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Psychiatry rotation > First aid psych > Flashcards

First aid psych Flashcards

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1
Q

Hypomanic episode

-sx, time criteria

A
  • at least 4 days
  • less severe manic episode
  • not severe enough to cause marked impairment in social/occupational functioning
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2
Q

What drug intox/withdrawal?

Euphoria, grandiosity, pupil dilation, prolonged wakefulness and attention, HTN, tachycardia, anorexia, paranoia, fever

A

Amphetamine intox

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3
Q

Opioid addiction tx options with drugs (3)

A
  1. methadone–long-acting oral opioid
  2. Suboxone (buprenorphine+naloxone)–partial agonist oral, long acting
  3. naltrexone–long acting opioid blocker. Used for relapse prevention once detoxed
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4
Q

Parkinson’s disease

sx (5)

A

parkinsons “TRAPS” the body

Tremor (at rest. pill-rolling tremor)

Rigidity–Cogwhell

Akinesia/bradykinesia

Postural instability

Shuffling gait

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5
Q

Lewy body dementia

-sxs

A

“guy in chair hallucinates to see Louie, then falls”

  • hallucination and dementia
  • Later proression: falls (parkinsonian)
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6
Q

Atypical antipsychotics

-side effects, which drugs (4)

A

Olanzapine/Clozapine–weight gain, hyperglycemia, diabetes

Clozapine–agranulocytosis (do weekly WBC monitoring) so infection risk, weight gain

“watch Clozapine Clozly”

Clozapine is useful for pts whose sxs are refractory to other antipsychotics.

Ziprasidone–long QT (torsade de pointes)

Risperadone–prolactin increase, gynecomastia, galactorrhea

Aripripazole

Quetiapine

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7
Q

What drug intox/withdrawal?

Fever, psychomotor agitation, analgesia, belligerence, impulsiveness, nystagmus, tachycardia, homicidality, psychosis, delirium, seizures

A

PCP intox

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8
Q

Parkinson symptoms: think what 3 diseases

A
  1. parkinsons
  2. lewy body dementia

(old person hallucinates and sees Louie, then falls)

  1. frontotemporal (Pick) dementia

(“Prick,” disease picks frontotemporal)

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9
Q

Antipsychotics

  • extrapyramidal sx (4)
  • mech and tx
A

4 hrs, 4 days, 4 wks, 4 mo

Acute dystonia–neck spasm

Akathesia–restlessness

Bradykinesia–parkinsonism

Tardive dyskinesia–oral-facial movements, potentially permanent.

mech of 1st 3: Increased Ach activity from DA blocking. So, use anticholinergics (benadryl, benztropine)

Tardive dyskinesia: caused by upregulation of DA receptors. Stop antipsychotic. CANNOT use anticholinergic b/c make it worse. Increased antipsychotic will actually improve sxs but only temporarily.

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10
Q

Cognitive disorders (2)

A
  1. delirium

check for anticholergic drugs

  1. dementia

In elderly patients, depression may present like dementia (pseudodementia)

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11
Q

Bupropion

  • side effects
  • what to be careful about
A

increase NE, DA.

  • side effects: stimulant effects–tachy, insomnia. HA, lower threshold for seizures, no sexual side effects
  • contraindicated in Bulimic patients and anorexic for lower seizure threshold
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12
Q

How does anticholinergic action affect the eye? Other than mydriasis

A

Cycloplegia, causing blurred vision

-loss of accomodation (relies on ciliaris muscle to adjust lens)

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13
Q

Parkinsons drugs (5) and mechs

A

BALSA

Bromocriptine (DA agonist)

Amantadine (may increase DA release)

Levo-dopa (with carbidopa)

Selegiline (MAO-B inhibitor in brain)

Antimuscarinics (benztropine)

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14
Q

What drug intox/withdrawal?

Euphoria, anxiety, paranoid delusions, slowed time perception, impaired judgment, social withdrawal, increased appetite, dry mouth, conjunctival injection, hallucinations

A

Cannabis intox

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15
Q

OCD

-drug tx (2)

A

SSRI high dose, Clomipramine (TCA)

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16
Q

Parkinson’s disease

-mech

A

Lewy bodies, loss of DA neurons in substantia nigra

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17
Q

Main side effects to know:

Carbamazapine

Valproic acid

Lamotrigine

Gabapentin

A
  1. agranulocytosis
  2. hepatotoxicity (necrotizing hepatitis), agranulocytosis ( do regular LFTs and CBC)
  3. Stevens-Johnson
  4. Tremor
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18
Q

Bipolar disorder

  • drugs to tx
  • drugs to avoid
A

Mood stabilizers: Carbamezapine, Lithium, Valproic acid

Atypical antipsychotics

-no antidepressants, can cause mania

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19
Q

What drug intox/withdrawal?

Euphoria, resp and CNS depression, reduced gag reflex, pupillary constriction, seizures

A

Opioid intox

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20
Q

Psych ROS, My mnemonic

A

Depressed persons seem anxious, some come psychotic.

Depression/mood

Personality (esp borderline)

Subst abuse

Anxiety disorders

Somatiform/eating disorders

Cognitive (delirium, dementia)

Psychotic disoders

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21
Q

Benzos: What durations? and name them and their main uses, according to FA Psych

  1. long acting (3)
  2. intermediate (4)
  3. short acting (3)
A
  1. 1-3 days
  2. 10-20 hours
  3. 3-8 hrs

Diazepam (Valium)–rapid onset, anxiety and seizure control

Chlordiazepoxide (Librium)–EtOH detox

Flurazepam (Dalmane)–rapid onset, insomnia

Alprazolam (Xanax)–panic attacks

Lorazepam (Ativan)–panic attacks, EtOH withdrawal

Temazepam (Restoril)–insomnia

Clonazepam (Klonopin)–panic attacks, anxiety

Oxazepam (Serax)

Triazolam (Halcion)–rapid onset, insomnia

Midazolam (Versed)–procedural sedation

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22
Q

Mirtazapine

  • mech
  • side effects
A
  • alpha 2 blocker. So, releases NE, 5-HT
  • sedation, increased appetite, weight gain.

(Good side effects for pts with insomnia, low appetite, anorexia, elderly (weight gain).

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23
Q

Tourette syndrome

  • time criteria
  • Tx
A

>1 year persistence of motor/vocal tics

Tx with antipsychotics or bx therapy

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24
Q

Delusional disorder

-sx, time criteria

A

>1 mo

  • persistent untrue belief system
  • functioning not impaired!
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25
What drug intox/withdrawal? Anhedonia, appetite increase, hypersomnolence, existential crisis
Amphetamine withdrawal
26
Time criteria (when start, how long last) -postpartum blues, depression, psychosis
blues: starts 2-3 days after delivery, usually resolves in 10 days depression: starts within 4 weeks of delivery, lasts 2 weeks to a year or more psychosis: usu lasts days to 4-6 weeks.
27
MAO-I -toxicity
HTN crisis with tyramine ingestion (no MAO to metabolize the food) Avoid many food such as Cheeses, wine
28
What drug intox/withdrawal? Sleep disturbance, depression, anxiety, seizure
Benzo withdrawal
29
Alzheimer's - what percent familial - what genes
familial, 10% Early onset: presenilin 1,2, ApoE4
30
What drug intox/withdrawal? Depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep
PCP withdrawal
31
Risk factors for suicide
SADPERSONS Sex-male Age (teen or elderly) Depression Previous attempt Ethanol/drug use Rational thinking loss Sickness (illness or 3+ Rx meds) Organized plan No spouse Social support--lacks
32
What drug intox/withdrawal? tachycardia, tremors, anxiety, seizures, hallucinations, delusions, confusion
DTs from EtOH withdrawal Autonomic hyperactivity Psychotic sxs Confusion
33
Major depressive disorder - dx criteria, time criteria - how long do depressive episodes last - types (4)
1. MDD: \>2 weeks. episodes last 6-12 months 2. Dysthymia (persistent mild depression): \>2 years 3. SAD: winter 4. Atypical depression: no time criteria. Mood reactivity, interpersonal rejection sensitivity MDD: Pt-reported low mood + 5 or more of SIGECAPS: Sleep change Interest loss Guilt Energy loss Concentration loss Appetite change Psychomotor retardation, agitation Suicidality
34
Manic episode -criteria (sx, time)
\>1 week of elevated mood, + 3 or more of following: DIG FAST **Distractibility** **Irresponsibility**--seek pleasure with no regard to consequences **Grandiosity**--inflated self-esteem **Flight of ideas**--racing thoughts **Activity increase** (more goal directed activity), psychomotor agitation **Sleep**--reduced need **Talkativeness** or pressured speech
35
Frontotemporal dementia -sxs
- "prick" - dementia with parkinsonian aspects - change in personality, uninhibited behavior
36
Hallucinations--what are MCC 1. visual 2. auditory 3. olfactory 4. tactile
1. medical illness (drug intox), less likely psychiatric 2. Psychiatric, less likely medical 3. brain tumor, epilepsy 4. Formication, coke bugs: EtOH withdrawal, cocaine abuse
37
What drug intox/withdrawal? Hypersomnolence, malaise, severe psychological craving, depression/suicidality
Cocaine withdrawal
38
What drug intox/withdrawal? Sweating, dilated pupils, piloerection, fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea (flu like sxs)
Opioid withdrawal
39
antisocial, conduct, oppositional defiant what order, and requirements/descriptions
Oppositional defiant--\>Conduct--\>Antisocial PD oppositional: pattern of hostile bx against authority, but no serious violations of social norms conduct: now, violating basic rights of others (hurt people, destroy property, theft) Antisocial: Must be \>18 and have hx of Conduct disorder before age 15
40
GAD - time criteria, vs what - Drug tx (3)
GAD: **\>6 mo** Adjustment: **\<6 mo** SSRI, SNRI, buspirone, CBT
41
What drug intox/withdrawal? Impaired judgment, pupil dilation, hallucinations, paranoid ideations, angina
Cocaine intox
42
What drug intox/withdrawal? Delirium, life-threatening CV collapse
Barbiturate withdrawal
43
Smoking cessation -what drugs can help? (2)
Bupropion (Wellbutrin)--increase NE and DA release Varenicline (Chantix)--nicotinic partial agonist
44
SSRIs - time to take effect - main side effects (3)
- 4-8 weeks 1. Anorgasmia, ED, low libido 2. GI upset (diarrhea), from serotonin activity in gut 3. Serotonin syndrome--hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures. Tx with cyproheptadine
45
Alzheimers drugs (4)
Memantine--NMDA receptor blocker Riva**stigmine**, Gallantamine, Donepezil--**AchE inhibitors** Mr Rivas is my man...Done with Alzheimers and feels Gallant.
46
Personality disorders 3,4,3
"weird, wild, worried" Paranoid, Schizoid, Schizotypal Borderline, Antisocial, Histrionic, Narcissistic Avoidant, Obsessive-compulsive, Dependent
47
Typical Antipsychotics -side effects (not including extrapyramidal)
Typical: 1. alpha-adrenergic blocker: hypotension, ED 2. antimuscarinic--dry mouth, incontinence, CNS confusion 3. antihistaminic--sedation 4. DA blocker--prolactin increase: gynecomastia, galactorrhea
48
Tricyclics - side effects - how to tx cardio toxicity
(similar to typical antipsychotics) anticholinergic--incontinence, dryness, CNS confusion, tachy antihistaminic--sedation alpha blockade--HoTN, ED 3 C's: Cardiac--arrhythmias from long QRS (tx with NaHCO3 to release in urine--use base to bind acid) Coma Convulsions
49
What drug intox/withdrawal? perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis
LSD intox
50
51
Which nutrition deficiencies can cause dementia (3)
B1/thiamine: wenicke-korsakoff syndrome (Beriberi) Triad for Wernicke encephalopathy: confusion, opthalmoplegia, ataxia. Korsakoff's psychosis: confabulation, personality change, permanent memory loss. Damage to mamillary bodies. Tx with thiamine B3: Pellagra. Diarrhea, dementia, dematitis B12: CNS/PNS demyelination
52
Bipolar disorder -types (3), time criteria
**Bipolar 1**--presence of at least 1 manic episode w/ or w/o hypomanic or depressive episode **Bipolar 2**--presence of hypomanic and depressive episode **Cyclothymic**--dysthymia and hypomania, **lasts \>2 years**
53
Panic disorder - dx criteria (3 things) - time criteria
-Attack, followed by \>1 mo of 1+ of the following: 1-persistent concern of additional attacks 2-worrying about consequences of attack 3-Bx change related to attacks
54
Tremor types and assoc disease | (3)
1. Essential (postural/action tremor--pt tries to hold arm in 1 position steady, maintain posture, but can't) - genetic predisoposition, pts often self medicate with EtOH. Tx with propranolol 2. Resting (pill-rolling) - Parkinsons 3. Intention tremor (slow zig-zag when pointing toward target) - Cerebellar dysfunction
55
4 dopaminergic systems in brain, their functions and diseases
1,2. schizophrenia mesolimbic, positive sxs mesocortical--negative sxs 3. parkinsonism Nigrostriatal, coordination of voluntary movements 4. prolactin tubuloinfundibular, controls prolactin
56
Lithium - what drug interaction to know - used for bipolar and what else?
- thiazides. (Lithium follows Na+ absorption in PCT). So, bipolar pt with recently diagnosed HTN gets ataxic with tremor. Cause: HCTZ - SIADH
57
Panic disorder -drug tx (3)
SSRI, SNRI-Venlafaxine, Benzos Not Buspirone Also CBT
58
Typical antipsychotics -name them by low/high potency, and specific side effects
"Try to Fly High, Cheating thieves are low" Trifluoperazine, Fluphenazine, Haloperidol--more EPS Chlorpromazine, Thioridazine--anticholinergic, antihistamine, alpha blocker Chlorpromazine--cornieal deposits Thioridazine--reTinal deposits
59
PTSD - time criteria, vs what - tx
PTSD: \>1 mo Acute Stress disorder: 3 days-1 mo Tx: SSRI, psychotherapy
60
Tricyclics -why be careful to use in elderly? And which to use if you have to?
Anticholinergic side effect can cause CNS confusion, hallucinations in elderly, esp with Amitriptyline. Use nortripyline (less anticholinergic)
61
Substance abuse: stages of overcoming addiction (6)
1. precontemplation--not yet acknowledged as problem 2. comtemplation--acknowledged, but not ready to change 3. preparation/determination--ready 4. action/willpower--taking action 5. maintenance 6. relapse
62
How does vascular dementia present differently from Alzheimers? -how common is vascular dementia?
- Often presents with focal deficits from infarcts. unlike alzheimers - 2nd most common cause of dementia
63
Dissociative disorders: (2)
1. dissociative identity disorder (formerly multiple personality) - presence of 2 or more distinct IDs/personality states 2. depersonalization/derealization disorder - persitent feelings of detachment from one's own body, thoughts, perceptions, actions
64
What drug intox/withdrawal? Irritability, depression, insomnia, nausea, anorexia
Cannabis withdrawal
65
schizophrenia and related forms of disease -differences, time criteria
Schizoi**d** (distant)--\>Schizo**t**ypal (thinking, magical)--\>Schizophrenia--\>Schizoaffective (+mood, \>2 weeks) Brief psychotic disorder (\<1 mo) Schizophreniform (1-6 mo) Schizophrenia (6 mo)
66
Schizophrenia -dx criteria (5 sx), time criteria
\>6 mo, and 2 or more of following 5: 1. delusions 2. hallucinations 3. disorganized speech 4. disorganized/catatonic behavior 5. Negative sx (flat affect, social withdrawal, etc)
67
Huntington's disease - mech - symptoms (4)
- atrophy of caudate nucleus - CAG repeats (Caudate loses Ach and GABA) - choreiform movements - aggression - depression - dementia (sometimes mistaken for substance abuse)
68
Lithium -side effects
LMNOP Lithium Movement (tremor) Nephrogenic Diabetes insipidous (tx for SIADH) O (HypOthyroidism) Pregnancy (fetal heart problems) Also, arrhythmia from heart block
69
Pt with anorexia -what problems to look for
- osteoporosis (caused in part by reduced estrogen), with metatarsal stress fractures - anemia - E-lyte disturbances (vomiting--\>met alk--\>hypokalemia (H+ leaves cell, K+ enters)--\> arrythmias)
70
Trazodone - mech - clinical uses - side effects
- blocks 5-HT2, alpha receptors - primary use is insomnia, b/c high doses required for antidepressive effects - priapism (TrazoBone)
71
SNRI -side effects, most common
- increase in BP most common - also stimulant effects, sedation, nausea - sexual side effects less severe than SSRI
72
Buspirone - how long to take effect? - react with alcohol, benzos? - mech
- 1-2 weeks - No - 5-HT agonist
73
What drug intox/withdrawal? emotional lability, slurred speech, ataxia, coma, blackouts
EtOH intox
74
Normal vs pathologic grief
Normal: can last 6-12 mo. may have simple hallucinations (hearing name called) Pathologic: lasts \>6-12 mo. can have depressive sx, delusions, hallucations
75
Bulimia signs
- Russell sign (dorsal hand callouses) - parotitis - enamel erosion - E-lyte disturbances/alkalosis

Psychiatry rotation (1 decks)

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