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PANCE Review > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

generalized anxiety disorder (GAD): definition, dx criteria, tx

A

persistent, excess anxiety over general life events > 6mo

Dx:

  • restlessness
  • easy fatigue
  • irritable
  • sleep distrubance
  • muscle tension
  • difficulty concentrating

Tx: behavior therapy + meds

  • 1st line: SSRI, SNRI, busprione
  • benzo for short-term adjust only
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2
Q

panic attack: definition, dx criteria, tx

A

extreme anxiety or intense fear

  • lasts 5-20 min
  • may or may not have identifiable trigger
  • accompanied by 1 mo of fear of additional attack or change behavior due to fear of attack

tx: therapy + meds
- short-course benzos (lorazepam) then start SSRI for long-term tx
- propranolol not as effective as SSRIs
- mild: relaxation, psychotherapy

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3
Q

phobias

A

irrational fear and persistent excess anxiety when presented with object or situation

  • causes immediate anxiety, panic attack
  • interferes with daily functioning
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4
Q

specific phobia

A

fear of specific object/situation lasting at least 6 months

  • onset in childhood
  • animals, insects, heights, blood, needles, contamination, confined spaces, choking, becoming sick, etc.

Tx:

  • 1st line: desensitization/ exposure therapy/ flooding
  • Short-term benzos, b-blockers
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5
Q

social phobia

A

fear of social situations

  • onset in adolescents
  • public speaking
  • using public bathrooms
  • eating in public
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6
Q

agoraphobia

A

anxiety about placing self in situation in which problem may occur and help will be unavailable

  • fear of public places (bus, crowd, cinema)
  • situations often avoided
  • often experience panic attack

Tx: therapy + meds

  • 1st line: SSRI, SNRI
  • beta-blockers (propanolol) for performance-related situations
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7
Q

obsessive-compulsive disorder (OCD): definition

A

obsessions: persistent, recurrent thoughts that are intrusive and inappropriate resulting in anxiety

compulsions: ritualistic/repetitive behaviors or thoughts pts do to relieve anxiety
- may have no connection b/t event pt is trying to avoid

most people realize that thoughts and behaviors are irrational

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8
Q

obsessive-compulsive disorder (OCD): common examples, tx

A

contamination: hand washing
doubt: worry (forget to lock door, turn off stove)
symmetry: extreme precision
other: nail biting, trichotillomania (hair pulling), skin picking, counting

Tx: therapy + meds

  • SSRI (higher dose)
  • exposure therapy
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9
Q

body dysmorphic disorder

A

preoccupation w/ imagined defect in physical appearance

  • exaggerated distortion of minor flaw
  • common: face, hair, skin, breasts, genitalia

Tx:

  • CBT + SSRI
  • delusional: add 2nd generation antipsychotic
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10
Q

post traumatic stress disorder (PTSD): definiton and sxs

A

exposure to actual or threatened death or serious injury; learning about event occurring to friend or family
- feel helpless, fear, horror than impair daily fx

sx:

  • KEY: last > 1 month
  • occur 1 week to yrs after event
  • fluctuate over time
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11
Q

post traumatic stress disorder (PTSD): 4 elements, common causes

A

4 major elements:

  • re-experince trauma (dreams, memories, flashbacks)
  • avoid reminders
  • sxs of hyperarousal (hyper-startle response, anger outburst, hyper vigilance)
  • emotional numbing (blame self or others, persistent negative state, anhedonia, feel detached)

common causes:

  • men: combat
  • women: rape/assault
  • natural disasters
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12
Q

post traumatic stress disorder (PTSD): tx

A

Therapy + meds

  • 1st line: SSRIs
  • SNRIs
  • benzos reduce anxiety; trazodone for insomnia
  • prazosin for nightmares
  • therapy: support groups, family
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13
Q

adjustment disorder: definition and example stressors

A

emotional symptoms in response to identifiable life stressor (not life-threatening)

  • sxs w/in 3 months of stressor and ending w/in 6 months after stressor resolves
  • reaction out of proportion to stressor / impairs daily functioning

ex. stressors:
- job loss, school or finance problems, moving, substance abuse, booming parents, retirement, legal issues

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14
Q

adjustment disorder: sxs, tx

A

sxs:
- depressed mood, tearful, anxiety, palpitations, agitation, reckless driving, fighting, vandalism, difficult functioning at work

tx:

  • 1st line: psychotherapy
  • benzos, hypnotics (zolpidem): briefly
  • SSRI if depression present
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15
Q

acute stress disorder: definition, populations affected

A

like PTSD, but with different onset and duration
= may be a pre-cursor to PTSD

acute stress d/o:

  • occurs within 1 mo of traumatic event
  • lasts 3 days - 1 month

populations affected:

  • motor vehicle accident survivors
  • violent crome victims/witnesses
  • natural disaster survivors
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16
Q

acute stress disorder: tx

A

similar to PTSD

  • therapy/support group
  • short course benzo (for severe anxiety)
  • +/- SSRI, TCAs, anticonvulsants, anxiolytics for insomnia and irritability if warrented
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17
Q

attention-deficit disorder (ADD or ADHD): characteristics, dx criteria

A

male (2-5x>F), 1st born son

  • 20-50% have dysfunctional sxs as adult
  • underdeveloped part of brain

Dx criteria:

  • hyperactivity, impulsivity, or inattentiveness (developmentally inappropriate for > 6 mo)
  • MUST manifest prior to age 12
  • MUST occur in 2 or more settings
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18
Q

attention-deficit disorder (ADD or ADHD): tx

A

1st line: stimulants

  • methylphenidate (Ritalin, Concerta)
  • dexmethylphenidate (Focalin)
  • amphetamine (Adderall)

Note: wt. loss and dec growth as SE of stimulants!

Behavior modification, family, educational managment

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19
Q

autistic disorder: characteristics

A

> 6 sxs from these categories:

  • impaired social interaction
  • impaired communication
  • repetitive stereotypes patters of behavior and activities (inflexible rituals, hypo or hype sensory)

Note: more common with boys; genetic component; evident prior to age 3

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20
Q

autistic disorder: management

A

Behavioral therapy
- 1st line

Refer: autism specialist

Speech and language pathology

Audiology testing and EEG (many have seizure d/o)

Meds:
- 2nd generation antipsychotics (for aggressive behavior)

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21
Q

anorexia nervosa: definition, grades, 2 types

A

distorted body image; fear of becoming fat even though underweight

  • egosyntonic: behaviors consistent with ideal image (person does not see anything wrong)
  • Mild: BMI>17
  • Moderate: BMI 16-17
  • Severe: BMI 15-16

2 types:

  • restricting: eat very little, excessive exercise, OC traits, withdrawn
  • binge eating/purging: use of laxatives and/or diuretics, depression and substance abuse
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22
Q

anorexia nervosa: findings and complications

A 
amenorrhea
electrolyte abnormalities
hypothermia
cardiac abnormalities: bradycardia, arrhythmia
lanugo (hair on body)
osteoporosis
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23
Q

anorexia nervosa: management

A

restore nutritional state and electrolyte abnormalities
- hospitalize if severely under weight or severe electrolyte imbalance

Outpatient:

  • behavior/family therapy
  • supervised, gradual weight gain

Meds: DO NOT play major role

  • 2nd gen. antipsychotics (may promote wt gain and reduce cognitive distortion
  • Bupropion (Wellbutrin) contraindicated: lowers sz threshold due to electrolyte disturbance
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24
Q

bulimia nervosa: characteristics

A

binge eating and purging (vomit, laxatives, diuretics)

  • at least 1 day/wk for 3 months
  • severity based on number of binge/purge episodes/week
  • rapid fluctuations in weight

Egodystonic: binging causes emotional distress

Person normal or overweight
- BMI>18

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25
Q

bulimia nervosa: physical findings

A 
Fluctuating weight
Dental erosions
Russell's sign: abraded knuckles (from self-induced purging)
esophagitis
acid-base disturbance:
 - hypokalemia alkalosis
 - hypo-mag, hypo-Ca++
Parotid gland enlargement (chipmunk cheeks)
Gastric distention
Cardiac arrhythmias
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26
Q

bulimia nervosa: management

A

restore nutrition/metabolic state

Meds:

  • 1st line: SSRIs: reduce binge/purge behaviors
  • Bupropion (Wellbutrin) contraindicated

Behavior/family/group therapy
- hospitalization usually not needed

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27
Q

eating disorders: general endocrine problems, somatic signs, behavioral signs

A

Endocrine issues:

  • inc growth hormone, cortisol
  • dec LH, FSH, estrogen
  • dec T3
  • abnormal glucose and dexamethasone suppression

Somatic signs:

  • arrested growth
  • fatigue
  • constipation or diarrhea
  • susceptible to fractures
  • delayed menarche

Behavior:

  • reluctance to be weights
  • depression
  • substance abuse
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28
Q

obesity / binge-eating disorder

A

BMI>30 or :20% over ideal body weight

dx criteria:

  • binge eating > 1/week for 3 months
  • no purging
  • sense of lack of control when eating
  • eating rapidly, eating when not hungry
  • feeling disgusted/guilty afterwards
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29
Q

obesity - tx

A

1st line: behavior modifications / group therapy
- new eating patterns

DEPRESSION is often alongside obesity
- tx with SSRIs

Surgery: gastric bypass

30
Q

major depressive disorder - criteria

A 
Depressed mood / anhedonia + 5+ of the following sx for >2 weeks
S: sleep (high or low)
I: interest
G: guilt
E: energy
C: concentration
A: appetite
P: psychomotor (retardation/agitation)
S: suicide
31
Q

major depressive disorder - tx

A

SSRI

  • start low and go slow
  • give 6 wks (and then reassess dx or inc. dose)

SNRI, TCA

  • can switch drug class
  • can combine drugs from different classes

Psychotherapy
Consider ECT

32
Q

seasonal affective disorder - definition, tx

A

fall or winter onset
20-40 y/o females

Tx:

  • light therapy
  • SSRIa
  • Bupropion
33
Q

postpartum depression - definition, tx

A

onset of sxs within 4 wks of delivery

Tx:

  • therapy +
  • SSRI (note: sertraline (Zoloft) best for breastfeeding)
  • estrogen may help
34
Q

disruptive mood dysregulation disorder (DMDD) - definition, tx

  • aka conduct disorder
  • called antisocial if > 18 y/o
A

severe temper tantrums > 3 times/wk for 12 months

  • kids age 6-18
  • sad, irritable, angry almost evert day
  • occurs in at least 2 settings

Tx:

  • therapy (individual and family)
  • +/- SSRI, stimulants
  • 2nd generation anti-psychotics (risperidone or ambilify) for aggression
35
Q

premenstrual dysphoric disorder (PMDD) -definition, tx

A

severe PMS

  • start week before menses (luteal has) and go away with menstruation
  • severe enough to affect work, daily activities, relationships
  • sadness, despair, tension, low energy
  • bloating, breast tenderness, H/A, muscle pain

Tx:

  • SSRI
  • OCP (low dose estrogen)
36
Q

serotonin syndrome

A

severe side effect that can occur with too much serotonin
- usually due to drug combos: SSRI + MAOI + demerol + triptans + dextromethorphan

sxs:

  • rapid onset
  • metal status changed
  • hyperthermia, diaphoresis
  • tremor, hypertonicity (clonus), seizures
  • renal failure, coma, death

Tx:

  • STOP serotonin drugs
  • benzodiazapines
  • IV hydration and aggressive cooling
37
Q

dysthymic disorder / persistent depressive disorder - criteria and tx

A

chronic, persistent mild depression

  • mores days than not for > 2 yrs, not w/o sx for > 2 mo, no major depressive episode
  • loss of interest, dec. productivity, social withdrawal, lack self esteem, poor concentration
  • NO psychotic or manic features
  • young adult onset

Note: can develop major depressive disorder or bipolar

Tx:
- SSRI + therapy

38
Q

bipolar I disorder - criteria

A

> 1 manic episode, often cycles with depressive episodes

  • Bipolar I has psychotic features / more severe
  • Often requires hospitalization
D: distracted
I: impulsive
G: grandiosity
F: flight of ideas
A: activity (high energy, agitation)
S: dec. ned for sleep
T: talkative

Psychotic symptoms: hallucinations, delusions

39
Q

bipolar I and II disorder - tx

A

Begin tx with a mood stabilizer
- typical 1st line is lithium or Depakote

Note: refer to specialist

40
Q

bipolar II disorder

A

at least 1 major depressive and 1 hypomanic episode

  • less severe than bipolar I
  • hypomanic sxs are milder than manic sxs
  • no “manic” episodes
  • no psychotic sxs
41
Q

Brief Psychotic Disorder

A

symptoms last 1-30 days but then person returns to complete normal functioning
- usually in the context of a severe stressor / traumatic event

42
Q

Schizophreniform Disorder

A

Note: almost the same as schizophrenia

  • precursor for schizophrenia
  • duration 1-6 months and may be able to still function
  • typically lead to full blown schizophrenia
43
Q

Schizoaffective Disorder

A

schizophrenia with mood disorder (BPD, depression) on top of it
- look for psychotic symptoms when mood issues NOT present to differentiate from mania or psychotic depression

44
Q

Delusional Disorder

A

having a delusion and nothing else; absence of other schizophrenia symptoms

  • delusion of at least 1 month (ex. someone put chip in my brain – but still functioning)
  • person still functioning

tx: antipsychotics

45
Q

schizophrenia - 3 categories of sxs

A

Manifests in teens and 20s with gradual onset of sxs

  • must last for 6 months or more
  • severe enough to disrupt social and occupational fx

positive sxs:

  • hallucinations (auditory common)
  • delusions (false ideas asked on incorrect perceptions of reality)

negative sxs:

  • emotional blunting
  • flat affect

disorganized sxs:

  • loose associations
  • word salad (talking but words do not make any sense)
  • neologisms (made up words)
  • thought blocking (getting stuck)
  • catatonia (strange postures)
  • echolalia (repeating back what someone said to them)
  • bizarre behavior often related to delusions/hallucinations
46
Q

schizophrenia - treatment

A
  • Antipsychotic medications (higher doses of the atypicals usually tried first – higher than for BPD, etc.)
  • Referral to community mental health center (which has prescribers, therapists, groups, help with jobs/functioning etc.)
  • Support groups for patient and/or caregivers
  • Prognosis is typically poor compared to other mental health conditions
  • Note: high rate of suicide
47
Q

somatic symptom disorders vs. factitious disorder vs. malingering

A

somatic symptom disorders: not conscious or intended (physical sxs that defy medical w/u)

  • somatic disorder
  • conversion disorder
  • illness anxiety disorder

Factitious Disorders: person is doing something intentionally (faking or causing an illness); limited or no external gain (attention seeking / likely begin hospitalized)

Malingering: intentional for external gain (money, time off work)

48
Q

somatic symptom disorder - definition, tx

A

sxs relate to many systems: GI, reproductive, neuro, pain, cardiac

  • sxs and fears are disproportionate to objective medical findings
  • numerous negative work-ups from variety of health care providers; several hrs a week in appts

Tx:

  • thorough W/U
  • assure pt you take them seriously
  • regularly scheduled appointments with the same provider can provide reassurance (Key!!)
  • CBT, relaxation
49
Q

conversion disorder

A

physical symptoms that can’t be explained physiologically; neurological W/U normal

  • symptoms: include blindness, seizures, paralysis, deafness, fainting, ticks
  • patients may have unexpected lack of concern to sxs

Tx: therapy, reassurance, reduce stress
- remission rate is high

50
Q

Illness anxiety disorder - definition, tx

A

6+ months of fear or belief that one has acquired or might acquire a serious illness

  • layman’s term: hypochondriac
  • few or no physical symptoms; extreme anxiety and worry

Tx:
- SSRI’s and CBT (cognitive behavior therapy); similar to OCD

51
Q

ETOH - labs in chronic abuse

A 
elevated GGT (1st sign), AST, ALT
 - AST:ALT 2:1

inc. HCL, LDH, MCV
dec. LDL, BUN, RBC volume

52
Q

ETOH - withdrawal signs and tx

A 
tremors: 10-18hr
anxiety, N/V
seizures: 7-48 hrs
hallucinations: within 2 days
delirium tremens: 2-5 days

tx:

  • benzos (diazapam) from agitation
  • thiamine (prevents Wernicke’s encephalopathy)
  • multi-vitamin, folic acid
  • haloperidol or risperidone: hallucinations
  • naltrexone: reduced cravings
53
Q

stimulants (amphetamines, cocaine) - intoxication, withdrawal, tx

A

intoxication:

  • euphoria
  • aggression
  • psychosis, hallucinations
  • tachycardia, elevated BP, dilated pupils

withdrawal:

  • fatigue, depression, hunger
  • H/A, seating, muscle cramps

tx:

  • benzodiazepines for agitation
  • short-term antipsychotics for psychotic sxs
  • rehab / detox
54
Q

opioids (heroin, morphine, oxycodone) intoxication, withdrawal, tx

A

intoxication:

  • euphoria
  • drowsy, lethargy
  • hypotension, bradycardia
  • constricted pupils

withdrawal:

  • lacrimation (tears), rhinorrhea
  • sweating, yawning
  • muscle aches
  • hypertension, tachycardia, anxiety

tx:

  • methadone
  • benzos for mild w/drawal
  • NSAIDS for muscle aches
55
Q

opioid dependence therapy

A
  1. methadone (full opioid agonist) maintenance program
  2. buprenorphine + naloxone (suboxone, partial opioid agonist)
  3. Naltrexone (opioid antagonist - interrupts reward pathway; approved for tx of alcohol and/or opiate use disorder)
56
Q

nicotine - tx

A

best: combo of counseling and meds

nicotine replacement therapy: patch, gum, nasal spray

Buproprion (Zyban): atypical antidepressant with unrelated anti-smoking activity
• Long-term abstinence rates similar to NRT (~19%)
• Start 1-2 weeks before quit date and continue 7-12 weeks after
• Can use patches with this

Varenicline (Chantix) – blocks pleasure of smoking
• Partial nicotine receptor agonist/antagonist
• Short-term quit rates higher than NRT, but long-term probably similar (~19%)
• Start week before quitting, 3 months of treatment
• Cannot use patches with this

57
Q

personality disorders - general characteristics

A

DS begin at birth

Traits become rigid and non-adaptive to situations

  • often may not notice PD until situation where it is not appropriate
  • traits interfere with daily functioning, ability to succeed in life or meet expected goals
  • traits cause serious problems with interpersonal relationships, serious problems to others

Common shared characteristics among personality disorders:

  • skewed/distorted sense of self
  • low frustration tolerance
  • often blame others, has “victim” mentality
  • often has POOR/NO insight into personality issues
58
Q

antisocial personality disorder

A

lack of empathy, aggressive, cruel w/ lack of regret / remorse, disregard for safety of self and others

  • repeat violation of others; blaming others; brain: cannot read others’ emotions like others can
  • antisocial disorder once 18 y/o and older (conduct beforehand)
59
Q

avoidant personality disorder

A

fear of rejection (sensitive), loner

- people want to have relationships, but afraid of being rejected

60
Q

borderline personality disorder

A

common, inconsistency / unstable “frenemy”, emotional instability, easily frustrated

  • people all good or all bad
  • needy, attention-seeking, push boundaries – want to feel special (call after hours); can get upset
  • behave similarly to all sexes
  • difficult to treat: get on nerves of provider; confused with bipolar disorder
61
Q

dependent personality disorder

A

dependent, indecisive, obsequious, people pleaser, helpless

  • often see marriages where wife is completely dependent on husband (decisions, going everywhere)
  • lack of ability to participate in shared-decision making; often has person w/ them who makes decisions
62
Q

histrionic personality disorder

A

provocative or seductive behavior, attention seeking, relationships considered more intimate than they are → sexual, women trying to get attention from men
- can make medical staff uncomfortable, exaggerate sxs and difficulties

63
Q

narcissistic personality disorder

A

self centered, entitled, demanding / want special treatment; lacking empathy for others
- ex. President Trump (extreme reaction to criticism; cannot admit to being wrong)

64
Q

obsessive-compulsive personality disorder

A

“just right” – compulsions are efforts to get rid of obsessions, repetitive behaviors
- rigidity around rules, neatness, cleanliness, order

Note: OCD realize they have strange behaviors vs. OCPD who wonders why others do not think way they do

65
Q

paranoid personality disorder

A

distrust, suspicious mistrust, think everyone is out to get them (everything seen through lens of suspicion); these people do not have a lot of friends
- difficult for pt to trust provider

66
Q

schizoid personality disorder

A

lack feelings and emotions, cold, indifferent, do not find joy in anything
- do not want to have relationships with people – lack of interest; seek jobs where they do not interact w/ people; lack of intimate relationships

67
Q

schizotypal personality disorder

A

hard time having close relationships (b/c so odd), odd beliefs or magical thinking (“eccentric”), somewhat psychotic beliefs
- like schizophrenia, but no decline in fx

68
Q

grief reaction / bereavement

A

sxs: shock, confusion, sadness, numbness
- may report illusions (seeing or hearing deceased)
- person maintains hope that things will get better (vs. major depressive disorder)

Tx:

  • therapy, reassurance
  • +/- benzos for insomnia, SSRIs, anti-depressants
69
Q

neuroleptic malignant syndrome

A

caused by dopamine blockade

  • can occur with high potency antipsychotics
  • confusion, high fever, elevated BP, tachycardia
  • “lead-pipe” rigidity
  • sweating, elevated CPK levels
70
Q

munchausen by proxy

A

form of abuse initiated by parent

  • make up sxs in child causing repeated visits to provider
  • parent gets attention being attentive, suffering parent

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