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Psych Flashcards

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1
Q

diagnosing GAD in adults

A

excessive uncontrollable worry about multiple issues for at least 6 months PLUS at least 3 of:

  • restlessness, feeling on edge
  • fatigue
  • difficulty concentrating
  • irritability
  • muscle tension
  • sleep disturbance
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2
Q

diagnosing GAD in children

A

same as adults (excessive worry for at least 6 months) but only need 1 additional symptom

*can manifest as need for perfectionism/order with difficulty coping when this is not attainable

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3
Q

for social anxiety disorder, performance only, when would you avoid prescribing benzodiazepines?

A
  • when performance could be impaired by sedation and cognitive effects (eg giving presentation, taking oral exam)
  • in patients with substance abuse
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4
Q

treatment of choice for Li toxicity

A

HD

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5
Q

what 2 meds can be used as adjuncts to antidepressants but never monotherapy?

A

aripiprazole, Li

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6
Q

what is a normal MoCA score?

A

> = 26

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7
Q

drug of choice for pediatric depression

A

fluoxetine

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8
Q

options to manage anti-psychotic induced Parkinsonism

A
  1. reducing dose of antipsychotic
  2. switch to antipsychotic with less potential to cause EPS
  3. add anticholinergic antiparkinsonian medication (eg benztropine, amantadine) when antispychotic medication is working well and there is concern for destabilizing pt w/ dosage reduction or switching to a new antipsychotic
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9
Q

what form of EPS is irreversible

A

tardive dyskinesia- lip smacking, tongue protrusion

switching to clozapine is an option

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10
Q

neuropsychiatric symptoms in Cushing syndrome

A
  • depressed or labile mood
  • anxiety, panic attacks
  • irritability
  • insomnia
  • memory deficits
  • fatigue
  • occasionally mania and paranoia
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11
Q

firstline drug for binge eating disorder

A

SSRI - sertraline

if pt can’t access psychotherapy or prefers meds

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12
Q

what should you counsel patients on before prescribing SSRIs?

A
  • common early side effects (insomnia/sedation, headache, dizziness nausea, anxiety)
  • late side effects (sexual dysfunction, weight gain)
  • avoid abrupt discontinuation (can lead to SSRI discontinuation syndrome - anxiety, dysphoria, flu-like symptoms)
  • response takes 4-6 weeks of continued use
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13
Q

tx MDD with psychotic features

A

antidepressant plus antipsychotic (ECT if severe suicidality or refusal to eat/drink)

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14
Q

differentiate dependent from borderline personality disorder

A

dependent pd: submissive. lack mood instability, impulsivity, and self-harm characteristic of borderline

borderline pd: also fear abandonment, but react with rage and demanding behavior.

while other personality disorders can have dependent features, depedent pd is differentiated by predominance of dependent behaviors w/o key personality characteristics of other disorders

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15
Q

nonstimulant options for ADHD

A

Atomoxetine is treatment of choice, nonaddictive

bupropion, TCAs, alpha-2 agonists

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16
Q

tx panic disorder

A

maintenance: SSRI and/or CBT
attack: benzo (should not be used in pts with suspected or h/o substance abuse)

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17
Q

which antidepressants have analgesic properties?

A

SNRIs

TCAs

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18
Q

how does alcoholic hallucinosis differ from DTs

A

alcoholic hallucinosis has rel stable vital signs, intact orientation. onset 12-48h after last drink.

DTs- confusion, HTN, fever, tachy, diaphoresis. onset 48-96h after last drink

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19
Q

what antidepressant is a/w hypertension

A

venlafaxine (dose dep)

BP should be monitored, esp at higher doses

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20
Q

treatment for borderline

A

dialectical behavior therapy

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21
Q

what neurotransmitters does MDMA affect?

A

incr serotonin, dopamine, NE

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22
Q

what strategies can reduce risk of relapse in schizophrenia?

A

educating pt and family about sxs and course of schizophrenia can reduce fam sress and conflict;

pts w/ critical, hostile or over involved families have higher risk of relapse

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23
Q

components of suicide risk assessment

A

Ideation

  • passive (wish to die, not waking up)
  • active (killing self)
  • freq, duration, intensity, controllability

Intent

  • strength of intent, ability to control impulsivity
  • determine how close pt has come to acting on a plan (rehearsal, aborted attempts)

Plan

  • specific details: method, time, place, means, preparations
  • lethality of method
  • likelihood of rescue
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24
Q

diagnostic criteria persistent depressive disorder (dysthymia)

A

chronic depressed mood >= 2 years

at least 2 of: appetite change, sleep change, low energy, low self-esteem, poor concentration, hopelessness

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25
diagnostic criteria of adjustment disorder with depressed mood
onset within 3 months of identifiable stressor marked distress and/or functional impairment does not meet criteria for another DSM-5 disorder
26
diagnostic criteria borderline
pervasive pattern of unstable relationships, self image and affects, marked impulsivity with at least 5 of: - frantic efforts to avoid abandonment - unstable and intense interpersonal relationships - markedly and persistently unstable self image - impulsivity in at least two areas that are potentially self damaging - recurrent suicidal behaviors or threats of self mutilation - mood instability - chronic feelings of emptiness - inappropriate and intense anger - transient stress-related paranoia or dissociation
27
what second gen antipsychotics have the greatest risk of metabolic side effects?
clozapine, olanzapine
28
which second gen AP have the lowest risk of metabolic side effects?
- aripiprazole - lurasidone - ziprasidone
29
TSH should be measured before and while taking __ (drug)
Lithium
30
structural abnormalities of orbitofrontal cortex and basal ganglia are a/w ___
OCD
31
features of cocaine withdrawal
minor physical sxs - depression, SI - fatigue, hypersomnia, hyperphagia - increased dreaming - impaired concentration - intense drug craving
32
firstline maintenance treatments for bipolar disorder
- lithium - valproate - quetiapine - lamotrigine
33
drugs that can be used to suppress REM sleep (for significant cateplexy)
antidepressants sodium oxybate
34
long term side effects of Li
- hyperparathyroidism - nephrogenic DI - CKD - thyroid dysfunction - Ebstein anomaly
35
baseline labs before prescribing Li?
- BMP (Cr, BUN) - UA - calcium (Li can cause hyperparathyroidism) - thyroid function tests - pregnancy test - ECG if risk factors for CAD (can cause dysrhythmias)
36
valproate side effect
neural tube defect
37
what mood stabilizers can cause stevens johnson syndrome
carbamazepine | lamotrigine
38
what can cause Li toxicity
(decr renal perfusion = decr clearance) - dehydration - thiazides, ACEi - NSAIDs - tetracyclines - metronidazole
39
bupropion is contraindicated in
bulimia | h/o seizures
40
medical causes of psychosis to r/o in child or adolescent
- SLE - metabolic or electrolyte disorder - thyroiditis - CNS infection - epilepsy
41
how long should treatment be continued in remitted single episode of major depression?
6 months if maintain complete remission at end of continuation phase, can gradually taper and discontinue the antidepressant
42
When should you maintain 1-3 years of antidepressants?
pts w/ high risk of recurrence: - 2 or more episodes - persistent residual depressive symptoms
43
when should antidepressant maintenance therapy be continue indefinitely?
pts w/ highly recurrent major depressive disorder -3 or more depressive episodes chronic episodes -at least 2 years severe episodes strong family history
44
switching SSRI to or from MAOI requires washout period of _
2 weeks | fluoxetine needs 5 weeks
45
endocrine causes of anxiety
- hyperthyroid, thyrotoxicosis - hypoglycemia - pheo - carcinoid syndrome
46
neuro causes of anxiety
``` epilepsy migraines brain tumors MS Huntington's ```
47
metabolic causes of anxiety?
vit B12 deficiency electrolyte abnormalities porphyria
48
respiratory causes of anxiety
``` asthma, COPD hypoxia PE PNA PTX ```
49
cardiac causes of anxiety
CHF angina arrhythmia MI
50
mnemonic to assess of anxiety is pathologic
SOD: Social or Occupational Dysfunction
51
features suggestive of psychogenic non-epileptiform seizures
- forceful eye closure - side-to-side head or body movements - rapid alerting and reorienting - memory recall of event typically occur in front of witnesses pt ma model behavior after a friend or relative w/ epilepsy
52
which SSRI can cause dose dependent QTc prolongation?
citalopram (avoid post MI)
53
what is Trazadone and what is it used for
antidepressant that is extremely sedating, used at low dose for sleep induction can cause orthostatic HTN, problematic in elderly
54
what tests should be monitored in pts taking Lithium
kidney and thyroid tests
55
which second-gen antipsychotic a/w prolonged QTc at higher doses?
Ziprasidone
56
NMS caused by
antipsychotics
57
which is reversible, wernicke or korsakoff?
wernicke
58
cause of Wernicke encephalopathy and symptoms
alcohol use disorder --> thiamine deficiency classic triad: ataxia, confusion, oculomotor dysfunction
59
neuropathologic findings in wernicke
mamillary body atrophy | dorsomedial thalamic neuron loss
60
neuropathologic findings in korsakoff
lesions in anterior and medial thalami and corpus callosum
61
most common psychiatric complication of MS?
depression - inflamm changes in brain - immune system changes - psychologic reactios to neuro deficits and challenges of living with MS
62
differentiating parkinson's disease dementia from lewy body dementia
parkinson's symptoms predate cognitive impairment by > 1 year
63
when are benzos less preferred in treating GAD tha persists despite SSRI
h/o using alcohol to self medicate
64
CJD is aossicated w/ high ___ in CSF
14-3-3 protein
65
high anti-Hu antibodies are seen in __
paraneoplastic encephalomyelitis (a syndrome a/w small cell lung cancer)
66
when are high anti-NMDA receptor antibody titers seen
anti-NMDA receptor encephalitis
67
substances that can induce depression
L-ABC Levodopa Alcohol Beta blockers (esp propranolol) Corticosteroids
68
tx options for OCD
CBT meds: - first line: SSRI - can also use Clomipramine (the most serotonin selective TCA)
69
brain imaging changes in Huntington's
caudate atrophy
70
red flags for child abuse
- delayed medical care for injury - inconsistent explanation of injury - mult injuries in various stages of healing -spiral bone fx - bruising c/w with hand or belt - cigarette burns - head injuries
71
what lab value abnormalities can be seen in NMS
leukocytosis | elevated CK
72
probable diagnosis of CJD requires
1. rapid progression of cognitive decline 2. at least two of: - myoclonus! (often startle) - visual or cerebellar signs - pyramidal or extrapyramidal signs - akinetic mutism 3. supportive findings from at least 1 diagnostic modaliy - periodic sharp waves on EEG - CSF with 14-3-3 - lesions on putamen or caudate nucleus on MRI
73
tourette's first line tx? second line?
first line: alpha 2 agonists - guanfacine; clonidine (more sedating) second line: antipsychotics
74
normal QT interval
0.4 - 0.44 sec
75
alzheimer's affects what region of brain
nucleus basalis of meynert
76
hemiballismus affects what region of brain
subthalamic nucleus
77
auditor pathways are in what region of brain
medial geniculate nucleus
78
kluver-bucy affects what region of brain
amygdaloid nucleus
79
GAD symptom mnemonic
worry WARTS ``` worried wound up (irritable), worn out absent minded (concentration) restless tense sleepless ```
80
normal QRS interval
80-100 ms
81
tx acute dystonia
benztropine | diphenhydramine
82
tx akathisia
benztropine benzodiazepine beta blocker (propranolol) (likely works by blocking noradrenergic and serotonergic inputs on dpamine pathways)
83
tx Parkinsonism
benztropine | amantadine
84
tx Tardive dyskinesia
valbenazine | deutetrabenazine
85
REM sleep behavior disorder is highly associated with __
underlying neurodegenerative disorders (parkinson's, mult system atrophy, dementia with lewy bodies)
86
___ is effective in treating most REM sleep disorders
clonazepam
87
Risk factors for restless leg syndrome
- Fe deficiency - other med comorbidities - meds (antidepr, antispych, dopamine blocking antiemetics, antihistamines)
88
what can differentiate between depression vs pseudodementia
depressed pts are aware of their cognitive impairment
89
essenial components of borderline that differentiate it from histrionic
negative self image | self-destructive behavior (self harm, suicide attempts)
90
when should you try clozapine for schizophrenia
failed adequaet trials (6 weeks each) of two different antipsychotics
91
firstline tx schizophrenia
SGA such as quetiapine, risperidone

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