UWorld - Step 2 CK "Psychiatry" Flashcards
Bath salts are sympathomimetics that have a similar effect profile to phencyclidine. What is a key distinguishing feature?
Bath salts have a prolonged duration, often causing psychiatric distortions for days or even up to a week.
Also, toxicology screens can detect PCP but not bath salts.
Give the DSM-V criteria for generalized anxiety disorder.
•Excessive worry or anxiety over multiple issues for greater than 6 months
•Inability to control worrying
•Impairment of life or significant distress
•Three or more of the following symptoms:
- Restlessness/feeling on edge
- Fatigue
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance
What is folie à deux?
It is a shared delusional disorder. Typically, one person develops a delusion and passes it on to a less dominant person (think parent-to-child). The best way to assess and manage this syndrome is to separate the two to break the cycle of reinforcement. Often only the dominant person needs treatment.
True or false: tardive dyskinesia can be treated with benztropine or trihexyphenidyl.
False.
Anticholinergics treat extrapyramidal symptoms (like acute dystonia, akathisia, or parkinsonism), but not tardive dyskinesia.
Tardive dyskinesia can be treated with lowering the dose of the offending medication or, if that fails, switching to clozapine.
Adverse effects of clozapine include agranulocytosis, seizures, metabolic syndrome, and _______________.
myocarditis
Bupropion is best in depressed patients with ________________.
weight gain and hypersomnolence (because it causes weight loss and is activating)
Scores less than _______ on the Mini-Mental State Examination (MMSE) are sensitive for dementia.
24
What is REM sleep behavior disorder?
A disorder in which people have complex motor or vocal actions in REM sleep (like sleepwalking or sleep talking).
Differentiate nightmare disorder and sleep terror disorder.
- Nightmare disorder –exactly like it sounds –is a disorder in which kids have vivid nightmares. They often fully wake up and remember the nightmare. It usually occurs in the second half of the night.
- Sleep terror disorder is characterized by incomplete awakening without recollection of a specific nightmare. Often kids will not recall even waking up.
Describe kleptomania.
Kleptomania is a disorder of impulse control in which people steal not for personal gain but rather for the thrill of stealing. The person will describe feeling a sense of pent-up energy or being hyper that is relieved by stealing.
True or false: trichotillomania is a disorder in which people eat their own hair.
False. Trichotillomania involves pulling one’s hair, often without consciousness of doing so. It is associated with OCD. Trichophagia is a disorder of eating hair.
A common sign of inhalation in an adolescent is _______________.
“glue sniffer’s rash” –dermatitis around the mouth and nose from chemical irritation
Interpersonal psychotherapy is great for depressed patients whose _________________.
depressive symptoms are related to interpersonal/relationship problems
Cognitive behavioral therapy works well with patients who have what two problems?
- Automatic negative interpretations of events
* Avoidance behavior
Delirium tremens typically occurs _________ days after abstinence from alcohol
2 (48 hours)
Patients with schizophrenia who have what social situations are at higher risks of relapse?
Critical, hostile, overinvolved family members
Therapy for schizophrenia involves counseling the family on minimizing stresses and conflicts.
What is normal pupil diameter?
- In bright settings: 2 - 4 mm
* In dark settings: 4 - 8 mm
Tourette’s and tic disorders are associated with two other conditions: _______________.
OCD and ADHD
Conjunctival injection and ____________ are signs of marijuana intoxication.
xerostomia (“cotton mouth”)
Avoiding social situations and _______________ are characteristic of avoidant personality disorder.
hypersensitivity to rejection
Differentiate separation anxiety disorder and stanger anxiety.
- Separation anxiety disorder is characterized by extreme distress upon being separated from a caregiver. Children with SAD will be calm around strangers so long as they are accompanied by their parents.
- Stranger anxiety is characterized by distress when children encounter new adults. They’ll be uncomfortable when meeting other adults even in the presence of their parents.
What are the diagnostic criteria for selective mutism?
Failure or refusal to talk in social situations for over one month (the classic case is a child who talks at home and with friends but is silent at school)
What is the hallmark of reaction formation?
In reaction formation, the person does the opposite of what they’re feeling.
For instance, a person who’s angry at their father for abandoning them as a child who then talks about how great it is to have to take care of the father is using reaction formation.
How should somatic symptom disorder be managed?
- Maintain contact with one provider (to avoid redundant or unnecessary workups)
- Focus on coping skills to treat mental distress
- Manage psychosocial stressors
- Psychiatric/psychological evaluation (if the patient agrees)
In what ages (according to textbooks) is an imaginary friend normal?
3-6
What is pseudocyesis?
Hysterical pregnancy: when a woman has amenorrhea, breast fullness, and morning sickness but is not pregnant
Risk factors are a history of infertility and prior pregnancy loss. Note: some women can be so convinced that they are pregnant that they will misinterpret home pregnancy tests.
