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
2
Q
Persistent complex bereavement disorder dx
A
Prolonged grief (>12 mo), difficulty accepting death, persistent yearning
Tx: psychotherapy
3
Q
Lab findings/Side effects in Lithium
A
Hyperparathyroidism and associated hypercalcemia
Nephrogenic DI
CKD
Thyroid dysfunction
4
Q
Teratogenic effects of Li
A
Ebstein anomaly (cardiac issue)
5
Q
Labs before Li starting
A
BMP, BUN, Cr, Ca, U/A, pregnancy, and thryoid function
6
Q
Tx of bipolar d/o w/ psychotic features
A
Antipsychotic (not just mood stabilizer)
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
8
Q
PMDD characterization
A
cyclical mood swings, irritability, appetite changes, resolve AFTER menses (not just exacerbation of underlying issue)
9
Q
Reduce risk of relapse in schizophrenia?
A
Family therapy (as well as antipsychotic med)
10
Q
New onset Li toxicity?
A
GI Sx, confusion, ataxia, tremor (neuromuscular irritability)
11
Q
Meds that decrease Li clearance?
A
Thiazaide diuretics, NSAIDs, ACE inhibitors
12
Q
Antipsychotics less likley to cause EPS?
A
Quetiapine (low-potency)
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
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
15
Q
Acute mania Tx options?
A
- Antipsychotics
- Li
- Valproate (avoid in liver disease)
- Combo in severe mania
- Adjunctive benzos for insomnia, agitation
16
Q
Acute Tx for panic disorder
A
Benzodiazepines
17
Q
GAD length of time of Sx?
A
6 months, persistent worry
18
Q
Manic episode critera
A
> 1 wk of elevated/irritable mood & increased energy/activity: >3 of DIGFAST
19
Q
Gender dysphoria criteria
A
Persistent (>6 mo) incongruence w/ sex at birth and gender, desire to be opposite, accompanying distress.
20
Q
Indications for hospitalization in anorexia nervosa?
A
Bradycardic <40, Hypotension <80/60, Hypothermia <35, Electrolyte bad/marked dehydration, organ compromise, BMI
21
Q
DID criteria
A
Discontinuity in identity and loss of personal agency w/ fragmentation into >= 2 distinct personality states, associated w/ trauma/abuse
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
23
Q
Bipolar II and depression tx?
A
Avoid antidepressant monotherapy due to risk of inducing mania
24
Q
First-line med for acute bipolar depression?
A
Sec-gen antipsychotics (quetiapine and lurasidone)
25
Tx of psychosis in PD ?
Anti-PD med reduction, and/or addition of low-potency antipsychotic (quetiapine, pimavanserin)
26
PCP intoxication tx?
Benzos
27
Ethylene glycol or methanol toxicity tx?
Fomepizole
28
PCP intoxication sx?
agitation, delusions, multidirectional nystagmus, disorientation
29
Tx of OCD?
SSRI and CBT (exposure and response prevention)
30
PTSD in child?
nightmares, traumatic themes in play, emotional regulation
31
Oppositional defiant disorder
angry/irritable mood, argues, defiant, for >= 6 months
Tx- parent management training, psychotherapy, no pharmacotherapy
32
Panic disorder
Recurrent, spontaneous anxiety attacks -> develops into avoidance behavior (frequently develop agoraphobia)
33
Social anxiety disorder
Fear of humiliation, criticism,
34
CBT uses
Depression, GAD, PTSD, panic d/o, OCD, ED, negative thought patterns (reducing automatic negative thoughts and avoidance behaviors that cause distress)
35
Psychodynamic psychotherapy uses
higher functioning, personality disorders
36
Motivational interviewing uses
SUD
37
DBT uses
Borderline personality disorder
38
Tx for specific phobia
CBT w/ exposure (first-line)
39
Dx for specific phobia
SPECIFIC object or situation, >6 mos; avoidance behavior, oftentimes in childhood after traumatic event
40
Reduce risk of long-term Rx misuse?
PDMP; see pts q 3 mo
41
Antidepressant for poor sleep and appetite?
Mirtazapine (SE: stimulation of appetite, weight gain, somnolence)
42
Definition of depression episode
>= 2 weeks, 5/9 SIGECAPS (one being anhedonia or depressed mood)
43
Cyclothymic vs BP1?
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
44
Definition GAD
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
45
NMS signs/Sx
Fever, confusion, muscle rigidity, autonomic instability
46
Delusional D/o Def
>= 1 delusion for >= 1 month
Other psychotic sx absent or not prominent, behavior not obviously bizarre, (personality d/o pervasive)
47
Schizophrenia definition
>= 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
48
Persistent depressive disorder definition
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
49
First-line tx for moderate to severe PMS/PMDD
SSRIs (eg fluoxetine)
Both continous and luteal-phase only (day 14) effective
50
Li toxicity onset questions
GI Sx, confusion, ataxia, tremor --> seizures
51
Meds that increase Li levels
ACEi, NSAIDs, tetracyclines, metronidazole
52
Side effect of OTC and cough meds (usually seen in young children)
confusion, hallucinations
53
Causes of serotonin syndrome
Serotonergic meds, especially combo
Drug interactions
Intentional overdose
Sertonergic drugs of abuse (MDMA)
54
Clinical features of SS
Mental status changes, autonomic dysregulation, neuromuscular hyperactivity
55
Management of SS
D/c all serotonin meds, supportive care, sedation, benzos
Serotonin antagonist (cyproheptadine) if supportive measures fail
56
Phenelzine class and use
MAOI; treatment resistant depression
57
Low levels of _____ in CSF seen in associated suicidal behavior
5-hydroxyindoleaceitic acid (5-HIAA) --> metabolite of serotonin
58
Pharmacotherapy of psychosis
- Second-gen antipsychotic (risperidone, aripiprazole, quetiapine, olanzapine, ziprasidone)
- First-gen antipsychotic (eg haloperidol)
- Adjunctive benzo for agitation
59
Antipsychotic EPS side effect: acute dystonia tx
Benztropine, diphenhydramine
60
Antipsychotic EPS side effect: akathisia tx
Beta blocker (only one), benzo, benztropine
61
Antipsychotic EPS side effect: parkinsonism tx
benztropine, amantadine
62
Antipsychotic EPS side effect: TD tx
valbenazine, deutrbenazine
63
Nucleus basalis of Meynert
Alzheimer's
64
Desipramine side effect
QT prolongation
65
SSRI to MAOI length?
at least 2 weeks, avoid SS
66
Tremors with Li tx?
propanolol
67
Tx of tourette?
alpha agonist (guanfacine, clonidine), atypical (risperidone)
68
GAD first-line? second line?
SSRIs/CBT then Buspirone
69
Schizoaffective definition
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
Alcohol use disorder findings
Women (>7/week, >3/day)
Men (>14/day, >4/day)
AST/ALT >2:1
Macrocytosis
71
Length of antidepressant trial
At least 4-6 weeks
72
Korsakoff findings
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
Adjustment d/o w/ depressed mood definition
Onset w/in 3 mos of stressor; marked distress, functional impairment; does not meet DSM-5 criteria for another d/o
74
Assessing for delirium vs. psychosis?
AMS in delirium; fluctuating cognitive impariment
Psychosis-- pt alert and oriented
75
Depression Sx in adolescents?
Irritable rather than sad, loss of interest, fatigue
76
Lab findings in NMS
increased CK and increase WBC
77
Pathophys cause of tardive dyskinesia
dopamine D2 receptor upregulation and supersensitivity from chronic blockade of dopamine receptors
78
Cause of salt craving, reduced body hair, irritability, decreased mood
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
Reaction formation
transforming unacceptable feelings and impulses into their extreme opposites
Resenting someone but then being very kind to them
80
Dx depression in ill patients?
Look for depressed mood, loss of interest (hard to differentiate w/ somatic sx)
81
Dependent personality disorder signs
excessive reassurance, advice in making decisions, avoid taking initiative due to feelings of inadequacy, seek out relationships (unlike avoidant), submissive behaviors
82
SI and antidepressants?
Age <25, small risk of becoming suicidal, incrs. suicidal thoughts, should not be withheld
83
Meds that can introduce delirium
opioids, benzos, anticholinergics (esp. elderly)
84
HIV-associated dementia
CDC4 <200, long-standing disease, subcortical symtpoms
85
Panic d/o dx
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
Panic d/o tx
SSRI/SNRI and/or CBT
Acute distress: benzos
87
Tx length for single-episode, unipolar major depression?
6 months once achieved effects
88
Tx length for >=2 episodes, persistent residual depressive symptoms
1-3 yrs
89
Tx length for >=3 lifetime depressive episodes, chronic episodes (>2 yrs), severe (suicide attempt)
indefinitely
90
Fts of ASD
Deficits in social communication, restricted, repetitive patterns of behavior, language delay
Tx- early intervention!!
91
GAD sx length?
6 mos
92
Adjustment d/o tx?
psychotherapy to target maladaptive response to stress
93
Binge eating d/o def
absence of compensatory, >=1 episode/week for 3 months+
Tx CBT, SSRI, lisdexamfetamine, topirmate
94
Sleep findings in depression
Decreased REM sleep latency, decreased slow-wave sleep and increase REM duration and density
95
Acute dystonia findings
sudden, sustained contraction of neck, mouth, tongue, and eye muscles
96
Illness anxiety d/o vs somatic d/o?
Illness anxiety has no somatic symptoms
97
MAOI + Tyramine
increased sympathomimetic (ie adrenergic) effect -> HTN
98
Lab finding w/ depression?
increased serum cortisol concentration (hyperactivity of hypothalamic-pituitary-adrenal axis)
99
Glucocorticoid therapy induced psychosis?
Dose reduction or d/c when possible; seen with high doses over long period of time
100
Separation anxiety presentation
Associated w/ transition or change; characterized by a marked fear of separation
101
PTSD associated with...
depression and suicidality
102
Social anxiety d/o definition
anxiety restricted to social and performance situations (can have performance only subtype)
103
Panic d/o definition
recurrent, unexpected panic attacks
104
Minors and SI?
do not need parental consent
105
PCP intoxication
(Hallucinogen) `Violent behavior, hallucinations, nystagmus, dissociation, amnesia, ataxia
106
LSD
(Hallucinogen) Visual hallucinations, euphoria, dysphoria/panic, tachycardia/HTN
107
Cocaine
(Stimulant) Euphoria, agitation/psychosis, chest pain, seizures, mydriasis, tachy/HTN
108
Methamphetamine
(Stimulant) Violent behavior, psychosis/diaphoresis, tachy/HTN, choreiform movements, tooth decay
109
Marijuana
(Cannabinoid) Increased appetite, euphoria, dysphoria/panic, slow reflexes, dry mouth, conjunctival injection
110
Heroin
(Opioid) Euphoira, depressed mental status, miosis, respiratory depression, constipation
111
Schizo negative sx
Apathy, avolition, affective flattening, alogia (brief answers), asociality (social w/d and diminished interest in relationships)
112
Alcohol withdrawal tx (liver disease?)
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
Irritability, agitation, psychosis, tachycardia, hypertension, diaphoresis, dilated pupils
Amphetamine toxicity
114
Tx of bipolar (first and second line)
Lithium and valproate; second-gen quetiapine and anticonvulsant lamotrigine
115
Delusions in schizotypal?
Not really-- can have magical thinking (supersition, clairirvoyance), suspiciousness, paranoid ideation
116
Fail at first-trial of antidepressant?
Try another. Different SSRI or another first-line antidepressant w/ diff mechanism of action (Serotonin-NE reuptake inhibitor) (eg venlafaxine, bupropion)
117
Bupropion- when to not use
seizure, history of bulimia (not just current)
118
List of SNRIs
Venlafaxine, Duloxetine, Desvenlafaxine, Levomilnacipran
119
Wash out length between antidepressants?
SSRI to MAOI (at least 5 weeks); 2 weeks for others
120
Social anxiety disorder definition and tx
Marked anxiety about >=1 situation for >=6 months
SSRI/SNRI, CBT (BB or benzo performance only subtype)
121
Nightmare disorder features
wakes up fully alert, frightening dream content, can be consoled, usually occur during REM sleep
122
Tx for partial response to antidepressants?
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
First-line tx for ADHD?
First-line: Stimulants (metylphenidate, amphetamine)
nonstimulants (atomexetine, alpha-2 agonists)
124
Dx of ADHD
Inattentive and/or hyperactive/impulsive for >6 mos
125
Psych fts of pancreatic cancer?
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
Non-adherence in schizo tx?
long-acting injectable; every few weeks to months.
127
Findings in vomiting?
Hypokalemic, hypochloremic metabolic alkalosis, hyperaldosteronism (due to volume depletion),
parotid gland enlargement, dental caries,
128
Brain findings in schizophrenia?
Lateral ventricular enlargement, cortical tissue volume loss
129
Sx of PTSD
Extreme irritability, sleep disturbance, anxiety/panic, angry outbursts
Tx: Psychotherapy, CBT, SSRI/SNRIs
130
Withdrawal sx of drugs
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
When patient doesn't recognize drinking problem...?
Increase patient's awareness that it interferes with goals ("do you think it played a role in missing your daughter's game?")
132
Valbenazine or deutetrabenazine tx....
tardive dyskinesia (stop agent if you can tho)
133
When should you be cautious to prescirbe benzo?
Misuse of other drugs seen; eg alcohol
134
Tx of MDD w/ psychotic features
antidepressant and antipsychotic or ECT
135
Do you see psychotic features in persistent complex bereaement d/o? Timing?
no. greater than 6 months
136
When to use combo therapy for bipolar d/o? What?
Severe (psychosis, aggression); Lithium or valproate + sec-gen antipsychotic (quetiapine)
137
Can Parkinson's present w/ psychosis?
Yes- can have visual hallucinations (use second-gen atnipsychotic). Differentiate from LBD w/ cognitive status
138
Brief psychotic d/o cause?
Stressor (life threatening event), resolves in month
139
SSRIs side effects (early and late)
Early-- HA, N, insomnia/sedation, anxiety
Long-term-- sexual dysfunction, weight gain
140
Pheochromocytoma presentation
Cause
Dx
What
HA, tachycardia, sweating, hypertension, anxiety sx; drug-resistant HTN, hyperglycemia, nml BMI
Elevated catecholamine
Elevated urinary and plasma catecholamine and metanephrines
Adrenal tumor
141
Alcohol use disorder
Naltrexone, Acamprosate (preferred in patients liver diease or opioid use)
Disulifirma second line
142
Clozapine- what you watching for?
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
Acute agitation management
Benzos, antipsychotic (Haloperidol + Lorazepam for rapid sedation in severely agitated patients)
144
Lamotrigine side effects
Drug rash; more severe is SJS and TEN
145
Narcolepsy def
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
Features of FAS
microcephaly, small palpebral fissures, midface hypoplasia, smooth philtrum, thin vermillion border
147
Benzo overdose
AMS, ataxia, slurred speech (but rarely severe CNS depression-- indicates w/ alcohol)
148
Methamphetamine use disorder
delusions, tactile hallucinations, agression, poor dentition, skin socres, teeth grinding
149
Best vital sign predictor for opioid overdose?
RR <12
150
TCA overdose signs
seizures, tachycardia, cardiac conduction delay, anticholinergic effects, QRS prolongation, pupil dilation, decreased bowel sounds
151
early side effects of SSRIs
activating effects, anxiety insomnia; w/ anxiety start w lower dose
152
Anorexia nervosa treatment
Psychotherapy, nutritional rehab, olanzapine if severe/refractory
153
PCP false positives
Dextromethorphan, Diphenhydramine, Ketamine, Tramadol. Ketamine
154
Amphetamine false positives
Atenolol, propranolol, bupropion, nasal decongestants
155
Cocaine vs amphetamine intoxication
Cocaine-- manic and sympathetic stimulation
PCP- prominent nystagmus, agitated and violent behavior
156
Hoarding tx
CBT targeted to behaviors
157
Antidepressant discontinuation syndrome?
Restart med followed by gradual taper
158
ADHD Tx w/o abuse properties?
NE reuptake inhibitors like atomexetine (also could use bupropion and TCAs)
Can use clonidine, guanfacine in kids
159
Atypical depression
mood reactivity, weight gain, hypersomnia, leaden paralysis,
160
Duloxetine use
SNRI-- diabetic neuropathy and depression (chronic pain)
