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Psychiatry Flashcards

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1
Q

mneumonic for mania

A

DIG FAST Distractability, Irritable mood/insomnia, Gradiosity, Flight of ideas, Agitation/incr in goal-directed activity, Speedy thoughts/speech, Thoughtlessness (seek pleasure w/out thought of consequences)

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2
Q

Suicide risk mnemonic

A

SAD PERSON Sex-male Age > 60 Depression Previous attempt Ethanol/drug abuse Rational thinking loss Suicide in family Organized plan/access No support Sickness

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3
Q

Depression mneumonic

A

Sleep Interest Guilt Energy Concentration Appetite Psychomotor slowing Suicidal idation

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4
Q

Tx of serotonin syndrome

A

removal of offending agents consider cyproheptadine

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5
Q

Sx of tyramine Rxn? Tx?

A

HTN, heacache, neck stiffness, sweating, n/v, visual problems. Can -> stroke Tx w/ phentolamine

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6
Q

Tx of acute dystonia

A

benztropine (cogentin) or diphenhydramine (benadryl)

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7
Q

timeline for Dx of schizo disorders

A

6 mons - schizophrenia

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8
Q

neurological pathways affected in schizophrenia

A

prefrontal cortical - low dopamine -> neg Sx mesolimbic - high dopamine -> pos Sx tuberoinfundibular - antipsychotics -> hyperprolactinemia -> gynecomastia, galactorrhea, menstrual changes nigrostriatal - antipsychotics -> EPS

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9
Q

List the typical antipsychotics. MOA?

A

chlorpromazine, thioridazine, trifluoperazine, haloperidol MOA-D2 antagonists

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10
Q

List the atypical antipsychotics. MOA?

A

risperidone, clozapine, olanzapine, quetiapine, aripiprazole, ziprosidone MOA-D2 and 5HT-2 antagonists

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11
Q

Concern with use of clozapine

A

high risk of agranulocytosis. Used if multiple other med trials have failed

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12
Q

AE of typical antipsychotics

A

EPS NMS anticholinergic Sx prolonged QT tardive dyskinesia thioridazine - irreversible retinal pigmentation chlorpromazine - corena/lens deposits

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13
Q

Examples of EPS

A

Dystonia, parkinsonism, akathisia(restlessness)

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14
Q

Tx of EPS

A

benztropine, diphenydramine, benzos, b-blockers(for akathisia)

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15
Q

atypical antipsychotics that are more “weight neutral”

A

aripiprazole and ziprasidone

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16
Q

AE of atypical antipsychotics

A

metabolic syndrome olanzapine/clozapine - weight gain ziprasidone - prolonged QT can cause same AE as typicals, but less likely to do so

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17
Q

drugs known to exacerbate psychotic Sx

A

b-blockers and digoxin

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18
Q

Dx of pt who meets criteria for major depressive disorder, manic, or mixed + delusions/hallucinations for 2 weeks in the absence of mood disorder Sx

A

schizoaffective disorder

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19
Q

Dx of delusional disorder

A

non bizarre, fixed delusions for at least 1 month functioning in life not significantly impaired doesnt meet criteria for schizophrenia

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20
Q

Tx of delusional disorder

A

trial of antipsychotics should be tried tho often unsuccessful. hard to treat

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21
Q

describe koro

A

Pt believes penis is shrinking and will -> death. Seen in Asia

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22
Q

describe amok

A

sudden unprovoked outbursts of violence which pt doesnt recollect. Often commits suicide afterwards. Seen in malaysia & SE asia

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23
Q

describe brain fag

A

HA, fatigue, visual changes in male students. seen in africa

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24
Q

difference between manic and hypomanic episode

A

manic - lasts at least 7 days, causes severe impairment in social/occupational functioning, requires hospitalization hypomanic - at least 4 days, no s/o impairment, does not require hospitalization

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25
high potency typical antipsychotics
Trifluoperazine, Fluphenazine, Haloperiod (Try to Fly High)
26
low potency typical antipsychotics
Chlorpromazine, thioridazine
27
AE of SSRIs
sexual dysfunction, GI distress, HA, rebound anxiety, serotonin syndrome
28
AE of TCAs
sedation, anticholinergic, alpha-blocking (orthostatic hypotension), weight gain
29
TCA toxicity Sx
Convulsions, Coma, Cardiotoxicity (arrythymias, prolonged QT). also: respiratory depression, hyperpyrexia, anticholinergic Sx.
30
AE of SNRIs (venlafaxine, duloxetine)
incr BP is most common
31
AE of MAO-I's
orthostatic hypotension is most common. hypertensive crisis with tyramine ingestion (wine/cheese). Serotonin syndrome w/ SSRIs. usually reserved for atypical depression
32
AE of electroconvulsive therapy
retro/anterograde amnesia, HA, nausea, muscle soreness
33
list the MAO-I's
Tranylcypromine, phenelzine, isocarboxazid, selegiline(MAO-B selective)
34
features of atypical depression
hypersomnia, hyperphagia, reactive mood, leaden paralysis, hypersensitivity to interpersonal rejection
35
normal grief
\<2 months. can have illusions, crying spells, problems sleeping, and trouble concentration, but not gross disorganization or suicidality
36
psych disorder with highest genetic link
bipolar I
37
AE of lithium
Movement(tremor Nephrogenic DI hypOthyroid Pregnancy problems-ebstein cardiac defect others: weight gain, GI, fatigue, arrhythmias, seizures, alopecia, metallic taste
38
anticonvulsants used in bipolar
carbemazepine and valproic acid. especially useful in rapid cycling (\>4 mood episodes per year)
39
Tx of mania in pregnancy
ECT
40
panic attack criteria
four of: Palpiations Abd distress Numbness, nausea Intense fear of death Choking, chills, chest pain Sweating, shaking, SOB
41
Tx of panic disorder
in acute setting, benzos SSRIs are best long term Tx
42
PTSD vs acute stress disorder
PTSD is \>1 month, and Sx could've occurred any time in past. In ASD event occurred \<1 month
43
Dx of generalized anxiety disorder
\> 6 months of excessive anxiety/worry + 3/6 of: restlessness, fatigue, decr concentration, irritability, muscle tension, sleep disturbance
44
mnemonic for personality disorder
pattern manifested in 2 or more of CAPRI: Cognition Affect Personal Relations Impulse control
45
cluster A personality disorders
schizoid(prefer isolation), schizotypal, paranoid a/w psychotic disorders
46
cluster B personality disorders
antisocial, borderline, histrionic, narcissistic a/w mood disorders
47
cluster C personality disorders
avoidant, dependent, obsessive compulsive a/w anxiety disorders
48
antisocial personality disorder vs conduct disorder
conduct is \<18 y/o
49
Tx of antisocial personality disorder
psychotherapy generally ineffective. dialectical behavior therapy and behavioral therapy best choice. pharm for anxiety/depression used w/ caution due to high addiction rates in this population
50
defense mechanism seen in borderline PD
splitting
51
defense mechanism seen in histrionic PD
regression (revert to childlike behaviors)
52
What is acamprosate(campral) used for?
Post detox alcohol relapse prevention. Can be used in liver disease.
53
Contraindications of Antabuse
Severe cardiac disease, preg, psychosis. Must monitor LFTs
54
Rotatory nystagmus is ? Intoxication
Pcp
55
opioid that -\> mydriasis
meperidine (demerol dilates)
56
symptomatic Tx of opioid withdrawal? Tx for severe withdrawal?
clonidine for autonomic instability, nsaids for pain, dicyclomine for abd cramps severe - detox w/ buprenorphine or methadone
57
Tx of pregnant opioid dependent woman
methadone
58
MOA of caffeine
adenosine antagonist, causing incr cAMP and a stimulant effect via dopaminergic system
59
core features of lewy body dementia
waxing and waning cognition, visual hallucinations, parkinsonism, sensitivity to neuroleptics. REM sleep behavior disorder is also common
60
Dx of mental retardation
IQ\<18
61
age for ADHD
onset before age 7
62
aspergers vs autism
in aspergers, children have normal language acquisition and cognitive development
63
congenital abnormalities a/w lithium
1st trimester - ebstein anomaly (atrialized R ventricle) 2nd/3rd - goiter, transient neonatal neuromuscular dysfunction
64
contraindication for lithium use
renal dysfunction
65
AE of methylphenidate
decr appetite -\> wt loss, nervousness, insomnia, tachycardia, abd pain, nausea
66
Tx of social phobia
assertiveness training (subtype of CBT) and SSRI
67
Tx of akathisia 2/2 antipsychotics
b blockers
68
Tx of anorexia nervosa
behavioral therapy, family therapy (maudsley approach) low dose atypical antipsychotics benzos prior to meals lower anxiety SSRIs not effective (lack of tryptophan in diet - precursor to serotonin)
69
Tx of bulemia
SSRIs - fluoxetine CBT, group/family terapy, Avoid buprorion - lowers seizure threshold
70
contraindications to buproprion
epilepsy, or things that may precipitate seizures - alcohol/benzo abuse, eating disorders
71
describe kleptomania. a/w?
compulsion to steal items not needed for personal use. more common in females. a/w bulemia
72
If giving lamotrigine, what drug should you know if they are on?
Valproic acid increases conc -\> incr incidence of Steven Johnson seen with lamotrigine. If on VPA, titration schedule is slower
73
time cutoff for Dx of primary insomnia
at least 1 month
74
time cutoff for Dx of narcolepsy
irresistible attacks of refreshing sleep that occur daily for at least 3 months.
75
DOC for narcolepsy with cataplexy? Other Tx of narcolepsy?
cataplexy - sodium oxybate other options: amphetamines, non-amphetamine stimulants (methylphenidate, modafinil, sodium oxybate), TCAs, SSRIs, SNRIs
76
Kleine-Levin Syndrome
rare disorder characterized by recurrent hypersomnia w/ episodes of daytime sleepiness with hyperphagia, hypersexuality, aggression
77
Tx of nightmares in PTSD
imagery rehearsal therapy
78
Medications a/w REM sleep behavior disorder
SSRIs, TCAs, MAOIs
79
indications for ECT
refractory depression, depression in pregnancy, refractory mania, NMS, catatonic schizophrenia
80
Dx of enuresis (Bed wetting)
must be \>5 w/ occurrence twice per week for \>3 months. Tx with ADH (desmopresin). 2nd line is imipramine
81
Tx of tourette's
typical antipsychotics (haloperidol or pimozide)
82
sleep meds assoc w/ sleep walking, sleep driving, and other dissociative events
zolpidem, zaleplon
83
anesthetic agent used prior to ECT
methohxital

Medicine (6 decks)

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