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psych Flashcards

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0
Q

drug detection window for barbiturates or opiates?

A

1-3d

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1
Q

Drug detection window for amphetamines

A

2-3 d

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2
Q

drug detection window for BZD

A

1-7d

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3
Q

Cocaine/metabolites drug detection window

A

6hrs - 3 days

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4
Q

drug detection window methadone

A

7-9 d

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5
Q

drug detection window phencyclidine

A

8d

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6
Q

difference between substance abuse and dependence

A

abuse: maladaptive pattern, 12 mos of dysfunction
dependency: physical sx of tolerance or w/d (not req), and evidence of loss of control over sx (CAGE…)

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7
Q

What are the stages of change in quitting substance use?

A

precontemplation, contemplation, determination, action, maintenance/relapse

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8
Q

Time period of delirium tremens most likely?

A

2-3 days after last drink (up to 3-5)

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9
Q

First signs of alcohol w/d?

A

tremulousness, sweats, incr HR, BP and w/in 24 hrs w/d sz

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10
Q

when do you get alcohol w/d hallucinations?

A

first 24 hrs but can occur anytime.

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11
Q

sx of Wernicke’s?

A

ataxia, ophthalmoplegia, amnesia

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12
Q

mechanism of thiamine def?

A

stops carbo metab

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13
Q

treatment of thiamine / glucose order?

A

always thiamine before glucose otherwise it can’t be metabolized

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14
Q

What is the drug in disulfiram and how does it work?

A

aldehyde dehyrogenase inhibitor causes rxn w/ alcohol with flushing, vomiting, tremors, resp distress, hypotension, death

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15
Q

what is mechanism of naltrexone?

A

opiate antagonist to decrease craving and amount drank during relapse

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16
Q

What is acamprosate?

A

balances glutamate and GABA to decrease craving and extend remission

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17
Q

pt w/ extreme agitation in ED with drool and nystagmus and high HR, no response to pain
likely dx?

A

phencyclidine PCP intoxication

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18
Q

Danger w/ PCP metab?

A

can have extreme swings of effects and behavior b/c of enterohepatic circulation

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19
Q

muscle rigidity and hyperacusis and violence can be seen w/ what intoxication?

A

PCP

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20
Q

vivid unpleasant dreams can be seen with what w/d?

A

cocaine/amphetamine w/d

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21
Q

Medication to use for acute opiate w/d? can add what for rapid detox?

A

clonidine every 4-8h, can add naltrexone 100mg for rapid detox

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22
Q

How does buprenorphine work? What two formulations

A

partial mu receptor agonist can be given w/ signs of w/d from opiates as:
Subutex sublingual OR suboxone unsupervised which also has naloxone in it

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23
Q

What is a major s/e of Chantix / Varenicline

A

serious neuropsych events, suicide, agitation, violence

its a partial nicotinic Ach receptor agonist

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24
BMI criteria for anorexia vs bulimia?
<17.5
25
when to hospitalize for eating d/o?
1. wt 40% below normal | 2. loss > 30lbs / 3 mo
26
FDA approved medication for bulimia (not anorexia)
SSRI Fluoxetine at higher doses for at least 1 yr
27
schizoid vs schizotypal PD?
schizoid: detached from social relationships and restricted range of emotions schizotypal: scute discomfort in close relationships, cognitive/perceptual disturbance, eccentricities
28
treatment for borderline PD?
dialectical behavioral therapy (version of CBT)
29
% of kids who still have ADHD sx in adulthood
60
30
academic skills and IQ of mild ID?
IQ 50-55-70 and academics to 6th grade
31
IQ and academic skills of moderate ID?
ID 35/40-50/55 and 2nd grade academics
32
most common preventable cause of ID?
fetal alcohol
33
gout, ID, and severe self injurious behaviors. DX?
Lesch Nyhans purine metab defect
34
CGG repeats
Fragile X
35
Visual change in elderly?
presbyopia (poor visual accommodation) and decreased acuity
36
Initial cognitive change in elderly?
visual memory declines before verbal | can't divide attention or do mental manipulation or timed tasks, or novel tasks
37
Length of time for an adjustment disorder
should be about 2 mos
38
Adjustment vs depression?
no major depression or anxiety | morale and self esteem good in adjustment d/o
39
Suicide in elderly?
increased rate and more deadly means
40
Factors to help ddx bereavement from depression?
pathological guilt, suicidal thoughts, psychomotor, functional impairment, hallucinations other than of deceased
41
most common anxiety d/o in elderly?
phobias
42
Neurological disorders likely to present w/ depression too (4)
1. stroke (50%) 2. dementia/AD (50%) 3. left sided lesions 4. Parkinson's disease (40%)
43
Old lady given too much benadryl needs what antidote/
physostigmine | too much anticholinergic, need cholinergic: cholinesterase inhibitor
44
Therapies that can be used in elderly?
1. Grief therapy: education about grief, monitoring | 2. reminiscence therapy: life story creation
45
Kubler Ross stages of grief
1. denial 2. anger 3. bargaining 4. depression 5. acceptance * dabda*
46
GAF when you become unable to work?
50 or below
47
superior, transient decreased functioning would give what GAF score?
80
48
Classical vs operant conditioning? (Conditioning = learning)
Classical: modified by antecedent (Pavlov - drool from bell; PTSD) Operant: modified by consequences (Skinner) - through reinforcing vs punishing consequences; contingency management
49
Classic example of negative reinforcement
to avoid nagging, kid does activity (Removal of aversive stimuli)
50
Main concepts of Cognitive-Behavioral Therapy
1. focus: on present goals, problem-solving 2. therapy: manualized / time limited 3. theory: a change in thoughts/behaviors will change emotions
51
Three examples of cognitive distortions?
1. all or nothing 2. overgeneralizing 3. catastrophizing
52
Two types of exposure therapy?
1. desensitization with slow increase of difficulty | 2. flooding: throw into most feared situation
53
Psychological defenses that are mature: name 4
1. humor 2. sublilmation: change libido to art 3. altruism 4. suppression
54
Neurotic defenses (5)
1. isolation of affect 2. displacement 3. reaction formation 4. intellectualization 5. denial
55
immature defenses (3)
1. regression 2. somatization 3. acting out
56
narcissistic defenses (4)
1. splitting 2. projection 3. projective identification 4. distortion
57
What is the name of a language-free intelligence test?
Leitner International Performance Scale: specialized IQ test
58
What is the flynn effect?
substantial and long-sustained increase in intelligence test scores
59
4 different achievement tests?
Weschler Individual Achievement Test (WIAT) PEabody Individual Achievement Test Woodcock Johnson III Test of Achievement Wide-range Achievement Test
60
2 Neuropsychological batteries for cognition?
1. Luria-Nebraska | 2. Halstead Reitan
61
What are good tests of attention?
continuous performance tests (Conners)
62
What are four good tests of memory?
1. Wechsler memory scale Auditory verbal learning test California verbal learning test Hopkins verbal learning test
63
What are 4 good language tests?
1. Test of Language Development (TOLD) 2. Peabody Picture Vocab Test - test of verbal comprehension only if can't talk 3. Boston aphasia diagnostic test 4. Western aphasia battery revised
64
How does the Peabody picture vocab test work?
pt points to picture most like the stimulus word read out loud by administrator (verbal comprehension only)
65
Great test for Executive function?
Wisconsin Card Sorting: assess learning, perseveration, set changes
66
What are projective tests and give 2 ex
test w/ ambiguous stimuli so that response reflects preoccupations 1. Thematic Apperceptive Test 2. Rorschach
67
Test used in malingering?
minnesota multiphasic personality inventory w/ 567 y/n questions w/ scales for faking "good", faking "bad", and defensiveness/evasiveness
68
Length of time to consider major depressive episode
at least 2 wks
69
what is the term for waxy flexibility
catalepsy
70
best tx for depression w/ melancholic features (poor mood reactivity, worse in AM, marked anhedonia)
TCA
71
post partum blues vs depression
blues: earlier | Depression w/in 4 wks, more severe
72
Risk of relapse after 1 major depressive episode
50%
73
adequate trial of antidepressant treatment?
4-8 wks at therapeutic dose
74
How long should you treat major depression
6-12 mos at full dose | continuation
75
Augmentation Strategies for Depression (MDD) 5
1. Lithium 2. T3 3. Aripiprazole 4. Quetiapine 5. Combination therapy: SSRI/SNRI + bupropion and mirtaz (Avanza/Remeron)
76
SSRIs and breastmilk
yes. Lowest rates with sertraline
77
?Long term behavioral effects with SSRIs in pregnancy
No
78
SSRI and pregnancy, what risks?
cardiac defects, peristent pulm hypertension, respiratory distress/LBW, neonatal abstinence syndrome
79
issue with MAOi and food?
tyramine foods have monoamine effects and can cause htn crisis
80
The black box warning on all antidepressants?
incr suicide (but none in studies) for pts < 24 yr
81
Contraindications for ECT?
No absolute. Relative: CV: recent MI, valve dz, CHF, vasc malformations CNS: incr ICP, recent stroke Pulm: COPD, PNA
82
What side lesions are more assoc w/ depression vs bipolar
left side: depr | right side: bipolar / mania
83
Medication to use for rapid cycling bipolar
Valproate 1500mg daily
84
What med is best for euphoric mania vs dysphoric/fixed/or rapid cycling mania?
euphoric: lithium others: VPA
85
What is a good antidepressant in bipolar that doesn't lead to mania?
Lamotrigine
86
Renal complication w/ Lithium and possible treatment?
DI (10%), try amiloride
87
Big drug interaction with Li/
many renal drugs incr level of Li (Diuretics, NSAIDs, ACEi, Angiotensin II antag
88
What d/o has highest suicide rate and what pop?
bipolar disorder | elderly
89
Neuro condition that can cause anxiety/panic?
TLE: thing of proximity to amygdala
90
TYpe of med: VEnlafaxine?
SNRI
91
Rate of Tourette's in OCD? | RAte of OCD in Tourettes?
Tourettes in OCD 5-7% | OCD in Tourettes: 35-50%
92
First line meds for OCD?
SSRIs, Clomipramine
93
MEdication that can be used to reduce PTSD nightmares?
Prazosin (alpha 1 antag)
94
acute stress disorder vs ptsd?
acute stress only in first month
95
GAD length of time criteria?
at least 6 mos
96
DElusional d/o vs schizophrenia?
delusional disorder is only non-bizarre thoughts/delusions
97
black box warning for antipsychotics?
increased all cause mortality in elderly
98
Antipsychotics with most weight gain?
clozapine and olanzapine
99
antipsychotics with most orthostasis?
chlorpromazine, clozapine, quetiapine
100
antipsychotics w/ most EPS?
high potency first generations and Risperidone
101
antipsychotic with most prolactin elevation?
risperidone
102
antipsychotic you need to take with food?
ziprasidone (ziplock bag: geodon)
103
antipsychotic with most akathisia/most activation?
aripiprazole: partial D2 agonist/antagonist
104
Antipsychotic with most concern for QT prolongation?
ziprasadone
105
CAuse of tardive dyskinesia?
dopamine receptor hypersensitivity
106
tx of NMS?
you basically have blocked DA too much, so you need more DA: Levo/carbidopa, Bromocriptine Dantrolene for muscle to prevent calcium release for rigidity
107
NMS vs serotonin syndrome major sx?
rigidity in NMS not serotonin syndrome
108
Timing of delusional disorder and tx?
>1 month usu don't respond well to teratment. Try CBT/antipsychotic meds

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