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1
Q

Mania mnemonic

A

DIG FAST
distractibility
irritable mood
grandiosity
flight of ideas
agitation/increase in goal directed activity
speedy thoughts/speech thoughtlessness: see pleasure without regard to consequences

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2
Q

suicide risk mnemonic

A 
SAD PERSONS
sex- male
age > 60
depression
previous attempt
ethanol/ drug abuse
rational thinking los
organized plan/access
no support
sickness
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3
Q

depression mnemonic

A 
SIG E CAPS
sleep
interest
guilt
energy
concentration
appetite
psychomotor changes
suicidal ideation - hopelessness, helplessness, worthlessness
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4
Q

alcohol intox/withdrawal

A

Intox - disinhibited, mood lability, incoordination, slurred speech, ataxia, blacouts, respiratory depression
Withdrawal - tremulousness, hypertension, tachycardia, anxiety, psychomotor agitation, nausea, seizures, hallucinations, DT

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5
Q

benzo intox/withdrawal

A

Intox - disinhibited, mood lability, incoordination, slurred speech, ataxia, blackouts, respiratory depression
Withdrawal - tremulousness, hypertension, tachycardia, anxiety, psychomotor agitation, nausea, seizures, hallucinations, DT

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6
Q

Bar intox/withdrawal

A

Intox - respiratory depression

Withdrawal - anxiety, seizures, delirium, life-threatening CV collapse

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7
Q

opioids intox/withdrawal

A

Intox - CNS depression, nausea, vomiting, sedation, decreased pain perception, decr GI, pupil constriction, resp depression
Withdrawal - increase dsympathetic activity, N/V/D, diaphoresis, rhinorrhea, piloerection, yawning, stomach cramps, myalgias, arthralgias, restlessness, anxiety, anorexia

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8
Q

amphetamines, cocaine intox/withdrawal

A

Intox - euphria, increased attention, aggressiveness, agitation, pupil dilatation, hypertension, tachy, cardiac arrhythmias, psychosis
Withdrawal - post use crash, restlessness, HA, hunger, severe depression, insomnia/hypersomnia, strong psychological testing

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9
Q

PCP intox/withdrawal

A

Intox - belligerence, impulsiveness, agitation, vert/horizontal nystagmus, hyperthermia, tachy, ataxia, psychosis, homicidal
Withdrawal - recurrence of symptoms from reabsorption in GI

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10
Q

LSD intox/withdrawal

A

Intox - altered perception, elevated mood, panic, flashbacks

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11
Q

Cannabis

A

Intox - euphoria, anxiety, paranoia, slowed time, social withdrawal, increased appetite, dry mouth

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12
Q

nicotine/caffeine intox/withdrawal

A

Intox - restlessness, insomnia, anxiety, anorexia

Withdrawal - irritability, lethargy, headache, increased appetite, weight gain

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13
Q

DT’s - timing, sx, tx

A

2-4 days
delirium, agitation, fever, autonomic hyperactivity, auditory and visual hallucinations
benzos and hydration

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14
Q

NMS - sx, tx

A

fever, rigidity, autonomic instability, clouding of consciousness
withhold neuroleptics, hydrate, consider dantrolene

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15
Q

Serotonin syndrome - sx, tx

A

AMS, fever, agitation, tremor, myoclonus, hyperreflexia, ataxia, incoordination, diaphoresis, shivering, diarrhea

stop agents, cyproheptadine

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16
Q

tyramine reaction/HTN crisis - cause, sx, tx

A

tyramine foods while on MAOI
HTN, HA, stiff nec, sweating, nausea, vomiting, visual problems, stroe, death
phentolamine

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17
Q

Dystonia - sx, tx

A

muscular spasm, eyes, tongue, jaw, neck

benztropine or diphenhydramine

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18
Q

medical causes of psychosis

A

CNS disease: alz, parinson, HD, tertiary syph, epilepsy, prion disease
endocrin: addison/cushing disease, hyper/hypo thyroid, yper/hypo calcemia, hypopit
nutritional: B12, folate, niacin
Other: SLE, porphyria

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19
Q

timeline of schizophrenia and phases

A

positive or negative sx for at least 6 months

prodromal - decline in functioning ie socially withdrawn and irritable
psychotic - perceptual disturbances, delusions, disordered thought
residual - occurs between psychosis, flat affect, social withdrawal, odd behavior

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20
Q

negative symptoms of schizo mnemonic

A 
5 A's
anhedonia
affect (flat)
alogia (poverty of speech)
avolition (apathy)
attention (poor)
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21
Q

Types of schizophrenia

A

paranoid - delusions and auditory hallucinations, older age of onset

disorganized type - disorganized speech, behavoir, flat or inappropriate affect –> poor functioning

catatonic type - rigid posture, inappropriate or repetitive and purposeless movements, echolalia, echopraxia

residual type - negative symptoms

undifferentiated - does not fit in others

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22
Q

drugs that mimic schizo

A

cocaine and amphetamine

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23
Q

predisposing factor to paranoid schizophrenia

A

deafness

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24
Q

schizophreniform timeline

A

1-6 months

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25
schizoaffective disorder
have major depressive, manic or mixed have delusions or hallucinations for 2 weeks in absence of mood disorder mood symptoms for substantial portion of psychotic illness not related to drugs
26
what do patients with schizoaffective disorder progress to
schizophrenia (60-80%)
27
brief psychotic disorder
psychotic symptoms 1 day to 1 month
28
delusional disorder - occurs, sx, tx
most common in older patients, immigrants, hearing impaired nonbizarre, fixed delusionsfor at least 1 month not schizophrenic functioning
29
major depressive disorder time course
2 weeks of depressed mood and anhedonia with at least 4 other symptoms
30
mania time course
elevated expansive or irritable mood for at least 1 week
31
mania vs hypomania
mania causes severe impairment in social functioning and may have psychotic features hypomania - no psychotic features, no marked impairment
32
major depressive disorder - prevalence and age
16.2% and 40
33
major depressive disorder - sleep problems
- multiple awakenings - initial and terminal insomnia - hypersomnia - REM shifted
34
major depressive disorder with atypical features - description and tx
mood reactivity, leaden paralysis, hypersomnia tx: MAOIs
35
bipolar disorder 1 - prevalence and tx
1%, age before 30 tx: lithium, anticonvulsants, atypical antipsych, ECT (pregnancy or refractory tx)
36
bipolar disorder 2 - description, prevalence, tx
major depressive episodes with hypomania | prevalence - more common than bipolar 1, age before 30
37
dysthynmic disorder - description
chronic mild depression, no episodes for at least 2 years - sx not gone for > 2 months - tx cognitive therapy or antidepressant meds - never have psychotic features
38
cyclothymic disorder
alternating hypomania and mild depressive symptoms - at least 2 years, never been sx free for > 2 months - no major depressive episodes and no manic episodes
39
adjustment disorder - time course
symptoms witin 3 months of stressor and end within 6 months, impairment in daily functioning or interpersonal relationships - not life threatening event
40
panic attacks/disorder - tx
SSRIs (paroxetine and sertraline) | - clomipramine and imipramine, benzos
41
performance anxiety - tx
propranolol
42
social anxiety - tx
paroxetine (SSRI)
43
OCD - prevalence and tx
2-3%, distressed by sx tx: SSRIs, TCAs
44
PTSD vs acute stress disorder timeline
ASD 1 month, lasting 1 month
45
GAD - tx, time course
6 months Tx: SSRIs, SNRIs
46
paranoid personality disorder
suspicion, no evidence, preoccupation with doubts of loyalty or trustworthiness, reluctance to confide in others - more common in men - family members of schizo
47
schizoid personality disorder
social withdrawal, no desire for close relationships and prefer to be alone - more common in men
48
schizotypal personality disorder
eccentric behavior and peculiar thought patterns, strange and eccentric - odd beliefs or magical thinking - can go to schizophrenia
49
antisocial personality disorder
more likely in men with alcoholic parents - no remorse for actions, impulsive and deceitful, violate law - at least 18, history of conduct disorder - coexistence of substance abuse and/or major depression common - DBT and behavioral therapy
50
borderline personality disorder
unstable moods and interpersonal relationships, fear abandonment, poorly formed identity, aggression common due to impulsive - unstable relationships, impulsivity, unstable mood/affect, unstable self image - splitting, patients all good or all bad - more ocmmon in women tx: psychotherapy, behavior/cognitive
51
histrionic personality disorder
attention seeking behavior and excessive emotionality - dramatic - need to be center of attention - inappropriately seductive or provocative behavior - uses physical appearance to draw attention to self 2-3% psychotherapy
52
narcissistic personality disorder
superiority, need for admiration, lack of empathy 5 or more - exaggerated self importance - preoccupation with unlimited money, success, brilliance - believes that he or she is special or unique <1% psychotherapy
53
avoidant personality disorder
social inhibition and intense fear of rejection - avoid social interaction and seek jobs without interpersonal contact - desire companionship 1-10% psychotherapy, beta blockers for anxiety sx
54
dependent personality disorder
poor self-confidence and fear separation, need to be taken care of - regression often seen in patients - clinging behavior 1% psychotherapy
55
OCPD
pattern of perfectionism, inflexibility, orderliness - prefectionist - loves rules and lists - no delegating men psychotherapy
56
substance abuse prevalence
17%
57
alcohol dependence prevalence
3-5%
58
alcohol withdrawal symptoms begin
6-24 hours, last 2-7 days
59
DTs time course
48-72 hours
60
DTs death
15-25% mortality if untreated, only 5%
61
altruism
mature defense | - acts that benefit others to experience pleasure
62
humor
mature defense | - expressing unpleasant or uncomfortable feelings without causing discomfort to self or others
63
sublimation
mature defense | - satisfying socially objectionable impulses in an acceptable manner
64
suppression
mature defense | - ignoring an unacceptable impulse or emotion to diminish discomfort and accomplish a task
65
order of medications in possible alcohol withdrawal
thiamine, then glucose/fluids/benzos
66
PCP intox pathognomonic
rotatory nystagmus
67
delirium + hemiparesis or focal signs and sx
CVA or mass lesion Dx: brain CT/MRI
68
delirium + elevated BP + papilledema
HTN encephalopathy Dx: Brain CT/MRI
69
delirium + dilated pupils + tachy
drug intox Dx: urine tox
70
delirium + fever + nuchal rigidity + photophobia
meningitis Dx: LP
71
delirium + tachy + tremor + thyromegaly
thyrotoxicosis Dx: T4, TSH
72
dementia with stepwise increase in severity and focal neuro signs
multi infacrt dementia Dx: CT/MRI
73
dementia + cogwheel + resting tremor
lewy body dementia, parkinson Dx: clinical
74
dementia + gait apraxia + urinary incontinence + dilated cerebral ventricles
NPH Dx: CT/MRI
75
dementia + obesity + coarse hair + constipation + cold intolerance
hypothyroid CT/MRI
76
dementia + diminished position and vibration + megaloblasts
vit B12 deficiency serum B12
77
dementia + tremor +_ abnl LFTs + kayser fleischer rings
wilson disease ceruloplasmin
78
dementia + diminished positiion and vibration + argyll robertson pupils (no response to light)
neurosyphilis CSF FTA-ABS or CSF VDRL
79
five stages of grief
``` denial anger bargaining depression acceptance ```
80
prolonged grief time course
6 months
81
delusions in alzheimer patiernts (%)
70%
82
hallucinations in dementia pateints (%)
33%
83
mentally retarded cases are mild
85%
84
MR affects % of population
1-3%, majority guys
85
ODD
negativistic, hostile, defiant behavior x 6 months - get along with peers, no regard for authority figures - 2-16% - age 3-8
86
Conduct disorder
1 year need to have 3/15 - aggression toward people and animals - destruction of property - deceitfulness or theft - serious rule violation 1-10% basic rights of others or social norms violated
87
Comorbid conditions with conduct disorder
ADHD (70%) and learning dosrder, substance abuse
88
premorbid condition for conduct disorder
antisocial personality disorder
89
comorbid condition with ODD
ADHD, substance abuse, mood disorders
90
ADHD prevalence
5-12%, 60% to adulthood
91
% of autism meet criteria for MR
70%
92
asperger vs autism
asperger have normal language and cognitive development
93
rett disorder
between 5-30 months decreased head growth and loss of hand skills, impaired language, retardation - suually girls - MECP2 on x chromo
94
childhood disintegrative disoder
normal development 2 years of life. loss of previously acquired skills before age 10 in at least 2 - language, social skills, bowel or bladder continence, play, motor skills
95
tourette's criteria
multiple motor and one or more vocal tics not due to CNS disease prior to 18 - no tic free for > 3 months stimulants exacerbate tics
96
ADHD and tourette's %
50%
97
age for separation anxiety
7 months to 6 years
98
stranger anxiety
8-12 months
99
sexual abuse in women %
15-25%
100
sexual abuse in men %
5-15%
101
dissociative fugue
sudden unexpected travel away from home, inability to reall one's identity or one's past - not aware they have forgotten everything
102
somatization disorder - sx, prevalence, PCP
multiple nonspecific sx not from medical condition or substance (onset before 30) - at least four pain sx - at least two GI sx - at least one sexual or reproductive sx - one pseudoneruological sx not limited to pain 0.1-0.5% 5-10% patients in primary care have disorder
103
conversion disorder
at least one neuro sx not explained medically - psychologticqal stressor precedes sx - patient calm and unconcerned about sx - not intentionally produced
104
only disorder equally common in men
hypochondriasis
105
tx of pain syndrome
SSRI, biofeedback, hypnosis, psychotherapy
106
factitious disorder
patients want to assume sick role, intentionally produce medical or psychological sx - only primary gain no secondary gain (money etc)
107
malingering
feigning physical or psych sx for personal gain - avoid police, room and board, money, narcotics - more common in men
108
amount of bulimia nervosa patients with comorbid klepto
1/4
109
2 types of anorexia nervosa
restrictive type - OCPD, no binge eating or purging binge-eating/purging - eat in binges with self induced vomiting, using laxatives, excessive exercise, diuretics
110
sx of anorexia
amenorrhea, cold intolerance/hypothermia, hypotension, bardycardia, arrhythmia, ACS, alopecia, edema, dehydration,
111
laboratory abnl of anorexia
hyponatremia, hypochloremic hypokalemic alkalosis, arrythmia, transaminitis, leukopenia, anemia, BUN, increase GH, increase cortisol
112
prevalence of anorexia and treatment
1% tx: outpatient with food unless 20% below or serious medical problems - behavioral therapy
113
refeeding syndrome
malnourished patients refed too quickly, fluid retention and decreased phosphorus, magnesium, calcium sx: respiratory failure, delirium, seizures tx: replace electrolytes and slow feedings
114
2 types of bulimia
purging type - vomiting laxatives enema or diurectics nonpurging type - excessive exercise or fasting
115
time course of bulimia and prevalence
binge eating and compensatory behaviors 2 times a week for 3 months 1-4%
116
laboratory findings in bulimia
hypochloremic hypokalemic alkalosis, metabolic acidosis with laxative, elevated bicarb, hypernatremia, incr BUN, incr amylase
117
tx for bulimia
antidepressants + therapy SSRIs, fluoxetine`
118
most common hypersomnia
breathing-related disorders, sleep anea
119
dyssomnia prevalence and crtieria and tx
5-10% > 1 month to years, reduced quality of life, increase risk of psych tx: sleep hygiene, CBT**, benzo (reduce sleep latency and nocturnal awakening)
120
insomnia antidepressent with depressive sx
trazodone
121
narcolepsy - sx
excessive daytime sleepiness and falling asleep at inappropriate times - at least 3 months - cataplexy - hallucinations
122
hypnagogic hallucination
transitioning to sleep
123
hypnapompic hallucination
transitioning from sleep
124
sleep walking prevalence
1-4%, 10-20% in children and adolescents
125
sleep walking tx
sleep hygiene, behavioral, clonazepam, benzo, TCA
126
sleep terror - sx, prevalence, tx
sudden arousal with screaming from slow wave sleep 1-6% children, 1-2% adults tx: condition is benign and self-limited, low dose benzo in adults
127
tx of nightmare disorder
imagery rehearsal therapy - use mental imagery to modify the outcome of recurrent nightmare, writing down improved outcome
128
tx of REM sleep beahvior disorder
clonazepam, imipramine, carbamazepine, pramipexole, levodopa
129
gonadal hormone that lowers libido/sexual function in men and women
progesterone and serotonin
130
hormone that increases libido
dopamine
131
most common sexual disorders in women
sexual desire disorder and orgasmic disorder
132
most common sexual disorders in men
secondary erectile disorder and premature ejaculation
133
paraphilias time course
unusual sexual urges or fantasies for at least 6 months, cause impairment in daily functioning
134
3 most common paraphilia
pedophilia, voyeurism, exhibitionism
135
tx of paraphilias
aversion therapy, insight oriented psychoterapy, behavior therapy, pharmacologic therapy (antiandrogens)
136
displacement
immature defense | - shifting emotions from undesirable situation to one that is tolerable
137
intellectualization
immature defense | - avoid negative feelings by using reasoning/ focusing on irrelevant details
138
isolation of affect
immature defense | - limiting experience of feelings or emotions to avoid anxiety, unconscious
139
rationlization
immature defense - explanation of event to justify outcomes - ie my boss fired me because she is short tempered and impulsive, not my fault
140
reaction formation
immature defense - doing the opposite of unacceptable impulse - man in love insults woman
141
repression
immature defense | - unconscious, preventing thought or feeling from entering consciousness
142
projection
immature defense - attributing objectionable thoughts or emotions to others - husband attracted to other women believes wife is having an affair
143
splitting
immature defense | - labeling person all good or all bad
144
biofeedback
used to treat migraines, HTN, chronic pain, asthma, incontinence - physiological data is given to patients as they try to mentally control physiological states
145
cognitive behavioral therapy
used for psychiatric illness - depression, anxiety, substance abuse
146
psychoterapy tx of borderline
DBT, decreases self destructive behaviors and hospitalizations
147
malpractice mnemonic
4 D's | - deviation from duty that was the direct cause of damage
148
positive sx of schizo pathway
mesolimbic dopamine pathway (nucleus accumbens, forxnix, amygdala)
149
negative sx of schizo pathway
mesocortical pathway dopamine
150
EPS pathway
dopamine nigrostriatum
151
prolactin pathway
tuberoinfundibular

Psychiatry Shelf (3 decks)

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