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Flashcards in Psych Tips, Techniques and Treatment Options Deck (184):
1

What is a good way to close a patient encounter

Ask the patient what their goal was for the visit

2

Generally how should you diagnose personality disorders

Unless a patient meets every single wicket for a disorder, use the diagnosis of Personality Disorder NOS

3

What treatment options should be considered when treating depression and an unresolved neurovegitative state

Consider using Buproprion first, and then adding adderall on later.

4

What are some common drugs that need to be titrated up and down

SSRI
SNRI
Benzodiazepines
Lamictal
Topamax
Beta blockers

5

When should you consider do genetic testing for medical treatment in psych?

consider in patients who are low responders and have sensitivity problems with a few different classes.

Generally not beneficial in patients that have tried many different classes already

6

What is the benefit of using an anxiolytic over a benzodiazepine when treating anxiety

Benzo's will only mask the problem, while anxiolytics have the ability to correct the problem.

7

What should you do if a patient is sensitive to a medication after beginning treatment

Switch to a different medication and start on a low dose. Titrate up slowly

8

What determines the interval between visits

Disease progression, patient stability and support group determines intervals.

4-6 weeks after initiating a medical change or unstable patient.
2-3 months if the patient is showing improvements but not at target
4-6 months if the patient is stable and has met or is near target

9

What is a good medication to start for a patient with anxiety?

Anxiety is closely related to Serotonin levels so initiate therapy with an SSRI.

If the patient is also experiencing depression, start with the lowest possible dose and titrate up slowly.

10

What psychiatric effect does antihypertensive medications have?

May cause depression

11

What cardiac effect does anti-depressants cause

Arrhythmias

12

If a patient is depressed and anxious but is experiencing negative sexual side effects from an SSRI, what is a good alternative

Mirtazipine

13

What is a serious complication of trazadone

Priapism in 1%

14

How is trazadone used medically

Commonly used as an adjunct of treatment with bupropion. It is also used to assist patients in sleeping

It is mainly used to treat anxiety and depression

15

How do you treat fibromyalgia and depression

Initiate treatment with an SNRI. Consider adding an SSRI after the SNRI has been maxed.

Be sure to monitor for symptoms of seratonin syndrome

16

What is a limiting side effect of duloxetine

comorbid liver disease

17

When adjusting dose of lamictal, what should the patient look for

a Rash. There is the potential to develop Steven-Johnson Syndrome (SJS)

18

Nefazadone. No longer used in the US do to what side effect

Liver dysFunction

Contraindicated in patients with a comorbid liver disease

19

what is the mnemonic for dementia

(DEMENTIAS)
Degenerative disease
Endocrine
Metabolic
Exogenous
Neoplasm
Trauma
Infection
Affective Disorder
Stroke/Structure

20

what is the mnemonic for delerium

(I WATCH DEATH)
Infection
Withdrawal
Acute metabolic/Abuse of substance
Trauma
CNS pathology
Hypoxia
Deficiencies
Endocrine
Acute vascular / MI
Toxins or drugs
Heavy metals

21

what is the mnemonic for a depressive episode

(SIG E CAPS)
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor agitation or Retardation
Suicidal ideation

22

what is the mnemonic for TCA toxicity

"Tri C's"
convulsions
coma
cardiac arrhythmia

23

what is the mnemonic for mania

(DIG FAST)
Distractability
insomnia
Grandiosity
Flight of ideas
Activities / Psychomotor agitation
Sexual indiscretions
talkativeness or pressured speech

24

what is the mnemonic for a personality disorder

(MEDIC)
Maladaptive
Enduring
Deviate from cultural norms
Inflexible
Causes impairment in social or occupational functioning

25

what is the mnemonic for the evaluation of EPS

"4 and A"
4 hours: acute dystonia
4 days: Akinesia
4 weeks: Akathisia
4 months: Tardive dyskinesia

26

what is the mnemonic for the features of substance abuse

(WITHDraw IT) 3 or more in a 12 month period

Withdrawal
Interest or important activities decreases
Tolerance
Harm
Desire to cut down
Intended time or amount exceeded
Time spent with or for substance increased

27

what is the screening tool for alcoholism?

"CAGE Questionnaire"
1. have you ever felt the need to cut down on drinking ?
2. have you ever felt annoyed by criticism of your drinking?
3. have you ever felt guilty of your drinking?
4. have you ever had to have a morning "eye opener"?

answer of yes to more than one makes alcoholism likely

28

what is the mnemonic for the risk factors associated with suicide

(SAD PERSONS)
Sex (male)
Age (older)
Depression
Previous attempt
Ethanol or substance abuse
Rational thought
Sickness
Organized plans and access to weapons
No spouse
Social support lacking

29

Can antihypertensive medications cause depression

yes

30

What cardiac side effect is associated with several antidepressants

May cause arrhythmia

31

If a patient is sensitive to the sexual side effects associated with SSRI's, what medication should be considered

mirtazipine

32

What is the major side effect of trazodone

Priapism
(1% of population)

33

When is trazodone indicated

Anxiety and depression
Can be used as an adjunct therapy with buproprion to assist with insomnia (increases sleep duration)

34

What is key consider when prescribing duloxetine

Comorbid liver disease use with caution.

35

What is the most serious side effect of lamictal

Rash. Can develop Steven Johnson Syndrome

36

When should you use nefazodone

not in the US. It is contraindicated with liver disease

37

What are the common side effects of topamax

Skinny and stupid (trouble finding words/speaking)

38

What tends to happen with depressed and anxious periods of increased stress

Generally their symptoms will decrease

39

What psychological conditions are generally associated with outburst

1. Bipolar
2. Anxiety
3. ADHD
4. Drug Side Effects

40

What drug is known to decrease seizure threshold

Buproprione

41

What can be used to help reduce racing thoughts at bed time

Neurontin

42

Is GAD always associated with Panic Disorders

NOPE, anxiety attacks are the key feature not necessarily generalized

43

If Lamictal is insufficient in treatment what is a good complimentary medication to add

Abilify

44

What is the drug of choice (gold standard) for anxiety and depression

Prozac (fluoxetine)

45

What affect does lap bands and gastric by-pass surgeries have on anti-depressants

Lap bands have a limited effect
Gastric Bypass will tend to have a greater effect

46

If a patient has bouts irritability, what other conditions should be considered

Anxiety

47

acute dystonia

neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures.[

48

akinesia

the inability to initiate movement due to difficulty selecting and/or activating motor programs in the central nervous system

a result of severely diminished dopaminergic cell activity in the direct pathway of movement.

49

akathesia

characterized by unpleasant sensations of inner restlessness that manifests itself with an inability to sit still or remain motionless

50

Tardive dyskinesia

characterized by repetitive, involuntary, purposeless movements. Some examples of these types of involuntary movements include grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking.

51

What is atypical depression

similar to MDD but is characterized by reversed vegetative symptoms, namely over-eating and over-sleeping, and separately by interpersonal rejection sensitivity.

52

What are the primary drugs used for depression

SSRI
SNRI
TCA

53

What are the primary drugs for atypical depression

MAOI
SSRI's

54

What can be used for depression with insomnia

Mirtazipine

55

Name the MAOI's generally used for depression

phenelzine
tranylcypromine
isocarboxazid

56

what is the mechanism for Buproprion

Norepinephrine - dopamine reuptake inhibitor

57

what kind of plasma levels should be drawn with carbamazepine

during the first three months weekly CBC's should be drawn.

Liver function tests every 6 months

58

what kind of plasma levels should be drawn with valproate

serum valproate levels (therapeutic 45-50mg/mL)

LFT's every 6-12 months

59

What are the 3 classifications of the causes of mental illness

Biologic
psychological
Environmental

60

What is included in Axis I

clinical syndromes (organic mental disorders)

61

What is included on Axis II

Personality disorders and Mental Retardation

62

What additional lab work is needed with Clozapine

weekly CBC for 6 months followed by every other week CBC's for 6 months

63

What is included on Axis III

General medical conditions

64

What is included on axis IV

Psychosocial and environmental problems (stressors)

65

What is included on Axis V

Global assessment of function

66

How is GAF determined

a numeric scale (0 through 100) used by mental health clinicians and physicians to rate subjectively the social, occupational, and psychological functioning of adults, e.g., how well or adaptively one is meeting various problems-in-living. The scale is presented and described in the DSM-IV-TR on page 34.

100 - no problems
40 - suicide idealation
10 - danger to hurting others or self

67

What are the positive symptoms associated with Schizophrenia

delusions
hallucinations
catatonia
agitation

68

What are the negative symptoms associated with Schizophrenia

affective flattening
apathy
social withdrawal
anhedonia
poverty of thought
content of speech

69

What is required for diagnosis of Schizophrenia

Two of the following for most of 1 month (group A)
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms

Marked social or occupational disturbance

Duration of at least 6 months of persistent symptoms such as attenuated forms of group A symptoms or negative symptoms

substance use, medical conditions and associated mood disorders ruled out

70

What are the subtypes of schizophrenia

Paranoid
disorganized
Catatonic
Undifferentiated
Residual

71

What is catatonic schizophrenia

clinical picture dominated by 2 of the following
a. motoric immobility as evidenced by catalepsy or stupor
b. excessive motor activity
c. extreme negativism or mutism
d. peculiarities of voluntary movement such as posturing, stereotyped movements, prominent mannerisms, or prominent grimacing
e. echolalia or echopraxia

72

What is the effect of GABA for psychiatric disorders

plays an inhibitory role with dopaminergic neurons.
GABA may be responsible for terminating or controlling the activity with in the dopamine system
1. Low levels of GABA are found early in the course of schizophrenia
2. Benzodiazepines, which work in part as GABA agonists can relieve some symptoms of schizophrenia in some patients
3. Baclofen, a GABA receptor Antagonist can exacerbate symptoms of schizophrenia

73

What is the theory behind using D2 blockers with schizophrenia

Dopamine receptros, particularly D2 receptors, are found in abnormal numbers in the brains of persons with schizophrenia.

74

How is glutamate affected in patients with schizophrenia

Glutamate levels are reduced in the CSF of persons with schizophrenia. In addition, glutamate receptor antagonist such as phencyclidine can cause schizophrenia-like symptoms

Glutaminergic neurons interact with both serotonergic and dopaminergic systems

75

What are two types of catatonic posturing

catatonic rigidity
wavy flexibility

76

What is a brief psychotic episode

Duration of schizophrenia like symptoms for one day but less than one month

77

What is schizopheniform disorder

schizophrenia like symptoms for more than one month but less than 6 months

78

What is schizoaffective disorder

schizophrenia with mania or major depression
1. Subtype Bipolar
2. Subtype Depressive

79

Which group of antipsychotic medication is associated more with anticholinergic side effects

low potency

80

Due 1st generation antipsychotics effect more of the positive or negative symptoms

Primarily positive but less effect on chronic well organized delusions

81

How do you treat the side effect of an acute dystonia

benztropine (1-2mg IM)
Diphenhydramine (25-50mg IV or IM)

82

What is the mechanism of benztropine

anticholinergic

83

How do you treat the side effect of akathisia

May respond to antiparkinsonian agents.

If the patient responds poorly to these agents, consider:
propranolol, benzodiazepines, vitamin E

84

What are the antiparkinsonian agents

Amantadine (Symmetrel)
Benztropine (Cogentin)
Biperiden (Akineton)
Diphenhydramine (Benadryl)
Trihexyphenidyl (Artane)

85

Buspirone is used to treat what

Antianxiety

86

Buproprion is used to treat what

depresssion

87

What is the mechanism for buspirone

binds to serotonin and dopamine receptors

88

Hydroxyzine can be used to treat what psychiatric disorder

Anxiety

89

Name the Atypical Antipsychotics

aripiprazole
asenapine
clozapine
iloperidone
olanzapine
paliperidone
Quetiapine
Risperidone
Ziprasidone

90

Name the conventional Antipsychotics

Chlorpromazine
Thioridazine
Fluphenazine
Perphenazine
Trifluoperazine
Thiothixine
Haloperidol
Loxapine
Molindone

91

What are the neurochemical factors associated with mood disorders

NE
Dopamine
5-HT
GABA

92

What is the proposed neurochemical cause of mania

increase NE activity

93

Name 2 dopaminergic agents that can be used to treat depression

Methylphenyldate
Modafinil

94

What is the duration of symptoms for a MDE

2 weeks

95

What is the duration of symptoms for a Manic episode

1 week

96

What defines a mixed episode

patient satisfies criteria for both manic episode and MDE over a 1 week period

97

What defines a hypomanic episode

Duration only needs to last 4 days and the symptoms of mania are milder

98

What is the duration of symptoms needed to diagnose dysthymia

2 years for adults
1 year for children and adolescents

99

What is a cyclothymic disorder

dysthymic disorder with intermittent hypomanic periods.

Chronic illness of at least 2 years in duration

100

Name the mood disorder modifiers

Severity (presence or absence of psychosis)
Remission
Catatonic features
Melancholia
Atypical features of depress
Postpartum onset

101

What are mood stabilizers used in the treatment of Bipolar

Lithium
Valproate
Carbamazepine
Second generation antipsychotics
Lamotrigine
Benzodiazepines for mania and sedation
Anticonvulsants (oxcatbazepine, topiramate, gabapentin, tigabine)

102

What are the side effects of lithium

tremor
sedation
nausea
polyruria
polydipsia
memory problems
weight gain
hypothyroidism

103

How is Lithium excreted

renally;
monitor clearance and therapeutic levels in pts with reduced kidney function

104

What are some side effects of Carbamazepine

blurred vision
ataxia
nausea
fatigue
hyponatremia
asymptomatic leukopenia

RARE BUT SERIOUS
AGRANULOCYTOSIS
SJS
PANCREATITIS

105

What is the pharmacological treatment of OCD

SSRI's

106

What is the duration required to diagnose GAD

6 months

107

What is the duration of symptoms required to diagnose panic disorder

1 month

108

What 2 SSRI's have an FDA approval for PTSD

Sertraline
Paroxetine

SSRI's are less effective against combat related PTSD

109

What is aphasia

impairment or loss of language function

110

What is apraxia

inability to execute previously learned complex motor behaviors such as bathing, dressing, driving, or drawing

111

What is agnosia

failure to recognize or identify previously known objects

112

What defines cortical dementia

characterized by the early appearance fo aphasia, difficulties with calculation and memory loss.

Disturbances of speech and psychomotor behavior are less predominant

113

What defines subcortical dementia

is characterized by the early appearance of problems with executive functioning and recall, dysarthria, motor skill impairment, and personality changes.

These symptoms can occur in the absence of significant aphasia

114

What is the pathology behind huntington's disease

progressive neurodegenerative disease that involves loos of GABAnergic neurons of the basal ganglia.

Manifest y choreoasthetosis and dementia

115

what is cataplexy

complete loss of muscle tone associated with narcolepsy and atonic seizures

116

what defines myoclonic seizures

muscle contraction with out loss of consciousness

117

What are the 4 types of generalized seizures

tonic clonic
atonic
Absence
myoclonic

118

What are the 2 types of partial seizures

Simple partial
Complex partial

119

What defines simple partial seizures

manifested by motor, sensory or autonomic disturbances depending on the location of the seizure focus

120

What defines complex partial seizures

disturbances of consciousness, including decreased awareness and alteration of cognition, emotion and sensory experience

may resemble symptoms of dissociative fugue

121

Define beriberi

thiamine deficiency

Wet beriberi: pt present with high-output cardiac failure,

Dry beriberi: peripheral neuropathy with bilateral distal impairment of motor and sensory skills and reflexes

Cerebral Beriberi: CNS damage with motor and cognitive impairments

122

Define pelagra

nicotinic acid deficiency

Caused by alcohol dependence, vegetarian diets, starvation

Symptoms include dermatitis, diarrhea, peripheral neuropathies, cognitive deficits, and personality changes that progress to delirium

123

Psychiatric symptoms of hyperparathyroid disorders

muscular weakness, anxiety and personality changes. Delirium, seizures and death can occur with a parathyroid storm

124

Psychiatric symptoms associated with hypoparathyroid disorder

increased excitability, transient parathesias, crampon, twitching, tetany and seizures

125

Hypothyroid disorder is also known as

myxedema

126

Psychiatric presentation of AIP

acute intermittent porphyria

abdominal pain, motor neuropahties and mental disturbances that range from personality changes to psychotic symptoms and delirium.

127

What are egosyntonic symptoms

patients do not recognize that anything is wrong with them that needs to be changed. They view existing disturbances as being the result of the worlds being out of step with with them.

128

Name the Cluster A personality disorders

Schizoid
paranoid
schizotypal

129

Name the cluster B personality disorders

histrionic
narcissistic
antisocial
borderline

130

Name the cluster C personality disorders

Avoidant
dependent
Obsessive-Compulsive Personality D/O

131

What is the progression to antisocial

conduct disorder
oppositional defiant
Antisocial

132

How do you distinguish avoidant from schizoid

avoidant personality has the fear of rejection yet still wants friends

Schizoid does not want friends

133

What defines conversion disorder

subjective symptoms unexplained by physical findings

Often the patient will show little concern to the symptoms

Modeling is common

134

what defines body dysmorphic disorder

unusual attention to and /or preoccupation with symptoms, organs, and body parts

135

what defines somatization disorder

four pain symptoms
two GI symptoms
one sexual symptom
One pseudoneurologic symptom

136

What defines hypochondriasis

preoccupation with fears of having a serious disease due to a misinterpretation of a bodily symptom

137

What is a dissociative fugue

sudden, unepected travel away from home or place of work with an inability to recall one's past and confusion about personal identity or assumption of a new identity

138

What is dissociative amnesia

inability to recall important personal information, usually of traumatic or stressful nature, too extensive to be accounted for by ordinary forgetfulness

139

What is a dissociative identity disorder

involves the presence of two or more distinct personalities or personality states which recurrently take control of the person's behavior

140

What is a depersonalization disorder

persistent or recurrent experiences of detachment from one's body or mental processes

141

What differentiates malingering from factitious disorder

malingering has a motive. Both have deliberate cause of symptoms

142

What are the stages of sexual response

I: desire
II: Excitement
III: Orgasm
IV: Resolution

143

What is sexual identity

individuals' biologic make up including chromosome configuration, genitalia, hormone levels, and after puberty the secondary sex characteristics

144

What is gender identity

a person's self-identification as male or female which usually occurs by age of 2-3 years

145

What is sexual orientation

the object of an individuals sexual desire

146

What is frotteurism

characterized by touching or rubbing against a nonconsenting person

147

What is klismphilia

arousal from enemas

148

What is telephone scatologia

arousal from making obscene phone calls

149

What sexual effect can dopaminergic medications have

increases libido

150

What body weight is required for diagnosis of anorexia

85% of ideal weight

151

What are the two subtypes of anorexia

Restricting
Binge/purge

152

What are the abnormal associated findings of anorexia

Peripheral edema
Lanugo hair development
Skin changes
Lowered metabolic rate
Decrease total brain volume

153

What medications are indicated for anorexia

Cyproheptadine (apetite stimulation)
Fluoxetine (after weight has returned)

154

What are associated findings in bulimia nervosa

ingestion of high calorie food
bingeing episodes occur in secret
wide fluctuations in weight
persistent overconcern with weight and body shape
attempts to lose weight
Lengthy phases of normal eating

155

What are some medical complications of bulimia nervosa

metabolic abnormalities
parotid gland swelling
dental erosions
menstrula irregularities
gastic dilation and rupture
chronic sore throats and esophagitis
anemia
Neropsychiatric symptoms (seizures, neuropathies)

156

How will a patient present with Neuroleptic malignant syndrome

altered mental status
muscle rigidity
hyperthermia
diaphoresis
tachycardia
elevated blood pressure

LABS:
Elevated CPK
Leukocytosis

157

What is used for the treatment of NMS

stop the offending agent
Fluids
Cooling blankets
dantrolene
ECT if pharmocotherapy fails

158

How will a patient present with Serotonin Syndrome

myoclonus
mental status changes
akathisia
diaphoresis
tremor
hyperreflexia
mydriasis
diarrhea
headache
autonomic instabilities

159

What is the treatment for serotonin syndrome

Stop the offending agent
supportive care
control agitation with benzodiazepine
Cyproheptadine can be given in moderate cases to control symptoms

160

What is pica

persistent (for a period of atleast 1 month) eating of nonfood products

161

What symptoms should cause you to suspect lead poison in a child

suspected in any child who has an encephalopathy or who exhits unusual behavior (irritability, anorexia, decreased activity)

162

What is rumination disorder

a potentially fatal disorder that is characterized by the regurgitation of previously ingested food followed by rechewing of the foot.

Onset is typically in the first year of life, but in mentally retarded individuals may be delayed until adult hood

163

What is anaclitic depression

infants that have failure to thrive after being removed from their between 9 and 12 months of age

164

What is reactive detachment disorder

The child has impaired social interactions that are due to pathologic parenting and not due to an autism spectrum disorder.

Two types:
inhibited type: the child does not initiate or respond appropriately socially and may avoid contact or approach and then avoid contact

Disinhibited type: children are overly familiar with strangers

165

What is autistic disorder

the child is relatively unresponsive to other hum beings, demonstrates bizarre responses to the environment, and has unusual language development.

Most commonly before the age of 3.

166

What 3 things are required to diagnose autism

Social interactional deficits
Communicative deficits
Behavioral deficits

167

What are the 3 subtypes of ADHD

inattentive type
hyperactive-impulsive type
combined type

168

What is the pharmacological treatment for oppositional defiant disorder in patients with ADHD

Stimulants
atomoxetine
clonidine

169

What is the medical treatment for tourettes

dopamine blocking agents
Clonidine
Guafacine

170

What is PANDAS

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal group A

abrupt onset in early childhood of OCD symptoms

171

What is somnambulism

sleep walking

onset between 4 and 8. peaks at 12

172

what is somniloquy

sleep talking

173

how are night terrors characterized

1. inconsolability of the child during the event
2. absence of recall of the content of the dream
3. absence of recall of the event the following morning

174

What is the treatment for narcolepsy

modafinil

175

What is primary nocturnal enuresis

Bed wetting

parasomnia that occurs during stages 3 and 4 sleep

176

What is primary diurnal enuresis

Bed wetting

parasomnia that occurs during the waking hours

177

What is secondary enuresis

unrinating at inappropriate time and places that develops after one year of good bladder control

178

What is encopresis

fecal incontinence beyond the period when bowel control should normally have developed

179

define dementia with lewy bodies

cytoplasmic inclusions found in cells of the sbstantia nigra in patients with idiopathic parkinson disease

180

what are lewy bodies

round inclusions composed of a-synuclein, found intracellulary in substantial nigra cells and in the locus ceruleus, nucleus basalis of Meynert, dorsal raphe nuclei, and dorsal motor nucleus of CN X

181

what is the pharmacological treatment for dementia

acetylcholinesterase inhibitors
NMDA receptor antagonist

182

What is parkinsons dementia

degenerative disease caused by the loss of dopaminergic neurons in the substantia nigra

183

What effect does anticholinergic medications have on dementia and cognition

exacerbates symptoms of dementia

Avoid anti-cholinergic medications in the elderly

184

What is the mechanism of cyproheptadine

Anti histamine