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Flashcards in Psych Deck (210):
1

Pathology in Korsakoff's

Hemorrhage + sclerosis in mammillary bodies, thalamic nuclei

Diffuse lesions in brainstem, cerebellum, limbic system

2

CBT vs SSRI in generalized anxiety discord (effectiveness)

CTB is as effective as SSRI

3

Rx of generalized anxiety

SSRI: paroxetine, escitalopram

SNRI: duloxetine, venlafaxine

4

SSRI/SNRI vs Benzo vs Buspirobe for generalized anxiety

SSRI/SNRI more effective

5

Defense mechanism in borderline personality

Splitting

6

Alzheimer's develops psychotic Sx (hallucinations / delusions)

Anti-psychotics

Risperidone

7

Dx borderline personality

5/8:
- impulsive
- unstable relationships
- anger
- moody
- self-damage act
- can't accept loss
- emptiness
- Boredom

8

Cocaine intoxication Sx

Sympathetic (tachycardia, HTN, sweating, mydriasis)

+/- paranoia, psychosis

9

Freud's psychosexual development

1. Oral phase:
0-18 mo
Stimulating mouth
Put anything in mouth

2. Anal phase:
18-36 mo
Pleasure in anal area
Control bowels


3. Phallic phase:
3-6 yr
Manipulation of genitals = 1ry source of pleasure.


4. Latency phase:
6- puberty
Connections to siblings, other children/adults

5. Genital phase:
> puberty
Relationship w/ opposite sex
Focused on genital area

10

SE of haloperidol (48hr)

Rx?

Acute dystonia (torticollis)
It's reversible EPS
Due to DA blockade at nigrostriatial


Rx with benzotropine

11

Non-pharm Rx of insomnia

CBT to change believes, techniques, attention shift

12

Amphetamine toxicity.

High DA + NE
Hallucinations + delusions
Paranoia
Low appetite
Activity w/ fatigue

13

Conversion disorder population

Women
Histrionic personality
Sexual abuse

14

Conversion disorder

Lack of concern regarding extreme decline in health.

Start suddenly after stress and ends suddenly

Not produced intentionally

15

Population at risk of suicide

Elderly white men
Single
Unemployed , low income
Mental illness
Hx is abuse (sexual / physical)
Hx of suicide thoughts
FHx of suicide attempts

16

Schizophrenia
Schizophreniform
Brief psychotic
Schizoid personality
Schiozoaffective

Schizophrenia = 6 mo
Schizophreform = 1-6 mo
Brief psychosis = < 1 mo
Schizoaffective = psychosis + mood
Schizoid PD = social withdrawal + no desire for relationships

17

What's discontinuation syndrome

After stopping SSRI
Anxiety
Influenza like
Diarrhea + GI upset
Insomnia, hyperarousal, lightheaded
Vertigo, tremor, paresthesia

Lasts 7 days if stop SSRI after 6wk use.

18

T/F: adults w/ ADHD impulsive + hyperactive as compared to kids

F

19

Patient w/ anorexia
Sever dehydration + orthostatic hypotension + electrolyte imbalance?

- Would you search pt belongings? Why?
- Confirm she's on Rx (contact professionals)

Yes!

Pts w/ eating disorders use laxative & diuretics

Facility must be informed to look for contraband.

20

What's Cognitive behavioral Rx?

Recognize + correct false self-beliefs

21

What's dialectical behavioral Rx?

Part of psychoanalysis/psychodynamic Rx that

Teach patient to analyze what leads up to a problem and identifies alternatives.

22

Rx of Tourette's

Anti-DA
Clonidine
Pimozide

23

Types of delusions
1. Nihilism
2. Persecutory
3. Grandeur
4. Somatic
5. Reference

1. Nihilism = belief that aspects of life are meaningless or non-existing
E.g. Going to work is pointless b/c world is coming to an end
Or no one is real or arm is dead

2. Persecutory = others trying to harm him

3. Grandeur =inflated sense of self

4. Somatic = belief they have physical defect / disease.
My brain is melting

5. Reference = publicly known figures refer to him directly

24

Percentage of smokers succeed in quitting

2-3%

25

T/F: genetics influence smoking persistence

T

26

What neuro system involved in reinforcing effect of nicotine

Mesolimbic

27

Percentage of population that experiment w/ smoking

55%

28

Hallmark of PCP (phenocyclidine) intoxication

Rotary nystagmus

29

Dx psychogenic seizure

Video-electroencephalograph VEEP

30

Cyclothoymia vs dysthymia

1. Cyclo: hypomania + mini depressive Sx for 2 years


2. Dysthymia: persistent mild depression

31

Hypnagogic vs hypnopompic hallucinations

Hypnoagogic: during sleeep


Hypnopompic: waking up

32

DOC delirium tremens

IV benzo (lorazepam

Use IM if > 65 YO

33

DOC panic disorder

SSRI

34

Involuntary admission?

1. Mental illness needs inpatient care
2. Danger to safety of patient or others.

35

Tourette associated w/?

OCD
ADHD

36

What's sublimation

Transform negative emotion to positive action

37

T/F: imipramine has sigmoidal relationship b/w plasma level and response

T

38

T/F: nortriptyline has sigmoidal relationship b/w response and level

F = Curvilinear

39

MOA of MAOi

Stop degradation of monoamine transmitters and increase their levels

(Serotonin, norepi, dopamine)

40

MOA of typical antipsychotic

Risperdione + clozapine

Dopamine antagonist

41

SE of clozapine (typical antipsychotic)

Agranulocytosis

42

Risk for delirium in hospitalized pts

Vision / hearing impairment

43

Panic disorder associated w/

Depression
Anxiety
Agoraphobia

44

Asthma + social phobia

SSRI

45

When to stop antidepressants

3 month for Rx
6 mo after Rx maintenance

46

Bipolar on lithium develops hypothyroidism

Start replacement
Don't stop lithium

47

Limbic system dz

Emotional disturbance

48

How Dx alcoholism

Ask about problem by alcohol

49

MAOi

Phenelzine
Tranylcypromine

50

Serotonin syndrome Sx

Anxiety + agitation + restless

HTN, tachy, fever, sweat, shiver


Hyperreflexia, tremor, rigidity

51

Rx serotonin syndrome

Stop all med
+/- benzo if anxious and agitated


+/- Cyproheptadine

52

SSRI + tramadol = ?

SSRI + tramadol = serotonin syndrome

MAOi + tamadol = serotonin syndrome

53

Maintenance drugs for bipolar

Lithium
Lamotrigine
Aripiprqzole
Olanzapine

54

Child with ADHD has future risk of

Social withdrawal
Substance abuse
Accident proneness
Normal adult functioning

55

T/F: D/C SSRIs ass. w/ high rate of relapse

T

56

Signs of marijuana abuse

Fatigue
Lethargy
Somnolence

57

What's reaction formation

Coining extreme opposite

58

Autism spectrum disorder

Repetitive behavior + normal language

59

Absolute contraindication to electroconvulsive Rx

None
Relative = recent cerebral hemorrhage, ICP

60

T/F: 2/3 of suicide death at 1st attempt

T

61

T/F: risk of suicide is higher in blacks

F: whites

62

Are SSRIs save in kids?

Yes 8-18 Yrs

63

SE of long term lithium

Nephrogenic DI

64

T/F: electroconvulsive therapy causes irreversible memory loss

F: reversible

65

Depression on SSRI => agitation , insomnia , sexual SE?

Rx with Mitrazpine = helps sleep , no agitation , rarely sexual. Helps appetite


NB: bupropion cause agitation!

66

Labs w/ lithium

Renal + thyroid

67

Akathisia

Motor restlessness
SE of anti-psychotics

68

Rx of neuroleptic syndrome

D/C med
Dantrolene
+/- bromocriptine
+/- amantadine

69

MOA of resperidone + SE

Dopamine D2 receptor blocker

High prolactin

70

T/F: phenelzine interacts with st Johns wort and

T
Levels become unpredictable

71

Anti depressant worsen HTN

Venlafaxine

72

Damage to parietal lobes (Rt + Lt)

Rt = contralateral hemi-neglect , dent deficit (anosagnosia)


Lt = Gerstmann's syndrome = Rt-Lt confusion, can't write, bad math

73

How to prevent benzo dependence

Use for short time

74

How are Atypical antipsychotics better than typical?

Cause less tardive dyskinesia

75

Sx suggestive of major depression

Withdrawal from family

76

T/F: anorexia nervosa causes:
Bradycardia
HTN
Parotid gland
Atropine breast
Dental caries

T
F
T
T
T

77

MC SE of TCA?

Dry mouth

78

What neurotransmitters decreased in depression

Serotonin
NE
Dopamine

79

Mature defense mechanisms

In healthy adults:
1. Altruism = service to others to experience empathy.

2. Anticipation = palming for future discomfort.

3. Asceticism = deny pleasure from experience.

4. Humor = express feelings in comic way

5. Suppression = postpone attention to impulse.

80

Neurotic defenses

1. Control = manage events to reduce inner conflicts.

2. Displacement = shift emotions

3. Externalizations = attribute personal matters to external world.

4. Inhibition = limit function to avoid anxiety.

5. Intellectualization = intellectual processing to avoid experiencing affect.

6. Isolation = separate Sth from associate affect.

7. Rationalization = rational explanation to justify action

8. Dissociation = modification of sense of self

9. Reaction formation = transforming unacceptable impulse into opposite

10. Repression = remove idea from conscious

11. Sexualize = bestowing sexual importance to objects

81

Immature defense

1. Acting out = impulsive action.

2. Block = block thought / impulse

3. Hypochondriasis = exaggerate illness to avoid situations.

4. Introjection = victim identity w/ aggressor

5. Passive-aggressive

6. Regression

7. Somatization = unconscious expression is psychotic pain in physical Sx.

82

Psychotic defense

Denial = replace reality w wishes.

Distortion = reshaping reality

Projection =

83

Is bupropion used in panic attacks? Why?

No.
stimulating effect

84

Drugs contraindicated with lithium

Thiazides
ACEI
NSAIDs

85

Antipsychotic causes high glucose

Olanzapine
Clozapine

86

What antipsychotic cause withdrawal if stopped abruptly?

Venlafaxine (?) short half life and rapid clearance if D/C

87

Mood stabilizers used in maniac episodes

Lithium
Valproic acid
Carbamazepine

88

Monotherpay induces mania in Bipolar

Fluoxetine

89

What's Tarasoff decision

Inform authorities when patient show intent towards a person

Keep patient in office till safe disposition is made

90

Neurotransmitter in OCD?

Serotonin

91

How to shift safely from MOAi to SSRI

Allow for 2 wk wash out period between stopping MOAi and starting SSRI

92

T/F: repeated episodes of alcohol withdrawal increase risk of future Sx?

T

93

Milieu therapy

Inpatient Rx
Use hospital environment as therapeutic intervention.

94

SE of olanzapine

High TG
Agranulocytosis
Dry mouth (xerostomia)
Tardive dyskinesia

95

Panic disorder + BPH

No TCA
Use SSRI

96

Addiction vs pseudo-addiction

Pseudo is how patients behave when pain is under treated and resolve completely when pain is effectively Rx.

97

What schizophrenic Sx respond well to anti psychotics

Positive Sx
Delusions
Hallucinations
Disorganized speech

98

T/F: antipsychotic don't cause urinary incontinence

T

99

MAOi contraindicated with what food

Aged cheese
Aged wine

High Tyramine

100

1st line in ADHD

Methylphenidate
Dextroamphetamine
Pemoline

101

Does ADHD cause intellectual disability

No

102

Psychotherapy for panic disorder

CBT

103

Cause of seasonal affective

Serotonin

104

Melatonin in seasonal affective

Worsens Sx

105

SE of methylphenidate in ADHD

HTN
Tachycardia
Insomnia
Headache
Anxiety
Growth suppression

106

MCC of delirium

Dementia

107

SE of antipsychotic + Rx

1. Parkinsonism
Tremor, Bradykinasia, micrographia
Rx: low dose, shift to atypical, anti-cholinergic

108

Anticonvulsant for mania

Valproic acid

Carbamazepine

109

When dose delirium termens start + how long last

Start 3-7 days after stopping

Last 7-10 days

110

% of alcoholic develop DT

Death from DT

5%

Death 35% if untreated + 5% of Rx

111

Pacing in Alzheimer's not Rx with anti cholinesterase

No additional Rx

112

Deal with paranoid patient

Explain diagnosis + Rx in details

Professional not too friendly

113

Piaget's Stage of cognition

1. Sensorimotor 0-2 Yrs
Explore via sensation + motor contact
Separation anxiety


2. Pre-operational 2-6
Symbols (words + images)
No logics
Pretend
Egocentric

3. Concrete operational 7-12
Logical about concrete objects
Add + subtract
Understand conversation

4. Formal operational >12
Reason abstractly
Hypothesize

114

What's schizophrenia drift

Schizophrenia patient move to cities + become urban poor


It's not urban poor that cause the disease it's where patients end up

115

What's biopsychosocial

Approach patient in biological psychological social manner

116

Drugs cause depression (15)

Isotretinoin
Alcohol
Disulfiram
Anticonvulsant: Metho + ethosuximide
Barbiturates: phenobarb + secobarb
Benzo:
BB: metoprolol, atenolol, carvedilol
Bromocriptine
CCB
Estrogen HRT
Fluoroquinolones
Interferon-alpha
Opioids
Statins
Acyclovir

117

Triad in Tourette's

Tourette's
OCD
ADHD

118

Tourette's population

Males (9x more )

119

Rx Tourette's

Alpha2-adrenergic = clonidine (less efficacy, less SE)


Dopamine antagonist: Haloperidol + pimozide (more effective, more SE)

120

Cardiac side effect of anti-psychotic

QT prolongation
Torsades de pointes

121

Anti-psychotics cause hypertensive encephalopathy

TCA + MAOi
Tyramine + MAOi

122

How to safely shift from one antipsychotic to another

Gradual reduction in dose of 1st drug then overlap with the 2nd drug before completely stopping the 1st one.

123

Rx of seasonal effective

early morning light therapy

124

T/F: Mania could be a Sx of MS

T

125

Is stammering ass with conversion disorder

No

126

Premenstrual dysphoric disorder Rx

Mood disorder
Fatigue
Insomnia
During luteal phase lead to missing work.

Rx: SSRI

127

Trazodone sexual SE

Priapism

128

Rx of bulimia

SSRI esp. fluoxetine

129

Tardive dyskinesia high risk population

Females
Older age
Hx or FHx of mood disorders or affective disorders.
Multiple antipsychotics

130

How to deal with borderline personality clinic setting

Maintain caring but detached stance.

Combine conflict resolution + social learning to minimize aggression

Be constantly available on phone

Frequent visits to monitor and provide support.

131

When explaining to borderline personality;
1. Detailed + technical
2. Simple + clear + non technical

Simple

132

Do you prescribe drugs for borderline? Why?

No
Use it to self-harm themselves.

133

Drug contraindicated with MAOi (analgesics)

Meperidine
Tramadol

134

Goal of Rx in anorexia nervosa

Prevent death from malnutrition

135

DOC in alcohol withdrawal

Short-acting benzo (liver impairment = short)

136

Smoking withdrawals

Impaired concentration
Longing for cigarette
Headache
Insomnia
Irritability
Inc. appetite

137

TCA poisoning

Sx in 2 hrs.
Palpitations + chest pain
Low BP
Altered LOC
Resp. depression => acidosis + low O2

138

Drugs cause mania

Definitive:
Levodopa
Steroids + anabolic steroids
MAOi
TCA

Risky:
Benzo
Amphetamine
Cimetidine
Captopril
Thyroxin
Methylphenidate

139

Psychiatric disease with T1DM?

Adjustment disorder + MDD

140

Rx of delirium in ICU

IV haloperidol increase dose q3min

141

Rx of social phobias

SSRIs

142

Anti depressant doesn't cause weight gain

Bupropion

143

Anti depressant cause weight gain

Mirtazapine > SSRIs (paroxetine > fluoxetine)

144

% of elderly with depression

20% in community
40% in nursing homes

145

T/F: TCA contraindicated in elderly

True cause postural hypotension + falls.

146

What's transvestism

Dressing and acting in manner of opposite sex

147

When does transvestism start?

Common in M or F?

Do they seek help?

Starts late childhood

M > F

Don't present for Rx

148

SE of amphetamine for ADHD

Transient insomnia + weight loss

149

Bipolar 1 vs 2

1: mania + depression

2: hypomania + depression

150

What's not considered conversion according to DSM 5

Sx limited to pain or sexual dysfunction

151

OCD risk in monozygotic twins?

Negligible

152

OCD more in M or F?

F (adults + kids)

153

Shortest half life benzo?

Alprazolam (xanax) 12 hrs.

154

Body dysmorphic asso

OCD
Social phobia
Delusional disorder

155

SSRI in elderly

Risk of falls

156

Activated charcoal helps in 90% of toxins except?

Iron
Lithium
Fluoride
Cyanide
Alkali

157

Sleep terror vs nightmare

Sleep terror = can't remember nightmares

Nightmare = remember

158

Anxiety vs OCD

Compulsions in OCD only.

159

MC neuro SE of SSRI

Insomnia > headache

160

What personality doesn't learn form experience + or feel guilt

Antisocial

161

Atypical depression Sx

Worst in morning and better at evening (diurnal variation in mood)

162

When is MAOi DOC?

Atypical depression

163

Rx of serotonin syndrome

Cyrproheptadine

164

Sleep abnormality in depression

Decreased REM latency

165

What's paraphilia? Example

Sexually arousing fantasies

Fetishism
Exhibitionism
Sexual sadism
Transvestism

166

T/F: Homosexuality is not paraphilia

T

167

MC endocrine SE of lithium

Hypothyroid > DI

168

Bupropion is contraindicated in?

Anorexia / bulimia
Seizures
Alcoholism

169

Hallucinations in narcolepsy

At sleep (hypnogogic)
On wakening (hypnopompic)

170

How to establish rapport?

Ask about feelings

171

How do disulfiram + Naltrexone work in alcoholism

Disulfiram = accumulates acetaldehyde


Naltrexone = decrease cravings

172

In bipolar when does mania recur if lithium stopped

6 mo

173

Most effective mono therapy in alcoholism

Chlordiazepoxide

174

Risk of schizophrenia in monozygotic

40%

175

Anti depressant avoid in anorexia nervosa

MAOi (phenelzine)
dietary restrictions

176

T/F: lanugo hair in anorexia

T

177

Donepzil SE

Arrhythmia needs pacemaker

178

Rx of sducidal ideation

Hospital admission

179

What overdose is more fatal?
Benzo or amitriptyline

TCA > benzo

180

T/F: opiates cause constricted pupils

True
Opiates: heroine, hydrocodone, oxycodone, hydromorphone, oxymorphone

181

Atypical cocaine dependence

Mood swings
Snorting (inflamed nares : big turbinates)
Paranoia

182

Dr reminded of relative by a patient?

Countertransference

183

Patient sexually attracted to Dr

Transference

184

T/F: Depression in kids presents as antisocial behaviors

T

185

T/F: kids with depression will have schizophrenia as adults

F

186

Psychosis + Parkinson's Rx

Atypical antipsychotics: queitapine + clozapine

187

OBGYN SE of antipsychotics

Typical antipsychotic (risperidone)
Block dopamine = high prolactin = amenorrhea, infertility, galactorrhea

188

Criteria for somatic symptom disorder

Somatic Sx
Excessive thoughts ass. with the Sx
=> seriousness of Sx
=> anxiety about general health
=> time + energy to figure out Dx

189

Rx of narcolepsy

Methylphenidate

190

Childhood gender identity disorder starts at? How?

Age 2
Kids cross-dress + opposite gender games
Hate their genitals

191

Bupropion in panic disorder

Not effective

192

Drugs for methamphetamine dependence?

None affective
Cognitive Rx only

193

School phobia vs truancy

Truancy: leave home but skip school

Phobia: Sx every morning disappear at weekends

194

Agitated with Hx of dystonia

Benzo vs haloperidol

Benzo

195

Benzo with shortest elimination half life

Triazolam

196

Flooding vs grader exposure Rx in phobia

Flooding: exposed and asked to reintegrate the subject, and remain there till anxiety resolve


Exposure: showing picture then going there

197

Capgras syndrome in psych

Patient thinks person replaced by exact double that acts exactly like original

198

Rx PTSD (psych)

SSRI
Benzo (acute)
Atypical antipsychotics (quetiapine, olanzapine, risperidone)

199

To diagnose adult ADHD
When should Sx start?

Since childhood

200

Earliest SE of lithium

Tremors

201

Valproic acid vs carbamazepine in bipolar

Valproate for maniac episodes


Carbamazepine if multiple maniac episodes, mixed or rapid cycling

202

Which SSRI doesn't cause D/C syndrome

Fluoxetine

Bcz long 1/2 life of 4-6 days

203

ID, Ego, superego

ID:
Since birth
Unconscious = primitive + instinctive

Ego:
Based on reality
Satisfied ID in realistic ways

Superego:
Morals + standards
Acquired from parents, society and sense of right.

204

Drug not helpful in tardive dyskinesia

Haloperidol

205

Vitamin E in tardive dyskinesia

Short duration of benefit

206

Metabolic SE of valproate

High ammonia due to low carnitine

Dx. Replace carnitine

207

Insomnia in depression on SSRI

Trazdone or zolpidem

208

Delirium tremens in >65 Rx

Short acting benzo (lorazepam)

209

Cough / URTI drug causes serotonin syndrome if used with SSRIs

Dextromethoephan

210

Level of intellectual disability:
Symbolic communication
Understand gesture + emotions
Express non verbally

Profound