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Psych Flashcards

1
Q

What is the best predictor of complications in TCA overdose?

A

QRS duration:
>100msec –> inc risk of arrhythmias, seizures, give NaBicarb

*seizures can occur in TCA overdose

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2
Q

Indications for ECT (5)

A
  1. treatment resistant
  2. psychotic features
  3. emergency conditions:
    - -pregnancy
    - -refusal to eat or drink
    - -imminent risk for suicide
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3
Q

drug interactions w/ lithium that can cause toxicity (4)

A
  1. thiazides
  2. NSAIDs (not aspirin)
  3. tetracyclines
  4. metronidazole
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4
Q

PCP (phencyclidine) intoxication

A 
hallucinations
**nystagmus 
dissociative feelings
agitation
confusion
pupil dilation
tachy
\+/- psychotic and violent behavior 
\+/- severe HTN
\+/- hyperthermia
Duration: 8 hours
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5
Q

acute intermittent porphyria

A

intermittent neurovisceral symptoms **abdom pain (non tender on exam)
neuro/psych abnormalities
elev urine porphobilinogen

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6
Q

nightmare disorder vs sleep terror disorder

A

nightmare disorder: night awakenings, recall of disturbing dreams, consolable , nightmares during REM and usually in second half of night

sleep terror disorder: non-REM arousal disorder, incomplete awakenings, inconsolable, no recall of dreams, usually in first 1/3 of night, autonomic arousal and amnesia in the AM

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7
Q

adjustment disorder timeline

A

wishing 3 months of stressor
lasts no longer than 6 months
**dont meet criteria for other disorder

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8
Q

neuroimaging for schizophrenia, Huntington’s, autism, OCD

A

schizophrenia: loss of cortical tissue V, vent enlargement *lateral, dec V of hippocampus, dec V of amygdala
Huntington: caudate atrophy
Autism: accelerated head growth during infancy, inc total brain V
OCD: structural abnorm in Orbit-frontal cortex and basal ganglia

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9
Q

treatment for catatonia?

A

benzo: lorazepam

ECT

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10
Q

echopraxia

A

imitating mvmts

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11
Q

echolalia

A

imitating speech

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12
Q

neologisms

A

made up words

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13
Q

clang associations

A

rhyming and punning *hip hop-esque

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14
Q

perserveration

A

inability to change the topic; giving the same response to different Qs

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15
Q

agnosia

A

inability to recognize people or objects even w/ intact sensory fxn

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16
Q

synesthesia

A

sensation of one modality perceived by another (e.g. seeing sounds)

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17
Q

psychosis exacerbating drugs (4)

A
  1. BB
  2. digoxin
  3. steroids
  4. anticholinergics
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18
Q

SCZ pathophys

A

+ sxs: inc DA in mesolimbic
- sxs: dec DA in prefrontal cortex
inc 5HT, NE
dec GABA, glutamate

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19
Q

substances that can induce mood d/o (5)

A 
BB (depression)
steroids
levodopa
cocaine (mania)
OCP (depression)
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20
Q

MDD risk factors (4)

A

stroke
pancreatic cancer
loss of parent before 11
genetics

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21
Q

MDD brain

A

reduced frontal lobe blood flow and metabolism

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22
Q

mania in pregnancy tx

A

*atypicals

if h/o postpartum mania –> Lithium ppx (c/I to breastfeeding)

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23
Q

tx for rapid cycling disorder

A

(4+ mood episodes in 1 year)

tx = carbamazepine

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24
Q

anxiety NTs

A

inc NE

dec GABA, 5HT

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25
Q

anxiety 2/2 GMC (5)

A
  1. hyperthyroidism
  2. Sjogren syndrome
  3. PE
  4. pheo
  5. seizure
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26
Q

OCD tx

A
  1. SSRI - fluvoxamine
  2. Clomipramine (TCA)
    last resort: ECT, cingulotomy
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27
Q

antisocial PD tx

A

SSRI and mood stabilizers help reduce aggression

psychotherapy useless

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28
Q

ETOH + H2 blockers –> ?

A

inc ETOH levels

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29
Q

barbiturates OD tx

A

IV NaHCO3

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30
Q

GHB

A

aka: sodium oxybate
CNS depressant, date rape drug
tx for cataplexy

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31
Q

inhalants

A

CNS depressants

tx: some need chelation

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32
Q

MDMA/MDEA(ecstasy) + SSRI –> ?

A

Serotonin syndrome

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33
Q

caffeine

A

adenosine antagonist + PDE blocker –> inc cAMP

OD: tinnitus, agitation, arrhythmias, seizures, death

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34
Q

demerol

A

opiate
pupil dilation, resp depressions, sedation, dec pain, dec GI motility
+ MAOI –> Serotonin syndrome

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35
Q

opioid withdrawal tx

A 
CLIP
clonidine
loperamide
ibuprofen 
promethazine

add methadone or buprenorphine if severe

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36
Q

PCP intox labs

A

+UDS 3-8 days
inc CPK
inc AST

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37
Q

chronic MJ use

A

resp sxs + gynecomastia

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38
Q

dronabinol

A

THC in pill used to treat anorexia *AIDS, cancer

39
Q

AD brain

A

diffuse atrophy w/ enlarged vent and flattened sulci
senile and neural plaques
neurofibrillary tangles

40
Q

levy body dementia

A

lewy body and neurotic accumulations in basal ganglia

sxs: Parkinsonism, VH
tx: AChE inh, antiparkinsonians, psychostimulants for motor sx

41
Q

what do antipsychotics do in Parkinson’s?

A

exacerbate dementia

42
Q

prader willi syndrome

A

partial deletion of chromo 15q –> MR
obesity
almond eyes
hypogonadism

43
Q

coprolalia

A

repetitive speaking of swear words

44
Q

Tourette etiology and tx

A

impaired DA regulation in caudate nucleus
tx: risperidone, alpha2 agonist (clonidine, guanfacine)
typical antipsychotics if sever

45
Q

abreaction

A

strong reaction pts get when retrieving traumatic memories

46
Q

dissociative amnesia

A

can’t recall personal info but can remember obscure details, aware that they can’t remember
TX: psychotherapy
lorazepam or amobarbital may help patient talk freely during interview

47
Q

depersonalization disorder tx

A

anxiolytics or SSRI

48
Q

ataque de nervios

A

Puerto rican culturally bound trance disorder that consists of convulsive mvmt, fainting, crying, visual probs

49
Q

ganser syndrome

A

giving approximate answers to simple Qs (e.g. how many legs do you have)

50
Q

intermittent explosive d/o dx and tx

A

dx: dec 5-HIAA in CSF

tx; SSRI + lithium + propranolol

51
Q

anorexia lab values

A

inc: cortisol, QTc, chol, BUN, GH
dec: RBC, WBC, LH/FSH, E/T, T4/T3, glucose

52
Q

refeeding syndrome

A

fluid retention and low Ca/Mg/Ph –> RADS (resp fail, arrhythmias, delirium, seizures)

53
Q

bulimia labs

A

contraction alkalosis
inc BUN, bicarb, amylase
abnorm T4/T3, cortisol

54
Q

sleep EEGs

A 
BATS Drink Blood
beta (awake)
alpha (resting)
Theta (I)
Sleep Spindles and K Komplexes (II)
delta (III)
beta (REM)
55
Q

narcolepsy etiology and tx

A

loss of hypothalamic neurons that contain hypocretin

tx (as needed): sleep hygiene, scheduled naps, stimulants for daytime, sodium oxybate (GHB) for cataplexy

56
Q

Kleine Levin syndrome

A

excess daytime sleepiness, aggression hyperplasia, hyper sexuality

57
Q

substance induced sexual dysfunction

A 
anti HTN
anticholinergics
antipsychotics
antidepressants
substance abuse
58
Q

premature ejaculation tx

A

SSRI or TCA can help

59
Q

frotteurism

A

sexual pleasure from touching/rubbing up on non consenting person

60
Q

sublimation

A

satisfying impulses/feelings in an acceptable manner

61
Q

suppression vs repression

A

suppression: consciously avoiding unacceptable impulse/emotion
repression: unconsciously avoiding unacceptable impulse/emotion

62
Q

reaction formation

A

doing the opposite of unacceptable impulse/emotion

63
Q

displacement vs projection vs transference

A

displacement: redirecting thoughts/feelings about one thing onto something more tolerable
projection: attributing ones inappropriate emotions/thoughts onto another person
transference: patient projects unconscious feeling onto doctor

64
Q

isolation of affect

A

separation of unpleasant idea from the feelings it evokes

65
Q

serotonin syndrome tx

A

cyproheptadine
benzo
*avoid taking w/in 5 wks of each other

66
Q

CYP inducers and inhibitors

A

inducers: smoking, carbamazepine, barbiturates, st john’s wort
inhibitors: fluvoxamine, fluoxetine, paroxetine, duloxetine, sertraline

67
Q

teratogenic psych meds

A

TCAs: fetal limb defects
VPA
lithium
Benzos: cleft palate + FAS facies

68
Q

longest and shortest half life SSRIs

A

longest: fluoxetine
shortest: Paroxetine

69
Q

chlorpromazine and thioridazine adverse effects

A

(low potency first gen antipsychotics)
anti-HAM, less so EPS and TD
chlorpromazine: corneal pigmentation, photosensitivity
thioridazine: retinal pigmentation –> night blindness

70
Q

ziprasidone and eating

A

food is required to activate ziprasidone in the body

71
Q

lithium overdose: when to do dialysis?

A

if Li >4.0

72
Q

benzos not metabolized by liver (3)

A

LOT
lorazepam
oxazepam
temazepam

73
Q

long vs short acting benzos

A

long: diazepam, clonazepam
intermediate: alprazolam, lorazepam, oxazepam, temazepam
short: triazolam, midazolam *medical/surgical uses

74
Q

barbiturates OD tx

A

sodium bicarb

75
Q

memantine

A

NMDA blockers used for moderate to severe Alzheimers

76
Q

ECT c/I (2)

A

recent MI

any possible/recent hemorrhagic stroke (inc ICP, aneurysms, bleeding d/o, BBB disruption)

77
Q

parens patriae

A

protecting citizens that can’t care for themselves

78
Q

circumlocution

A

substations of word or description for a word that can’t be recalled

79
Q

verbigeration

A

repetitive, meaningless talking

80
Q

glossolalia

A

ability to speak a new language suddenly

81
Q

koro

A

asian pt believes his penis is shrinking and will disappear causing his death

82
Q

amok

A

sudden unprovoked outburst of violence
*to run amok
person has no recollection
*Asian

83
Q

sangue dormido

A

Portuguese d/o with numbness, tremors, paralysis, convulsions, stroke, heart attack

84
Q

dhat

A

anxiety and illness anxiety about semen discharge

85
Q

windigo

A

NA d/o

possession by a demon that murders and eats human flesh

86
Q

capgras syndrome

A

delusion that family and friends have been replaced by identical imposters

87
Q

lycanthropy

A

delusion that one is a werewolf or other animal

88
Q

cotard syndrome

A

delusion that one has lost everything, including internal organs

89
Q

Kluver Busy syndrome

A

bilateral amygdala lesions –> docility, hyperplasia, hypersexuality, disinhibition

90
Q

NE, 5HT, DA, ACh synthesis locations

A 
NE = locus seules
5HT = raphe nucleus
DA = substantia nigra
Each = nucleus accumbens
91
Q

MDMA/ecstasy/molly intoxication

A

synthetic amphetamine w/ hallucinogenic properties
–> inc NE, DA, 5HT
inc sociability, empathy, sexual desire
HTN, tachy, hyperthermia, serotonin syndrome, hyponatremia, death
*not detected on routine tox screen

92
Q

sudden onset of psychosis in child/teen

A

think medical or substance cause

  • SLE
  • thyroiditis
  • metabolic/electrolyte disorder
  • CNS infection
  • epilepsy
93
Q

SLE and neuropsych

A

arthralgia + psychosis (can also cause depression, anxiety, mania)
thrombocytopenia, hematuria, proteinuria
seizures, headaches, periph neuropathy, stroke, chorea
+ANA, anti dsDNA, anti smith, anti U1 ribonucprotein

94
Q

anorexia nervosa tx

A

CBT
nutritional rehab
olanzapine for severe cases
hospitalization if medically unstable (signs of dehydration, HR <40, hypotension, hypothermia, cardiac dysrhythmias, electrolyte disturbance, liver or heart failure, seizures, pancreatitis, syncope, very low weight-<70% expected

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