2014-03-07 USMLE Psych - USMLE Psych Flashcards Preview

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Flashcards in 2014-03-07 USMLE Psych - USMLE Psych Deck (71):
1

Age of onset of schizophrenia

Men 15-25
Women 25-35

2

Prevalance of schizoprenia

1% in most cultures

3

List the differences between psychotic disorders

6 month = schizophrenia

4

Why are atypical antipsychotics preferred for maintainence therapy in psychotic disorders?

less EPS and better effect on negative symptoms

5

Onset of dystonia if EPS reaction?

hours to days

6

Treatment of acute dystonia

- anithistamines (diphenhyd)
- anitcholinergics (benztropine, trihexyphenidyl)

7

Onset of akathisia if EPS reaction

within days

8

Treatment of akathisia

can try b-blockers

9

Onset of parkinsonism if EPS reaction

within months of treatment

10

Parkinsonism from EPS most common in

older women

11

Acute dystonia from EPS most common in

young men

12

Onset of tardive dyskinesia if EPS reaction

after years of treatment

13

Treatment of tardive dyskinesia

- none
- likely stop antipscyhotic and switch to atypical

14

Features of neuroleptic malignant syndrome

- rigidity
- high fever (up to 107)
- high CPK
- sweating
- myoglobinuria
- mutism
- altered mental status (agitated of obtunded)

15

Treatment of neuroleptic malignant syndrome

- stop antipsychotic
- supportive care for fever and renal
- consider giving dantrolene

16

classic side effect of thorazine

retinal pigment deposits

17

classic side effect of clozapine

agranulocytosis

18

Classic side effects of chlorpromazine

- jaundice
- photosensitivity

19

3 classic side effects of SSRIs

- insomnia
- anorexia
- sexual dysfunction

20

Firs line treatment of depression

therapy and SSRIs

21

Mechanism of action of TCAs

- NE reuptake block
- serotonin reuptake block
- a-adrenergic block
- AchM block

22

Why do TCAs cause orthostatic hypotension?

a-adrenergic block

23

MAOIs may be good for

atypical depression (eating and sleeping more)

24

TCA overdose most concerning for

cardiac arrhythmias

25

MAOIs + tyramine =

HTN crisis

26

Age of onset of bipolar disorder

16-30 years old

27

1st line agents for bipolar disorder

- lithium
- valproic acid
(carbamezapine 2nd line)

28

What is bipolar II?

hypomania with major depression

29

What is cyclothymia

2 years of hypomania with depressed mood without major episodes of either

30

4 classic side effects of lithium

- renal (DI)
- thyroid
- tremor
- CNS effects

31

Classic side effect of valproic acid

liver dysfunction

32

Classic side effect of carbamazepine

bone marrow depression

33

10 major risk factors for suicide

- age above 45
- substance use
- h/o violence
- prior attempts
- male
- psych history
- recent loss
- loss of health
- unemployment/retirement
- not married/partnered

34

Greatest age risk for suicide

over 65 (15-24 also high)

35

Normal grief can last up to

1 year

36

Typical age for panic disorder

20-40

37

Treatment of panic disorder

SSRIs (fluoxetine)

38

Panic disorder is associated with

agoraphobia

39

Describe conversion discorder

- ppt event
- unexplanable neuro symptoms

40

Key features of somatization disorder

multiple complaints in multiple organ systems with negative workup

41

Treatment of somatoform disorders

- frequent clinic visits and/or therapy

42

Difference between factitious disorder and malingering

factitious disorder the patient wants to assume role of the patient. It's intentional but no monetary or other gain.

43

Key features of paranoid personality disorder

- everyone's out to get them
- law suits

44

Key features of schizoid personality disorder

- loner and not interested in having friends

45

Key features of schizotypal personality disorder

- bizarre beliefs
- bizarre way of talking but no psychosis

46

Key features of avoidant personality disorder

- inferiority complex
- has no friends but wants them

47

Key features of histrionic personality disorder

- center of attention
- seductive
- dramatic and attention seeking

48

Key features of narcissistic personality disorder

- no empathy
- use others for own gain
- sense of entitlement

49

Key features of antisocial personality disorder

* must have had conduct disorder
- criminal
- male
- alcohol and drugs
- somatization

50

Key features of borderline personality disorder

- unstable in every realm
- splitting
- 2 minutes of psychosis
- impulsive
- constant crisis

51

Key features of dependent personality disorder

- cannot be alone
- cannot do anything alone

52

Key features of obsessive-compulsive personality disorder

* different than OCD
- restricted affect
- rules are more important than objectives

53

What is a dissociative fugue?

patients have amnesia, travel, assume new identity

54

Dissociative identity disorder most likely assoicated with

childhood sexual abuse

55

Usually onset of OCD

adolescents or early adulthood

56

Treatment of OCD

- SSRIs (fluvoxamine
- clomipramine
- behavioral therapy

57

Features of narcolepsy

* decreased REM latency (enter REM as soon as fall asleep)
- cataplexy
- hypnopompic or phynagogic hallucinations

58

Treatment of narcolepsy

modafinil or amphetamines

59

Formications are associated with

cocaine

60

Cocaine withdrawl features

- sleepy
- hungry
- irritable/depressed

61

amphetamines are classically associated with ____ symptoms

psychotic

62

Likely drug intoxication if vertical and horizontal nystagmus

Phencyclidine (PCP)

63

Treatment of PCP overdose

- urine acidification

64

Is PCP toxic in overdose

yes. can cause dealth from consulsions, coma, respiratory arrest.

65

Are there withdrawl symptoms from PCP?

no

66

Are withdrawl symptoms from opiods dangerous?

no

67

Typical age for use of inhalants

11-15 years

68

Serious effects of inhalants

- respiratory depression
- arrhythmia
- asphyxiation
- nervous system toxic
- nephrotoxic

69

Is benzo withdrawl dangerous?

yes, like alcohol

70

3 classic syptoms of caffeine withdrawl

- headache
- irritability
- fatigue

71

6 times when ok to break confidentiality

- patient's request
- child abuse
- court mandate
- duty to warn/protect
- reportable disease
- danger to other