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Flashcards in Psych - Case Files, UW, etc. Deck (102):

What is the risk of recurrence of a major depressive episode if SSRIs or other treatments are discontinued?



What are the major side effects of SSRIs?

GI sx (pain, nausea, diarrhea), sleep disturb (sedation or insomnia), tremor, dizzy, sex dysfunction


What is retinitis pigmentosa, and which psychiatric medication can cause this disorder?

Pigmentation of retina that may cause poor night vision

Side effect of first generation AP Thioridazine


What is an appropriate treatment of priapism from Trazadone?

Epinephrine injection into corpus of penis


What are contraindications for using bupropion?

Patients with eating or seizure disorder


What are symptoms of life threatening lithium overdose, and how do you best treat?

Seizures and coma

Dialysis to treat


What can be useful for excessive daytime sleepiness in shift workers?



What must be ruled out to make a diagnosis of schizophrenia?

Psychosis secondary to substance abuse and or general medical conditions

Schizoaffective DO and mood DO must be R/O


What symptom is most specific to a diagnosis of schizophrenia?

Bizarre delusions


What symptom is most specific to a diagnosis of schizophrenia?

Bizarre delusions


What is the immediate treatment for panic attacks? Long term treatment for panic disorder?

1. Short acting benzo (alprazolam) - discontinue after initial few weeks


What is the definition of agoraphobia?

Anxiety about being in situations or places from which escape will be difficult, or in which help may not come if panic attack occurs


What differentiates social phobia vs. specific phobia?

Social phobia involves social or performance situations while specific involves a specific object or situation


How can ADHD be differentiated from hypo mania?

ADHD has distractibility, impulsivity and hyperactivity present on daily basis since age 7 (also look for preschool age sx)

And often oppositional defiant disorder and conduct disorder present


What needs to be monitored closely in patients taking lithium or carbamazepine?

Li - thyroid and kidney fxn

Carba - aplastic anemia or agranulocytosis


What mood stabilizers are a better option in young women of child bearing age?

Atypical APs - olanzapine risperidone seroquel


How can one differentiate schizoid PD from avoidant?

Avoidant find loneliness as ego-dystonic and strongly wish for relationships with others

Schizoid do not feel need for relationships at all


What defense mechanism is frequently seen in schizoid PD?



What is the best course of therapy for major depression with psychotic features? (Especially in elderly with SI)



What medical conditions should raise caution before doing ECT?

Raised ICP, unstable angina, recent MI, electrolyte imbalance


What pharma tx can be given for anxiety associated with performance situation just before the feared situation?

Beta blockers - atenolol and propranolol


What are typical exam findings of PCP intoxication?

Angry, belligerent, dysarthria, vertical nystagmus


How does treatment for PCP intoxication vary based on the symptoms?

Benzodiazepines if psychotic symptoms not present

Haldol if severe psychosis but this may worsen anti-cholinergic side effects, hyperthermia, dystonia


What should be avoided in patients with generalized anxiety disorder?

Benzodiazepines, because habit forming and will make buspirone and to lesser extent SSRIs less effective


What are PANDAS?

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections

Include OCD and other disorders


What is the triad of wernicke encephalopathy?

Acute reversible triad of delirium, 6th nerve palsy, ataxia, caused by thiamine deficiency


What are the CAGE questions?

Have you attempted to Cut down on drinking, Annoyed by criticism, Guilty for drinking,Eye opener

Yes to 2 or more is sensitive for EtOh dependence


What is the most sensitive test for delirium and what will it show?

EEG, generalized slowing

If delirium by EtOH or sedative hypnotic withdrawal, can show fast low voltage activity

Hepatic encephalopathy - triphasic delta waves


How do depressed youth often present to their pediatrician?

Sudden onset anger and irritability, lack of interest in fun activities, low E, poor grades


What are the key features of OCPD and how do you differentiate from OCD?

INFLEXIBLE THINKING AND BEHAVIOR - Difficulty making decisions and finishing work, blames others for problems (egosyntonic), rigid and stubborn manner

w/ OCPD there are no intrusive repetitive thoughts or ritualistic behaviors as with OCD


What are the preferred treatments for OCD?

SSRI or clomipramine are first line pharma

CBT-evoked response prevention taught to manage anxiety


What are the features of somatization disorder?

Numerous somatic complaints related to several body areas, not full explained by medical cause.

Focus is on symptoms themselves not fear of specific disease or defect


What is the best treatment for Schizoaffective DO depressive subtype?

2nd gen AP

Add SSRI only if mood sx don't improve with AP


What should be used for treating ADHD when there are concurrent substance abuse problems? What if main meds are ineffective?


Bupropion, imipramine, nortriptyline, pemoline


What are the 5 axis' of psychiatric diagnosis?

Axis 1: Clinical disorders (schizo, MDD)
Axis 2: Personality DO and Mental retardation
Axis 3: Physical disorders and other Gen Med conditions
Axis 4: Psychosocial problems contributing to psych prob
Axis 5: Global Assessment of Functioning


What is formication and how does it usually develop?

Hallucinated sensation that insects/snakes crawling over skin

Common SE of extensive cocaine/amphetamine use


What must be monitored in patients being treated with stimulants or atomoxetine?

Follow appetite, and monitor height and weight, because of risk of medication related growth rate changes


What is the advantage of using atomoxetine over Ritalin for ADHD? What should be avoided with Atom?

Atomoxetine begins working immediately to reduce symptoms and has longer onset of action

Don't take on empty stomach, can cause N/V


What meds are most helpful for patients with ASD?

Hypnotics and anxiolytics in short term (beta blockers may prevent development of PTSD)


What is the defense mechanism sublimation?

Mature DM - involves satisfying socially objectionable manners in an acceptable manner (e.g. person who enjoys exerting dominance over others, becomes prison guard)


What is the difference between suppression and repression?

Suppression is a mature defensive mech and involves conscious avoidance of particular emotion/thought

Repression is immature DM and is unconscious


What are ideal characteristics for patients who are to undergo psychoanalysis?

-Age under 40, not psychotic, intelligent, stable in relationships and ADLs


What is interpersonal therapy and how is it used?

-type of psychotherapy used for Tx of depression
-focus is on the present, and specific problem areas that may interfere w/ pt self esteem and interpersonal relationships


What is the basis of the central idea behind cognitive behavioral therapy?

-Our emotions are due to our thinking (cognition)
-we may get rewarded for how we act, contributing into increase of these thoughts and actions (behavior)


What are the best treatment modalities for bulimia nervosa?

1. Nutritional rehab
2. CBT
3. Antidepressant - SSRI (fluoxetine first, then sertraline)


What may be used by patients with bulimia to induce vomiting and what should patients be checked for?

Ipecac - can cause ipecac intoxication w/ pericardial pain, dyspnea, generalized muscle weakness; which are associated w/ HoTN, tachycardia, and ECG abnormalities
-Risk of toxic cardiomyopathy and death


What differentiates bulimia from anorexia?

Bulimia pts are less resistant to getting help, have more alcohol abuse, and have more emotional lability
-Bulimia has later onset


What drug can decrease autonomic and other sx of oops of withdrawal? MoA?

Clonidine, blocks NE neurons of locus ceruleus


What can treat sx of opioid withdrawal for patients who don't want prescription meds?

NSAID like ibuprofen for muscle aches

Loperamide for loose stools

(Promethazine for N/V, but need script)


What are the diagnostic criteria for pain DO?

-severe distressing pain at 1 or more sites, causing fxnal impairment
-psychological factors play important part in pain
-not explained by another axis 1 DO


How can you treat patient who has overdosed on TCA?

Sodium Bicarbonate, helps with ECG abnormalities


What medication is preferred for patient with bipolar 2?

Lamotrigine - helps with depression (make sure NO mania Hx)


What antipsychotic decreases suicide risk in schizophrenia?



What are the signs associated with adjustment disorder?

Emotional response to specific stressor w/in 3 mo, clinically significant somatic sx, and some mood disorders (depression, anxiety, mixed, conduct DO)


What aspect of the presentation differs most with depression in adults vs Peds?

Child and adolescents more often have irritability or short temper, than sadness with depression


What other disorders occurs most along with sleep terrors?

Restless leg syndrome and sleep disordered breathing


Which medications are useful sleeping aids and how long should they be used for?

Ramelteon, Trazodone and Z-drugs

don't use z-drugs longer than 2 weeks bc of tolerance and withdrawal symptoms


What should be the first step if seeing a new patient and suspecting somatization disorder?

Get thorough H&P and complete labs w/ blood work to r/o medical causes


What is the immediate treatment of an acute dystonic reaction?

Benztropine 2mg IM w/ repeat dose in 30min if no improvement


What is the difference between somatization and conversion DOs?

Somatization - multiple physical symptoms present for chronic length, before age of 30, not explained by any medical cause

Conversion - sx of neurologic DO w/o obvious cause or trauma (unconscious, not for external gain, internal conflict)


How can you differentiate autism spectrum DOs from Rett DO?

In Rett there is a period of normal development early on then gradual decline and loss of skills

In ASD there is evidence of disorder early on


What should be done in causes where early autism is suspected?

Full medical workup to rule out hearing/vision difficulties that may be causing poor language development


What can help to relieve some of the anxiety associated with avoidant personality DO?

Mainly CBT for APD, but SSRIs and beta-blockers can be given for anxiety


How can you differentiate autism spectrum DOs from Rett DO?

In Rett there is a period of normal development early on then gradual decline and loss of skills

In ASD there is evidence of disorder early on


What should be done in causes where early autism is suspected?

Full medical workup to rule out hearing/vision difficulties that may be causing poor language development


What can help to relieve some of the anxiety associated with avoidant personality DO?

Mainly CBT for APD, but SSRIs and beta-blockers can be given for anxiety


What is dissociative fugue?

Unexpected sudden departure from home and pt cannot recall past or identity, forges new identity; lasts hours to days, sometimes months

In setting of severe trauma or life stressor


What are predisposing factors to dissociative fugue?

Alcohol abuse, certain mood DOs, personality DOs, Hx of head trauma


What are the symptoms and time course of alcohol withdrawal?

6-8hrs: jittery and tremulous
8-12hrs: psychosis and perceptual sx
12-24hrs: seizures
24-72hrs to 1 week: DTs


What drug should be avoided in EtOH withdrawal and why?

Antipsychotics -> lower seizure threshold


What medication is preferred in the treatment of alcohol withdrawal in a patient who demonstrates poor liver function?

Lorazepam, bc metabolized solely by glucoronidation, less dependent on liver function


How can you differentiate paranoid delusions from ideations?

PD = fixed false beliefs, psychosis, require tx w/ APs

PI = paranoid personality disorder, suspiciousness NOT a Del, can be tx with reassurance


What medication can be helpful to prevent benzo withdrawal seizures in individuals prone to it?

Carbamazepine in conjunction with the benzo taper


Which benzos are more likely to cause withdrawal syndrome?

Those with shorter half lives: Alprazolam (Xanax), oxazepam, temazepam, versed


What may be a cause for anger and self destructive behavior in mentally retarded individuals?

Underlying medical condition that is causing pain

Also look for concurrent psychotic disorder that is separate from mental deficit


What two pieces of info are key in diagnosing mental retardation?

IQ score and evidence of deficits in adaptive functioning (conceptual skills, social skills, practical skills)


What is the most common cause of mental retardation?

Idiopathic or unknown


Which medications work best for agitation and psychosis from illicit drug intoxication?

Haldol and other APs


What is a patient on MAOIs consuming tyramine rich foods at risk for and what should be monitored?

Hypertensive crisis, monitor blood pressure closely


What is the treatment of akathisia?

Beta blocker or benzo


Which drugs may decrease suicidality?

Lithium and clozapine


Why do you titrate clozapine slowly?

Prevent agranulocytosis and seizures


What are the manifestations of ecstasy intoxication? What is a potentially dangerous drug interaction?

Hypertension, tachycardia, hyperthermia, hyponatremia

Can develop serotonin syndrome - autonomic dysregulation, AMS, high fever, neuromuscular irritability, and seizures (especially if pt on SSRI, MAOI, TCA etc.)


What psychological reactions do patients who ingested bath salts present with?

Amphetamine analogs - hyperactivity, combativeness, severe agitation, hyperthermia


What type of defensive mech is rationalization and what is it's definition?

Immature - excusing an unacceptable behavior in a false but logical way, usually to avoid difficult truths


What are the main impairments present in Asperger's syndrome?

Impairment in reciprocal social interactions and restricted interests. Desire relationships, lack awareness of social conventions. Normal language development


What are the major needs of people with OCPD?

Need for order and perfection, and to carry out activities in a extremely methodical way (usually before adulthood). These methods can severely impact life and work, resulting in missed deadlines, etc. Ego-syntonic


How can you distinguish paranoid personality disorder from delusional disorder?

PPD is characterized by a pervasive pattern of distrust and suspicion (interpersonal problems), but no persistent delusions or other psychotic symptoms

DD is >= 1 delusion for at least 1 month, can involve erotomanic, grandiose, jealous, persecutory and somatic subtypes


Which AP is least likely to cause weight gain?



What medications are preferred for EtOH detox in patient with liver cirrhosis?

LOT - lorazepam, oxazepam, tonozepam

These are Not fully metabolized by liver


What are the main tx from dystonia side effects of APs?

AntiAch - benztropine

Anti-histamine - diphenhydramine


What drugs can interact with lithium?

Diuretics, NSAIDA besides aspirin, SSRIs, ACEI/ARB, antiepileptics


What is the preferred treatment for patient's with mild-moderate bipolar disorder? Severe?

Atypical antipsychotics

Combo therapy with lithium/valproate + atypical AP


What's the risk of developing bipolar d/o in pt with single parent who has bipolar? Both parents? Monozygotic twin?

10%, 60%, 70%


What is the preferred therapy for specific phobia?

Behavior therapy (exposure, systematic desensitization etc.)


What are Zuprasidone (Geodon) and Lurasidone (Latuda)? What can they be used to treat?

Z - (atypical AP) adjunct to Li or Valproate in maintenance treatment of bipolar

L - (atypical AP) treats depressive episodes of bipolar depression alone or with Li/Val


What is introjection?

immature DM, that involves incorporating another's attitudes into one's own perspective (victim of DM, blames partner's aggression on themselves)


What is the best method of treatment for hypochondriasis?

Hypochondriasis occurs more commonly during times of psychological stress, therefore inquire about recent/current emotional stressors and provide brief psychotherapy


What are the order of treatments for conversion disorder?

1. Education and self-help techniques to pt and family
2. CBT
3. Physical therapy for motor symptoms


How long should a patient who is tolerating an SSRI, but not noticing improvements, c/w the dose before considering raising it?

Go for at least 4 weeks, and if no improvement then consider increasing dose


What common side effects are seen commonly with Clozapine and Olanzapine, and what should be checked frequently?

Metabolic adverse effects - weight gain, dyslipidemia, hyperglycemia

Check fasting blood sugar and lipids, and get regular BMI, BP and waist circumference checks


What neuroimaging findings are present in schizophrenia? PTSD? OCD? Autism?

Schizo - enlargement of cerebral vesicles
PTSD - decreased hippocampal volume
OCD - orbitofrontal cortex and striatum abnormal
Autism - increased total brain volume