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Psychiatry > UW review > Flashcards

UW review Flashcards

1
Q

Depersonalization/derealization VS dissociative amnesia

A

Depersonalization/derealization– persistent or recurrent experiences

Dissociative amnesia- inability to recall important personal info, can be fugue

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2
Q

Persistent complex bereavement disorder dx

A

Prolonged grief (>12 mo), difficulty accepting death, persistent yearning

Tx: psychotherapy

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3
Q

Lab findings/Side effects in Lithium

A

Hyperparathyroidism and associated hypercalcemia
Nephrogenic DI
CKD
Thyroid dysfunction

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4
Q

Teratogenic effects of Li

A

Ebstein anomaly (cardiac issue)

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5
Q

Labs before Li starting

A

BMP, BUN, Cr, Ca, U/A, pregnancy, and thryoid function

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6
Q

Tx of bipolar d/o w/ psychotic features

A

Antipsychotic (not just mood stabilizer)

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7
Q

Antipsychotic mechanism and side effects in tuberoinfundibular (what gen?)

A

Blocking dopamine-2 receptors
Galactorrhea, menstrual irregularities, infertiliy
Worse in first-gen (haloperidol, fluphenazine) AND second-gen agent risperidone and paliperidone

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8
Q

PMDD characterization

A

cyclical mood swings, irritability, appetite changes, resolve AFTER menses (not just exacerbation of underlying issue)

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9
Q

Reduce risk of relapse in schizophrenia?

A

Family therapy (as well as antipsychotic med)

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10
Q

New onset Li toxicity?

A

GI Sx, confusion, ataxia, tremor (neuromuscular irritability)

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11
Q

Meds that decrease Li clearance?

A

Thiazaide diuretics, NSAIDs, ACE inhibitors

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12
Q

Antipsychotics less likley to cause EPS?

A

Quetiapine (low-potency)

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13
Q

Management of TD in anitpsychotic meds?

A

D/C if you can, switching to second-gen antipsychotic (queitapine, clozapine) if needed
Tx w/ valbenazine oreutetrabenazine

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14
Q

Acute mania management and fast?

A

Olanzapine (or others I assume) b/c it can have IM injection and rapid onset

Valproate and carbamazepine can be used but require oral admin

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15
Q

Acute mania Tx options?

A
  • Antipsychotics
  • Li
  • Valproate (avoid in liver disease)
  • Combo in severe mania
  • Adjunctive benzos for insomnia, agitation
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16
Q

Acute Tx for panic disorder

A

Benzodiazepines

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17
Q

GAD length of time of Sx?

A

6 months, persistent worry

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18
Q

Manic episode critera

A

> 1 wk of elevated/irritable mood & increased energy/activity: >3 of DIGFAST

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19
Q

Gender dysphoria criteria

A

Persistent (>6 mo) incongruence w/ sex at birth and gender, desire to be opposite, accompanying distress.

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20
Q

Indications for hospitalization in anorexia nervosa?

A

Bradycardic <40, Hypotension <80/60, Hypothermia <35, Electrolyte bad/marked dehydration, organ compromise, BMI

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21
Q

DID criteria

A

Discontinuity in identity and loss of personal agency w/ fragmentation into >= 2 distinct personality states, associated w/ trauma/abuse

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22
Q

Buproprion effects

A

NE-Dopa reuptake inhibitor, lack of sexual side effects, efficacy in ADHD, effective for smoking cessation, help w weight loss

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23
Q

Bipolar II and depression tx?

A

Avoid antidepressant monotherapy due to risk of inducing mania

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24
Q

First-line med for acute bipolar depression?

A

Sec-gen antipsychotics (quetiapine and lurasidone)

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25
Q

Tx of psychosis in PD ?

A

Anti-PD med reduction, and/or addition of low-potency antipsychotic (quetiapine, pimavanserin)

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26
Q

PCP intoxication tx?

A

Benzos

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27
Q

Ethylene glycol or methanol toxicity tx?

A

Fomepizole

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28
Q

PCP intoxication sx?

A

agitation, delusions, multidirectional nystagmus, disorientation

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29
Q

Tx of OCD?

A

SSRI and CBT (exposure and response prevention)

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30
Q

PTSD in child?

A

nightmares, traumatic themes in play, emotional regulation

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31
Q

Oppositional defiant disorder

A

angry/irritable mood, argues, defiant, for >= 6 months

Tx- parent management training, psychotherapy, no pharmacotherapy

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32
Q

Panic disorder

A

Recurrent, spontaneous anxiety attacks -> develops into avoidance behavior (frequently develop agoraphobia)

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33
Q

Social anxiety disorder

A

Fear of humiliation, criticism,

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34
Q

CBT uses

A

Depression, GAD, PTSD, panic d/o, OCD, ED, negative thought patterns (reducing automatic negative thoughts and avoidance behaviors that cause distress)

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35
Q

Psychodynamic psychotherapy uses

A

higher functioning, personality disorders

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36
Q

Motivational interviewing uses

A

SUD

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37
Q

DBT uses

A

Borderline personality disorder

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38
Q

Tx for specific phobia

A

CBT w/ exposure (first-line)

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39
Q

Dx for specific phobia

A

SPECIFIC object or situation, >6 mos; avoidance behavior, oftentimes in childhood after traumatic event

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40
Q

Reduce risk of long-term Rx misuse?

A

PDMP; see pts q 3 mo

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41
Q

Antidepressant for poor sleep and appetite?

A

Mirtazapine (SE: stimulation of appetite, weight gain, somnolence)

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42
Q

Definition of depression episode

A

> = 2 weeks, 5/9 SIGECAPS (one being anhedonia or depressed mood)

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43
Q

Cyclothymic vs BP1?

A

Cyclothymic– chronic, fluctuation mood disturbance fo, mild Sx, can’t Dx either a current or past MDD or hypomanic/manic episode

Dx- >= 2 yrs and insufficient # Sx to meet full criteria for hypomanic, manic, or depressive episodes

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44
Q

Definition GAD

A

Excessive worry, anxiety (multiple issues) >= 6 mos, )

> = 3 of following: restlessness/on edge, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance

Tx: CBT, SSRIs or SNRIs

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45
Q

NMS signs/Sx

A

Fever, confusion, muscle rigidity, autonomic instability

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46
Q

Delusional D/o Def

A

> = 1 delusion for >= 1 month

Other psychotic sx absent or not prominent, behavior not obviously bizarre, (personality d/o pervasive)

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47
Q

Schizophrenia definition

A

> = 2 of the following (at least 1 Sx from 1-3)

  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Disorganized or catatonic behavior
  5. Negative Sx (eg apathy, flat affect)

Impairment >= 6 mos

Adolescents commonly have prodromal phase w/ social withdrawal

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48
Q

Persistent depressive disorder definition

A

Chronic depressed mood for >= 2 yrs (1 yr in children)

> =2 of following: appetite, sleep issues, low energy/fatigue, low self-esteem, poor concentration, feelings of hopelessness

Never w/o symptom for 2 months at a time

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49
Q

First-line tx for moderate to severe PMS/PMDD

A

SSRIs (eg fluoxetine)

Both continous and luteal-phase only (day 14) effective

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50
Q

Li toxicity onset questions

A

GI Sx, confusion, ataxia, tremor –> seizures

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51
Q

Meds that increase Li levels

A

ACEi, NSAIDs, tetracyclines, metronidazole

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52
Q

Side effect of OTC and cough meds (usually seen in young children)

A

confusion, hallucinations

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53
Q

Causes of serotonin syndrome

A

Serotonergic meds, especially combo

Drug interactions

Intentional overdose

Sertonergic drugs of abuse (MDMA)

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54
Q

Clinical features of SS

A

Mental status changes, autonomic dysregulation, neuromuscular hyperactivity

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55
Q

Management of SS

A

D/c all serotonin meds, supportive care, sedation, benzos

Serotonin antagonist (cyproheptadine) if supportive measures fail

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56
Q

Phenelzine class and use

A

MAOI; treatment resistant depression

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57
Q

Low levels of _____ in CSF seen in associated suicidal behavior

A

5-hydroxyindoleaceitic acid (5-HIAA) –> metabolite of serotonin

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58
Q

Pharmacotherapy of psychosis

A
  • Second-gen antipsychotic (risperidone, aripiprazole, quetiapine, olanzapine, ziprasidone)
  • First-gen antipsychotic (eg haloperidol)
  • Adjunctive benzo for agitation
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59
Q

Antipsychotic EPS side effect: acute dystonia tx

A

Benztropine, diphenhydramine

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60
Q

Antipsychotic EPS side effect: akathisia tx

A

Beta blocker (only one), benzo, benztropine

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61
Q

Antipsychotic EPS side effect: parkinsonism tx

A

benztropine, amantadine

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62
Q

Antipsychotic EPS side effect: TD tx

A

valbenazine, deutrbenazine

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63
Q

Nucleus basalis of Meynert

A

Alzheimer’s

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64
Q

Desipramine side effect

A

QT prolongation

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65
Q

SSRI to MAOI length?

A

at least 2 weeks, avoid SS

66
Q

Tremors with Li tx?

A

propanolol

67
Q

Tx of tourette?

A

alpha agonist (guanfacine, clonidine), atypical (risperidone)

68
Q

GAD first-line? second line?

A

SSRIs/CBT then Buspirone

69
Q

Schizoaffective definition

A

2 weeks psychosis w/o major depressive or manic episode

Schizophrenia– mood sx present for relatively brief periods

MDD or BP w/ psychotic fts – psychotic sx ONLY during mood episodes

70
Q

Alcohol use disorder findings

A

Women (>7/week, >3/day)

Men (>14/day, >4/day)

AST/ALT >2:1

Macrocytosis

71
Q

Length of antidepressant trial

A

At least 4-6 weeks

72
Q

Korsakoff findings

A

Complication of Wernicke’s, acute d/o of thiamine deficiency

Retrograde/anterograde amnesia, preserved long-term memory, confabulation, lack of insight

Mamillary body atrophy

73
Q

Adjustment d/o w/ depressed mood definition

A

Onset w/in 3 mos of stressor; marked distress, functional impairment; does not meet DSM-5 criteria for another d/o

74
Q

Assessing for delirium vs. psychosis?

A

AMS in delirium; fluctuating cognitive impariment

Psychosis– pt alert and oriented

75
Q

Depression Sx in adolescents?

A

Irritable rather than sad, loss of interest, fatigue

76
Q

Lab findings in NMS

A

increased CK and increase WBC

77
Q

Pathophys cause of tardive dyskinesia

A

dopamine D2 receptor upregulation and supersensitivity from chronic blockade of dopamine receptors

78
Q

Cause of salt craving, reduced body hair, irritability, decreased mood

A

primary adrenal insufficiency (Addison disease) –autoimmune destruction of adrenal cortex

Mineralocorticoid deficiency– salt wasting, hypoTN, salt craving, weight loss

Glucocorticoid deficiency– fatigue, psych sx

Androgen deficiency – loss of libido, suppression of secondary sexual characteristics (usually women)

79
Q

Reaction formation

A

transforming unacceptable feelings and impulses into their extreme opposites

Resenting someone but then being very kind to them

80
Q

Dx depression in ill patients?

A

Look for depressed mood, loss of interest (hard to differentiate w/ somatic sx)

81
Q

Dependent personality disorder signs

A

excessive reassurance, advice in making decisions, avoid taking initiative due to feelings of inadequacy, seek out relationships (unlike avoidant), submissive behaviors

82
Q

SI and antidepressants?

A

Age <25, small risk of becoming suicidal, incrs. suicidal thoughts, should not be withheld

83
Q

Meds that can introduce delirium

A

opioids, benzos, anticholinergics (esp. elderly)

84
Q

HIV-associated dementia

A

CDC4 <200, long-standing disease, subcortical symtpoms

85
Q

Panic d/o dx

A

Recurrent and unexpected panic attacks w/ >=4 of following:

  • CP, palp, SOB, choking
  • Trembling, sweating, nausea, chills
  • dizziness, paresthesias
  • derealization, depersonalization
  • fear of losing control/dying
86
Q

Panic d/o tx

A

SSRI/SNRI and/or CBT

Acute distress: benzos

87
Q

Tx length for single-episode, unipolar major depression?

A

6 months once achieved effects

88
Q

Tx length for >=2 episodes, persistent residual depressive symptoms

A

1-3 yrs

89
Q

Tx length for >=3 lifetime depressive episodes, chronic episodes (>2 yrs), severe (suicide attempt)

A

indefinitely

90
Q

Fts of ASD

A

Deficits in social communication, restricted, repetitive patterns of behavior, language delay

Tx- early intervention!!

91
Q

GAD sx length?

A

6 mos

92
Q

Adjustment d/o tx?

A

psychotherapy to target maladaptive response to stress

93
Q

Binge eating d/o def

A

absence of compensatory, >=1 episode/week for 3 months+

Tx CBT, SSRI, lisdexamfetamine, topirmate

94
Q

Sleep findings in depression

A

Decreased REM sleep latency, decreased slow-wave sleep and increase REM duration and density

95
Q

Acute dystonia findings

A

sudden, sustained contraction of neck, mouth, tongue, and eye muscles

96
Q

Illness anxiety d/o vs somatic d/o?

A

Illness anxiety has no somatic symptoms

97
Q

MAOI + Tyramine

A

increased sympathomimetic (ie adrenergic) effect -> HTN

98
Q

Lab finding w/ depression?

A

increased serum cortisol concentration (hyperactivity of hypothalamic-pituitary-adrenal axis)

99
Q

Glucocorticoid therapy induced psychosis?

A

Dose reduction or d/c when possible; seen with high doses over long period of time

100
Q

Separation anxiety presentation

A

Associated w/ transition or change; characterized by a marked fear of separation

101
Q

PTSD associated with…

A

depression and suicidality

102
Q

Social anxiety d/o definition

A

anxiety restricted to social and performance situations (can have performance only subtype)

103
Q

Panic d/o definition

A

recurrent, unexpected panic attacks

104
Q

Minors and SI?

A

do not need parental consent

105
Q

PCP intoxication

A

(Hallucinogen) `Violent behavior, hallucinations, nystagmus, dissociation, amnesia, ataxia

106
Q

LSD

A

(Hallucinogen) Visual hallucinations, euphoria, dysphoria/panic, tachycardia/HTN

107
Q

Cocaine

A

(Stimulant) Euphoria, agitation/psychosis, chest pain, seizures, mydriasis, tachy/HTN

108
Q

Methamphetamine

A

(Stimulant) Violent behavior, psychosis/diaphoresis, tachy/HTN, choreiform movements, tooth decay

109
Q

Marijuana

A

(Cannabinoid) Increased appetite, euphoria, dysphoria/panic, slow reflexes, dry mouth, conjunctival injection

110
Q

Heroin

A

(Opioid) Euphoira, depressed mental status, miosis, respiratory depression, constipation

111
Q

Schizo negative sx

A

Apathy, avolition, affective flattening, alogia (brief answers), asociality (social w/d and diminished interest in relationships)

112
Q

Alcohol withdrawal tx (liver disease?)

A

Benzos

Liver disease– lorazepam, oxazepam, temazepam (lack active metabolites and undergo hepatic metabolism via phase II glucuronidation instead of P450)

Chlordiazepoxide, diazepam, lorazepam most commonly used (chlor and dia have longer half-lives)

Lorazepam and diazepam available IV

113
Q

Irritability, agitation, psychosis, tachycardia, hypertension, diaphoresis, dilated pupils

A

Amphetamine toxicity

114
Q

Tx of bipolar (first and second line)

A

Lithium and valproate; second-gen quetiapine and anticonvulsant lamotrigine

115
Q

Delusions in schizotypal?

A

Not really– can have magical thinking (supersition, clairirvoyance), suspiciousness, paranoid ideation

116
Q

Fail at first-trial of antidepressant?

A

Try another. Different SSRI or another first-line antidepressant w/ diff mechanism of action (Serotonin-NE reuptake inhibitor) (eg venlafaxine, bupropion)

117
Q

Bupropion- when to not use

A

seizure, history of bulimia (not just current)

118
Q

List of SNRIs

A

Venlafaxine, Duloxetine, Desvenlafaxine, Levomilnacipran

119
Q

Wash out length between antidepressants?

A

SSRI to MAOI (at least 5 weeks); 2 weeks for others

120
Q

Social anxiety disorder definition and tx

A

Marked anxiety about >=1 situation for >=6 months

SSRI/SNRI, CBT (BB or benzo performance only subtype)

121
Q

Nightmare disorder features

A

wakes up fully alert, frightening dream content, can be consoled, usually occur during REM sleep

122
Q

Tx for partial response to antidepressants?

A

Add antidepressant with a different mechanism of action, second-gen antipsychotic, Li, Triiodthyronine, or psychotherapy

Can add Bupropion! Can add on buspar when augmentation w/ seocnd antidepressant ineffective

123
Q

First-line tx for ADHD?

A

First-line: Stimulants (metylphenidate, amphetamine)

nonstimulants (atomexetine, alpha-2 agonists)

124
Q

Dx of ADHD

A

Inattentive and/or hyperactive/impulsive for >6 mos

125
Q

Psych fts of pancreatic cancer?

A

Prodromal depression and anxiety in 1/3 of pts; nonspecific anxiety, premonitory sesnation, and feeling “low” for no reason

Also can see new-onset DM (thin, older pts)

Next step: CT abdm

126
Q

Non-adherence in schizo tx?

A

long-acting injectable; every few weeks to months.

127
Q

Findings in vomiting?

A

Hypokalemic, hypochloremic metabolic alkalosis, hyperaldosteronism (due to volume depletion),

parotid gland enlargement, dental caries,

128
Q

Brain findings in schizophrenia?

A

Lateral ventricular enlargement, cortical tissue volume loss

129
Q

Sx of PTSD

A

Extreme irritability, sleep disturbance, anxiety/panic, angry outbursts

Tx: Psychotherapy, CBT, SSRI/SNRIs

130
Q

Withdrawal sx of drugs

A

alcohol– tremors, delirium, tachycardia, palpitations

benzos- tremors, anxiety, perceptual disturbances,

heroin– nausea, vomiting, abdm pain, diarrhea, dilated pupils, lacrimation, yawning

Stimulants (cocaine, amphet)– increased appetite, hypersomnia, intense psychomotor retardation, severe depression

Nicotine– dysphoria, irritability, anxiety, increased appetite

Cannabis– irritability, anxiety, depressed mood, insomnia

131
Q

When patient doesn’t recognize drinking problem…?

A

Increase patient’s awareness that it interferes with goals (“do you think it played a role in missing your daughter’s game?”)

132
Q

Valbenazine or deutetrabenazine tx….

A

tardive dyskinesia (stop agent if you can tho)

133
Q

When should you be cautious to prescirbe benzo?

A

Misuse of other drugs seen; eg alcohol

134
Q

Tx of MDD w/ psychotic features

A

antidepressant and antipsychotic or ECT

135
Q

Do you see psychotic features in persistent complex bereaement d/o? Timing?

A

no. greater than 6 months

136
Q

When to use combo therapy for bipolar d/o? What?

A

Severe (psychosis, aggression); Lithium or valproate + sec-gen antipsychotic (quetiapine)

137
Q

Can Parkinson’s present w/ psychosis?

A

Yes- can have visual hallucinations (use second-gen atnipsychotic). Differentiate from LBD w/ cognitive status

138
Q

Brief psychotic d/o cause?

A

Stressor (life threatening event), resolves in month

139
Q

SSRIs side effects (early and late)

A

Early– HA, N, insomnia/sedation, anxiety

Long-term– sexual dysfunction, weight gain

140
Q

Pheochromocytoma presentation

Cause

Dx

What

A

HA, tachycardia, sweating, hypertension, anxiety sx; drug-resistant HTN, hyperglycemia, nml BMI

Elevated catecholamine

Elevated urinary and plasma catecholamine and metanephrines

Adrenal tumor

141
Q

Alcohol use disorder

A

Naltrexone, Acamprosate (preferred in patients liver diease or opioid use)

Disulifirma second line

142
Q

Clozapine- what you watching for?

A

Neutropenia (agranulocytosis — complete absence of neutrophils); but participate in computer-based registry that requires regular monitoring of the ANCs

Least likely to show EPS; no TD

143
Q

Acute agitation management

A

Benzos, antipsychotic (Haloperidol + Lorazepam for rapid sedation in severely agitated patients)

144
Q

Lamotrigine side effects

A

Drug rash; more severe is SJS and TEN

145
Q

Narcolepsy def

A

Lapses to sleep >3/week for 3 months. W… cataplexy OR low CSF hypocretin-1 OR shortened REM latency

See: hypnagogic or hypnopompic hallucinations, sleep paralysis

146
Q

Features of FAS

A

microcephaly, small palpebral fissures, midface hypoplasia, smooth philtrum, thin vermillion border

147
Q

Benzo overdose

A

AMS, ataxia, slurred speech (but rarely severe CNS depression– indicates w/ alcohol)

148
Q

Methamphetamine use disorder

A

delusions, tactile hallucinations, agression, poor dentition, skin socres, teeth grinding

149
Q

Best vital sign predictor for opioid overdose?

A

RR <12

150
Q

TCA overdose signs

A

seizures, tachycardia, cardiac conduction delay, anticholinergic effects, QRS prolongation, pupil dilation, decreased bowel sounds

151
Q

early side effects of SSRIs

A

activating effects, anxiety insomnia; w/ anxiety start w lower dose

152
Q

Anorexia nervosa treatment

A

Psychotherapy, nutritional rehab, olanzapine if severe/refractory

153
Q

PCP false positives

A

Dextromethorphan, Diphenhydramine, Ketamine, Tramadol. Ketamine

154
Q

Amphetamine false positives

A

Atenolol, propranolol, bupropion, nasal decongestants

155
Q

Cocaine vs amphetamine intoxication

A

Cocaine– manic and sympathetic stimulation

PCP- prominent nystagmus, agitated and violent behavior

156
Q

Hoarding tx

A

CBT targeted to behaviors

157
Q

Antidepressant discontinuation syndrome?

A

Restart med followed by gradual taper

158
Q

ADHD Tx w/o abuse properties?

A

NE reuptake inhibitors like atomexetine (also could use bupropion and TCAs)

Can use clonidine, guanfacine in kids

159
Q

Atypical depression

A

mood reactivity, weight gain, hypersomnia, leaden paralysis,

160
Q

Duloxetine use

A

SNRI– diabetic neuropathy and depression (chronic pain)

Psychiatry (1 decks)

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