Review Flashcards
(172 cards)
1
Q
How do we clinically assess mania
A
DIG FAST distractibility irritable mood/insomnia grandiosity flight of ideas agitation/increase in goal-directed activity speedy thoughts/speech thoughtlessness: seeks pleasure without regard for consequences
2
Q
How do we assess suicide risk
A
SAD PERSONS sex --male age >60 depression previous attempt ethanol/drug use rational thinking loss suicide in family organized/plan/access no support sickness
3
Q
How do assess for depression
A
SIGECAPS sleep interest guilt energy concentration appetite psychomotor suicidal ideation
4
Q
delirium tremens is what
A
a psychiatric emergency characterized by:
2-4 days after cessation of alcohol. delirium, agitation, fever, autonomic hyperactivity, auditory and svisual hallucinations
5
Q
what is the treatment of DTs
A
aggressive treatment with Benzodiazepines
6
Q
what is neuroleptic malignant syndrome
A
fever, rigidity, autonomic instability, clouding of consciousness, elevated WBC, CPK.
7
Q
what is the treatment for NMS
A
withhold neuroleptics, hydrate. consider dantrolene and bromocriptine.
8
Q
what is serotonin syndrome
A
precipitated by drug combinations MAOi and SSRIs. altered mental status, fever, agitation, tremor, myoclonus, hyperreflexia, ataxia, incoordination, diaphoresis, shivering, diarrhea,
9
Q
treatment for Serotonin syndrome
A
Benzos, cyproheptidine.
10
Q
hypertensive crisis
A
combination of tyramine containing foods and MAOis. hypertension, headache, neck stiffness, sweating, nausea, vomiting, visual problems,. can cause stroke or death
11
Q
treatment of hypertensive crisis
A
phentolamine or nitroprusside.
12
Q
what is acute dystonia
A
early sudden onset of muscle spasms, can be of the eyes, neck, tongue, jaw and can even be laryngospasm.
13
Q
treatment for acute dystonia
A
benztropine. diphenhydramine
14
Q
lithium toxicity
A
when lithium levels are greater than 1.5. nausea, vomiting, myoclonus, seizure, nephrogenic diabetes insidious, hyperreflexia, slurred speech, incoordination.
15
Q
treatment for lithium tox
A
hydration and consider hemodialysis
16
Q
TCA toxicity
A
primarily anticholinergic effects. hypotension, cardiac conduction disturbances, hallucinations, respiratory depression, agitation, depression, seizures.
17
Q
treatment for TCA tox
A
activated charcoal, cathartics and supportive treatment
18
Q
what is contained in the thought process portion of mental status
A
tangibility, loosening of associations, flight of ideas, neologisms, word salad, clang associations, thought blocking.
19
Q
what is tangibility
A
point of the conversation is never reached, responses usually in the ballpark
20
Q
what is loosening of associations
A
no logical connection between thoughts
21
Q
what is flight of ideas
A
thoughts change abruptly from one idea to another, usually accompanied by rapid pressured speech
22
Q
neologism
A
made up words
23
Q
what is word salad
A
collection of words incoherent.
24
Q
what are clang associations
A
word connections due to phonetics rather than meaning “my car is red, I have been in bed, I hurt my head.
25
what is thought blocking
abrupt end to the conversation or cessation of communication before the idea is finished.
26
what do we always ask when a patient has hallucinations?
does this happen when falling asleep (hypnogogic) or when waking up (hypnopompic)
27
what are positive symptoms of schizophrenia
hallucinations, delusions, bizzarre behaviors, disorganized speech. these responds more robustly to antipsychotic.
28
what are negative symptoms schizophrenia
flat or blunted affect, anhedonia, alogia, and lack of interest in socialization. these are more likely to be treatment resistant.
29
how do we diagnose schizophrenia
must have at least 2 of the following for at least one month and at least one must be either 1, 2, 3:
1) delusions
2) hallucinations
3) disorganized speech
4) grossly disorganized or catatonic behavior
5) negative symptoms
30
what are the statistics of schizophrenia world wide prevalence, monozygotic twins, risk of inheritance if both parents have it, risk if first degree relative
prevalence is 1%. 50% concordance rate in twins, 40% inheritance rate if both parents, 12% if a first degree relative.
31
what are the most commonly abused drugs in SZ
nicotine by far the most, alcohol, cannabis, cocaine
32
what is the difference between schizophrenia and schizophreniform
they have the same criteria, but schizophreniform lasts between 1 and 6 months, whereas schizophrenia lasts greater than 6 months.
33
can people recover from schizophreniform
yes, 30% recover completely. 2/3 progress to schizoaffective or full schizophrenia
34
what are the criteria for schizoaffective
meet the criteria for major depressive or manic episode during which the psychotic symptoms of schizophrenia are also met. they must have delusions or hallucinations for at least 2 weeks without mod symptoms (this differentiates between affective and mood disorder with psychotic features). mood symptoms are present for a majority of the psychotic illness
35
what makes the prognosis for schizoaffective worse
slow onset, early onset, poor premorbid adjustment. predominance of psychotic symptoms. is there is long course and a family history of schizophrenia.
36
what is brief psychotic disorder
psychotic symptoms of schizophrenia for between 1 day top one month with a full return to premorbid level of functioning.
37
is brief psychotic disorder rare
yes. much more rare than a diagnosis of schizophrenia.
38
what is the prognosis for brief psychotic disorder
almost all completely recover, but there is high rate of relapse.
39
how to differentiate between schizophrenia and delusional disorder
the delusions are usually different. delusional disorder delusions are usually not bizarre.
40
what are the types of delusions in delusional disorder
erotomania, grandiose, somatic, persecutory, jealous, mixed, unspecified.
41
why is delusional disorder hard to treat?
because there is a lack of insight
42
what is schizotypal disorder
personality disorder with paranoid, odd or magical beliefs eccentric, lack of friends, social anxiety, yet the criteria for overt psychosis are not met.
43
what its schizoid
personality disorder, solitary activities lack of enjoyment from social interactions, not psychosis.
44
what is the definition of hypomania
distinct period of abnormally and persistent elevated, expansive, or irritable mood with increased goal directed activity or energy that lasts for at least 4 consecutive days.
45
what are the differences between mania and hypomania
mania lasts for at least 7 days, while hypomania lasts for 4; mania causes severe impairment in social or occupational functioning, while hypomania doe snot cause marked or impaired function; mania usually requires hospitalization, while hypomania does not; mania can have psychotic features, while hypomania does not.
46
how do we diagnose PTSD?
```
TRAUMA
trauma
revisiting (re-experiencing)
avoidance
unable to function
month or more
arousal
```
The experience is also associated with negative emotions such as fear, horror, anger and guilt.
the symptoms of increased arousal are reactivity, hyper-vigilance, exaggerated startle response, irritability or anger outburst, impaired concentration and insomnia.
47
what are the features of serotonin syndrome
the three As. agitation, autonomic stimulation, hyperactive neuromuscular junction.
hyperreflexia, clonus, tremor, seizure, hypertonia. hyperthermia, diaphoresis, diarrhea, tachycardia and agitation
MYDRIASIS
48
what is the definition of delirium
```
rapid onset (hours to days), fluctuating levels of consciousness, can have psychotic features, inattention.
associated with illness or medications.
```
49
what is the difference between delirium and psychosis due to a medical problem
the onset for delirium is rapid and there are other features with delirium, not purely psychosis, for example inattention, forgetfulness, fluctuating levels of consciousness.
50
what is a delusional disorder
fixed, persistent, false belief that occurs for longer than one month. they do not have decreases in functional status and do not fit the criteria for a psychiatric disorder.
51
what is highly comorbid with adhd
tourettes. be careful because the vignettes could so similar that you won't know the difference.
52
what is the only FDA approved medication for tourettes
pimozide
53
what is the treatment for lithium-induced nephrogenic diabetes insipidus
removing the agent for adding thiazide diuretic, such as hydrochlorothiazide, ameloride, indomethacin, desmopressin
54
what drug can cause delirium when administered in the context of EPS
diphenhydramine can cause polypharmacy delirium.
55
what is the treatment for diphenhydramine induced delirium
physostigmine
56
when do sleep walking and night terrors occur
during deepest sleep, N3
57
how do night terrors present
The child will be tachycardic, diaphoretic, and very frightened. The child will have a sudden attack and sit up in bed, yet he or she will not be fully awake. He or she will generally fall asleep after the episode, and at times may not have any recollection of the event. Night terrors often occur in combination with somnambulism (sleepwalking). Sleepwalking and night terrors both occur during the deepest stages of non-REM sleep (stages 3 and 4).
58
how frequently do you check blood draws for agranulocytosis when on clozapine
Once every week for first 6 months
Once every 2 weeks for next 6 months
Once every month indefinitely after
59
what is the treatment for ASD
behavioral modification therapy. there is no role for pharmacology
60
what are the most common presentations for acute dystonia and what are the treatments
torticolis, ocular upward gaze, diphenhydramine and benztropine
61
which antipsychotics do you use for the treatment of psychosis in parkinsons patients
quetiapine, clozapine. benzos are the best choice.
62
which eeg pattern will night terrors have
delta
63
what is the presentation of phencyclidine OD
possible track marks, a common indicator of intravenous drug abuse. She is febrile, tachycardic, with additional symptoms consistent with hallucinogen intoxication. Her father describes violent behavior with vertical nystagmus, depersonalization, and hallucinations.
64
do people have memory of their nightmares
yes.
65
what is the treatment for nightmares
psychotherapy.
66
what is the treatment for refractory nightmares
clonazepam
67
what are the treatments for insomnia
good sleep hygiene is important. if this is already done then use of phototherapy can help.
68
what is the diagnostic criteria for tourettes
childhood vocal and motor ticks that last over 1 year.
69
what is the treatment for tourettes
antipsychotics, clonidine/guanfecine, behavioral therapy
70
what are the treatments in order for enuresis
lifestyle change, enuresis alarms, desmopressin
71
what are the treatments for chronic insomnia
sleep hygiene methods, CBT, benzos, non-benzos (zolpidem), antidepressants (trazodone, amitryptiline)
72
what do delirium tremens look like
anxiety, tremors, tachycardia and can involve tactile hallucinations, increased respiratory rate, increased blood pressure.
73
what is the treatment for DT
benzos long acting.
74
what is the treatment for sleep terros
reassurance that this will go away in 1-2 years s the recommended treatment, but benzos can be also be given.
75
what is the treatment for seasonal affective disordre
bright light therapy and antidepressants
76
what are the features of atypical depression
mood reactivity. leaden paralysis, increased appetite, increased sleep.weight gain, increased sensitivity to rejection.
77
what is melancholic depression
Melancholic depression is a subtype of clinical depression requiring either anhedonia or lack of mood reactivity. It also involves depression, severe weight loss, psychomotor agitation, early morning awakening, excessive guilt, and worse mood in the morning.
78
what neurotransmitter is involved in the pathology of OCD
serotonin
79
what does aspirin intoxication cause
metabolic acidosis and respiratory alkalosis
80
how do we treat post surgical shivering
meperidine. however, if the person has a contraindication then use dexmedetomide or clonidine.
81
what is absolutely contraindicated in a patient taking an MAOI
TCA, dextromorphan, meperidine, SSRI/SNRI,
82
what is munchausen disorder
patients actively make themselves sick by falsifying medical test or taking excessive medication or meds not prescribed to them.
don't confuse this with malingering.
83
if a patient has a normal electrolyte panel and the ability to concentrate urine what is the diagnosis but a complaint of excessive urination
central polydipsia.
| this is excessive thirst that causing excessive urination.
84
what is the best choice for a benzo in the treatment of panic disorders
potency or short acting.
| look for clonazepam or olams such as alprazolam.
85
what drug do you use for acute mania in a pregnant woman
haliperidol because valproate, lithium are teratogenic and lamotrigine is only for bipolar depression
86
what is first line treatment for late life depression
sertraline
87
what is the treatment for hallucinations that are not distressing or commanding
they do not have to be treated. You can be conservative
88
what is a leading cause of enuresis in children with obesity
obstructive sleep apnea
89
what is the approach to enuresis
urinalysis, focused history and physical with fluid intake, stool and voiding diary then a thorough clinical evaluation
90
what is confabulation
Confabulation is characterized by a memory disturbance, defined as the production of fabricated, distorted or misinterpreted memories about oneself or the world, without the conscious intention to deceive.
91
what does flumazenil do and what is it used for
this is to reverse Benzodiazepines overdose
92
what are fluency disorders
this is stuttering and fluttering speech
93
what kind of drug is benztropine
anti-muscarinic
94
what kind of fractures are often found in anorexia
metatarsal fractures
95
what are the treatments for OCD
SSRIs, clomipramine (TCA), venlafaxine
96
what is the mechanism of mertazapine
increases the release of serotonin and norepinephrine
97
what is the mechanism of action of bupropion
decreases the reuptake of dopamine, norepinephrine and serotonin
98
what treatments are good for depression and insomnia
mertazapine and trazadone
99
what are some of the anticholinergic side effects
```
dry mouth, tachycardia, urinary retention, confusion
Red as beat flushing
dry as a bone no sweating
blind as a bat dilated pupils
mad as a hatter confusion
```
100
what is ego-syntronic
your behavior is consistent with your beliefs
101
what drug is for Benzodiazepines reversal and what are SE
flumazenil and seizures
102
what are the symptoms of bereavement
major complaint is the feeling of loss, normal self-esteem, negative feelings of pain and grief are mixed with positive memories.feeleings of love, no SI, daily functioning is maintained
103
what treatments do you give to a patient that fails haloperidol and has a history of diabetes
ziprasidone or aripiprazole low risk profile for metabolic disorder
104
which antipsychotic can cause hypothermia by disrupting the thermoregulatory center
fluphenazine --think the flu causes shivers
105
what is the treatment of acute intermittent porphyria
heme and glucose. inhibition of ALA synthase
106
what is the best treatment for GAD and sexual dysfunction
buspirone
107
what is habit reversal training
CBT for tourettes
108
what is the treatment for dissociative identity disorder
trauma-focused psychotherapy
109
what is the treatment for adjustment disorder
CBT/psychotherapy
110
what is the only FDA approved weight loss therapy
combination topiramate and phentermine f
111
what common defense mechanism is seen in paranoid personality disorder
projection --attributing thoughts and feelings to others. paranoia results from projection
112
what is central sleep apnea
sleep apnea due to a medical condition such as heart failure
113
what stage of sleep do most of the parasomnias occur?
in the non-REM deep sleep phases N3 and 4.
| the exception is nightmare and REM-sleep behavior disorder
114
what is the mechanism of action for amenorrhea in anorexia
loss of pustule GnRH
115
what are the primary symptoms of narcolepsy
excessive daytime sleepiness and sleep attacks
116
what is idealization
thinking about all the positive things about yourself and others while disregarding the others
117
what is intellectualization
using facts and logic to distance oneself from an emotional situation
118
what receptors are targeted by atypical antipsychotic
dopamine 2 and serotonin 2a
119
what are the side effects of SSRIs
headache, nausea, vomiting, insomnia, nervousness and sexual dysfunction
120
mechanism of action of mertazapine
alpha 2 agonist that increased the release of the norepinephrine and serotonin
121
what is second line pharmacological treatment of atypical depression
MAOIs
122
what is the definition of the specifier catatonia
cataplexy (immobility), purposeless movement extreme negativism, mutism, bizarre postures and echolalia
123
what is agoraphobia, what is it associated with and what is the treatment
this is an anxiety disorder that consists of fear of places that cause panic, such as ones that you cannot escape from, become trapped or embarrassed.
treatment is CBT and SSRIs
124
what are the development for a 3 month old
gross motor roll, no fine motor, laughing, and smiling
125
what are the development for a 6 month old
sit, switches, cooing, stranger anxiety begins
126
what are the development for a 9 month
gross motor they pull, they have pincer, say papa, play with another/stranger anxiety peaks
127
what is the development for a 12 month old
two legs motor, fine motor track, two word language, two of us for social
separation anxiety
128
what is separation anxiety, what does it look like and what is the treatment
excessive and developmentally innappropriate fear/anxeity regarding the separation from attachment figures. leads to extreme distress, usually fear about loss of harm to attachment figures. excessive worry. reluctance to leave home or be alone, sleep alone, complaints of physical symptoms
nightmares, lasts for >4 weeks in children and >6months in adults.
treatment is CBT, family therapy. SSRIs work well with adjuvant therapy
129
what is the longterm treatment for panic disorder
CBT with SSRIs
130
what is advanced sleep phase disorder and what is the treatment
when the circadian rhythm sleep wake cycle begins and ends earlier than normal
the treatment is phototherapy in the evening
131
what do you give a patient with depression and sexual SE
bupropion
132
what is anaclitic depression
a pattern of muscle wasting and psychological depression thought to stem from lack of social contact during key developmental stages. this can be part of reactive attachment disorder
133
what two classes of drugs should you avoid when taking SSRIs
dNSAIDs except for aspirin
134
what are the only two drugs that are FDA approved for depressive symptoms of bipolar
lithium and lamotrigine
135
what is the treatment for NMS
supportive therapy with dantrolene and bromocriptine being second line
136
what is parental emotional abuse associated with
suicide, antisocial personality, depression, borderline personality,
137
what is sublimation
replacing an unacceptable impulse into a more acceptable and socially accepted one
138
what are the signs of delirium tremens
hallucinations, agitation, with changes in vital signs, such as hyperventilation, tachycardia, and hypertension.
139
what are the signs of alcoholic hallucinosis
12-24 hours after abstinence and usually resolves within 24 hours. hallucinations not associated with confusion, patients are aware that they are hallucinating and there is usually no changes in vitals
140
what is the best option for a person that has a good response to SSRIs but has sexual SE
augment or replace the current with bupropion
141
what are common sexual SE of SSRI use
anorgasmia or decreased libido
142
agoraphobia is defined how
anxiety disorder persistent and irrational fear of being in situations that difficult to escape or where help will be difficult. sing public transportation, being in open or enclosed spaces, standing in line a crowd or leaving the home alone.
143
what is Jamis vu
when you "haven't seen this before, but you really have" or the opposite of deja vu
144
what is presque vu
tip of the tongue phenom or when you cant quite recall something
145
what is deja entendu
hearing something familiar, as if you have heard it before. This is very similar to deja vu
146
what is a paraphillic disorder
auto-erotic asphyxiation is an example. its when people have sexually excitement or fantasy our a particular object or engaging in a particular act.
147
when do kids usually begin to show their parents an object that they also want them to take interest in?
when they are 12 months old
148
what NSAIDs can you use when taking lithium
aspirin and sudinlac
| Do not use ibuprofen
149
when is the onset for FTD
45-65. survival is about 8 years
150
how do you know the difference between avoidant and schizoid
schizoid choose to be alone, avoidant fear rejection and think people won't like them
151
what ethnic group is at the highest risk for SJS?TEN from carbamazepine
southeastern asian --the Han Chinese
152
what does anticholinergic syndrome look like, what is the treatment for anticholinergic syndrome
what could be the offending agent?
increased heart rate, decreased BP, pupillary dilation with no accommodation. can cause hallucinations
physostigmine
atropine
153
what drug has a similar mechanism of action as varenicline
buprenorphine
a partial agonist of the mu-opioid receptor.
154
what is the mechanism of action for varenicline
partial agonist at the nicotinic AChR but binds more weakly than nicotine.
155
what is the mechanism of action of bupropion and what is it similar to mechanistically
it is an antagonist of the nictinic AChR.
| it is similar to naloxone
156
what kind of depression is likely in a graduate student who is preoccupied with face-picking and nail-biting during the interview
depression with anxiety and/or obsessive-compulsive subtype
the personality and evidence fit perfectly
157
Are somatic symptoms found in major depression
yes, they are often found. this can cloud the diagnosis. look for mood symptoms beginning before the somatic symptoms.
158
what kind of disorder is tillotrichomania and what is first line therapy
this is an anxiety disorder with impulsive action.
| CBT
159
which antidepressants can cause weight gain
paroxetine and mertazapine
160
what does alcohol do to the autonomic nervous system with respect to cardiac fucntion
can temporarily suppress the regulation of cardiac pacemakers
161
what drug causes rotary nystagmus
PCP
162
what are the most common consequences of sexual abuse or rape?
PTSD, depression and suicidal ideation and attempts.
163
Do we use SSRIs for hoarding disorder
No. Not unless there is OCD comorbid. There is limited efficacy
164
what is the treatment for pseudodementia
SSRI
165
when is orlistat indicated
when the BMIis greater than 30
166
what are the prodromal signs of schizophrenia
decline in functioning that precedes first psychotic break. the patient usually becomes socially withdrawn and irritable. they may have physical complaints declining school work performance. or a newfound interest in religion.
167
what is the differential for depressed mood
major depressive disorder, adjustment disorder, normal stress response
168
what is normal stress response
not excessive or out of proportion to severity of stressor. no significant impairment
169
what is adjustment disorder
identifiable stressor with an onset within 3 months of stressor. marked distress. significant functional impairment but it does not meet the criteria for DSM-5 criteria
170
what is conversion disorder
this is neurological symptoms such as paralysis, loss of speech, vision, verbal expression, swallowing, or some other voluntary system, non-epileptic seizure, following a stressor. This is not factitious disorder or malingering, but the symptoms do not fit a neurological disorder.
171
what are the therapies for conversion disoder
first line: self-help and education.
| second line is CBT
172
what is the treatment for kleptomania
CBT and SSRIs
