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STEP2 > Psychology > Flashcards

Psychology Flashcards

1
Q

What criteria must be met for a diagnosis of intellectual disability?

A

deficits in both intellectual functioning and the ability to do daily activities

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2
Q

What are the most common causes of intellectual disability?

A
  • fetal alcohol syndrome is the most common overall

- trisomy 21 and fragile X syndrome are the most common genetic causes

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3
Q

Describe the presentation and treatment of autism. What is the development of autism associated with?

A
  • 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
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4
Q

Describe the diagnosis and treatment of ADHD.

A
  • 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
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5
Q

What are the clinical features and treatment of oppositional defiant disorder?

A

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

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6
Q

What are the clinical features and treatment of conduct disorder?

A

these children demonstrate rule breaking and violate the rights of others; should reward prosocial and nonaggressive behavior while using antipsychotics to control aggression

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7
Q

What are the clinical features of disruptive mood dysregulation disorder?

A

these individuals have a constantly irritable or angry mood interspersed with temper outbursts, diagnosed before age 10

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8
Q

Tourette disorder is associated with what two other psychiatric illnesses?

A

OCD and ADHD

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9
Q

MDD is associated with what neurotransmitter imbalances?

A

decreased NE, DA, and serotonin

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10
Q

If an SSRI is started and the patient sees no benefit, how long should the medication be trialed before switching to another agent?

A

4-6 weeks

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11
Q

Which SSRIs are safest for cardiac patients?

A

sertraline and escitalopram

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12
Q

How long must SSRIs be discontinued before an MAOI can be started?

A

this transition requires a 2 week wash out period

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13
Q

What are the indications for ECT?

A
  • treatment refractory depression
  • inability to care for one’s self
  • impending suicide
  • psychotic features
  • MDD complicated by pregnancy
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14
Q

What are the criteria for a manic episode?

A

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
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15
Q

Mania is associated with what neurotransmitter imbalances?

A

an increase in NE and serotonin

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16
Q

What are considered first-line medications for mania?

A
  • 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
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17
Q

What are the criteria for dysthymia?

A

at least 2 symptoms of major depressive episode lasting for at least 2 years and never without symptoms for longer than 2 months

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18
Q

What are the criteria for cyclothymic disorder?

A

must meet criteria for hypomanic episodes and mild depression for more than 2 years

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19
Q

What is unique about the presentation and treatment of atypical MDD?

A
  • 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
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20
Q

What is the treatment for MDD with seasonal pattern?

A

phototherapy and either an SSRI or bupropion

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21
Q

Describe the differences between postpartum blues, depressive disorder with peripartum onset, and bipolar disorder with permpartum onset/brief psychotic disorder with peripartum onset.

A

> 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

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22
Q

Describe the presentation and treatment of bereavement.

A

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

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23
Q

Describe the presentation and treatment of serotonin syndrome.

A
  • 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
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24
Q

What is the difference between brief psychotic disorder, schizophreniform disorder, and schizophrenia?

A

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

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25
Q

What are the diagnostic criteria for schizophrenia?

A

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
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26
Q

Clozapine should only be started in which psychotic patients?

A

those who have failed two other antipsychotic medications

27
Q

Which antipsychotics have the fewest metabolic effects?

A

ziprasidone and aripiprazole

28
Q

What is unique about the adverse effect profile for each of the following antipsychotics:

  • olanzapine
  • risperidone
  • quetiapine
  • ziprasidone
  • clozapine
  • aripiprazole
  • lurasidone
A
  • 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
29
Q

Which antipsychotic is preferred for pregnant patients?

A

lurasidone

30
Q

What is the treatment for the EPS of antipsychotics?

A
  • dystonia: diphenhydramine
  • akathisia: propanolol
  • parkinsonism: benztropine or trihexyphenidyl
  • tardive dyskinesia: stop offending agent and use valbenazine
31
Q

Describe the presentation and treatment of neuroleptic malignant syndrome.

A
  • 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
32
Q

How is schizoaffective disorder defined? What is the treatment?

A
  • 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
33
Q

How are panic attacks and panic disorders diagnosed? How does the treatment differ for the two?

A
  • 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
34
Q

What is the treatment for OCD?

A
  • SSRIs are the treatment of choice combined with exposure and response prevention therapy
  • if SSRIs fail, add clomipramine as the preferred TCA
35
Q

What is the treatment for body dysmorphic disorder?

A

SSRIs and individual psychotherapy

36
Q

What is the treatment for PTSD and acute stress disorder?

A
  • SSRIs
  • prazosin for nightmares
  • relaxation techniques and hypnosis
37
Q

Which benzodiazepines are suitable for treating alcohol withdrawal in those with liver disease?

A

LOT: lorazepam, oxazepam, temazepam

38
Q

When can flumazenil be used?

A

it is used only for the acute treatment of benzodiazepine overdose; for those with chronic dependence it will precipitate a dangerous withdrawal

39
Q

What is the treatment for opioid overdose and for opioid withdrawal?

A
  • overdose: naloxone

- withdrawal: clonidine, methadone, buprenorphine

40
Q

Name four medications useful for treating alcohol use disorder.

A
  • 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
41
Q

How is somatic symptom disorder differentiated from conversion disorder?

A
  • 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
42
Q

What effects do antipsychotics (dopamine antagonists) elicit based on their action in the mesolimbic, nigrostriatal, and tuberoinfundibular tracts.

A
  • mesolimbic: antipsychotic effect
  • nigrostriatal: extrapyramidal symptoms of akathisia, parkinsonism, and dystonia
  • tuberoinfundibular: hyperprolactinemia
43
Q

What is the best treatment for a pregnant patient with bipolar disorder?

A

lamotrigine, which has the lowest teratogenicity of the mood stabilizers

44
Q

What are Wernicke encephalopathy and Korsakoff syndrome? What neurologic lesions is each associated with?

A
  • 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
45
Q

What is the key difference between binge-eating disorder and bulimia nervosa?

A

binge-eating disorder does not involve any compensatory behaviors like bulimia nervosa does

46
Q

Describe the presentation and treatment of binge-eating disorder.

A
  • patients present with recurrent episodes of binge eating and have no compensatory behaviors
  • treat with CBT, an SSRI, lisdexamfetamine, and topiramate
47
Q

Describe the presentation and treatment of anorexia nervosa.

A
  • 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)
48
Q

Describe the presentation of bath salts intoxication.

A
  • presents with tachycardia, severe agitation, combativeness, delirium, and psychosis
  • in contrast to other stimulants, the effects take several days to subside
49
Q

What is reactive attachment disorder?

A

a pattern of emotional and social withdrawal stemming from past experiences of neglect or abuse leading to insecure attachment to caregivers

50
Q

Which opioids do not appear on a UDS and why?

A
  • 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
51
Q

For which patients is there an increased risk for suicide during the course of antidepressant therapy?

A

for those under age 25

52
Q

What is the indication for the following:

  • CBT
  • interpersonal psychotherapy
  • psychodynamic psychotherapy
  • motivational interviewing
  • DBT
  • biofeedback
A
  • 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
53
Q

How would you differentiate opioid withdrawal from cocaine intoxication?

A
  • 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
54
Q

What is the preferred treatment for catatonia?

A

benzodiazepines or ECT

55
Q

What is the primary difference between factitious disorder and malingering?

A

factitious disorder is unconsciously motivated and for intrinsic gain whereas malingering is consciously driven and for secondary gain

56
Q

The treatment for adjustment disorder is what?

A

psychotherapy

57
Q

What is the treatment for bulimia nervosa?

A

SSRIs and CBT

58
Q

What are the four key features of narcolepsy? How is it treated?

A
  • daytime sleepiness, sleep paralysis, hypnogogic/hypnopompic hallucinations, cataplexy
  • treat with sleep hygiene, daytime naps, and modafinil
59
Q

Narcolepsy is associated with what molecular deficit?

A

loss of hypocretin

60
Q

What is impotence and how should it be treated?

A
  • it is the inability to attain or maintain an erection until completion of the sexual act
  • treat with psychotherapy and couples sex therapy
61
Q

What is the treatment for premature ejaculation?

A

thought to be secondary to anxiety, so use psychotherapy, behavioral modification techniques, and SSRIs

62
Q

What are considered protective factors for suicide?

A
  • strong connection to family
  • pregnancy or responsibility for children
  • religious affiliation
63
Q

What are risk factors for attempting suicide?

A 
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

STEP2 (27 decks)

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