Psych Flashcards
(93 cards)
1
Q
Most common cause on intellectual disability
A
Fetal alcohol syndrome
2
Q
Most common genetic causes of intellectual disability
A
Down and Fragile X
3
Q
Deficits in Autism spectrum disorders
A
Social interactions, behavior, and language
4
Q
ASD is also with which perinatal infections?
A
Rubella and CMV
5
Q
ASD patients have a higher incidence of …
A
abnormal ECG, seizures, and abnormal brain morphology
6
Q
Which drugs are approved for tx of irritability in ASD?
A
Risperidone and aripiprazole
7
Q
ADHD is asso w lower levels of …
A
dopamine
8
Q
Disruptive mood dysregulation disorder (DMDD) features
A
Chronic, severe, persistent irritability with temper outbursts and angry, irritable, or sad mood between outbursts. Should not be dx’ed before age 6 or after 18.\
9
Q
Intermitten explosive disorder features
A
not aggressive on a continuous basis; periods of good behavior
10
Q
Tourette disorder is asso w what other psych disorders?
A
ADHD and OCD
11
Q
MDD is asso w decreased levels of …
A
NE, 5HT, and DA
12
Q
How is sleep affected in MDD?
A
Decreased REM latency, increased REM
13
Q
Tx of depression + neuropathy
A
Duloxetine (an SNRI)
14
Q
Tx of depression +/- fear of gaining weight / sexual s/e’s +/- desire to quit smoking
A
Bupropion
15
Q
Tx of depression + insomnia + decreased appetite
A
Mirtazapine
16
Q
Bipolar disorder is asso with increased levels of…
A
NE and 5HT
17
Q
Bipolar disorder type I features
A
Mania (>1 week, affects function, warrants hospitalization) + depression
18
Q
Bipolar disorder type II features
A
Hypomania (<1 week, does not severely affect function) + depression
19
Q
Tx of acute mania
A
Lithium and valproate, may use atypical antipsychotics (e.g. quetiapine) and anticonvulsant lamotrigine
20
Q
Tx if acute mania + severe sxs
A
Use atypical antipsychotics (quetiapine) d/t shorter onset of action
21
Q
Tx of mania in pregnancy
A
Lurasidone, risk of fetal EPS in third trimester
22
Q
This is never a correct answer on STEP 2
A
refer to psych
23
Q
Persistent depressive disorder timing
A
> 2 years
24
Q
Cyclothymic disorder features and tx
A
Hypomanic episodes + mild depression, >2 years, tx w lithium, valproate, antipsychotics, or psychotherapy
25
Tx of major depressive disorder with seasonal pattern
phototherapy and bupropion or SSRI
26
Seasonal affect disorders so with abnormal...
melatonin metabolism
27
Duration of postpartum blues or "baby blues"
birth to 2 weeks
28
Duration of depressive disorder with peripartum onset
within 1-3 weeks after birth
29
Duration of bipolar disorder with peripartum onset and brief psychotic disorder with peripartum onset
during pregnancy up to 4 weeks after birth
30
Bereavement duration
typically lasts less than 6 mo to 1 yr
31
Litium s/e's
tremors, weight gain, GI disturbance, nephrotox, diabetes insidious, leukocytosis, teratogenic
severe tox: confusion, ataxia, lethargy, abnormal reflexes
32
Valproate s/e's
Tremors, weight gain, GI disturbance, alopecia, teratogenic, hepatoxicity (elevated LFTs). Must monitor levels of the drug. Tox: hyponatremia, coma, death.
33
Serotonin syndrome unique feature and tx
Neuromuscular irritability (hyperreflexia and myoclonus); strop the medication and give cyproheptadine (serotonin antagonist)
34
Neuroleptic malignant syndrome unique feature and tx
Rigidity; most important intervention is d/c'ing the offending drug and if refractory use dantrolene or bromocriptine
35
Brieft psychotic disorder duration
>1 day, <1 mo
36
Schizophreniform duration
>1 mo, <6 mo
37
Schizophrenia duration
>6 mo
38
Schizophrenia features
>/= 2 of the following sxs, one must be in 1-3, >6 mo
Positive sxs (d/t high DA levels):
1) delusions (persecution/grandiosity)
2) hallucinations (mostly auditory)
3) disorganization of speech and 4) behavior
5) Negative sx (muscarinic receptors and serotonin): flat affect, poverty of speech/movement, anhedonia, cognitive delay
39
Acutely psychotic pt mgmt
hospitalize, use atypical as 1st line agent, if IM medication needed d/t combative behavior use short acting olanzapine or ziprazidone, if not available use haloperidol
40
Noncompliant patient with schizophrenia, mgmt
use long acting antipsychotic (risperidone or paliperidone) or use depot (olanzapine, risperidone, less so haloperidol)
41
If 2 trials of antipsychotics fail, use...
clozapine
42
Clozapine
last resort, most effect, agranulocytosis, must monitor CBC first weekly then monthly
43
Typical antipsychotics
Most potent: haloperidol, fluphenazine; less potent: thioridazine, chlorpromazine
44
Atypical antipsychotics and their major s/e's
The -pines and the -drones
Pines: metabolic s/e's
Drones: movement d/o's, QT prolongation
45
Atypicals by risk of weight gain / metabolic abnormalities
Highest risk: olanzapine and clozapine
Medium risk: quetiapine and risperidone
Low risk: aripiprazole and ziprasidone
46
Aripiprazole is a partial _ _ and is approved as adjunct thx for _
dopamine agonist; MDD
47
Schizoaffective disorder features
mood sxs (meet criteria for depression or bipolar) + psychotic sxs, the psychotic sxs must be present for at least 1 month and be present while the patient has no mood sxs for at least 2 weeks, unlike schizophrenia, where mood sxs may be present some of the time, in schizoaffective mood sxs are present most of the time
48
Mood disorder with psychotic features
psychotic sxs occur exclusively during mood sxs
49
Delusional disorder tx
Gentle confrontation, atypical antipsychotics
50
Acute dystonia, onset and tx
hours to days after starting antipsychotic med; tx with anticholinergic agents (benztropine, trihexyphenidyl, diphenhydramine); e.g. may give haloperidol with diphenhydramine ti prevent s/e's
51
Akathisia (restlessness), onset and tx
weeks after starting antipsychotic med; tx with beta-blocker
52
Tardive diskinesia, onset
> 6 mo after starting antipsychotic
53
Panic disorder, r/o...
ACS (ECG and trop), hyperTH (TSH), and asthma (wheezing)
54
Tx of panic disorder vs panic attack
SSRI; benzo (alprazolam)
55
2 types of phobias
Specific phobia and social phobia, sxs must be present for >6 mo
56
Tx of specific phobia
exposure techniques, CBT (flooding - "bombing" the pt - or desensitization - exposure in relaxed state)
57
Tx of social phobia
beta-blocker (atenolol, nadolol, propranolol)
58
OCD tx
SSRIs, CBT (exposure and response prevention)
59
Hoarding disorder tx
SSRI
60
PTSD tx
1st line: paroxetine, sertraline; prazosin reduced nightmare
61
Acute stress disorder vs PTSD, duration
acute stress disorder: >2 days, <1 mo
| PTSD: >1 mo
62
GAD general criteria
>6 mo of excessive worry + somatic complaint
63
Rapid acting benzos
Lorazepam (IV/IM) - use in emergencies, alprazolam (PO) - use in panic attacks
64
Long acting benzo
Clonazepam
65
Benzos used in withdrawal
Diazepam, chlordiazepoxide
66
Liver safe benzos
Lorazepam and oxazepam
67
Flumazenil, use
benzo antagonist, use only with overdose is acute and you're certain that there is no benzo dependence (causes acute withdrawal similar to DT, seizures)
68
How many positive responses needed for positive CAGE test?
2
69
Adjustment disorder duration
sxs usually occur within 3 months of stressor and remit within 6 mo of removal of the stressor
70
Russell sign
callus/scarring on dorsum of hand
71
Electrolyte abnormalities d/t vomiting
hypokalemia, hypochloremia, and metabolic acidosis
72
Impotence is 50% more likely in ...
smokers
73
Depersonalization/derealization disorder
persistent or recurrent experience of depersonalization ("outside observer") and derealization (experiencing surroundings as unreal)
74
Dissociative amnesia
inability to recall important personal information, usually of traumatic or stressful nature; includes dissociative fugue
75
Dissociative identify disorder
involves fragmentation in to at least 2 distinct personality states
76
Somatic symptom disorder
excessive anxiety about >/= 1 physical symptom(s) lasting for >/= 6 mo and can occur in patients whose sxs are explained by recognized diseases
77
Delusional disorder criteria
>/= 1 delusion > month, no other psychotic sxs, normal functioning apart from direct impact of delusions
78
PCP intoxication unique finding
multidirectional nystagmus
79
Woman who presents with s/s of early pregnancy and beliefs that she is pregnant when she in fact is not...
pseudocyesis
80
Antidepressant discontinuation syndrome
caused by the abrupt discontinuation or rapid taper of start half-life serotonergic antidepressant --> leads to sudden onset of dysphoria, fatigue, insomnia, myalgias, dizziness, flu-like sxs, GI sxs, temor, and neurosensory disturbances; tx with re-introduction of the same antidepressant and then tapering over 2-4 weeks
81
body dysmorphic d/o dx
preoccupation with perceived bodily defect; NOT DX'ED WHEN CRITERIA FOR EATING D/O ARE MET
82
difference between bulimia and purge-bing type of anorexia nervosa?
bulimia patients typically maintain normal body wt
bradycardia and refeeding syndrome in anorexia patients
SSRIs effective in bulimia, ineffective in anorexia
83
PCP intoxication
nystagmus, dissociative feelings, psychotic and violent behavior, severe HTN, hyperthermia, quick onset and duration typically <8 h
84
risk factors for Rx opioid misuse
age <45, psychiatric d/o, personal or FH of substance d/o, presence of legal hx. review the states' rx drug-monitoring program data, do random urine drug screens and regular f/u's (at least q3months) to reduce risk of rx opioid misuse
85
difference between somatic sx d/o and panic d/o
multiple physical sxs, high health care use, and preoccupation with sxs are seen in both conditions; however in somatic sx d/o, physical sxs are persistent overtime. panic attacks have abrupt onset and resolve within minutes
86
pharmacotherapy in alcohol use d/o
medications that target the reinforcing effects of alcohol by modulating opioid and glutamate functions are effect. first line treatment options include naltrexone, a mu-opioid antagonist, and acamprosate, a glutamate modulator. naltrexone decreases alcohol craving, reduces heavy drinking days, and increases days of abstinence; in patients takin opioids it can precipitate w/drawal. acamprosate is used to maintain abstinence and should be avoided in patients with renal failure.
87
things that falsely show as positive amphetamines on urine tox screen
pseudoephedrine, bupropion, selegiline
88
cyclothymic disorder dx in children
sxs for 1 year
89
cyclothymic disorder part of which spectrum
bipolar
90
tx of anorexia nervosa
psychotherapy, nutritional rehabilitation, olanzapine if severe/refractory
91
Tourette time criteria
sxs must be present for >1 year, must occur before age 18
92
Tourette tx
antipsychotics, alpha-2 agonists, and behavioral therapy (habit reversal training)
93
PCP intoxication tx
benzos benzos benzos, antipsychotics 2nd-line
