start w/ psych Flashcards
(217 cards)
1
Q
what law is that mandates professional reporting of cases of suspected or identified child abuse and neglect?
A
child abuse protection and treatment act, 1974, public law 93-247
2
Q
what is akathisia and what causes it?
A
motor restlessness; not able to sit still
3
Q
what is the pharm treatment for GAD?
A
SSRI first line if that doesnt work then another SSRI before going to second line. Also, use CBT
4
Q
what disorder is characterized by anxiety occuring within 3 months of an identifiable stressor?
A
adjustment disorder
5
Q
a person is afraid to speak in a public forum because they dont want to be judged. what is the diagnosis and treatment?
A
non-generalized circumscribed social anxiety
trx: beta blocker, benzo, cbt
6
Q
what is the treatment for persistent complex bereavement disorder?
A
first line: CBT focusing on loss (thinking about loved one in peaceful manner) and restoration (living life again)
pharmacotherapy not recommended
7
Q
acute, abrupt transient confused state from an identifiable cause?
A
delirium
8
Q
how long do amphetamines last?
A
4-6 hours
9
Q
patient takes dopaminergic and antipsychotic drugs then has muscle rigidity, autonomic instability, altered mental status, and hyperthermia. diagnosis?
A
neuroleptic malignant syndrome
10
Q
what is the treatment for add/adhd?
A
no first line between pharm and therapy.
therapy: CBT
pharm: METHylphenidate (CNS stimulant)
amphetamine + detroamphatmine (psychostimulant)
atomoxetine (norepinephrine reuptake inhibitor) non addictive!! so preferred choice adolescents/adults, 2-4 weeks for effect, only used for >=6 y/o
buproprion (atypical antidepressant) adults only
11
Q
what is the minimum age for PTSD?
A
6y/o
12
Q
what are the cluster B personality disorders?
A
- antisocial personality disorder
- borderline personality disorder
- histrionic personality disorder
- narcissistic personality disorder
13
Q
patient is intenionally falsifying/exaggerating signs and symptoms of medical or psychiatric illness to assume the sick role and get sympathy. The patient has an inner need to be seen as ill or ijured, but not for concrete personal gain (malingering). the difference between this disorder and somatic is that this patient is faking their symptoms. This may include hurting themselves, or willingness to undergo surgery repeatedly or painful tests. what is the diagnosis and treatment?
A
factitious disorder, no great treatment
14
Q
What are the stimulants?
A
amphetamines, cathinones, cocaine
15
Q
what is conversion disorder/functional neurological symptom disorder?
A
one or more sx of of altered voluntary motor or sensory function (loss of limb function, tremor, abn. posturing, fake seisures absent skin sensation, vision, hearing, somatic is worrying about illness that caused it)
MUST consult neuro and educate
(hoover’s sign: the heel should push down on the contralateral side)
16
Q
which type a personality disorder requires 5 symptoms rather than 4?
A
schizotypal
17
Q
what is the treatment for EPS symptoms associated w/ anti-psychotics?
A
diphenhydramine and benztropine (anti-cholinergics), also stop offending drug
18
Q
what is the time frame for post traumatic stress disorder and what is the initial response?
A
initial response includes fear and helplessness
>1 month: acute PTSD
>3 months: chronic PTSD
19
Q
what is the diagnosis of acute stress disorder?
A
experiencing, witnessing, or learning of an event that occured to family member of close friend that included: death, serious injury, or sexual violation w/ 9 symptoms from the categories of INTRUSION, NEGATIVE MOOD, DISSOCIATION, AVOIDANCE, and AROUSAL 3 DAYS TO 1 MONTH after trauma. typically occur right after trauma, but persist for at least 3 days to 1 month.
20
Q
when a patient is unable to restrain impulses that result in verbal or physical aggression, that are unplanned out of proportion to the provocation and cause subjective distress or psychosocial impairment?
A
intermittent explosive disorder
21
Q
patient’s behaviors deviate sharply from the norms, values, and laws of society. They commonly commit criminal acts with disregard for violation of laws. They are at least 18 and may have been diagnosed with conduct disorder as a child. They disregard and violate the rights of others. Drunk driving is common. what is the diagnosis and treatemtn
A
antisocial personality disorder
treatment: psychotherapy establish limits
22
Q
patient has hx or recurrent episodes of panic attacks what is the diagnosis and treatment?
A
panic disorder antidepressant (SSRI) and CBT
23
Q
what is factitious disorder?
A
The patient pretends to be sick because they want to assume the sick role. To confirm this diagnosis and r/o malingering the you must confirm there is no external reward. Poor prognosis
24
Q
what are the dominant symptoms of panic disorder?
A
- sudden onset of palpitations
- chest pain
- choking senstation
- dizziness
- feeling of unreality
- secondary fear of dying, losing control, going mad
25
what is the major difference between PTSD and adjustement disorder?
PTSD is assoicatated w/ re-experiencing and avoidance of the stressful event and increased arousal
26
what meds are used for sleep onset insomnia?
the Z's are non-benzo hypnotics
zaleplon: NO ETOH= RESPIRATORY DEPRESSION
zolpidem: may cause depersonalization
triazolam/lorazepam
ramelteon: melatonin receptor agonist
27
what are sources for someone suffering from domestic violence?
1. family advocacy program
2. local police
3. child protective services
4. women's shelter
5. command
28
pt. describes having marked anxiety when receiving an injection so they havent been to the doctor in years. What treatment would you give them?
CBT (exposure therapy)
specific phobia
29
motor ticks including blinking and shrugging + verbal or phonetic tics (grunts, throat clearing) MC beginning in boys 2-5. what is the diagnosis and treatment?
1. habit reversal therapy
2. dopamine blocking agents
3. alpha adrenergics
30
what is the treatement for conduct disorder?
psychotherapy
31
what is the diagnostic criteria for **inhalant intoxication?**
**two** or more of the following
1. dizziness
2. nystagmus
3. incoordination
4. slurred speech
5. unsteady gait
6. lethargy
**7. depressed reflexes**
8. psychomotor retardation
9. tremor
10. generalized weakness
11. blurred vision or diplopia
12. stupor or coma
13. euphoria
32
what is the diagnostic criteria for ADHD?
present in 2 areas
present for \<12 y/o
sx \> 6 months
maladaptive/inappropirate for child's developmental stage
33
erroneous beliefs that typically cause misinterpretation in perceptions and experiences
delusions
34
patient is dependent and submissive. They constantly need to be reassured, and relies on others for decision making and emotional support. patient refuses to initiate things and has intense discomfort when alone. What is the diagnosis and treatment?
Psychotherapy: behavioral and group
pharm: anxiolytics and antidepressants
35
patient experiences traumatic event \>1 month and has persistent re-experiencing of the event. They have increased arousal (insomnia, irritable, dec. concentration, exaggerated startle response). They attempt to avoid the stimuli. what is the diagnosis?
PTSD
36
what are the 3 essential features of anorexia nervosa?
1. persistent energy intake restriction
2. intense fear of getting fat, or persistent behavior that interferes w/ weight gain
3. disturbed interpretation of appearance (weight for shape)
at least 1 per week for 3 months
37
what is the treatment for cannabis intoxication?
supportive
pharm for psychomotor agitation: anti-seizure meds, benzo, anti-psychotics
38
how quickly can alcohol withdrawal symptoms begin?
6-12 hours
39
how do manage suicidal ideation, but no viable plan?
may need aggressive treatment, but potentially not inpatient treatment. STAT psych consult provider to provider, take away firearms
40
treatment for conduct disorder?
**mutisystemic treatment** that focuses on correcting the bheavior within the individual or the individuals family, instead of within society
41
what is the criteria for gambling disorder?
**4** or more for in **12 month** period
1. gamble increasing amt. of money
2. irritable when cutting down gambling
3. repreated unsuccessful efforts to stop
4. preoccupied w/ gambling
5. gambles when distressed
6. trys to get even
7. lies to conceal gambling
8. jeopardizes friendship
9. relies on others to provide money
42
what is the diagnostic criteria for sedative, hypnotic, or anxiolytic intoxication?
**one or more** of the following:
1. slurred speech
2. incoordination
3. unsteady gait
4. nystagmus
5. impairment in cognitition
6. stupor or coma
43
who do you refer someone to that has hypersomolence disorder?
sleep medicine for polysonography and multiple sleep latency test immediately after
44
what are the cluster C disorders?
1. avoidant personality disorder
2. dependent personality disorder
3. obsessive personality disorder
45
how much calcium and vit D should be added to a female athletes diet?
1200-1500 mg Ca and 400 IU of Vit D
46
patient is afraid of meeting new people and social situations. what is the diagnosis and treatment?
generalized social anxiety disorder
trx: SSRI, SNRI, CBT
47
what is the typical age for onset of autism?
before 3
48
how can you distinguish conduct disorder from oppositional defiant disorder?
conduct disorder has the prescence of physical aggresion and other severe forms of antisocial behavior.
conduct disorder categories \>3 in the past 12 months with at least one in the last 6 months
(1) Physical aggression to people and animals including bullying, fighting, weapon carrying, cruelty to animals, and sexual aggression; (2) Destruction of property, including fire setting and breaking and entering; (3) Deceitfulness and theft; and (4) Serious rule violations, including running away from home, staying out late at night without permission, and truancy
49
what is used to treat depression for bipolar?
electroconvulsive therapy
or
fluoxetine and olanzapine
50
who do you report elder abuse to?
adult protective services, and potentially law enforcement
51
what is used to treat sleep maintenance insomnia?
zolpidem extended release
eszopiclone (lunesta)
temazepam/estazolam
low dose doxepin
52
what is a contract for safety?
document where patient vows not to harm themselves or others, and to get help if they have suicidal thoughts
53
what is the diagnostic criteria for panic disorder?
**recurrent UNEXPECTED panic attacks**. at least one has been **folllowed by a month** or more of one of the following:
1. **persistent worry about additional panic attacks**
2. significant **maladaptive change** in behavior related to the attacks
54
what is the female athlete triad?
low bone mineral density, low energy availability, menstrual dysfunction
55
diagnosis of sleep apnea?
polysomnography w/ at least 5 apnea or hypopnea per hr and either
1. nocturnal sleep distubance: snore, apnea
2. daytime sleepiness, fatigue, unrefreshing sleep
if \>15 apnea or hypopnea don't need to be tired or snore
56
what are the only two medications that are approved for autism spectrum disorder?
risperidone
aripiprazole
57
what is the diagnostic criteria for caffeine intoxication?
**five** or more of the following signs
1. restlesness
2. nervousness
3. excitement
4. insomnia
5. flushed face
6. diuresis
7. GI disturbance
8. Muscle twitching
9. Rambling flow of thought and speech
10. Tachycardia or cardiac arrhythmia
11. periods of inexhaustibility
12. psychomotor agitation
58
what is the difference between manic and hypomanic?
7 days for manic, 4 days for hypomanic, and with
59
what does DIGFAST stand for?
distractability
impulsivity
grandiosity
flight of ideas
activities (psychomotor agitation)
sleep decreased
talkative (pressured speech)
60
excessive and persistent worrying that occurs more days than not for **6 months or more.**
generalized anxiety disorder treat w/ pharm and psych
61
patient has **neurologic dysfunction** suggestive of a **physical disorder** that **cannot be explained clinically**. The symptoms are **NOT intentionally** produced or feigned. The patient has depression/anxiety/schizophrenia/personality disorder too. The patient has paralysis/mustism, gait abnormalities, involunatry mvmts, tics, blindness, anesthesia, deafness. What is the diagnosis and treatment?
conversion disorder/ function neurologic symptom disorder
trx: education and psychotherapy
62
what is the treatment for hypersomnolence?
pharm only no therapy
modafinil (provigil): DOC
armodafinil
methylphenidate (ritalin)
63
what is a treatment for stimulant dependence?
modafinil
64
what is the diagnostic criteria for opioid withdrawal?
**three or more** of the following within minutes to days:
1. dysphoric mood
2. n/v
3. muscle aches
4. rhinorrhea
5. **pupillary dilation/piloerection**/sweating
6. diarrhea
7. yawning
8. fever
9. insomnia
65
what is the diagnostic criteria for stimulant intoxication?
**two or more** of the following
1. Tachycardia or bradycardia
2. pupillary dilation
3. elevated or lowered BP
4. persperation or chills
5. N/V
6. weight loss
7. psychomotor agitation or retardation
8. muscle weakness, chest pain, respiratory depression
9. confusion seizures, dyskinesia(involuntary muscle mvmts), dystonias (involuntary muscle contractions)
66
what are the risk factors for suicide?
sad persons
sex (male)
age (teen/elderly)
depression
previous attempt
ETOH/drugs
Rational thinking loss
Sick person
Organized plan
no social support
stated future attempt
67
what is the diagnostic criteria for MDD?
**five or more** of the following for **\> 2 weeks** and resulting in altered functioning. **at least one must be depressed mood or anhedonia** (lack of pleasure)**.**
1. depressed mood
2. anhedonia
SIGECAPS
68
piloerection/excessive lacrimation/mydriasis/yawning is associated with what withdrawal?
opioid
69
what is the first line therapy for acute stress disorder?
CBT
second line: Benzodiazepines 2 weeks max (any longer and increases risk of PTSD)
70
patient cant apologize, grandiose opions of self, exploits others to fulfill own needs, and lacks empathy. personality?
narcissistic
71
what is sustained remission in alcohol use disorder?
12 months or longer
72
patient has depressive symptoms for most days for **at least 2 years**. what is the diagnosis?
persistent depressive disorder
73
what is schizophreniform disorder?
meets criteria for schizophrenia, but \<6 months
74
what is impaired joint attention is ASD?
The child shows reduced spontaneous seeking to share enjoyment about object. Looking back and forth age 8-10 months. pointing 14-16 months.
75
patient has a pattern of distrust and suspiciousness of others. The patient miseterprets others actions as malevolent and has a preoccupation with doubt regarding the loyalty of others. What is the diagnosis and treatment?
paranoid personality disorder: psychotherapy is treatment of choice (CBT/maybe group?)
76
what is cataplexy and what is it assocated with?
narcolepsy
it is defined as the sudden, muscle weakness/paralysis usually brought on by a strong emotion (laughter, excitement). The patient is aware this is happening, but can't move. It lasts for 1-2 min then they fall asleep
77
what is the treatment ment for oppositional defiant disorder?
therapy
specificaly:
1. parent mangement training programs/ family therapy
2. social skills program
3. cognitive problem solving skills training
78
patient breaks laws, no remorse or guilt, appears friendly on surface. most likely personality disorder?
antisocial
79
what are the requirements for insomnia?
difficulty falling asleep, staying asleep, or waking up with difficulty falling back asleep for at least:
3 x per week
3 months
80
patient is a perfectionist that requires a great delal of order and control. They have rigid adherence to routine (rules, lists, lacks spontaniety). Any change in this leads to extreme anxiety. They are preoccupied with minute details and have difficulty completing tasks, delegating work. What is the diagnosis and treatment?
psychotherapy: CBT (first line)
pharm: beta blockers for anxiety and SSRIs for depression
81
what antidepressant is CI in eating disorder?
buproprion
82
what is the criteria for oppositional defiant disorder and treatment?
angry/irritable mood, argumentative/defiant behavior, or vindictiveness more than **6 months** and at least 4 symptoms
angry/irritable
1. loses temper
2. touchy or easily annoyed
3. angry and resentful
argumentative/defiant
1. argues w/ authority figures
2. defies or refuses to comply w/ authroity figurels
3. deliberatley annoys others
4. blames others for mistakes and behaviors
vindictiveness:
1. spiteful twice in last 6 months
83
what is the treatment for opioid intoxication?
naloxone
84
what are the diagnostic signs of caffeine withdrawal?
followed within 24 hrs by **three or more** of the following signs or symptoms:
1. HA
2. marked fatigue or drowsiness
3. dysphoric mood, depressed mood, or irritability
4. flu-like symptoms (N, V, or muscle pain/stiffness)
85
what is the time frame for PTSD symptoms?
1 month
86
what is the diagnostic criteria for seative, hypnotic, or anxiolytic withdrawal?
**two or more** developing within several hours to a few days:
1. autonomic hyperactivity (sweating/ pulse \>100)
2. hand tremor
3. insomnia
4. N/V
5. **Transient visual, tactile, or auditory hallucinations or illusions**
6. psychomotor agitation
7. anxiety
**8. grand mal seizures**
87
what is the name of the phase that acute grief phase typically transitions to w/in several months?
integration phase: patient has hallmarks of healing (return to work, re-expierence pleasure, seek companionship)
88
a person w/o a body image problem reports a lack of interest in eating that's significant enough that the patient says they have decreased energy and significant weight loss. What is the diagnosis and what is the diagnostic criteria?
avoidant/restrictive food intake disorder
- patient doesnt eat because of sensory characteristics w/ eating food, lack of interest, aversive consequences of eating. These are manifested by insufficient nutritional intake and decreased energy w/ 1 of the following:
1. significant weight loss
2. reliance of enteral feeding
3. nutritional deficiency
4. interference w/ psychosocial functioning
89
what meds should you not use for GAD?
buspirone or buproprion
90
what are the cluster A disorders?
1. paranoid personality disorder
2. schizoid personality disorder
3. schizotypal personality disorder
91
patient presents with hypoventilation, respiratory distress, CNS depression, prolonged QTc, and miosis? what is the treatment
IV naloxone, opioid overdose
92
what are the treatments for insomnia?
sleep hygiene, CBT-I, stimulus control therapy (no longer than 20 min in bed w/o sleeping), sleep restricition (only in bed while sleeping)
93
what is the only clinical feature that is always present in delirium tremens and how quickly will it begin?
delirium is always present, but can have extreme autonomic hyperactivity, fever, severe tachycardia, HTN, agitation, drenching sweats, hallucinations, and disorientation occuring 72- 96 hrs after last drink. CAN BE FATAL
94
what is the other name for conversion disorder?
functional neurological symptom disorder
95
patient has magical thinking, metaphoric speech and is aloof and isolated, what is the diagnosis?
schizotypal
96
what is considered early remission for alcohol use disorder?
3 months, but less than 12 months
97
what is the time period for persistent complex bereavement disorder?
12 months
98
what are the diagnostic criteria for intermittent explosive disorder?
1. verbal or physical aggression **twice a week** for **3 months** that doesnt result in damage
2. **3** outbursts that result in destruction or injury in a **12 month** period
at least 6 years old
out of proportion to the provovation and arent premeditated
99
what is the criteria for delusional disorder?
**one** or more delusion for **one month** or longer**. no hallucinations** and **NOT FUNCTIONALLY IMPAIRED**
TREATMENT:
first line: antipsychotic medication
second line: psychotherapy
100
if someone has anxiety about getting sick for at least 6 months that includes either routinely checking themselves for signs of illness or not exhibiting maladaptive avoidance for healthcare, but do not have somatic symptoms, what is their diagnosis and treatment?
illness anxiety disorder
therapy and pharm w/ majority of focus on therapy
SSRI-first line then SNRI and atypical antidepressant
therapy tailored to patient
101
what is the difference between generalized and non-generalized/circumscribed SOCIAL anxiety disorder?
generalized: fears occur in multiple situations, but are specifically **social interaction** situations
Non-generalized/circumscribed: social performance situations
102
what is the diagnostic criteria for BINGE EATING DISORDER?
both of the following:
1. eating more in a set amount of time than most people would
2. sense of lack of control
3 of the following
1. more rapid eating
2. eating until uncomfortable
3. eating when not hungry
4. eat alone because embarrased
5. feeling disgusted
the eating causes distress/shamed
one a week for 3 months
no inappropriate compensatory behavior
this typically runs in families so it is genetic
103
what is the diagnostic criteria for GAD?
excessive anxiety or worry on more days than not for 6 months with 3 or more of the following 6
1. restless/keyed up
2. easily fatigued
3. difficulty concentrating
4. irritable
5. muscle tension
6. sleep disturbance
104
patient has a preoccupation with having or acquiring a serious illness despite medical workups showing no disease. There is not somatic symptoms present, and if they are they are only mild. The patient is repeatedly checking themselves for illness, but they may avoid the DR. because they are scared of what they might find out. What is the diagnosis and treatment?
illness anxiety disorder
regular scheduled appointements for reassurance
105
patient is a perfectionist, preoccupied with details, rules, and schedules?
obsessive compulsive
106
what are the diagnostic criteria for use disorders?
use causes impairment or distress, as manifested by at least **2** of the following, occuring within a **12 month** period.
1. taken in larger amounts than supposed to
2. persistent desire to cutdown
3. spending a lot of time to obtain the drugs
4. craving, or strong desire to use
5. recurrent use is messing up work
6. continue using despite social problems
7. giving up other activities to use
8. using in situations where it is hazardous
9. continue using despite knowing physical or psychological problems
10. tolerance
11. withdrawal
107
what are typically the first drugs used by children and adolescents bcause they are cheap, accessible, and legal to possess?
inhalants
108
what is the main difference between bulimia and anorexia?
bulimia patients have a normal BMI, but anorexia patients are less than normal BMI
109
what must you do to diagnose add/adhd?
formal screening via psychologist or reviewing an appropriate screening tool (connor's)
110
**progressive**, chronic intellectual deterioration of selective fucntions. MEMORY LOSS and loss of impulse control, motor and cognitive functions.
dementia
111
what are the meds used for smoking cessation?
buproprion (less sex side effects/inc. seizure), varencicline
112
pt has fear or anxiety lasting for 6 months or more of situations where help may not be available or it may be difficult to leave the situation in the event of a panic attack. The patient has fear of at least 2 of the following: public transportation, open space, enclosed space, standing in line/a crowd, being outside of the home alone. what is the diagnosis and treatment?
agoraphobia/ CBT
113
what is used to treat LATE/TERMINAL insomnia and what is important about their use?
zaleplon
zolpidem sublingual
require at least 4 hours of time in bed remaining after their administration
114
when does grief become complicated?
persistent, disruptive emotinoal responses for at least 6 months after the death of a loved one. refer this person to a psychiatrist
115
116
patient feigns illness in order to obtain attention, sympathy or to play the sick role rather for external rewards. May have objective physical findings as a result of self harm, and a willingness to undergo procedures. Diagnosis?
factitious disorder
117
what are the diagnostic criteria for cannabis intoxication?
**two** or more of the following signs or symptoms **within 2 hrs** of cannibis use
1. conjunctival injection
2. increased appetite
3. dry mouth
4. tachycardia
118
patient is impulsive, conveys false emotions, dramatic, inappropriate sexual behavior, and desires to be the center of attention. what is ther personality disorder?
histrionic
119
what are intrusion symptoms that are associated w/ acute stress disorder?
recurrent
1. memories
2. dreams
120
what is schizoaffective disorder?
schizophrenia + mood disturbance (MDE or Manic episode)
121
what is used for cocaine dependence?
bromocriptine
122
what is the treatment for hallucinogen intoxication?
benzodiazepines, antipsychotics, antiseizure meds
123
what are the three phases of treatment for bipolar?
acute: inpatient
continuation: mood stabilizers (valproate, lithium, carbamazapine)
maintenance: reg f/u last months to years
124
what is the diagnostic criteria for PICA?
someone \>2y/o **eating nonnutritive food** for **\>1 month**.
amplifying info: usually comes to everyones attention when there is some sort of general medical complication. It can occur in normally developing children, but typically in adults it coincides with intellectual disability or mental disorder.
125
what is the treatment for bipolar?
mood stabilizers:
1. lithium
2. valproic acid
3. carbamazepine
126
patients mood is emotional, dramatic, and seductive. They are attention seeking, and need to be the center of attention. They are self absorbed and have temper tantrums. The patients tend to be suggestible (easily influcenced by others) and often are inappropriate, sexually provocative, and seductive. what is the diagnosis and treatment?
psychotherapy: treatment of choice (CBT, individual, or group therapy)
127
what are red flags for autism spectrum disorder?
1. deficits in social skills
2. delayed talking
3. frequent tantrums/ intolerance to change
4. no babbling by 9 months
5. no pointing by 12 months
6. no orientation to name by 12 month
7. no single words by 16 months
8. lack of pretend/symbolic play by 18 months
9. no spontaneous, meaningful two-word phrases by 24 months
10. loss of language or social skills at any age
128
what are the most important complications of panic disorder?
SI and suicide attempts
129
what is the diagnostic criteria for **stimulant withdrawal?**
**dysphoric mood and two** of the following:
1. fatigue
2. vivid, unpleasant dreams
3. insomnia or hypersomnia
4. increased appetite
5. psychomotor retardation or agitation
130
what is the treatment for **inhalant intoxication**?
1. respiratory depression
2. ventricular arrhythmias
3. hypokalemia
4. hospitalization
131
what are the diagnostic criteria for ASD?
persistent deficits in social interaction and communication:
1. social-emotional reciprocity, reduced sharing of interests, failure of normal back and forth
2. abnormalities in eye contact and nonverbal communication, lack of facial expression or understanding/using gestures
3. deficits in developing and maintaining relationships
repetitive patterns of behavior, interests or activities w/ 2 of the following
1. repeptivive mvmts or speech
2. insistence on sameness
3. highly restricted, fixated interests
4. hyper/hypo reactivity to sensory input
all these symptoms must be present in early developmental period
132
what is the treatment for alcohol intoxication?
mild: observation
mod: fluid rehydration
severe: thiamine bolus/montior respiratory depession
133
patient has grandiose sense of self importance, but need praise and admiration. Patient has an inflated self image and considers themselves special, but really they have a low self esteem. what is the diagnosis and treatment?
narcissitic personality disorder
psychotherapy TOC, individual or group
134
what are risk factors for suicide?
1. hx or previous attempt or threat (#1!!!)
2. psychiatric illness
3. never married/living alone
4. increasing age (males \>85)
5. military service
6. poor health
7. fam hx
135
patient has excessive or unreasonable degree of fear triggered either by exposure to or anticipation of a specific object or circumstance
136
what patient population is buproprion CI in?
seizures, eating disorders
137
patient desires relationships, but avoids them because of an inferiority complex. They have intense feelings of inadequacy, fear of rejection, and humiliation. What is the diagnosis and treatment?
avoidant personality disorder
treatemtn: CBT,
pharm: beta blockers or SSRIs
138
what is the treatment for intermittent explosive disorder?
pharm and therapy
therapy: cognitive restructuring, relaxation training, coping skils, relapse prevention
pharm: **first line: fluoxetine**
139
what is the treatment for tobacco use disorder?
psychotherapy: CBT
pharm: Bupropion, Varenicline
140
what drug class can cause synesthesia (blending of senses), hearing colors or seeing sounds
hallucinogens
141
what is the definition of hypersomnolence?
self reported excessive sleepiness despite 7 hours of sleep and one of the following
1. difficulty being fully awake after an abrupt awakening
2. being sleep despite 9 hours of block sleep
3. recurrent lapses of sleep in the same day
3 X WEEK FOR 3 MONTHS
142
patient has few friends, is a loner, and indifferent to praise and critisicm. what is most likely personality disorder?
schizoid
143
what can clozapine cause?
agranulocytosis, myocarditis, PE, and insulin resistance, elderly with dementia related psychosis, and seizures
so monitor WBCs and neutrophils
144
In the acute phase of grief, immediately following death what are some of the feelings the bereaved individual may express?
numbness, shock, and denial
145
what is a treatment for opioid dependence?
buprenorphrine/naloxone
146
what is the diagnostic criteria for **other hallucinogen intoxication?**
**two** or more of the following signs developing during or shortly after hallucinogen use:
1. **pupillary dilation**
2. tachycardia
3. sweating
4. palpitations
5. **blurring of vision**
6. tremors
7. incoordination
147
patient socially withdrawn, and awkward and uncomfortable in social situations. personality?
avoidant
148
what is the diagnostic criteria for cannabis withdrawal and treatment?
**three or more** sx **w/in 1 wk**
1. irritable
2. nervousness
3. sleep difficulty
4. decreased appetite or weight loss
5. restlessness
6. depressed mood
7. at least one of the following physical symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache
149
what are the indications for inpatient management for anorexia?
\<75% of expected birth weight, rapid weight loss, electrolyte imbalance, and cardiac disturbances
150
what is the treatment for depression in a seasonal pattern?
phototherapy (TOC) and buproprion
151
lithium causes what in 65% of patients?
tremor
152
patient is **less than** **18** with vocal and motor tics (PE shows: facial grimacing, shoulder shrugging, eyeblinking, or head jerking). persistence for **\>1 year.** what is the diagnosis and treatment?
trourette syndrome.
trx: dopamine agonists or antagonists, botulinum toxin, pimozide
coprolalia: bad words
153
what are the specifications for insomnia?
episodic: at least 1 month, but \<3 months
persistent: longer than 3 months
recurrent: 2 w/in a year
154
what is the time period for bulimia?
one episode per week for 3 months
155
patient is voluntarily socially withdrawn and anhedonic introversion. The patient has hermit like behavior and has **flattened affect in interpersonal settings.** The patient is anhedonic meaning they appear indifferent to others. The patient prefers to be alone and has little enjoyment in close relationships. What is the diagnosis and treatment?
schizoid personality disorder
psychotherapy: individual or group is FIRST LINE TREATMENT
156
patient has uncontrolled worry and anxiety for how long to have generalized anxiety disorder?
6 monts
157
how might a person reexperience a traumatic event following PTSD?
1. intrusive thoughts/perceptions/images
2. distressing dreams
3. acting or feeling that the event was recurring
4. intense psychological distress at symboic cues
5. physiologic reactivity upon exposure to those cues
158
what is the diagnostic criteria for **hallucinogen persisiting perception disorder**?
after cessation of hallucinations, the re-experiencing of **one or more** of the perceptual symptoms
1. geometric hallucinations
2. false perceptions of mvmt in ther peripheral visual fields
3. flashes of color
4. intensified colors
5. trails of images of moving objects
6. positive after images
8. halos around objects
9. macropsia (seeing things larger), micropsia (seeing things smaller
159
what sort of injuries on a 0-6 month old should be a sign of abuse?
any
160
what is the diagnostic criteria for phencyclidine intoxication (PCP)?
within **1 hr, 2** or more of the following signs
1. vertical or horizontal nystagmus
2. HTN or tachycardia
3. numbness or diminished responsiveness to pain
4. ataxia
5. dyarthria
6. muscle rigidity
7. seizures or coma
8. hyperacusis
161
what are protective risk factors against suicide?
1. social/family support
2. pregnancy
3. parenthood
4. religious
162
what is the first line therapy for PTSD?
SSRI
163
what is brief psychotic disorder?
\>=1 psychotic symptom that resolves in \<1 month
164
patient is self destructive, impulsieve, erratic emotions, sexual, extremely intense, always in a crisis. most likely personality disorder?
borderline
165
what are the two types of anorexia nervosa?
restricting type
binge-eating/purging type
BOTH DURING THE LAST 3 MONTHS
166
what is the time frame for phobia and treatment?
\>6 months, CBT specficially systematic desensitization
167
what is the criteria for attention deficit disorder? (inattention)
**6 symptoms** or more for at least **6 months** that are inconsisitent w/ developemtnal level and negatively impacts life (if **\>17** then only **5** **symptoms**) **some symptoms must be present prior to age 12, at least 2 settings**
1. doesnt give close attention and makes careless mistakes w/ school work/work
2. difficulty maintaining attention in tasks
3. doesnt listen when spoken to
4. doesnt follow instructions and fails to finish work
5. difficulty organizing tasks
6. dislikes tasks that require sustained mental effort
7. loses things
8. easily distracted
9. forgetful
168
what is the diagnostic time length for persistent complex bereavement disorder?
one of the following for **AT LEAST 12 MONTHS** after death
1. persistent yearning/longing
2. intense sorrow
3. preoccupation w/ the deceased
4. preoccupation with the circumstances of the death
and **6** of the following
1. difficulty accepting death
2. disbelief
3. difficulty with prositive remininscing
4. bitterness
5. self blame
6. avoidance
7. desire to die
8. difficulty trusting others
9. loneliness
169
patient is odd, eccentric with peculiar thought patterns, it's almost like schizophrenia, but doesnt have psychosis. The patient has inapproprate affect, and odd appearance, and magical thinking (clairvoyace, telepathy). The pateint also has pervasive discomfort with close relationships, and may talk to self in public. What is the dianosis and treatment?
schizotypal personality disorder
psychotherapy TOC
170
abruptly stopping what can induce mania?
antidepressants
171
all the substances have the same use criteria except for?
hallucinogens and inhalants
172
how many rexperiencing events, avoidance/numbing events, or hyperarousal events must a person have to be diagnosed w/ PTSD?
1 rexperiencing
3 avoidance or numbing
2 hyperarousal
173
how long does cocaine last?
rarely longer than 2 hours
174
what are the two kinds of hallucinations associated w/ narcolepsy and when do they occur?
hypnagogic (falling asleep)
hypnopompic (waking up)
175
what are the 3 essentials for bulimia nervosa?
1. recurrent episodes of binge eating
2. recurrent inappropriate compensatory behaviors to prevent weight gain
3. self evaluation that is unduly influenced by body shape and weight
must describe "LACK OF SELF CONTROL" with excessive food consumption (dissociative)
individuals are in the normal weight or overweight range. BMI \>=18.5
more common white females
increases suicide risk
at least 1 per week for 3 months
176
what other disorders and commonly seen in people with bulimia nervosa?
bipolar, depressive, substance use (stimulants & alcohol), personality (MC borderline)
177
what is the treatment for alcohol withdrawal?
first line: Benzodiazepines
second line: anticonvulsants (carbamazepine, phenytoin)
178
what is the diagnostic criteria for **opioid intoxication**?
**pupillary constriction** AND **one** or more of the following:
1. drowsiness or coma
2. slurred speech
3. impairment in attention or memory
179
what is the only SSRI that is approved for bulimia?
fluoxetine
180
How long will symptoms of caffeine withdrawal typically last?
2-9 days w/ the possibilty of withdrawal HA occuring up to 21 days later
181
patient has unstable, unpredictable mood and affect with unstable self image and relationships. This is MC in women. The patient can't tolerte being alone and will go to extremes to stop abandonment. The patient is impulsive with self damaging behaviors like suicide, self mutilation, substance abuse, and spending. What is the diagnosis and treatment?
borderline personality disorder
psychotherapy: dialectical behavior therapy
182
what is the difference between bipolar I and II?
you need a manic episode for bipolar I (+/- on MDE or HME), this also needs to result in a hospitalization or cause marked impairment, or have psychotic features
you need major depressive episode + hypomanic episode for bipolar II (NO ME) no psychotic features or hospitalization
183
what are the hallucinogens?
PCP, LSD, dextromethorphan, synthetic cannabinoids, ecstacy, psilocybin, salvia, mescalamine (peyote)
184
what is the presentation for serotonin syndrome?
hyperthermia, htn, hallucinations, dizziness, ataxia, tremors, sweating, diarrhea, and dilated pupils, hypereflexia, and myoclonus
185
using cannabis, what effect can last 12-24 hours much longer than the euphoria that may only last 4-12 hours
psychomotor impairment
186
what are the treatment options for PTSD?
first line: SSRI, SNRI
second line: TCA, MAOI, mirtazipine, atypical antipsychotics, prazosin (sleep/nightmares)
therapy: trauma focused (cognitive restructuring, stress inoculation training), imagery rehearsal therapy, psychodynamic, hypnosis, group therapy
187
what are the common features of substance use disorders?
1. impaired control
2. social impairments
3. risky use of the substance
4. pharmacological
a) tolerance
b) withdrawal
188
what is the most effective treatment for agoraphobia?
CBT
189
how long does LSD last?
6-12 hours
190
what are the signs of alcohol withdrawal?
two or more of the following
1. autonomic hyperactivity
2. increased hand tremor
3. insomnia
4. N/V
5. transient visual, tactile, auditory hallucinations
6. psychomotor agitation
7. anxiety
8. generalized tonic and/or clonic seizures
191
patient presents w/ various pains from different organ systems before the age of 30. patient must have has excessive thoughts about the pain and it has lasted beyond 6 months. What is the diagnosis and management?
somatization symptom disorder
SSRI, regular f/u with PCM
192
what meds are commonly used for post partum depression?
SSRIs
193
what is the diagnostic criteria for narcolepsy?
recurrent IRREPRESSIBLE need to sleep, falling asleep, or napping occurring w/in the same day AT LEAST 3 X WEEK FOR 3 MONTHS.
1. cataplexy (muscle weakness/paralysis following emotions OR grimaces/jaw-opening episodes w/ tongue thrust/ global hypotonia w/ no emotions)
2. hypocretin/ orexin deficiency in CNS
3. polysomnography w/ REM \<=15 min or multiple sleep latency test w/ mean sleep latency \<= 8 min and \>=2 sleep-onset REM periods
194
how do you manage suicidal ideation?
reduce immediate risk
manage underlying factors
monitor and follow up
195
what is the diagnosis for atention deficit/hyperactivity disorder? (hyperactivity and impulsivity)
**6 symptoms** or more that are inconsistent w/ developmental level for **at least 6 months (\>17** then only **5 symptoms**) **symptoms must be present prior to age 12, at least 2 settings**
1. fidgets/taps hands/squirms
2. leaves seat when supposed to be sitting
3. runs or climbs when inappropriate
4. unable to play or engage in leisure activity
5. "on the go" "driven by a motor" (uncomfortable being still for extended period of time)
6. talks excessivley
7. blurts out an answer
8. difficulty waiting his or her turn
9. interrupts or intrudes on others
196
what are mild, moderate, and severe sleep apnea?
\<15 mild
15-30 mod
\>30 severe
197
what is required to make a new diagnosis of schizophrenia?
at least 6 months w/ functional decline w/:
at least 2 of the following with one of them being
1. hallucination
2. delusions
3. disorganized thought
198
what is the treatment for a possible suicide attempt?
emergent psych evaluation
199
what is the treatment for Restless leg syndrome?
iron replacement
pramipexole (mirapex)
ropinirole (requip)
rotigotine transdermal patch
gabapentin
benzodiazepine
200
patient lacks self confidence. personality
dependent
201
what is a treatment for alcohol dependence?
disulfram
202
how are use disorders written?
code, severity, substance, specifiers
203
what is the most effective treatment for GAD?
combination therapy, SSRI and CBT
204
pt. has taken serotonin agonists. rapidly has agitation, tachycardia, mydriasis, shivering, diaphoresis, clonus, hyperreflexia, and tremor. What is the treatment diagnosis and treatment?
serotonin syndrome
treatment: Benzo, hydration/cooling, cyproheptadine
205
patient is suspicious, cold, and humorless. what is the personality disorder?
paranoid
206
when to admit for anorexia?
weight loss \>25%
bradycardia, hypothermia
hypokalemia, dehydration, dysrhythmias
risk of suicide
outpatient trx fails
207
what is the criteria for conduct disorder?
repetitive pattern of behavior in which the basic rights of others or major age-appropriate norms are violated, at least **3** of the following for **12 months**
**agression to people or animals**
1. bullies
2. initiates fights
3. used a weapon
4. physcially cruel to humans and animals
5. stolen
6. forced sexual activity
**destruction of property**
1. setting fires to cause damage
2. destroyed property on purpose
**deceitfulness and theft**
1. broken into someone's house/car
2. con's people
3. shoplifting/forgery
**serious violations of rules**
1. stays out at night against parents wishes before 13
2. ran away at least twice
3. truant from school before 13
**if greater than 15 consider antisocial**
specify childhood or adolescent onset: before 10 or at 10 and later
208
what is under appearance in the AMSIT?
appearance
LOC
posture and motor behavior
grooming
facial expression
speech and language
209
what is under the M in AMSIT?
mood, affect
210
what is under sensorium in AMSIT?
speech and thought
orientation
attention(digit span, serial 7s, spelling backward)
remote memory, recent memory
211
what is under intelligence for AMSIT?
intellingence: proverb
asking questions, calculating
212
what is under thought process for AMSIT?
insight and judgement
logic, relevance, organization, coherence of thoughts
thought content
perceptions: halluncinations, illusions (linear logical goal oriented?)
213
what is the treatment for Atypical depression?
MAO inhibitors: phenelzine, tranylcypromine, isocarboxazid, selegiline
214
what is a dangerous outcome of MAOI inhibtors?
hypertensive crisis
215
what is the criteria for major depressive disorder?
depressed mood or anehodonia w/ \>=5 of the following for 2 weeks.
1. fatigue
2. insomnia/hypersomnia
3. feelings of guilt or worthlessness
4. recurring thoughts of death or suicide
5. psychomotor agitation
6. weight change
7. appetite change
8. decreased concentration
SSRI/ CBT/ ECT
216
recurrent hypomania, but diagnosis of MDE is not established. What is the diagnosis and what is the treatment?
cyclothymic
mood stabilizers
217
