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Psychiatry > Review > Flashcards

Review Flashcards

1
Q

How do we clinically assess mania

A 
DIG FAST
distractibility
irritable mood/insomnia
grandiosity
flight of ideas
agitation/increase in goal-directed activity
speedy thoughts/speech
thoughtlessness: seeks pleasure without regard for consequences
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2
Q

How do we assess suicide risk

A 
SAD PERSONS
sex --male 
age >60 
depression
previous attempt
ethanol/drug use
rational thinking loss
suicide in family
organized/plan/access
no support
sickness
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3
Q

How do assess for depression

A 
SIGECAPS
sleep 
interest
guilt
energy
concentration
appetite
psychomotor
suicidal ideation
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4
Q

delirium tremens is what

A

a psychiatric emergency characterized by:
2-4 days after cessation of alcohol. delirium, agitation, fever, autonomic hyperactivity, auditory and svisual hallucinations

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5
Q

what is the treatment of DTs

A

aggressive treatment with Benzodiazepines

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6
Q

what is neuroleptic malignant syndrome

A

fever, rigidity, autonomic instability, clouding of consciousness, elevated WBC, CPK.

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7
Q

what is the treatment for NMS

A

withhold neuroleptics, hydrate. consider dantrolene and bromocriptine.

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8
Q

what is serotonin syndrome

A

precipitated by drug combinations MAOi and SSRIs. altered mental status, fever, agitation, tremor, myoclonus, hyperreflexia, ataxia, incoordination, diaphoresis, shivering, diarrhea,

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9
Q

treatment for Serotonin syndrome

A

Benzos, cyproheptidine.

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10
Q

hypertensive crisis

A

combination of tyramine containing foods and MAOis. hypertension, headache, neck stiffness, sweating, nausea, vomiting, visual problems,. can cause stroke or death

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11
Q

treatment of hypertensive crisis

A

phentolamine or nitroprusside.

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12
Q

what is acute dystonia

A

early sudden onset of muscle spasms, can be of the eyes, neck, tongue, jaw and can even be laryngospasm.

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13
Q

treatment for acute dystonia

A

benztropine. diphenhydramine

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14
Q

lithium toxicity

A

when lithium levels are greater than 1.5. nausea, vomiting, myoclonus, seizure, nephrogenic diabetes insidious, hyperreflexia, slurred speech, incoordination.

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15
Q

treatment for lithium tox

A

hydration and consider hemodialysis

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16
Q

TCA toxicity

A

primarily anticholinergic effects. hypotension, cardiac conduction disturbances, hallucinations, respiratory depression, agitation, depression, seizures.

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17
Q

treatment for TCA tox

A

activated charcoal, cathartics and supportive treatment

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18
Q

what is contained in the thought process portion of mental status

A

tangibility, loosening of associations, flight of ideas, neologisms, word salad, clang associations, thought blocking.

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19
Q

what is tangibility

A

point of the conversation is never reached, responses usually in the ballpark

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20
Q

what is loosening of associations

A

no logical connection between thoughts

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21
Q

what is flight of ideas

A

thoughts change abruptly from one idea to another, usually accompanied by rapid pressured speech

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22
Q

neologism

A

made up words

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23
Q

what is word salad

A

collection of words incoherent.

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24
Q

what are clang associations

A

word connections due to phonetics rather than meaning “my car is red, I have been in bed, I hurt my head.

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25
Q

what is thought blocking

A

abrupt end to the conversation or cessation of communication before the idea is finished.

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26
Q

what do we always ask when a patient has hallucinations?

A

does this happen when falling asleep (hypnogogic) or when waking up (hypnopompic)

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27
Q

what are positive symptoms of schizophrenia

A

hallucinations, delusions, bizzarre behaviors, disorganized speech. these responds more robustly to antipsychotic.

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28
Q

what are negative symptoms schizophrenia

A

flat or blunted affect, anhedonia, alogia, and lack of interest in socialization. these are more likely to be treatment resistant.

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29
Q

how do we diagnose schizophrenia

A

must have at least 2 of the following for at least one month and at least one must be either 1, 2, 3:

1) delusions
2) hallucinations
3) disorganized speech
4) grossly disorganized or catatonic behavior
5) negative symptoms

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30
Q

what are the statistics of schizophrenia world wide prevalence, monozygotic twins, risk of inheritance if both parents have it, risk if first degree relative

A

prevalence is 1%. 50% concordance rate in twins, 40% inheritance rate if both parents, 12% if a first degree relative.

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31
Q

what are the most commonly abused drugs in SZ

A

nicotine by far the most, alcohol, cannabis, cocaine

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32
Q

what is the difference between schizophrenia and schizophreniform

A

they have the same criteria, but schizophreniform lasts between 1 and 6 months, whereas schizophrenia lasts greater than 6 months.

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33
Q

can people recover from schizophreniform

A

yes, 30% recover completely. 2/3 progress to schizoaffective or full schizophrenia

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34
Q

what are the criteria for schizoaffective

A

meet the criteria for major depressive or manic episode during which the psychotic symptoms of schizophrenia are also met. they must have delusions or hallucinations for at least 2 weeks without mod symptoms (this differentiates between affective and mood disorder with psychotic features). mood symptoms are present for a majority of the psychotic illness

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35
Q

what makes the prognosis for schizoaffective worse

A

slow onset, early onset, poor premorbid adjustment. predominance of psychotic symptoms. is there is long course and a family history of schizophrenia.

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36
Q

what is brief psychotic disorder

A

psychotic symptoms of schizophrenia for between 1 day top one month with a full return to premorbid level of functioning.

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37
Q

is brief psychotic disorder rare

A

yes. much more rare than a diagnosis of schizophrenia.

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38
Q

what is the prognosis for brief psychotic disorder

A

almost all completely recover, but there is high rate of relapse.

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39
Q

how to differentiate between schizophrenia and delusional disorder

A

the delusions are usually different. delusional disorder delusions are usually not bizarre.

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40
Q

what are the types of delusions in delusional disorder

A

erotomania, grandiose, somatic, persecutory, jealous, mixed, unspecified.

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41
Q

why is delusional disorder hard to treat?

A

because there is a lack of insight

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42
Q

what is schizotypal disorder

A

personality disorder with paranoid, odd or magical beliefs eccentric, lack of friends, social anxiety, yet the criteria for overt psychosis are not met.

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43
Q

what its schizoid

A

personality disorder, solitary activities lack of enjoyment from social interactions, not psychosis.

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44
Q

what is the definition of hypomania

A

distinct period of abnormally and persistent elevated, expansive, or irritable mood with increased goal directed activity or energy that lasts for at least 4 consecutive days.

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45
Q

what are the differences between mania and hypomania

A

mania lasts for at least 7 days, while hypomania lasts for 4; mania causes severe impairment in social or occupational functioning, while hypomania doe snot cause marked or impaired function; mania usually requires hospitalization, while hypomania does not; mania can have psychotic features, while hypomania does not.

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46
Q

how do we diagnose PTSD?

A 
TRAUMA
trauma
revisiting (re-experiencing)
avoidance 
unable to function
month or more
arousal

The experience is also associated with negative emotions such as fear, horror, anger and guilt.
the symptoms of increased arousal are reactivity, hyper-vigilance, exaggerated startle response, irritability or anger outburst, impaired concentration and insomnia.

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47
Q

what are the features of serotonin syndrome

A

the three As. agitation, autonomic stimulation, hyperactive neuromuscular junction.
hyperreflexia, clonus, tremor, seizure, hypertonia. hyperthermia, diaphoresis, diarrhea, tachycardia and agitation
MYDRIASIS

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48
Q

what is the definition of delirium

A 
rapid onset (hours to days), fluctuating levels of consciousness, can have psychotic features, inattention.
associated with illness or medications.
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49
Q

what is the difference between delirium and psychosis due to a medical problem

A

the onset for delirium is rapid and there are other features with delirium, not purely psychosis, for example inattention, forgetfulness, fluctuating levels of consciousness.

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50
Q

what is a delusional disorder

A

fixed, persistent, false belief that occurs for longer than one month. they do not have decreases in functional status and do not fit the criteria for a psychiatric disorder.

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51
Q

what is highly comorbid with adhd

A

tourettes. be careful because the vignettes could so similar that you won’t know the difference.

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52
Q

what is the only FDA approved medication for tourettes

A

pimozide

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53
Q

what is the treatment for lithium-induced nephrogenic diabetes insipidus

A

removing the agent for adding thiazide diuretic, such as hydrochlorothiazide, ameloride, indomethacin, desmopressin

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54
Q

what drug can cause delirium when administered in the context of EPS

A

diphenhydramine can cause polypharmacy delirium.

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55
Q

what is the treatment for diphenhydramine induced delirium

A

physostigmine

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56
Q

when do sleep walking and night terrors occur

A

during deepest sleep, N3

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57
Q

how do night terrors present

A

The child will be tachycardic, diaphoretic, and very frightened. The child will have a sudden attack and sit up in bed, yet he or she will not be fully awake. He or she will generally fall asleep after the episode, and at times may not have any recollection of the event. Night terrors often occur in combination with somnambulism (sleepwalking). Sleepwalking and night terrors both occur during the deepest stages of non-REM sleep (stages 3 and 4).

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58
Q

how frequently do you check blood draws for agranulocytosis when on clozapine

A

Once every week for first 6 months
Once every 2 weeks for next 6 months
Once every month indefinitely after

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59
Q

what is the treatment for ASD

A

behavioral modification therapy. there is no role for pharmacology

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60
Q

what are the most common presentations for acute dystonia and what are the treatments

A

torticolis, ocular upward gaze, diphenhydramine and benztropine

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61
Q

which antipsychotics do you use for the treatment of psychosis in parkinsons patients

A

quetiapine, clozapine. benzos are the best choice.

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62
Q

which eeg pattern will night terrors have

A

delta

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63
Q

what is the presentation of phencyclidine OD

A

possible track marks, a common indicator of intravenous drug abuse. She is febrile, tachycardic, with additional symptoms consistent with hallucinogen intoxication. Her father describes violent behavior with vertical nystagmus, depersonalization, and hallucinations.

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64
Q

do people have memory of their nightmares

A

yes.

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65
Q

what is the treatment for nightmares

A

psychotherapy.

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66
Q

what is the treatment for refractory nightmares

A

clonazepam

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67
Q

what are the treatments for insomnia

A

good sleep hygiene is important. if this is already done then use of phototherapy can help.

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68
Q

what is the diagnostic criteria for tourettes

A

childhood vocal and motor ticks that last over 1 year.

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69
Q

what is the treatment for tourettes

A

antipsychotics, clonidine/guanfecine, behavioral therapy

70
Q

what are the treatments in order for enuresis

A

lifestyle change, enuresis alarms, desmopressin

71
Q

what are the treatments for chronic insomnia

A

sleep hygiene methods, CBT, benzos, non-benzos (zolpidem), antidepressants (trazodone, amitryptiline)

72
Q

what do delirium tremens look like

A

anxiety, tremors, tachycardia and can involve tactile hallucinations, increased respiratory rate, increased blood pressure.

73
Q

what is the treatment for DT

A

benzos long acting.

74
Q

what is the treatment for sleep terros

A

reassurance that this will go away in 1-2 years s the recommended treatment, but benzos can be also be given.

75
Q

what is the treatment for seasonal affective disordre

A

bright light therapy and antidepressants

76
Q

what are the features of atypical depression

A

mood reactivity. leaden paralysis, increased appetite, increased sleep.weight gain, increased sensitivity to rejection.

77
Q

what is melancholic depression

A

Melancholic depression is a subtype of clinical depression requiring either anhedonia or lack of mood reactivity. It also involves depression, severe weight loss, psychomotor agitation, early morning awakening, excessive guilt, and worse mood in the morning.

78
Q

what neurotransmitter is involved in the pathology of OCD

A

serotonin

79
Q

what does aspirin intoxication cause

A

metabolic acidosis and respiratory alkalosis

80
Q

how do we treat post surgical shivering

A

meperidine. however, if the person has a contraindication then use dexmedetomide or clonidine.

81
Q

what is absolutely contraindicated in a patient taking an MAOI

A

TCA, dextromorphan, meperidine, SSRI/SNRI,

82
Q

what is munchausen disorder

A

patients actively make themselves sick by falsifying medical test or taking excessive medication or meds not prescribed to them.

don’t confuse this with malingering.

83
Q

if a patient has a normal electrolyte panel and the ability to concentrate urine what is the diagnosis but a complaint of excessive urination

A

central polydipsia.

this is excessive thirst that causing excessive urination.

84
Q

what is the best choice for a benzo in the treatment of panic disorders

A

potency or short acting.

look for clonazepam or olams such as alprazolam.

85
Q

what drug do you use for acute mania in a pregnant woman

A

haliperidol because valproate, lithium are teratogenic and lamotrigine is only for bipolar depression

86
Q

what is first line treatment for late life depression

A

sertraline

87
Q

what is the treatment for hallucinations that are not distressing or commanding

A

they do not have to be treated. You can be conservative

88
Q

what is a leading cause of enuresis in children with obesity

A

obstructive sleep apnea

89
Q

what is the approach to enuresis

A

urinalysis, focused history and physical with fluid intake, stool and voiding diary then a thorough clinical evaluation

90
Q

what is confabulation

A

Confabulation is characterized by a memory disturbance, defined as the production of fabricated, distorted or misinterpreted memories about oneself or the world, without the conscious intention to deceive.

91
Q

what does flumazenil do and what is it used for

A

this is to reverse Benzodiazepines overdose

92
Q

what are fluency disorders

A

this is stuttering and fluttering speech

93
Q

what kind of drug is benztropine

A

anti-muscarinic

94
Q

what kind of fractures are often found in anorexia

A

metatarsal fractures

95
Q

what are the treatments for OCD

A

SSRIs, clomipramine (TCA), venlafaxine

96
Q

what is the mechanism of mertazapine

A

increases the release of serotonin and norepinephrine

97
Q

what is the mechanism of action of bupropion

A

decreases the reuptake of dopamine, norepinephrine and serotonin

98
Q

what treatments are good for depression and insomnia

A

mertazapine and trazadone

99
Q

what are some of the anticholinergic side effects

A 
dry mouth, tachycardia, urinary retention, confusion
Red as beat flushing
dry as a bone no sweating
blind as a bat dilated pupils
mad as a hatter  confusion
100
Q

what is ego-syntronic

A

your behavior is consistent with your beliefs

101
Q

what drug is for Benzodiazepines reversal and what are SE

A

flumazenil and seizures

102
Q

what are the symptoms of bereavement

A

major complaint is the feeling of loss, normal self-esteem, negative feelings of pain and grief are mixed with positive memories.feeleings of love, no SI, daily functioning is maintained

103
Q

what treatments do you give to a patient that fails haloperidol and has a history of diabetes

A

ziprasidone or aripiprazole low risk profile for metabolic disorder

104
Q

which antipsychotic can cause hypothermia by disrupting the thermoregulatory center

A

fluphenazine –think the flu causes shivers

105
Q

what is the treatment of acute intermittent porphyria

A

heme and glucose. inhibition of ALA synthase

106
Q

what is the best treatment for GAD and sexual dysfunction

A

buspirone

107
Q

what is habit reversal training

A

CBT for tourettes

108
Q

what is the treatment for dissociative identity disorder

A

trauma-focused psychotherapy

109
Q

what is the treatment for adjustment disorder

A

CBT/psychotherapy

110
Q

what is the only FDA approved weight loss therapy

A

combination topiramate and phentermine f

111
Q

what common defense mechanism is seen in paranoid personality disorder

A

projection –attributing thoughts and feelings to others. paranoia results from projection

112
Q

what is central sleep apnea

A

sleep apnea due to a medical condition such as heart failure

113
Q

what stage of sleep do most of the parasomnias occur?

A

in the non-REM deep sleep phases N3 and 4.

the exception is nightmare and REM-sleep behavior disorder

114
Q

what is the mechanism of action for amenorrhea in anorexia

A

loss of pustule GnRH

115
Q

what are the primary symptoms of narcolepsy

A

excessive daytime sleepiness and sleep attacks

116
Q

what is idealization

A

thinking about all the positive things about yourself and others while disregarding the others

117
Q

what is intellectualization

A

using facts and logic to distance oneself from an emotional situation

118
Q

what receptors are targeted by atypical antipsychotic

A

dopamine 2 and serotonin 2a

119
Q

what are the side effects of SSRIs

A

headache, nausea, vomiting, insomnia, nervousness and sexual dysfunction

120
Q

mechanism of action of mertazapine

A

alpha 2 agonist that increased the release of the norepinephrine and serotonin

121
Q

what is second line pharmacological treatment of atypical depression

A

MAOIs

122
Q

what is the definition of the specifier catatonia

A

cataplexy (immobility), purposeless movement extreme negativism, mutism, bizarre postures and echolalia

123
Q

what is agoraphobia, what is it associated with and what is the treatment

A

this is an anxiety disorder that consists of fear of places that cause panic, such as ones that you cannot escape from, become trapped or embarrassed.
treatment is CBT and SSRIs

124
Q

what are the development for a 3 month old

A

gross motor roll, no fine motor, laughing, and smiling

125
Q

what are the development for a 6 month old

A

sit, switches, cooing, stranger anxiety begins

126
Q

what are the development for a 9 month

A

gross motor they pull, they have pincer, say papa, play with another/stranger anxiety peaks

127
Q

what is the development for a 12 month old

A

two legs motor, fine motor track, two word language, two of us for social
separation anxiety

128
Q

what is separation anxiety, what does it look like and what is the treatment

A

excessive and developmentally innappropriate fear/anxeity regarding the separation from attachment figures. leads to extreme distress, usually fear about loss of harm to attachment figures. excessive worry. reluctance to leave home or be alone, sleep alone, complaints of physical symptoms
nightmares, lasts for >4 weeks in children and >6months in adults.
treatment is CBT, family therapy. SSRIs work well with adjuvant therapy

129
Q

what is the longterm treatment for panic disorder

A

CBT with SSRIs

130
Q

what is advanced sleep phase disorder and what is the treatment

A

when the circadian rhythm sleep wake cycle begins and ends earlier than normal
the treatment is phototherapy in the evening

131
Q

what do you give a patient with depression and sexual SE

A

bupropion

132
Q

what is anaclitic depression

A

a pattern of muscle wasting and psychological depression thought to stem from lack of social contact during key developmental stages. this can be part of reactive attachment disorder

133
Q

what two classes of drugs should you avoid when taking SSRIs

A

dNSAIDs except for aspirin

134
Q

what are the only two drugs that are FDA approved for depressive symptoms of bipolar

A

lithium and lamotrigine

135
Q

what is the treatment for NMS

A

supportive therapy with dantrolene and bromocriptine being second line

136
Q

what is parental emotional abuse associated with

A

suicide, antisocial personality, depression, borderline personality,

137
Q

what is sublimation

A

replacing an unacceptable impulse into a more acceptable and socially accepted one

138
Q

what are the signs of delirium tremens

A

hallucinations, agitation, with changes in vital signs, such as hyperventilation, tachycardia, and hypertension.

139
Q

what are the signs of alcoholic hallucinosis

A

12-24 hours after abstinence and usually resolves within 24 hours. hallucinations not associated with confusion, patients are aware that they are hallucinating and there is usually no changes in vitals

140
Q

what is the best option for a person that has a good response to SSRIs but has sexual SE

A

augment or replace the current with bupropion

141
Q

what are common sexual SE of SSRI use

A

anorgasmia or decreased libido

142
Q

agoraphobia is defined how

A

anxiety disorder persistent and irrational fear of being in situations that difficult to escape or where help will be difficult. sing public transportation, being in open or enclosed spaces, standing in line a crowd or leaving the home alone.

143
Q

what is Jamis vu

A

when you “haven’t seen this before, but you really have” or the opposite of deja vu

144
Q

what is presque vu

A

tip of the tongue phenom or when you cant quite recall something

145
Q

what is deja entendu

A

hearing something familiar, as if you have heard it before. This is very similar to deja vu

146
Q

what is a paraphillic disorder

A

auto-erotic asphyxiation is an example. its when people have sexually excitement or fantasy our a particular object or engaging in a particular act.

147
Q

when do kids usually begin to show their parents an object that they also want them to take interest in?

A

when they are 12 months old

148
Q

what NSAIDs can you use when taking lithium

A

aspirin and sudinlac

Do not use ibuprofen

149
Q

when is the onset for FTD

A

45-65. survival is about 8 years

150
Q

how do you know the difference between avoidant and schizoid

A

schizoid choose to be alone, avoidant fear rejection and think people won’t like them

151
Q

what ethnic group is at the highest risk for SJS?TEN from carbamazepine

A

southeastern asian –the Han Chinese

152
Q

what does anticholinergic syndrome look like, what is the treatment for anticholinergic syndrome
what could be the offending agent?

A

increased heart rate, decreased BP, pupillary dilation with no accommodation. can cause hallucinations

physostigmine

atropine

153
Q

what drug has a similar mechanism of action as varenicline

A

buprenorphine

a partial agonist of the mu-opioid receptor.

154
Q

what is the mechanism of action for varenicline

A

partial agonist at the nicotinic AChR but binds more weakly than nicotine.

155
Q

what is the mechanism of action of bupropion and what is it similar to mechanistically

A

it is an antagonist of the nictinic AChR.

it is similar to naloxone

156
Q

what kind of depression is likely in a graduate student who is preoccupied with face-picking and nail-biting during the interview

A

depression with anxiety and/or obsessive-compulsive subtype

the personality and evidence fit perfectly

157
Q

Are somatic symptoms found in major depression

A

yes, they are often found. this can cloud the diagnosis. look for mood symptoms beginning before the somatic symptoms.

158
Q

what kind of disorder is tillotrichomania and what is first line therapy

A

this is an anxiety disorder with impulsive action.

CBT

159
Q

which antidepressants can cause weight gain

A

paroxetine and mertazapine

160
Q

what does alcohol do to the autonomic nervous system with respect to cardiac fucntion

A

can temporarily suppress the regulation of cardiac pacemakers

161
Q

what drug causes rotary nystagmus

A

PCP

162
Q

what are the most common consequences of sexual abuse or rape?

A

PTSD, depression and suicidal ideation and attempts.

163
Q

Do we use SSRIs for hoarding disorder

A

No. Not unless there is OCD comorbid. There is limited efficacy

164
Q

what is the treatment for pseudodementia

A

SSRI

165
Q

when is orlistat indicated

A

when the BMIis greater than 30

166
Q

what are the prodromal signs of schizophrenia

A

decline in functioning that precedes first psychotic break. the patient usually becomes socially withdrawn and irritable. they may have physical complaints declining school work performance. or a newfound interest in religion.

167
Q

what is the differential for depressed mood

A

major depressive disorder, adjustment disorder, normal stress response

168
Q

what is normal stress response

A

not excessive or out of proportion to severity of stressor. no significant impairment

169
Q

what is adjustment disorder

A

identifiable stressor with an onset within 3 months of stressor. marked distress. significant functional impairment but it does not meet the criteria for DSM-5 criteria

170
Q

what is conversion disorder

A

this is neurological symptoms such as paralysis, loss of speech, vision, verbal expression, swallowing, or some other voluntary system, non-epileptic seizure, following a stressor. This is not factitious disorder or malingering, but the symptoms do not fit a neurological disorder.

171
Q

what are the therapies for conversion disoder

A

first line: self-help and education.

second line is CBT

172
Q

what is the treatment for kleptomania

A

CBT and SSRIs

Psychiatry (11 decks)

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