape
Genito-pelvic pain/penetration disorder (vaginismus) is characterized by:
Difficulties with 1 of following:
Vaginal penetration during intercourse
Vaginal or pelvic pain during intercourse or attempted penetration pr fear or anxiety of, before, during, after
Tenseness of pelvic floor muscles during attempted vaginal penetration
6 months duration
Female organismic disorder:
Persistent delay or lack of orgasm on nearly all or nearly all occasions of sexual activity
Factitious disorder vs malingering:
Factitious disorder: Intentional falsification of signs and symptoms in order to assume sick role. Severe Factitious disorder where invasive, potentially life-threatening treatments are sought is known as Münchausen syndrome.
Malingering: there is secondary gain (avoiding work, getting certain benefits etc)
Hoarding disorder criteria:
Treatment
Difficulty discarding items regardless of their actual value
Difficulty due to perceived need to save items
Accumulation compromises daily life
Not attributable to other condition
Treatment: CBT + SSRI
Patients with OCPD have a need for order and perfection. Frequently do not complete tasks in a timely manner. Meticulous way of doing this that must be followed, also rigid, stubborn.
Repeat
The odds of a manic episode at some point in the lifetime of a patient with a family member with bipolar disorder is ___
The prevalence of bipolar disorder in the general population is ____
10% (5-10%)
1%
If both parents: 60%
Monozygotic twin: 70%
ECT is indicated for:
Common side effect of ECT:
Severe depression
Persistent suicidality in treatment resistant depression
Depression in pregnancy, or post-partum depressionw/acute suicidality or potential threat to infant
NMS
Recurrent mania
Catatonic schizophrenia
Common side effect: amnesia
Contraindications: space occupying lesion, MI in past 3 months
Delusional disorder:
1 or more delusions greater than 1 month in the absence of psychosis.
Schizoaffective disorder:
Treatment:
Concurrent mood episode, active phase symptoms of schizophrenia with at least 2 week history of delusions or hallucinations when prominent mood symptoms (mania or depression) were absent
Treatment: long-term atypical anti-psychotic therapy
A patient who poses significant public health risk. E.g. Meningococcal meningitis should be __________ if refusing treatment
Hospitalized involuntarily until no longer a public health concern.
Dysthymia or persistent depressive disorder:
Treatment:
What two symptoms would make you think of a disorder more severe than dysthymia:
Low-grade depression. 2 years of at least 2 symptoms:
Poor appetite
Insomnia
Low energy
Difficulty concentrating or making decisions
Hopelessness
Criteria can be 1 year for child or adolescent
Treatment: SSRI or SNRI
Severe symptoms: suicidal ideation or psychotic symptoms
Hospitalize anorexic patient if:
Biggest concerns during refeeding I.e. Refeeding syndrome:
Electrolyte disturbances (Hypokalemia, hypophosphatemia)
Bradycardia
Dehydration
Excessive weight loss
Refeeding syndrome: heart failure, electrolyte disturbances, arrhythmias
Dementia
Criteria:
Memory impairment AND 1 or more of following: Agnosia Aphasia Apraxia Loss of executive functioning
Vascular dementia has a __________ rate of progression
Stepwise deterioration
Personality disorders cannot be diagnosed before age 18
Repeat
Patients with new onset hallucinations, particularly olfactory and gustatory should have ____________(diagnosis) ruled out first.
Psychosis caused by general medical condition. E.g. Seizure in s/o prior head trauma
Hallucinated sensation that insects or snakes are crawling up skin is ____________. It is often associated with cocaine or amphetamine use.
Formication
ADHD criteria:
Treatment:
Which treatment is preferred in families with substance abuse problems? What is a major side effect of the drugs?
Rule out which medical condition?
6 or more symptoms before the age of 7, present in more than one setting for at least 6 months:
Inattention (making careless mistakes, often losing things, difficulty organizing tasks etc).
Hyperactivity (fidgeting or squirming, being “on the go”, talking excessively)
Impulsivity: difficulty waiting for one’s turn, often blurting out answer before question is complete
Treatment: methylphenidate, amphetamines, atomoxetine. Atomoxetine is preferred in families with substance abuse, cannot be abused.
Side effect of stimulants: tics
Rule out: lead intoxication which can lead to hyperactivity
Histrionic personality disorder:
Treatment:
Theatrical and overblown speech and seductive manner, attention seeking, suggestible to others’ thoughts, think of relationships as much more intimate than they really are.
Treatment: Supportive psychotherapy (NOT insight-oriented)
Adjustment disorder:
Criteria:
Treatment:
Develop emotional response within 3 months of stressor
Clinically significant symptoms develop as a result of stressor
Symptoms do not persist longer than 6 months after stressor is resolved
Five different subtypes
Treatment: psychotherapy
Anorexic patients are more likely to have what pregnancy complications:
Premature, small for gestational age
Also, the anorexic or previously anorexic pts get osteoporosis, elevated cholesterol and carotene, cardiac arrhythmias, euthyroid sick syndrome
For anything to be a disorder it MUST cause social, occupational, functional impairment. In the absence of these forms of impairment, the identified symptoms/response are likely normal.
Repeat
Lithium is associated with _____________ congenital abnormality.
What are other side effects of lithium?
Inferiorly placed, malformed tricuspid valve - Ebstein’s abnormality - associated with atrialization of right ventricle.
Also increases septal defects.
Both in first trimester. Later on, goiter and neonatal neuromuscular dysfn
Other side effects: hypothyroidism, nephrogenic diabetes insipidus. As a result, always do Creatinine and thyroid function test before starting lithium
Bipolar disease management:
Atypical antipsychotics can be used for mild or moderate disease
Mood stabilizer monotherapy is alternative
Combination therapy is suggested.
What psychiatric disorder is most likely to develop in a person who felt with childhood abuse?
Depression
Mental retardation:
Normal: 90-110
Mild MR: 55-70
Moderate: 40-54
Severe: 25 to 39
Special types of delusions (named delusions)
Cotard - nihilistic delusions of nothingness; e.g. Lost Organs, world beyond them reduced to nothingness
Capgras - familiar ppl have been replaced by identical looking imposters.
Fregoli - thinking different familiar people around you are actually the same person (I.e. other people in disguise)
Delusions and hallucinations within 1 week of delivery are concerning for:
Post-partum psychosis.
When paired with prior history of depressive episodes, strongly suggests episodic mood disorder like bipolar.
Treat acute dystonia reaction with
Benztropine 2mg with repeat dose in 30min if no improvement.
Treat akathisia
Reduce dose of anti-psychotic or add beta blocker or benzo.
To diagnose PANDAS:
To treat PANDAS use:
Diagnose: anti-streptolysin O titers (rise 3-6 wks after infection) or 8 wks after infection, anti-DNAase B
Treat: If OCD component, treat with SSRI and CBT. Then treat tics with atypical antipsychotic.
Consider PANDAS in the setting of episodic tics.
Erythema of the turbinates and nasal septum should raise suspicion of ________________ especially in the setting of recent weight loss due to lack of appetite and recent strange behavior.
Cocaine use
Conjunctival injection, dry mouth, tachycardia and increased appetite are concerning for _____________ intoxication. Paranoia may occur.
Cannabis
What is sthe mainstay treatment for catatonia?
Benzos or ECT
The most likely sleep disturbance seen in a depressed patient is:
Early morning awakening.
The REM sleep latency is also decreased but this is less common.
SSRI monotherapy is NOT recommended in bipolar disease because _________
It can induce manic phase
Double depression = dysthymia + MDD
Dysthymia is _______
Dysthymia - 2 years of depressive symptoms that do not meet criteria for MDD with no more than 2 consecutive months free of the symptoms in that period.
Cyclothymia
Criteria:
Treatment:
Cyclothymia - Hypomania and subclinical depression
Treatment: same as for bipolar depression
Of note, if someone with cyclothymia later meets criteria for MDD, then they can be re-classified as bipolar II
Docility, lack of fear response, hyperphagia, hypersexuality, and anterograde amnesia are concerning for…
Kluver Bucy syndrome (associated with damage to temporal lobes – especially the amygdala)
Methadone is safe to use in pregnancy. Total abstinence to no substitute opiate should NOT be qattempted during pregnancy.
Repeat
What type of psychotherapy is best for patients with borderline personality disorder?
Individual, dialectical behavioral therapy - offshoot of CBT focused on mindfulness and distress tolerance
What percent of people with MDD will eventually commit suicide?
15%
Sexual sadism
Aroused by giving punishment. This diagnosis can inly be given if there is occupational or social dysfunction as a result.
In a patient with anxiety with tachycardia, diaphoresis, and moldy dilated pupils, the most likely part of the brain to light up is _______
Locus ceruleus
Projective identification is like ______
Self-fulfilling prophesy.
The most effective treatment for atypical depression is _______
Phenelzine - MAOI. Depression with atypical features includes weight gain, Hypersomnia, mood reactivity (I.e. Pt perks up when you discuss a happy subject)
Global confusion, autonomic over activity (tachycardia, HTN) in the setting of recent alcohol use is concerning for: ________.
Treat:
Delirium Tremens. Treat with IV Benzodiazepines.
Think of suicidality as a feature of depression NOT psychosis. Depression with psychotic features should be treated with_________
SSRI and anti-psychotic
Thioridazine side effects are ________
Retinal pigmentation that can lead to blindness.
Retrograde ejaculation
If a pt on lithium needs an analgesic, and is prescribed an NSAID, appropriate course of action is to switch to ________
Aspirin.
What common drugs INCREASE lithium levels in a patient?
Thiazide diurectics.
Pimozide is a ___________ (type of drug)
What med should it not be combined with?
Old anti-psychotic.
Side effect: interacts with citalopram to prolong QTcq
What is are some of the metabolic side effects of clozapine
Hyperglycemia, hypercholesterolemia
Pancreatitis is a side effect of which mood stabilizer
Valproic acid
Which anti- psychotics have the lowest metabolic profile (I.e. Weight neutral)?
Aripripazole and ziprasidone
In a GAD patient on warfarin, only _________ therapy does not interact with warfarin
Benzo - clonazepam
For binge eating, prescribe
The risk of this med is:
Topamax.
It carries a risk of renal stones.
Repetitive movements of just the month but not the tongue on anti- psychotics is ________
Rabbit syndrome
Aripriprazole - akathisia
Ziprasidone is weight neutral but prolongs QT
All TCAs lower seizure threshold
Repeat
(Brief) Psychodynamic therapy aims at resolving a focal conflict
Repeat
Psychoanalysis can worsen schizophrenia because of required level of introspection
Repeat
Suicidality is marked by rigid black and white thinking. It is most likely to respond to _____________
Cognitive therapy
Imaginary friends btwn ages 2 and 6 are considered normal. They do not indicate abuse or stress.
Repeat
A diagnosis of somatic disorder should prompt a search for other psychiatric illnesses
Repeat
To evaluate the short term memory of a patient who is undergoing ECT use the…
Brown Peterson Task
For hypertensive crisis happening in the setting of TCA use, treat with …
Alpha blocker (e.g. IV phentolamine)
Inhalant depresses reflexes. What is the only treatment for inhalant abuse!
Repeat. Abstinence.
In pregnancy and concurrent psychosis, the drugs of choice considered to be safe are:
Typical high potency anti-psychotics e.g. Haloperidol
Abdominal cramps, confusion, palpitations and muscle twitching are concerning for…
Nicotine
A newly married man is switched to an anti-depressant with no sexual side effects but develops jaundice, abdominal pain, fatigue on it. The offending agent is:
Nefazodone
Which SSRI can increase blood pressure as a side effect?
Venlafaxine
Prozac is fluoxetine, it has a long half-life.
Paxil is paroxetine, it has a short half-life.
Repeat
A first time panic attach must be thoroughly worked up medically to rule out other potential causes
Repeat.
An SSRI should be tried for 8 weeks before switching to another SSRI.
Repeat
Testamentary capacity = level of competence required to make a valid will.
Understanding nature of will Knowledge of one's assets Knowledge of natural heirs Absence of acute psychosis Freedom of undue influence or coercion
Treat Alzheimer’s dementia with an ACh-mets erase inhibitor like galantamine first before adding memantine
Repeat
To evaluate hemispheric dominance of language use the _______
Wada test
What is appropriate intervention for secondary enuresis (bed wetting in a child who has been potty trained)?
- Behavioral therapy
2. Imipramine
Rapid cycling bipolar disease responds best to which mood stabilizer?
Valproic acid
