Psychiatry UWORLD Flashcards

1
Q

Indications for ECT

A
  • severe depression refractory to antidepressents
  • depression in pregnancy
  • refractory mania
  • neuroleptic malignant syndrome
  • catatonic shcizophrenia
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2
Q

Medication for refractory schizophrenia

A

Clonzapine

*Leukopenia SE.

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3
Q

Long-term SE of lithium

A

nephrogenic diabetes insipidus
Hyperparathyroidism w/ hypercalcemia
thyroid dysfunction

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4
Q

treatment of Akathisia (SE medication, dose dependent)

A

Reduction of antipsychotic dose and tx with beta blocker (propranolol) or a benzodiazepine (lorazepam)

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5
Q

conversion disorder

A

sudden onset of a neurological symptom (eg bilateral LE weakness) that is incompatible with normal neurological examination/ clinical findings.

precipitated by stress and patients can present as hysterical or strangely indifferent (la belle indifference) to their symptoms

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6
Q

somatic symptoms disorder

A

one or more persistent physical symptoms w/ disproportionate and excessive anxiety, concern and energy devoted to symptoms.

IN contrast to conversion, in SSD the symptoms are by definition physiological

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7
Q

Treatment of panic disorder immediate vs long-term

A

immediate: benzo

Long-term: SSRI/ SNRI/ CBT (cognitive behavioral therapy)

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8
Q

how long do antidepressants take to respond?

A

6-8 wks

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9
Q

tx specific phobia

A

behavioral therapy

Short acting benzos may help acutely but have a limited role

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10
Q

tx of Kleptomania

A

cognitive behavioral psychotherapy is tx of choice

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11
Q

Patient fails SSRI for depression. What is next medication?

A

Antidepressant with a different mechanism of action, such as serotonin norepinephrine reuptake inhibitor

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12
Q

Alcohol withdrawal symptoms and timing

A
  1. mild withdrawal: anxiety, insomnia, tremors, diaphoresis, palpitations, GI upset, intact oritentaion (6-24hr last drink)
  2. Seizures : 12-48
  3. Alcohol hallucinosis: visual, auditory, or tactile: intact oritentation, stable vital signs. 12-48
  4. Delirium tremens: confusion, agitation, fever, tachycardia, HTN, diaphoresis, hallucinations (48-96)
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13
Q

Which type of medication can cause seizures following abrupt discontinuation?

A

Alprazolam (Xanax) aka short acting benzo

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14
Q

important side effect of buproprion

A

inhibits reuptake of NE, D, 5-HT
** Decreased seizure threshold** seen in higher doses

AVOID in seizure disorder as well as eating disorders

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15
Q

patient on risperidone has bradykinesia, masked facies, and micrographia… what is tx?

A

anticholinergic: benztropine is indicated to help reduce this patient’s EPS.

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16
Q

Post partum blues

vs

Post partum depression

vs

Postpartum psychosis

A
  1. 2-3 days. Mild depresison/tearfulness/irritability
    tx: reassurance and monitoring
  2. within 4 weeks
    Moderate-severe depression, SIGECAPS
    tx: antidepressants, psychotherapy
  3. days to weeks
    delusions, hallucinations, thought disorganization, bizarre behavior
    tx: antipsychotic; hospitalize– do not leave mother alone with infant – risk of infanticide
17
Q

Ecstasy intoxication can cause what type of syndrome? and electrolyte change?

A

Serotonin syndrome: autonomic dysregulation, high fever, altered mental status, neuromuscular irritability, and seizures

Hyponatremia

18
Q

Adjustment disorder with depressed mood vs MDD

A

adjustment disorder with depressed mood does not meet the SIGECAPS criteria for MDD

19
Q

treatment for hoarding disorder

A

SSRI and cognitive behavioral therapy

20
Q

Neuropsychiatric manifestations of SLE:

A
seizures
headaches
peripheral neuropathy
strokes
chorea
21
Q

Social anxiety DO (social phobia)

vs

Panic DO

vs

Specific phobia

vs.

Generalized anxiety disorder

A

Anxiety restricted to social and performance situations, ** Fear of scrutiny** and embarrassment

recurrent, *Unexpected panic attacks

Excessive anxiety about a * specific object* or situation

Chronic (>6months) multiple worries, anxiety, tension

22
Q

GAD tx:

A

cognitive behavioral therapy

SSRI or SNRI

23
Q

Narcolepsy tx:

A
  1. Modafinil and armodafinil: address excessive, uncontrolled, daytime sleepiness.
  2. Amphetamine stimulants: first line except has potential risk of abuse and tolerance and SE
  3. Sodium oxybate: reduces cataplexy.