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Psychiatry > Shelf Review Anki Deck Unshuffled > Flashcards

Shelf Review Anki Deck Unshuffled Flashcards

1
Q

Key features of adjustment disorder

A
  • Sx occur in response tostressor- Resolves within 6 months of end of stressor- Symptoms directly relate to stressor- Does NOT meet criteria for MDD[ If they meet criteria for MDD, it is MDD! ]
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2
Q

Diagnose a major depressive episode

A 
Depressed mood or loss of interest for 2+ weeks5/9
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicidality[SIGECAPS ]
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3
Q

Diagnosedysthymic disorder in kids

A 
Depressed mood1 year
<1 month without symptoms2/6
Concentration
Hopelessness
Appetite
Sleep
Energy
Self-esteem[CHASES ]
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4
Q

Diagnose dysthymic disorder in adults

A

Depressed mood for2years

<2 monthwithout symptoms

2/6

Concentration

Hopelessness

Appetite

Sleep

Energy

Self-esteem

[CHASES]

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5
Q

Atypical depression can beconfused with ___ .

A

Borderline Personality Disorder (due to seemingly unstable mood + interpersonal sensitivity)Distinguish by TIMELINE

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6
Q

Diagnose atypical depression

A

Preserved mood reactivity2/4HyperphagiaHypersomniaLeaden paralysisSensitivity to interpersonal rejection

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7
Q

Timeline of a brief psychotic episode

A

1 day -1 month

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8
Q

Timeline of schizophreniform

A

1-6 months

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9
Q

Diagnose schizophrenia

A

1 monthpsychosis in setting of 6 month of symptoms

2/5 for 1 monthDelusionsHallucinationsDisorganized speechDisorganized/catatonic behaviorNegative symptoms

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10
Q

Diagnose acute stress disorder

A

Trauma +(same 4 Sx clusters as PTSD)BUT onset within 4 wkssx last less than 4 wks

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11
Q

Reaction to trauma that presagesacute stress disorder

A

numb, detached, dissociated

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12
Q

Diagnose PTSD

A

Symptoms > 1 month, onset anytimeTraumatic experience +1) Re-experiencing (flashbacks, nightmares)2) Avoidance3) Hyperarousal4) Mood/Cognitive Sx

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13
Q

Diagnose generalized anxiety disorder

A

Anxious about everything for 6 months3/6- Restlessness- Fatigue- Concentrating difficulty- Irritability- Muscle tension- Sleep disturbance

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14
Q

Diagnosis of Panic disorder

A

1) At least 1 panic attack-Sudden onset, no known trigger-Autonomic Sx-Feeling of impending doom
2) Fear of attacks in between

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15
Q

Features of a panic attack

A
  • No warning- No specific trigger- Feeling of impending doom

- Autonomic (tachycardia, sweating, SOB)

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16
Q

Diagnose bipolar

A

1 manic episode

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17
Q

How long does hypomania last?

A

4-7 days

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18
Q

How long does manialast?

A

> 7 days or hospitalized

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19
Q

Diagnose schizoaffective

A

Majority time =psychosis + moodAnd

Psychosis alone forat least 2weeks

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20
Q

Diagnose paranoid personality disorder.

A
  • Not psychotic, rathera pattern of relating to others/worldsuch that they always expect others to have bad intentions- “Always been that way”
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21
Q

Diagnose delusional disorder.

A

One single non-bizarre delusion(and minor ones related to it)- Functional outside the delusion

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22
Q

Describe delusions in schizophrenia.

A

Many bizarre delusions

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23
Q

Typical age of onset of schizophrenia?

A

Men: 17-25Women: 25-30Onset after age 40 extremely rare

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24
Q

Typical age of onset for delusional disorder?

A

Middle age (40s-50s)

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25
Q

Substance-induced depression can be caused by intoxication with ___.

A
  • Alcohol- Benzodiazepines- Barbituates- Opiates
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26
Q

Substance-induced depressioncaused bywithdrawal from ___.

A
  • Cocaine- Meth
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27
Q

Substance-induced maniacan be caused by intoxication with ___.

A
  • Cocaine- Meth
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28
Q

Substance-induced psychosis can be caused by intoxication with ___.

A

PCP, cannabis, LSD

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29
Q

Substance-induced mania can be caused by withdrawal from ___.

A
  • Alcohol- Benzodiazepines
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30
Q

Which antidepressant is associated with dry mouth, constipation, sedation and weight gain?

A

TCA’s

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31
Q

Antidepressants with fewest sexual side effects?

A
  • Buproprion- Mirtazipine
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32
Q

What is the washout period to transition from SSRI to MAO-I? And the exception?

A

2 weeks- Except fluoxetine

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33
Q

Antidepressant associated with priapism

A

Trazodone

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34
Q

Antidepressant with dietary restrictions

A

MAOI: don’t eat tyramine

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35
Q

Antidepressant that self-tapers when stopped

A

Fluoxetine

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36
Q

Which antidepressant is contraindicated with meperidine (demerol)?

A

MAOI

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37
Q

Antibiotic with serotonin activity

A

Linezolid

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38
Q

Antidepressant that increases seizure risk?

A

Buproprion

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39
Q

Which antidepressants have the highest likelihood of withdrawal?

A
  • Paroxetine- Venlafaxine
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40
Q

Which antidepressantsare more activating?

A
  • Fluoxetine- Buproprion
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41
Q

How do you treat OCD?

A

SSRI’s- Sertraline- Fluvoxamine- Clomipramine

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42
Q

Adjunct antidepressant to promote sleep and appetite?

A

Mirtazapine

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43
Q

Adjunct antidepressant particularly helpful withanxiety symptoms?

A

Buspirone

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44
Q

Adjunct antidepressant that can help with SSRI-relatedsexual dysfunction?

A
  • Buproprion- Buspirone
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45
Q

What are other adjunct antidepressants?

A
  • Aripiprazole- Lithium
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46
Q

Which atypical antipsychotic is also an adjunct antidepressant?

A

Aripiprazole

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47
Q

Which antipsychotic is also used as amood stabilizer?

A

Quetiapine

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48
Q

Which antipsychotic has the highest likelihood of EPS?

A

Risperidone

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49
Q

Which antipsychotics are weight-neutral?

A
  • Aripiprazole- Ziprasidone
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50
Q

Which atypical antipsychotics are the worst for metabolic syndrome?

A
  • Olanzapine- Clozapine
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51
Q

Which atypical antipsychotic is associated with hyperprolactinemia?

A

Risperidone

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52
Q

Which atypical antipsychoticincreases seizure risk

A

Clozapine

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53
Q

What are 3 life-threatening adverse effects of clozapine?

A
  • Seizure- Agranulocytosis- Cardiomyopathy
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54
Q

Which atypical antipsychotic causesprolonged QTc?

A

Ziprasidone

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55
Q

Which medications increase lithium levels?

A
  • OCP’s- Thiazides- Spironolactone
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56
Q

How does lithium toxicity present?

A
  • Coarse tremor- Altered mental status- Nausea/vomiting/diarrhea
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57
Q

What are common lab abnormalitiesseen with Lithium?

A

Benign leukocytosis

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58
Q

What EKG changes are seen with Lithium?

A

Flattened T waves (looks like low K)

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59
Q

What lab abnormalitiescan be seen with valproate?

A
  • LFT’s- Thrombocytopenia
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60
Q

What mood stabilizer lessens efficacy of birth control?

A

Carbamazepine (dirty, auto-inducer)

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61
Q

Which mood stabilizeris associated withSJS?

A

Lamotrigine

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62
Q

What mood stabilizeris associated withweight loss?

A

Topiramate

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63
Q

What fetal abnormality is associated with Lithium?

A

Ebstein’s anomaly: atrialized right ventricle

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64
Q

What fetal abnormality is associated with valproate?

A

Neural tube defects

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65
Q

How does valproate toxicity present?

A
  • Nystagmus- Ataxia
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66
Q

Which mood stabilizer causes cognitive dulling?

A

Topiramate

“dope-amax”

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67
Q

What mood stabilizers are associated with SIADH?

A
  • Carbamazepine- Oxcarbezipine
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68
Q

What mood stabilizeris associated with nephrogenic DI?

A

Lithium

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69
Q

How do you treat major depressive disorder?

A

SSRIECT is the last line

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70
Q

How do you treat bipolar disorder?

A
  • Acute mania: mood stabilizer + atypical antipsychotic- Maintenance: mood stabilizer only
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71
Q

How do you treat panic disorder?

A

SSRI or CBTAcute relief: benzodiazepine

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72
Q

How do you treat OCD refractory to medication?

A

Deep brain stimulationor cingulotomy

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73
Q

How do you treat generalized anxiety disorder?

A

SSRI

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74
Q

How do you treat atypical depression?

A

MAOI

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75
Q

How do you treat catatonia?

A
  • Lorazepam- ECT
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76
Q

How do you treat borderline personality disorder?

A

DBT(dialectical behavior therapy)

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77
Q

What arecommonside effectsofMAOI’s?

A
  • GI distress- Orthostatic hypotension- Sleep disturbance- Dry mouth- Headache
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78
Q

What are dangerous side effects of MAOI’s?

A
  • Serotonin syndrome- Hypertensive crisis
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79
Q

What are symptoms of serotonin syndrome?

A
  • Flushing- Diaphoreis- Myoclonic jerks
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80
Q

How do MAOI’s cause hypertensive crisis?

A

Tyramine interaction- No aged cheeses or cured meats

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81
Q

What is themechanism of actionof theMAOI’s?

A

Inhibits the enzyme that metabolizes 5-HT, NE, DA

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82
Q

How do youtreathypertensive crisis?

A

Phentolamine- NOT beta blockers

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83
Q

What areadvantagesoftranylcypromine?

A

Amphetamine-like properties

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84
Q

What areadvantagesofselegiline?

A
  • Used in Parkinson’s disease- Transdermal form available
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85
Q

Tyramine found in

A
  • Aged cheeses- Cured meats- Soy sauce- Sauerkraut- Beer
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86
Q

Alprazolam

A

Benzodiazepine- Fast-Intermediate onset- Short-Intermediate T1/2
*Addictive due to fast onset, high seizure risk due to short half life

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87
Q

Clonazepam

A

Benzodiazepine- Slow onset- Intermediate-long t1/2

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88
Q

Diazepam

A

Benzodiazepine- Fast onset- Longt1/2

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89
Q

Chlordiazepoxide

A

Benzodiazepine- Intermediate onset- Longestt1/2

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90
Q

How does the time to onset affect benzodiazepine use?

A

Addictive potential

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91
Q

How does t1/2 affect Benzodiazepine use?

A
  • More seizure risk during withdrawal with shortert1/2
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92
Q

Use of triazolam

A

Falling asleep

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93
Q

What is xanax used for?

A
  • Panic attacks- Highly addictive
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94
Q

Which benzodiazepine has the least addictive potential?

A

Clonazepam (slow onset)

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95
Q

Which benzodiazepine is highly addictive? (besides alprazolam)

A

Diazepam

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96
Q

What ischlordiazepoxideused for?

A

Alcohol withdrawal

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97
Q

What determines addictive potential of benzodiazepines?

A

Onset of action[ faster = worse ]

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98
Q

What determines seizure risk of benzodiazepines?

A

Half-life[ short = worse ]

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99
Q

What areadvantagesofzolpidem?

A

Widely available

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100
Q

What aredisadvantagesofzolpidem?

A
  • Strange dreams and dissociative symptoms- Less effective after 2 weeks
  • Associated with falls in hospital
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101
Q

What areadvantagesofzaleplon?

A
  • Very short acting- May be taken if wide awake in the middle of the night
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102
Q

What aredisadvantagesofzaleplon?

A

Can be habit forming

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103
Q

What areadvantagesoframelteon

A
  • Similar to melatonin- Unlikely to be habit forming
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104
Q

What areadvantagesofeszopiclone?

A

Can be taken for longer periods than other hypnotics

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105
Q

What aredisadvantagesofeszopiclone?

A
  • Expensive- Withdrawal syndrome
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106
Q

What areadvantagesoftrazodone?

A
  • Relatively benign- Commonly used on inpatient unit
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107
Q

What arecommon side effectsoftrazodone?

A
  • Grogginess in am- Priapism (trazoboner)
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108
Q

What are common side effects of TCA’s?

A

H: sedation

A: orthostatic hypotension, tachycardia, arrhythmias

M: dry mouth, constipation, urinary retention, blurred vision, tachycardia
+ Weight gain

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109
Q

What is acontraindicationto usingTCA’s?

A

Contrandicated with pre-existing cardiac conduction abnormalities.- Lethal overdose: widened QRS&raquo_space; Torsades&raquo_space; V-Fib

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110
Q

How do you treat TCA overdose?

A

Sodium bicarbonate and magnesium

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111
Q

What is the mechanism of action of theTCAs?

A

5-HT and NE reuptake inhibition

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112
Q

What are disadvantages ofTCA’s?

A
  • “Dirty” drugs – side effects are common!- Can be lethal in OD
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113
Q

Which TCA is the least likely to cause orthostatic hypotension?

A

Nortriptyline

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114
Q

Which TCA is the least sedating with the fewest anticholinergic side effects?

A

Desipramine

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115
Q

Which TCA is the most 5-HT specific?

A

Clomipramine

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116
Q

Which TCA is used for OCD?

A

Clomipramine

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117
Q

Which TCA’s can be used for chronic pain and headaches?

A

ImipramineAmitriptylineDoxepin

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118
Q

Which SSRI’sare “opposites”?

A

Prozac vs Paxil- Prozac is activating, long half life- Paxil sedating, short-half life

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119
Q

What arecommonside effectsofSSRIs

A
  • Sexual dysfunction- GI upset- Headaches- Low incidence of SE overall
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120
Q

What are advantages offluoxetine

A
  • Relatively activating- Extremely long half-life: no need to taper, use with poor compliance
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121
Q

Which SSRI should be used for neurovegetative depressives?

A

Fluoxetine

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122
Q

Which SSRI should be used for anxious depressives?

A

Paroxetine

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123
Q

What aredisadvantagesoffluoxetine?

A

Dirtiest SSRI with the most side effects- Sexual dysfunction- Activating properties can worsen anxiety

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124
Q

What areadvantagesofparoxetine?

A
  • Relatively sedating- Used in anxiety disorders
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125
Q

What aredisadvantagesofparoxetine?

A

Short half life- Significant discontinuation syndrome

- Can’t miss a dose!

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126
Q

What areadvantagesofsertaline?

A
  • Few drug-drug interactions- Used in medically ill and elderly
  • Used in anxiety disorders (more anxiolytic than activating)
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127
Q

What aredisadvantagesofsertraline?

A
  • Tends to cause GI upset, particularly when starting- Relatively shorter half-lifecan lead to discontinuation syndrome
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128
Q

What areadvantagesof (es)citalopram?

A
  • Few drug-drug interactions- Very low incidence of side effects
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129
Q

What aredisadvantagesof(es)citalopram?

A
  • Prolongs QT- Can’t go above 40
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130
Q

What areadvantagesoffluvoxamine?

A

Primarily used in anxiety disorders (OCD, social anxiety, PTSD)

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131
Q

What aredisadvantagesoffluvoxamine?

A
  • BID dosing (twice a day)- Very short half life: discontinuation syndrome
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132
Q

What areadvantagesofSNRI’s?

A
  • Potentially helps with chronic pain and diabetic neuropathy
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133
Q

What aredisadvantagesofvenlafaxine?

A
  • Contraindicated in pts with poorly controlled HTN- Very short half life: significant withdrawal syndrome
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134
Q

What aredisadvantagesofduloxetine?

A
  • Very expensive- Can cause significant nausea
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135
Q

What is themechanism of actionofbuproprion?

A

Inhibits reuptake ofnorepinephrineanddopamine

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136
Q

What is themechanism of actionofmirtazapine?

A

5-HT2a/c, 5-HT3a antagonist

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137
Q

What arecommonside effectsofbuproprion?

A
  • Rarely sexual side effects- Can increase anxiety
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138
Q

What arecommonside effectsofmirtazapine?

A
  • Appetite stimulation- Sedation (low doses)
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139
Q

What are advantagesofbuproprion?

A
  • Can treat sexual side effects- No weight gain- Activating

- Helpful in smoking cessation

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140
Q

What aredisadvantagesofbuproprion?

A
  • Can worsen anxiety- Lowers seizure threshold: contraindicated in patients with eating disorders and epilepsy
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141
Q

What areadvantagesofmirtazapine?

A
  • Great in patients with poor appetite- Sleep aid at low doses
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142
Q

What aredisadvantagesofmirtazapine?

A
  • Can lead to weight gain
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143
Q

What arecommonside effectsof thetypical antipsychotics?

A
  • Varying degrees of EPS- Varying degrees of anti-HAMH: sedationA (alpha): orthostatic hypoTNM (muscarinic): dry mouth, tachy, urinary retention, blurry vision, constipation
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144
Q

What is themechanism of actionof the typical antipsychotics?

A

D2 blockade

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145
Q

Potency of the typical antipsychotics in increasing order?

A

Chlorpromazine < Perphenazine < Fluphenazine = Haloperidol

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146
Q

Which typical antipsychotics have a high incidence of extrapyramidal symptoms?

A
  • Haloperidol- Fluphenazine
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147
Q

Which typical antipsychotic is associated with sedation and weight gain?

A

Chlorpromazine

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148
Q

What are advantages of haloperidol?

A
  • High efficacy- Widely available andcheap

- Fewer anticholinergic side effects- Short-acting injectable for PRN use- Long-acting decanoate (4w)

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149
Q

What aredisadvantagesofhaloperidol?

A
  • High incidence of extrapyramidal symptoms
150
Q

What areadvantagesoffluphenazine?

A
  • Similar to haldol- Long-acting decanoate (2-3w)
151
Q

What areadvantagesofperphenazine?

A
  • Moderate potency- Lower risk of extrapyramidal symptoms

evidence from CATIE study

152
Q

What aredisadvantagesofperphenazine?

A

BID dosing

153
Q

What areadvantagesofchlorpromazine?

A
  • Low potency- Approved in children
154
Q

What aredisadvantagesofchlorpromazine?

A
  • Low potency- Lots of anticholinergic side effects
155
Q

Symptoms of metabolic syndrome

A
  • Hypertension- Insulin resistance- Central obesity- Dyslipidemia (High triglycerides, low HDL)
156
Q

What arecommonside effectsofatypical antipsychotics?

A
  • Metabolic syndrome- Some anti-HAM
157
Q

What is the most efficacious atypical antipsychotic?

A

Clozapine

158
Q

What is the most dangerous atypical antipsychotic?

A

Clozapine

159
Q

What is themechanism of actionofrisperidone?

A

D2R blockage5HT2A receptor antagonist

160
Q

What is themechanism of actionofolanzapine?

A

D2R blockage5HT2A receptor antagonist

161
Q

What is themechanism of actionofaripiprazole?

A

mixed agonist/antagonist

162
Q

What is themechanism of actionofquetiapine?

A

D2R blockade5HT2A receptor antagonist

163
Q

What is themechanism of actionofziprasidone?

A

D2R blockade5HT2A receptor antagonist

164
Q

What is themechanism of actionofclozapine?

A

D2 and D4 blockade5HT2A receptor antagonist

165
Q

Which atypical antipsychotic causes hyperprolactinemia?

A

Risperidone

166
Q

Which atypical antipsychotic causes metabolic syndrome?

A

Olanzapine

167
Q

Which atypical antipsychotic causes sedation, weight gain and orthostatic hypotension?

A

Quetiapine

168
Q

Which atypical antipsychotic causes QT prolongation?

A

Ziprasidone

169
Q

Which atypical antipsychotic causes sedation, weight gain, drooling, cardiomyopathy (reversible) and agranulocytosis?

A

Clozapine- Require weekly blood draws!

170
Q

What areadvantagesofrisperidone?

A
  • High potency- Dissolving form (M tab)- Long-acting consta form
171
Q

What aredisadvantagesof risperidone?

A
  • Relatively high incidence of EPS- Hyperprolactinemia
172
Q

What areadvantagesofolanzapine?

A
  • Effective- Zydis form (dissolving tab)(evidence from CATIE study)
173
Q

What aredisadvantagesofolanzapine?

A
  • Absolute WORST in terms of metabolic effects
174
Q

What areadvantagesofaripiprazole?

A
  • Adjunctive antidepressant- Tends to be more activating

- Theoretically weight neutral

175
Q

What aredisadvantagesofaripiprazole?

A
  • Can activate a bit too much- Akathisia
176
Q

What areadvantagesofquetiapine?

A
  • Useful as sleep aid- Approved as monotherapy as a mood stabilizer
177
Q

What aredisadvantagesofquetiapine?

A
  • Side effects are not dose-dependent- Sedation- Weight gain- Dizziness makes hard to tolerate(CATIE)
178
Q

What areadvantagesofziprasidone?

A

NAME?

179
Q

What aredisadvantagesofziprasidone?

A
  • Prolongs QTc- Must be taken with food
180
Q

What areadvantagesofclozapine?

A

Effective

181
Q

What aredisadvantagesofclozapine?

A
  • Weekly blood monitoring- Significantly lowers seizure threshold
  • Potentially dangerous side effects
182
Q

What arecommonside effectsoflithium?

A
  • Polyuria- Polydipsia- Sedation- Tremor (fine)
183
Q

What are the mostdangerousside effectsoflithium?

A
  • Nephrogenic diabetes insipidus (ADH receptor blocker)- Renal impairment- Hypothyroid
184
Q

What areadvantagesoflithium?

A
  • Effective- Not typically associated with weight gain
185
Q

Which labs should be monitored with lithium?

A

Blood draws:- Lithium levels- BUN/Creatinine

- T4/TSH

186
Q

What is the therapeutic window of lithium?

A

Narrow- Therapeutic 0.7-1.2

- Toxic >1.2

187
Q

What are the signs and symptoms of lithium toxicity?

A
  • Nausea/Vomiting/Diarrhea-Coarse tremor- Ataxia- Altered mental status- Renal failure- Convulsions- Coma
188
Q

What is acontraindicationto lithium?

A

Renal disease

189
Q

Whatdrug-drug interactionsshould be considered withlithium?

A
  • Diuretics- NSAIDs- Thiazides- Spironolactone
190
Q

What skin change does lithium cause?

A

Acne

191
Q

What is most often found on CBC with lithium?

A

Benign leukocytosis

192
Q

What can be seen on EKG with lithium?

A
  • Flattened T-waves- U waves
193
Q

What arecommonside effectsofvalproate?

A
  • Sedation- Weight gain- Alopecia
194
Q

What arethe most dangerousside effectsofvalproate?

A
  • Hepatotoxiciity- Thrombocytopenia- Pancreatitis
195
Q

What is theadvantageofvalproate?

A

Slightly wider therapeutic window

196
Q

What labs must be monitored withvalproate?

A
  • Platelets:<50 bad! >150 OK- LFT’s:3x ok
197
Q

What drug-drug interactions should be considered with valproate?

A

p450

198
Q

What areteratogenicside effectsofvalproate?

A

Neural tube defects

199
Q

What is the most dangerous effect of valproate overdose?

A

Fulminant hepatic failure

200
Q

What symptoms are associated with valproate toxicity?

A
  • Nausea/Vomiting- Ataxia- Nystagmus- Lethargy- Coma
201
Q

What aredisadvantagesofcarbamazepine?

A
  • Bone marrowsuppression- SIADH

- Many drug-drug interactions!- Deactivates birth control- P450: autoinducer

202
Q

Which mood stabilizer is a p450inducer?

A

carbamazepine

203
Q

Which mood stabilizer deactivates birth control?

A

Carbamazepine

204
Q

What areadvantagesoflamotrigine?

A

Useful in bipolar depression

205
Q

What aredisadvantagesoflamotrigine?

A
  • Must titrate very slowly (every 2 weeks)- Risk of SJS
206
Q

What areadvantagesoftopiramate?

A
  • Can promote weight loss- Can treat headaches- Impulse control in bipolar disorder
207
Q

What aredisadvantagesoftopiramate?

A
  • “Dopamax” (makes you slow and tired)- Word finding problems- Kidney stones
208
Q

Which drugs can be given with topiramate to minimize metabolic syndrome?

A
  • Metformin- Antipsychotic
209
Q

How do you treat akathisia?

A

Propranolol

210
Q

How do you treat dystonia (including acute)?

A
  • Benztropine- Diphenhydramine
211
Q

How do you treat tardive dyskinesia?

A
  • Discontinue drug- Clozapine
212
Q

How do you treat hypertensive crisis (from MAOI)?

A

Phentolamine

213
Q

How do you treat SSRI discontinuation syndrome?

A

Restart SSRI

214
Q

What is the difference between drug abuse and dependence

A

Abuse gets you in trouble (ex.DUI, rob, sex, jail, hospital)
Both have physical sithdrawal symptoms, tolerance, impaired control

215
Q

SSRI + ecstasy

A

Serotonin syndrome

216
Q

What neurotransmitteris affected by hallucinogens?

A

5-HT agonism

217
Q

What is the mechanism of action of alcohol?

A

GABA

218
Q

What is the mechanism of actionof benzos

A

GABA

219
Q

What is the mechanism of action of opiates?

A

Opioid mu receptor

220
Q

What is themechanism of actionofcocaine?

A

Dopamine, 5-HT, NE reuptake blocker

221
Q

What is themechanism of actionofamphetamine?

A

Reuptake blocker and release increaser

222
Q

How do amphetamines compare to cocaine?

A

Amphetamines last longer

223
Q

What is themechanism of actionofecstasy?

A

Amphetamines + 5-HT agonist

224
Q

How does alcohol intoxicationpresent?

A
  • Altered mental status- Slurred words- Ataxia

- Decreased respiratory rate- Sluggish pupils- Active (to a point)

225
Q

How do you treatalcohol intoxication?

A
  • Thiamine- Hydration
226
Q

How do you treat alcohol withdrawal?

A

Benzodiazepine taper

227
Q

How does benzo intoxication present?

A

Similar to alcohol intoxication, but less active

228
Q

How do you treat benzo intoxication?

A

Flumazenil

229
Q

How does benzo withdrawal compare to alcohol withdrawal?

A

More rebound anxiety in benzos

230
Q

How do you treat benzo withdrawal?

A

Benzo taper

231
Q

How doesopiate intoxication present?

A
  • Pinpoint pupils- Decreased RR
232
Q

How do you treat opiate intoxication?

A

Naloxone

233
Q

How do you treat opiate withdrawal?

A
  • Clonidine- Immodium- Symptom relief
234
Q

What is a dangerous side effect of methadone?

A

Increases QT

235
Q

What is suboxone?

A

Buprenorphine + naloxone- Precipitates withdrawal in heavy users- Give methadone

236
Q

How does cocaine intoxication present?

A

Angina/MI

237
Q

How do you treat cocaine intoxication?

A

Haldol

238
Q

Feature of cocaine withdrawal NOT typicall seen with amphetamine withdrawal

A

Acute suicidality

239
Q

How do you treatcocaine withdrawal?

A

None, supportive

240
Q

How do you treat amphetamine withdrawal?

A

None, supportive

241
Q

How does amphetamine intoxication compare to cocaine?

A

No coronary symptoms with meth

242
Q

How do you treat amphetamine intoxication?

A

Haldol

243
Q

How does PCP intoxicationpresent?

A
  • Aggression- Rrotary/vertical nystagmus
244
Q

What is the mechanism of action of PCP?

A

NMDA antagonist

245
Q

How do you treatPCP intoxication?

A
  • Haldol- Minimize stimuli
246
Q

How do you treatPCP withdrawal?

A

None, supportive

247
Q

When does alcohol withdrawal start?

A

6-24 hours

248
Q

When does alcohol withdrawal peak?

A

24-48 hour”POD 1”

249
Q

When does alcohol withdrawal end?

A

5-7 days

250
Q

What are early symptoms of alcohol withdrawal?

A
  • Tongue tremor (fasciculations)- Tremulous

- Sweat- Anxiety- Irritable

251
Q

What are symptoms of alcohol withdrawal at 36 hours?

A
  • Vital signs instability- Seizure
252
Q

What are symptoms ofalcohol withdrawalat4-5 days?

A
  • Delirium tremens- Bad VS instability- Visual hallucinations
  • Micropsia (things look small)
253
Q

Which benzos bypass liver metabolism

A

LorazepamOxazepamTemazepam

254
Q

How does alcohol hallucinosiscompare to delirium tremens?

A

VS instability with delirium tremens

255
Q

How does wernicke korsakoffpresent?

A
  • Ataxia- Altered mental status- Abnormal eye movement- Confabulation
256
Q

What neuroanatomy is responsible for wernicke korsakoff?

A

Mamillary bodies

257
Q

How do you treat / preventwernicke korsakoff?

A

Thiamine

258
Q

What substance causes anion gap metabolic acidosisand afferent pupillary defect?How do you treat?

A

Methanol (moonshiners)- Treat with fomepizole

259
Q

What substance causesanion gap metabolic acidosisandcalcium oxalate crystals?How do youtreat?

A

Ethylene glycol- Treat with fomepizole

260
Q

What substance causesrespiratory alkalosis+metabolic acidosiswith tinnitus?How do youtreat?

A

Salicylates- Treat with sodium bicarbonate

261
Q

What substance causeshyperthermia, dry flushed skin, tachy, agitated, stumbling around?How do youtreat?

A

Diphenhydramine- Treat with physostigmine

262
Q

What substance causes altered mental status, drowsiness, widened QRS on monitor?How do youtreat?

A

TCA- Treat with bicarbonate and magnesium

263
Q

What substance causesabdominal pain, n/v, jaundice and elevated LFTs?How do youtreat?

A

Acetaminophen- Treat with N-acetylcysteine

264
Q

How does neuroleptic malignant syndromepresent?

A
  • Lead-pipe rigidity- High CPK

- Fever

265
Q

How do you treat neuroleptic malignant syndrome?

A
  • Cooling- Fluids- Dantrolene/bromocriptine
266
Q

How does serotonin syndromepresent?

A
  • Flushing- Hyperreflexia- VS instability
267
Q

How do you treat serotonin syndrome?

A
  • Cooling- Fluids- Cyproheptadine
268
Q

What are 4 effects of benzodiazepines on sleep?

A
  1. Decreased time to sleep onset2. Prolong stage 2 (worthless sleep)3. Prolong total sleep time4. Decrease REM
269
Q

Describe 4 clinical features of narcolepsy

A
  1. Daytime tiredness2. Hypnopompic/hypnogogic hallucinations
  2. Sleep paralysis
  3. Cataplexy
270
Q

What are hypnogogic / hypnopompic hallucinations?

A

Hypnogogic: hallucinate whengoingto sleepHypnopompic: hallucinate when waking up

271
Q

Treatment of cataplexy in narcolepsy

A

GHB (gamma-hydroxybutyrate)(aka sodium oxybate)(But in real life, Fluoxetine or Venlafaxine)

272
Q

2 clinical features of sleep terrors

A
  1. Autonomic activation (breathing heard, tachycardic, sweaty)2. Amnesia
273
Q

When do sleep terrors happen?

A
  • First 1/3 of night- During N3 (stage 3 sleep)
274
Q

Clinical features of REM sleep behavior disorder

A

Lack of atonia during REM: they act out dreams

275
Q

How do you treat REM sleep behavior disorder?

A

Clonazepam- to decrease relative amount of REM sleep

276
Q

REM sleep behavior disorder highly associated with ___ .

A

Lewy body dementia and Parkinson’s

277
Q

How does restless legs syndrome present? (differ from Akathisia)

A

PHYSICALfeelings of discomfort in legs - creeping, crawling, painAlso relieved by movement(Akathisia is subjective, INNER feeling, not actually physical)

278
Q

Treatment ofrestless legs syndrome

A
  • Mild: Clonazepam- More severe = DA agonists like ropinorole/pramipexole
279
Q

Clinical features of periodic limb movement disorder

A

ASLEEP: Middle insomnia woken up with rhythmic leg movements

280
Q

Treatment ofperiodic limb movement disorder

A

Same as restless leg syndrome… (DA agonists, ropinorole/pramipexole) they are highly comorbid

281
Q

Diagnose anorexia

A

BMI 18.5Adolescents: 85% expected body weight (EBW)Fear of weight gainDistorted body image

282
Q

Predominant emotion in anorexia

A

AnxietyEgo-Syntonic Pathology (exerting CONTROL over weight relieves anxiety)

283
Q

Diagnosis of bulimia

A

Binging (central pathology)With consequent compensatory behavior (eg, purging)

284
Q

What weight is associated with bulimia?

A

Normal-high

285
Q

ADHD Timeline: symptoms before age ___.

A

DSM IV: 7 years oldDSM 5: 12 years old

286
Q

Enuresis is normal before age ___.

A

5 years old

287
Q

Encoporesis is normal until age___.

A

4

288
Q

First line treatment for anorexia?

A

None

289
Q

How do you treatbulimia?

A
  1. Fluoxetine

2. Topiramate

290
Q

Which psych drug causes an increased WBC?

A

Lithium

291
Q

Which drugs cause decreased WBC?

A
  • Clozapine- Carbamazepine- HIV
292
Q

Causes of increased H&H

A

Polycythemia vera

293
Q

Causes of macrocytic anemia?

A
  • B12 deficiency- Folate deficiency (think alcoholics)
294
Q

Causes of microcytic anemia

A
  • Iron deficiency (restless legs)- Anorexia- Lead poisoning- Porphyria
295
Q

Causes of increased platelet count?

A

Autoimmune diseases- Lupus- Sjogrens- Sarcoidosis

296
Q

Cause of decreased platelet count?

A

Valproate

297
Q

Causes of hypernatremia?

A
  • Dehydration- Diabetes Insipidus (Lithium)- Alcohol
298
Q

Causes of hyponatremia?

A
  • Psychogenic polydipsia- SIADH (carbamazepine)- Ecstasy
299
Q

Causes of increased K+/Cl-?

A

Renal failure (Lithium)

300
Q

Causes of decreasedK+/Cl-?

A

Bulimia (metabolic alkalosis)

301
Q

Causes of decreasedK+?

A
  • Laxatives- Anorexia
302
Q

Causes of HCO3- changes?

A

Poison with metabolic acid-base disturbances

303
Q

Causes of increased BUN/Cr-?

A
  • Uremic encephalopathy- Lithium toxicity- Rhabdomyolysis from neuroleptic malignant syndrome
304
Q

Very high glucose with altered mental status?

A
  • DKA- HONK (HyperOsmolar Non-Ketotic state)
305
Q

Low glucose with normal c-protein

A

Factitious disorder: exogenous insulin

306
Q

Causes of increased Ca++?

A
  • Multiple myeloma

- Hyperparathyroidism (secondary to Lithium)[ Hypercalcemia gives you “psychiatric overtones” ]

307
Q

Cause of low Ca++?

A

Anorexia

308
Q

Causes of increased liver enzymes?

A
  • Alcohol (AST>ALT)- Acetaminophen/valproate overdose- Alcoholic hepatitis
309
Q

Cause of decreased liver enzymes?

A

Cirrhosis- Encephalopathy and altered mental status

310
Q

Causes of increased albumin/protein?

A
  • Acute HIV- Multiple myeloma
311
Q

Causes of decreased albumin?

A

CirrhosisAnorexia

312
Q

High TSH leads to ___.

A

Depression[ hypothyroidism ]

313
Q

Low TSH leads to ___.

A

Anxiety[ hyperthyroidism ]

314
Q

What symptoms are associated with neurosyphilis?

A
  • Dementia- Intermittent psychosis(irreversible)
315
Q

What drug class causes a widened QRS?

A

TCA’s

316
Q

What drug causes ST elevations?

A

Cocaine

317
Q

Which drugs prolong QT?

A
  • Ziprasidone- Methadone
318
Q

Which condition is associated with heart block?

A

Anorexia

319
Q

How does acute intermittent porphyria present?

A
  • Intermittent psychosis
  • Microcytic anemia
  • Multiple abdominal scars from ex-laps
320
Q

Liver cirrhosis + psychiatric symptoms?

A

Wilson’s

321
Q

What psychiatric symptomsare seen with Huntington’s?

A
  • Depression- Later personality changes
322
Q

Which medications are associated with depression?

A
  • Chronic steroids- Accutane- Interferon- Beta blockers
323
Q

Which medications can cause psychosis/delirium?

A
  • Steroids- Levodopa- Benzos- Anticholinergics
324
Q

How do you differentiate between factitious disorder and malingering?

A
  • Primary gain (factitious): internal conflict- Secondary gain (malingering): external benefits, ex. attention, escape from law
325
Q

How do you differentiate between factitious and conversion disorder?

A
  • Conscious production of symptoms (factitious)- Unconscious production of symptoms (conversion)
326
Q

How do you differentiate between somatizationand hypochondriasis?

A
  • Somatization: nebuloussymptoms- Hypochondriac: fixation on one diagnosis
327
Q

How do you treat somatization and hypochondriasis?

A

Regularly scheduled visits

328
Q

What is the nucleus of serotonin?

A

Dorsal raphe

329
Q

What is nucleus of norepinephrine?

A

Locus ceruleus

330
Q

What are the nuclei of dopamine?

A
  • VTA- Substantia nigra
331
Q

What is capgras syndrome?

A

Delusion that a familiar person has been replaced by an imposter

332
Q

What isfregoli syndrome?

A

Delusion that strangers are people you know in disguise

333
Q

What is Cotardsyndrome?

A

Nihilistic delusion that he/she is dead- Somatic/physical delusions (rotting, dust)

334
Q

What are symptoms of frontal lobe seizures?

A
  • Personality change- Disinhibition- Hemiballismus
335
Q

What are symptoms of temporal lobe seizures?

A
  • Olfactatory/gustatory hallucinations (auras)- Auditory hallucinations
  • Hyperemotional – fight or flight (amygdala)- Hyperreligious
  • Intermittent aphasia
336
Q

What is the most common cause of inherited mental retardation?

A

Fragile X

337
Q

What is the most common genetic cause of mental retardation in US

A

Down syndrome

338
Q

Down syndrome are predisposed to ____ later in life?

A

Alzheimer’s

339
Q

What is the leading non-genetic cause of mental retardation?

A

Fetal alcohol syndrome

340
Q

Whatdevelopmental disorderis only seen in females?

A

Rett syndrome- Regression of language, intellect and motor skills

341
Q

Fragile X phenotype

A

Marfanoid + big balls

342
Q

Prader-Willi

A
  • Obese- Hyerphagia- Hypogonadism[ paternal gene deleted ]
343
Q

Lesch-Nyhan

A
  • Self-mutilation- Motor degeneration
344
Q

PKU phenotype

A

Mousy smellPale skin/hair

345
Q

Congenital hypothyroid

A

PalePuffy facedProtuberant tonguePot belliedProtruding umbilicusPoor brain development

346
Q

Fetal alcohol syndrome

A
  • Smooth philtrum- Microcephaly- Micrognathia- Small low set ears- Hypotelorism
347
Q

Tuberous sclerosis

A
  • Ashleaf spots- Intractable seizures- Mental retardation
348
Q

Rett syndrome

A

In girls

- Hand wringing- Head stops growing- Regression of language, intellect and motor skills

349
Q

How does child depression differ from adult symptoms?

A
  • Irritability- Psychomotor agitation- Somatic complaints
350
Q

How do you treat enuresis?

A
  1. Fluid restriction, pee before bed2. Bell and pad (classical conditioning)3. DDAVP (old sources = imipramine)
351
Q

How does separation anxiety present?

A

Scared of something happening to parent- Can happen at any age

352
Q

What is the difference between oppositional defiant disorder and conduct disorder?

A

Conduct disorder: breaks law

ODD doesn’t: okayif behavior is only in one setting

353
Q

How do you treat tic disorder and related disorders?

A

Clonidine:for tourette’s + ADHD

Risperidone, haldol, pimizide (D2 blockers): for tourette’s

354
Q

How does alzheimer’s dementia present?

A
  • Gradual memory decline- Working memory goes first (set switching)- Paranoia
355
Q

What will be seen with alzheimer’s dementia?

A

Diffuse cortical atrophy

356
Q

How do you treat alzheimer’s dementia?

A
  • Cholinesterase inhibitors: Galantamine, Donepezil,- NMDA antagonist
357
Q

How does lewy body dementia present?

A
  • Hallucinations of little people- Parkinsonism, rapidly progressing
358
Q

What can be seen on labs/imaging with Lewy Body dementia?

A

Not much atrophy on imaging

359
Q

How do you treat Lewy Body dementia?

A

Don’t give D2 blockers!- Quetiapine is ok though

360
Q

How odes vascular dementia present?

A

Step wise decline

361
Q

What imaging is associated with vascular dementia?

A

Multiple infarcts of varying ages

362
Q

How do you treatvascular dementia?

A

Risk reduction (ASA)

363
Q

How does frontotemporal dementia present?

A

Early onset- Selective language devolvement- Personality change- Parkinsonism

364
Q

What imaging is associated with frontotemporal dementia?

A

Preferential atrophy

365
Q

How do you treat frontotemporal dementia?

A

None- Try to limit things that make it worse

366
Q

How does huntington’s present?

A
  • Depression (endogenous)- Personality changes- Dementia
367
Q

How do you treat huntington’s?

A

None

368
Q

What imaging is associated with huntington’s?

A

Caudate atrophy

369
Q

How does Creutzfeldt Jacob’s disease present?

A

Rapidly progressive dementia (3 months)

370
Q

What imaging and labs are seen with Creutzfeldt Jacob disease?

A
  • Spongiform encephalopathy- EEG: periodic sharp wave complexes
  • LP: high 14-3-3 protein
371
Q

4 types of REVERSIBLE dementia

A
  • NPH- B12- depression- hypothyroidism

Psychiatry (9 decks)

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