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Psychiatry Flashcards

In-class material (68 cards)

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1
Q 
What are the various tx availble for Insomnia based on the categories below?
→ Non-pharm 
→ Antidepressant (2) 
→ Anticonvulsant (1)
→ Non benzos (2) 
→ Melatonin receptor agonist (1)
→ Benzo (2)
A 
→ Non-pharm 
     Sleep hygiene
→ Antidepressant (2) 
     Trazodone 
     Mirtazapine 
→ Anticonvulsant (1)
     Quetiapine
→ Non benzos (2) 
      Zolpidem ("z-solid sleep")
      Eszopiclone
→ Melatonin receptor agonist (1)
     Ramelteon
→ Benzo (2) → "L & T" 
     Lorazepam 
     Temazepam
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2
Q 
Parasomnias, which ones do you tx? 
How? + Which ones are REM vs NREM?
Options: 
Sleepwalking
REM Behavior Disorder 
Nightmare Disorder 
Sleep Terror Disorder 
Enuresis
A

Sleepwalking → nope, just education (NREM)
REM Behavior Disorder → Clonazepam (REM)
Nightmare Disorder → avoid meds (bb, TCA, etoh, clozapine, L-dopa, nicotine) (REM)
Sleep Terror Disorder → Diazepam (NREM)
Enuresis → Desmopressin (?)

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3
Q 
Characterized by: 
-Sleep attacks 
-Cataplexy
-Sleep paralysis 
-Hypnagogic hallucination
\+
Tx?
A

Narcolepsy

Tx:
→Stimulant: Dextromethamphetamine
→Modafinil
→Armodafinil

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4
Q

Manifestation of intrusion sx (flashbacks, nightmares), avoidance sx, negative cognitive/mood alterations, hyper-arousal sx (irritability etc) w/ complete resolution in 3 weeks is categorized as what?

A

Acute Stress Disorder

→ PTSD sx that last < 4 weeks

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5
Q 
Characterized by: 
→ Perceived or actual event
→Intrusion sx
→Avoidance sx
→ Negative alteration
→ Hyeperarousal
→ Duration of sx 
Dx? 
How many under the criteria? 
Tx?
A 
PTSD: 
→ Perceived or actual event (*necessary) 
→Intrusion sx (> 1)
→Avoidance sx (> 1)
→ Negative alteration (> 2) 
→ Hyeperarousal (> 1) 
→ Duration of sx (3 options)

Tx:
1st line Psychotherapy like TF- CBT
+
SSRI (sertraline)

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6
Q

ID the timelines for the 3 subtypes of PTSD?

A

Acute: resolution in < 3 mo
Chronic: resolution in > 3 mo
Delayed onset: > 6 mo

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7
Q

Russel’s Sign

Duration of sx to be diagnostic?
https://www.brainscape.com/decks/8022609/cards/quick_new_card
L/T results?

Tx?

A

Bulimia

Calloused knuckles

2 binge/purge per week x 3 mo

Metabolic alkalosis, ↓ K, ↓ Mg, ↓ Cl

Tx:
SSRI: Fluvoxamine or fluoxitine

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8
Q

Risk Factors of Substance Use Disorder

A

Psych disorders, PTSD, childhood trauma

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9
Q

Leading cause of preventable disease, disability, death
vs
3rd leading cause of preventable death in US

A

Tobacco

ETOH

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10
Q

Addiction starts with deficits in ________ & progresses into deficit in _________.

-What reinforcement is associated to each?

A

Impulsivity (positive/pleasure) → Compulsivity (negative/relieve an anxiety)

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11
Q

Characterized by the following large categories for DSM-5 criteria:
→Impaired control over use of a substance
→Social impairment
→Risky use of the substance
→Pharmacologic criteria (tolerance & withdrawal)

A

Substance Use Disorder

*10 possible categories of substances

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12
Q

of criteria needed to ID the degree of severity in SUD
→Mild
→Moderate
→Severe

A

Mild: 2-3
Moderate: 3-5
Severe: > 6

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13
Q

3 FDA approved tx for ETOH use disorder?

3 non-FDA approved tx?

A

Naltrexone, acamprosate, disuliram

Non-FDA:
Gabapentin, topiramate

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14
Q

3 tx for for Tobacco use disorder?

A

NRT, Varenicline, Wellbutrin

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15
Q 
Autonomic hyperactivity (sweating, ↑ HR) 
Hand tremor, insomnia, anxiety
N/V
Transient hallucinations or illusions 
Seizures 
....
Sx of?
Tx?
A

Alcohol use Withdrawal

Tx:
→ Thiamine, dextrose
→ Benzo vs seizures

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16
Q

Grades:
0: craving & anxiety
1: yawning, lacrimation, rhinorrhea, perspiration
2: previous sx + midrasis, piloerection, anorexia, tremors, hot/cold flashes, generalized aching
3/4: high intensity sx, ↑ body temp, ↑ BP, ↑ pulse, ↑ RR (resp depression)

A

Opioid Withdrawal

Overdose:
→resp depression, peripheral vasodilation, pinpoint pupils, pulm edema, coma, death

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17
Q

Risk factors for major depression

A

FHx of psych disorders

PMHx

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18
Q

Major depression diagnosis criteria

A

5 SIGECAPS sx
+
> 2 weeks duration

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19
Q

PHQ2 quesitons?

-what is PHQ9

A

PHQ2:

  1. Feeling down, depressed, hopeless?
  2. Little interest or pleasure?
    * You can do this in a primary care setting as the 1st screening then if (+) do the PHQ9
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20
Q

If I have the following…
→prior attempt, plan, etoh abuse, firearms, psych dz, sudden lift in mood/antidepressant
…what am i at risk for?

A

HIGHEST risk of suicide

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21
Q

Progression of prescribing SSRIs for Major Depression

A
  1. F/u in 1-2 weeks
  2. If better → F/u in 6 mo → 9 mo can revaluate need
  3. If NOT better → change dose or med → F/u in 1-2 weeks → keep trying to change
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22
Q

1st line SSRI in child (2)

A

Fluoxetine & Escitalopram

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23
Q

4 Steps to do Prior to Discharging an Adolescent Who Attempted Suicide

A
  1. Caution family about drugs/etoh
  2. Firearms or OD drugs?
  3. Need a SUPPORTIVE person
  4. NEED a F/U apt
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24
Q

MC psych disorder in children

A

Anxiety

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25
Mnemonic: STUDENTS PANIC → How many needed to diagnose? →Tx
``` Panic Attack SOB Trembling Unsteady Depersonalization Excessive HR Numb Tingling Sweating ``` ``` Palpitation Abd pain Nausea Intense fear Chest pain ``` NEED: 4 Tx: Acute attack → Benzo
26
Panic Disorder →Duration of sx to diagnose →1st line tx
> 1 mo of concern/fear of recurrent panic attacks 1st line tx: SSRI: sertraline, fluoxetine, paroxetine
27
MC co-current diagnosis w/ anxiety
Major depression (50-60% of time)
28
Generalized Anxiety Disorder →Duration of sx to diagnose →1st line tx
> 6 mo + impairment of life moments 1st line tx: SSRI (Escitalopram, paroxetine) →others, SNRI (venlafaxine, duloxetine) or buspirone
29
2 categories of sx in DSM-5 criteria for ADHD →ID the quantity of each necessary for dx →In what settings? →What screening tool can be used in variable settings? →1st line tx →ADHD + tics →CI of stimulants
INATTENTIVE sx (>5 adult; >6 child) HYPERACTIVITY/IMPULSIVITY sx (>5 adult; >6 child) ``` Settings: > 2 Vanderbilt screening (parent, teacher etc) ``` Tx: Stimulants (Methylphenidate, amphetamine) ADHD + tics: Amoxetine CI of stimulants: Bupropion
30
2 categories of sx for Autism Spectrum Disorders →How many total sx necessary for dx? →Gold standard screening? →GS tx?
1. Social communication & interaction deficit 2. Restricted & repetitive behavior, interest, activity NEED: > 6 sx ADOS(autism diagnostic observation schedule) + Hearing & visual screening GS Tx: Applied Behavioral Analysis +/- other meds like riseperidone or aripiprazole or SSRIs
31
MC comorbid disorder along w/ bipolar
Anxiety (75%) Other: ADHD, substance use disorder, eating disorders
32
Which meds cause the following series of SE: A) TREMOR, weight gain, HYPOthyroidism, arrhythmia, many DDI B) NEURAL TUBE DEFECTS, cleft lip/palate, hepatotoxic, pancreatitis What do they tx?
A) Lithium B) Valproate Usually used to tx Bipolar 1/2
33
``` ID the details of the DSM-5 criteria for Bipolar 1 Disorder: →Types of episode & quantity? →Duration →Effect on life →Additional criteria & quantity? ```
``` →Types of episode & quantity? MANIC episode (> 1) →Duration > 1 week →Effect on life Impairs function →Additional criteria & quantity? 3 of the DIGFAST criteria ```
34
DIGFAST → what are they?
``` D: distractibility I: irritability G: grandiose F: flight of ideas A: activity ↑ S: sleep deficit/less need (*Usually the 1st sx) T: talkative/fast talking ```
35
Bipolar 1 vs. Bipolar 2 | Tx
Mood Stabilizers: (for BP1 & hypomania in BP2) 1st line: Lithium Other: Valproic acid, carbamazepine Antipsychotics: (for BP1 & hypomania in BP2) 2nd generation like olanzapine Only to subdue pt: Haloperidol or benzodiazepine BP2 depression: Lithium, valproate, carbamazepine, lamotrigine, atypical antipsych BP2 mixed hypomania & depression: atypical antipsych, valproate
36
``` ID the details of the DSM-5 criteria for Bipolar 2 Disorder: →Types of episode & quantity? →Duration →Effect on life →Additional criteria & quantity? ```
``` →Types of episode & quantity? Hypomania Major depression >1 episodes of each/both! →Duration Hypomania > 4 days Major depression > 2 weeks →Effect on life Impairs function →Additional criteria & quantity? 3 of the DIGFAST criteria ```
37
Bipolar 1 vs Bipolar 2, how do they compare in terms of suicide?
Bipolar 2 has high suicide attempts but both have suicidality as a risk
38
Diagnostic duration for Cyclothymic Bipolar disorder?
2 years of not extremely severe depression/hypomania
39
Diagnostic duration of sx/presentation to diagnose either Anorexia or Bulimia?
3 months
40
Lanugo
Anorexia
41
Anorexia: →Diagnostic weight must by _____% below expected which is about _____ standard deviations from this value →Amenorrhea can be diagnostic at _____ months
15% 1.5 3 mo
42
Pharm 1st line in anorexia
Olanzapine (low dose)
43
Deadly complication of restoring normal weight in anorexia
Refeeding syndrome → characerized by HYPOphosphatemia & volume overload → can result in death Solution: feeding must be slow/in small amts
44
Screening for anorexia
EAT 26 (96% accurate)
45
Types of INAPPROPRIATE COMPENSATION in bulimia (5)
1. Self-induced vomiting 2. Laxatives 3. Diuretics 4. Fasting 5. Excessive exercise
46
Parotid swelling
Bulimia
47
Russel's sign
Bulimia (calloused knuckles)
48
Metabolic alkalosis values form bulimia
↓ K+ ↓ Mg+ ↓ Cl- *can progress to cardiac abnormalities (T-wave flattening/inversion, ST depression, QTc lengthening)
49
Bulimia & Binge Eating Disorder common tx?
Psychotherpay CBT | SSRI → Fluvoxamine
50
What risk factor makes child abuse 5 x's more likely? | What are the other risk factors?
Poverty (5x's greater than general pop) Other: SUD, FHs, divorce, parental mental illness, foxter care
51
MC type of child abuse
Neglect
52
Retinal hemorrages of hyphema in baby
Shaken Baby Syndrome | Child Abuse
53
The general long term impact of child abuse on the victim
Overall ↓ lifespan
54
When is it more likely for domestic violence or a severe assault in this context to occur?
When the victim is attempting to escape their relationship
55
When discussing elder abuse, what age is "elder"?
> 60 yo *A breech in the trusted relationship with the elder
56
During what time period is forensic evidence able to be collected from the victim?
24 hrs | "rape kit"
57
Sexual Abuse child victim, do you give them all abx prophylaxis?
PREpubertal + no sx → no POSTpubertal + no sx → yes Symptomatic → YES!
58
Dialectical Personality Tx
1st line tx in borderline personality disorder
59
CC of pt is "Aggression" what do you think of as possible causes
``` ADHD DMDD Intermittent Explosive Disorder TBI Seizures Autism ```
60
ODD, Conduct Disorder & Intermittent Explosive Disorder | ...are all?
Impulse Control Disorders
61
ODD vs conduct disorder
ODD is > 6 mo of > 4 sx BUT no harming of property or ppl Conduct disorder is > 12 mo of 3 or > 6 mo of 1 sx + YES harming in 4 categories (Aggression, destruction, deceit, serious rule violation)
62
ODD vs DMDD (Disrupted Mood Dysregulation Disorder)
ODD is > 6 mo of > 4 sx BUT no harming of property or ppl | DMDD is out of proportion temper tantrums > 12 mo > 3 times per week (not the pts baseline)
63
Intermittent Explosive Disorder vs ODD vs DMDD
Intermittent Explosive is verbal aggression OR damaging behavioral outbursts (not the pts baseline) ODD is > 6 mo of > 4 sx BUT no harming of property or ppl DMDD is out of proportion temper tantrums > 12 mo > 3 times per week (not the pts baseline)
64
Mainstay of care for somatic symptom disorders? What are they?
Psychotherapy + SINGLE provider f/u + Socialization Illness Anxiety Disorder Conversion Disorder Somatization Disorder Others that are for the pt's personal gain: Factitious Disorder & Malingering
65
2 types of Illness Anxiety Disorder →Duration of sx? →How can it present?
1. Care seeking 2. Care avoidant > 6 mo Presents: highly focused on the idea of a sx or dx
66
Neurologic presentation + La belle differance
Conversion disorder | →often presents as paralysis, pseudosizure, aphonia, blindness, sensory deficit, neuro/ortho complaint
67
Pt complains of pain, fatigue & is preoccupied excessively w/ this sx (disproportionately) in the past 6 mo
Somatic Sx Disorder
68
Personality disorder MC associated w/ malingering
Antisocial personality disorder

Clinical Medicine (6 decks)

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