Lange Q&A Flashcards
(406 cards)
0
Q
biggest risk factor for suicide
A
prior suicide attempt
1
Q
narcolepsy triad
A
sleep attacks
cataplexy
hypnopompic/hypnagogic hallucinations or sleep paralysis
2
Q
what stage of sleep does nightmare disorder occur in
what happens quickly upon arousal
A
latter third of night and during REM sleep
person quickly becomes oriented upon arousal
3
Q
what stage of sleep do sleep terrors occur?
A
stages 3-4
4
Q
when diagnosing MDD in children, what symptom can substitute for depressed mood?
A
irritable mood
5
Q
- markedly limited vocab
- making errors in tense
- difficulty recalling words or producing sentences with developmentally appropriate length or complexity
A
expressive language disorder
6
Q
avg number of words spoken by a 2 year old
A
200
8
Q
criteria for schizoaffective disorder
A
presence of psychotic sxs for at least 2 weeks in the absence of mood sxs
9
Q
how to tx schizoaffective disorder
A
antipsychotic + antidepressant
10
Q
new mom is sad and always thinks she hears her child crying… what is it? how to tx?
A
postpartum depression with psychotic features
tx with SSRI and APD
11
Q
bilateral abducens nerve palsy, horizontal nystagmus, ataxia, global confusion, apathy
A
wernicke’s encephalopathy
12
Q
drug to tx delusional disorder
A
antipsychotic
13
Q
if someone presents in acute manic state and agitated, what do you give?
A
antipsychotic and benzo
-start mood stabilizers non-emergently as they take a week to take effect
14
Q
you can get acute stress disorder or PTSD from witnessing something traumatic (life threatening, serious injury, etc)
T/F
A
T
15
Q
which SSRI side effect can persist for the duration of tx?
A
sexual dysfunction
16
Q
what to give in TCA overdose? what do ppl die from?
A
sodium bicarb
cardiac arrhythmia
17
Q
pharm management of opiate withdrawal
A
clonidine
methadone
18
Q
what drug to give to delirious old ppl
A
haldol
19
Q
best tx for borderline personality
A
DBT
20
Q
what is phenelzine
A
MAOI
21
Q
MDD > bereavement if :
A
- depressive sxs last for longer than 2 moths
- survivor has guilt surrounding anything other than actions they should have taken to prevent the death
- survivor has prominent hallucinatons
- psychomotor retardation
- suicidal ideation
22
Q
onset of emotional or behavioral disturbances within 3 months of a significant life event that may manifest as marked change in an individual’s ability to function in school, work, or interpersonal relationships
- not as severe as MDD
- not bereavement
A
adjustment disorder
23
Q
first line agent for panic disorder
A
SSRI
24
Q
treating OCD
A
CBT and SSRIs
25
first line drug for tourette's
| what about for severe cases
clonidine
| antipsychotic
26
atomoxetine
| what is it and what is it used for
SNRI
| tx for ADHD
27
common side effect of clonidine and what to do about it
sedation
| either wait it out for a few weeks or reduce the dose
28
if alcoholics can abstain from alcohol for 4 weeks, only 5% of them will continue to have sxs of depression (T/F)
T
29
you can have delusions in dysthymia and adjustment disorder (T/F)
F
30
MZ twin concordance with bipolar disorder
80-90%
31
what is residual type of schizophrenia
absence of positive sxs and a preponderance of negative sxs
32
non addicting sleep agent
benadryl
33
Li, carbamazepine, depakote
| which one does not cause decrease in WBC
Li- it can cause a modest benign increase in WBC
- carbamazepine- benign reduction in WBC count but severe blood dyscrasias occur in 1/125,000 patients
- depakote- often a benign thrombocytopenia but can cause rarely agranulocytosis
34
what to do with somatization disorder?
look up previous test results/previous care
| assess for other treatable psychiatric illnesses
35
somatization disorder often assoc with which personality disorder
histrionic
36
what to give a shizotypal personality person who is under stress and has "micropsychotic episodes"
low dose APDs
37
lab findings in chronic alcoholic
elevated or depressed LFTs
hypomagnesemia
thrombocytopenia
increased PT
38
which anti-epileptic can be used for alcohol withdrawal
carbamazepine
39
good test to evaluate short term memry
Brown Peterson task
| -useful during ECT as it can result in amnesia
40
fluvoxamine MOA
SSRI
41
venlafaxine MOA
serotonin and norepinephrine reuptake inhibitor
42
factitious disorder by proxy
mother is most likely (anxious/depressed/angry)
2 personality disorder associations
depressed
| histrionic and borderline
43
time cut off for acute stress disorder
within 4 weeks of event
44
what happens when MAOI + aged cheese, wine, beer, pickled foods
how to tx
hypertensive crisis
| tx with alpha blocker (IV phentolamine)
45
side effects of clozaril
seizures
tachycardia, hypotension, sedation, fatigue, weight gain
does not affect prolactin so does NOT cause galactorrhea
46
which routine monitoring test do you have to get for patients on clozaril
CBC with diff
47
frequently used tool to asses dementia
MMSE
20-25 suggestive of cognitive impairment
< 20 definitive impairment
48
wisconsin card sort test is used to test ________, which is located in _______
executive function
| frontal lobe
49
when assessing mania, rule out this medical condition
thyroid disorder
50
phenytoin (dilatin) side effects
gingival hyperplasia, nystagmus, dizziness, slurred speech, ataxia, mental confusion, decreased coordination
51
ebstein anomaly assoc with ______
lithium
52
hepatic failure assoc with this mood stabilizer
depakote
53
risk of schizophrenia in general population and if you have one parent with it
1% and 12%
54
the Rorschach test is a associative projective test (T/F)
T
55
a manic episode can be due to cocaine intoxication T/F
T
56
amok
culture-bound syndrome of Malaysian origin that refers to a violent or furious outburst with homicidal intent. often results in multiple casualties
- prodromal brooding
- homicidal outburst
- persistence in reckless killing without an apparent motive
- claim of amnesia
57
dhat
anxiety regarding the discharge of semen (Indian)
58
ganser syndrome
patient who responds to questions by giving approximate or outright ridiculous answers
59
latah
Malaysian or Indonesian term
| -middle aged women who have sudden fear, often with dissociation and catatonic-like features (echolalia, echopraxia)
60
if you can't use benztropine for EPS, what should you use instead?
amantadine
61
denial is a ______ defense
regression
rationalization
suppression
denial- narcissistic defense
regression- immature defense
rationalization- neurotic defense
suppression- mature defense
62
in psychogenic coma, you would still have normal cold water caloric nystagmus (T/F)
T
63
how to calculated IQ
(mental age/chronological age) x 100
64
how to tx severe depression in elderly with multiple medical (esp cardiac) conditions
ECT
65
atypical specifier for depressive episode
mood reactivity
| 2/4: increased appetite or weight gain, hypersomnia, leaden paralysis, rejection sensitivity
66
melancholic specifier for depressive episode
loss of interest or pleasure in all or almost all activities or a lack of reactivity to usually pleasurable stimuli
67
identification
defense mechanism in which the person incorporates the characteristics and qualities of another person or object into his or her own ego system
68
fixation
overactive attachment to a person or object
69
catatonia
psychomotor disturbance involving motor immobility, excessive motor activity, mutism, negativism, peculiar voluntary movements, echolalia, echopraxia
70
catalepsy
an immobile position that is maintained
71
you should avoid using benadryl as a sleep aid in older pts due to anticholinergic effects and possible delirium (T/F)
T
72
MAOI + meperidine (demerol)
hypertensive crisis
73
depression tx during pregnancy
MAOI
ECT
SSRI
- MAOI- contraindicated due to exacerbation of pregnancy induced HTN
- ECT- safe
- SSRI (such as fluoxetine)- relatively safe
74
most common sx of caffeine withdrawal
HA
75
tx of NMS
D/C the offending drug
IV dantrolene and PO bromocriptine
cooling measures
76
lithium toxicity
| how to tx?
severe CNS and renal impairment
- dysarthria, coarse tremor, ataxia
- impaired consciousness, fasciculations or myoclous, seizures, coma
tx: gastric lavage, rehydration, hemodialysis
77
right parietal stroke would most likely cause issues with ______ memory
visual, nonverbal
| can test with Rey-Osterrieth Test (copying a complex figure and then drawing it from memory)
78
fluoxetine takes ______ to wash out of the system
| what are the implications
6 weeks
| do not start MAOI within this time frame or you might cause serotonin syndrome
79
some complications of anorexia
osteoporosis, constipation, cold intolerance, leukopenia, thyroid dysfunction, cardiac arrhythmias
80
mortality rate for anorexia
5-20%
81
if the sxs of major depressive episode begin within 2 months of the loss and do not persist beyond the 2 month period, it is normal bereavement unless:
- thoughts of death other than feelings they would be better off dead
- expressing guilt other than about the actions taken or not taken at the time of death
- morbid preoccupation with worthlessness
- marked psychomotor retardatio
- hallucinations other than that of the deceased individual
yep
82
complicated bereavement is chronic and unremitting distress (T/F)
T
83
sxs within 3 months of an identifiable stressor with marked distress in excess of what would be expected from experiencing the stressor
adjustment disorder
84
dysthymic disorder requires ________ of sxs
2 years
85
best studied drug to tx OCD
clomipramine (TCA)
| also evidence for SSRIs but need higher doses than for depression
86
nausea, vomiting, bradycardia, seizures might be due to ________
anticholinesterase toxicity
87
sxs when you drink while taking disulfiram
flushing, sweating, dyspnea, hyperventilation, tachycardia, hypotension, nausea, vomiting
88
lithium interacts with these pain meds so that lithium levels are increased --> abdominal pain, diarrhea, drowsiness
ibuprofen, indomethacin, ketoprofen, diclofenac, phenylbutazone, naproxen, piroxicam
-acetaminophen, aspirin, opiates do not interact
89
mirtazapine (remeron) MOA
| what is a benefit?
increases both adrenergic and serotonergic neurotransmission
| it's nice because it doesn't cause appreciable sexual dysfunction
90
medically ill patients with depressive disorders may respond to psychostimulants (T/F)
T
| ex. methylphenidate
91
huffing, sniffing, etc intoxication sxs
visula disturbances, dyscoordination, depressed reflexes, euphoria, nystagmus
92
conjunctival injection, increased appetite
marijuana use
93
diminished response to pain, euphoria, staring into space
PCP intoxication
94
hair loss is assoc with this mood stabilizer
| also nausea, vomiting, indigestion, sedation, mildly elevated serum transaminase levels, hepatic failure
depakote
95
SSRIs cause what kind of sexual dysfunction
decreased libido, delayed orgasm
96
retrograde ejaculation can be caused by ______
antipsychotics
97
ADHD sxs need to have started before age _____
7
98
if your first stimulant doesn't work for ADHD tx, what do you do?
try another stimulant
99
la belle indifference is classically seen with ____
conversion disorder
| -indifference shown toward a deficit or loss of function
100
in a pregnant schizophrenic in labor, which APD would you give?
a high potency APD like haldol because the lower potency APDs have more alpha blocking properties and my lower BP significantly
101
conjunctival injection, mild sedation, dose dependent hypothermia, dry mouth, increased appetite, tachycardia, euphoria, sense of slowed time
cannabis intoxication
102
miosis, bradycardia, hypotension, hypothermia, constipation, euphoria
opiate intoxication
103
unpredictable behavior, assaultiveness, belligerence, agitation, nystagmus, tachycardia, numbed response to pain, muscle rigidity, hyperacusis, hpertension, echolalia, anticholinergic effects
PCP intoxication
104
confusion, muscle twitching, weakness, abdominal cramps, depression, palps, coma, respiratory failure
nicotine intoxication
105
tachycardia, pupils dilated, constriction of coronary arteries, euphoria
cocaine intoxication
106
mania in bipolar disorder can often present with psychotic symptoms (T/F)
T
107
cocaine can produce both _____ and _____
mania and psychosis
108
metabolic disturbances in bulimia patients
hypokalemic-hypochloremic alkalosis (due to vomiting)
| elevated Na
109
best therapy for bulimia
CBT
110
_______ is more commonly seen in children with mDD compared to adolescents with MDD
psychomotor agitation
| -appears anxious and irritable > sad and depressed
111
most common suicide method in children
substance ingestion
112
common side effects of DDAVP (2)
headache and nausea
113
the approximate comorbidity of childhood anxiety disorders and MDD is ______ percent
50%
114
side effects of fluoxetine (4)
GI (nausea, loose stools)
insomnia
agitation
headaches
115
Rett disorder is only seen in ______ and demonstrates _______% concordance in identical twins
girls
| 100%
116
odd repetitive movements with hands, head circumference normal until 12 months and then halts in growth
Rett disorder
117
adjustment disorder does not last longer than ______
6 months
118
first line tx for tourette disorder
clonidine
| -others include TCA, high potency APD, atypical APD
119
what disorder is commonly associated with tourette?
OCD
120
what do you need to dx tourette?
multiple motor tics AND at least one vocal tic at sometime during the illness
onset before age 18
121
first line tx for ADHD and its side effects
stimulants
| -increased risk of developing tics
122
how to dx reading disorder
achievement in reading is substantially lower than IQ
123
_____ % of children with learning disorders have a comorbid psych disorder
50%
124
pharmacologic tx of enuresis
DDAVP
125
side effects of stimulants
insomnia, decreased appetite, weight loss, dysphoria, irritability
126
non-stimulant med for ADHD
atomoxetine- NE reuptake inhibitor
127
metabolic issues with anorexia patients
hypercholesterolemia
mild normocytic normochromic anemia
leukopenia
128
early onset schizophrenia (before age 10) is associated with a (better/worse) outcome
worse
129
ADHD vs. mania... who has the lower self esteem
ADHD
130
children understand the irreversibility of death around age _____
7-8
131
biggest averse effect of clonidine upon initiation of tx
sedation
132
the process of adopting other people's characteristics
| -ex: girl who just came from the doctor's wants to "play doctor" with her friend
identification
133
defense mechanism: emotions are shifted from one idea or object to another that resembles the original but evokes less stress
"student who is angry at mother talks back to teacher instead"
displacement
134
defense mechanism: a person's character or sense of identity is temporarily but drastically modified in order to avoid emotional distress
dissociation
135
defense mechanism: unacceptable impulse is transformed into its opposite
"man who is in love with his married coworker insults her"
reaction formation
136
child abuse most likely results in which psych condition in the grown up child
MDD
137
what kind of therapy for OCD?
CBT
138
range for mental retardation
normal: 90-110
mild: 55-70
moderate: 40-54
severe: 25-39
139
goal of which age group: establish a secure sense of trust that occurs in the relationship with one's responsive caregiver
infancy
140
goal of which age group: identification with superheroes
preschool (oedipal phase)
141
goal of which age group: increasing understanding that they are a separate being from their caregiver and they practice separating and reuniting with their caregiver
toddlers
142
goal of which age group: ability to think logically and concretely (can identify that equal amounts of liquid in two differently shaped containers hold the same amount)
school age (concrete operations)
143
goal of which age group: ability to think abstract fashion
adolescence (formal operations)
144
prevalence of schizophrenia in general population
1%
145
nihilistic delusion that they have lost blood, heart, intestines, as well as that the world beyond them has been reduced to nothingness
Cotard syndrome
146
delusion that familiar people assume the guise of strangers
Fregoli delusion
147
delusional disorder is characterized by the presence of _______ delusions
nonbizzare (potentially feasible)
148
durations of brief psychotic disorder, schizophreniform disorder, and schizophrenia
brief psychotic disorder: 1 day-1 month
schizophreniform: 1 month-6 months
schizophrenia: > 6 months
149
good prognosis for schizophrenia
```
good premorbid functioning
later age at presentation
female gender
acute and rapid onset of sxs
presence of mood symptoms
```
150
best acute tx for catatonia
benzos or ECT
151
contraindications to ECT
space occupying lesion (ex. large meningioma)
| MI in the last 3 months
152
most consistent sleep disturbance of depression
early morning awakenings
153
episodic hypomania and subclinical depression
cyclothymia
154
only _______ is necessary to diagnose bipolar I
manic episode
155
major depressive episodes and hypomanic episodes
bipolar II
156
double depression
major depressive episode superimposed on dysthymic episode
157
DTs, if untreated, have a mortality of ____
30%
158
docility, lack of fear response, anterograde amnesia, hyperphasia, hypersexuality
kluver bucy syndrome
159
Onset of mood and behavioral changes following an acute stressor. Does not last more than 6 months
Adjustment disorder
160
Patient exposed to traumatic event and has flashbacks, numbing, and increased arousal for up to 1 month after the event
Acute stress disorder
161
Pregnant heroin addict. What do you give her?
Methadone is safe
162
Episodic mood symptoms and chronic psychotic symptoms outside of the mood symptoms
Schizoaffective disorder
163
Emotional lability, dysarthria, impulsivity after years of repeated head trauma
Punch drunk syndrome (dementia pugilistica)
164
Subcortical arteriosclerotic encephalopathy
| Multiple small infarcts in the white matter with sparing of the cortical regions
Binswanger disease
165
What's a good indicator of dependence > abuse?
Inability to quit despite desire to quit or knowledge of its negative aspects
166
Defense mechanism: unconscious incorporation of someone else's traits into ones own manner (adolescents have similar hairstyles to admired rock stars)
Identification
167
Best treatment for borderline patients
DBT (individual psychotherapy)
168
Number of ECT sessions you need for:
Depression
Catatonic conditions
Psychosis and mania
6-12
2-4
> 20
169
Drug for OCD
SSRIs
170
What to give to delirious old people
Haldol
171
Standard antidepressant response rate
70%
| 30% get better without any treatment
172
Duration of major depressive episode
With treatment
Without treatment
3 months
| 6-13 months
173
what to give for acetaminophen overdose
acetylcysteine
174
what to give in iron overdose
deferoxamine
175
best meds for PTSD
SSRIs
| -can use APD as an adjunct
176
best psychotherapy for panic disorder
CBT
177
infarctions of the left frontal hemispheres present with _____
depression
178
infarctions of the right frontal hemisphere present with ______
euphoria, inappropriate indifference, mania
179
____% of the cases of impotence in ppl age 30-50 have a psychological cause
90
180
low _____ (neurotransmitter) in pts with suicide, impulsivity, and violence/aggression
serotonin metabolite (5-HIAA)
181
short term memory deficits, unstable smooth pursuit eye movements, decreased ability to habituate to repeated sensory stimuli, difficulty conceptualizing complex visual compositions can all be seen in pts with ______
schizophrenia
182
which antidepressants have a higher propensity to induce mania?
TCA > SSRI
183
memory loss surrounding a discrete period of time
localized amnesia
184
forgetting entire preceding life
generalized amnesia
185
forget all events following a trauma, except for the immediate past
continuous amnesia
186
inability to recall certain aspects of the an event, though other memories of the event may be intact
selective amnesia
187
circuitous, over-inclusive answer that only eventually gets to the point
circumstantiality
188
a response composed of a series of disconnected ideas
loosening of associations
189
when the patient strays off the point entirely, never returning to the original intention of the answer
tangentiality
190
sense that one's surroundings are strange or unreal
derealization
191
feeling that one's identity is lost or the feeling of being unreal or strange
depersonalization
192
mental activity not in accordance with reality
dereism
193
abnormal recall of details
hypermnesia
194
uncontrollable or excessive talking sometimes seen in manic episodes
logorrhea
195
abrupt interruption of a idea and then, after a period of time (a few seconds), beginning a new topic
derailment
196
rapid and frequent changes in ideas or topics, but the connections may still be recognizable
flight of ideas
197
persistence of a visual image after the stimulus has been removed
palinopsia
198
neuroanatomical areas affected in OCD
caudate nucleus, frontal lobes, cingulum
199
response to antidepressants... order the sxs
sleep, energy, appetite changes --> libido --> hopelessness/helplessness --> suicidal ideation
200
taijin-kyofusho
belief that one's body is offensive to others
201
zar
delusional belief of possession by a spirit
202
which area of the brain is hyperactive in anxiety states?
locus ceruleus (location of NE neurons)
203
why must you wait at least 14 days after discontinuing an MAOI before starting a serotonergic agent
to avoid serotonin syndrome
204
euphoria, interpersonal sensitivity, anxiety, tension, or anger, impaired judgment, impaired social and occupational functioning
- tachycardia or bradycardia, pupillary dilation, insomnia, blood pressure changes, sweating or chills, nausea or vomiting
- chronic use- dry skin, acne-like lesions, chronic nose bleeds
- often in airline pilots
amphetamine intoxication
205
fatigue, vivid dreams, sleep disturbances, increased appetite, and psychomotor retardation or agitation
- withdrawal from what?
- often in airline pilots
amphetamines
206
headache, sleepiness, irritability, concentration problems, vomiting, muscle aches/stiffness
-withdrawal from what?
caffeine
207
cocaine intoxication is similar to _______ intoxication
- at higher doses, seizures, chest pain, hyperpyrexia, death
- paranoia
amphetamine
208
dysphoric mood, hypersomnia, increased appetite, fatigue = _______ withdrawal
cocaine
209
blockade of _______ is thought to improve cognitive and affective symptoms in schizophrenia and other psychotic disorders
5-HT2A
210
blockade at the ____ receptor is responsible for the dizziness, sedation, and orthostatic hypotension associated with many of the atypical antipsychotics
alpha-1
211
blockade of the _____ in the mesolimbic and mesocortical areas of the brain are responsible for reducing the positive psychotic symptoms in schizophrenia
D2
212
blockade of the ____ is believed to contribute to sedation and cause weight gain
H1 receptor
213
blockade of the ____ cause sedation, dry mouth, and constipation
muscarinic 1 receptor
214
self fulfilling prophecy- a patient views the world as full of unloving people, then acts to push her therapist to the breaking point where he terminates her care, therefore confirming her belief that the world is full of unloving people
projective identification
215
denial, splitting, displacement, projection, projective identification
immature defenses
216
rationalization, reactive formation
neurotic defenses
217
altruism, humor
mature defenses
218
phenelzine MOA
MAO-A and MAO-B blocker
219
selegiline MOA
MAO-B inhibitor at low doses for Parkinson's
| nonselective MAO inhibitor at high doses for depression
220
what does MAOI overdose look like?
hyperpyrexia and autonomic excitability sufficient to cause rhabdo
221
what to do for MAOI overdose
supportive care
if delirium develops, give lorazepam
if ventricular arrhythmias develop, tx with lidocaine
222
cyproheptadine
5-HT2A antagonist sometimes used in most severe cases of serotonin syndrome
223
depression with weight gain, hypersomnia, and mood reactivity... what is it and what to tx with?
atypical features
| tx with MAOIs
224
when to use clozapine
tx of patients with schizophrenia who have failed 2 or more APD trials
225
how to tx depression with psychotic features
combo of antidepressant and antipsychotic
OR
ECT
226
how to address akathisia in pts on antipsychotics
lower the APD dose as much as possible
add beta blocker like propranolol
if still not controlled, add lorazepam
227
first line tx for bipolar depression
lithium, lamictal, quetiapine
| -second line: depakote
228
most common dangerous complication of NMS
rhabdomyolysis
229
potential side effect of long term thioridazine use
retinal pigmentation
230
most potent benzo
clonazepam > alprazolam > diazepam > oxazepam > chlordiazepoxide
231
what to check before starting:
- Li
- antipsychotics
- depakote (valproic acid)
- Li: electrolytes, Cr, BUN, thyroid
- antipsychotics: fasting glucose, lipids
- depakote: LFTs
232
in some ppl, NSAIDs can _________ Li levels
increase
233
most common side effects of methylphenidate (2)
difficulty falling asleep
| decreased appetite
234
stimulants may exacerbate ________ (movement abnormality)
tics
235
tx for Tourette's
haloperidol... clonidine (alpha 2 agonist ) for mild cases
236
if someone on long term haldol presents with tardive dyskinesias, you might offer them this
clozapine
237
borderline personality disorder... what medication do you give?
if depressed, give SSRI
| if not depressed, give mood stabilizer or second generation antipsychotics
238
risk of SSRI during pregnancy
persistent pulmonary HTN of the newborn
239
risk of Li during pregnancy
Epstein anomaly of the heart
240
risk of depakote during pregnancy
neural tube defects, developmental delay
241
pharmacologic tx of bulimia
SSRI and topamax
242
interaction between lamictal and depkaote and OCPs
OCPs decrease lamictal levels
| depakote increases lamictal levels
243
trazodone... what is it?
antidepressant which affects serotonin system by weak reuptake inhibition and antagonist activity at various serotonin receptors
-extremely sedating so good for sleep
244
important sexual side effect of trazodone
priapism
245
most common EKG findings when taking Li
T wave inversion/depression
246
thiazide diuretics can _____ Li levels
increase
| -other things: spironolactone, triamterene, NSAIDs (except aspirin and sulindac), metronidazole and tetracycline
247
pharm tx for OCD
SSRIs and clomipramine (TCA)
248
how to tx refractory OCD
- augment SSRI with second gen APD for pts with moderate response to SSRI
- for pts with no response, consider switching to different SSRI or to clomipramine
- psychotherapy for all cases
249
what to give for refractive schizophrenia
clozapine
250
orthostatic hypotension when on an antidepressant
imipramine (TCA) > nortriptyline (TCA)
| not bupropion, fluoxetine, or mirtazapine
251
first line tx for mania
depakote or Li w or w/o concurrent antipsychotic
252
mirtazapine side effect profile
increased appetite, weight gain, sedation
253
bupropion side effect profile
insomnia, weight loss
254
common cardiac issue with TCAs
slowing of cardiac conduction
255
of the common antipsychotics, ______ is least likely to cause orthostatic hypotension
haldol
| -good for old people so they don't fall down
256
_______ is good for treating nightmares in PTSD
prazosin
| alpha-1 blocker, traditionally used to treat HTN and BPH
257
be careful using benzos and second gen APDs in elderly pts
yep
258
what to give someone just coming into the ED with AMS (3 things)
glucose, thiamine, naloxone
| -don't give flumazenil b/c it may acutely lower the seizure threshold
259
one of the most effective medications for opioid detox
buprenorphine
260
best tx for depression and for neuropathic and fibromyalgia pain
duloxetine (SNRI) > TCA due to risk of overdose with TCA
261
this APD really really causes weight gain
olanzapine
262
side effect profile of risperidone
orthostatic hypotension
may cause weight gain
no appreciable anticholinergic
263
agranulocytosis is a side effect of this APD
clozapine
264
atypical (2nd gen) APDs usually do not cause tardive dyskinesia
which one completely obeys this rule and which one is the top culprit for going against this rule?
clozapine truly obeys this rule
| risperidone is the leading culprit in causing EPS at high doses
265
first line pharm treatment for bulimia nervosa
SSRI
| can also do topamax
266
most common side effect of TMS for depression
headache
267
this first gen APD and citalopram when used together can prolong QTc
pimozide
268
this second gen APD is most likely to cause hyperglycemia and lead to development of diabetes
clozapine
269
some SSRIs in kids may increase the risk of suicidal thoughts (T/F)
T
270
this bipolar drug increases risk of pancreatitis
depakote
271
this APD can cause agranulocytosis
clozapine
272
sialorrhea (drooling) can occur with this APD. how to tx it?
clozapine
| -behavioral measures and clonidine
273
how to tx persistent sinus tachy in patients being treated with clozapine
propranolol
274
least likely APDs to cause metabolic syndrome
aripiprazole and ziprasidone --> risperidone and quetiapine --> clozapine and olanzapine
275
good drug for middle insomnia (falling asleep but frequently awakening during the night)
zaleplon
276
contraindications for ECT
```
recent MI (past 6 months)
significant intracranial space occupying lesion
```
277
IV haloperidol can lengthen QTc (T/F)
T
278
most dangerous side effect of lamictal
stevens johnson syndrome
279
dangerous but rare side effect of carbamazepine
aplastic anemia
280
spasm of the neck and back that causes the patient to arch forward
opisthotonos (arc de cercle)
281
spasm of the extra ocular muscles, often resulting in the patient looking up and unable to look down
oculogyric crisis
282
leaning posture induced by the spasm of the torso muscles
pleurothotonos (Pisa syndrome)
283
spasm of the neck muscles that usually brings the neck to one side or another but may also pull forward or backward
torticollis
284
2 antidepressants that don't have sexual dysfunction
bupropion, mirtazapine
285
bupropion is good for anxiety (T/F)
F
| bupropion is likely to worsen anxiety
286
insatiable sexual desire in a woman
nymphomania
287
insatiable sexual desire in a man
satyriasis
288
parapraxis
freudian slip
289
this mood stabilizer can cause kidney stones
topamax
290
which APDs cause high prolactin
first gen APDs and risperidone
291
obstructive jaundice is a side effect of this APD
chlorpromazine
292
orthostatic hypotension is especially troublesome in these two APDs
chlorpromazine and clozapine
293
ability of the ego to cope with competing conflicts between id, ego, and superego which help one manage stress and maintain stability
ego strength
294
goal of supportive therapy
strengthening of current defense mechanisms
295
goal of cognitive therapy
correction of faulty ideas
296
goals of existential psychotherapy
exploring the feeling of meaninglessness in life and investigating the freedom of individuals
297
goal of psychodynamic psychotherapy
personal change
| defenses are examined gradually in order to achieve a more optimal level of functioning
298
group members are see as the audience and the cast in reenactments of scenarios and conflict
psychodrama
299
when a patient relives an emotional or traumatic experience to get rid of or purge negative emotions and move forward
abreaction
300
major focus of interpersonal psychotherapy
communication analysis
| you can do this via role playing
301
major tool of psychoanalysis is the careful interpretations of the transference neurosis (t/f)
T
302
Erikson stages
```
trust vs mistrust- birth to 1 year
autonomy vs. shame/doubt- ages 1-3
initiative vs. guilt- ages 3-5
identity vs. role confusion- ages 11-19
intimatcy vs. isolation- ages 20-40
```
303
in brief psychodyanmic therapy, a single focal area of conflict is identified and during the therapy the time is spent actively interpreting transferences as they pertain to this identified focal conflict
yep
304
which type of therapy is not good for schizophrenics
psychoanalysis because they have difficulty with reality testing
305
dreams are used to uncover ________
psychic conflicts
306
which personality disorder could benefit from both individual and group psychotherapy
borderline personality patients
307
patients who are suicidal have severe hopelessness and think about events in rigid, black and white ways (T/F)
T
308
expression of emotion elicits emotional response in other members of the group
contagion
309
when the group recreates a family of origin or the original dynamics of a conflict which yeps a patient work through their original conflict
corrective experience
310
presenting an aversive stimulus after a behavior in order to decrease that behavior
punishment
311
an aversive stimulus is removed in order to increase a desired behavior
negative reinforcement
312
this antidepressant does not cause sexual dysfunction but can cause hepatitis and liver failure
nefazodone (serotonergic)
| -requires regular LFT monitoring
313
this antidepressant can cause high blood pressure
venlafaxine (inhibits reuptake of serotonin and norepinephrine)
314
which antidepressant is likely to cause a withdrawal syndrome (flu-like sxs)
paroxetine b/c of its short half life
315
this antidepressant has fewer withdrawal sxs due to its long half life and so may be used for pts with poor compliance and sometimes miss doses
fluoxetine
316
which second gen APDs cause weight gain?
| which ones are weight neutral?
weight gain: clozapine, olanzapine, quetiapine, risperidone
| weight neutral: ziprasidone, aripiprazole
317
what is tranylcypromine
MAOI
318
for dysthymic disorder, how long should you try a medication before deciding that it's a failure?
8 weeks
319
nihilistic delusion that one is dead or that the body or organs are dying
Cotard syndrome
320
when the husband of a pregnant woman has similar sxs of pregnancy and/or labor
Couvade syndrome
321
the intense sxs of depression in bereavement do not usually last longer than 6 months (T/F)
F
| it's 2 months
322
making an obscene gesture in Tourette's
copropraxia
323
bruxism
grinding of teeth
324
complex motor tic where movements of another are repeated
| classic sxs of catatonia
echopraxia
325
repetition of words but is the repetition of one's own words as if the person "gets stuck" on the same word or phrase
palilalia
326
slip of the tongue
parapraxis
327
approx answers, talking past the point, amnesia, disorientation, fugue, conversion sxs
Ganser syndrome
| common in prisoners
328
culture-specific hysterical reaction in Inuit, especially women, who may perform irrational or dangerous acts, followed by amnesia for the event
piblokto
329
displacement is a _____ defense
neurotic
330
projection is a _____ defense
primitive
331
reaction formation is a ______ defense
neurotic
332
which movement disorder is assoc with Wilson's disease
hemiballismus
333
dementia drugs
donepezil, galantamine, rivastigmine
| these are all AChE inhibitors
334
risk factors for completed suicide
```
age > 45
male
separated/divorced > married
white race > black race
Jews/Protestants > Catholics
```
335
Wechsler Adult Intelligence Scale- Revised (WAIS-R) is for ages _____ and up
16
336
patients with one major depressive episode have a ____% chance of recurrence
50%
337
zaleplon is relatively contraindicated in those with severe ______ dysfunction
liver
338
______ is the only med indicated for tx of childhood depression
fluoxetine
339
side effects of St. John's wort
increased photosensitivity, stomach upset, rashes, fatigue, restlessness, HA, dry mouth, dizziness, confusion
-SSRI doses should be decreased while pts are taking this supplement
340
first line for bipolar depression
lamictal
341
neutropenia is a potential complication of this mood stabilizer
carbamazepine
342
10 year recovery rate for anorexia nervosa
25%
343
timeline of Rett vs. childhood disintegrative disorder
Rett- girls ages 5 months and 4 years
| childhood disintegrative disorder- normal development for at least the first 2 years
344
how to tx secondary nocturnal enuresis
behavioral therapy and then imipramine (TCA)
345
microcephaly, short palpebral fissures, flat midface, thin upper lip
fetal alcohol syndrome
346
disturbed and inappropriate social relatedness assoc with pathological care
reactive attachment disorder
347
melancholic features of MDD
anhedonia, depression worse in the morning, terminal insomnia, marked psychomotor abnormalities, significant weight loss, inappropriate guilt
348
belief that one's thoughts can control outside events
magical thinking
349
general classes of drugs to tx a manic episode
mood stabilizers and 2nd gen APDs
350
return of sxs that are brief and transient and is frequently assoc with the abrupt discontinuation of benzos
rebound
351
how to test attention in person with low education level
random letter test
352
while ________ is a first line tx for bipolar disorder, those individuals with greater than 3 manic or depressive episodes per year (rapid cycling) respond better to ____ or ______
Li
| depakote, carbamazepine
353
how to tx pregnant woman with bipolar
can use haldol
354
global rigidity, AMS, fever, CV instability, elevated CPK, risk of rhabdo
NMS
355
drugs for PTSD
- SSRIs are first line
| - prazosin (alpha 1 blocker) can help with reexperiencing, hyperarousal, avoidance
356
Erikson's 8 stages
```
trust vs. mistrust (birth to 1 year)
autonomy vs. shame and doubt (1-3 yrs)
initiative vs. guilt (3-5 yrs)
industry vs. inferiority (6-11 yrs)
identity vs. role diffusion (11 years to end of adolescence)
intimacy vs. isolation (21-40 yrs)
generativity vs. stagnation (40-65 yrs)
integrity vs. despair (>65 yrs)
```
357
personality traits assoc with partial complex seizures
hyperreligious thinking, preoccupation w/ moral behavior, altered sexual behaviors, hypergraphia or over elaborative communication styles (viscosity), heightened experience of emotions
358
tremor, diaphoresis, rigidity, myoclonus, autonomic dysregulation, hyperthermia, rhabdo, renal failure, coma
serotonin syndrome
359
when stopping fluoxetine, you must wait ______ for washout before starting an MAOI
5 weeks (five half lives)
360
foods with tyramine
liver, beer, red wine, aged cheeses, smoked fish, dry sausage, fava beans
361
doses of thioridazine should not > 800 or you risk this complication
pigmentary retinopathy
362
avoid this SSRI in dementia as it has anticholinergic effects and induce delerium
paroxetine
363
dysarthria, ataxia, coarse tremor, abdominal pain --> seizures, neuromuscular irritability, impaired consciousness
Li toxicity
364
for ECT to be effective, the seizure should last at least ______ seconds
25
365
withdrawal from _____ can cause depression and SI in severe cases
cocaine
366
this mood stabilizer may cause hypothyroidism
Li
367
a posttraumatic dementia that develops after blunt head trauma
dementia pugilistica
368
what is wellbutrin MOA
DA and NE reuptake inhibitor
369
acute stress disorder lasts for a max of ______ weeks
4
370
most common side effect of olanzapine
sedation
371
this disorder is most commonly associated with ADHD
oppositional defiant disorder (ODD) and conduct disorder
372
irresistible attacks of refreshing sleep that occur during the day over at least 3 months
narcolepsy
373
stranger anxiety usually occurs at ______ months
8
374
separation anxiety usually occurs between _____ and _____ months
10 and 18
375
nausea, sedation, weight gain, hair loss, transaminitis = side effects of which mood stabilizer
depakote
376
diarrhea, severe tremor, polyuria, ataxia, confusion, seizures, gastric distress, weight gain, tremor, fatigue, cognitive deficits; kidney, herat, thyroid = side effects of which mood stabilizer
lithium
377
CT finding in pts with schizophrenia
increased ventricle-to-brain ratio due to loss of brain weight
378
ex: fear of/belief in infestation is an example of what?
delusional disorder
| -hallucinations, if present, are not a primary feature and are congruent with the delusion
379
which mood stabilizer causes hypothyroidism
lithium
380
worsening of depression in the morning with some improvement in mood in the evening is typically seen in MDD with _________
melancholic features
381
maintenance of rigid posture or resistance to commands and instructions
negativism
382
best med to tx psychosis in a Parkinson's disease patient
clozapine because it has the least D2 activity/activity in the basal ganglia/smallest likelihood of causing EPS
383
pergolide
DA agonist used in PD as adjuvant therapy
384
NAC is used in ________ overdose
acetaminophen
385
if there is tolerance or withdrawal, you suspect ____________
dependence > abuse
386
good tx for agoraphobia, specific phobia, and OCD
gradual exposure
387
cocaine blocks ______ reuptake, which leads to psychosis
DA
388
PCP MOA
NMDA receptor inhibitor, which affects glutamate
389
multiple distinct personalities that assume control of the patient's awareness of the environment and behavior
dissociative identity disorder
390
nonbizarre delusions for at least 1 month
delusional disorder
391
sudden onset of a florid psychotic episode immediately after a marked psychosocial stressor in the absence of increasing psychopathology before the stressor
brief psychotic disorder
392
boys with mental retardation and autism; dysmorphic features (long face and enlarged ears)
fragile X- trinucleotide repeats
393
seeking out situations or objects that are or were feared
counterphobic behavior
394
zyprexa (olanzapine) can lead to severe weight gain
yep
395
dizziness, ataxia, sedation, dysarthria, nausea, hyponatremia, cardiovascular conduction problems, rarely aplastic anemia and agranulocytosis
carbamazepine side effects
396
nausea, vomiting, diarrhea, sedation, dizziness, tremor, alopecia, weight gain
depakote side effects
397
schizophrenia age of onset in men vs. women
men: 15-25
women: 25-35
398
```
panic disorder is associated with which:
diabetes
hypoglycemia
MVP
obesity
alcohol dependence
```
alcohol and other substance dependence
399
necrosis of the globes pallidus is assoc with ______
CO poisoning
400
the most common compulsion in OCD is _______
excessive or ritualized hand washing/showering/bathing/toothbrushing/grooming
401
there are no absolute contraindications to receiving ECT (T/F)
T
402
delusion that a famous person or superior is intensely in love with the patient
erotomanic delusion
403
patient is on haldol and develops tardive dyskinesia... what do you do?
switch to an atypical
404
h/o alcohol dependence, visual disturbances, AMS, papilledema, abdominal pain
what is this and how do you tx?
methanol poisoning; methanol --> formaldehyde --> formic acid (this is the problem)
tx with fomepizole (inhibitor of alcohol dehydrogenase)
405
psychotic sxs in patients with advanced PD may be caused by _______
sinemet
406
PD patients often develop this mood disorder
depression
