U world Flashcards
1
Q
Patient with bipolar disorder that has responded well to lithium but wants to discontinue it due to the stigma around lifelong medication
A
Too bad
2
Q
Amphetamine intoxication
A
Patients are agitated, irritable, and possibly have psychosis
Physiological signs include tachycardia, HTN, diaphoresis, mydriasis,
and possibly arrhythmia, seizure, hyperthermia
3
Q
Postpartum blues
A
Onset: 2-3 days; peaks at 5 days
=» Resolves within 14 days
Sx: Mild depression, tearfulness, irritability
Tx: Reassurance
*Pts are at increased risk of developing postpartum depression
4
Q
Postpartum depression
A
Onset: Within 4 weeks of delivery
Sx: Severe depression, sleep or appetite changes, low energy, psychomotor changes, guilt, concentration difficulty, suicidal ideation
(SIG E CAPS)
Tx: SSRIs; psychotherapy
5
Q
Postpartum psychosis
A
Onset: Days to weeks
Sx: Delusions, hallucinations, thought disorganization, bizarre behavior
Tx: Antidepressants, antipsychotics, mood stabilizers; HOSPITALIZATION w/ MONITORING
6
Q
Nightmare disorder
A
Recurrent awakenings from highly disturbing and frightening dreams BUT the patient can be consoled to calm down
-Child awakes fully alert and may have sweating
***Disorder occurs during REM Sleep
7
Q
Sleep Terror Disorder
A
Non-REM arousal disorder characterized by incomplete awakenings, unresponsiveness to comfort, and no recall of dream content
*Typically occur in the first third of the night and are characterized by marked autonomic arousal and amnesia
8
Q
Adjustment disorder treatment
A
Psychotherapy
9
Q
Extremely severe depression
A
CBT is not first line
Try meds and if those are not possible =»> ECT
10
Q
Indications for ECT
A
Treatment resistance
Psychotic features
Emergency conditions (pregnancy, refusal to eat or drink, imminent risk for suicide)
*No absolute CIs but severe CVD, recent MI, space-occupying brain lesion, and recurrent stroke increase the risk
11
Q
Neuroimaging in schizophrenia
A
Lateral ventricular enlargement **
Loss of cortical tissue volume possible
12
Q
REM sleep behavior disorder
A
Complex motor behaviors that occur during REM sleep
- Can present as dream enactment; most likely to occur in the latter part of the night
- Pts. may awake w/ transient confusion but quickly become alert
- Can be a prodromal sign of neurodegeneration with Parkinson’s
13
Q
Anorexia nervosa
A
Pts. have significantly low weight and an intense fear of weight gain
-Pts. may show binge eating, purging, or restriction of diet
Sx: Bradycardia, hypotension, hypothermia, hair loss, dry skin, lanugo, amenorrhea
14
Q
Hoarding Disorder treatment
A
CBT
SSRIs can possibly used in conjunction but have limited efficacy
15
Q
Cyclothymic disorder
A
Symptoms do not meet either a major depressive or manic episode but fall somewhere in between
- Think of this as the most mild form of bipolar disease
- Patient mst have these symptoms for >2yrs
16
Q
Patient who is on an antipsychotic and can’t stop moving around the room or walking out of the room
A
Akathisia- inability to sit still due to restlessness; causes extreme distress sometimes
Tx: Reduce antipsychotic and administer a BB, benztropine, or benzo
17
Q
Reasons for involuntary commitment to the hospital
A
Suicidal/homicidal plans
Inability to take care of self
18
Q
Treatment of NMS
A
Dantrolene
Bromocriptine
19
Q
Avoidant personality disorder
A
Patient avoids personal interaction due to fears of criticism and rejection
20
Q
Kleptomania
A
Patient has a repetitive failure to resist impulses to steal; they have increasing tension prior to theft with relief when committing the theft
-Stolen objects are often given away, discarded, or returned; guilt and remorse ARE PRESENT
Tx: CBT + SSRIs
21
Q
Tx of catatonia
A
Benzodiazepines
Typically will respond within 7 days to a trial run of lorazepam
ECT if refractory
22
Q
Serotonin syndrome triad
A
Tremors
Hyperreflexia
Myoclonus
⭐️ Typically will have GI symptoms as well
23
Q
Drug that can cause seizure with abrupt discontinuation
A
Short-acting benzos (alprazolam, lorazepam)
Pts. Will usually have a history of depressive mood and sleep issues
24
Q
Elderly patient who becomes agitated after taking their meds
A
Probably paradoxical agitation due to benzodiazepine use
25
Other distinguishing feature of PCP use
Nystagmus
26
Projection
Attributing ones own feelings to others
27
Tx of acute dystonia
Benztropine
Or
Diphenyhydramine
28
Test question about switching antidepressants
Never pick an MAOI or TCA unless it mentions a 4 week washout period
29
Ecstasy intoxication
Euphoria, increased sociability, increased libido
OD: HTN, tachycardia, hyperthermia, serotonin syndrome, Hyponatremia
⭐️ Not detected on routine drug screens
30
Drug to switch someone to if they develop tardive dipyskinesia while on an antipsychotic and cannot tolerate a ️Decreased dose of their medicine
Clozapine; has the least likelihood of causing EPS
31
Hypertensive crisis
️Occurs when a patient on an MAOI ingests Tyramine containing food
-Patients can also have headache, intracranial ️Bleeding, stroke
32
Acute onset of psychiatric and neurologic abnormalities alongside inexplicable abdominal pain may be what?
Acute intermittent porphyria
Abdominal pain is neuropathic in nature; may be other Neuropathies, anxiety, insomnia, restlessness, and psychotic symptoms present
-Lasts for days to weeks, age of onset is in 30-40s
33
Dermatitis around a mouth or nostrils in someone who uses drugs
Could be glue sniffers rash
LFTs may be slightly elevated
34
Good prognostic factors for schizophrenia
Later onset in life
Good social support
Positive sx.
Mood symptoms
Acute onset
Female gender
Few relapses
Good premorbid functioning
35
Bad prognostic factors for schizophrenia
Early onset
Poor social support
Negative sx.
FH
Gradual onset
Male gender
Many relapses
Poor premorbid functioning
Substance use
36
"Weight-neutral" second-generation antipsychotics
Ziprasidone
Aripiprazole
37
Treatment for tardive dyskinesia
Remove typical antipsychotic and add a benzo
38
Koro
Intense anxiety that the penis will recede into the body possibly leading to death
Culture: Southeast Asia
39
Amok
Sudden, unprovoked outbursts of violence often followed by suicide
Culture: Malaysia
40
Brain fag
Headache, fatigue, eye pain, cognitive difficulties, and other somatic disturbances in males
Culture: Africa
41
Good prognostic factor for Autism
Verbal language by age 5
42
mood stabilizer to use in patient on thiazides
Valproate
43
Cognitive Behavioral Therapy
Patients: Maladaptive thoughts, avoidance behavior, ability to participate in homework
Focus: Challenges maladaptive thoughts that underline emotional reactions
Targets avoidance with behavioral techniques such as relaxation, exposure, and behavior modification
44
Interpersonal psychotherapy
Patients: Depressed with relationship conflicts
Focus: Links current relationship conflicts to depressive symptoms
45
Supportive Psychotherapy
Patient: Lower functioning in crisis, psychotic
Focus: Therapist is a guide who reinforces coping skills and helps to build adaptive defense
46
Psychodynamic psychotherapy
Patient: Higher functioning but has persistent patterns of dysfnxn
Focus: Builds insight into how unconscious conflicts and past relationships cause symptoms
Uses transference
Breaks down maladaptive defenses
47
Motivational interviewing
Patient: Substance abuse disorder
Focus: Addresses ambivalence and enhances motivation to change
Nonjudgmental, acknowledges resistance
48
Dialectical behavioral therapy
Patient: Borderline personality disorder; self-injury
Focus: Improves emotion regulation, mindful awareness, distress tolerance, manages self-harm
*Has a GROUP therapy component
49
Biofeedback
Patient: Prominent physical symptoms; pain disorders
Focus: Improves awareness and control over physiological reactions
Lowers stress levels
Integrates mind and body
50
Signs NOT ASSOCIATED WITH NORMAL BEREAVEMENT
Functional decline inhibiting work ethic
Feelings of worthlessness, self-loathing, and suicide risk
Thoughts of dying but not related to the deceased
51
CIs to Bupropion
Seizure disorders
Bullimia nervosa/Anorexia nervosa
-These individuals already have electrolyte abnormalities that will be further precipitated by bupropion
52
Manic episode
```
Distractibility
Insomnia/Impulsive behavior
Grandiosity
Flight of ideas
Agitation/Activity
Speech (pressured)
Thoughtlessness
```
Must have at least 3
53
Anhedonia
Inability to experience pleasure
54
ADR to worry about w/ TCAs
Cardiac arrhythmia
55
"Melancholic features" of depression
Early morning awakenings
Excessive guilt
Depression worse in morning
Psychomotor disturbance
56
"Rapid cycling" of bipolar episodes
4 or more manic episodes in 1 year
57
ADRs of Lithium
Weight gain
Tremor
GI
Fatigue
Arrhythmia
Seizure
Hypothyroidism
Nephrogenic DI
Metallic taste
Alopecia
58
Treatment for a pregnant woman having a manic episode
ECT
59
Treatment for premenstrual dysphoric syndrome
SSRIs
OCPs second line
60
Disruptive Mood Dysregulation Disorder
Severe, recurrent verbal/physical outbursts that are inconsistent with the developmental level with symptoms beginning before age 10
- Symptoms must be present in at least 2 settings
- Symptoms for at least 1 year with no more than 3 months without them
Tx: Psychotherapy
61
MC ADR of desmopressin
Headache
62
Lab to check with restless leg syndrome
Iron study
63
ADR with stimulants that can lead to kids getting teased
Repetitive grimacing and blinking
64
Lab findings with anorexia
Hypercholesterolemia
Normocytic anemia
Leukopenia
Possibly Hypokalemia and hypochlorydia
Increased amylase
Hypomagnesemia
65
Alexia
Inability to read
66
Anomia
Inability to name objects even though it is recognizable and can be described
67
Agnosia
Inability to recognize objects despite intact senses
68
Iq ranges
Normal: 90-110
Mild ID: 55-70
Moderate ID: 40-54
Severe ID: 25-39
Profound ID: <25
69
Cotard Syndrome
Nihilistic delusional content
Patients may also feel that they have literally lost their inner organs
70
Capgras Syndrome
Delusion that people have been replaced by imposters
71
Folie a deux
Similar delusions seen in two patients who associate; probably due to influence of one on the other
72
Fregoli delusion
Belief that familiar people are assuming the guise of strangers
73
Underlying etiology to postpartum psychosis
Bipolar disorder
Patients typically have psychiatric history
74
Most consistent sleep abnormality in MDD
Early morning awakenings
75
Specific benzo to use for DTs
Oxazepam (is not hepatically metabolized)
Lorazepam (ditto)
76
Are break-ups considered traumatic events?
No
Therefore, it cannot possibly be acute stress disorder if a patient experiences dysfnxn, it is actually adjustment disorder
77
If a patient is using drugs and depressed, does the DSM say they can have a disorder/
No ya dingus
78
Feelings and attitudes originating from the clinician that have been evoked by the patient
Countertransferrence
-Can even happen when a doctor gets excited to see a cute patient
79
How many patients typically respond to a placebo?
About 1/3
80
Average length of untreated MD episode
6-13 months
81
Treatment of an acute manic episode
Lithium
or
VA
82
NT that is lower in patients w/ history of suicide attempt or aggressive behavior
Serotonin
83
Unusual associations w/ schizophrenia
Short-term memory deficits
Unstable smooth-pursuit eye movements
Sensory gating abnormalities
84
Treatment for patient who has migraines and depression
Amitriptyline
85
Localized amnesis
Memory loss surrounding a discrete period of time, typically after a traumatic event
86
Prominent epicanthal folds w/ a heart murmur
Think Down Syndrome
87
Patient who switches medications and starts becoming depressed (especially if a BB)
Think substance-induced mood disorder
88
Addition of tramadol (or other opioid) to an SSRI
Serotonin syndrome ya dingus
89
Patient on sinemet who is experiencing hallucinations and stealing shit
Decrease their dose but dont take it away if they still have Parkinsonian symptoms
90
Patient who is being abused and says she might kill boyfriend
Still admit to psych unit
91
Dissociative fugue
Person who doesn't remember who they are and is found traveling
These people will be oriented to time and place tho
92
Voyeuristic disorder
Sexual pleasure from watching unsuspecting people unclothed
93
Frotteuristic disorder
Sexual pleasure from rubbing against a nonconsenting person
94
Immediate management of an acutely psychotic patient
Haldol ya dingus
95
Mood stabilizer that does not cause agranulocytosis
Lithium
Most of the others do
96
Initial work up on a somatic symptom disorder pt
Assess for other psychiatric illnesses
97
Personality disorder common w/ somatic symptom disorder
Histrionic
98
Med to administer in hypertensive crisis
Doxazosin, prazasoin (a-blockers)
Nitroprusside
99
Common ADR of clozapine outside of typical expectations
SEIZURE
100
Possible ADR of benztropine after administering for EPS
Anticholinergic effects (Flushing, tachycardia, dilated pupils)
Discontinue the med and start amantadine (will alleviate the EPS)
101
What type of defense is denial?
Narcissistic defense
102
What test can you do if you want to determine if someones unresponsiveness is psychogenic or due to a coma-like state?
Cold-caloric induced nystagmus
103
Method used to calculate IQ
Mental age/Chronological age x 100
104
Identification
Unconscious defense mechanism in which the person incorporates the characteristics and qualities of another person or object into their ego system
105
Painkiller to avoid in pts. who are on MAOIs
Meperidine
Can cause hypertensive crisis
106
Pregnancy and MAOIs
Dont
Start on fluoxetine preferably or ECT if necessary
107
First thing to do in NMS
DISCONTINUE MEDS
108
Rey-Osterrieth Test
Test you gave to that pt. w/ CBD
Tests visual nonverbal memory; right parietal lesions may show abnormalities here
109
Atropine
Antimuscarinic agent used to reverse excessive cholinergic activity
110
Effect of NSAIDs on lithium levels
Decrease clearance =>> Greater potential for toxicity
111
Medically ill pts (like HIV) who have symptoms of depression can respond to what class of medications?
Stimulants
112
Huffing intoxication signs/symptoms
Visual disturbances
Dyscoordination
Depressed reflexes
Euphoria
Nystagmus
113
Deja entendu
Feeling that one is hearing something they have heard before
114
Unthought of causes of substance-induced depressive disorder
Antihypertensives
Anticonvulsants
Diuretics
Sulfonamides
115
Sleep problems w/ MDD
REM sleep shifts to earlier in the night and with greater duration but with reduced stages of 3 and 4
Initial and terminal insomnia
Multiple awakenings
116
Only possible total CI to ECT
Previous rxn to anesthesia
117
Treatment for major depression w/ psychotic features
Antidepressant + atypical antipsychotic
118
Length of untreated manic episode
Months
119
Tx for acute mania
Preferably lithium and an atypical antipsychotic
BUT
If the answer only gives you one option, go with the atypical
120
Treatment of a pregnant woman with a MANIC episode
ECT
121
Best treatment for rapid cyclers in Bipolar
Carbamazepina or Depakote
122
Time requirement for dysthymia
2 years
123
Disruptive Mood Dysregulation Disorder criteria
Severe outburst out of proportion to situation >2 times per week and inconsistent w/ developmental level
- Mood in b/w outbursts is still irritable
- Symptoms in at least 2 settings
- Symptoms for at least 1 year and must have started before age 10
Tx: Psychotherapy, meds
124
Patient with chronic, intractable pain who is frustrated. What should you work them up for?
Signs of depression
125
Test to order w/ suspected narcolepsy
Polysomnography
126
Someone who doesn't want treatment after an acute stressor, what should you do?
"Provide information about the range of reactions to trauma"
Seems like bullshit but that was the answer
127
Patient w/ agranulocytosis on clozapine but still having hallucinations
Doesn't matter, discontinue the clozapine
You can always switch to something else later
128
Can you have signs of hallucinations or delusions with a manic episode?
Yes
129
Patient w/ mild tremors of his fingers and hands but stable everywhere else
Essential tremor you fuckhead
130
Patient w/ specific phobia and no history of substance abuse
Give em a benzo
131
Treatment of acute stress disorder as in like it has only been happening for a couple of days so far
Benzos
132
Amitriptyline in an old person
Take them off that shit
133
Who do you not want to give Bupropion to?
ANXIETY PEOPLE
Eating disorders
Hx. of seizure
134
Patient who has been treated for schizoaffective disorder and now has elevated LFTs, what drug caused it?
Valproic acid
135
Aprosody
Speech without any melodic intonation
136
What parts of the brain have increased activation in OCD?
The caudate, frontal lobes, and Cingulum
137
Circumlocution
Substitution of a word or description for a word that cannot be recalled or spoken
I do this shit all the time
138
First symptoms to respond to SSRI treatment
Sleep, energy, and appetite changes
139
Treatment of seizure after MAOI OD
Benzos
140
First line options for treatment of bipolar depression
Lithium
Lamotrigine
Quetiapine
141
Treatment of Tourette's
Mild: Clonidine
Moderate-severe: antipsychotics
142
Most severe ADR of SSRI exposure to a fetus
Persistent pulmonary hypertension of the newborn
143
Drugs on an anorexic with no other psychiatric illness
Nah
144
Drug to give older people to help them sleep
Trazadone
Don't worry unless they have a history of priapism
145
EKG abnormality with lithium
T wave depression
146
Patient with refractory ocd
Treat with added atypical antipsychotic
147
Patients with increased sensitivity to lactate infusion
Panic disorder patients
148
HLA-DR2 association on this test
Narcolepsy
149
Tx of cocaine intoxication
Benzo
150
Patient showing regressive behavior in the hospital
Think histrionic personality disorder
151
Pharmacologic treatment of Bullimia
SSRIs
Second line: topiramate
152
First generation antipsychotic that can cause QT prolongation
Pimozide
153
Antipsychotics available in injectable form
Haloperidol
Risperidone
154
Treatment of sailorrhea in Pts on antipsychotics
Clonidine
155
Treatment of tachycardia in pt on clozapine
Bb
156
Depressive symptom that takes the longest to improve
Suicidality
157
Antipsychotic NOT associated with QT prolongation
Olanzapine
158
Anxious pt who is on warfarin
Give benzos; SSRIs will interact with the cyps
159
Symptoms of alcohol withdrawl at 3 days
Sweating
Flushing
Tremulous ness
Delirium Tremens
160
Focus of interpersonal psychotherapy
Clarifying communication patterns
161
Therapy used for borderline personality disorder
Combined individual and group psychotherapy
162
Contagion
Expression of emotion elicits emotional response from other members in the group
163
Patient who is on SSRI and occasionally misses doses but has no problems
Probably on fluoxetine
**Longest half-life of the SSRIs
164
Ganser Syndrome
Dissociative disorder in which pts. give approximate answers to questions and may have fugue, disorientation, amnesia, and conversion symptoms
165
You are served a subpoena for the records of a patient. What do you do?
Ask patient if they would like the info released
166
Initial drugs to start with potential Alzheimer's
Donepizel, rivastigmine, or galantamine
167
Are white or black people at greater risk for committing suicide?
White people
168
Percent risk of someone w/ MDD having another episode
50%
169
ADRs of St. John's Wort
Photosensitivity
GI distress
Fatigue
Rash
Restlessness
Headache
Dry mouth, dizziness, confusion
***May be potentiated w/ concurrent SSRI use
170
Likelihood of full recovery w/ bullemia
25%
171
Reactive Attachment Disorder
Disturbed and inappropriate social relatedness associated w/ pathological care
***Patients will act unusually clingy with adults and act very openly and socially with them but will act aggressive to younger children their age
172
Antidepressants which may work better w/ atypical depression
MAOIs
173
Mood stabilizer to use w/ rapid cycling in Bipolar
Depakote
2nd line: Carbamazepine
174
Drug to use in pregnant patient w/ bipolar disorder if you have to switch them
Haldol
175
Personality traits associated w/ complex partial epilepsy
Hyperreligous thinking
Preoccupation w/ moral behavior
Altered sexual behavior
Hypergraphia (exaggerated body language)
176
SSRI w/ greatest anticholinergic effect
Paroxetine
Avoid in Alzheimer's or NCG pts
177
Best immediate treatment for a severely agitated patient on PCP
Haldol
178
Epicanthic folds, flat nasal bridge, single palmar crease
Down syndrome
179
Smooth philtrum, short palpebral fissure, thin upper lip (fish mouth)
Fetal alcohol syndrome
May also see growth retardation and signs of CNS involvement
180
What work up is needed on a patient with a possible specific learning disorder
Check for sensory deficits
181
How long do symptoms have to be present to diagnose ADHD and what age does this have to happen before
6 months
12
182
Provisional tic disorder
Single or multiple motor and/or vocal tics for <1 year or do not meet criteria for Tourette's
183
Tx of ODD
Behavior modification
Parent management training if only problems at home
184
Substance induced psychotic disorder
Hallucinations and/or delusions
Symptoms do not occur only during episode of delirium
Evidence of substance abuse
185
Schizophrenia criteria
Two or more of the following:
Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
Negative symptoms
⭐️At least one symptom must be one of the first three
⭐️ illness must be for at least 6 months
Symptoms cannot be due to substance or other condition
186
Treatment of serotonin syndrome
1. Stop drugs
2. Start benzos
- alternatively, Cyproheptadine
187
Tx of NMS
1. Stop medication
2. Supportive care
3. Consider Dantrolene, bromocriptine, or Amantadine
188
Tx of hypertensive crisis
1. Stop drugs
2. Administer phentolamine
3. Other symptomatic management
189
Bilateral Abducens palsy, horizontal nystagmus, and confusion
Wernicke's
190
Treatment of delusional disorder
Antipsychotic
191
Acutely manic patient who is delusional and disruptive
Still give the antipsychotic even tho they are not hallucinating
192
Most common ADR of an SSRI 3 months after treatment
Sexual dysfnxn
Other problems resolve by this point
193
Dissociative trance
Acute narrowing or loss of awareness of surroundings manifesting as unresponsiveness, potentially win minor stereotyped behaviors
194
Lab findings in intermittent explosive disorder
️Decreased 5-HIAA in CSF
Abnormal EEG findings
195
Intermittent Explosive Disorder treatment
SSRIs + CBT
Anticonvulsants
Lithium (mood stabilizers after SSRIs)
196
Risk of bipolar disorder in monozygotic twins
90%
197
Most important thing about voices in a schizophrenic
What are they saying?
Need to determine patients safety
198
Tx for Illness Anxiety Disorder
CBT
199
Which people have higher incidences of Factitious disorder
Healthcare workers
200
Compound synthetic heroin contains
MPTP; dopaminergic neuron toxin that harms the SN
201
Teenager who wont keep his room clean and has mood swings that do not overall disrupt function
Normal behavior ya dingus
202
Person who has 5/9 SIGECAPS but may have somatization
Pick MDD over Somatization
203
Poorly educated family that believes their son is episodically possessed by the devil, what do you suspect?
Epilepsy; get an EEG
204
Patient who has performance anxiety and also has COPD
Give him a benzo
Family history is not enough to rule this medication out
205
anti-HAM effects
H: sedation, weight gain
A: hypotension
M: dry mouth, blurred vision, urinary retention, constipation
Found in TCAs and typical antipsychotics
206
EPS
Parkinsonism
Akathisia
Dystonia
207
SSRI to use in pregnancy
Fluoxetine
208
Shortest half-life of SSRIs leading to quick withdrawal sx.
Paroxetine
209
Nefazodone
Same as trazadone but also carries a Black Box warning for serious liver failure
210
TCA mechanism of action
Inhibit reuptake of NER And serotonin
211
Doxepin
Type of TCA
212
Tx for TCA OD
Sodium bicarbonate
213
Amoxapine
Tetracyclic antidepressant that has a similar ADR profile to typical antipsychotics
214
MAOI that does not require dietary restrictions
Selegline
215
Psychotic patient who is withdrawn and has a flattened affect, what do you treat with?
ATYPICAL antipsychotic
216
ADRs w/ typical antipsychotics
Low potency =>> More anti-HAM
High potency =>> More EPS
217
What pathway is involved w/ the positive symptoms of schizophrenia?
Mesolimbic pathway
Nucleus accumbens =>> Fornix =>> Amygdala =>> Hippocampus
218
Negative sx. of schizophrenia
Mesocortical pathway
219
Only antipsychotic shown to decrease suicide risk
Clozapine
220
Atypical antipsychotic that shows partial D2 agonism
Aripiprazole
221
Patient who cannot take a benzo but wants something to help their anxiety/help them sleep
Hydroxyzine
222
Initial medication in someone who is acutely psychotic but they say nothing of medication adherence
Start on something orally first
223
Patient who may have pseudodementia but has weight loss and increasing social isolation
These signs point towards MDD
224
4 stipulations of malpractice
1. Psychiatrist-patient relationship exists
2. Physician did not meet standard of care
3. Patient was harmed
4. Harm was a direct result of physician's negligence
225
Idea of parens patriae
Protecting citizens who cannot care for themselves
226
Mature defense mechanisms
Altruism
Humor
Sulbimation
Suppression (conscious)
227
Neurotic defenses
Controlling
Displacement
Intellectualization
Isolation of affect
Rationalization
Reaction formation
Repression (unconscious)
*These are seen in OCD, anxiety, and stressed patients
228
Immature defenses
Acting out
Denial
Regression
Projection (attributing objectionable thoughts to others)
-Husband who is in love with another woman believes his wife is having an affair
229
Concepts used in psychoanalysis
Free association
Dream interpretation
Therapeutic alliance
Transference
Countertransference (bad)
230
Patient who is having a manic episode and testing positive for THC
Diagnose Bipolar disease
While marijuana can cause psychosis, it does not cause a full manic episode
231
Social Anxiety Disorder
Marked anxiety about >1 social situation for >6 months
-Pts. fear scrutiny and embarrassment which leads to avoidance of social situations and marked impairment or distress
Tx: SSRI + CBT
232
Hypersomnolence disorder
Excessive sleepiness despite 7 hours with recurrent periods of sleep within the sam day, nonrestorative sleep, and difficulty being awake after awakening
-Can be caused by viral infxns, head trauma, or genetics
Tx: Modafanil; scheduled napping
233
Causes of central sleep apnea
Heart failure
Acute stroke
Renal failure
OPIOID USE
Tx: Treat underlying condition + CPAP
234
DOC for cataplexy
Sodium oxybate
235
Delayed sleep phase disorder
Chronic delay in sleep onset and awakening times w/ preserved quality
Tx: Melatonin
236
Advanced sleep phase disorder
Normal duration and quality of sleep onset and awakening times earlier than desired
237
Shift-work disorder
Sleep deprivation and misalignment of the circadian rhythm secondary to non-traditional work hours
238
Tx for sleepwalking
Low dose benzo ONLY if they sleepwalk and do dangerous shit
239
Type of CBT used for OCD
Exposure and Response prevention
