Psych/behavior & Substance Abuse Flashcards
(155 cards)
1
Q
Alpha ketogluarate dehydrogenase requires thiamine as a cofactor to convert alpha ketoglutarate to what
A
Succinyl co A
2
Q
What ratio of metabolic biproducts is increased during alohol consumption
A
NADH to NAD +
NAD+ is used up
3
Q
The tuberoinfundibular pathway connects the hypothalamus to the ____
A
Pituitary gland
4
Q
The uberoinfundibular pathway is responsible for the tonic inhiition of _______
A
Prolactin secretion
5
Q
How may antipsychotics cause a patient to have amenorrhea and galactorrhea
A
Blockade of dopamine 2 receptors –> inhibiting tuberoinfundibular pathway –> loss of prolactin secretion inhibition
6
Q
Haloperidol MOA
A
First generation antipsychotic
7
Q
Function of the orbitofrontal cortex
A
Modulatory connections to the limbic system (emotions)
Involved in behavioral and emotional regulation
8
Q
Function of the lateral prefrontal cortex
A
Executive functioning (includes motivation, organization, planning, and purposeful action)
9
Q
What is an impulse disorder that is specific to repetitive outbursts of impulsive aggression that is grossly disproportionate to the situation
A
Intermittent explosive disorder
10
Q
Treatment for anorexia nervosa
A
Cognititve behavioral therapy
Nutritional rehabilitation
Olazapine if no response to other 2 treatments
11
Q
Bulimia nervosa treatment
A
Cognititve behavorial therapy
Nutritional rehabitlitation
SSRI (fluoxetine) (often in combo with above)
12
Q
Binge eating disorder treatment
A
Cognitive behavioral therapy
Behavioral weight loss therapy
SSRI
Lisdexamfetamine
13
Q
Anorexia nervosa is defined as a BMI < ____
A
18.5 kg/m^2
14
Q
Bulimia nervosa clinical features
A
Recurrent episodes of bings eating
Binge eating and inappropriate compensatory behavior to prevent weight gain
Excess worrying about body shape/weight
15
Q
Binge eating disorder clinical features
A
Recurrent episodes of binge ating
Lack of control during eating
(No inappropriate compensatory behaviors as seen in bulimia)
16
Q
What are the common side effects seen in high potency (haloperidol) first generation antipsychotics
A
Extrapyramidal symptoms (acute dystonia, akathisia, parkinsonism) Tardive dyskinesia
17
Q
What are the common side effects seen in low potency (chlorpromazine) first generation antipsychotics
A
Sedation
Cholinergic blockade
Orthostatic hypotension
Weight gain
18
Q
What are the common side effects seen in second generation antipsychotics
A
Metabolic syndrome
Weight gain
Extrapyramidal symptoms (less common than first generation antipsychotics though)
19
Q
As a class, first generation antipsychotics are assciated with a high risk of extrapyramidal symptoms due to their potent ____ antagonism
A
D2
20
Q
Define akathisia
A
Inner restlessness and inability to sit still
21
Q
Tricyclic antidepresants’ inhibitory affects on ___ receptors can cause tachycardia, delirium, dilated pupils, flushing, decreased sweating, hyperthermia, ileus, and urinary retention
A
Muscarinic acetylcholine
22
Q
Tricyclic antidepressants’ inhibition of ____ receptorscan lead to peripheral vasodilation (orthostatic hypotension)
A
Alpha 1 adrenergic
23
Q
Tricyclic antidepressants’ inhibition of ____ can lead to conduction defects and arrhythmias
A
Cardiac fast sodium channels
24
Q
Tricyclic antidepressants’ inhibition of presynaptic NE and serotonin reuptake can cause what adverse effects
A
Seizures
Tremors
25
Tricyclic antidepressants' inhibition of ____ receptors can lead to desation and increased appetite
Histamine (H1)
26
Most deaths from tricyclic antidepressant overdose is due to ____ and ____
Cardiac arrhythmias
| Refractory hypotension
27
TCA overdose is treated with ____ which increases serum pH and promotes TCA dissociation from sodium channels
Sodium bicarbonate (NaHCO3)
28
Indications for lithium in bipolar disorder
Manic and depressive features
29
Indications for valproate in bipolar disorder
Manic features
30
Indication for carbamazepine in bipolar disorder
Manic features
31
Indication for lamotrigine in bipolar disorder
Depressive features
32
Duration of symptoms in brief psychotic disorder
> 1 day, < 1 month
33
Duration of symptoms in schizophreniform disorder
>1 month <6 months
34
Duration of symptoms in schizophrenia
>6 months
35
A patient found to be lethargic, ataxic, disoriented and have slurred speech followed by rapid improvement and a parioral and perinasal rash indicates what type of substance use
Inhalants
36
Inhalation/misuse of nitrous oxide is associated with ____ deficiency and resultant symptoms of polyneuropathy (symmetric numbness, gait abnormalities)
B12
37
frontotemporal dementia microscopic features includes initial neuronal loss in the frontotemporal lobes with ___ and ___ inclusions
```
Tau protein (neurofibrillary tangles, pick bodies)
TDP-43 protein
```
38
____ protein is involved in DNA repair and transcription and it becomes abnormally ubiquinted in frontotemporal dementia
TDP-43
39
Pathologically ubiquitinated TDP-43 is seen in what two diseases
Frontotemporal dementia
| Amyotrophi lateral sclerosis
40
What abnormal labrotory findings are seen in bulimia nervosa
Hypokalemia
| Metabolic alkalosis
41
Treatment for social anxiety disorder (social phobia)
SSRI/SNRI
Cognitive behavioral therapy
Beta blocker or benzo for performance-only subtype
42
Duration of symptoms in post traumatic stress disorder
> 1 month
43
First line treatment PTSD
SSRI/SNRI
44
Phenelzine MOA
MAO inhibitor
45
If antipsychotic medication cannot be reduced or discontinued, drug induced parkinsonism is best treated with _____
Centrally acting anticholinergic agent (benztropine)
46
Why should levadopa not be used for treating drug induced parkinsonism in a patient being treated with antipsychotics
Levadopa can exacerbate or even precepitate psychosis (use anticholinergic instead)
47
_____ disorder is characterized by a pattern of behaviors that violate major societal norms or rights of others. Behaviors seen in this disorder include byllying, frequent fights, using weapons, torturing animals, breaking into houses, and sexual coercion. It generally presents in middle childhood to adolescence and is more common in boys
Conduct
48
What are the first line drug treeatments for school-age children with ADHD
Stimulant drugs including methylphenidate and amphetamines
49
Which cluter A personality disorder is described as a person who prefers to be a loner and is detatched and unemotional
Schizoid
50
What cluster C personality disorder is described as avdance due to fears of criticism and rejection
Avoidant
51
A patient with normal development through age 10 months followed by regression and development of hand wringing likely has what diagnosis (other features include seizures, intellectual disability, autistic features, breathing abnormalities, and deceleration of head growth)
Rett Syndrome
52
Rett syndrome is caused by a de novo mutation in the X-linked _____ gene
MECP2
53
Treatment for akathisia, an extrapyramidal side effect of antipsycotic medication
Reduction of antipsychotic dose, if possible, or the addition of beta blocker or a benzodiazepine
54
Decreased renal perfusion due to what medications can cause decreased lithium clearance and therefore toxicity
Thiazide diuretics
NSAIDs
ACE inhibitors
55
Positive psychotic symptoms are thought to be caused by an excess of dopamine in the ____ pathway
Mesolimbic
56
____ is the compulsive consumption of nonstaple food or non nutritive substance for > 1 month
Pica
57
Pica is most commonly seen in what 2 populations
Pregnant women
| Schoolchildren
58
What is the term for involuntary movements after chronic use of antipsychotics which typically involves lip smacking or choreoathetoid movements
Tardive dyskinesia
59
Lacrimation and yawning are specific findings for what drug withdrawal
Opiod
60
What is the term for the mature defense mechanism inwhich someone puts unwanted feeligns aside to cope with reality
Supression
61
What is the mature defense mechanism in which someone chanels impulses into socially acceptable behaviors
Sublimation
62
What is the best approach when treating a patient with somatic symptom disorder
Schedule regular visits with their primary care provider who can monitor them and avoid unnecessary diagnostic testing and specialist referals
63
What are the signs and symptoms of neuroleptic malignant syndrome
Fever
Altered mental status
Generalized muscle rigidity (lead pipe rigidity)
Autonomic instability
64
Neuroleptic malignant syndrome is thought to be primarily ue to dysregulation of ______
Dopamine
65
During alcohol withdrawal, symtpoms are due to increased activity of what receptors
NMDA glutamate
66
Chronic alcohol exposure leads to the downregulation of what receptors
GABA A
67
How is methadone metabolized
P450 system, specifically the CYP3A4
68
Fluconazole, voriconazole, ketoconazole, ciprofloxacin, clarithromycin, cimetidine,, and fluvoxamine all inhibit_____ which prrolongs the effects of methadone
P450 3A4
69
Clozapine drug class
Atypical antipsychotic (used in treatment resistant schizophrenia)
70
Adverse effects of clozapine
Agranulocytosis
Seizures
Myocarditis
Metbolic syndrome
71
What is the diagnosis of someone who has mood episoides with concurrent active phase symptoms of schizophrenia with more than 2 weeks of delusions or hallucinations inthe absence of prominent mood symptoms
Schizoaffective disorder
72
Which first generation antipsychotics are more likely to precipitate extrapyramidal symptoms such as acute dystonia, akathisia, and parkinsonism
High potency (haloperidol, fluphenazine)
73
What personality disorder may lead to maladaptive pattern of behavior characterized by social inhibition, feelings of inadequacy, andfear of embarrassment and rejection
Avoidant
74
Moa buspirone
Partial agonist f 5HT1a receptor
75
Does buspirone carry a risk of dependence
No (slow onset of action, lacks muscle relaxnt or anticonvulsant properties)
76
What asepct of an ADHD diagnosis may require a teacher's evaluation
The symptoms aer present in 2 or more settings (home and school for example)
77
Phenelzine MOA
Monoamine oxidase inhibitor
78
Monoamine oxidase inhibitors work by inhibitig oxidtive deamination, thereby increasing the presynaptic availibility of _____, _____, and _____
Serotonin
Norepinephrine
Dopamine
79
MAOIs are supperior to other antidepressants in treating what type of depression
Major depressive disorder with atypical features
80
Major depressive disorder with atypical feactures is characteriezed by ______ (mood improve in response to positive events), ______ (patients arms and legs feel extremely heavy), ______ (overly sensitive to slight criticism) and the reversed vegatiative signs of incerased sleep and appetite
Mood reactivity
Leaden paralysis
Rejection sensitivity
81
At age 2, a child should have a vocabulary of __-___ words and be able to use 2 word phrases
50-200
82
What is the most commonly delayed milestone and an isolatd delay in this milestone with usually catch up in preschool
Language
83
What disease may present in an adolescent patient as postural tremor on extension of the arms, broad based gait, slurred speech, sad mood, distractibility, and elevated serum transaminases
Wilsons disease
84
Wilsons disease is an autosomal recessive mutation in what gene
ATP7B
85
Wilsons disease is an autosomal recessive mutation of ATP7B that causes a hepatic accumulation of ____
Copper
86
Mehanism of action: citalopram
SSRI
87
What disorder presents with repeated nocturnal episodes of violent motor behaviors reflecting dream enactment
REM sleep behavior disorder
88
What are the primary mecahnisms of action for second generation antipsychotics
Dopamine D2 receptor antagonism
| Serotonin 2A receptor antagonism
89
Drug class: quetiapine
Second generation antipsychotiv
90
______ is an immature defense mechanism where the patient will attribute their own feelings to others
Projection
91
_____ is an immature defense mechanism where a patient transfers their feelings to less threatening object/person
Displacement
92
______ disorder is characterized by 1 or more delusions for 1 or more months in the abence of other psychotic symptoms
Delusional
93
____ is a full mu-opiod receptor agonist used for withdrawal and maintenance treatment for opiod use disorders. Its long half life allows it to effectively supress cravings and withdrawal symptoms
Methadone
94
____ is an immature defense mechanism in which a patient will experience a person or situation as all positive or all negative
Splitting
95
Splitting is commonly seen in people with ____ disorder which contributes to unstable relationships and mood instability that exemplify this disorder
Borderline personality
96
The most common adverse affects of methylphenidate are what?
Decreases appetite
Weight loss
Insomnia
97
_____ disorder is defined as 1 or more unexplained symtpomswth excessive thoughts, anxiety, and behaviors in response to symptoms
Somatic symptom disorder
98
_____ disorder hasminimal to no symptoms and preocupation with the idea of having a serious illness
Illness anxiety disorder
99
______ disorder presents with neurologic symptoms incompatible with anatomy or pathophysiology
Conversion disorder (functional neurologic symptom disorder)
100
_______ disorder is falsification of symptoms/inducing inury in the absence of obvious external rewards
Factitious disorder
101
_____ is falsification of illness for obvious external rewards
Malingering
102
The stages of change include precontemplation, contemplation, ______, action, maintenance
Preparation
103
How might lithium use cause weight gain, hair loss, and bradycardia
Lithium induced hypothyroidism
104
What differentiates adjustment disorder fom normal sadness
Impaired social and/or occupational functioning
105
How is opiod overdose treated
Naloxone
106
How does naloxone treat opiod overdose (MOA)
Antagonizes opiod receptors (competes with opiod medications and displaces them)
107
Adverse affects of clozapine treatment (4)
Agranulocytosis
Seizures
Myocarditis
Metabolic syndrome
108
Why might a patient on resperidone present with amenorrhea and breast tenderness
Hyperprolactinemia due to ihibition of D2 receptors which normally inhibit prolactin release
109
First line treatment for specific phobia
Cognitive behavioral therapy
110
What is the first line pharmacotherapy for moderate to severe alcohol use disorder
Opiod antagonist naltrexone
111
What is the second line pharmacotherapy for alcohol use disorder
Aldehyde dehydrogenase inhibitor
112
Clinical features of tourette syndrome include ____ and ____ with an onset of <18 (usually 6-15)
Motor tics
| Vocal tics
113
Treatment for a patient with panic disorder presenting with acute distress
Benzodiazepine
| SSRI/SNRI and or CBT are first line but would not produce relief of symptoms acutely
114
Substance induced psycotic disorder may present similarly to schizophrenia but with an acute onset corilating to stimulant use as well as physical signs such as tachycardia, diaphoresis, hypertension and what other finding in the eyes
Mydriasis
115
When individuals with conduct disorder continue to display a pattern of violating th rights of others into adulthood, they are diagnosed with ______
Antisocial personality disorder
116
Define conjunctival injection
Red eyes
117
The most characteristic physiological signs of _____ intoxication are conjunctival injection, tachycardia, increased appetite, and dry mouth
Marijuana
118
BMI < _____ is consistant with anorexia nervosa diagnosis
18.5
119
Describe the restricting subtype of anorexia nervosa
Patients fast and exercise excessively but do not purge
120
Describe the binge eating/purging subtype of anorexia nervosa
Patients engage in vomiting and/or use substances (laxative, enemas, or diuretics) to avoid weight gain
121
How do opiods cause central sensitization (3)
```
Opiod receptor down regulation
Recetor decoupling (from second messengers)
Upregulation of excitatory NMDA receptors
```
122
What is a partial opioid receptor agonist that binds with high affinity but has has low intrinsic activity which may precipitate withdrawal in long term opiod users
Buprenorphine
123
First line treatment for OCD
SSRI
124
REM sleep behavior disorder is strongly associated with neurodegeneration due to accumulation of _____
Alpha-synuclein
125
What is the unconscious shifting of emotions or desires associated wth a person from the past to another person in the present
Transference
126
What immature defense mechanism is transforming unacceptable feelings/impulses into the extreme opposite
Reaction formation
127
Of the risk factors for suicide what is the strongest single factor thatis most predictive of completed suicide
Past suicde attempt
128
Why might lorazepam, oxazepam, clonazepam be better choices for sleep aid than diazepam, chordiazepoxide, or flurazepam
Lorazepam has an intermediate duration of action so has less of a chance to precipitate adverse ideeffects of sedation and fatigue when the patient wakes up as the medications with long durations of action
129
What drug class is first line therapy for psychomotor agitation associated with alcohol withdrawal and to prevent progression to seizures and delirium
Benzodiazepines
130
Chlorodiazepoxide MOA
Benzodiazepine
131
Mecanism of action of antipsychotics
Antagonism of postsynaptic dopamine D2 receptors
132
Withdrawal from what drug is characterized by anxiety, tremor, insomnia, and sympathetic hyperactivity and can also be accompanied by psychosis, seizures, or death
Benzodiazepines
133
What immature defense mechanism is transferring feelingsto less threatening object/person
Displacement
134
A patient using what substance may present with violent behavior, dissociation, hallucinations, amnesia, nystagmus, and/or ataxia
PCP (phencyclidine)
135
PCP (phencyclidine) is a hallucinogen that works primaritly as a _____ receptor antagonist as well as a monoamine reuptake inhibitor
NMDA
136
A patient that deliberately induces an infection in the absence of obvious external rewards is consistent with ____ disorder
Factitious
137
side effects frome what medication can include the following: confusion, constipation, acute urinary retention, hypotension, and sedation
Tricyclic antidepressants
138
Describe schizotypal personality disorder
Unusual thoughts, perceptions, and behaviors
139
Postpartum blues is a normal, self-limiting condition that occurswihtin a few days postpartum, the symtpoms typically peak at 5 days and resolve within __ days
14
140
Postpartum depression typically presents within 4-6 ___folowing delivery
Weeks
141
Discribe a learning disorder
Difficulties with key academic skills (reading, writing, or mathematics)
142
Patient presening with anxiety, weight loss without trying, tachycardia, warm moist skin, tremor, frightened stare and restlessness are consistent with what diagnosis
Hyperthyroidism
143
____ disorderis characterized by excessive concern about having a serious, undiagnosed disease, despite few or no symptoms and negative medical workup
Illness anxiety disorder
144
In acute distress disorder, syptoms usually develop directly following the trauma and last from 3 days to _______. When symptoms persist long, the diagnosis is changed to post-traumatic stress disoder
1 mont
145
How does transference differ from countertransference
Transference: patient's reactions towards a provider
Contertransference: provider's reaction to a patient
146
Bipolar II characteristics
Hypomanic episodes
| 1 or more depressive episodes
147
Bipolar I characteristics
Manic episodes
| Depressive episodes common but not required for diagnosis
148
Dx of persistent depressive disorder requires depressed mood more days than not for more than _____ and at least 2 other depressive symptoms
2 years
149
Pure dysthymic syndrome is a subset of persistent depressive disorder with what characteristics
Someone who has never met the criteria fo a major depressive episode
150
Attention deficit hyperactivity disorder should not be diagnosed until what age
4-5
151
In cognitive testing, what does reciting months of the year backwards test for
Concentration
152
Name an antidepressant that does not cause sexual dysfunction
Buprpion
153
What isbthe process of a previously neutral stimulus eliciting a response after association with a natural, unlearned stimulus
Classical conditioning
154
What is the process of a behavior becoming associated with an environmental consequence
Operant conditioning
155
What diagnosis is described by angry/irritable mood, argumentative/defiant behavior, or vendictiveness for 6 months oor more
Oppositional defiant disorder
