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psych clin Flashcards

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1
Q

trx of SAD

A

light therapy and bupropion

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2
Q

which drugs are specific for premenstrual dysphoric disorder

A

sertraline
perioxitine
fluoxetine

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3
Q

trx for bipolar (and their AEs)

A

lithium, valproic acid, carbamezapine (check blood levels)

second gen antipsychotics to calm mania

lamotrigine for bipolar w depression
can cause STEVEN-JOHNSON SYNDROME= rare but deadly allergic rash from neck up

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4
Q

criterion for social anxiety disorder/social phobia

A

persistent fear of social performance/exposure to unfamiliar ppl

may have panic attacks
person recognizes their fear is unreasonable/excessive

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5
Q

social anxiety disorder has increased risk of what

A

alc dependence, severe depression

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6
Q

most often medical ds causes psych sx

A 
UTI
pnuemonia
electrolyte abn
sepsis
thyroid
hypoxia
hypoglycemia
hyponatremia (elderly w ssris)
stroke, CNS lesion
MI
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7
Q

trx for delerium in ER

A

sedative: haloperidol +lorazepam (IM 15-30 min)
only haloperidol in elderly

keep pt safe, in quiet room

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8
Q

describe labs for alc withdrawal

A 
low platelets on CBC
MCV>100
hypoNa on BMP
dec hepatic function
blood alc level
drug urine screen
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9
Q

trx for alc withdrawal in the ER

A

IV fluids
thiamine
glucose

meds= IV lorazepam (if liver impaired)
IV diazepam/chlordiazepoxide (if liver good)

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10
Q

meds to give violent pts in the ER

A

haloperidol, lorazepam, olanzapine, ketamine

get full labs and consults

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11
Q

trx for PTSD

A 
SSRi
therapy
prazosen for nightmares
EMDR (REM to desensitize)
NO GIVE BENZOS bc of increased risk of addiction
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12
Q

acute stress disorder vs PTSD

A

ASD= 3 days 1 month

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13
Q

criterion for adjustment disorder

A

emotional/behavior changes associated witha stressor within 3 months but no longer than 6 months

=not proportionate disress and decreased functioning

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14
Q

sx associated with conversion disorder=

A

unexplained neural deficits w change in voluntary movement, initiated or worsened by a stressor

~pseudo-seizures (normal EEG), numbness, paralysis, tremor

NOT fake
associated with sexual and physical abuse as a child

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15
Q

what is factitious disoder

red flad?

A

munchausen
munchausen by proxy
red flag= lots of allergies

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16
Q

risk factors for alzheimers

A

(progressive and irreversible)
female, FH, head trauma, down’s syndrome
=50-60% of dementia

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17
Q

risk factors for vascular dementia

A

male, old, HTN, CV ds

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18
Q

what is pick’s ds

A

a type of progressive dementia
associated with frontotemporal lobe atrophy
=young, volatile, and violent

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19
Q

describe lewy body dementia

A

memory loss, parkinsonian sx, frank visual hallucinations

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20
Q

what are some reversible causes of dementia

A 
drugs
hypothyroid
metabolic ds
hematomas
normal P hydrocephalus
inc ICP
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21
Q

what labs are important when you suspect dementia

A

thyroid, glucose, vitamines
b12 (<400 means need trx)
kidney function, A1c

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22
Q

what imaging test can diagnose Alzheimer

A

pet scan

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23
Q

causes of delirium w psychosis in elderly

A 
drugs
infection
retention/constipation
hypoxemia
stroke/seizure
lack of sleep
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24
Q

what can happen if you give elderly diphenhydramine

A

seretonin syndrome and psychosis

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25
explain the domains of adaptive functioning in intellectual disability
conceptual= school for that age (preschool=language, school=reading and regulate emotions, adults= stuck at school level) social domain= v gullible and easily manipulated by peers practical domain= personal care and daily living tasks
26
what is the difference between intellectual disability and global developmental delay
GDD is just the dx for people who can't be tested, i.e. kids too young, post severe head injury
27
define language disorder
persistent difficulty of acquisition and use of language across modality = x comprehesion (less vocab, sentence structure, impaired discourse)
28
define speech sound disorder
diff PRODUCTION of speech
29
define childhood onset fluency disorder
stuttering (time patterning)
30
define social (pragmatic) communication disorder
diff w social use of verbal and nonverbal communication inappropriate greeting and info sharing, can't understand the rules of language, diff w sarcasm ="autism of language", associated w the delay of reaching milestones
31
what must be present for dx of autism spectrum
all 3 deficits 1. in social-emotional reciprocity 2. nonverbal communication 3. in making, maintaining, and understanding relationships + 2+ of below - repetitive motor movements, use of objects, speech - insistence of sameness, inflexibility - highly restricted, fixated interests - hyper/hypo sensitivity to sensory input
32
trx for autism spectrum
most consistently useful= education and support for pt, parents, family, teachers parallel process FDA approved meds= risperidone, aripriprazole (for agitation) off label= valproic acid, gabapentin, stimulants, alpha agonists, anti-depressants
33
what specifiers are needed dx of autism spectrum disorder
w or w/o accompanying intellectual repair w or w/o accompanying language repair associated w neurodev/mental/behav disorder associated w catatonia associated a med/gen/env factor
34
with the tourrette's triad, which sx are more associated w males and females
``` males= tics, ADHD females= OCD sx ```
35
ADHD is associated with what parts of the brain
prefrontal cortex and dorsal anterior midcingulate cortex DA and NE
36
which tests can be used to dx for ADHD
TOVA (variables for attention) | Conner's continuous performance tasks
37
med trx for ADHD
alpha 2 adrenergic agonists= guanfacine and clonidine bupropion (antidepress w mixed catechol effect) atomexatine (not first line bc CV AR) modafanil= adults only= inhibit DA uptake= can cause DRESS syndrome, steven-johnson syndrome, epidermal necrolysis methylphenidate= increase extracell DA
38
define developmental coordination disorder
-acquire and execute coordinated motor skills way behind expected age v clumsy
39
define stereotypic movement disorder | specificities?
repetitive, pointless motor behavior specific= w self-injurious behavior, w known med/gen/neurodev/env factor ``` severity= mild= easily suppressed mod= require explicit protective measure severe= continuous monitoring ```
40
meds for tourrettes
ONLY FDA: haloperidol, pimozide, aripriprazol (antiDA) fluphenazine, risperidone guanfacine, clonidine VMAT2 inhibitor (-benazine) botulin-toxin injections anticonvulsants= topiramate, gabapentin, valproic acid
41
what is the reward deficiency syndrome
DA malfunction--> vulnerability to addiction associated w hippocampus and amygdala
42
what blood alcohol level does intoxication start at
0.08 g/dL
43
med trx for alcohol withdrawal
benzos (makre sure no alc in blood--> resp suppression) anticonvulsants= carbomezapine, gabapentin, valproic acid disulfiram (=more harm than good) naltrexon acamprosate (3x a day)
44
to taper off benzos, which long eliminating drugs can you switch them to
clonazepam, chlordiazepoxide, diazepam
45
what drugs can you give if you need to taper off benzos or barbs quickly
best= gabapentin, tizanidine | also carbamezapine and valproic acid
46
which benzos are not effected by age or hepatic insufficiency (bc only glucoronidation)
oxazepam, lorazepam, temazepam | can use w cirrhosis
47
trx for opioid withdrawal
antiemetics, antacids, anti-diarrhea, M relaxant, NSAIDs, clonidine, methadone--> high risk qtc prolongation naltrexone buprenorphine= highly motivated patients
48
cocaine use can have what medical effects
risk of MI, CVA (get EKG) rhabdomyolysis--> compartment syndrome psychosis bc of xneuroadaptation
49
SEs of chronic amphetamine use
neurotoxicity from glutamate, axonal degeneration, permanent psychosis
50
how does tobacco change drug metabolism neuroadaptation?
induce cyp1a2 (i.e. olanzapine) DA release from ventral tegmental area to nucleus accumbens
51
med trx for tobacco use
bupropion | varenicline
52
trx of PCP intoxication
antipsychotics and benzos, less stimulating environment
53
terms for classical conditioning
(simultaneous) condition, unconditioned response and stimulus extinction
54
terms for operant conditioning
(in order) | positive/negative reinforcement/punishment
55
phases of sexual response cycle
1. desire= drive (bio) + motivation (willing)+ wish fullfilment (cultural hope) 2. excitement= arousal phase (erection, vaginal lubrication, nipples hard) vasodilation of genitals and M in body contractions 3. orgasm = rhythmic contractions of perineal Ms 4. resolution (rapid if orgasmed, hours if didnt') Ms have refractory period and fast resolution Fs have no refractory period, long resultion
56
define female sexual interest/arousal disorder
decreased sexual interest for 6+ months for 3+.. | less interset, thoughts, receptiveness, pleausre, sensations
57
define male hypoactive sexual desire
persistent deficient sexual fantasies/desire for 6+ months
58
define erectile disorder
at least 6+ months of | cant get erection, keep it, or is less rigid
59
define female orgasmic disorder
delay/no orgasm for 6+ months
60
define delayed ejaculation disorder
6+ months almost always can't ejaculate
61
define premature ejaculation disorder
6+ months of ejaculation within 1 min of penetration
62
define genito-pelvic pain penetration disorder
6+ months of 1+ | pain w penetration, tensing/tightened of floor Ms w penetration, fear of pain
63
define voyeurism
peeping tom, 18+ yo
64
define fetishistic disorder
arousal from nonliving objects, not focused on genital parts
65
define pedophilia
attracted to kids <13, must be 16+ and 5+ years older than kid can be exclusive or nonexclusive
66
define frotteuristic disorder
touching/rubbing against nonconsenting individuals | male 15-25
67
risk factors of child abuse
``` child what makes taking care more diff colicky infant <1 year nonbio parent ``` ``` parent criminla hx substance abuse hx of mental health teen parents ``` social isolation, poverty
68
most common type of child abuse, most commonly causes death
neglect
69
response to suspected emotional abuse
if isolated w no immediate harm: refer to family therapy and parenting classes if recurrent w immediate harm: call CPS
70
response to neglectful child abuse
call CPS, send social worker to home
71
response to physical or sexual child abuse
call CPS
72
increased risk of sexual abuse in what population of children
deaf children trans kids intellectually disabled
73
risk factors for elder abuse
elders- dementia, psych dx, physical dependence, incontinence perpetrator- substance abuse, male, financial dependence on victim
74
pharm trx for anorexia
not first line, only use if resistant NO USE BUPROPION or TCA only give SSRIs if anxiety/depression is bad enough to interfere w care ``` olanzopine= for help w weight gain lorazepam= decrease anxiety associated w eating ```
75
trx for bulimia
gold standard = CBT give CBT+pharm+nutritional rehab meds= 1st line= fluoxetine 2nd line= sertralin/fluvoxamine 3rd= TCA
76
trx for binge eating disorder
1st line= CBT+interpersonal therapy
77
describe stress theory
sympathetic response to stress = increase catechol release, serotonin turnover, DA transmision =increase CRH-->ACTH decrease growth, immunity

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