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Flashcards in Psychiatry Deck (155):
1

operant conditioning

Learning in which a particular action is elicited because it produces a punishment or reward. Usually deals with VOLUNTARY responses.

2

mature defense mechanisms

SASH - sublimation, altruism, suppression, humor

3

schizophrenia risk - 1) general population 2) parent or sibling of someone affected 3) monozygotic twin

1%,10%,50%

4

Infant deprivation effects

1) FTV
2) poor language/socialization skills
3) lack of basic trust
4) reactive attachment disorder (infant withdrawn/unresponsive to comfort)
The 4 W's: Weak, wordless, waning, wary.

5

epidemiology of physical abuse in kids

40% of deaths in children

6

peak incidence of sexual abuse in kids

9-12 years old

7

ADHD onset

Before age 12.

8

ADHD treatment and alternatives

1) stimulants (methylphenidate)
2) +/- CBT
3) atomoxetine, guanfacine, clonidine

9

ASD association

increased head/brain size

10

ASD presentation

Usually in early childhood.

11

percent of patients with ADHD that go on to adult ADHD

50%

12

ADHD physical association

decreased frontal lobe volume/metabolism

13

conduct disorder treatment

CBT

14

antisocial personality disorder treatment

CBT

15

oppositional defiant disorder treatment

CBT

16

separation anxiety disorder treatment

CBT, play therapy, family therapy

17

common onset of separation anxiety disorder

7-9 years

18

Tourette's onset

Before age 18.

19

magic number for tourette's

symptoms longer than 1 year

20

incidence of coprolalia in tourette's

10-20%

21

tourettes associations

OCD + ADHD

22

Tourette's treatment

psychoeducation + behavioral therapy

23

Treatment for intractable tics

low-dose high-potency antipsychotics (e.g, fluphenazine, pimozide) + tetrabenazine + clonidine

24

rett syndrome presentation

loss of development + loss of verbal abilities + ID + ataxia + stereotyped hand-wringing

25

neurotransmitter changes in Anxiety

increase in NE, decrease in GABA + 5-HT

26

neurotransmitter changes in depression

decrease in NE + dopamine + 5-HT

27

order of orientation loss

1st--time
2nd--place
3rd--person

28

dissociative amnesia

memory problems following severe trauma or stress

29

Findings in delirium

EEG abnormalities (as opposed to dementia, in which EEG is usually normal)

30

pseudodementia

depression + hypothyroidism. This is why you need to measure TSH + B12 levels.

31

dementia presentation

apraxia + aphasia + agnosia + loss of abstract thought + behavioral/personality chagnes + impaired judgment.

32

olfactory hallucinations. when do they happen?

usually in epileptics + brain tumors

33

gustatory hallucinations. when do they happen?

epileptics

34

formication

sensation of bugs crawling on one's skin

35

schizophrenia magic number

6 months

36

schizophrenia diagnosis

requires at least 2 of following:
1) delusions
2) hallucinations
3) disorganized speech
4) disorganized or catatonic behavior
5) negative symptoms (flat affect, social withdrawal, lack of motivation, lack of speech or thought)

37

brief pyschotic disorder magic number

less than 1 month

38

schizophreniform disorder magic number

1-6 months

39

schizoaffective disorder magic number

>2 weeks

40

lifetime prevalence of schizophrenia

1.5%

41

delusional disorder magic number

>1 month

42

manic episode magic number

>1 week

43

manic episode diagnosis

3 of DIGFAAST (FA 510)

44

hypomanic episode magic number + diagnostic criterion

4 consecutive days. No impairment in functioning.

45

cyclothymic disorder magic number

2 years

46

MDD magic number

6-12 months

47

MDD diagnosis caveat

Must include depressed mood or anhedonia

48

MDD treatment alternatives

SNRIs + mirtazapine + bupropion. ECT.

49

Peresistent depressive disorder (dysthymia) magic number

at least 2 years

50

changes in sleep stages during depression

decreased slow-wave sleep + decreased REM latency + increased REM early in sleep + increased Total REM sleep + repeated nighttime awakenings + early-morning awakening

51

terminal insomnia

early morning awakening

52

treatment for atypical depression

CBT and SSRIs are first line

53

most common form of depression

atypical

54

other features of atypical depression

long-standing interpersonal rejection sensitivity + mood reactivity (being able to experience improved mood in response to positive events, albeit briefly).

55

postpartum blues incidence

50-85%

56

postpartum blues onset

2-3 days after delivery

57

postpartum blues treatment

supportive + followup to assess for depression

58

postpartum depression incidence

10-15%

59

postpartum depression timeframe

within 4 weeks after delivery

60

postpartum psychosis incidence

0.1-0.2%

61

nonintuitive RF's for postpartum psychosis

First pregnancy

62

postpartum psychosis treatment

Hospitalization + initiation of atypical antipsychotic. ECT if refractory.

63

Pathologic grief diagnosis + caveat

>6 months + satisfies major depressive criteria. Hallucinations NOT pathologic grief.

64

ECT indications

treatment-refractory depression + depression with psychotic symptoms + acutely suicidal patients.

65

ECT contraindications

Grand-mal seizures in anesthetized patients.

66

ECT AE's

disorientation + headache + partial anterograde/retrograde amnesia usually resolving in 6 months.

67

Panic attack diagnosis + Panic disorder diagnosis

at least 4 of PPANIICCCCSSS for attack + 1 month of at least 1 of following (persistent concern of additional attacks, worrying about consequences of attack, behavioral change related to attcks)

68

Agoraphobia treatment

CBT + SSRIs + MAO inhibitors

69

GAD magic number

at least 6 months

70

adjustment disorder treatment

CBT + SSRIs

71

adjustment disorder magic numbr

impairment in function + less than 6 months

72

ego-dystonic

Feature of OCD. Behavior inconsistent with one's own beliefs and attitudes.

73

treatment for body dysmorphic disorder

CBT.

74

Acute stress disorder magic number

Between 3 days and 1 month.

75

Acute stress disorder treatment

CBT. Pharmacotherapy usually NOT indicated.

76

malingering vs. somatic symptom disorder vs. factitious disorder

somatic -- no conscious attempt to deceive.
factitious -- chief goal is psychological (primary gain)
malingering -- chief goal is external (secondary gain).

77

munchausen syndrome

CHRONIC factitious disorder with predominately physical signs/symptoms. History of hospitalization and willingness to undergo invasive procedures.

78

illness anxiety disorder

hypochondriasis

79

personality disorders -- A,B,C

"Weird, wild, worried"

80

major defense mechanism in paranoid personality disorder

projection

81

conduct disorder vs. antisocial personality disorder

conduct is if 18 years old.

82

treatment for BPD

dialectical behavior therapy

83

schizoid vs. avoidant

avoidant people desire relationships with people, unlike schizoid people.

84

Obsessive-compulsive personality disorder vs. OCD

obsessive-compulsive is ego-syntonic (behavior consistent with one's own beliefs and attitudes). OCD is ego-dystonic.

85

anorexia magic number

less than 18.5

86

Refeeding syndrome

Fluid and electrolyte disturbances following feeding, especially hypophosphatemia. Can occur in malnourished patients, such as anorexics.

87

anorexia nervosa treatment

psychotherapy + nutritional rehabilitation are first line.

88

bulimia nervosa magic number

3 months

89

Russell sign

dorsal hand calluses from induced vomiting (seen in bulimia nervosa).

90

paraphilia

intense sexual arousal to atypical objects, situations, or individuals. characteristic of transvestism.

91

vaginismus

Discomfort resulting from involuntary vaginal muscle spasm, making penetration painful or impossible.

92

drugs associated with sexual dysfunction

antihypertensives + neuroleptics + SSRIs + ethanol

93

sleep phase in which sleep terror disorder occurs

slow-wave sleep

94

hypocretin produced in

lateral hypothalamus (low in narcolepsy)

95

cataplexy

loss of muscle tone (narcolepsy)

96

sleep physiology in narcolepsy

episodes start with REM sleep

97

narcolepsy treatment

Daytime -- stimulants (amphetamines, modafinil).
Nighttime -- sodium oxybate (GHB).

98

substance abuse disorders caveat

at least 2

99

opioid intoxication presentation

euphoria + respiratory/CNS depression + decreased GAG reflex + pupillary constriction

100

benzo intoxication presentation

ataxia + minor respiratory depression

101

amphetamines intoxication presentation

pupillary dilation + paranoia + fever

102

cocaine intoxication presentation

pupillary dilation + hallucinations (including tactile) + paranoid ideations + angina + sudden cardiac death

103

cocaine intoxication treatment

alpha-blockers + benzodiazepines

104

DT mortality rate

5-15%

105

opioid withdrawal presentation

sweating + dilated pupils + piloerection ("cold turkey") + fever + rhinorrhea + yawning + nausea + stomach cramps + diarrhea ("flu-like" symptoms")

106

barbiturate withdrawal presentation

delirium + life-threatening cardiovascular collapse

107

benzo withdrawal presentation

sleep disturbance + depression + rebound anxiety + seizures

108

amphetamine withdrawal presentation

anhedonia + increased appetite + hypersomnolence + existential crisis

109

cocaine withdrawal

hypersomnolence + malaise + severe psychological craving + depression/suicidality

110

nicotine withdrawal treatment

bupropion + varenicline

111

time frame of marijuana detection in urine

1 month

112

marijuana withdrawal

irritability + depression + insomnia + nausea + anorexia.

113

timeframe for marijuana withdrawal

Most symptoms peak in 48 hours and last for 5-7 days.

114

when do you use naltrexone for opioid rehab?

relapse prevention once detoxified (it is long-acting).

115

why does naloxone/buprenorphine have low abuse potential?

if injected, naloxone will precipitate withdrawal because of antagonism. When taken orally, naloxone isn't orally bioavailable, so doesn't have any antagonism.

116

approach to management of alcoholism

1) naltrexone is first line and can be initiated while the individual is still drinking. It blocks rewarding and reinforcing effects of alcohol.
2) disulfiram only used in abstinent patients with strong motivation to maintain abstinence.

117

ethyl glucuronide (EtG)

Commonly used biomarker to detect recent alcohol ingestion (metabolite of ethanol).

118

onset of withdrawal in alcoholism

6-12 hours after individuals top or dramatically decrease alcohol intake

119

DT timeframe, peaking...

2-4 days after last drink

120

DT presentation

presentation = HTN (can be severe) + profound agitation + global confusion + disorientation + hallucinations + fever + diaphoresis + tachycardia

121

alcoholic hallucinosis + timeframe

distinct condition from DT. visual hallucinations 12-48 hours after last drink.

122

first-line for social phobias

SSRIs + beta-blockers

123

high-potency antipsychotics + SE profile

(Try to Fly High P) --> Trifluoperazine, Fluphenazine, Haloperidol + pimozide
- neurologic side effects

124

typical antipsychotics treat...

positive symptoms

125

treatment for extrapyramidal side effects of typical antipsychotics

benztropine + diphenhydramine

126

typical antipsychotics side effects (other than endocrine)

- muscarinic blockade (dry mouth + constipation)
- alpha 1 blockade (hypotension)
- histamine blockade (sedation)
QT prolongation

127

NMS treatment

dantrolene + D2 agonists (bromocriptine)

128

Low potency antipsychotics + SE profile

(Cheating Thieves) Chlorpromazine, thioridazine
- non-neurologic side effects (anticholinergic, antihistamine, alpha1 blockade)

129

chlorpromazine unique side effects

corneal deposits

130

thioridazine unique side effect

retinal deposits

131

evolution of EPS side effects

4 hr --> acute dystonia (muscle spasm, stiffness, oculogyric crisis)
4 day --> akathisia (restlessness)
4 week --> bradykinesia (parkinsonism)
4 month --> tardive dyskinesia

132

atypiacl antipsychotics

olanzapine + clozapine + quietiapine + risperidone + aripiprazole + ziprasidone

133

clozapine SEs

agranulocytosis + seizure

134

risperidone SE's

may increase prolactin (causing lactation and gynecomastia, leading to decreased GnRH, LH, and FSH, causing irregular menstruation and fertility issues.

135

lithium MOA

not established; maybe inhibition of phosphoinositol cascade.

136

Lithium pharmacologic notes

1) narrow therapeutic window
2) almost exclusively excreted by kidneys
3) most reabsobred at PCT with Na+

137

SSRIs

fluoxetine + paroxetine + sertraline + citalopram

138

delay before SSRIs take effect

4-8 weeks

139

serotonin syndrome presentation

hyperthermia + confusion + myoclonus + cardiovascular instability + flushing + diarrhea + seizures.

140

drugs that cause serotonin syndrome

Anything that increases serotonin. MAOIs + SNRIs + TCAs + SSRIs

141

diabetic peripheral neuropathy treatment

duloxetine

142

imipramine

TCA

143

doxepin

TCA

144

amoxapine

TCA

145

desipramine

TCA

146

TCA mechanism

block reuptake of norepinephrine + 5-HT

147

other indications for TCA's

peripheral neuropathy + chronic pain

148

amitriptyline

tertiary TCA (more anticholinergic side effects than secondary TCA's)

149

nortriptyline

secondary TCA

150

TCA side-effects

convulsions + coma + cardiotoxicity + respiratory depression + hyperpyrexia + confusions and hallucinations in elderly (due to anticholinergic side effects)

151

TCA to use in old people

nortriptyline

152

MAOIs

tranylcypromine + phenelzine + isocarboxazid + selegeline

153

MAOIs mechanism

MAO inhibition leads to inceased levels of amine neurotransmitters (NE + 5-HT + dopamine)

154

MAOI contraindications

SSRIs + TCAs + St. John's wort + meperidine + dextromethorphan (to prevent serotonin syndrome)

155

trazodone indication

insomnia