UWorld - Psych Flashcards
1
Q
Treatment of Body Dysmorphic Disorder
A
Cognitive Behavioral Therapy
and/or
SSRI
2
Q
Dx: Psychosis with nystagmus
And Tx?
A
Dx = PCP (Phencyclidine) Intoxication Tx = benzodiazapine (e.g. lorazepam)
3
Q
Dexmedetomidine mechanism and use
A
Dexmedetomidine is an alpha 2 agonist, used for procedures in the ICU
4
Q
Drug for treatment resistant schizophrenia (poor response to at least 2 antipsychotic meds). Side effect of this drug.
A
Clozapine
Side effect = agranulocytosis
5
Q
Personality disorder: someone who prefers to be a loner
A
Schizoid (cluster A odd/eccentric)
6
Q
Personality disorder: magical thoughts
A
Schizotypal (cluster A odd/eccentric)
7
Q
Personality disorder: disregard for the rights of others
A
Antisocial (cluster B dramatic/erratic)
8
Q
Personality disorder: chaotic relationships, abandonment fears, labile mood (easily changes), impulsivity, inner emptiness, self-harm
A
Borderline (cluster B dramatic/erratic)
9
Q
Personality disorder: attention-seaking
A
Histrionic (cluster B dramatic/erratic)
10
Q
Personality disorder: grandiosity, lack of empathy
A
Narcissistic (cluster B dramatic/erratic)
11
Q
Personality disorder: Avoidance due to fears of criticism
A
Avoidant (cluster C anxious/fearful)
12
Q
Personality disorder: Suspicious
A
Paranoid (cluster A Odd/eccentric)
13
Q
Personality disorder: submissive, clingy
A
Dependent (cluster C anxious/fearful)
14
Q
Personality disorder: controlling, perfectionistic
A
Obcessive-compulsive personality disorder (cluster C anxious/fearful)
15
Q
Street drug that can cause Serotonin Syndrome
A
Ecstasy
16
Q
Symptoms of Serotonin Syndrome
A
Neuromuscular hyperactivity (e.g. seizure) Autonomic stimulation (e.g. fever) Agitation
17
Q
How to treat serotonin syndrome
A
Cyproheptadine (5HT2 receptor antagonist)
18
Q
Timetable of Major Depressive Disorder
A
> /= 2 weeks of 5/9 SIGECAPS
19
Q
Timetable of dysthymia (persistent depressive disorder)
A
> /= 2 yrs of chronic depressed mood, but not meeting enough SIGECAPS to diagnose depression
20
Q
Timetable of Adjustment disorder with depressed mood.
Treatment
A
- Onset within 3 months of identifiable stressor, but does not meet enough SIGECAPS. Lasting less than 6 months. If more than 6 months then it is Generalized Anxiety Disorder.
Treatment = Psychotherapy
21
Q
Use of Zolpidem
A
Zolpidem is a nonbenzo hypnotic used to treat insomnia
22
Q
Most effective treatment for major depressive disorder
A
SSRI and psychotherapy:
cognitive-behavioral therapy or interpersonal psychotherapy
23
Q
Timetable for Social anxiety disorder (social phobia)
A
More than 6 months of anxiety in 1 or more social situations.
24
Q
Tx for Social anxiety disorder
A
Cognitive Behavioral Therapy
and
SSRI/SNRI
25
Tx for Social anxiety disorder - performance subtype
Beta blocker
OR
Benzodiazepine
26
Timetable for Acute Stress Disorder
| And Tx
More than 3 days, less than 1 month
of symptoms after exposure to traumatic event
Tx: Cognitive Behavioral Therapy
27
Timetable for Post-Traumatic Stress Disorder
lasts more than 1 month.
| less than 1 month is Acute Stress Disorder
28
Timetable for Generalized Anxiety Disorder
More than 6 months.
| Less than 6 months is Adjustment disorder.
29
Timetable for diagnosing: Specific Phobia
| Tx?
More than 6 months of anxiety related to something specific.
| Tx = systematic desensitization
30
Fluoxetine mechanism
SSRI
31
Panic disorder next step in treatment
Benzodiazepines (e.g. Lorazepam)
32
Palpitations, chest pain, trembling, dizziness, fear of dying and avoidance behavior. Dx? Tx?
Dx: Panic disorder
Tx Short term = benzodiazepins
Tx Long term = SSRI and CBT
33
What is the difference between oppositional defiant disorder vs conduct disorder vs antisocial personality disorder.
Oppositional defiant disorder (ODD) is a pattern of defiance of rules and authority figures, and blaming others.
Conduct disorder is more severe and aggressive, such as cruelty towards animals, stealing, destruction of property.
If over 18 it is antisocial personality disorder.
34
define: Kleptomania
An impulse control disorder characterized by inability to resist impulse to steal objects of low monetary value.
35
Venlafaxine mechanism
SNRI
36
Define the defense mechanism: Reaction formation
Transforming unacceptable feelings and impulses into their extreme opposites.
37
Which ones are the mature defense mechanisms and what are their definitions?
```
Sublimation = Channeling impulses into socially acceptable behaviors
Suppression = Putting unwanted feeling aside to cope with reality.
```
38
Define the defense mechanism: Displacement
Transferring feelings to less threatening object/person
39
Define the defense mechanism: Projection
Attributing one's owns feeling to others
40
Define the defense mechanism: Splitting
Experiencing a person/situation as either all positive or all negative
41
Instead of depressed mood, pediatric depression can present with ______ mood
irritable mood
42
Treatment of pediatric depression
Psychotherapy and SSRI
43
Malingering vs Factitious Disorder
Malingering = faking symptoms for secondary gain
| Factitious Disordering = faking symptoms to assume the sick role (not for secondary gain)
44
Atomoxetine mechanism and use.
Atomoxetine is a norepinephrine reuptake inhibitor. It is used as an alternative to stimulant medications like methylphenidate in the treatment of ADHD.
45
Modafinil. What condition is this used for?
Narcolepsy
46
Despiramine. Drug class.
TCA
47
Guanfacine. Mechanism and use
Alpha 2 agonist.
Used in ADHD in children and adolescents.
NOT in adult ADHD
48
Clonidine. Mechanism and use.
Alpha 2 agonist.
Used in ADHD in children and adolescents.
NOT in adult ADHD
49
Borderline Personality Disorder. Tx?
Dialectical Behavioral Therapy (DBT)
50
Ability to recall bad dreams
No motor activity
Dx?
Nightmare disorder
51
Ability to recall bad dreams
Plus motor activity
Dx?
Rapid eye movement (REM) sleep behavior disorder
52
Mature coping mechanisms
Sublimation
| Suppression
53
def. Displacement
Transferring feeling to less threatening object/person
54
def Acting Out
Expressing unacceptable feelings through actions
55
def Reaction Formation
Transforming unacceptable feeling/impulses into the opposite
56
def Splitting
Experiencing a person/situation as either all positive or all negatives
57
Neuroimaging seen in obsessive-compulsive disorder
Abnormalities in orbitofrontal cortex and basal ganglia
58
Neuroimaging seen in schizophrenia
Enlargement of cerebral ventricles
59
Phenelzine mechanism
MAOI
60
Venlafaxine mechanism
SNRI
61
Anti-depressants that cause hypertension
SNRI
| MAOI after ingestion of tyramine
62
Anti-depressants that cause hypotension
MAOI
63
Abrupt cessation of this anti-anxiety med causes withdrawal seizures
Alprazolam (short-acting benzo)
64
Mirtazapine mechanism and use
Antidepressant
Alpha2 receptor antagonist
Which results in an increase of release of NE and Seratonin.
Also acts
65
Buproprion – mechanism
NE and Dopamine reuptake inhibitor
66
Timetable of postpartum depression and Tx
Onset > 4 wks after birth
| Tx: SSRI
67
Timetable of postpartum blues and Tx
Onset 2-3 days after birth
Resolutions: within 2 wks
Tx: Reassurance and monitoring
68
Torticollis in schizophrenic taking a 1st gen antipsychotic
| Dx? Tx?
Dx: Acute dystonia, extrapyramidal side-effect
Tx: Benztropine OR Diphenhydramine
69
Restlessness in a schizophrenic taking 1st gen antipsychotic
| Dx? Tx?
Dx: Akathisia, extrapyramidal side effect
Tx: Benztropine, Beta blocker (propranolol), Benzo (lorazepam)
70
Rigidity and tremor in a schizophrenic taking 1st gen antipshychotic
Dx? Tx?
Dx: Parkinsonism, extrapyramidal side-effect
Tx: Benztropine, Amantadine
71
Discoordination of extremities and lip smaking in a schizophrenic taking 1st gen antipsychotic
Dx? Tx?
Dx: Tardive dyskinesia, extrapyramidal side-effect
Tx: Valbenazine
72
Inability to recall personal information after a stressful event
Dissociative amnesia
73
Severe periodontal infections. What is the immunodeficiecy?
Leukocyte Adhesion Deficiency
74
Timetable of Generalized Anxiety Disorder
More than 6 months of persistent worry about multiple issues
75
What antidepressant to use for a patient that has poor sleep and poor appetite?
Mirtazapine
76
Treatment for Obsessive Compulsive Disorder
CBT and SSRI
77
Somatic symptom disorder
Symptoms are unconcious, motivations are unconcious.
| Variety of body complaints lasting months to years.
78
Illness anxiety disorder
aka hypochondriasis
| Excessive procuppation with having a serious illness
79
Rare but fatal adverse effect of valproate
Hepatotoxicity
80
What is the drug overdose:
| Chest pain, seizures, mydriasis
Cocaine
81
What is the drug overdose:
| Dry mouth, conjunctival injuection
Marijuana
82
What is the drug overdose:
| Nystagmus
Phencyclidine (PCP)
83
Parotid gland enlargement and hand abrasions.
| Dx?
Bulimia Nervosa
84
Timetable of dysthymia
Dysthymia = Persistent Depressive Dysorder (PDD)
| More than 2 years of symptoms (at least 2 depressive symptoms), with no more than 2 months without depressive symptoms.
85
What is the timetable of Generalized Anxiety Disorder?
| What is the shorter form of Generalized Anxiety Disorder?
More than 6 months of restlessness, irritability, sleep disturbance, fatigue, muscle tension, difficulty concentrating.
If less than 6 months since end of a stressor, then it is called: Adjustment Disorder.
86
Dialectical Behavioral Therapy is best for _______
Borderline personality disorder
87
AST:ALT ratio in alcoholics
> 2:1
88
1st line treatment for Generalized Anxiety Disorder
CBT
| SNRI or SSRI
89
What psychiatric condition is propranolol used for?
Social anxiety disorder - performance subtype
90
Most-likely antipsychotic medication to cause a side-effect of gynecomastia and glactorrhea.
Risperidone
91
def Cataplexy. Dx?
```
Cataplexy = brief loss of muscle tone when experiencing strong emotion
Dx = associated w/ Narcolepsy
```
92
Pupils in seratonin syndrome
Pupils are dilated (mydriasis)
93
Symptoms of Lithium toxicity (Acute and Chronic)
```
Acute = GI symptoms (nausea vomiting diarrhea)
Chronic = Neurological symptoms (Confusion, Ataxia, Tremors/fasciculations)
```
94
Do NOT mix the following drugs with lithium, because they can cause Lithium toxicity.
- Thiazide diuretics
- ACE inhibitors
- NSAIDs (not aspirin)
- Tetracyclines & Metronidazole
95
Treatment for Benzodiazepine overdose
Flumazenil
96
TCA overdose treatment and mechanism.
Sodium bicarbonate (stabalizes cardiac cell memb)
97
Pramipexole mechanism, use, major side effect, treatment of the side effect.
Pramipexole = non-ergot dopamine receptor agonist
Used to treat Parkinsons
Side Effect = Hallucinations
Treatment of side effect = quetiapine/clozapine
98
Type of dementia that is characterized by Apathy and Personality Changes.
Frontotemporal dementia
99
Type of dementia associated with visual hallucinations.
Dementia with Lewy bodies
100
Type of dementia associated with myoclonus or seizures.
Prion disease
101
Type of dementia associated with ataxia and urinary incontinence
Normal Pressure Hydrocephalus
102
Timetable of Postpartum Depression
Onset within 4-6 weeks
| Lasting > 2 weeks
103
Common side effects of methylphenidate
Decreased appetite
Weight loss
Insomnia
104
Benzodiazepine withdrawal symptoms
Anxiety
Insomnia
Seizures
Psychosis
105
Name an SSRI with short half life
| and another SSRI with long half life
Short half life SSRI = Paroxetine
| Long half life SSRI = Fluoxetine (4-6 days)
106
Name benzodiazepines with short half lives and with long half lives
Short half life Benzo = Alprazolam, Lorazepam
| Long half life Benzo = Diazepam
107
What is the downside of using benzodiazepines with short half lives?
Benzodiazepins with short half lives have higher addictive potential and higher risk of withdrawal.
108
How to manage benzo withdrawal.
Use long half life benzo (eg Diazepam) and taper gradually.
109
How to treat benzo overdose. Side effect of treatment.
Flumazenil
| Side effect = precipitate withdrawal
110
Citalopram mechanism
SSRI
111
Treatment of panic disorder
SSRI and CBT
112
Treatment of agoraphobia
SSRI and CBT
113
Delusional disorder criteria
1 or more delusion
1 month or longer
No other psychotic symptoms
114
Abuse of what drug will cause mydriasis and psychosis.
Amphetamine
115
What happens to pupils in TCA overdose?
Dilated pupils
116
What is the most lethal side effect associated with TCA overdose? How to treat it and when?
Cardiac conduction delay - QRS prolongation
When QRS is longer than 100 msec then there is a higher risk of ventricular arrhythmia. Therefore, with QRS over 100 msec treat with sodium bicarbonate.
117
Treatment of Obsessive Compulsive Disorder
SSRI and CBT
118
Aripiprazole drug class and mechanism
Atypical antipsychotic
Aripiprazole is a partial D2 agonist.
Unlike the other antipsychotics, which are D2 antagonists.
119
Buproprion mechanism. What side effect profile makes Buproprion a good choice as an antidepressant?
Norepinephrine and Dopamine reuptake inhibitor.
| Buproprion side effect profile does NOT include weight gain, and NO sexual side effects.
120
Timetable of persistent depressive disorder (PDD) aka dysthymia.
> 2 years
No symptoms free period for > 2 months
2 or more SIGECAP symptoms, without meeting the criteria for major depression.
121
Timetable for delusional disorder
1 or more delusions for 1 month or more
122
Side effect of clozapine
Agranulocytosis, complete absence of neutrophils
123
Treatment of nightmare is PTSD
Prazosin
124
Treatment of Neuroleptic Malignant Syndrome
Dantrolene or Bromocriptine
125
Medications to avoid if taking Lithium, as they can induce lithium toxicity
Thiazides
ACE Inhibitors
NSAIDs
Tetracyclines, Metronidazole
126
Symptoms of Lithium Toxicity
G (acute)I: nausea, vomiting, diarrhea
| Chronic: Ataxia, Tremors, Fasciculations
127
Treatment of Neuroleptic Malignant syndrome and mechanisme
```
Bromocriptine = Dopamine agonist (also used in Parkinsons)
Dantrolene = Ryanodine receptor antagonist
```
128
Severe depression with refusal to eat or drink. Tx?
Electroconvulsive therapy
(for emergency condition of pt refusing to eat/drink)
ECT also used for someone who is actively suicidal
129
Diagnosis when patient meets symptoms of depression plus pt is having auditory hallucinations.
Dx = Major Depression with Psychotic Features.
130
Mechanism of Aripiprazole
Atypical Antpsychotic that is both an antagonist, but also a partial agonist at D2 receptors.
131
- Normal Prolactin Range
- Prolactin levels w/ medication related hyperprolactinemia
- Prolactin levels due to Prolactinoma
Normal = 3-30
Medication (e.g. Risperidone) = 30-100
Prolactinoma = >200
132
Immediate treatment of patients with mania and severe agitation
Antipsychotic medications
133
Side-effect of lamotrigene
Stevens-Johnson rash
134
First-line treatment for anorexia nervosa
Nutritional rehabilitation
and
Psychotherapy (CBT)
135
Deliberate fabrication of symptoms in order to assume the sick role. Dx?
Factitious disorder
136
Pt with psychotic symptoms and excoriations due to chronic skin picking. Dx?
Methamphetamine use disorder
137
Antidepressant medication for smoking cessation. Rx? Mechanism of the drug?
```
Buproprion = NDRI
Varenicline = Nicotinic ACh receptor partial agonist
```
138
What is the favorable side effect profile of buproprion?
- Buproprion does NOT cause sexual side effects
- Helps with weight loss
- Mild stimulant = increased wakefulness
139
Nightmare with no recall of dream. Dx?
Sleep terror disorder
140
Nightmare with recall of dream. Dx?
Nightmare disorder
141
How long is an adequate antidepressant trial? And how long should you continue antidepressant if remission is achieved in the trial period?
```
Trial = 4-6 weeks.
Continue = 6 months
```
142
What is acute dystonia? Tx?
Acute dystonia is muscle stiffness such as torticolis, muscle spasm, and oculogyric .
Acute dystonia is an antipsychotic extrapyramidal side effect.
Tx = Bromocriptine and Diphenhydramine
143
Bromocriptine mechanism
Dopamine agonist
144
What is akathisia? Tx?
Akathisia is restlessness.
Akathisia is an antipsychotic extrapyramidal side effect.
Tx = Benztropine, Propranolol, Lorazepam
145
Diphenhydramine mechanism.
H1 blocker
146
Benztropine mechanism
Muscarinic antagonist
147
What is drug-induced Parkinsonionism? Tx?
Drug-induced Parkinsonionism includes symptoms of tremor, rigidity and bradykinesia.
Drug-induced Parkinsoionism is an antypsychotic extrapyramidal side effect.
Tx = Benztropine, Amantadine
148
Amantadine mechanism
Increases dopamine release and decreases dopamine reuptake
149
What is tardive dyskinesia? Tx?
Tardive Dyskinesia is dyskinesia of mouth, face, trunk extremities.
It occur after more than 6 months of antypsychotic use as an extrapyramidal side effect.
Tx = Valbenazine
150
Valbenazine mechanism
Reduction of dopamine release by inhibiting vesicle transport.
151
Tx for Acute Bipolar Depression. (aka Major Depression in a patient that has a diagnosis of Bipolar)
Second gen antipsychotics: Quetiapine OR Lurasidone
| OR anticonvulsant: Lamotrigine
152
Tx for PTSD.
- CBT
- SSRI/SNRI
- Prazosin for nightmares
153
Paroxetine mechanism
SSRI
154
Prazosin mechanism
alpha 1 blocker
155
What test to perform if child has psychosis but also proteinuria and hematuria?
Test for antinuclear antibodies
BECAUSE child may have
Systemic Lupus Erythematosus
156
Mnemonic and list of findings in SLE
```
RASH OR PAIN:
Rash (malar or discoid)
Arthritis
Serositis (pleuritis, pericarditis)
Hematologic disorders (cytopenias)
Oral/nasopharyngeal ulcers
Renal disease
Photosensitivity
Antinuclear antibodies
Immunologic disorder (anti-dsDNA, anti-Sm, antiphospholipid)
Neurologic disorder (seizures, psychosis)
```
157
The 6 Ps of Acute Intermitent Porphyria
Psychological disturbances
Polyneuropathy
Painful abdomen
Port-wine colored urine
Precipitated by drugs (cyt p450 inducers, alcohol) and starvation
Porphobilinogen deaminase (affected enzyme)
158
What are the major risks for suicide. Mnemonic.
```
SAD PERSONS
Sex
Age
Depression
Previous attempt
Ethanol abuse
Rational thought loss (psychosis)
Social support lacking
Organized plan
No spouse or significant other
Sickness or injury
```
159
First line antidepressants.
SSRI
SNRI
Buproprion
Mirtazipine
160
Wash out period if switching to MAOI
If using fluoxetine then washout period is 5 wks, because fluoxetine has a long half-life.
Other antidepressants have a 2 wk washout.
161
Buproprion mechanism
Inhibit NE and D reuptake
162
Mirtazipine mechanism
Alpha 2 antagonist, which increases release of NE and 5HT.
163
Pt stares blankly, is mute, and motionless. If physician lift's pt's arm then the arm remains in the position. Dx? Tx?
```
Dx = Catatonia
Tx = Benzodiazepine (lorazepam) OR ECT
```
164
Drugs that induce lithium toxicity.
```
Thiazide diuretics
ACE inhibitors
NSAIDs
Tetracyclines
Metronidazole
```
165
1st line treatment of psychosis.
2nd gen antipsychotics (e.g Quetiapine)
166
1st line treatment for Acute Stress Disorder
Trauma-focused cognitive behavioral therapy. Educate the patient about symptoms, normalizing the stress response.
167
```
REM sleep disorder
vs
Nightmare disorder
vs
Sleep terror disorder
```
REM sleep disorder is associated with complex motor behaviors or vocalization during REM sleep.
Nightmare disorder is awakenings with sleep recall. Nightmare's of nightmare disorder occur during REM sleep.
Sleep terror disorder is partial arousal with no dream recall. These occur during non-REM sleep.
168
3 weeks after birth of child, female pt has depression and psychosis. Dx? Tx?
```
Dx = Postpartum Psychosis
Tx = hospitalization --> antipsychotics, antidepressants, mood stabilizers
```
169
Timetable of postpartum depression.
4-6 wks after birth of child
170
Paroxetine drug class.
SSRI
171
Brief psychotic disorder timetable.
More than 1 day.
| Less than 1 month.
172
Dementia associated with apathy.
Frontotemporal dementia
173
Dementia associated with visual hallucinations.
Dementia with Lewy bodies
174
Dementia associated with myoclonus
Prion disease (Creurtzfeldt-Jakob disease)
175
What anti-depressants are more likely to cause antidepressant discontinuation syndrome?
Seratonergic medication with short elmination half-life:
| Paroxetine and Venlafaxine
176
Indications for hospitalization of anorexic pt.
BMI < 15
Vital sign abnormalities (Temp, BP, P)
Electrolyte abnormalities
177
First and second line treatment for anorexia nervosa with BMI less than 18.5 but more than 15.
First line = CBT and nutritional rehab
| Second line = olanzapine
178
What is the MOST EFFECTIVE treatment for major depressive disorder.
The COMBINATION of antidepressant (eg SSRI) and psychotherapy is more effective than either alone.
179
Most antidepressants should be discontinued 2 weeks before beginning MAOI to avoid _____________
Seratonin Syndrome
180
Immediate management of mania
1st or 2nd gen antipsychotic
181
What medications to use for individuals with alcohol use disorder who want to stop? Mechanism? When are these medications contraindicated?
```
To decrease craving use:
Naltrexone (mu-opioid receptor antagonist)
- Contraindicated in opioid users
- Contraindicated in liver disease
Acamprostate (glutamate modulator)
- Contraindicated in renal disease
```
182
How much time after last drink does delirium tremens begin?
48 - 96 hours
183
Hallucinations in a patient whose last alcoholic drink was 12 hours ago. Dx? How long does it last?
Alcoholic hallucinosis.
| Lasts 12 - 48 hours.
