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Psych 2.0 Flashcards

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1
Q

Define Fear and what part of the NS controls it

Define Anxiety

How long does anxiety have to be present to be relevant

A

Emotional response to imminent threat; Autonomic

Anticipation of future threats;
Phobic stimulus w/ active avoidance

x6mon

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2
Q

How is Anxiety d/t Specific Phobia Tx first line or w/ meds?

What is the key feature of a Social Anxiety d/o

What is the key feature of a Panic D/o

A

First line: psychotherapy
Meds: SSRI/SNRI

Fear of social situation where scrutiny may occur

Recurrent, unexpected attacks

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3
Q

How are Panic d/os Tx

How is Agoraphobia Tx

Define Generalized Anxiety d/o

A

First line: psychotherapy, S/SNRI, TCA

Just like GAD:
Group therapy w/ SS/NRI, Gabapentin

Excessive worry about multiple things x 6mon

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4
Q

How is Generalized Anxiety D/o Tx

How is Generalized Anxiety categorized into severity

What are five examples of Somatic Sxs

A

Psychotherapy;
Gabapentin Buspirone SS/NRI Propranolol TCA

GAD-7 scores:
5-9: mild 10-14: mod 15-21: severe

Pain SOB Tremor Fatigue Paralysis

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5
Q

Define Somatization

What Sx is MC present

What aggravating issue can these Pts exhibit

A

Physical Sxs mimicking absent Dz x6mon;
Pysch distress felt in physical form

Pain

Dr shopping

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6
Q

How is Somatic Sx D/o Tx

Define Illness Anxiety D/o and how are they Tx?

What is unique about their presentation

A

Social/Peer support
Refractory= SS/NRI but expect exacerbated Sxs

Hypochondriasis;
Pt worries they MAY acquire serious illness;
Therapy; SSRI if underlying A/D d/o

Absent/minimal somatic Sxs w/ high anxiety

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7
Q

Define Conversion D/o and what can it AKA?

How are these Pts managed for Tx

Define Factitious D/o

A

Altered voluntary motor/sensory function;
Functional Neurological Sx d/o

Non-pharm, possibly w/ hypnosis

Falsified S/Sxs or induced issue w/ intent of deception but no secondary gain

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8
Q

How is Factitious D/o managed

Define La Belle Indifference

Define Obsession and Compulsion

A

Psych consult w/ confrontation/biofeedback; Short term anxiolytics
CPS removes child if Munchausen by Proxy

Pt w/ sudden, unexpected lack of concern to Conversion D/o Sx

O: intrusive thought/urge/images causing anxiety
C: behavior/acts done in response to obsession

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9
Q

OCD is MC in ? gender

What are these Pts at risk for in the future

How are these Pts Tx

A

Male

Half have SIs
One quarter will have attempts

Systemic desensitization/CBT
SSRIs/Clomipramine- TCA

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10
Q

Define Body Dysmorphic D/o

What are the MC areas reported

How is this Tx

A

Perceived defect in body not observable by others

Hair Nose Skin

Psychotherapy
SSRI/Clomipramine- TCA

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11
Q

Define Hoarding D/o

What is rare in these Pts Hx

How are they Tx

A

Difficulty discarding items regardless of value

Theft

CBT, rarely SSRIs

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12
Q

Define Trichotillomania

What areas are MC affected

How are they Tx

A

Pulling out own hair

Scalp Eye brow/lid

Biofeedback/Desensitization/Habit reversal
Hydroxyzine, Topical steroids
Anti-depressants/psychotics

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13
Q

Define Excoriation

What parts of the body are MC affected

How is this Tx

A

Picking at skin

Face Arms Hands

CBT w/ habit reversal
Fluoxetine, Naltrexone

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14
Q

Define MDD

What are two common presenting complaints

What risk is present at all time for these Pts

A

Depressed mood/loss of interest w/ 4 SIGECAPS Sxs x 2wks

Fatigue, Insomnia

Suicide w/ biggest RF: Hx of attempts

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15
Q

How is MDD Tx

When is electroconvulsive therapy indicated

What meds may be used

A

CBT w/ phototherapy

Medication can’t be used
Extremely suicidal

SSRI (Tx sex dysfunction w/ PD5-I/buproprion)
SNRI if chronic pain

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16
Q

What medication is safe for Ps w/ MDD and acute MI/unstable angina Hx

What class needs to be used w/ caution for MDD Pts

What class is used as third line Tx

A

Sertraline

TCA w/ cardiac/seizure Pts

MAOI

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17
Q

What class of drug is used for short term Tx or refractory depression of MDD

Maintain therapy x ? long after resolution of MDD Sxs

What are the indications to continue the full dosage indefinitely

A

Stimulants

x12mon

First episode before 20/after 50y/o
Over 40y/o w/ two episodes
One episode after 50y/o
Three episodes over lifetime

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18
Q

Define PDD

How is this Tx

A

Depressed mood x 2yrs w/ two Sxs w/ remission lasting no longer than 2mon

Same as MDD:
CBT, Phototherapy, SSRI, SNRI, TCA

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19
Q

Characteristics of Bipolar 1

Characteristics of Bipolar 2

What is the essential feature needed to make Dx of BP2

A

Manic mood x 1wk or needing admission w/ 3 Sxs d/t severity

Elevated mood x 4d w/ three Sxs w/out impairment or severe enough for admission

Hypomanic and depressive episode

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20
Q

What is first line Tx for Bipolar 1

What is used for acute management in rapid cyclers

What is used for long term management

A

Valproic acid

2nd generation antipsychotic and benzos

Lithium Valproate Quetiapine Lamotrigine

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21
Q

Why is BP2 scarier than 1

How is this Tx

Criteria for insomnia

A

Higher rate of successful suicides

Valproic acid- first line
2nd generation antipsychotic and benzos- rapid cycles
Lithium Valproate Quetiapine Lamotrigine- long term

Unhappy quality/quantity and can’t get to/stay asleep for 3 nights per week x 3mon

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22
Q

How is insomnia Tx

Define Hypersomnolence D/o

A 
CBT w/:
Hydroxyzine
Exzopiclone
Lorazepam
Diphenhydramine
Zolpidem/Zaleplon

Excessive sleepiness despite 7hrs or more of sleep3/week x 3mon

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23
Q

Criteria for Narcolepsy

What can trigger the visible and awake Sx of this condition

How is this Tx/managed

A

Irrepressible sleep/excessive napping 3x/wk x 3mon w/ cataplexy, hypocretin or +sleep study

Cateplexy triggered by laughter/joking

Dextroamphetamine sulfate
Modafinil

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24
Q

What is the s/e of using Modafinil for Narcolepsy Tx

What female Pt education piece is needed w/ this medication

Sleep study criteria for OSA

A

HA, anxiety

Dec OCP efficacy

5 episodes per hour w/ Sxs
15 episodes per hour

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25
? is the MC breathing related sleep d/o Define Circadian Rhythm sleep-wake cycle d/o What can resolve this issue for some Pts
OSA Altered rhythm leading to excessive sleepiness Set own schedules, can have normal sleep quality/duration
26
How is Circadian Rhythm Sleep Wake d/o Tx Criteria for Restless Leg Syndrome How is this Tx
Melatonin Zolpidem Benzos Urge to move legs d/t uncomfortable sensation that is relieved w/ movement Fe replacement- if deficient Ropinirole- first line dopamine agonist Gabapentin Clonazepam
27
# Define Substance/Medication induced sleep d/o Define Delusions Define Hallucinations
Disturbed sleep after starting new medication that is capable of disturbing sleep Fixed beliefs that don't change w/ conflict/evidence Perception of experiences w/out external stimulus
28
When/How is disorganized thinking suspected in a Pt What are two types of disorganized thinking Three examples of 'positive' Sxs of psychotic d/o
Inferred by their speech Derailment- switches from topic to topic Tangent- questions answered obliquely/unrelated Hallucination Delusion Uncontrollable repetitive movements
29
# Define Delusional D/o Sxs of ? other d/o are considered mild compared to delusional d/o Sxs How is this d/o Tx/managed
One delusion x 1mon w/out meeting schizophrenia criteria Not functionally impaired, behavior is not odd Bipolar Protection from harm to self/others Antipsychotics- drug of choice w/ antidepressants
30
# Define Brief Psychotic D/o How is this worked up and managed
Delusion, Hallucination or Disorganized speech for at least a day but back to normal within one month Prevent harm to self/others; possible admit Eval w/ brain imaging if first psychosis episode Antipsychotics (TxOC) w/ antidepressants
31
Criteria for Schizophrenia How does the onset of this Dz indicate the Dx If Pt has a Dx of Autism or Communication d/o, a schizophrenia Dx can only be made if ?
Two of the five Sxs, most of the time, for one month: Delusion Hallucination Disorganized speech/behavior or catatonia Negative Sxs Dec level of function in one area of life Prominent delusion/hallucinations w/ schizophrenia Sxs and w/out mood episodes
32
How is schizophrenia Tx Define Dissociation What are the two parts of Dissociative Symptoms
Protect self/others from harm Full eval w/ imaging Antipsychotics (TxOC) w/ antidepressants Disconnecting from thoughts/feelings/memories Depersonalization: sense of being in a dream Derealization: surroundings are dreamlike
33
Criteria for Acute Stress D/o How is this Tx non-pharm What meds can be used for Tx/management
9 Sxs lasting 3-30d after experiencing trauma Psych debrief Exposure therapy Trauma CBT Benzos Morphine- early pain relief= dec PTSD Propranolol SSRI
34
# Define PTSD Non-pharm Tx
Exposure to trauma w/ intrusive Sxs, avoiding stimuli associated w/ event, and at least two negative alterations in cognition/mood and two alterations in arousal/reactivity Psychotherapy Cognitive processing therapy Prolonged exposure therapy Eye movement desensitization therapy
35
Pharm Tx for PTSD
``` SSRIs- only class approved for Tx: Sertraline Peroxetine ``` Propranolol- peripheral Sxs Clinidine- hyperarousal Prazosin- nightmares Carbamazepine- impulse/anger management Benzos- anxiety/panic attacks Trazodone- insomnia
36
# Define Adjustment D/o One of ? Sxs needs to be present What time frame should these Sxs resolve
Emotional behavior Sxs developing w/in 3mon of identifiable stressor Distress OOPT stressor intensity Impaired social/occupational function <6mon of stressor or consequences
37
How is Adjustment D/o Tx What meds may be used
Immediate: bag breathing Removal from stressed situation Log daily stressors Stress reduction exercises SSRIs Benzo/Antihistamine sedatives
38
Time frame for Acute Stress Reaction Time frame for PTSD Time frame for Adjustment D/o
Trauma causing Sxs 3-30d and PTSD-like Sxs Trauma causing Sxs 30d/> and PTSD-like Sxs Stress Sxs presenting <3mon, resolving <6mon
39
# Define Bereavement What is the natural response to this situation and in ? two stages When the above response becomes 'complicated' its AKA ?
Someone who is close dies Grief: Acute, Integration Persistent Complex Bereavement D/o
40
What happens in the acute phase of grief What happens in the integration phase of grief What are the four hallmarks of healing from death
Intense, distressing emotions of numb/shock/denial that act as adaptive mechanism to relieve pain Transition period months later but can be extended if loss was d/t suicide Recognize they've grieved Think/talk about deceased w/out emotions Return to work/daily activities Seek companionship/pleasure w/ others
41
Criteria for Persistent Bereavement D/o What are the RFs for this to develop What are common comorbidities seen in these Pts
Sxs x 12mon (x6mon if death was of child) that is OOPT to norm ``` Hx of Anx/Dep Insecurity Multiple previous deaths Death of child/young adult Violent death Hostile/insensitive behavior of others ``` Depression PTSD Substance abuse
42
How is Persistent Complex Bereavement D/o Tx Without Tx, Pts may develop ? issues by 13mon, 25mon? What is the strongest RF for suicide and what is a strong predictor for suicide
Monitor q1-4wks Behavioral therapy (first line) Pharmacotherapy (second line) if PTSD/depression present 13: HTN Eating Depression Smoking 25: CV/Neoplastic dz RF: Previous attempt/threat Predict: psych d/o
43
What are the RFs from highest to lowest for suicide risk When does age become a RF
``` Never married Widowed Separated Divorced Married w/out kids ``` Males >85y/o
44
What are protective factors against suicide What acronym is used to assess suicide risk objectively What are the subjective and objective part of the assessment
Social/Family connections Pregnancy Parenthood Religion AMSIT: Appearance Mood Sensorium Intellect Thoughts Mood: subjective Affect: objective
45
When are SSRIs used in assessing suicide risk When are suicide rates the highest after d/c 6 red flags for history of child abuse
Pt w/ underlying psych condition First week ``` Delay in seeking care Impossible history for injury No Hx or denies trauma Evolving story of events Resuscitation efforts at home Self inflicted/inflected by sibling/pet ```
46
# Define Anorexia Nervosa This condition rarely presents prior to ? milestone How is this Tx
Restricted intake w/ lower than normal body weight and intense fear of weight gain Puberty Restore normal weight, eating behavior and psych
47
All Pts Dx w/ Anorexia Nervosa need to be co-managed/Tx w/ ? on the team What are the four indications to admit
Psychiatrist Hypovolemia Major electrolyte d/o Out Pt failure Protein energy malnutrition
48
# Define Bulimia Nervosa What risk is w/ this type of eating d/o How are they Tx
Loss of control while eating, eating too much in one sitting w/ inappropriate compensatory mechanisms to prevent weight gain x 3mon Inc suicide risk Psychotherapy Fluoxetine hydrochloride/SSRIs
49
# Define Binge Eating D/o How are these Pts Tx Define ADHD
Recurrent binge eating w/out compensatory mechanisms Psychotherapy w/ CBT Impaired function/development w/ inattention and hyperactivity/impulsitivity
50
How is ADHD Tx What medication may be used in Pts when the above is c/i or if Pt has major depression What meds are used if Pt has underlying HTN issues
Psychoeducation w/ Stimulants 1st: Desipramine (TCA) 2nd: Atomoxetine Guanfacine, Clonidine
51
What may be the first Sx of Autism Spectrum D/o What are the only two FDA approved psychotropic meds for these Pts How is Oppositional D/o categorized
Delayed language development w/ lack of social interest Risperidone, Aripiprazole Mild: one setting Mod: two settings Sev: three/more settings
52
Oppositional D/o actions can be at everyone except ? What background/history indicates this d/o What are the two MC co-occuring conditions
Siblings Child care disrupted by different caregivers ADHD, Conduct d/o
53
How is Oppositional Defiant D/o Tx How is Conduct D/o Tx Personality d/D/o is a pattern of behavior deviating from cultural norms w/ ? manifestations
Psychotherapy: reward/punish of behaviors Psychotherapy along w/: Antipsychotics: Haloperidol Risperidone Olanzapine Lithium- mood stabilizer Stimulants if ADHD present CAPRI: Cognition Affect Personal Relations Impulsive
54
What are the 3 Cluster A personality D/os
Paranoid- distrust or suspicion w/ quick reactions of anger (pathologically jealous/suspicious) Schizoid- detachment from social relationships w/ restricted range of emotions (doesn't fit in, doesn't mind) Schizotypical- discomfort w/ close relations and distorted behavior
55
Schizotypal personalities often improve w/ ? medications What are the four Cluster B personality d/os
Antipsychotics Antisocial- disregard for others since 15y/o and must be 18y/o for Dx Borderline- unstable personal relationships w/ impulsivity and poor self image Histrionic- excessively emotional and attention seeking Narcissistic- grandiosity w/ need for admiration but lacking empathy
56
What findings are common in the history of Antisocial personality d/os What are the three Cluster C personality D/os
"con man" Abuse Animal cruelty Arson Avoidant- social inhibition w/ intense fear of rejection Dependent- submissive/clingy need to be taken care of w/ separation anxiety OCD- preoccupation w/ order/perfection
57
What class of medication is used for Sx relief of borderline personality d/o What class is used for hostility, agitation Sxs What meds are used for avoidant personalities
SSRIs reduce aggression, impulse Anticonvulsant- dec behavior dyscontrol Antipsychotics SSRIs, Benzos
58
Alcohol intoxication increases w/ ? personality characteristics What does alcohol withdrawal look like
Sensation seeking Impulsivity ``` Tremors Autonomic hyperactivity Insomnia N/V/Tachy Tonic clonic seizure ```
59
? medication is used to discourage alcohol use ? medication is used to remove the pleasure effect of alcohol use What is used if Pt is experiencing hallucinations during withdrawal
Disulfiram- aversion med Naltrexone- opiate antagonist to dec pleasure Haloperidol
60
Adjustment d/o can rarely but potentially evolve into ? psych Dxs Pts w/ anxiety d/os are likely to self medicate w/ CNS depressants, MC being ? Time frame for adjustment d/o to develop?
GAD, Major depression Alcohol W/in 3mon of stressor
61
What meds may be used for Adjustment D/o Tx These Pts are at risk for ? future medical issues Define Sunday Neuroses
Lorazepam- acute anxiety SSRIs- long term management Increased risk for autoimmune dzs Pts do well w/ scheduled week but unscheduled weekend/retirement causes anxiety
62
How is GAD Tx w/ meds What med is possibly the most anxiogenic antidepressant ? medication is used for reducing peripheral Sxs
SSRI: Escitalopram Paroxetine SNRI: Venlafaxine Duloxetine Buspirone Propranolol
63
? medication is used in benzo over doses How is panic d/os Tx w/ meds Social phobia and agoraphobia can be Tx w/ ? meds
Flumazenil- benzo antagonist SSRIs: Fluoxetine Paroxetine Sertraline SNRI: Venlafaxine SSRI: Paroxetine Sertraline Fluvoxamine SNRI: Venlafaxine Gabapentin
64
OCD Sxs can overlap w/ ? other spectrum Sxs What meds are used during Tx What meds can be used as adjuncts w/ SSRIs for Tx resistant cases
Body dysmorphia Excoriation Tic/Trichotillomania Hoarding SSRI: Fluoxetine Sertraline Paroxetine Fluvoxamine Clomipramine Antipsychotics/Topiramate
65
What procedure is FDA approved for Tx of OCD
Transcranial Magnetic Stimulation

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