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psychiatry > UW > Flashcards

UW Flashcards

1
Q

SSRI in breastfeeding

A

sertraline

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2
Q

clozapine for schizo only if fails with … (number) medications

A

2

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3
Q

somatic symptom disorder - management

A

regularly scheduled appointments, which establish a strong physician-patient relationship and limit diagnostic testing and subspecialty referrals
(rarely respond to reassurance)

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4
Q

somatic symptom disoreder - clinical features

A

1 or more somatic symptoms causing distress + functional impairent

  1. excessive thoughts or behaviors related to somatic symptoms
  2. more than 6 months
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5
Q

severe symptoms of benzo withdrawal

A

psychosis + seizures

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6
Q

folie a deux - most important frist intervention

A

separate the pair to disrupt the mutually reinforcing nature of the shared delucion and to enable a more careful assessment to each individual pathology
- psychiatric treatment in the dominant, the nondominant individual rarely need drugs

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7
Q

intermittent explosive disorder?

A

like antisocial but without history of conduct disorder or other fearures of antisocial

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8
Q

borderline - history of …… is common

A

childhood trauma

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9
Q

type of amnesia as a SE of electroconvulsive therapy

A

anterograde and retrodrage

retrograde persists longer

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10
Q

Electroconvulsive therapy - contraindications

A

no absolute

  • increased risk if:
  • severe CVD, recent MI
  • space occupying brain lesion
  • recent stroke, unstable aneurysm
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11
Q

suicidal patient - when t admit

A

if ideation, intnet + plan
- if ideation but no plan or intent –> ensure close follow up, treat mdifiable RF (depression etc), recruit family or friends to support, reduce acces to potentioal means

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12
Q

best combination for bipolar (if not controled by single drug)

A

lithium or valproate PLUS 2nd generation antipsychotic

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13
Q

evidence based monotherapy options for bipolar

A

lithium, valproate, quetiapine, lamotrigine

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14
Q

specific phobia - history and clinical features / treatment

A
  1. marked anxiety about a specific object or situation (the phobic stimulus) for more than 6 months
  2. common types: fear for flying, heights, animas etc)
  3. common 10%
  4. usually develops in childhood, often after traumatic events
    treatment: CBT with exposure, benzo in acute
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15
Q

agranulocytosis - definition

A

complete absence of NEUTROPHILS

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16
Q

1st line treatment for anorexia nervosa

A

nutritional rehab
+
psychoterapy

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17
Q

anorexia nervosa - indications for hospitalization

A
  1. bradycardia (less than 40) 2. dysarhythmia 3. hypotension (less than 80/60) 4. orthostasis
  2. hypothermia (less than 35) 6. electrolyte disturbances 7. marked dehydration 8. organ compromise 9. BI less than 15
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18
Q

treatment of PCP

A

1st line: benzo
2nd line: haloperidol
3rd line: propofol

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19
Q

dextromethorphan in children can cause

A

hallucinations

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20
Q

how to seperate use of cocaine from maniac

A

cocaine has physical symptoms: dilated pupils, diaphoresis, tremors

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21
Q

Narcolepsy - diagnostic criteria

A 
recurrent lapses into sleep or naps (at least 3 times per week for 3 months)
PLUS
1 of the following:
- cataplexy
- low hypocretin-1 in CSF
- shortened REM sellp latency
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22
Q

increased sensitivity to lactate infusion has been associated with

A

panic attacks

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23
Q

abnormalities in cortico-striato-thalamo-cortical circuits have been associated with

A

OCD

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24
Q

how to decrease the trisk or replapse in schizophrenia

A

miniimzaing conflicts and stress in home

- family psychosscial interventions are indicated

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25
Q

commonly abused inhalants

A

glue, toluene, nitrous oxide, amyl nitrite, spray paints

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26
Q

inhalant abuse - effects

A

immediate effect lats 15-25 mins
acts i CNS
- can cause dermatitis (glue sniffer;s rash) around mouth or nostrils)
liver function test may be elevated
- chronic nitrous oxide casues Vit B12 def

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27
Q

gender dysphoria - initial management

A
  • assessment of safety
  • support, psychoterapy (individual, family)
  • referral to specialist services (medical + mental health multidisciplinary)
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28
Q

sleep terrors - management

A

reassurance

low dose of benzo at bedtime if episodes are frequent, persistent and distressing

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29
Q

cognitive impairment in elderly patients - ddx

A
  1. normal aging
  2. Major depression
  3. Mild neurocognitive disorder
  4. major neurocognitive disorder (dementia)
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30
Q

cognitive impairment in elderly patients - normal aging

A

slight decrease in fluid intelligence (ability to process new information quickly, normal functioning in daily activities
- word finding difficulty

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31
Q

unexplained abd pain and new onset neuropsychiatric symptoms (including neuropathies, anxiety, mood changes, psychosis)

A

acute intermittent porphyria

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32
Q

disulfiram vs naltrexone vs acamprosate as treatment of alcoholism

A

naltrexone –> to reduce craving (in active drinkers)
disulfiram –> in abstinent patients (2nd line)
acamprosate –> abstinent patients

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33
Q

naltrexone - contraidincations

A

liver problems

patients on opioids

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34
Q

acamprosate contraindications

A

renal failure

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35
Q

DDX of depressed mood

A
  1. Major depressive
  2. Dysthymia
  3. Adjustment disorder with depressed mood (within 3 months of stressor event, marked distress or/and functional impairment)
  4. Normal stress response
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36
Q

normal stress response

A
  • not excessive or out of proportion to severit of stressor

- no significant functional impairment

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37
Q

how to stop a seretonergic antidepressant

A

gradually (with a taper)

if abrupt or rapid taper of a short HL –> psychological and physical symptoms

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38
Q

antidepressant discontinuation syndrome - manifestations / management

A

dysphoria, fatique, insomnia myalgias, flu liike, GI , tremor, neurosensory
begin within 2-4 days after the stopping of medication
- management: re-institute the same andtidepressant and taper the dose gradually over 2-4 weeks, or start fluoxetine which is long HT and stop it gradually

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39
Q

general anxiety disorder - when to give benzo

A

nondepressed patientswithout a history of substance abuse who fail to respond to or cannot tolerate antidepressants

40
Q

normal aging vs dementia (major cognitive disorder) - memory loss

A
  • in aging they can provide details about incidents of forgetfulness
  • patients are more concern about memory loss
  • recent memory for important events + conversations is intact
41
Q

normal aging vs dementia (major cognitive disorder) - word findings difficulty

A

in aging is occasional WITHOUT receptive aphasia

42
Q

normal aging vs dementia (major cognitive disorder) independence + functioning

A
  • in aging they maintain independence in daily activities
  • able to operate common appliances (devices)
  • Maintains interpersonal social skills
  • not lost in familiar territory (may have to pause briefly to reorient)
43
Q

OCD -time

A

consuming more than 1 h / day or causing significant distress or impairment

44
Q

Major depressive disorder - season

A

seasonal pattern characterised by seasonal onset and remission (MC fall-winter onset and spring-summer remission
treatment: bright light therapy alone or with an antidepressan

45
Q

medication-induced psycotic disorder

A

acute onset of delusions and/or hallucinations that are temporally associated with the use of a new medication
- glucocorticoids (esp high doses) are often implicate

46
Q

conversion disease - management

A

education about the disorder –> if not respond –> CBT

47
Q

HIV-associated dementia

A

severe form of dementia in untreated and/or long-standing HIV and CD less than 200
- subcortical symptoms early in the course

48
Q

HIV mediated dementia - number of CD4

A

less than 200

49
Q

2ry causes of acute onset psychosis in children _ adolescents

A
  1. medical disorders: CNS injury / dysfunction, metabolic / electrolyte disturb / systemic (SLE, thyroiditis)
  2. Illicit substance: hallucinogen, marijuana, sympathomimetics (cocaine), alcohol withdrawal, Bath salts
  3. Medication SE: intoxitation or withdrawal
50
Q

another SE of lithium

A

hyperparathyroidism

51
Q

baseline studies for lithium

A
  • urea, Cr, Ca2+, urinalysis
  • Thyroid function test
  • ECG coronary risk factors
52
Q

How to differentiate Parksinon disease dementia from Lewy bodies

A

by timing of symptom onset

if parkinsonism predates cognitive impairment by more than 1 year, then is Parkinson

53
Q

treat depression with Buproprion if

A

smoking cessation and weight loss are also goals

54
Q

anorexia nervosa - Thyroid

A

often have low levels of T3 and/o T4 (euthyroid sick syndrome) due to body;s adaption to chronic nutritional depletion –> no thyroid replacement (dangerous for cardiac arrhythmias and osteopenia)

55
Q

generalised anxiety disorder - time

A

6 months or more

it can be years

56
Q

neuroimaging of schizophrenia

A

loss of cortical tissue volume with ventrical enlargement is a subset of patients with schizo, with lateral ventricular enlargement being the most widely replicatied finding
- decreased volume of amygdala and hyppocampus

57
Q

autism - neuroimaging

A

accelerated head growth during infancy and increaesd total brain volume

58
Q

OCD - neuroimaging

A

structural abnormalities in the orbitofrontal cortex and basal ganglia

59
Q

Metabolic effects of the 2nd generation antiphsycotics - highest risk drugs / how to monitor

A
  1. Clozapine 2. Olanzapine
    Baseline + regular follow-up: BMI, fastign glucose + lipids, BP, waist circumference (at 3 months and then annually)
    - more frequent if DM or gained more than 5% of initial weight
60
Q

Antipsychotic extrapyramidal effects - definition

A
  1. acute dystonia: sudden sustained contraction of the next, mouth, tongue and eye muscles
    2 .Akathisia: subjective restlessness, inability to stil still
  2. Parkinsonism: Gradual onset tremor, rigidity, bradykenesia
  3. Tardive dyskinesia: Gradual onset tremor after prolonged therapy (more than 6 months): dyskenesia of the mouth, face, trunk and extremeties
61
Q

antipsychotic extrapyramidal effects - treatment

A
  1. acute dystonia: benzotropine, diphenhydramine
  2. akathisia: propranolol, lorazepam, benzotropine
  3. parkinsonism: benzotropine, amantadine
  4. Tardive dyskinesia: stop the drug is possible, if it is not: switch to 2nd generation (esp clozapine), valbenazine
62
Q

abused drug that causes Seretonin syndrome

A

ecstasy

bath salts

63
Q

illicid synthetic amphetamines and analogs - name 2 drugs / urine

A
  1. MDMA (ecstasy) 2. bath salt

may or may not show up as amphetamnies in routine urine toxicology

64
Q

bath salts can cause

A

amphetaminese anaoge: seretonin syndrome. agitation, combativeness, acute psychosis, less likely hyponatremia

65
Q

capacity?

A

patient’s ability to understand the illness, treatment options and consequences and to express a choice reflecting a preference
- communicates, understands, appreciates, rationale

66
Q

diagnosis of depression - next step

A

evaluate for suitability (ideation, intent, plan)

67
Q

treatment of ADHD in patient with history of substance abuse

A

atomoxetine

68
Q

ADHD - CBT?

A

medication is generally considered as 1st line –> CBT can be added if medication is not fully effective or as monotherapy if medication is contraindicated

69
Q

clonidine + guanfancine in ADHD

A

only in children

not effective in adults

70
Q

dopamine pathways

A
  1. mesolimbinc: antipsychotic efficacy
  2. nigostratial: extrapyramidal symptoms
  3. tuberoinfundibular: hyperprolactinemia
71
Q

post-stroke depression

A

common and underdiagnosed
increased disability and mortality
benefit from SSRI

72
Q

2nd generation antipsycotics - mechanism

A

seretonin S2 and dopamine D2 antagonists

the added serotonin n receptor binding reduces the likelihood of extrapyramidal side effects

73
Q

neuroleptic malignant syndrome - treatment

A
  1. stop antipsychotcis or restart recent dopamine agents
  2. supportive care (hydration, cooling, ICU
  3. refractory –> dantrolene or bromocriptine
74
Q

the risk of lithium toxicity is increased with concurrent use of

A

thiazide, ACEi, tetracyclines, metronidazole, NSAID
or overdose
or volume depletion

75
Q

lithium acute toxicity

A

GI: nausea, vomiting, diarrhea

late naurologic sequence

76
Q

alcohol withdrawal syndrome - manifestations / time

A
  1. mild withdrawal: 6-24h
  2. seizures: 12-48h
  3. alcholic hallucinosis: 12-48h
  4. delirium tremens: 48-96h
77
Q

alcohol withdrawal,mild withdrawal - time / symptoms

A

6-24h

anxiety, insomnia, tremors, diaphoresis, palpitations, GI, INTACT ORIENTATION

78
Q

alcohol withdrawal, seizures - time and symptoms

A

12-48

single or multiple generalized tonic-clonic

79
Q

alcohol hallucinosis - time and symptoms

A

12-48

visual, auditory or tactile, INTACT ORIENTATION, STABLE VITALS

80
Q

delirium tremens - time and symptoms

A

48-96h

confusion, agiation, fever, tachycardia, hypertension, diaphoresis, hallucinations

81
Q

body dysmorphic disorder - main characteristic

A

defects are not observable or appear slight to others

82
Q

body dysmorphic disorder - treatment

A
  1. SSRI

2. CBT

83
Q

personality traits vs mood disorders

A

mood dirorders are not for a whole life and have more symptoms

84
Q

RF for prescription opiod misuese include

A
  1. younger than 45
  2. psychiatric disorder
  3. personal or family history of substance disorder
  4. presensce of a legal history
85
Q

how to reduce the risk for prescription opioid misuse

A
  1. review of the state’s prescription drug monitoring program data
  2. random urine drug screens
  3. regular follow up are
86
Q

guidelines for opioids follow up

A

every 3 months, and even more frequently in high risk situation

87
Q

MC side effects of methylphenidate

A

anorexia
weight loss
insomnia

88
Q

hoarding disaster?

A

distinct from OCD
- accumulation of a large number of possessions that may clutter living areas to the point that they are usuable –> distress when attempting to discard possessions

89
Q

hoarding disorder - treatment

A

CBT

SSRI may be used in paralle, but with limited effect

90
Q

active suicidal teenager doesn’t want to inform parents - next step

A

inform the parent and hospitalize the patient with or without consent

91
Q

CBT - indications

A
  1. depression
  2. generalized anx disorder
  3. PTSD
  4. OCD
  5. Eating disorder
  6. Negative thoughts pattern
92
Q

CBT - features

A

combines cognitive + behavioral
challenges maladaptive cognitions
targets avoidance with behavioral techniques (relaxation, exposure, behavioral modification)

93
Q

effective drugs during depressive phase of bipolar

A
  • 2nd generation antipsychotics (quetiapine, lurasidone)

- lamotrigine

94
Q

mechanism of neuroleptic malignant syndrome

A

dopamine antagonism

95
Q

parenteral nutrition - complications

A
  1. osmotic load (so ti is for more than 48 hours through central line)
  2. central-line associated bloodstream infection
  3. cholelithiasias

psychiatry (6 decks)

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