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NCAPA Psych > Psych > Flashcards

Psych Flashcards

1
Q

Need to r/o what 2 things prior to psych dx?

A
  • all other general med conditions & other mental d/o

- substance abuts

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2
Q

MC neurotransmitters

A

serotonin, norepi, dopamine (mostly involve limbic sys)

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3
Q

serotonin fx

A

regulate sleep, appetite, mood, inhibits pain

low in dep/suicide

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4
Q

norepi fxn

A

triggers anxiety, some types of depression, role in determining motivation/reward
(constricts blood vessles, raises BP)

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5
Q

dopamine fxn

A

movement, influences motivation, how person perceives reality, reward sys
- psychosis, substance abuse

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6
Q

SIGECAPS

A 
sleep
interest
guilt
energy
concentration
appetite
psychomotor
suicidal thoughts
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7
Q

MDD dx criteria

A
  • depressed mood or anhedonia w/ 4+ sx
  • SIGECAPS
  • x 2 wks
  • no hypo/mania
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8
Q

lab wu for MDD

A

tsh, cbc, cmp, vit b12, ua/uds, hiv, vdrl

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9
Q

MDD tx options

A

SSRI

SNRI, TCA, MAO-I, Wellbutrin (bupropion), remeron (mirtazapine), desryel (trazadone)

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10
Q

Persistent Depressive D/o

A
  • similar to MDD, but LESS severe
  • only need 2 sx w/ depressed mood to make dx
  • x 2 yrs more days than not
  • CBT
  • difficult to write question on
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11
Q

DIG FAST

A 
distractibility
injudiciousness
grandiosity
flight of ideas
activities
sleep
talkativeness
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12
Q

Bipolar I d/o dx criteria

A
  • at least 1 manic episode
  • x 1 wk (though if hospitalized, duration does NOT matter)
  • may/may not have had prev episode of hypomania/depression
  • mania typically followed by an intense depressive episode (most time spent in depression)
    SOCIAL IMPAIRMENT is differentiating factor between BPID and BPIID!!!
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13
Q

Mania

A
  • abnml & perisistent elevated, expansive or irritable mood & increased goal-directed activity/energy
  • 3+ add’l sx (DIGFAST)
  • social/occupational impairment!!!
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14
Q

Bipolar II d/o criteria

A
  • hypomanic AND depressive episodes in the past/currently
  • at least 4 consecutive days of hypomania OR 2 wks of depression
  • difficult to write question on
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15
Q

Hypomania

A
  • abnml & perisistent elevated, expansive or irritable mood & increased goal-directed activity/energy
  • 3+ add’l sx (DIGFAST)
  • NO social/occupational impairment!!!
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16
Q

mania/hypomania predominant BPD tx

A
  • mood stabilizers (1st line = Lithium, then VPA, carbamazepine)
  • atypical antipsychs
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17
Q

depression predominant BPD tx

A
  • lamictal, Symbyax (olanzapine/fluoxetine), seroquel)

- NO antidepressants as monotherapy (inc risk of mania!)

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18
Q

duration of anxiety d/o for dx

A

6 months

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19
Q

MC anxiety c/o

A

GAD

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20
Q

GAD dx criteria

A
  • excessive worry more days than not x 6+ mos
  • usually assoc w/ 3+ of the following sx: fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness, HA
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21
Q

GAD diagnostics

A

cbc, cmp, tsh, uds, ekg, xr, ct/mr

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22
Q

GAD tx

A
  • SSRI (paroxetine, escitalopram)
  • SNRI (duloxetine, venlafaxine)
  • buspirone
  • BZD
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23
Q

specific phobias

A
  • usually develops early in life (< 10 y.o.)
  • excessive fear/anxiety of certain situations/objects x > 6+ mos
  • active avoidance
  • can develop from personal/witnessed events
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24
Q

GS tx for specific phobias

A

CBT (exp & response prevention)

can do adj meds if comorbid psych d/o

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25
Q

social anx d/o

A
  • fear/anx of being scrutinized = avoidance
  • x 6+ mos
  • long-term tx: SSRI/SNRI (venlafaxine) AND CBT (exposure)
  • short-term tx: BZD, BB
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26
Q

panic d/o

A
  • recurrent panic attacks (4+ sx) w/o obv trigger (unexpected)
  • worry about add’l attacks, maladaptive behaviors
  • attack last 30 min (rarely > 1 hr)
  • tx: SSRI (paroxetine, sertraline, fluoxetine) or SNRIs (venlafaxine) - BZD acutely
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27
Q

schizophrenia

A
  • males = females; peak onset in 20s
  • high risk for suicid and SUD
  • negative & positive sx
  • 6 mos of fxnl decline w/ 1 month of acute (active) sx
  • at least 2 sx of: hallucinations, delusions, disorganized speech, disorganized/catatonic behaviors, and negative sx
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28
Q

assoc fts of schizo

A

inappropriate affect, mood/sleep disturbances, food refusal, depersonalization, derealization

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29
Q

schizo tx

A
  • atypical (watch for hyperglycemia) vs typical antipsych
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30
Q

psychosis ddx

A
  • based on duration (brief psychotic d/o: like schizo, but < 1 month) (schizophreniform d/o: like schizo, but between 1-6 mos)
  • based on presence of mood sx (schizoaffective d/o: psychotic sx + mood episode at least 2 wks w/ only + psych sx) (mood d/o w/ psychosis: presence of mood episode + psychotic sx)
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31
Q

delusional d/o

A
  • 1+ delusions (usually non-bizarre in content) x at least 1 month
  • functioning not as impaired, does not meet schizo crit
  • tx: difficult b/c lack of insight, CBT, atyp antipsychs
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32
Q

3 clusters of PTSD sx

A
  • re-experiencing the trauma
  • avoiding reminders of the trauma
  • increasing phys arousal and/or reactivity
33
Q

PTSD time line

A

sx > 1 month (typically present w/in 3 mos of event)

34
Q

PTSD tx

A
  • CBT (exp)
  • SSRI (sertraline, paroxetine), SNRI (venlafaxine)
  • BB (propranolol)
  • mood stabilizer
  • A blocker (prazosin) for nightmares
  • TCA (trazodone) for insomnia
  • avoid BZD
35
Q

acute stress d/o

A
  • sx for at least 3 days for dx
  • duration < 1 month
  • 50% develop PTSD
  • tx: CBT 1st line, short term trial of BZD
36
Q

adjustment d/o

A
  • identifiable stressor!
  • presents w/in 3 mos of stressor
  • resolved w/in 6 mos of stress removal
  • CANNOT meet crit for other psych d/o
  • tx w/ CBT & pharm (sx dependent)
37
Q

Persistent complex bereavement d/o

A
  • sev, persist grief & mourning rxn w/ sig distress/impair
38
Q

somatic sx d/o

A
  • at least 1 somatic sx + distressing thought/feeling/behavior in response
  • sx NOT intentionally produced
  • SSRI + CBT (difficult to tx…reassurance)
39
Q

somatic sx d/o ddx

A
  • conversion d/o (neuro sx: motor/sensory, onset assoc w/ stress/trauma, tx: CBT, psych comorbids)
  • illness anx d/o (tx: CBT, psych comorbids)
  • factitious d/o aka munchausen (intentionally produced/falsified sx aka internal incentive: tx w/ CBT)
  • malingering (intentional, external incentive)
40
Q

can you use wellbutrin for anorexia or bulimia

A

NEITHER, contraindicated (lowers SZ threshold)

41
Q

3 essential fts of bulimia

A
  • recurrent binge eating
  • recurrent compensatory behaviors to prev wt gain
  • negative self-eval influenced by body shape/wt
42
Q

only med for bulimia

A

fluoxetine (SSRI)

43
Q

MC abused substances

A

cannabis, EtOH, opioids

44
Q

EtOH

A

intox: pupil dilation (tx: supportive)

w/d: pupil dilation, tachycardia, DTs (tx: CIWA, BZD, folate, thiamine)

45
Q

EtOH dependency tx

A
  • antabuse: inhibs metabolism = sev sx similar to w/d sx
  • naltrexone: blocks opioid recepts, reduced cravings/reward resp (must be opioid free x 10+ days, monitor LFTs)
  • campral (decreases cravings, must abstain!)
46
Q

sedatives, hypnotics, anxiolytics intox vs w/d s/s

A
  • intox: decreased RR, dysarthria, impaired memory

- w/d: n/v, sweat, tachycardia, dilated pupils, elevated BP

47
Q

sedatives, hypnotics, anxiolytics intox vs w/d tx

A
  • intox: flumazenil for BZD, supportive
  • w/d: CIWAS, scheduled BZD, sx control
  • med taper + CBT for dependency
48
Q

Opioids intox vs w/d

A

intox: pupil constriction, dec RR, AMS = triad

w/d: myalgia, rhinorrhea, lacrimation, diarrhea, abd cramp

49
Q

opioid o/d tx

A

supportive THEN naloxone (antagonist) when unresponsive

50
Q

opioid w/d tx

A

COWS protocol, reassurance, supportive

51
Q

opioid dependency tx

A
  • methadone (GS!): full receptor agonist, synth opioid
  • suboxone (buprenorphine + naloxone): partial receptor agonist
  • naltrexone: receptor blocker (no ops x 10+ days, UDS b/4 starting, monitor LFTs)
52
Q

MC tx’d youth d/o

A

ADHD

53
Q

ADHD

A
  • must have sx b4 12 y.o.

- must have 6+ sx present in 2+ settings x 6+ mos

54
Q

ODD

A
  • angry/irritable, argumentative/defiant, vindictive
  • 4+ sx x 6 mos
  • ADHD = common comorbid
  • Tx: CBT (1st) for kid & family, mood stabilizer & atyps for aggressive behavior
55
Q

Conduct d/o

A
  • repetitive & persistent of violating others’ rights
  • aggression to ppl/animals, destroy property, lie/steal, break rules (esp < 13 y.o.)
  • 3+ sx in last 12 mos
  • tx: multi-factorial (CBT, parent mgmt training)
56
Q

ASD repetitive behavior tx

A

fluoxetine

57
Q

ASD aggression/irritability tx

A

risperdal & abilify

58
Q

egosyntonic vs egodystonic

A
  • pt thinks other has problem

- pt knows they have problem

59
Q

Cluster A personality d/o

A

“mad”

  • schizoid (voluntary social isolation)
  • schizotypal (eccentric, + sx, NO delusions)
  • paranoid: no hallucinations
60
Q

Cluster B personality d/o

A

“bad”

  • anti-social: law-breaking, 18+ y.o.
  • borderline: MC in psych pop, AEIOUS sx
  • histrionic
  • narcissistic
61
Q

Cluster C personality d/o

A

“sad”

  • avoidant: lonely (desires relationships, feels inadequate/fears rejection)
  • dependent
  • OC: MC in gen pop
62
Q

personality d/o tx

A
  • SSRI/SNRI for anx/negative affect
  • Mood stabs
  • atypicals for positive sx
  • NOT FOR ANTISOCIAL
  • DBT (dialect) = GS! for borderline
63
Q

suicide completion vs attempt

A
  • men > women
  • women > men

50% have seen PCP w/in 1 month
active vs passive SI

64
Q

domestic violence screening tools

A
  • HITS (hurt, insult, threatened, scream)
  • STAT (slapped, threatened, and throw)
  • WAST (woman abuse screening tool)
  • women who talked to PCP 4x likely to use intervention
65
Q

SSRI

A

sertraline, es/citalopram, fluoxetine, paroxetine

  • common SE: N, D, HA, sexual dysfxn
  • fluoxetine has the longest T 1/2 (fewest w/d sx)
66
Q

serotonin syndrome FEVER

A
  • fever
  • encephalopathy
  • Vital sign instability
  • enzyme elevation (CK)
  • rigidity
67
Q

SNRI

A

des/venlafaxine, duloxetine, levo/milnacipran

  • common SE: N, dry mouth, constipation, insomnia, HA, sexual dysfxn
  • avoid St. John’s wart, FEVER
68
Q

TCA

A

amitriptyline, nortriptyline, doxepine, imipramine

  • common SE: anticholinergic (hot, dry, urinary retention, pupil dilation, burred vision, confusion)
  • can also use for migraines, neuropathic pain, bed wetting
  • caution w/ SI pts (OD can = long QT)
69
Q

MAO-I

A

selegiline, phenelzine

  • blocks breakdown of all neurotransmitters
  • anticholinergic SE
  • caution w/ other antidep use
  • avoid tyramine foods (HTN crisis)
70
Q

Atypical antidepressants

A

mirtazapine (remeron)
- SE: WT gain, sedation, constipation, LESS sex dysfxn

wellbutrin (bupropion)

  • smoke cess, SAD, less SE (wt, sex, GI)
  • contraindicated w/ SZ and eating d/o
  • avoid abrupt d/c (taper)

trazodone

  • insomnia
  • SE: priaprism
71
Q

BZD anxiolytic

A
  • GABA recept reduction
  • adjuvant therapy
  • monitor vitals
72
Q

BZD T 1/2 (short to long)

A
  • xanax
  • ativan
  • klonopin
  • valium, librium
73
Q

mood stabilizer - lithium

A
  • gold standard
  • acute/chronic mgmt
  • common SE: drowsy, N/V, hand tremor, inc thirst/urination, mem prob, poor conc
  • monitor TSH (hypo), BMP, lithium levels!
  • can cz Ebstein anomaly (tricuspid valve)
  • tox: tremor, N/V/D, vertigo, confusion, inc DTR (Sz, coma)
74
Q

mood stabilizer - AED

A
  • common SE: drowsy, dizzy, N, tremor, fatigue, rash, wt gain
  • VPA: thrombocytopenia, elevated LFTs, hair loss
  • carbamazepine: hypoNa, agranulocytosis, thrombocytopenia, aplastic anemia, spina bifida, SJS
  • lamotrigine: lacy rash, SJS
75
Q

atyp antipsych 1st gen

A

haloperidol, chlropromazine, fluphenazine

  • D2 antags (reduce DA)
  • too much DA = psych sx; too little = Parkinson sx
  • common SE: EPS (tardive dyskinesia), anticholinergic & antihistamine adr
  • neuroleptic malignant synd (FEVER, tx w/ dantrolene)
76
Q

neuroleptic malignant synd vs serotonin synd

A

serotonin synd has hyperreflexia/clonus

77
Q

atyp antipsych 2nd gen

A

clozapine, risperidone, olanzapine, seroquel, geodone, abilify, latuda

  • DA & serotonin antagonists
  • pref’d 1st line b/c lower risk for EPS
  • common SE: wt gain, HLD, insulin resistance (met synd), QTc prolong, black box for increased mort from CVE in dementia pts
78
Q

what 2nd gen atyp antipsychs approved for Bipolar d/o?

A

quietiapine, lurasidone, fluoxetine/olanzapine

79
Q

2nd gen drug specific SE

A
  • risperidone: galactorrhea, gynecomastia, pituitary issues

- clozapine: agranulocytosis (CBC q wk)

NCAPA Psych (1 decks)

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