Med-Pscyh Flashcards
(208 cards)
1
Q
What is the CAM score and describe its criteria
A
CAM score = Diagnosis Delirium and differentiates it from Dementia/Depression
AIDA: Requires A and I, but only either D vs. A
Acute onset and fluctuating
Inattention (spell “world” backwards & forward)
Disorganized thinking (rambling/illogical)
Altered level of consciousness (intermittently not alert?)
2
Q
S/S of Alcohol Withdrawal -10
these sx PEAK during 2nd day of abstinence and resolve by day 5
A
PAST NITE
Psychomotor agitation
Anxiety
Seizures
Tremor & DELIRIUM TREMENS
NV
Insomnia & Irritability
Transient Hallcuinations
Excitable autonomics (⬆︎HR, BP)
3
Q
Describe Delirium Tremens-5 ; when does DT onset?
A
Further progression of Excitable autnomics =
- ⬆︎ HR
- ⬆︎ BP
- Fever
- Hallucinations
- Tremulousness –> Death
Onsets 2 days post last EtOH (when withdrawal sx peak)
4
Q
lab w/u for suspected substance abuse-5
A
- Serum Drug Screen
- Serum AAA (APAP/ASA/Alcohol)
- Urine Drug Screen
- UA
- ABG
5
Q
Name 5 major Risk Factors of Altered Mental Status
A
- Dementia
- Age
- Substance Abuse
- Physical issues (Sleep loss/Immobility/Dehydration/Pain)
- ICU
6
Q
Main cause of Delirium in Hospitalized Elderly
A
MULTIFACTORIAL
(Urinary Catheters/Restraints/Poor Sleep/Constipation/Malnutrition)
7
Q
What are Non-Rx ways to ⬇︎Agitation in Delirius pts -5
A
- DC Delirum-causing meds (Benzo, Benadryl)
- No restraints
- Normalize Sleep
- Reorientation (Write Date on message board)
- Correct Derangements (dehydration, metabolic)
8
Q
Developmental Milestones for a 1 Year Old
Gross Motor - 3
Fine Motor
Language
Social & Cognition - 2
A
9
Q
Developmental Milestones for a 18 Month Old
Gross Motor - 2
Fine Motor - 2
Language - 2
Social & Cognition - 2
A
10
Q
Developmental Milestones for a 2 Year Old
Gross Motor - 2
Fine Motor - 2
Language - 2
Social & Cognition - 3
A
11
Q
Developmental Milestones for a 3 Year Old
Gross Motor - 2
Fine Motor - 2
Language - 2
Social & Cognition - 2
A
12
Q
Developmental Milestones for a 4 Year Old
Gross Motor - 1
Fine Motor - 1
Language - 2
Social & Cognition - 1
A
Get Audiologic testing in kids with Language Delay!
13
Q
Developmental Milestones for a 5 Year Old
Gross Motor - 2
Fine Motor - 4
Language - 2
Social & Cognition - 2
A
Get Audiologic testing in Kids with Language Delay!
14
Q
Autism usually presents by age ____
What is the CP?-3
EAAARRRLY intervention for Autism is the KEY!
A
Presents by age 2
- Social Communication deficit (limited language/eye contact, plays alone,poor pickup of social cues)
- Repetitive Behavior (rocking, hand flipping)
- Fixated Interest (insist on same routines, 1-sided convos on fixated topics)
- Autism is +/- language or intellectual impairment*
- Also, consider Fragile X syndrome testing*
15
Q
How do Older Adults typically present with Depression?
A
With c/o somatic complaints (i.e. sleeping problems) instead of mood changes
16
Q
For Bipolar Mania dx, you need at least [__ sx +/- ___] that last for ___ duration. What are the sx? (7)
A
[3 sx +/- major depression]; 1 week duration;
BIPOLAR
Buying excessively (⬆︎ in pleasurable activity)
Inflated self-esteem
Psychomotor agitation (pacing)
wide awOke - won’t sleep
Lots of talking
ADD like distractability
Racing thoughts
17
Q
Tx for Delirium in Elderly - 3
A
Haloperidol vs Risperidone vs Quetiapine
Note: Do NOT use Haloperidol in DLB (Dementia with Lewy Bodies)
18
Q
What is the diagnositic criteria for Major Depression DO? - 3
A
- At least 5 out of 9 of SIG E CAPS for
- ≥2 weeks
- At least 1 must be Sadness or Interest loss anhedonia
19
Q
The diagnositic criteria for Major Depression DO assess for 9 major sx
What are they?
A
SIG E CAPS
Sadness most of day/everyday
Interest loss anhedonia most of day/everyday
Guilt & worthlessness
Energy deprived & fatigued
Concentration loss
Appetite ⬇︎
Psychomotor agitation/retardation observable by others
Sleep ∆ (insomnia vs Hypersomnia)
Suicidal ideation (thinking about it but haven’t acted yet)
20
Q
What is CAGE and how is it interpreted?
A
CAGE = Determines EtOH abuse; ≥ 2 positive answers = EtOH abuse/dependence and 1 positive answer warrants further eval
- ever tried to Cut back on drinking?
- Angry when someone criticizes ur drinking?
- Guilty about how much you drink?
- need an Eye opener in morning to prevent withdrawal/calm nerves?
21
Q
Clinical criteria for diagnosing PMS (PreMenstrualSyndrome)
A
At least 5 sx TOTAL (from Group A and B) beginning 1 week before menses but resolving during follicular phase of menses
If sx occur irregularly or throughout menses = mood or personality DO
22
Q
Clinical criteria for diagnosing PMS (PreMenstrualSyndrome) relies on sx from Group A and Group B
Describe sx for Group A - 6
A
At least 5 sx (from Group A and B) began 1 week before menses, improve during menses and resolve during week after menses
A: (at least one)
- Mood lability
- irritability
- depression
- hopelessness
- anxiety
- ⬇︎libido
23
Q
Clinical criteria for diagnosing PMS (PreMenstrualSyndrome) relies on sx from Group A and Group B
Describe Group B sx - 6
A
At least 5 sx (from Group A and B) began 1 week before menses, improve during menses and resolve during week after menses
B: (at least one)
- Food cravings
- sleep change
- feeling “out of control”
- ⬇︎energy
- Anhedonia
- Physical sx (constipation/diarrhea/breast TTP/HA)
24
Q
Tx for Premenstrual syndrome - 4
A
- Menstrual Diary (determines relationship of sx to menses)
- Exercise
- Stress Reduction
- SSRIs **if severe**
25
Why should Haloperidol be **CAUTIOUSLY** given to Alcoholics
**Haloperidol ⬇︎Seizure threshold** and alcoholics going thru withdrawal may already be at risk for seizures!
26
Describe the clinical features of OCD - 2
1. Obsessions (w/symmetry, contamination, taboo urges like killing, fear of arm)
2. Compulsions (rituals-that may be used to help combat obsessions)
## Footnote
*tx = high dose SSRIs + exposure CBT*
27
OCD tx - 2
[High Dose SSRIs] + [exposure CBT]
28
Indication for Deep Brain stimulation ; what part of the brain is targeted
[SEVERE, tx-refractory OCD]; nucleus accumbens
29
Ebstein's anomaly etx
Maternal **lithium** use during [1st trimester pregnancy] --\> malformation and displacement of tricuspid valve into R Vt --\> Tricuspid Regurgitation --\> R Atrial Enlargement and R Axis deviation --\> **HEART FAILURE**
30
What kinds of teratogenic effects are you concerned about if Lithium is taken during **2nd** and **3rd** trimester pregnancy? -2
1. Goiter formation
2. Transient Neonatal Neuromuscular dysfunction
## Footnote
*Ebsteins anomaly is concern for 1st trimester only*
31
Diagnostic criteria for Nightmare Disorder - 3
1. Recurrent episodes of waking from sleep with ability to re**M**ember dream
2. Child is fully alert on awakening
3. Child can be consoled
## Footnote
*Night**M**ares occur during RE**M** and is developmentally normal for kids*
32
What is the difference between Sleep Terrors and Nightmare Disorder? - 4
Sleep terrors are :
1. NON-REM disorder
2. with incomplete awakenings
3. and can NOT be consoled
4. and pt **S**eems to forget the dream
33
What is REM sleep behavior disorder?
Complex motor behaviors or vocalization **during REM**
34
Diagnostic criteria for Schizoaffective Disorder - 4
*SchizoAffective is weird so*
***D****o **N**ot **M**iss **D**iagnosis!*
1. **D**epressive or Manic "moody" episodes **concurrent with schizophrenia criteria A sx**
2. **N**OT 2/2 substances or med condition
3. **M**ood episodes are present most of the time
4. \*\*\*\***D**elusions or Hallucinations lasting ≥ 2 weeks **in the absence of Mood episodes**\*\*\*\*
*"I'm not feeling depressed for the first time in years, but the voices just won't go away"*
35
Key features for Schizoid personality disorder - 3
SchiZOID are **DULL**
1. **D**etached
2. **U**nemotional
3. **LL**ONERS that are content with being alone!!!!
36
Key features for SchizoTypal personality disorder
Schizo**T**ypal have magical **T**hinking
magial **T**hinking / eccentric / odd behavior
37
Difference between Avoidant disorder and Schizoi**D** disorder
Avoidant DO = *PERVASIVELY* avoids people **only due to fears of REJECTION** or scrutiny (pts don't want or like this = egoDystonic)
vs.
SchizoiD DO = avoidance that these pts are perfectly content with = egoSyntonic
38
In psychiatry, what is splitting? Which demographic is commonly seen in
Splitting people into either all good, or all bad; Borderline PD (***PESSP***)
39
Key features for Borderline personality disorder - 5
**PESSP**
1. **P**ervasive Instability
2. **E**mptiness & fears of abandonment --\> ⬆︎**suicide**
3. **S**elf-defeating behavior
4. **S**plitting is common (people are either good or bad)
5. **P**aranoid when stressed
*these pts usually have hx of child abuse, will react to stressors with rage and manipulative behavior and tx = **D**BT only*
40
*Delusional PD involves ≥ __ delusion for ≥ ___ months, **with no other sx***
Describe the subtype Erotomaniac delusional PD
*≥1 delusion for ≥1 month*
Erotomaniac = pt attempts to contact the object of delusion (usually --\> legal problems)
41
What is the Function and Dz associated with the [Meso**corticalLimbic** dopaminergic system]
Regulates Behavior ; Schizophrenia
42
What is the Function and Dz associated with the [Nigrostriatal dopaminergic system]
Voluntary mvmnt coordination ; Parkinsonism
43
What is the Function of the [Tuberoinfundibular dopaminergic system]? ; What disease occurs when it is **blocked** by antipsychotics?
INHIBITS Prolactin Secretion ; Hyperprolactinemia--\> infertility
## Footnote
*This occurs mostly with FIRST generation antipsychotics*
44
*Psych pts who've taken [D2 R Blockers] chronically may develop EPS*
Why would abrupt discontinue of [D2 R Blockers] --\> **worsening** of EPS sx?
Chornic blockade of D2 Receptors --\> ⬆︎D2 receptors and sensitivity. With abrupt [D2 R blocker] d/c, these receptors are over stimulated even with low dopamine levels --\> Exaggerated EPS
## Footnote
*EPS = TADD sx*
45
**Serotonin Syndrome** Clinical Presentation (8)
"Serotonin gave me the **SHIVERS**!"
***S**hivering*
[**H**yperreflexia & Myoclonus]
**I**NC Temp
*[**V**ital sign instability] (tachycardia vs. tachypnea vs. HTN)*
***E**ncephalopathy (Confusion vs. Agitation)*
**R**estlessness
**S**weating
*Italicized = Triad Sx*
46
How do you treat *Refractory* Serotonin Syndrome
Cyproheptadine
(antihistamine with anti-serotonergic properties)
47
Describe Neuroleptic Malignant Syndrome
RARE SE of Any Dopamine Blocker (Antipsychotics vs. GI meds) that --\> **FEVER**
- [**F**ever \> 40C]
- **E**ncephalopathy (Confusion)
- **V**itals unstable (INC HR / RR / BP from autonomic dysfunction)
- **E**nzymes CreaTine and WBC ⬆︎
- **R**igitidy ⬆︎ (Tremor)
Tx = supportive, dantrolene, [dopamine agonist if refractory]
48
What's the best way to approach treatment for [Neuroleptic Malignant Syndrome] - 3
Treat Rigiditiy with **Dantrolene** (inhibits Ca+ release from sk. muscle sarcoplasmic reticulum)
+
**supportive care**
followed by [Bromocriptine or Amantadine] dopamine agonist if refractory
49
What is the diagnostic criteria for ADHD? - 3
1. Sx present for **at least 6 mo.** AND inappropriate for dvpmental age
2. Sx **start** **between 6-12 yo** and not after 12 yo
3. Evident in **2 or more settings** (school/work/home)
## Footnote
*And Obvi, ALL psych disorders MUST be functionally impairing, NOT 2/2 medical condition and/or cause significant distress*
50
Diagnostic criteria for Cyclothymic disorder - 3
1. Chronic flutuating mood (depression vs bipolar) disturbance
2. lasting ≥ 2 years
3. and does not meet full criteria for hypomanic or depressive episodes
51
What is the clinical criteria for **hypomanic** episodes
1. Elevated or irritable mood 4\< x \<7 days PLUS
2. ≥3 Classic BIPOLAR sx
52
Diagnostic criteria for Bipolar II ? - 3
1. Major Depressive Episodes +
2. **hypo**manic episode +
3. NOT functionally impairing
53
What is the clinical criteria for **Manic** episodes
1. Elevated or irritable mood **≥ 7 days** PLUS
2. ≥3 Classic BIPOLAR sx
54
Diagnostic criteria for Bipolar I ? - 3
1. Major Depressive Episodes +
2. **Manic** episode +
3. Functionally impairing
55
What is the difference between Acute Stress Disorder and PTSD?
ASD is ACUTE! which = [3 days ≤ sx ≤ 1 month] post exposure
vs
PTSD = sx \> 1 month
56
Diagnostic criteria for Panic disorder - 2
1. Panic attacks +
2. Persistent concern about additional attacks and +/- attempts to avoid them
## Footnote
*Be sure to r/u medical conditions that mimic them*
57
Describe Advanced sleep phase syndrome
## Footnote
*This is a Circadian rhythm disorder*
circadian rhythm DO in which you can not stay awake past 7 pm --\> early morning insomnia
58
Diagnostic criteria for Delayed sleep phase syndrome - 4
## Footnote
*This is a Circadian rhythm disorder*
*AKA "The Night Owls"*
1. inability to fall asleep at "normal" bedtimes
2. Difficulty waking in morning
3. Excessive early daytime sleepiness
4. **Normal sleep ONLY WHEN ALLOWED TO SET OWN UR SLEEP SCHEDULE with later bedtimes**
59
Diagnostic criteria for Persistent Depressive Dysthymia disorder - 3
1. at least 2 / 6 of **sigeca**
2. CONSTANT for ≥ 2 years (or 1 year in kids)
3. No relief \> 2 mo
## Footnote
*Major Depressive Episodes may also occur with this*
60
*Clozapine's SE is agranulocytosis*
Name the Granulocytes - 3
**BEN**
**B**asophils
**E**osinophils
**N**eutrophils
*Clozapine also causes Metabolic Syndrome X, Seizures and Myocarditis*
61
Which test are routinely (q3-6 mo) done in Lithium patients?-2 why?
Thyroid function test: monitor for hypothyroidism
Creatinine: monitor renal function
62
Diagnostic criteria for Adjustment disorder with depressed mood - 4
1. [≤ 4 SIGeCAPSS s/s] within 3 mo. of acute stressor that --\>
2. **functionally impairing**
3. and resolves within 6 mo. after stressor ends
4. NOT 2/2 an other more specific disorder
## Footnote
*Tx = CBT*
63
Postpartum **depression** affects women during what time periods? What 2 methods are used to screen for this?
within 1st year \> first 3 mo ;
1. [PHQ2 --(if both +)--\> PHQ9]
2. Edinburgh Postnatal Depression Scale
*Screen prenatal, postnatal and well child*
64
Give brief descriptions that differentiate Postpartum
Blues vs Depression vs Psychosis
* Blues = onsets right after birth, peaking at postpartum day 5 and subsiding PPD14, worst w/lactation
* Depression = onset right after birth - 12 months later. **Traditional s/s**. Previous Depression hx is RF
* Psychosis = RARE but onsets IMMEDIATELY after birth
65
Tx for Delirium
Short course of PO haloperidol
## Footnote
*alternatives: Aripiprazole/Olanzapine/Risperidone*
66
What would you expect diagnostic appearance of a **Major Depression** pt to be - 3
1. ⬇︎Body wt
2. poor grooming
3. poor hygiene
67
What would you expect diagnostic appearance of an **Anorexia Nervosa** pt to be - 3
1. ⬇︎Body wt
2. baggy clothes
3. Lanugo -image
69
What is echopraxia
repetitive imitation of **mvmnts** of another person
## Footnote
*EchoLALIA = repetitve imitation of **verbiage** of another person*
70
What is sterotyping
isolated purposeless mvmnt performed reptitively
71
What is alexithymia
Pt can NOT describe their mood
73
What is **pressured** speech? ; Which pt mental illness exhibit this?
**ABC (S)TAMP LICKER**
rapid and difficult to interrupt (verbally runs you over!) ; Mania
75
Describe **referential** delusions
random events are of some special significance
## Footnote
*"the Cubs won, so that's a signal the alien invasion is coming!"*
76
What is the diagnostic clinical criteria for Panic Disorder/Specificier? - 3
## Footnote
*DSM5 no longer considers this its own DO but now as a Specifier for other conditions*
1. **Recurrent** Panic Attacks
2. **Unexpected** Panic Attacks
3. At least 1 attack is followed by ≥1 mo. of 1 or both of below:
- persistent worry of having another panic attack
- huge behavior changes to try and avoid future panic attacks
4. ≥ 4 of Panic Specifier symptoms - *image*
* And obvs can't be 2/2 drugs or other condition*
77
What is formication
feeling bugs crawling under skin
## Footnote
*common in Cocaine and Meth users!! lol*
78
What is hallucinosis
**pt knows** their hallucinations aren't real
## Footnote
*Common in Alcoholics*
79
What is the diagnostic clinical criteria for Agoraphobia? - 3
1. Fear & Avoidance OOP of ≥ 2 / 5 agora situations - *image*
2. Fear & Avoidance OOP are **\>** **6 months**
3. Fear & Avoidance OOP --\> distress and functional impairment
## Footnote
*OOP = Out Of Proportion*
80
What is the diagnostic clinical criteria for Generalized Anxiety Disorder? - 2
1. Excessive anxiety includes ≥ 3 / 6 of anxiety sx - *WATCHERS*
2. Sx **≥** **6 months**
## Footnote
* Excessive anxiety --\> distress and functional impairment*
* OOP = Out Of Proportion*
83
What is the diagnostic clinical criteria for PTSD? - 3
## Footnote
*Lifetime prevalence = 8% and more common in Women*
1. All 4 sx categorymet - *image*
2. sx **\>** **1 month**
3. Exposure done via Direct (single or repeated), Witnessed, occurred to close fam/friend
84
What is the diagnostic clinical criteria for Acute Stress Disorder? - 3
*image*
85
Risk factors for developing PTSD? - 7
## Footnote
*Lifetime prevalence = 8% and more common in Women*
1. Substance abuse
2. Violence, Mood or Anxiety med hx (self or family)
3. Suicidal Ideation/attempts
4. Work or Marriage problems
5. Homelessness
6. Prior trauma
7. Female
87
Demographic for Panic Disorder - 2 ; What is this group at risk for?
**Women** in the **late teens/early 20s ;** Death from Stroke vs MI
## Footnote
*Usually Occurs with MDD/GAD/OCD*
88
Tx for Panic Disorder - 6
**CBT** (can be used alone)(breathing technique, exposure therapy) +/-
## Footnote
2. SSRI (1st line rx)
3. SNRIs
4. [Benzo or BBlocker for situational]
5. TCA
6. MAOi
* Similar to Social Phobic Anxiety Disorder tx*
91
Diagnostic clinical criteria for Specific Phobia - 2 ; Tx?
1. Specific things (objects/locations/events) **provoke IMMEDIATE fear/anxiety OOP** --\> active avoidance
2. sx ≥ **6 mo**
Tx = CBT Exposure Therapy (*ONLY USE BENZOS IF CBT IS UNAVAILABLE*)
92
Diagnostic clinical criteria for Specific Phobia - 2 ; Tx?
1. Specific objects or locations **provoke IMMEDIATE fear/anxiety OOP** --\> active avoidance
2. sx ≥ **6 mo**
Tx = Exposure Therapy
93
What are the **\_\_\_\_\_** organic causes of Anxiety
**Endocrine** - 5
**Cardiovascular** - 5
*Substances can also induce Anxiety*
94
What are the **\_\_\_\_\_** organic causes of Anxiety
**Metabolic** - 5
**Neurological** - 7
* Metabolic includes the "Zebras"*
* Substances can also induce Anxiety*
95
How is GAD associated with pharmacotherapy cessation?
60-80% of GAD pts **relapse** **within 1st year** after stopping pharmacotherapy
96
Tx for Generalized Anxiety Disorder -9
1. CBT
2. SSRI (1st line rx)
3. SNRI (1st line rx)
4. TCA (2nd line rx)
5. Benzo
6. Buspirone
7. Lyrica
8. Mirtazpine
9. Trazodone
101
Tx for PTSD -7
1. **SSRI (1st line rx)**
2. Prazosin (nightmare sx)
3. Clonidine (hyperarousal sx)
4. Propranolol (hyperarousal sx)
5. CBT
6. Exposure therapy
7. EMDR (Eye Mvmnt Desensitization and Reprocessing)
102
What is the diagnostic clinical criteria for Obsessive Compulsive Disorder? - 2
1. Intrusive Obessions, Compulsions or both that \> 1 hr/day AND/OR
2. Intrusive Obessions, Compulsions or both that--\> distress or functional impairment
## Footnote
*Obessesion=Contamination, Symmetry, Somatic, Violence, Sex, Religion*
104
OCD tx - 6
1. CBT
2. Exposure & Response prevention
3. SSRIs-higher doses than anxiety tx (1st line rx)
4. Clomipramine TCA (2nd line rx) - consider after 2 failed trials of SSRI
5. SNRI (2nd line rx)
6. Atypical antipsychotics (augmenting agent)
105
*In Hoarding Disorder, pts accumulate possessions and cause functionally impairing clutter*
When **in untreated pts** are these areas typically cleaned?
ONLY when **CBT** intervention by 3rd parties is made
## Footnote
*Medical causes and other disorders should ALWAYS be ruled out before diagnosing psych conditions*
106
Diagnostic clinical criteria for Social Phobic Anxiety Disorder - 2
1. OOP Fear/Anxiety with Social *interactions* which could --\> **humiliation or scrutiny** by others (giving speech/meeting new peeps/eating/drinking)
2. Fear/Anxiety ≥ **6 mo**
## Footnote
*Tx similar to Panic Disorder tx*
113
Which substances are known for inducing Anxiety - 8
1. Cocaine
2. Amphetamines
3. Caffeine
4. CTS (CorTicoSteroids)
5. Hallucinogens (Cannabis, PCP)
6. Inhalants
7. Theophylline
8. Thyroid hormones
114
Common side effects of SSRI - 7
1. GI distress
2. SIADH --\> Wt Gain
3. ⬇︎Libido
4. Sedation
5. Dry Mouth
6. HA
7. **induces mania/hypomania in Bipolar pts!**
## Footnote
*****SSRI DC --\> Nausea/HA/Dizziness/Lethargy/FluLikeSx/Zapping*
115
What are 3 major precautions to remember with SSRIs?
1. **induces mania/hypomania in Bipolar pts! (THIS IS FOR ANY ANTIDEPRESSANT)**
2. **⬆︎**suicidality within first 2 weeks in young adults
3. SSRI Discontinuance --\> Nausea/HA/Dizziness/Lethargy/FluLikeSx/Zapping
116
Hoarding disorder tx
CBT targeting hoarding behaviors
## Footnote
*Consider adding SSRI **only** if there's also depression / anxiety*
117
How should you manage Autism? - 3
1. **Early dx & tx**
2. Multimodal tx (speechTherapy/CBT/education)
3. pharm adjunct
118
What are the signs of Cocaine intoxication? - 4
1. MyDriasis (*Pupils Wide Open on coke!*)
2. Chest Pain --\> Arrhythmia and MI
3. Seizures
4. Hyperthermia
119
What are the signs of Amphetamine intoxication? - 6
1. Psychosis +/- delirium
2. Combative Agitation
3. Myoclonus
4. MyDriasis
5. Tachycardia
6. HTN
## Footnote
*These effects **last a long time** when from bath salts!*
120
Which rx agents cause false positive amphetamine results on urine tox? - 3
1. pseudophedrine
2. Buproprion
3. Selegiline
121
How long does opioid withdrawal typically last?
3-5 days
## Footnote
*Sweating/Lacrimation/Rhinorrhea/Myalgia/Diarrhea*
122
Phencyclidine (AKA \_\_\_) is a \_\_(*MOA*)\_\_\_ and main intoxication signs are what?-4
PCP (Hallucinogenic dissociative anesthetic = [NMDA Glutamate R Blocker])! ;
1. Multidirectional Nystagmus
2. Violence w/⬇︎pain perception
3. HTN
4. Hyperthermia
123
LSD main toxication sign is \_\_\_\_\_
Visual Hallucinations
124
[Phencyclidine PCP] and Ketamine are both _____ with similar effects. What's the main differences?-2
Hallucinogenic Dissociative anesthetics
1. Ketamine is short lived
2. Keamine causes blunted behavior (i.e.impaired consciousness) while PCP causes violent behavior
125
What is Eye movement desensitization and reprocessing treatment? ; What is it indicated for?
Integration of eye mvmnts with therapy ; PTSD
126
Tx for Acute Bipolar **Mania** -3
**ALV**
[**A**ntipsychotics (1st or 2nd gen)] \> **L**ithium \> **V**alproate
NO ANTIDEPRESSANTS
127
Tx for Bipolar I and II - 6
Treat Bipolar pts b4 they go **BALLD**!
## Footnote
**-B**enzos adjunct prn
**-A**ntiPsychotics (Only use 2nd gen for Depressive phase)
**-L**ithium or Valproate \*\*
-**L**amotrigine (depression phase only)
**-D**epakOte \*\*
128
Buspirone MOA ; indication
Buspir**one** = [5HT**1**a partial agonist]; GAD; [slow onset] and [lacks muscle relaxant/anticonvulsant properties]
129
What are the cons of Buspirone? - 3
1. slow onset
2. lacks muscle relaxant properties
3. lacks anticonvulsant properties
130
Describe Shift work sleep disorder
Recurrent **sleep interruption** 2/2 shift work --\> daytime sleepiness, difficulty initiating sleep, difficulty maintaining sleep
131
Describe Trichotillomania is ; what's a serious complication of this?
compulsive **Hair pulling DO** in which pt attempts to stop pulling hair out of scalp, eyebrows and eyelashes but can't. ; Possibly leads to trichophagia (swallowing hair) which --\> bowel obstruction
## Footnote
*Related to OCD and has ⬆︎morbidity in those with hx or fam hx of OCD*
132
Trichotillomania tx
CBT - habit reversal training
133
[Drug-induced parkinsonism] is an EPS component caused by ____ blockers. ; What's the antidote for EPS?-6
## Footnote
*EPS = TADD sx*
D2 blockers;
1. Clozapine (use for **T**ardive Dyskinesia in extreme cases)
2. Propranolol (use for **A**kathisia)
3. Diphenhydramine (**DD**)
4. Benztropine (**DD**)
5. Trihexyphenidyl (**DD**)
6. Lorazepam (**DD**)
* Obviously ⬇︎ (not d/c) D2 blocker as well*
* EPS = TADD sx*
134
MDMA MOA
synthetic amphetamine that ⬆︎synaptic "SND" **S**erotonin, **N**orEpi, **D**opamine
## Footnote
*Can cause Serotonin Syndrome when taken with SSRI!! MDMA may also cause hypOnatremia*
135
In pts with TCA overdose, what's the most important vital to monitor and why?
**QRS duration** ; QRS \> 100 msec --\>⬆︎Vt arrhythmias and seizures (tx: NaHO3)
136
*PCP and Amphetamine intoxication presentations may be similar*
How can you tell them apart? - 2
1. PCP will show up in urine tox
2. PCP has multidirectional nystagmus
137
Signs and symptoms of MDMA intoxication - 3
1. Hyperthermia
2. Seizures
3. Delirium
138
Teens who develop significant acute changes in behavior should be assessed for what potential factors? - 4
1. Psychosocial stressors
2. Trauma (physical or sexual)
3. Substance use
4. Psych disorders
## Footnote
*Don't just throw drugs at them! Do detailed eval*
139
Borderline personality disorder pt typically have a remote hx of what?
**PESSP**
CHILD ABUSE
140
When is it ok for Bipolar pts to discontinue their rx therapy? ; Explain
NEVER!!
It is a **lifelong** illness requiring maintenance rx for years (and forever in severe bipolar pts)
141
Tardive Dyskinesia is an EPS component caused by ____ blockers. ; What's the antidote for it?
## Footnote
*EPS = TADD sx*
D2 blockers;
**Switch to Clozapine**
*Obviously ⬇︎ (not d/c) D2 blocker as well*
142
What makes up the ExtraPyramidal Symptoms? - 4
*EPS = TADD sx*
1. **T**ardive dyskinesia (tx=switch to clozapine)
2. **A**kathisia
3. **D**ystonia
4. **D**rug-induced Parkinsonism
143
*In addition to TSH, BUN/Creatinine and urinalysis labs...*
What other test should be ordered before starting pts needing Lithium **if they have CAD risk**?
EKG (Lithium causes dysrhythmias in CAD pts)
144
Tx for Somatic Symptom disorder
Regularly scheduled Med visits (*Goal: Improve functionality*)
## Footnote
*DO = preocupation with unexplained (but proven to be benign) medical sx*
145
Somatic Symptom disorder clinical presentation
preocupation with unexplained **(but proven to be benign)** medical sx
146
What is Functional Neurological Symptom Disorder? ; tx?
unexplained neurological deficits **2/2 emotional stressors** ; EDUCATION about the Disorder!
## Footnote
*AKA CONVERSION DISORDER*
147
Jimson Weed Poisoning clinical presentation - 7
*Jimson Weed = AntiCholinergic*
"Blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone, the bowel & bladder lose their tone, and the heart runs alone....."
1. Blind as a bat = [**Mydriasis and [cycloplegia** (blurry vision especially when focusing on near objects)]
2. Mad as a hatter= **Agitation & Hallucinations**
3. Red as a Beet = **Cutaneous flushing** despite vasoconstriction
4. Hot as a hare = **Hyperthermia** from DEC ability to sweat
5. Dry as a bone= **DEC Secretions** (including sweat)
6. **Bladder & Bowel lose tone**
7. Heart runs alone = No vagal tone at SA --\> **Tachycardia**
148
Malignant Hyperthermia etx ; Which pts are susceptible?
After giving [**inhaled anesthestics** vs **succinylcholine**] (to genetically predisposed pts (AUTO DOM)) --\> [Fever & Muscle Rigidity soon after surgery with Unstable Vitals]
## Footnote
**M**alignant = **M**uscle Rigiditiy
**Malignant** = Unstable Vitals
**Hyperthermia** = Fever
149
Malignant Hyperthermia Tx
Dantrolene
## Footnote
*TREAT PROMPTLY! AS THIS IS LIFE THREATENING CONDITION!*
150
Malignant Hyperthermia clinical presentation - 3
1. **Malignant** = Malignant Unstable Vitals
2. **M**alignant = **M**uscle Rigidity
3. **Hyperthermia** = Fever
151
Disulfiram MOA ; indication
inhibits aldehyde dehydrogenase ; **thwarts urge to drink EtOH** by causing horrible rxn when EtOH is consumed
## Footnote
*ONLY give to pts who will be abstinent and HIGHLY motivated*
152
*Naltrexone is 1st line tx for alcohol use disorder and can be taken while pt is still drinking*
When is Naltrexone contraindicated? - 3
1. Liver Failure
2. Acute Hepatitis
3. Pt currently uses opioids
## Footnote
*It CAN be used in mild liver dysfunction*
153
Acamprosate MOA ; indication
GABA analog ; **Maintains** **Alcohol abstinence** once its reached by ⬇︎ cravings (1st line rx)
## Footnote
*Renal excreted so Be sure to monitor renal function and SE = Diarrhea*
154
What behaviors from a toddler regarding sex are medically concerning? - 4
1. precocious sexual knowledge
2. preoccupation with masturbating
3. excessive talk about sexuality
4. simulating oral/anal/genital2genital contact
## Footnote
*curiousity with their own or other children's genitals is normal*
155
Which rx is most optimal for Bulimia Nervosa
Fluoxetine
## Footnote
*is also helpful in Anorexia Nervosa if its refractory to therapy*
156
Difference between Tourette and [Chronic Tic DO]
Tourette = [Motor **_AND_** Vocal Tics BOTH] for ≥ 1 year
## Footnote
*These sx must occur before 18 yo and tx = Antipsychotics vs Alpha 2 R agonist vs CBT*
157
Tx for Tourette's and Chronic Tic Disorder - 6
1. CBT Habit Reversal Training
2. Clonidine - alpha 2 R agonist
3. Guanfacine - alpha 2 R agonist
4. **Risperidone**
5. Haloperidol
6. Pimozide antipsychotic
## Footnote
*Antipsychotics are more effective*
158
Side effects of ADHD stimulants - 4
1. ⬇︎Appetite --\> Wt loss
2. Insomnia
3. Tachycardia
4. Tics (in children AND RARE)
159
Buproprion MOA - 2
**Dopamine** and **NorEpi** reuptake inhibitor
160
Why is Mirtazapine a good choice for depressed pts who are losing weight and can't sleep
It's SE includes ⬆︎appetite/wt gain and somnolence
161
*There are 3 Dopamine D2 pathways in the brain*
Name the pathways ; what overall effect do they have when activated?
Stimulation of....
**Mesolimbic** = Psychosis
**Nigrostriatal** = Mvmnt Coordination
**Tuberoinfundibular** = INHIBITS Prolactin when activated (*if blocked --\> infertility from hyperprolactinemia*)
162
Which antipsychotic actually has a **dual** blockade effect? ; Which 2 receptors does it block?
Risperidone ;
1. D2 R blocker
2. Serotonin 2A R blocker (helps to ⬇︎EPS side effects)
163
S/S of Opioid withdrawal - 7
1. Sweating
2. Lacrimation
3. Rhinorrhea
4. Myalgia
5. Diarrhea
6. Yawning
7. MyDriasis
## Footnote
*These last for 3-5 Days*
164
S/S of Amphetamine and Cocaine withdrawal - 4
Cocaine withdrawal hits **HARD**
1. **H**ungry
2. **A**ngry irritable
3. **R**est a lot w/unpleasant dreams
4. **D**epressed (can mimic MDD vs Bipolar)
*can last several days*
165
Which comorbidities is Tourette's associated with?
1. OCD (develops within ~5 years of tic onset)
2. ADHD
166
Describe the clinical tool used to assess whether a pt is seriously contemplating suicide
**SAD PERSONS**
## Footnote
*Each is worth 1 point and* *[normal 4--(outpt tx)--**7** --\> Hospitalize now!]*
**S**ex Male
**A**ge external to 19-45
**D**epression diagnosis
**P**revious attempt hx (STRONG RISK FACTOR!)
**E**tOH/substance abuse
**R**ational thinking impaired (psychosis, delusions, hallucinations)
**S**ocial support lacking
**O**rganized plan
**N**o significant Other
**S**ickness physically (i.e. chronic pain)
167
What is the strongest single risk factor for suicide
previous suicide attempt
168
Diagnostic clinical criteria for Disruptive Mood Dysregulation disorder - 3
1. Frequent Temper Outburst
2. Severe irritability
3. Poor Frustration tolerance
169
What type of psychiatric side effects does CTS (CorTicoSteroids) have? - 4
**S**teroids **M**ake **P**eople **D**epressed!
1. **S**uicidality
2. **M**ania
3. **P**sychosis
4. **D**epression
170
*AntiSocial Personality disorder is essentially Charlie Sheen*
What is the nuance for diagnosing this disorder in regards to age of onset?
ASPD pts must have had conduct DO **before 15 yo**, with a continuance into adulthood
171
What regimen, for maintenance therapy, is considered in Bipolar pts who DON'T respond to monotherapy maintenace?
Treat Bipolar pts b4 they go **B(****AL****)D**!
**A** + **L**
[**A**ntipsychotic 2ND GEN] + [**L**ithium or Valproate]
172
Tx for Major Depression **with psychotic features** - 2
1. ECT \> antipsychotic ➕
2. Antidepressant
## Footnote
*Use ECT in elderly as it is more rapid acting*
173
*A pt has a **single** episode of major depression but responds well to antidepressant SSRI tx*
What do you do when he asked to stop the SSRI since he's now feeling "great"?
Cont Antidepressant rx for **additional 4-9 months** once remission is reached and then d/c
## Footnote
* This is called continuation phase tx*
* Pt with multiple episodes of MDD should cont SSRI for additional 1-3 years after reaching remission and indefinitely if their depression is SEVERE*
174
[T or F] Pt confidentiality shuld be maintained even when a pt is having Active suicidal ideation
FALLLSEE!!!!
## Footnote
Active (i.e. plans to hang themself) suicidal or homocideal ideation warrants breaking confidentiality and informing parents or whomever
175
Is Parental consent required for hospitalization? ; what about psychotropic medications?
NO, not required for hospitalization if pt is harm to self or others ; YES required for psych meds
176
Which **SGAs** can be administered as *Long acting injectables* (4)
B: Which of these are excreted via **RENAL**
"**OPRAH**"
1. **Risper**idone
2. **Pal**iperidone (*Metabolite of **Risper**idone*)
3. **Ol**anzapine
4. **A**ripiprazole
B: **Pal**iperidone = SHOULD NOT BE USED IN RENAL FAILURE PTS
**H**aloperidone = FGA is also long acting injectable
177
3 SGAs that cause the greatest **weight gain**
"**i** _**C**ause_ _**O**besity_"
**i**Loperidone / _**C**lozapine_ / _**O**lanzapine_
***C**lozapine & **O**lanzapine cause [Metabolic Syndrome X] as well so monitor Fasting glucose and lipids!*
178
Which antipsychotic **DOES NOT** cause EPS
Clozapine
## Footnote
*This also treats Tardive Dyskinesia!*
179
A: **High** binding SEs of Olanzapine (2)
B: Which Receptors are blocked (2)
A:
1. Wt. Gain
2. Metabolic Syndrome
B: [A1 adrenergic] / H1
180
Which antipsychotic is *the most* associated with prolonged QT?
Ziprasidone
181
Tx for Kleptomania - 5
1. CBT
2. SSRI
3. Opioid R Blockers
4. Lithium
5. Anticonvulsants
182
MAOi MOA ; indications-2
inhibit metabolism of **SED** (**S**erotonin/**E**pi/**D**opamine)
1. refractory depression
2. atypical depression
183
Foods containing ____ can be have a dangerous interaction with MAOIs
What is the rxn when these two mix?
Tyramine ; **HYPERTENSIVE CRISIS** 2/2 sympathetic activation!
## Footnote
*This will first present as a HA*
184
Explain what Cognitive Behavioral Therapy is
Therapy that **changes cognitive distortions** (i.e. overgeneralization, catastrophizing, minimalizing positive events)
185
Explain what Biofeedback therapy is
Uses signals from body (HR, temperature, BP) as indicators of emotional distress and teaches this to pts to control their responses
186
Explain what Dialectical behavioral therapy is - 3 ; What disorder is this specifically used for?
Targets
1. emotional dysregulation
2. self-destructive
3. suicidal behaviors
Borderline Personality DO
187
In Motivational Interviewing, therapist focus on pt's motivation for change and ambivalence
What illness is this usually used to treat?
Substance Abuse DO
188
*Diagnostic clinical criteria for Generalized Anxiety Disorder consist of a ≥6 month time period of ≥3 out of 6 major sx*
What are the 6 GAD sx?
wa**TCHERS**
## Footnote
Worry / Anxiety that --\> to...
1. **T**ension in muscles
2. **C**oncentration ⬇︎
3. **H**yperarousal IRRITABILITY
4. **E**nergy ⬇︎
5. **R**estlessness/on edge
6. **S**leep disturbance
189
Contraindications for Buproprion - 4
1. Seizure hx
2. Bulimia nervosa
3. Anorexia Nervosa
4. Use of MAOI within prior 2 weeks
190
Tx for Anorexia Nervosa - 5
1. **Nutritional rehab**
2. CBT
3. Hospitalization if vitals unstable
4. Fluoxetine if refractory to #1-3
5. Olanzapine if refractory to #1-3 (⬇︎obsessive thoughts and ⬆︎ wt)
191
How is Anorexia Nervosa associated with thyroid dysfunction? ; Should this be medically addresed with supplement?
pts with **anorexia** nervosa naturally have ⬇︎levels of T3 and T4 2/2 body's adaption to chronic nutritional depletion ; T3 and T4 will return ON THEIR OWN with refeeding so DO NOT REPLACE
192
Clinical presentation of REM sleep behavior disorder ; What could this indicate if it occurs reoccurs frequently?-2
**Physical Dream Enactment** during REM sleep (latter part of the night) ; Parkinson's or DLB
## Footnote
*Pt kicking, talking and pushing you off the bed while they're dreaming*
193
Describe Sleep terrors and sleepwalking
**non**-REM sleep arousal disorder that occurs in younger pts during first trimester of sleep period **with NO MEMORY of dreams**
## Footnote
*In **S**leep terrors/walking, you **S**eem to forget the dream...*
194
What is the difference between Sleep Terror and Nightmare disorder? - 2
1. in night**M**ares, you re**M**ember the dream!
2. Nighmares = REM (occurs in mid night) / Sleep Terrors-Walking = NonREM (occurs 1st trimester)
195
*Depressed pt has been on an SSRI "for a while" and doesn't see much improvement*
What constitutes an adequate "trial" of SSRI before switchin to SNRI?
≥ 6 weeks
196
Most common side effect of ElectroConvulsive Therapy (ECT)
Transient Amnesia
197
What are the primary electrolyte disturbances seen in Anorexia or Bulimia Nervosa - 3
1. ⬆︎Amylase
2. ⬇︎K+
3. ⬇︎Cl
198
Antipsychotics (\_\_\_ generation) can be used to treat the depressive phase of Bipolar disorder
Which 2 are the best to be used?
Treat Bipolar pts b4 they go **BALLD**!
2nd generation Antipsychotics for Bipolar *Depression* =
Quetiapine and Lurasidone
199
Clinical presentation for Illness Anxiety disorder
Anxiety over the possibility of having a specific Illness even though there are **little to no symptoms**
## Footnote
*In Somatic symptom disorder....Somatic symptoms ARE present!*
200
What are the triggers of Sleep Terrors/Walking - 4
1. Sleep Deprivation
2. Stress
3. illness
4. meds affecting CNS
201
What's the most common neurostructural findings for OCD - 2
1. OrbitoFrontal Cortex structural ∆
2. Basal Ganglia structural ∆
202
Name the main signs and symptoms of Methamphetamine abuse - 4
1. Paranoid delusions
2. Formication tactile hallucinations (bugs crawling under skin)
3. Poor Dentition 2/2 clenching & decay
4. **Excoriations 2/2 skin picking**
## Footnote
*These pts will still need Antipsychotics and CBT*
203
Pts with chronic alcohol use commonly present with what subacute sx? - 2 ; why is this?
1. Insomnia
2. Anxiety
Pt use EtOH to fall asleep but when EtOH levels drop during mid-night --\> CNS hyperarousal --\> sleep awakenings and mild withdrawal
204
In which conditions do you see Catatonia? - 4
syndrome of marked psychomotor disturbance occuring in **severe**
1. mood disorders w/psychotic features (Depression,Bipolar)
2. psychotic DO
3. Autism
4. Med conditions (infection/metabolic/neuro/rheum)
*Tx = Lorazepam vs ECT*
205
clinical presentation of Catatonia - 5
1. EchoLalia/praxia
2. **Mutism**
3. **Waxy flexibility** (resistance to repositioning)
4. **Catalepsy** (limbs remain fixed and immobile)
5. negativism
## Footnote
* Possibly* Catatonic Agitation
* Tx = Lorazepam vs ECT*
206
Dx for Catatonia? ; Tx for Catatonia?-2
Dx: Give 1-2 mg Lorazepam IV --\> wait 10 min --\> if pt improves = Catatonia ;
1. Lorazepam
2. ECT
207
What is the irony of short acting benzos (i.e. Alprazolam) and seizures?
Benzos treat seizures BUT **short acting benzos** can --\> seizures (along with anxiety and psychosis) if there is abrupt d/c
208
How long should a Doc wait to start an SSRI after discontinuing a MAOI?
## Footnote
*This is to avoid Serotonin Syndrome SHIVERS*
2 weeks
209
What 3 elements should all Depressed pts be initially evaluated for?
SUICIDE via suicide risk assessment!
1. Ideation
2. Intent
3. Plan
If 2 and 3 present --\> hospitalization
210
Selective Mutism cp
verbal and talkative at home **but refuse to speak in specific social settings (like school)**
## Footnote
*Refusal to speak at school should not be considered normal shyness*
211
When does Stranger Anxiety onset and subside
starts 6-9 mo and ends 3 yo
## Footnote
*anxiety/distress when encountering unfamiliar people, even when parent is around*
212
Common characteristics of Cocaine Withdrawal (3)
* SEVERE ACUTE DEPRESSION (CRASH)
* Hyperphagia
* Hypersomnia w/vivid dreams
213
Phencyclidine (AKA \_\_\_) is a \_\_(*MOA*)\_\_\_ and main toxication sign is \_\_\_\_\_
PCP (Hallucinogen = [NMDA Glutamate Blocker])! ; [Vertical Nystagmus]
214
Tx for Acute Stress Disorder
Trauma focused CBT
215
Cocaine MOA and toxicity signs (4)
[Presynaptic Reuptake inhibitor] of **DNS** [Dopamine/NorEpi/Serotonin]
1. myDriasis responsive to light
2. Tachycardia
3. Agitation
4. Vasoconstriction --\> Myocardial ischemia (cp)
216
In Psychiatry, what is Displacement
Displacing feelings meant (but never given to) one person toward a "safer" person
217
In Psychiatry, what is Transference
Transfering unconscious emotions associated with a person in the past --\> person in present
## Footnote
*Pts abused as kids have difficult time seeking care in the future since they associate it with poor caretaking*
218
In Psychiatry, what is Projection
Projecting your unaccetable feelings of something onto someone else (as if they have the feelings) so u don't have to acknowledge ur own feelings
219
What biochemical changes are associated with Major Depression Disorder?
hyperactivity of hypothalamic-pituitary-adrenal axis --\> **⬆︎Cortisol**
220
Side effects of Lithium - 4
If not careful, Lithium **TANS** you!
1. **T**remors - late
2. **A**taxia - late
3. **N**VD early on
4. **S**eizures - late
precipitants: NSAIDs, thiazides, tetracyclines, metronidazole
221
Which drugs have an interaction with Lithium - 5
1. Thiazide
2. NSAIDs
3. ACE inhibitors
4. Tetracyclines
5. Metronidazole
222
What is the best way to prevent schizophrenia relapse
Minimize conflict and stress, especially with family
223
In psychiatry, what is splitting? Which demographic is commonly seen in
Splitting people into either all good, or all bad; Borderline PD
224
In psychiatry, what is sublimation
chanelling unacceptable thoughts or impulses into something socially acceptable (channeling anger into running)
225
What is the difference between a child with Separation Anxiety Disorder and a normal child who has reluctance to be separated?
Separation Anxiety Disorder kids will have physical sx (abd pain, HA, nightmares, ⬇︎sleep)
226
When treating the Depression/Anxiety in Alzheimer's pts, which SSRI should you **avoid**?
paroxetine
## Footnote
*if sx persist, use ACEI*
227
*SSRIs with short half lives need to be tapered*
Which 2 SSRIs are in this group?
Paroxetine and FluVoxamine
