Psychiatry Flashcards
(190 cards)
1
Q
Weight neutral 2nd gen antipsychotic drugs
A
Aripiprazole and ziprasidone
2
Q
Side effect of 2nd gen antipsychotic drugs?
A
Metabolic syndromes
Increase BP/glucose/weight/cholesterol
3
Q
Symptoms of NMS?
A
Fever/confusion/”lead pipe” rigidity/increased CPK/leukocytosis/increase HR/RR/BP
4
Q
Name this drug!
Side effect—>retinal pigmentation
Side effect—>deposits in lens and cornea
A
Thioridazine
Chlorpromazine
5
Q
Tx plan for schizophreniform disorder
A
6 month of antipsychotic
6
Q
Schizoaffective disorder critieria
A
at least 2 weeks of delusion and hallucination without mood disorder (distinguish from mood disorder with psychotic features)
7
Q
Criteria for delusional disorder
A
Delusion for a year/function well over 1 month
Erotomanic (sb in love with ya)/grandeur/persecution/somatic/jealous/mixed
Could have hallucination
8
Q
Koro/Amok/Brain fag?
A
Koro—>anxious that penis would recede into the body
Amok—>burst of violence with suicide
Brain fag—>somatic disturbance among African males
9
Q
Criteria for major depressive disorder
Pt with what medical condition tend to develop it?
How does it affect sleep stages?
A
5 out of SIG E CAP for over 2 weeks
Stroke
Increase duration of REM and decrease stage 3 and 4
10
Q
What is a psychiatric emergency? and what is its criteria?what about hypomania
A
Maniac episode/ symptoms over 7 days
Over at least 4 days
11
Q
Tx for atypical depression (mood reactivity)?
A
SSRI (not MAOi)
12
Q
Criteria for Bipolar I and II
A
Bipolar I (highest genetic linkage)--->manic episodes with or without depression Bipolar II--->major depression and hypomania
13
Q
Li+ side effect?
A
LMNOP Li+ Movement (tremor) Nephrogenic DI HypOthyroidism Pregnancy
14
Q
Tx for rapid cycling bipolar
A
Carbamazapine or volproic acid
15
Q
Prego with manic episode, tx?
A
ECT
16
Q
Criteria of persistent depressive disorder (dysthymia)? MDD is episodic
A
Over 2 years and never asymptomatic over 2 months
17
Q
Criteria for cyclothymic disorder and tx
A
Alternate between symptoms of hypomania and depression (not full hypomania and depression otherwise it would be bipolar II) over 2 years
Tend to become bipolar
Tx—>Li+
18
Q
Tx for premenstral dysphoric disorder
A
SSRI/OCP can reduce symptoms
19
Q
Criteria for disruptive mod dysregulation disorder
A
severe verbal and physical outbursts >3 times a week for 1 year before age of 10
At least 2 settings
20
Q
Tx for anxiety disorder
A
Psychotherapy for mild (CBT)
Drugs combo for severe
Use benzo to bridge till SSRI start working
21
Q
Risk factor for panic attacks?
A
Smoking
22
Q
Timeline for criteria of agoraphobia or phobia
A
over 6 months
23
Q
Criteria for selective mutism/tx?
A
Failure to speak in social settings for at least 1 month (related to anxiety)
Tx—>SSRI/CBT
24
Q
when does stranger and separation anxiety start? and when does it become pathologic
Tx?
A
6 month, peaks at 9 month 1 year, peaks at 1 year and half Separation anxiety disorder---->reluctant to leave home/sleep alone At least for 1 month in children Tx--->CBT/SSRI
25
GAD criteria? tx?
Excessive worrying over 6 month
Fatigue/impaired attention/restlessness
Tx--->CBT/SSRI
26
Ketamine usage and MOA?
NMDA antagonist
| Start and maintain anesthesia
27
Side effect of risperidone that is different from the rest of the atypical?
Increase prolactin--->amenorrhea/infertility/sexual dysfunction
28
Criteria for panic disorder
Increase or decrease risk for suicide?
Tx?
```
Recurrent panic attacks
Fear of future panic attacks--->change behaviors
Lead to agoraphobia
Increase risk for suicide
CBT and SSRI
```
29
pathophysiology of OCD and tx
Intrusive obsession that pt tries to suppress using compulsions (repetitive behaviors)--->causing anxiety
CBT (exposure response)/SSRI/ECT (last resort)
30
Pt underwent multiple plastic surgeries/repetitive grooming/comparing looks with others, diagnosis and tx?
Body dysmorphic disorder/SSRI and CBT
31
What precedes hoarding disorder and what tx?
Stressful and traumatic event
| CBT
32
Tx for trichotillomania and excoriation disorder?
SSRI/2nd antipsychotic/N-acetylcysteine/Li+
| CBT (habit reversal training)
33
Criteria for PTSD and acute stress disorder? tx? what med is used for nightmares?
Nightmares/flashbacks/avoidance/increase arousal
Acute stress disorder---> >1 month
SSRI/CBT (cognitive processing therapy)
Prazosin (alpha 1 antagonist)
34
What comorbid disorder occur with PTSD?
Substance abuse disorder so don't use addictive meds for PTSD pts
35
Criteria for adjustment disorder? tx?
Stressful event happens within 3 month and resolve by 6 months
Supportive psychotherapy
36
Difference between PTSD and adjustment disorder?
Event happened in PTSD is life threatening, and not so in adjustment disorder
37
What are the 3 clusters of personality disorder? tx?
Cluster A--->eccentric/like psychotic disorders
Cluster B--->emotional/dramatic/like mood disorders
Cluster C--->anxious/fearful/like anxiety disorder
Use psychotherapy since most of pt are not aware
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Cluster A
Paranoid--->jealous (think others are cheating on them)/everybody is against them
Schizoid--->happy to be alone, forever and ever/cold
Schizotypal--->odd and magical/social anxiety
39
Cluster B
Antisocial--->adult version (18yr) of conduct disorder/no remorse/manipulative (charming)
Borderline personality disorder--->impulsivity/extreme love-hate relationship/recurrent suicide attempts
Histrionic--->theatrical and attention seeking/seductive/easily influenced
Narcissistic--->superiority/need for admiration/lack empathy/arrogant--->depressed if recognition are not gained
40
What kind of defense mechanism does pt with boarderline personality disorder/histrionic/dependent personality disorder use?
boarderline--->Splitting
| Histrionic and dependent--->Regression
41
Cluster C
Avoidant personality disorder--->social anxiety/fear of rejection, unliked/want relationships/very shy
Dependent--->poor self confidence/helpless when left alone/always in relationships/submissive/clinging
Obsessive compulsive--->perfectionism/inflexible/no delegation/frugal/rigid
42
Avoidant personality disorder looks like which other disorder?
Social anxiety disorder
43
Difference between OCD and OCPD?
OCD is ego-dystonic--->pts are aware
| OCPD is ego-syntonic--->pts are not aware
44
EtOH can cause what kind of medical condition?
Metabolic acidosis
45
Withdraw symptoms of EtOH?
Irritability--->seizure--->DT (2 to 3 days)
46
Tx for alcohol use disorder
Naltrexone--->decrease craving
Acamprosate--->for relapse prevention after detox/contraindicate in pt with renal disease
Disulfiram--->block aldehyde dehydrogenase
Topiramate--->decrease craving
47
Symptoms of DT
disorientation/agitation/hallucination/increase RR, HR and BP
48
Cocaine MOA and complication
Block reuptake of DA/NE/Epi
| MI/stroke/hemorrhage
49
Methamphetamine MOA and complication
Block reuptake of DA and NE
| Induce psychosis/tooth decay
50
What is MDMA? and does it show up on tox screen?
Amphetamine and no
51
What kind of drug is heroin?
Opioid
52
High and low potency typical antipsychotics
High (NMS/TD)--->trifluoperazine/fluphenazine/haloperidol
| Low (antihistamine/antiM/anti alpha1)--->chlorpromazine/thioridazine
53
What drug class are prochlorperazine and metoclopramide?
Prochlorperazine--->typical antipsychotic
| Metoclopramide--->D2 antagnonist
54
Rotatory nystamus and what is its MOA
PCP intoxication
| Anti NMDA
55
tx for barb intoxication and barb withdraw mimics?
Alkalinize urine with NaCO3
| Alcohol
56
MAOi and what opioid taken together can cause serotonin syndrome?
Meperidine
57
Opioid withdraw symptoms?
insomnia/nasal discharge/yawning/sweating/dilated pupils
58
Tx for prego with opioid-dependence?
Mathadone
59
What is in suboxone
Buprenorphine (partial agonist) and naloxone
60
Difference between naloxone and naltrexone
Naloxone--->for emergency opioid intox
| Naltrexone--->long acting, for long term dependence
61
What drug is used to treat the autonomic symptoms of opioid withdraw
Clonidine
62
What is dronabinol?
FDA approved THC
63
what are the 4 mood stabilizers and their side effects
Li+--->LMOP
valproic acid--->weight gain/hepatitis
carbamazapine--->aplastic anemia
lamotrigine--->steven johnson
64
Which TCA has the fewest antiM side effect?
Nortriptyline
65
Effect of mirtazapine
Antidepressant--->cause weight gain and sedating
66
How long should bereavement be abated?
Within 6 months
67
Criteria for intellectual disability
Deficits in intellectual/adaptive functioning
| Require ongoing support of daily life
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Global developmental delay
Failure to meet expected developmental milestones
| need future reevaluation
69
Criteria for ADHD
Inattention and hyperactivity/impulsivity (2 types)
> 6 months and in 2 or more settings
Diagnosed
70
Comorbid disorders with ADHD?
Oppositional defiant/conduct/learning disorder
71
ADHD tx
First line --->methylphenidate or other stimulants
Second line --->atomoxetine (NE reuptake inhibitor)
alpha 2 agonist --->clonidine (sedating)/guanfacine
72
What should be checked and be aware before starting Li+/valproic acid/carbamazapine
Li+--->check for kidney and thyroid function and Na+ level /dont change diet or use salt wasting diuretics
Valproic acid--->check liver function
Carbamazapine--->aplastic anemia
73
Which opioid has the highest affinity for mu receptor?
Buprenorphine
74
And when is opioid withdraw fetal
during pregnancy for the fetus
75
What is the symptoms of acute Li+ toxicity?
Confusion/mimic CVA
76
What to do with a manic pt who's on max dose of Li+?
Add a 2nd gen antipsychotic
77
What to give bipolar pt who's depressed?
Lamotrigine or seroquel
78
Criteria for Autism spectrum disorder
Impaired in social interaction and communication---->no eye contact/no interest in making friends
Peculiar and intense interest (like bugs)
Rigid routine/repetitive motor movement (hand flapping)
Aggression/disruptive
Associated with epilepsy
79
What syndromes are associated with autism
Fragile X syndrome/Down/Rett/tuberous sclerosis
80
Tx for autism
Behavioral therapy
| Low dose atypical antipsychotic for aggression/irritability
81
Characteristics and criteria of Tourette's disorder
Worst of tic disorder--->many motor and at least one vocal tic for at least 1 year (eye blinking/throat clearing) before age of 18
Pt feel urge before the tic and feel tension released after
Fluctuating course
82
What aggravate tic disorder? and what are its comorbid disorders?
Anxiety/excitement/fatigue
| OCD and ADHD
83
Tx for Tic disorders
Clonidine or guanfacine
Typical or atypical antipsychotics
habit reversal therapy
84
Criteria for Persistent motor or vocal tic disorder/provisional tic disorder
Persistent--->either motor or vocal (not both)
| Provisional--->Tourette under 1 year
85
Criteria for oppositional defiant disorder and tx
anger/irritable/argumentative/vindictive/involve at least 1 non sibling over 6 months
Tx--->behavior therapy/parent management training
86
Difference between oppositional defiant disorder and conduct disorder
ODD does not involve physical aggression or violet other people's basic rights
87
Criteria for conduct disorder and tx
aggression (physical and sexual) to people and animal/property destruction/theft/lie/violation of rules (run away) over 1 year
Tx--->behavioral therapy/parent management training
88
What are the primary and secondary enuresis and encopresis
Primary--->never continence
Secondary--->achieved continence before
Enuresis--->2x a week for 3 months/wetting when sleep or wake/ >5 year old
Encopresis--->poop in not normal places/1x month for 3 months/ >4 year old
89
Genetic predisposition for nocturnal enuresis
Higher risk for paternal urinary incontinence
90
Tx for enuresis and encopresis
Enuresis--->behavioral therapy with rewards/urine alarm/desmopressin (ADH analog)/imipramine (TCA)
Encopresis--->bowel training/treat constipation if that is the cause
91
Criteria for dissociative amnesia and tx
Unable to recall autobiographical info following traumatic event/memories are retrievable
Tx--->CBT or supportive therapy
92
What is dissociative fugue
Under dissociative amnesia--->sudden travel away from home with amnesia of autobiographical info
93
What are depersonalization and derealization
Depersonalization--->out of body experience
Derealization--->experience the surrounding as if they are in a dream or movie
Common during time of stress
94
Criteria for dissociative identity disorder and what usually precede it?
2 or more personalities/memory impairment
Preceding events--->childhood physical/sexual abuse/neglect
Comorbid with PTSD/MDD/suicidality
95
Tx for dissociative identity disorder
Psychotherapy/meds for comorbid disorders
96
What is the normal duration for acute dissociative reaction following stressful events
up to 1 month
97
Criteria for somatic symptom disorder and tx
1 or more somatic symptoms/anxiety from them/frequent change of physicians/ >6 months
Tx--->schedule regular visit with ONE PCP and avoid unnecessary medical workups
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Criteria for illness anxiety disorder and tx
Hypochondria/anxious about their health/no medical problems or mild in severity/ >6 months
Similar tx with somatic symptom disorder
99
Criteria for factitious disorder
Maunchhausen syndrome/intentionally pretend to be sick without external rewards (otherwise it would be malingering)
100
Comorbid for factitious disorder
Personality disorder/might with childhood abuse
101
Criteria for intermittent explosive disorder and tx
Recurrent verbal or physical outbursts or rare physical outbursts that damage people or property/reaction out of proportion
tx--->SSRI/anticonvulsant or Li+/CBT
102
What do you find in lab in impulsive or aggressive people like intermittent explosive disorder
Low serotonin or 5-HIAA in CSF
103
Criteria for kleptomania and comorbid and tx
Steal useless stuff that release tension/follow by guilt and depression
Comorbid--->eating disorder (bulimia)/anxiety disorder
tx--->CBT/SSRI
104
Criteria for pyromania
Set fire to release tension/fascinated about fire
105
Criteria for anorexia nervosa and tx
restricting or binge and purge type
Low BMI/amenorrhea/disturbed body image/electrolyte abnormality/lanugo/salivary gland enlargment/Russell's sign
Tx--->hospitalization if BMI below 18/CBT especially family therapy
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Comorbid with anorexia
OCPD
107
Criteria for bulimia and tx
Binge eating and compensatory behaviors 1x week for 3 months (compensatory behaviors can be throwing up, excessive working out and etc.)
Normal or overweight
Tx--->SSRI (fluoxetine) and CBT
108
Cortisol is increase or decease in anorexia pt
Increased
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Which antidepressant is known to lower seizure threshold and shouldn't give pt with what disorder?
Bupropion
| Eating disorder
110
Criteria for binge eating disorder and tx
Binge eating without purging or compensatory behaviors/over 3 months/obese pt with metabolic syndromes like DM
Tx--->CBT/drugs to suppress appetite
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What drugs can be used for weight lost?
Phentermine/amphetamine/topiramate/orlistat
112
What are dyssomnias and parasomnias
Dyssomnias--->insomnia or hypersomnia
| Parasomnias--->unusual sleep behaviors
113
Timeline for acute and chronic insomnia and tx for chronic insomnia
Acute 3 month
| Tx for chronic---->CBT/benzo for acute/three Zs/trazodone
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Physiological change in REM sleep
Increase BP/HR/RR
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Possible causes and tx for hypersomnias
Viral infection
| Modafinil/methylphenidate/atomoxetine
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Causes of central sleep apnea
Cheyne-Stokes breathing due to HF/stroke
| Opioid use
117
What can sleep hypoventilation cause
Pul HTN/cor pulmonale/eventual respiratory failure
118
Criteria for narcolepsy and tx
daytime sleepiness/unable to move/hypnagogic or hypnopompic hallucination/cataplexy
Tx--->stimulant (modafinil/sodium oxybate)
119
What drug is effective against cataplexy
Sodium oxybate
120
What level is low for narcolepsy pt
Hypocretin
121
What are the non-REM sleep disorder
Sleepwalking (eyes are open)/sleep terrors/nightmare disorder (no confusion upon awakening unlike the other two)
122
What tx is for nightmares disorder or PTSD
Imagery rehearsal therapy or prazosin
123
What are REM sleep disorders and tx
Sleep talking/limb jerking/yelling/punching
No confusion upon awakening
Tx--->clonazepam/melatonin
124
How does progesterone and serotonin affect libido
Inhibit libido in both men and women
| Serotonin inhibit sexual function
125
Tx for premature ejaculation/male and female hypoactive sexual desire disorder
Premature--->SSRI/TCA
| Hypoactive--->testosterone for both genders
126
Gender dysphoria
transsexual
127
MC paraphilia?
Pedophilia/voyeurism/exhibitionism
128
How old is the victim of pedophilia
under 13
129
What are voyeurism/frotteuritism/transvestism
Voyeurism--->peeping tom
frotteuritism--->rubbing against a nonconsenting person
Transvestism--->cross dressing
130
What is split tx in psychiatry
Psychiatrist prescribe meds and therapist provide therapy
131
What are Id/superego/ego
Id--->unconscious/primal
Superego--->what we want to be (ideal)
Ego--->mediator between Id and superego--->use defense mechanism
132
What are the mature defense mechanism
Altruism/humor/sublimation (like to fight, instead of beating up ppl become a boxer/channeling)/suppression (conscious)
133
What are the neurotic defense mechanism
Controlling
displacement (boss yell at you, you yell at your kid)
intellectualization (focus on irrelevant details--->doctor dying from colon cancer explain to his son the pathophysiology of his disease)
Isolation of affect--->no emotion
Rationalization
Reaction formation
Repression--->unconscious
134
What are the immature defense mechanism
Acting out/denial/regression/projection
135
What is the goal of psychoanalysis and what are the target population of patients?
Bringing unconscious to conscious
| Stable patients
136
What techniques are used in psychoanalysis
Free association/dream interpretation/alliance/transference/counter transference
137
Difference between classic and operant conditioning
Classic--->tie behavior to a stimulus (Pavlov's dog)
| Operant--->behaviors follow positive or negative reinforcement
138
What are aversion therapy/token economy/biofeedback
Aversion--->e.g. disulfram
Token economy--->give reward for doing something (use on psych ward to encourage pt to take showers and what not)
Biofeedback-->give pt physiological stats for them to control
139
What therapy is used to reduce self harm from borderline personality disorder
Dialectical behavioral therapy
140
Symptoms of serotonin syndrome
Confusion/flushing/sweating/tremor or myoclonus/hyperthermia
141
Drug for EPS syndrome
Benztropine (anti M)
142
SSRI with the longest half life?
Fluoxetine
143
SSRI with what drug besides MAOi can produce serotonin syndrome
Triptans
144
What is the unique side effect of Effexor
Increase BP
145
SSRI are CYP450 inhibitor or inducer?
Inhibitor
146
Which antidepressat cause priapism
Trazodone
147
What are the NE/DA reuptake inhibitor antidepressant
Trazodone/nefazodone
148
MOA of TCA
inhibit reuptake of NE/serotonin
149
What are the secondary amines and what are they different from tertiary amines
Nortiptyline/despramine--->less anti M effect
150
Which TCA is used to treat OCD/sleep aid
OCD--->clomipramine
| Sleep aid---->doxepin
151
What to give for TCA overdose
Sodium bicarb
152
Cause of hypertensive crisis
MAOi + tyramine
153
What to use during serotonin syndrome
Benzo/cyproheptadine
154
What to use for IBS
SSRI/TCA
155
Side effect of chlorpromazine
blue-gray skin discoloration
156
MOA of atypical antipsychotic
block NE/DA reuptake
157
What drugs increase level of Li+
NSAIDs
158
Check what before starting carbamazapine and valproic acid
LFT
159
If a pt has liver damage from let's say alcoholism, what benzo can you give?
LOT
Lorazepam
Oxazepam
Temazepam
160
Which benzo has a long half life and rapid onset?
Diazepam (Valium)
161
Conditions for malpractice
Duty to care/negligence (perform subpar care)/pt is harmed/harm comes from negligence
162
What minors are considered emancipated? can they make their own medical decision?
Self-supporting/in military/married/have children or pregnant
Yes
163
What are the definition for capacity and competence
Capacity--->assessed by physician
| Competence--->assessed by a judge
164
What is the most important factor when assessing violence
Past violent history
165
What drug to give elderly pt for agitation and aggression? and what to give for an elderly pt with Parkinson's with the same scenario?
Citalopram
| Quietapine
166
What group of drugs can enhance the affect of antidepressant?
Atypical antipsychotic
167
Which antipsychotic decrease prolactin
Abilify
168
What else can illicit tactile hallucination besides alcohol withdraw?
Stimulants
169
What are K2 and spice?
Synthetic marijuana
170
What opioid causes seizure? and what else can it cause?
Tramadol/serotonin syndrome
171
When do you see delirium?
Postop/infection/starting a new med
172
How to treat delirium
antipsychotic
| DONT USE BENZO
173
What is Ecstasy or Molly?
MDMA
174
MOA of bupropion?
DA and NE reuptake inhibitor
175
First line tx for bipolar?
Monotherapy first, if don't response then combo:
| Li+ or valproic acid + a second gen antipsychotic like seroquel or lamotrigine
176
How to distinguish between psychosis and delirium
If the patient is confused/disorientated--->delirium
| If cognitively normal--->psychosis
177
Tx for catatonia and akathisia?
Catatonia - benzo or ECT
| Akathisia - benzo or beta blocker
178
What is acute stress disorder
PTSD under 1 month
179
What is the most effective tx for MDD, side effect, and what drugs to give before that?
ECT/increase ICP/atropine, barb, succinylcholine
180
What drugs can used as adjunct for antidepressants?
Li+/T3 or T4/amphetamine/estrogen/abilify
181
What is paradoxical reaction of benzo and what to use for that?
Benzo induce agitation/use flumazenil
182
What can Ambient cause?
Amnesia and sleep disorder such as sleep eating
183
What is ICU triad?
Pain/agitation/delirium
184
What drugs to use for delirium?
Antipsychotic
| NO benzo!
185
What 2 features must have for MDD? either or
Depressed mood or anhedonia
186
What drug is used fro conduct disorder?
Risperidone
187
What does amphetamine intoxication and withdraw present?
Intox - psychosis/anorexia/dilated pupil
| Withdraw - increase appetite/depression
188
What drugs can cause delirium?
Benzo/anti M/antibiotics
189
Ketamine intox
Dissociative (depersonalization/derealization)
Hallucination
Amnesia
190
Tx for acute mania
Antipsychotic
