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Psychiatry Shelf > Shelf Facts > Flashcards

Shelf Facts Flashcards

1
Q

Mania mnemonic

A

DIG FAST
distractibility
irritable mood
grandiosity
flight of ideas
agitation/increase in goal directed activity
speedy thoughts/speech thoughtlessness: see pleasure without regard to consequences

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2
Q

suicide risk mnemonic

A 
SAD PERSONS
sex- male
age > 60
depression
previous attempt
ethanol/ drug abuse
rational thinking los
organized plan/access
no support
sickness
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3
Q

depression mnemonic

A 
SIG E CAPS
sleep
interest
guilt
energy
concentration
appetite
psychomotor changes
suicidal ideation - hopelessness, helplessness, worthlessness
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4
Q

alcohol intox/withdrawal

A

Intox - disinhibited, mood lability, incoordination, slurred speech, ataxia, blacouts, respiratory depression
Withdrawal - tremulousness, hypertension, tachycardia, anxiety, psychomotor agitation, nausea, seizures, hallucinations, DT

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5
Q

benzo intox/withdrawal

A

Intox - disinhibited, mood lability, incoordination, slurred speech, ataxia, blackouts, respiratory depression
Withdrawal - tremulousness, hypertension, tachycardia, anxiety, psychomotor agitation, nausea, seizures, hallucinations, DT

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6
Q

Bar intox/withdrawal

A

Intox - respiratory depression

Withdrawal - anxiety, seizures, delirium, life-threatening CV collapse

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7
Q

opioids intox/withdrawal

A

Intox - CNS depression, nausea, vomiting, sedation, decreased pain perception, decr GI, pupil constriction, resp depression
Withdrawal - increase dsympathetic activity, N/V/D, diaphoresis, rhinorrhea, piloerection, yawning, stomach cramps, myalgias, arthralgias, restlessness, anxiety, anorexia

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8
Q

amphetamines, cocaine intox/withdrawal

A

Intox - euphria, increased attention, aggressiveness, agitation, pupil dilatation, hypertension, tachy, cardiac arrhythmias, psychosis
Withdrawal - post use crash, restlessness, HA, hunger, severe depression, insomnia/hypersomnia, strong psychological testing

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9
Q

PCP intox/withdrawal

A

Intox - belligerence, impulsiveness, agitation, vert/horizontal nystagmus, hyperthermia, tachy, ataxia, psychosis, homicidal
Withdrawal - recurrence of symptoms from reabsorption in GI

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10
Q

LSD intox/withdrawal

A

Intox - altered perception, elevated mood, panic, flashbacks

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11
Q

Cannabis

A

Intox - euphoria, anxiety, paranoia, slowed time, social withdrawal, increased appetite, dry mouth

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12
Q

nicotine/caffeine intox/withdrawal

A

Intox - restlessness, insomnia, anxiety, anorexia

Withdrawal - irritability, lethargy, headache, increased appetite, weight gain

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13
Q

DT’s - timing, sx, tx

A

2-4 days
delirium, agitation, fever, autonomic hyperactivity, auditory and visual hallucinations
benzos and hydration

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14
Q

NMS - sx, tx

A

fever, rigidity, autonomic instability, clouding of consciousness
withhold neuroleptics, hydrate, consider dantrolene

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15
Q

Serotonin syndrome - sx, tx

A

AMS, fever, agitation, tremor, myoclonus, hyperreflexia, ataxia, incoordination, diaphoresis, shivering, diarrhea

stop agents, cyproheptadine

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16
Q

tyramine reaction/HTN crisis - cause, sx, tx

A

tyramine foods while on MAOI
HTN, HA, stiff nec, sweating, nausea, vomiting, visual problems, stroe, death
phentolamine

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17
Q

Dystonia - sx, tx

A

muscular spasm, eyes, tongue, jaw, neck

benztropine or diphenhydramine

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18
Q

medical causes of psychosis

A

CNS disease: alz, parinson, HD, tertiary syph, epilepsy, prion disease
endocrin: addison/cushing disease, hyper/hypo thyroid, yper/hypo calcemia, hypopit
nutritional: B12, folate, niacin
Other: SLE, porphyria

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19
Q

timeline of schizophrenia and phases

A

positive or negative sx for at least 6 months

prodromal - decline in functioning ie socially withdrawn and irritable
psychotic - perceptual disturbances, delusions, disordered thought
residual - occurs between psychosis, flat affect, social withdrawal, odd behavior

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20
Q

negative symptoms of schizo mnemonic

A 
5 A's
anhedonia
affect (flat)
alogia (poverty of speech)
avolition (apathy)
attention (poor)
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21
Q

Types of schizophrenia

A

paranoid - delusions and auditory hallucinations, older age of onset

disorganized type - disorganized speech, behavoir, flat or inappropriate affect –> poor functioning

catatonic type - rigid posture, inappropriate or repetitive and purposeless movements, echolalia, echopraxia

residual type - negative symptoms

undifferentiated - does not fit in others

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22
Q

drugs that mimic schizo

A

cocaine and amphetamine

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23
Q

predisposing factor to paranoid schizophrenia

A

deafness

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24
Q

schizophreniform timeline

A

1-6 months

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25
Q

schizoaffective disorder

A

have major depressive, manic or mixed

have delusions or hallucinations for 2 weeks in absence of mood disorder

mood symptoms for substantial portion of psychotic illness

not related to drugs

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26
Q

what do patients with schizoaffective disorder progress to

A

schizophrenia (60-80%)

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27
Q

brief psychotic disorder

A

psychotic symptoms 1 day to 1 month

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28
Q

delusional disorder - occurs, sx, tx

A

most common in older patients, immigrants, hearing impaired

nonbizarre, fixed delusionsfor at least 1 month
not schizophrenic
functioning

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29
Q

major depressive disorder time course

A

2 weeks of depressed mood and anhedonia with at least 4 other symptoms

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30
Q

mania time course

A

elevated expansive or irritable mood for at least 1 week

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31
Q

mania vs hypomania

A

mania causes severe impairment in social functioning and may have psychotic features

hypomania - no psychotic features, no marked impairment

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32
Q

major depressive disorder - prevalence and age

A

16.2% and 40

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33
Q

major depressive disorder - sleep problems

A
  • multiple awakenings
  • initial and terminal insomnia
  • hypersomnia
  • REM shifted
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34
Q

major depressive disorder with atypical features - description and tx

A

mood reactivity, leaden paralysis, hypersomnia

tx: MAOIs

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35
Q

bipolar disorder 1 - prevalence and tx

A

1%, age before 30

tx: lithium, anticonvulsants, atypical antipsych, ECT (pregnancy or refractory tx)

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36
Q

bipolar disorder 2 - description, prevalence, tx

A

major depressive episodes with hypomania

prevalence - more common than bipolar 1, age before 30

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37
Q

dysthynmic disorder - description

A

chronic mild depression, no episodes for at least 2 years

  • sx not gone for > 2 months
  • tx cognitive therapy or antidepressant meds
  • never have psychotic features
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38
Q

cyclothymic disorder

A

alternating hypomania and mild depressive symptoms

  • at least 2 years, never been sx free for > 2 months
  • no major depressive episodes and no manic episodes
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39
Q

adjustment disorder - time course

A

symptoms witin 3 months of stressor and end within 6 months, impairment in daily functioning or interpersonal relationships
- not life threatening event

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40
Q

panic attacks/disorder - tx

A

SSRIs (paroxetine and sertraline)

- clomipramine and imipramine, benzos

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41
Q

performance anxiety - tx

A

propranolol

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42
Q

social anxiety - tx

A

paroxetine (SSRI)

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43
Q

OCD - prevalence and tx

A

2-3%, distressed by sx

tx: SSRIs, TCAs

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44
Q

PTSD vs acute stress disorder timeline

A

ASD 1 month, lasting 1 month

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45
Q

GAD - tx, time course

A

6 months

Tx: SSRIs, SNRIs

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46
Q

paranoid personality disorder

A

suspicion, no evidence, preoccupation with doubts of loyalty or trustworthiness, reluctance to confide in others

  • more common in men
  • family members of schizo
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47
Q

schizoid personality disorder

A

social withdrawal, no desire for close relationships and prefer to be alone
- more common in men

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48
Q

schizotypal personality disorder

A

eccentric behavior and peculiar thought patterns, strange and eccentric

  • odd beliefs or magical thinking
  • can go to schizophrenia
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49
Q

antisocial personality disorder

A

more likely in men with alcoholic parents

  • no remorse for actions, impulsive and deceitful, violate law
  • at least 18, history of conduct disorder
  • coexistence of substance abuse and/or major depression common
  • DBT and behavioral therapy
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50
Q

borderline personality disorder

A

unstable moods and interpersonal relationships, fear abandonment, poorly formed identity, aggression common due to impulsive

  • unstable relationships, impulsivity, unstable mood/affect, unstable self image
  • splitting, patients all good or all bad
  • more ocmmon in women

tx: psychotherapy, behavior/cognitive

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51
Q

histrionic personality disorder

A

attention seeking behavior and excessive emotionality - dramatic

  • need to be center of attention
  • inappropriately seductive or provocative behavior
  • uses physical appearance to draw attention to self

2-3%

psychotherapy

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52
Q

narcissistic personality disorder

A

superiority, need for admiration, lack of empathy
5 or more
- exaggerated self importance
- preoccupation with unlimited money, success, brilliance
- believes that he or she is special or unique

<1%

psychotherapy

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53
Q

avoidant personality disorder

A

social inhibition and intense fear of rejection

  • avoid social interaction and seek jobs without interpersonal contact
  • desire companionship

1-10%

psychotherapy, beta blockers for anxiety sx

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54
Q

dependent personality disorder

A

poor self-confidence and fear separation, need to be taken care of

  • regression often seen in patients
  • clinging behavior

1%

psychotherapy

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55
Q

OCPD

A

pattern of perfectionism, inflexibility, orderliness

  • prefectionist
  • loves rules and lists
  • no delegating

men

psychotherapy

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56
Q

substance abuse prevalence

A

17%

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57
Q

alcohol dependence prevalence

A

3-5%

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58
Q

alcohol withdrawal symptoms begin

A

6-24 hours, last 2-7 days

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59
Q

DTs time course

A

48-72 hours

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60
Q

DTs death

A

15-25% mortality if untreated, only 5%

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61
Q

altruism

A

mature defense

- acts that benefit others to experience pleasure

62
Q

humor

A

mature defense

- expressing unpleasant or uncomfortable feelings without causing discomfort to self or others

63
Q

sublimation

A

mature defense

- satisfying socially objectionable impulses in an acceptable manner

64
Q

suppression

A

mature defense

- ignoring an unacceptable impulse or emotion to diminish discomfort and accomplish a task

65
Q

order of medications in possible alcohol withdrawal

A

thiamine, then glucose/fluids/benzos

66
Q

PCP intox pathognomonic

A

rotatory nystagmus

67
Q

delirium + hemiparesis or focal signs and sx

A

CVA or mass lesion

Dx: brain CT/MRI

68
Q

delirium + elevated BP + papilledema

A

HTN encephalopathy

Dx: Brain CT/MRI

69
Q

delirium + dilated pupils + tachy

A

drug intox

Dx: urine tox

70
Q

delirium + fever + nuchal rigidity + photophobia

A

meningitis

Dx: LP

71
Q

delirium + tachy + tremor + thyromegaly

A

thyrotoxicosis

Dx: T4, TSH

72
Q

dementia with stepwise increase in severity and focal neuro signs

A

multi infacrt dementia

Dx: CT/MRI

73
Q

dementia + cogwheel + resting tremor

A

lewy body dementia, parkinson

Dx: clinical

74
Q

dementia + gait apraxia + urinary incontinence + dilated cerebral ventricles

A

NPH

Dx: CT/MRI

75
Q

dementia + obesity + coarse hair + constipation + cold intolerance

A

hypothyroid

CT/MRI

76
Q

dementia + diminished position and vibration + megaloblasts

A

vit B12 deficiency

serum B12

77
Q

dementia + tremor +_ abnl LFTs + kayser fleischer rings

A

wilson disease

ceruloplasmin

78
Q

dementia + diminished positiion and vibration + argyll robertson pupils (no response to light)

A

neurosyphilis

CSF FTA-ABS or CSF VDRL

79
Q

five stages of grief

A 
denial
anger
bargaining
depression
acceptance
80
Q

prolonged grief time course

A

6 months

81
Q

delusions in alzheimer patiernts (%)

A

70%

82
Q

hallucinations in dementia pateints (%)

A

33%

83
Q

mentally retarded cases are mild

A

85%

84
Q

MR affects % of population

A

1-3%, majority guys

85
Q

ODD

A

negativistic, hostile, defiant behavior x 6 months

  • get along with peers, no regard for authority figures
  • 2-16%
  • age 3-8
86
Q

Conduct disorder

A

1 year need to have 3/15

  • aggression toward people and animals
  • destruction of property
  • deceitfulness or theft
  • serious rule violation

1-10%

basic rights of others or social norms violated

87
Q

Comorbid conditions with conduct disorder

A

ADHD (70%) and learning dosrder, substance abuse

88
Q

premorbid condition for conduct disorder

A

antisocial personality disorder

89
Q

comorbid condition with ODD

A

ADHD, substance abuse, mood disorders

90
Q

ADHD prevalence

A

5-12%, 60% to adulthood

91
Q

% of autism meet criteria for MR

A

70%

92
Q

asperger vs autism

A

asperger have normal language and cognitive development

93
Q

rett disorder

A

between 5-30 months decreased head growth and loss of hand skills, impaired language, retardation

  • suually girls
  • MECP2 on x chromo
94
Q

childhood disintegrative disoder

A

normal development 2 years of life. loss of previously acquired skills before age 10 in at least 2
- language, social skills, bowel or bladder continence, play, motor skills

95
Q

tourette’s criteria

A

multiple motor and one or more vocal tics not due to CNS disease prior to 18
- no tic free for > 3 months

stimulants exacerbate tics

96
Q

ADHD and tourette’s %

A

50%

97
Q

age for separation anxiety

A

7 months to 6 years

98
Q

stranger anxiety

A

8-12 months

99
Q

sexual abuse in women %

A

15-25%

100
Q

sexual abuse in men %

A

5-15%

101
Q

dissociative fugue

A

sudden unexpected travel away from home, inability to reall one’s identity or one’s past
- not aware they have forgotten everything

102
Q

somatization disorder - sx, prevalence, PCP

A

multiple nonspecific sx not from medical condition or substance (onset before 30)

  • at least four pain sx
  • at least two GI sx
  • at least one sexual or reproductive sx
  • one pseudoneruological sx not limited to pain

0.1-0.5%
5-10% patients in primary care have disorder

103
Q

conversion disorder

A

at least one neuro sx not explained medically

  • psychologticqal stressor precedes sx
  • patient calm and unconcerned about sx
  • not intentionally produced
104
Q

only disorder equally common in men

A

hypochondriasis

105
Q

tx of pain syndrome

A

SSRI, biofeedback, hypnosis, psychotherapy

106
Q

factitious disorder

A

patients want to assume sick role, intentionally produce medical or psychological sx
- only primary gain no secondary gain (money etc)

107
Q

malingering

A

feigning physical or psych sx for personal gain

  • avoid police, room and board, money, narcotics
  • more common in men
108
Q

amount of bulimia nervosa patients with comorbid klepto

A

1/4

109
Q

2 types of anorexia nervosa

A

restrictive type - OCPD, no binge eating or purging

binge-eating/purging - eat in binges with self induced vomiting, using laxatives, excessive exercise, diuretics

110
Q

sx of anorexia

A

amenorrhea, cold intolerance/hypothermia, hypotension, bardycardia, arrhythmia, ACS, alopecia, edema, dehydration,

111
Q

laboratory abnl of anorexia

A

hyponatremia, hypochloremic hypokalemic alkalosis, arrythmia, transaminitis, leukopenia, anemia, BUN, increase GH, increase cortisol

112
Q

prevalence of anorexia and treatment

A

1%

tx: outpatient with food unless 20% below or serious medical problems
- behavioral therapy

113
Q

refeeding syndrome

A

malnourished patients refed too quickly, fluid retention and decreased phosphorus, magnesium, calcium

sx: respiratory failure, delirium, seizures
tx: replace electrolytes and slow feedings

114
Q

2 types of bulimia

A

purging type - vomiting laxatives enema or diurectics

nonpurging type - excessive exercise or fasting

115
Q

time course of bulimia and prevalence

A

binge eating and compensatory behaviors 2 times a week for 3 months

1-4%

116
Q

laboratory findings in bulimia

A

hypochloremic hypokalemic alkalosis, metabolic acidosis with laxative, elevated bicarb, hypernatremia, incr BUN, incr amylase

117
Q

tx for bulimia

A

antidepressants + therapy

SSRIs, fluoxetine`

118
Q

most common hypersomnia

A

breathing-related disorders, sleep anea

119
Q

dyssomnia prevalence and crtieria and tx

A

5-10%
> 1 month to years, reduced quality of life, increase risk of psych

tx: sleep hygiene, CBT**, benzo (reduce sleep latency and nocturnal awakening)

120
Q

insomnia antidepressent with depressive sx

A

trazodone

121
Q

narcolepsy - sx

A

excessive daytime sleepiness and falling asleep at inappropriate times

  • at least 3 months
  • cataplexy
  • hallucinations
122
Q

hypnagogic hallucination

A

transitioning to sleep

123
Q

hypnapompic hallucination

A

transitioning from sleep

124
Q

sleep walking prevalence

A

1-4%, 10-20% in children and adolescents

125
Q

sleep walking tx

A

sleep hygiene, behavioral, clonazepam, benzo, TCA

126
Q

sleep terror - sx, prevalence, tx

A

sudden arousal with screaming from slow wave sleep

1-6% children, 1-2% adults

tx: condition is benign and self-limited, low dose benzo in adults

127
Q

tx of nightmare disorder

A

imagery rehearsal therapy - use mental imagery to modify the outcome of recurrent nightmare, writing down improved outcome

128
Q

tx of REM sleep beahvior disorder

A

clonazepam, imipramine, carbamazepine, pramipexole, levodopa

129
Q

gonadal hormone that lowers libido/sexual function in men and women

A

progesterone and serotonin

130
Q

hormone that increases libido

A

dopamine

131
Q

most common sexual disorders in women

A

sexual desire disorder and orgasmic disorder

132
Q

most common sexual disorders in men

A

secondary erectile disorder and premature ejaculation

133
Q

paraphilias time course

A

unusual sexual urges or fantasies for at least 6 months, cause impairment in daily functioning

134
Q

3 most common paraphilia

A

pedophilia, voyeurism, exhibitionism

135
Q

tx of paraphilias

A

aversion therapy, insight oriented psychoterapy, behavior therapy, pharmacologic therapy (antiandrogens)

136
Q

displacement

A

immature defense

- shifting emotions from undesirable situation to one that is tolerable

137
Q

intellectualization

A

immature defense

- avoid negative feelings by using reasoning/ focusing on irrelevant details

138
Q

isolation of affect

A

immature defense

- limiting experience of feelings or emotions to avoid anxiety, unconscious

139
Q

rationlization

A

immature defense

  • explanation of event to justify outcomes
  • ie my boss fired me because she is short tempered and impulsive, not my fault
140
Q

reaction formation

A

immature defense

  • doing the opposite of unacceptable impulse
  • man in love insults woman
141
Q

repression

A

immature defense

- unconscious, preventing thought or feeling from entering consciousness

142
Q

projection

A

immature defense

  • attributing objectionable thoughts or emotions to others
  • husband attracted to other women believes wife is having an affair
143
Q

splitting

A

immature defense

- labeling person all good or all bad

144
Q

biofeedback

A

used to treat migraines, HTN, chronic pain, asthma, incontinence
- physiological data is given to patients as they try to mentally control physiological states

145
Q

cognitive behavioral therapy

A

used for psychiatric illness - depression, anxiety, substance abuse

146
Q

psychoterapy tx of borderline

A

DBT, decreases self destructive behaviors and hospitalizations

147
Q

malpractice mnemonic

A

4 D’s

- deviation from duty that was the direct cause of damage

148
Q

positive sx of schizo pathway

A

mesolimbic dopamine pathway (nucleus accumbens, forxnix, amygdala)

149
Q

negative sx of schizo pathway

A

mesocortical pathway dopamine

150
Q

EPS pathway

A

dopamine nigrostriatum

151
Q

prolactin pathway

A

tuberoinfundibular

Psychiatry Shelf (3 decks)

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