Psychology Flashcards
What criteria must be met for a diagnosis of intellectual disability?
deficits in both intellectual functioning and the ability to do daily activities
What are the most common causes of intellectual disability?
- fetal alcohol syndrome is the most common overall
- trisomy 21 and fragile X syndrome are the most common genetic causes
Describe the presentation and treatment of autism. What is the development of autism associated with?
- it is associated with prenatal or perinatal infections
- presents with repetitive, stereotyped behaviors and difficulties with social communication and actions before age 3
- treat with behavioral modification programs and antipsychotics for aggression
Describe the diagnosis and treatment of ADHD.
- diagnosis requires 6 months of symptoms (inattention, hyperactivity, etc.) that interfere with daily functioning in two areas with symptoms present since at least age 12
- first-line treatment are stimulants
- atomoxetine is a second-line agent with fewer side effects and less abuse potential
- alpha-2 agonists (clonidine and guanfacine) are second-line agents helpful for comorbid tic disorders, but have no benefit in adult populations
What are the clinical features and treatment of oppositional defiant disorder?
these children have very few difficulties with their peers but tend to have problems with authority figures; should be treated by teaching parents appropriate child management strategies
What are the clinical features and treatment of conduct disorder?
these children demonstrate rule breaking and violate the rights of others; should reward prosocial and nonaggressive behavior while using antipsychotics to control aggression
What are the clinical features of disruptive mood dysregulation disorder?
these individuals have a constantly irritable or angry mood interspersed with temper outbursts, diagnosed before age 10
Tourette disorder is associated with what two other psychiatric illnesses?
OCD and ADHD
MDD is associated with what neurotransmitter imbalances?
decreased NE, DA, and serotonin
If an SSRI is started and the patient sees no benefit, how long should the medication be trialed before switching to another agent?
4-6 weeks
Which SSRIs are safest for cardiac patients?
sertraline and escitalopram
How long must SSRIs be discontinued before an MAOI can be started?
this transition requires a 2 week wash out period
What are the indications for ECT?
- treatment refractory depression
- inability to care for one’s self
- impending suicide
- psychotic features
- MDD complicated by pregnancy
What are the criteria for a manic episode?
3 of the following if elevated mood (4 if irritable mood) which lasts at least one week and is severe enough to require hospitalization and interfere with functioning
- Distractibility
- Insomnia
- Grandiosity
- Flight of Ideas
- Activity Increase
- Speech (Pressured)
- Thoughtlessness/Impulsivity
Mania is associated with what neurotransmitter imbalances?
an increase in NE and serotonin
What are considered first-line medications for mania?
- lithium is the go to agent
- valproate and atypical antipsychotics can also be used
- atypical antipsychotics are event preferred for acute mania with severe features due to it’s rapid onset
What are the criteria for dysthymia?
at least 2 symptoms of major depressive episode lasting for at least 2 years and never without symptoms for longer than 2 months
What are the criteria for cyclothymic disorder?
must meet criteria for hypomanic episodes and mild depression for more than 2 years
What is unique about the presentation and treatment of atypical MDD?
- it is characterized by reverse vegetative changes including increased sleep, increased weight, increased appetite, and greater interpersonal sensitivity
- this distinction is important because this form of MDD is treated with SSRIs or MAOIs as first-line agents
What is the treatment for MDD with seasonal pattern?
phototherapy and either an SSRI or bupropion
Describe the differences between postpartum blues, depressive disorder with peripartum onset, and bipolar disorder with permpartum onset/brief psychotic disorder with peripartum onset.
> Postpartum Blues
- onset and resolution within 2 weeks of birth
- includes sadness, mood lability, and tearfulness but no negative feelings
- treatment is supportive
Postpartum MDD
- onset within 4-6 weeks of birth
- meet criteria for MDD and may have negative feelings toward the baby
- treatment is with antidepressants
Postpartum Bipolar/Psychosis
- characterized by depression, mania, hallucinations, delusions, and thoughts of harming self or baby
- treat with antipsychotics, lithium, and sometimes hospitalization
Describe the presentation and treatment of bereavement.
differs from MDD in the severity of symptoms and time course as bereavement is less severe and typically resolves within 6-12 months; as such, treatment is with supportive psychotherapy
Describe the presentation and treatment of serotonin syndrome.
- presents with cognitive disturbance, autonomic stimulation (hyperthermia, tachycardia, sweating), tremulousness, and hyperreflexia
- treat by withdrawing all serotonergic agents, providing supportive care, and using cyproheptadine as needed
What is the difference between brief psychotic disorder, schizophreniform disorder, and schizophrenia?
time course: brief psychotic disorder lasts 1 day to 1 month, schizophreniform lasts 1-6 months, and schizophrenia is symptoms lasting more than 6 months
What are the diagnostic criteria for schizophrenia?
at least 2 of 5 symptoms for 6 months with at least one being an A symptom
- A: hallucinations, delusions, disorganized speech
- B: disorganized behavior, negative symptoms
Clozapine should only be started in which psychotic patients?
those who have failed two other antipsychotic medications
Which antipsychotics have the fewest metabolic effects?
ziprasidone and aripiprazole
What is unique about the adverse effect profile for each of the following antipsychotics:
- olanzapine
- risperidone
- quetiapine
- ziprasidone
- clozapine
- aripiprazole
- lurasidone
- olanzapine: high incidence of metabolic disturbance
- risperidone: high potency atypical and more likely to cause EPS or hyperprolactinemia
- quetiapine: low risk for EPS
- ziprasidone: low risk for metabolic disturbance but more likely to prolong QT interval
- clozapine: high risk for agranulocytosis and cardiomyopathy
- aripiprazole: low risk for metabolic disturbance but more likely to cause compulsive behavior like gambling
- lurasidone: safest for pregnancy
Which antipsychotic is preferred for pregnant patients?
lurasidone
What is the treatment for the EPS of antipsychotics?
- dystonia: diphenhydramine
- akathisia: propanolol
- parkinsonism: benztropine or trihexyphenidyl
- tardive dyskinesia: stop offending agent and use valbenazine
Describe the presentation and treatment of neuroleptic malignant syndrome.
- presents with rigidity, autonomic dysfunction, agitation, and obtundation
- treat by discontinuing the offending agent and supportive care; then try dantrolene, dopamine replacement with bromocriptine, or a benzodiazepine
How is schizoaffective disorder defined? What is the treatment?
- patients must meet criteria for a major mood episode while also meeting criteria for psychosis and have at least a 2 week period of psychosis without mood symptoms
- treat with a combination of antipsychotics and mood stabilizers
How are panic attacks and panic disorders diagnosed? How does the treatment differ for the two?
- panic attacks are defined by intense anxiety and dread or doom accompanied by at least 4 symptoms of autonomic hyperactivity
- panic disorder is defined by recurrent attacks and worry or maladaptive behavior aimed at avoiding more attacks
- panic attacks can be treated with benzodiazepines alone; however, panic disorder should be treated with an SSRI plus a benzodiazepines taper
What is the treatment for OCD?
- SSRIs are the treatment of choice combined with exposure and response prevention therapy
- if SSRIs fail, add clomipramine as the preferred TCA
What is the treatment for body dysmorphic disorder?
SSRIs and individual psychotherapy
What is the treatment for PTSD and acute stress disorder?
- SSRIs
- prazosin for nightmares
- relaxation techniques and hypnosis
Which benzodiazepines are suitable for treating alcohol withdrawal in those with liver disease?
LOT: lorazepam, oxazepam, temazepam
When can flumazenil be used?
it is used only for the acute treatment of benzodiazepine overdose; for those with chronic dependence it will precipitate a dangerous withdrawal
What is the treatment for opioid overdose and for opioid withdrawal?
- overdose: naloxone
- withdrawal: clonidine, methadone, buprenorphine
Name four medications useful for treating alcohol use disorder.
- disulfiram, an acetaldehyde dehydrogenase inhibitor
- topiramate, which reduces cravings
- naltrexone, an opioid receptor antagonist
- acamprosate, which is safer than naltrexone for patients with liver disease
How is somatic symptom disorder differentiated from conversion disorder?
- conversion disorder has a more acute onset while somatic symptom disorder must have a duration greater than 6 months
- the anxiety of somatic symptom disorder may be tied to a symptom that can be explained by a recognized disease process while that of conversion disorder cannot
What effects do antipsychotics (dopamine antagonists) elicit based on their action in the mesolimbic, nigrostriatal, and tuberoinfundibular tracts.
- mesolimbic: antipsychotic effect
- nigrostriatal: extrapyramidal symptoms of akathisia, parkinsonism, and dystonia
- tuberoinfundibular: hyperprolactinemia
What is the best treatment for a pregnant patient with bipolar disorder?
lamotrigine, which has the lowest teratogenicity of the mood stabilizers
What are Wernicke encephalopathy and Korsakoff syndrome? What neurologic lesions is each associated with?
- Wernicke encephalopathy is due to thiamine deficiency and characterized by a triad of encephalopathy, ataxia, and oculomotor dysfunction
- it is associated with mamillary body atrophy and dorsomedial thalamic neuron loss
- Korsakoff syndrome is a complication of this characterized by amnesia, confabulation, apathy, and lack of insight
- it is associated with lesions to the anterior and medial thalami and to the corpus callosum
What is the key difference between binge-eating disorder and bulimia nervosa?
binge-eating disorder does not involve any compensatory behaviors like bulimia nervosa does
Describe the presentation and treatment of binge-eating disorder.
- patients present with recurrent episodes of binge eating and have no compensatory behaviors
- treat with CBT, an SSRI, lisdexamfetamine, and topiramate
Describe the presentation and treatment of anorexia nervosa.
- patients have a BMI less than 18.5, intense fear of weight gain, and a distorted view of body shape
- treat with CBT, nutritional rehab, and olanzapine (for weight gain)
Describe the presentation of bath salts intoxication.
- presents with tachycardia, severe agitation, combativeness, delirium, and psychosis
- in contrast to other stimulants, the effects take several days to subside
What is reactive attachment disorder?
a pattern of emotional and social withdrawal stemming from past experiences of neglect or abuse leading to insecure attachment to caregivers
Which opioids do not appear on a UDS and why?
- a typical UDS screens for morphine metabolites and will be positive for morphine or codeine
- therefore, it only identifies natural opioids
- synthetic and semisynthetic opioids do not trigger a positive result
For which patients is there an increased risk for suicide during the course of antidepressant therapy?
for those under age 25
What is the indication for the following:
- CBT
- interpersonal psychotherapy
- psychodynamic psychotherapy
- motivational interviewing
- DBT
- biofeedback
- CBT: depression, GAD, panic disorder, PTSD, OCD, eating disorders, negative thought patterns
- interpersonal psychotherapy: depression
- psychodynamic psychotherapy: personality disorders
- motivational interviewing: substance use disorders
- DBT: borderline personality disorder
- biofeedback: prominent physical symptoms/pain disorders
How would you differentiate opioid withdrawal from cocaine intoxication?
- remember that opioid withdrawal will take 3-5 days while cocaine intoxication is likely to resolve in the course of an ED visit
- opioid withdrawal is also unlikely to be characterized by psychosis whereas delusions are more common with cocaine intoxication
What is the preferred treatment for catatonia?
benzodiazepines or ECT
What is the primary difference between factitious disorder and malingering?
factitious disorder is unconsciously motivated and for intrinsic gain whereas malingering is consciously driven and for secondary gain
The treatment for adjustment disorder is what?
psychotherapy
What is the treatment for bulimia nervosa?
SSRIs and CBT
What are the four key features of narcolepsy? How is it treated?
- daytime sleepiness, sleep paralysis, hypnogogic/hypnopompic hallucinations, cataplexy
- treat with sleep hygiene, daytime naps, and modafinil
Narcolepsy is associated with what molecular deficit?
loss of hypocretin
What is impotence and how should it be treated?
- it is the inability to attain or maintain an erection until completion of the sexual act
- treat with psychotherapy and couples sex therapy
What is the treatment for premature ejaculation?
thought to be secondary to anxiety, so use psychotherapy, behavioral modification techniques, and SSRIs
What are considered protective factors for suicide?
- strong connection to family
- pregnancy or responsibility for children
- religious affiliation
What are risk factors for attempting suicide?
Sex (male) Age (younger and older) Depression Prior Attempt (#1 risk factor) EtOH/Drug Use Rational Thinking Loss Social Support Lacking Organized Plan No Spouse Sick
