U-World: Block 9 (Psych) Flashcards

Question

Asking a patient to draw a clock oriented to a specific time tests for what?

Answer 1

Executive function

Answer 2

Assesses attention and concentration/ intellect

Answer 3

Schizophrenia

Answer 4

Medication side effect. Risperidone is an anti-psychotic used to treat Schizophrenia. It inhibits D2 dopamine receptors—> increased prolactin (bc dopamine normally inhibits prolactin, but you are putting the brake on dopamine so that it cannot in turn put the brake on prolactin)—> excess prolactin inhibits GnRH—> amenorrhea

Answer 5

“Weird (cluster A), Wild (cluster B), and Worried (cluster C)”

Answer 6

Episodes lasting 2 or more weeks with at least 5 of the 9 “SIG E CAPS” depression symptoms. (SIG E CAPS= 1. depressed mood, 2. Sleep disturbance, 3. loss of Interest, 4. Guilt of feelings of worthlessness, 5. Energy loss and fatigue, 6. Concentration problems, 7. Appetite and weight changes, 8. Psychomotor retardation or agitation (inc or dec motor activity), 9. Suicidal ideation)

Answer 7

1. depressed mood 2. Sleep disturbance 3. loss of Interest 4. Guilt of feelings of worthlessness 5. Energy loss and fatigue 6. Concentration problems 7. Appetite and weight changes 8. Psychomotor retardation or agitation (inc or dec motor activity) 9. Suicidal ideation)

Answer 8

Hypothyroidism (check those TSH levels)

Answer 9

Patient has emotional symptoms (anxiety, depression) after (within 3 mo) something happens that triggers it (a stressor like they got a divorce, got diagnosed with an illness, got a new job). (If symptoms last 6 months or more, however, we call it GAD or generalized anxiety disorder). Note that it is a diagnosis of exclusion. In other words, if the patient is depressed after getting a new job and meets the criteria for MDD (major depressive disorder), they have MDD NOT adjustment disorder! If they don’t meet the criteria for anything (less severe depression/ anxiety following a life event) we can then call it adjustment disorder.

Answer 10

Persistent depressive disorder (dysthymia) | Remember, it’s called persistent if it goes on for more than 2 years

Answer 11

Milder depression (sometimes only 2 depressed symptoms) lasting MORE THAN 2 YEARS (no more than 2 months w/o depressive symptoms).

Answer 12

OCD (obsessive compulsive disorder) (Note these people do rituals/ routines that are unproductive but they feel like they have to or something bad will happen)

Answer 13

Making sure firearms are not available to the patient (patients are far more likely to COMPLETE suicide if a gun is available in their home vs. having to find one and having time to get in a better mental state/ change their mind about suicide by the time they do)

Answer 14

Suppression (voluntarily choosing to not think about something bc you can’t handle it) *note: this is a “mature” defense, meaning it’s a healthy coping mechanism. Contrast this to Repression (involuntarily forgetting a memory bc you can’t handle it), which is NOT a mature defense (not a healthy coping mechanism).

Answer 15

“Mature adults wear a SASH” SUBLIMATION (using negative emotions in a positive way like channeling anger toward step 1 into studying like a pro) ALTRUISM (caring for others to decrease your own stress/ anxiety like helping a pre-med student with the application process to feel good about yourself during med school stress) SUPPRESSION (choosing to not think about something like not thinking about step 1 until the test results come back bc it’s out of your control for the time being and you can’t handle the thought) HUMOR (joking about the boards)

Answer 16

Acting out. Immature.

Answer 17

Denial. Immature.

Answer 18

Displacement (transferring feelings to a less threatening object/ person). Immature.

Answer 19

Dissociation (temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress. No or incomplete memory of traumatic event.) immature.

Answer 20

Fixation (partially remaining at a more childish level of development). Immature.

Answer 21

Idealization (expressing extremely positive thoughts about self or others while ignoring negative thoughts). Immature.

Answer 22

Identification (largely unconscious mimicking or behavior/ traits of another person). Immature.

Answer 23

Intellecualization (using facts/ logic/ non-emotional aspects to distance yourself from feelings). Immature.

Answer 24

Isolation (or affect) (separating feelings from ideas and events). Immature.

Answer 25

Passive aggression (being rude/ expressing hostility in a round-about, not direct, way). Immature.

Answer 26

``` Passive aggression (being rude/ expressing hostility in a round-about, not direct, way). Immature. *you’re trying to get to her w/o being upfront and honest about how you feel ```

Answer 27

``` Passive aggression (being rude/ expressing hostility in a round-about, not direct, way). Immature. *you are trying to get back at him w/o being upfront and honest about how you feel (he needs to pick up after himself) ```

Answer 28

Projection (attributing your own unacceptable feelings to another). Immature.

Answer 29

Rationalization (justifying behavior to avoid difficult truths or to avoid blaming yourself). Immature.

Answer 30

Reaction formation (showing opposite behavior of unwanted/ unacceptable feelings that you have—bc you feel guilty about the true feelings you have). Immature.

Answer 31

Regression (turning back the clock to deal with stress in the world). Immature.

Answer 32

Splitting (believing people are all good or all bad, no gray area). Immature.

Answer 33

Sublimation (channeling impulses to socially acceptable behaviors). Mature (“mature adults wear a SASH”).

Answer 34

Altruism (turning negative feelings into generosity/ caring for others to decrease your own stress and anxiety). Mature (“mature adults wear a SASH”).

Answer 35

Suppression (choosing to not worry/ think about something). Mature (“mature adults wear a SASH”).

Answer 36

Humor. Mature (“mature adults wear a SASH”).

Answer 37

Altruism (turning negative feelings into generosity/ caring for others to decrease your own stress and anxiety). Mature (“mature adults wear a SASH”).

Answer 38

Delirium Treat the underlying cause of the delirium (in this case, the UTI) plus treat with an anti-psychotic (to treat the agitation and make the patient sleepy and calm like sedative) if the patient is at risk for harming their self or others (such as in this case- the patient’s delirium has gotten so bad she is psychotic and aggressive to nurses).

Answer 39

Brain inflammation—> mental status changes (after surgery, infection, while on certain drugs)

Answer 40

Depression-related cognitive impairment Always rule out depression in a person presenting with dementia-like symptoms! Treat the depression and the memory impairment should go away.

Answer 41

Schizophrenia

Answer 42

Clozapine | Not first line bc has nasty side effects- agranulocytosis, seizures, myocarditis, and metabolic syndrome

Answer 43

Linezolid It acts like a MAO inhibitor (meaning it blocks the MAO enzyme that normally breaks down serotonin before its re-uptake by the pre-synaptic neuron—> no breakdown of serotonin means more serotonin at the synaptic cleft) If you’re already on an SSRI (blocking serotonin re-uptake—> increasing serotonin at the synaptic cleft), another med that also leads to more serotonin can lead to TOO MUCH serotonin= serotonin syndrome (life-threatening).

Answer 44

Major depression with psychotic features | The psychosis is occurring during the depression

Answer 45

Hearing voices, having delusions

Answer 46

No. They are “on top of the world” like walking around naked at night, not sleeping for 2 weeks and not tired, spending all their money, calling the president bc they think the president will talk to them bc they’re so important...but not hearing voices/ having psychosis.

Answer 47

Delusional disorder

Answer 48

Patient meets criteria for depression (episodes of depression lasting at least 2 weeks with at least 5 out of the 9 SIG E CAPS depression symptoms) AND has psychosis (delusions and/ or hallucinations) WITH the depression (psychosis is never occurring on its own/ in the absence of depression).

Answer 49

Akathisa (restlessness and inability to remain in 1 position)= extrapyramidal side effect of anti-psychotic medication. (Fix this problem by decreasing the dose of her medication, or supplement with a beta-blocker.)

Answer 50

Restlessness, inability to stay in 1 position | An extrapyramidal side effect of anti-psychotic medications (if dose is too high for the patient)

Answer 51

Benzodiazepines 1. Diazepam 2. Chlordizepoxide (The long-acting benzo’s that allow for smooth withdrawal/ taping off the drug)

Answer 52

Benzo’s (note: most benzodiazepines end in “-Pam” but this is an exception) This is a long-acting Benzo used to treat alcoholic withdrawal (allows for smooth tapering off drug)

Answer 53

Both benzodiazepines and alcohol bind to GABA-A receptors (they enhance GABA inhibitory/ CNS depressant effects, but bind to different sites on the GABA-A receptors). So, if an alcoholic quits alcohol and gets put on a Benzo, the Benzo will take the place of the alcohol in binding to the GABA receptor to avoid withdrawal symptoms and the patient will slowly get tapered off the drug.

Answer 54

Illness anxiety disorder (aka hypochondriasis)

Answer 55

They have a symptom (ex: minor abdominal pain) and they are convinced it’s something crazy that it is not (ex: pancreatic cancer).

Answer 56

Illness anxiety disorder (aka hypochondriasis)—> no symptoms, yet convinced they have something (ex: perfectly healthy but sure they have pancreatic cancer) Somatic symptom disorder—> have a symptom, but convince they have something it’s not (ex: minor abdominal pain but sure it is pancreatic cancer)

Answer 57

Patient fakes illness because they like playing the “sick role” and getting medical attention

Answer 58

Menchausen—> pretend to be sick (or make self sick) a lot bc like playing “sick role” and getting medical attention Menchausen by proxy—> pretends their kid or elder is sick (or makes them sick) to get medical attention

Answer 59

(SSRI= selective serotonin reuptake inhibitor) Block the serotonin transporters (on the pre-synaptic cleft to prevent re-uptake and thus increase serotonin in the synaptic cleft) (*note: SSRIs do NOT block serotonin receptors on the post-synaptic side)

Answer 60

They like to be alone, more comfortable that way (a cluster A “weird” personality disorder) “SchizOID like to avOID people”

Answer 61

Cluster A personality disorder (“weird”) Schizoid—> They like to be alone, more comfortable that way (“SchizOID like to avOID people”) Schizotypal—> They have odd beliefs/ magical thinking/ superstitious

Answer 62

Cluster B (“wild”) Antisocial- disregard the rights of others, criminal, often end up in jail (“conduct disorder” if <18 years old) (“Bad”) Borderline- unstable mood and relationships, splitting (see things/ people as all good or all evil), fear of abandonment, can be suicidal, self-mutilation, emotional emptiness (“Borderline”) Histrionic- attention-seeking, dramatic, sexually provocative (“flamBoyant”) Narcissistic- sense of entitlement, lacks empathy, thinks they’re the best, doesn’t respond well to criticism (“Best”)

Answer 63

Cluster C (“Worried”) Avoidant- afraid of rejection, avoid people bc worried people won’t like them, hypersensitive to rejection and criticism (“lonely and longing”- they want relationships but too afraid they are inadequate) Obsessive-compulsive personality disorder- loves to-do lists, always needs a plan, perfectionist, OCD-type of behaviors however, they are productive/ all helping to achieve a goal Dependent- excessive need for support, low self-confidence, often stuck in abusive relationships

Answer 64

Schizotypal personality disorder (cluster A- “weird”) *note: don’t confuse with another disorder based on her having no friends—her weird behaviors are leading to her having no friends

Answer 65

Avoidant personality disorder (cluster C- “worried”) | “Lonely and longing”-wants relationships but think they are inadequate/ people won’t like them

Answer 66

Do not intubate. You must always follow the advanced directive (if there is one).

Answer 67

She initially presented with depression symptoms only and was given an SSRI. But she really had Bipolar (make sure to screen for this in depressed patients before starting them on an SSRI by asking if they’ve ever had a time in their life where they feel on top of the world/ go days without sleeping/ do irrational things). So the SSRI triggered a manic episode! (SSRIs are contraindicated in bipolar patients for this reasons...think of it as they make sad people happy and too much happy for a bipolar patient—> mania. They need mood stabilizers instead.)

Answer 68

SSRIs (selective-serotonin re-uptake inhibitors) Fluoxetine (Sketchy: “fly out” banner) Paroxetine (“parrot air”) Sertraline (“desert airline”) Citalopram (“city”)

Answer 69

SSRI (selective-serotonin re-uptake inhibitors) Fluoxetine (Sketchy: “fly out” banner) Paroxetine (“parrot air”) Sertraline (“desert airline”) Citalopram (“city”)

Answer 70

SSRI (selective-serotonin re-uptake inhibitors) Fluoxetine (Sketchy: “fly out” banner) Paroxetine (“parrot air”) Sertraline (“desert airline”) Citalopram (“city”)

Answer 71

SSRI (selective-serotonin re-uptake inhibitors) Fluoxetine (Sketchy: “fly out” banner) Paroxetine (“parrot air”) Sertraline (“desert airline”) Citalopram (“city”)

Answer 72

SSRI (selective-serotonin re-uptake inhibitors) Fluoxetine (Sketchy: “fly out” banner) Paroxetine (“parrot air”) Sertraline (“desert airline”) Citalopram (“city”)

Answer 73

4 or 5 years (cannot diagnose before that bc normal toddler behavior is “ADHD” like)

Answer 74

Nothing- this is normal development. Children are not expected to be fully potty trained and capable of dressing themselves until age 5. Also, ADHD is not even considered as a diagnosis until age 4-5 because normal toddler behavior is low attention span.

Answer 75

Rett syndrome -neurodevelopmental disorder in girls, presents similarly to Autism (due to MECP2 mutation on the X chromosome) Deceleration of head growth (brain not growing normally), repetitive hand movements, they start out having normal development and regress)

Answer 76

Narcolepsy (disorder of sleep-wake cycles) | hypocretin-1 (aka Orexin) in CSF

Answer 77

HypnaGOgic—> hallucinations just before GOing to sleep HypnoPOMPic—> hallucinations just before awakening (get POMPed up in the morning)

Answer 78

Sexual dysfunction (occurs in 50% of patients on SSRIs) *other side effects (less common): weight gain, drowsiness, seizures, SIADH/ hyponatremia

Answer 79

Body dysmorphic disorder (a subtype of OCD where you’re obsessed over your appearance and engage in repetitive things like hours of research on thighs in order to reduce anxiety)

Answer 80

GAD (generalized anxiety disorder)

Answer 81

Excessive anxiety and worry about different aspects of life (work, school, children) for most days of 6 months or more. Need 3 or more of the following 6 symptoms for adults, 1 or more for kids: (1) restlessness, (2) irritability, (3) sleep disturbance, (4) fatigue, (5) muscle tension, (6) difficulty concentrating.

Answer 82

SSRIs (Remember the obsessively neat dude in Sketchy: the office “serotonin sitcom” scene)

Answer 83

Autism (ASD) -poor social interactions, communication problems, repetitive behaviors (need sameness), may have intellectual disability and unusual gifts/ abilities (savants), more common in boys and usually presents early childhood

Answer 84

Anorexia nervosa (binge eating/ purging type) *remember, the diagnosis of anorexia vs. bulimia is based on BMI. If < 18.5–> anorexia, NOT bulimia

Answer 85

Benzodiazepine (1st line= SSRIs, but Benzos are good for short-term anxiety treatment and kick in/ get out of the system faster)

Answer 86

3 or more of the “DIG FAST” symptoms: Distractibility Impulsivity (do crazy things like spend all their money w/o thinking of the consequences) Grandiosity (inflated self-esteem, think they can do anything) Flight of ideas (racing thoughts) Activity (doing a bunch of stuff that’s not productive but they think they’re working toward a goal)/ agitation Sleep- they don’t need it Talkativeness or slurred speech

Answer 87

Nightmares—> REM sleep (“REMembering a bad dream”) Night terrors (screaming episodes in the night that you DON’T remember)—> N3 (deepest sleep, slow-wave) (“wee and flee in N3”)

Answer 88

N3 (deepest sleep) | “Wee and flee in N3”

Answer 89

N2 (almost half your sleep is in this phase)

Answer 90

1. Awake (eyes open)- beta waves 2. Awake (eyes closed)- alpha waves NON-REM 3. N1- theta waves 4. N2- sleep spindles and K complexes 5. N3 (deepest sleep, slow-wave)- delta waves 6. REM SLEEP- beta waves *remember “at night BATS Drink Blood”—B (beta), A (alpha), T (theta), S (sleep spindles and K complexes), D (delta), B (beta)

Answer 91

Generalized anxiety disorder (GAD)- excessive worry for at least 6 mo about multiple issues Panic disorder- multiple panic attacks with physical symptoms, anxious thought is more specific, sometimes no obvious trigger

Answer 92

Oppositional defiance disorder- kids not respecting authority Conduct disorder- kids showing aggression toward people/ animals, committing crime like theft, destruction of property (more severe violations of the basic rights of others)

Answer 93

Adjustment disorder (anxiety/ depression within 3 mo of a stressor and does not meet the criteria for another disorder like MDD or GAD)

Answer 94

Like PTSD, but only lasting between 3 days- 1 month (flashbacks following a traumatic life event)

Answer 95

MAO inhibitor Tyramine consumption—> hypertensive crisis Remember that MAO inhibitors block the breakdown of monoamines (serotonin, NE, dopamine) by MAO (the point is to increase serotonin at the synaptic cleft—> make the depressed person happy). BUT, they also block the breakdown of Tyramine (in meats, cheeses, and beer), so consumption of Tyamine on a MAO inhibitor—> build up of Tyramine, which enters systemic circulation—> HTN crisis (note this is why MAO inhibitors are rarely used for depression treatment— serotonin syndrome and Tyramine HTN crisis are bad side effects, so use only in treatment-resistant depression.)

Answer 96

Tricyclic antidepressants | Sketchy: tripping

Answer 97

Tricyclic antidepressants | Sketchy: tripping

Answer 98

``` Tricyclic antidepressants (Sketchy: imprint on face) ```

Answer 99

``` Tricyclic Antidepressants (Sketchy: “I want to ride my tricycle” recess scene. Imipramine= imprint on face. Amitriptyline and Nortriptyline= tripping.) ```

Answer 100

Anti-muscurinic means the muscurinic (parasympathetic) receptors are blocked. So, you’d expect to see sympathetic (fight or flight) symptoms. Dry mouth—> you aren’t producing saliva when running from a bear (you produce it when resting and DIGESTING) Constipation—> no time to poop when running from a bear Urinary retention—> no time to pee when running from a bear Confusion—> ? Inc HR—> heart beats faster when running from a bear Dilated pupils—> gotta let in more light to see better when running from a bear Dec sweat—> this is opposite of what you’d expect...bc sweat glands have muscurinic receptors, even though sweat is a sympathetic function Inc temp—> body heats up from the energy/ ATP spike while running from a bear

Answer 101

Non-benzodiazepine anxiolytic (but not in Sketchy) Used to treat GAD (Generalized Anxiety Disorder) Takes 1-2 weeks to work No major side effects—does NOT cause sedation, addiction, or tolerance and does not interact with alcohol.

Answer 102

1. Lithium (stabilizing chair LIFT) 2. Valproate (winter festiVAL) 3. Carbamazepine (classic CAR carving) 4. Lamotrigine (Llama) (Remember the Lithium “Ski Mania” sketch in Sketchy)

Answer 103

NO! These are all SSRIs, which can trigger a manic episode in a bipolar individual (think of it as: SSRIs take the sad patient and make them happy. They are capable of taking the bipolar patient and making them too happy= mania)

Answer 104

Anti-psychotics

Answer 105

Mood stabilizers

Answer 106

At least 2 of the following symptoms (with at least 1 being from symptom #1-3): 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Disorganized behavior 5. Negative symptoms (flat affect, apathy, anhedonia/ can’t feel pleasure, alogia/ poverty of speech, social withdrawal) Has to have been going on for at least 6 months with at least 1 month of continuous symptoms

Answer 107

``` Auditory hallucinations (hear voices) (Olfactory and tactile hallucinations, where patients smell or feel things, are seen more in substance abuse and other neurological problems) ```

Answer 108

POSITIVE- hallucinations, delusions, unusual thought processes, disorganized speech, bizarre behavior NEGATIVE- flat or blunted affect, apathy, anhedonia (can’t feel pleasure), alogia (poverty of speech), social withdrawal COGNITIVE- reduced ability to understand or make plans, dec working memory, inattention

Answer 109

Have regularly scheduled doctor visits with the SAME doctor (avoid referrals and unnecessary testing) *remember somatic symptom disorder is when a patient has a symptom and is convinced it’s something that it’s not (ex: tummy ache and believes he/ she must have pancreatic cancer, despite normal test results)

Answer 110

Insomnia, tremor (“the shakes”), anxiety, autonomic hyperactivity like inc BP and HR

Answer 111

8-12 hrs—> Insomnia, tremor (“the shakes”), anxiety, autonomic hyperactivity like inc BP and HR 12-48 hrs—> seizures 48-96 hrs—> delirium tremors (DT) (fever, disorientation, severe agitation)

Answer 112

``` Age 7 (Before this, kiddos may think the dead person will magically come back to life and they may also think the grief of others is their fault. This is NOT a “complicated grief reaction”, but is “age-appropriate behavior.”) ```

Answer 113

Feelings of detachments...feeling like you’re watching yourself/ outside of your own body

Answer 114

Inability to recall important personal information following trauma/ stress (but usually reversible).

Answer 115

When a person takes on 2 or more distinct identities/ personality states (Associated with sexual abuse, PTSD, depression, substance abuse, borderline personality, and somatoform conditions) aka MULTIPLE PERSONALITY DISORDER

Answer 116

Bipolar II Note: these are hypOmanic episodes, not full-on manic episodes, so bipolar II not I. Mania (bipolar I) would involve more severe symptoms...the person would not be able to work jobs but would engage in meaningless “work” running around naked thinking they’re king of the world type of behavior.

Answer 117

Hyperthyroidism (this is seeming to involve more systemic symptoms, not just generalized anxiety disorder where you lose weight w/o trying...if you lost weight from anxiety it’d be due to a change in appetite from stress, not you kept up with your normal eating routine and just noticed you’re shedding pounds).

Answer 118

``` MAO inhibitors (Sketchy: Selegiline= sledge hammer, Tranylcypromine= “try a sip of wine,” Phenelzine= funnel, Isocarboxazid= boxed wine) ```

Answer 119

MAO inhibitor (sledge hammer in Sketchy)

Answer 120

MAO inhibitor (“Try a sip of wine” in Sketchy)

Answer 121

MAO inhibitor (funnel in Sketchy)

Answer 122

Isocarboxazid (boxed wine in Sketchy)

Answer 123

Selegiline (sledge hammer in Sketchy)

Answer 124

Physostigmine—> antidote for anticholinergic agent overdose Flumazenil—> antidote for benzo overdose Naloxone—> antidote for opioids overdose Cyproheptadine—> antidote for serotonin syndrome/ overdose on serotonergic agents (SSRIs, SNRIs, TCAs, MAOIs)

Answer 125

Flumazenil (fluffy dog wearing a muzzle in Sketchy. It is a competitive antagonist at benzo receptor site)

Answer 126

Ramelton (Sketchy: “Melt Away” sign for Melatonin and Ramelton= melatonin receptor agonist)

Answer 127

No, not the best idea. They are more prone to symptoms such as confusion, falls, delirium, disorientation...

Answer 128

Classical conditioning- learning by associating a stimulus with something (ex: Palvot’s dogs became conditioned to think the bell meant food). Operant conditioning- learning by punishment/ rewards.

Answer 129

Daytime stimulants: amphetamines or Modafinil | And/or nighttime sodium oxybate (GHB)

Answer 130

Orexon (aka hypocretin)

Answer 131

Benzos—> provide CNS depression in place of alcohol (bind a different site on GABA-A receptors) and allow for tapering off the drug Naltrexone—> Block mu-opioid receptors to reduce cravings Acamprostate—> modulates glutamate neurotransmission at the NMDA (glutamate) receptors Disulfiram—> blocks aldehyde dehydrogenase enzyme—> build up of acetylaldehyde—> you feel sick and lousy if you drink alcohol while on this drug

Answer 132

Factitious disorder imposed on self (aka Munchasusen syndrome) She is injecting herself with fecal material (E.Coli is not usually found in the arms) + she is a healthcare worker (more likely to get this bc of access to things like...fecal material). She is making herself sick because she likes the medical attention.

Answer 133

1st gen anti-psychotics—> block D2 dopamine receptors 2nd gen anti-psychotics—> block D2 dopamine receptors (to a lesser degree) and serotonin (5-HT 2A) receptors *the fact that they block D2 to a lesser degree makes them less likely to cause extrapyramidal side effects

Answer 134

Panic attack

Answer 135

1st line—> SSRIs and Venlafaxine (another antidepressant) (along with cognitive behavioral therapy) Acute setting—> benzos (why? Bc SSRIs will take a few weeks to kick in and you need to do something right now for your patient that feels like he/ she is having a heart attack it’s so bad)

Answer 136

``` Cocaine toxicity (delusions + sympathetic signs) *you wouldn’t get dilated pupils in a primary psych disorder ```

Answer 137

Delirium (waxing and waiting level of consciousness that is acute, reversible). *not vascular dementia bc onset of this man’s agitation is abrupt and there’s fever (possibly infection), some underlying pathology going on.

Answer 138

Brief psychotic disorder—> 1 positive symptom lasting < 1 mo. (Usually stress-related like you just had a death in the family you’re not coping well with) Schizophreniform disorder—> 2 symptoms lasting 1-6 mo. (Milder Schizophrenia that hasn’t lasted 6 months).

Answer 139

Brief psychotic disorder (1 schizophrenia symptom lasting < 1 mo after stress)

Answer 140

1. Pre-contemplation (not thinking about a behavior modification= denial that you have a problem) 2. Contemplation (thinking about a behavior modification= accepting you have a problem) 3. Preparation (preparing for a behavior modification= planning to make a change) 4. Action (putting the plan into action) 5. Maintenance (keeping up with the behavioral modification)

Answer 141

Preparation stage (preparing for a behavior modification= planning to make a change)

Answer 142

Orbitofrontal cortex (involved with behavioral and emotional regulation)

Answer 143

Behavioral and emotional regulation

Answer 144

SSRIs Prazosin for nightmares (Also cognitive behavioral therapy is first line!)

Answer 145

Inhalant use disorder He’s sniffing up inhalants like white out or paint to get high. The rash is known as “glue sniffer’s rash.” Causes these problems, but has prompt recovery (within 45 min).

Answer 146

Schizophrenia He has paranoid delusions and negative symptoms (lack of hygiene, social withdrawal, lack of motivation). That’s at least 2 of the symptoms on the diagnostic list lasting > 6 mo.

Answer 147

Anti-psychotics (1st or 2nd generation). Block dopamine D2 receptors (2nd gen also block serotonin receptors, but D2 dopamine are the primary receptors blocked that all anti-psychotics have in common).

Answer 148

Lasts between 3 days- 1 month. If goes on longer than 1 month, it’s termed PTSD.

Answer 149

Acute stress disorder | After 1 mo we call it PTSD

Answer 150

ALT and AST (liver enzymes)

Answer 151

Wilson disease (Autosomal recessive mutation in copper-transporting enzyme—> copper accumulation and deposition. This condition commonly presents in childhood. They can get copper deposits in the liver—> high liver enzymes, brain—> psych symptoms, and cornea—> Kaiser-Fleischer rings.) *These kids may get misdiagnosed with a primary psych disorder but the other pathologic findings can give it away

Answer 152

``` Schizophreniform disorder (2 symptoms of Schizophrenia lasting 1-6 months, so less severe than Schizophrenia which involves >2 of the symptoms to make a diagnosis + going on > 6 mo.) This guy in particular is showing delusions and negative symptoms (lack of hygiene and social withdrawal) ```

Answer 153

Intermittent explosive disorder

Answer 154

Splitting (categorizing into extreme positives and extreme negatives, characteristic of borderline personality disorder because these ppl have unstable relationships)

Answer 155

``` Bulimia nervosa (forcing herself to vomit at least weekly over the past 3 months) (Note that if she had this description and were forcing herself to vomit but BMI were LOW, it would be called anorexia nervosa binge-eating/ purging type) ```

Answer 156

- parotid gland hypertrophy (these glands enlarge from repeated vomiting) - enamel erosion (from repeated vomiting staining the teeth) - electrolyte disturbance (vomit—> loss of H+, Cl-, and K+) (hypokalemia/ low K+, hypochloremia/ low Cl-) - metabolic alkalosis (loss of H+ so losing acid—> blood is basic) - dorsal hand calluses from induced vomiting (Russell sign) - tachycardia (inc HR) - hypotension (dec BP)

Answer 157

Anorexia nervosa

Answer 158

Stimulants (like methylphenidate and amphetamines) Work by blocking NE and dopamine retuptake at synapses in the prefrontal cortex—> more NE and dopamine (By providing more NE and dopamine you are stimulating the prefrontal cortex to do its job)

Answer 159

Adequate clinical trial= 4-6 weeks | They take this long to achieve maximal clinical effect

Answer 160

Social anxiety disorder (Don’t get tricked and think adjustment disorder with anxiety just bc this girl’s symptoms worsen when her friend leaves! The onset of her symptoms was before this—she did not start having anxiety after the friend left—and it’s normal for an anxiety disorder to get worse when a tough thing happens in life like your friend moves away)

Answer 161

Fear of going out into public places

Answer 162

Persistent erection of the penis for > 4 hrs not associated with sexual excitement (medical emergency bc if not treated it can result in permanent damage to the penile tissue and erectile dysfunction)

Answer 163

Folate vitamin supplementation

Answer 164

Bipolar disorder and epilepsy

Answer 165

Neural tube defects

Answer 166

Antiepileptic Drugs *some also used in bipolar (like valproate, carbamazepine, phenytoin, phenobarbital) and folate antagonists (methotrexate, TMP-SMX)

Answer 167

Decreased appetite—> weight loss and insomnia “People with ADHD don’t eat and don’t sleep”

Answer 168

Substance-induced psychotic disorder Patient is abusing stimulants, like cocaine. This is not a manic episode bc you wouldn’t get other sympathetic symptoms like high HR, BP, and dilated pupils in mania.

Answer 169

Drug-induced Parkinsonism (this is a extrapyramidal side effect of drugs that block D2 dopamine receptors= anti-psychotics) *treat with Benztropine or Amantadine (anti-cholinergic meds)

Answer 170

Subacute sclerosis panencephalitis from Measles virus (rubeola) *This is a rare complication of Measles that occurs many years after you recover from the initial infection. Your brain basically melts. Measles virus antibodies would be found in the CSF of these patients.

Answer 171

Outpatient give SSRIs (SSRIs + cognitive behavioral therapy= first line) Inpatient/ acute panic attack give benzos (we don’t send patients home with benzos but do use them to treat acute attacks in the hospital)

Answer 172

No. They are addictive, so used sparingly. For example, use in an acute panic attack like patient comes into the ER feeling like they’re going to die (don’t give out for panic attacks in an outpatient setting- use the first line SSRIs). Or use in a hospital for a patient going through alcoholic withdrawal (don’t just give to an alcoholic trying to taper off of alcohol- use other meds to reduce cravings, etc.)

Answer 173

Myoglobinuria Fever Encephalopathy Vitals unstable Enzymes increased (high CK due to rhabdomyolysis) Rigidity in muscles (“lead pipe” rigidity)

Answer 174

1. Dantrolene (RyR receptor antagonists that blocks Ca2+ release from the SR of skeletal muscle) * makes sense bc rhabo/ muscle breakdown is part of NMS 2. Bromocriptine (or another dopamine agonist) * makes sense bc anti-psychotics block D2 dopamine receptors, so you are trying to restore dopamine to make up for the overdose

Answer 175

1. Malignant hyperthermia (toxicity of inhaled anesthetics and succinylcholine) 2. Neuroleptic Malignant Syndrome (NMS) (toxicity of anti-psychotic drugs) (Dantrolene= trampoline in Sketchy)

Answer 176

Cocaine This is a stimulant, so going off of it gives the following withdrawal symptoms: inc appetite, hypersonia (inc sleeping), psychomotor retardation, severe depression (“crash”- the opposite of being high), vivid dreams

Answer 177

Increased appetite/ eating

Answer 178

Feeling lousy | The opposite of “euphoria” or getting high

Answer 179

Consumption of non staple “foods” (ice, paint chips, dirt, hair, etc.) for > 1 month

Answer 180

Hallucinations—> you see something that’s not there (ex: you see an alien and there’s no aliens in the room) Illusions—> you misinterpret something you see (ex: there’s a person in the room but you look at them and see an alien)

Answer 181

Delusion—> you’re perception of something if off (ex: you think your roommates are always talking about you, you think your neighbor is out to get you, you think you’re married to a celebrity that you aren’t, you think you’re as good as Kobe Bryant at basketball when you really suck) Hallucination—> you hear/ see something that’s not really there (ex: you are talking to an imaginary friend but you think they’re real)

Answer 182

1 or more delusion lasting >1 month without a mood disorder or other psychotic symptoms

Answer 183

Delusional disorder (1 or more delusion lasting >1 month without a mood disorder or other psychotic symptoms) *not paranoid personality disorder, as this would involve excessive mistrust in others and not beliefs that are delusional

Answer 184

Anxiety, tremor, difficulty sleeping, sympathetic hyperactivity (sweating, palpitations), seizures if severe *bc you took away the CNS depression your body got used to

Answer 185

``` Neuro symptoms (loss of sensory or motor function) following an acute stressor, but neuro exam is 100% normal (*They’re not consciously making it up like in factitious disorder/ Münchausen syndrome...the symptom actually may be distressing to them. They are also not excessively anxious about a symptom being a particular thing like in somatic symptom disorder.) ```

Answer 186

2nd gen anti-psychotic

Answer 187

2nd gen antipsychotic

Answer 188

2nd gen anti-psychotic

Answer 189

2nd gen anti-psychotic

Answer 190

2nd gen anti-psychotic

Answer 191

2nd gen antipsychotic

Answer 192

``` Quetiapine—> “quiet” Olanzapine—> “only” Risperidone—> “whispering” Aripiprazole—> “appropriate” Ziprasidone—> zipper Clozapine—> closet ```

Answer 193

1st gen—> extrapyramidal side effects | 2nd gen—> metabolic effects (weight gain, dyslipidemia, hyperglycemia, inc DM risk)

Answer 194

Transference—> you project feelings about someone else onto your physician (ex: you are mad at your dad for neglecting you in the past so you get mad at your psychiatrist for cancelling an appointment on you bc it subconsciously reminds you of your dad that wasn’t there for you, or you see your psychiatrist like your mom) Countertransference—> how the doctor feels about the patient (ex: patient reminds doctor of their sister)

Answer 195

``` 2 weeks (This is self-resolving, normal due to hormonal changes) ```

Answer 196

Within 2 weeks—> postpartum blues | After that—> postpartum depression

Answer 197

Non-benzo hypnotic agents (use for insomnia to help you sleep) * they are non-benzos but still bind the same GABA-A receptor site and work as an agonist of it—> CNS depression, but less side effects bc chemically distinct * remember “ZZZ mattresses” in Sketchy

Answer 198

Spouse—> adult children—> parents—> siblings—> other relatives (“The spouse ChiPS in”)

Answer 199

PTSD *NOT depersonalization/ derealization Disorder bc she has a cluster of symptoms (not just this) involving flashbacks too and it’s be > 1 mo, meets PTSD criteria

Answer 200

``` Normal behavior (Hallucinations can be normal and comforting in the bereavement process. Plus she’s only 5 and doesn’t understand the permanence of death yet.) ```

Answer 201

Displacement (He is transferring negative feelings toward his wife onto the office staff. Acting out would be like if he key‘d his wife’s car to get her back)

Answer 202

Something like “sorry, I cannot say whether or not she is my patient.” Do NOT say yes she’s my patient but I can’t tell you about her health...patient confidentiality includes not saying WHO your patients are. Don’t lie (no need to say “no she’s not my patient”), but don’t confirm or deny!

Answer 203

She does! Decision-making capacity requires that the patient communicates a choice, understands the info provided on the condition and treatment option, appreciates the consequences, and gives a rationale for a decision. She did all of these. Mild cognitive impairment (forgetting the date) does NOT automatically mean lack of decision-making capacity!

Answer 204

Medicare is for elderly patients >65, disabled, or end-stage renal diseases (mediCARE= care for the elderly) Medicaid is for low-income patients (medicAID= aid for poor)

Answer 205

Attempt to contact the sister Without an advanced directive or designated proxy (patient picks someone to makes decisions on their behalf), decision making goes to “next of kin” (spouse—> adult children—> parents—> kids—> other relatives). If there is NO family available, THEN friends may act as a substitute and make a decision on behalf of the patient.

Answer 206

Do not give CPR Even though the “next of kin” order would allow the husband to make a decision on the patient’s behalf over the friend, this lady filled out a form designating her friend to be her decision-making in a situation like this which takes precedence. Always follow the advanced directive/ proxy first if there is one!!

Answer 207

Prognosis < 6 mo.

Answer 208

``` PCP (“angel dust”) Blocks NMDA (glutamate) receptors (—> hallucinations and inhibits reputable of dopamine, NE, and serotonin—> more sympathetic activity) ```

Answer 209

Bupropion (an atypical antidepressant with a good sexual profile, it is a NE-dopamine reuptake inhibitor)

Answer 210

NMS (life-threatening reaction to first generation anti-psychotics)—> hypOreflexia (decreased reflexes) *diffuse rigidity (“lead-pipe”) Serotonin syndrome (life-threatening reaction to too many SSRIs/ serotonin promoting meds)—> hypERreflexia (increased reflexes), *includes Clonus

Answer 211

NMS (neuroleptic malignant syndrome)= life-threatening relation to first gen anti-psychotics (used to treat bipolar) Characterized by: “lead-pipe” rigidity in muscles, hyporeflexia, hyperthermia, sympathetic hyperactivity (high BP, HR), and mental status changes.

Answer 212

Previous suicide attempt

Answer 213

Bipolar I Remember, Bipolar I is 1 manic episode plus or minus a hypomanic or depressive episode (“bipolar I patients think they’re number 1” from grandiosity in manic episodes) Bipolar II is hypomania + depression (no mania)

Answer 214

Bipolar I with psycotic features

Answer 215

Lithium (mood stabilizer) | Can cause hypothyroidism—> wight gain, dry skin, hair loss, constipation

Answer 216

Lithium can cause hypOthyroidism and DI (diabetes insipidus)

Answer 217

You have to allow time for MAO to regenerate (bc MAO inhibitors IRREVERSIBLY inhibit MAO...and that way it’s re-established to break down serotonin...otherwise, you’d be taking the SSRI which increases serotonin in the cleft and no MAO to break it down—> serotonin syndrome)

Answer 218

Acute Dystonia (sudden muscle stiffness) Anesthesia (restlessness) drug-induced Parkinsonism (cogwheel rigidity, slow movement) Tardive dyskinesia (involuntary jerky, repetitive movements like sticking out the tongue)

Answer 219

- confusion - dry mouth - constipation, intestinal ileus - hyperthermia, flushing - urinary retention

Answer 220

Yes. It is a TCA (tricyclic antidepressant) and blocks the following receptors: serotonin and NE reuptake, fast Na+ channels, muscarinic ACh receptors, alpha-1 receptors, and H1 histamine receptors. Since it blocks histamine receptors, it causes sedation/ sleepiness and can therefore be used (though not often) for insomnia (problems getting to sleep).

Answer 221

TCA’s block the following receptors: serotonin and NE reuptake, fast Na+ channels, alpha-1 receptors, H1 histamine receptors, and cholinergic ACh receptors. Since they block muscurinic ACh receptors, they cause confusion, dry mouth, constipation, hyperthermia, and URINARY RETENTION. Think of it as blocking the PNS, so you get sympathetic effects= not peeing.

Answer 222

Valproate (it is a mood-stabilizer and a broad spectrum anti-epilepsy medication)

Answer 223

Valproate= anti-epileptic medication and mood stabilizer Blocks voltage-gated Na+ channels and enhances availability of (increases) GABA

Answer 224

Normal sadness/ depressed mood *this is NOT adjustment disorder bc although the sadness happened after a life adjustment and it does not meet the criteria, it’s not affecting her productivity/ functioning either. Impaired social and occupational functioning is a criteria for most psych disorders, including adjustment disorders!

Answer 225

Cognitive behavioral therapy (CBT) that is exposure-based *2nd line= short-acting benzos to calm you down

Answer 226

Agoraphobia This means they get anxiety/ fear about leaving the house and going to public/ crowded situations where they feel trapped and helpless in the even of a panic attack

Answer 227

Autism spectrum disorder (ASD) *characterized by impaired social communication/ interaction + repetitive interests/ behaviors (with or w/o language and intellectual impairment)

Answer 228

“ADAPT” Acute Dystonia (sudden muscle stiffness) Akesthesia (restlessness) drug-induced Parkinsonism (cogwheel rigidity, slow movements) Tardive dyskinesia (involuntary jerky movements, like sticking out the tongue)

Answer 229

Premature ejaculation (he’s having early ejaculation/ loss of control) NOT sexual dysfunction due to DM bc that would cause erectile dysfunction (impaired blood flow through small penile vessels) not this problem he’s having. NOT depression causing it bc he currently doesn’t report depressed symptoms. NOT the Trazodone causing it—it has a side effect of priapism (sustained erection), not the problem he’s having.

Answer 230

Inhibits reuptake of NE and dopamine—> increased NE and dopamine in cleft (“NET DAT ball pro” where “ball pro” helps you remember Buproprion and NET DAT helps you remember NE transmitter and dopamine transmitters are blocked)

Answer 231

NO! Contraindicated due to seizure risk/ side effect.

Answer 232

Chronic, fluctuating mood disturbance involving many periods of hypomanic and depressive symptoms, but doesn’t meet criteria for hypomanic or major depressive episodes.

Answer 233

This is normal adolescent behavior *this is NOT body dysmorphic disorder. To make this diagnosis, we’d need info like she’s obsessing over how she looks in the mirror or researching her thighs 8 hrs/ day...

Answer 234

Intentional and repeated fire setting w/o an obvious motive (however, if other destruction of property, etc is going on, then it is conduct disorder)

Answer 235

Acute-onset state with fluctuating levels of consciousness, impaired attention, and disorientation that occurs when there’s an underlying medical condition. Often seen after surgery, infection, or onset of new medications (elderly also at higher risk)

Answer 236

Bulemia- yes, SSRIs help | Anorexia nervosa- no

Answer 237

Decreased total sleep time (you wake up more in the middle of the night/ more fragmented sleep, wake up earlier, and nap more/ feel more tired throughout the daytime)

Answer 238

SSRI/ SNRI

Answer 239

Separation anxiety disorder (Note that this is NOT adjustment disorder with anxiety bc, even though the symptoms got worse after they moved, she had symptoms before too so the onset wasn’t due to the move.) **for this diagnosis, separation anxiety symptoms must be present for at least 4 weeks in kids, 6 months in adults.

Answer 240

No. We don’t diagnose personality disorders in kids bc their personalities are still developing.

Answer 241

Opioids (this includes prescription analgesics and heroin)

Answer 242

Anorexia nervosa—> underweight, intense fear of weight gain/ distorted image of self, can be binge/purge (eat and throw it up) type or restricting type (stop eating) Bulimia nervosa—> normal or overweight, episodes of binge eating followed by behavior to compensate (vomiting, exercise, fasting) to prevent weight gain, worry about body shape and weight Binge eating disorder—> recurrent binge eating with lack of control but NO COMPENSATORY BEHAVIORS (after they binge eat, they do NOT force them self to vomit)

Answer 243

1. Methadone (“done timer” in Sketchy) - it is a full mu-opioid receptor agonist 2. Buprenorphine (“blueprint” in Sketchy) - it is a partial mu-opioid receptor agonist Both of these drugs have a long half life (long tapering flag in Sketchy), which allows it to suppress cravings and withdrawal symptoms from opioids

Answer 244

Being super thin shuts off GnRH (your body knows you cannot sustain a pregnancy)—> low estrogen—> less protective effect against osteoclasts= more osteoclasts breaking down bone

Answer 245

Anorexia nervosa binge/purge type - enlarged parotid (overstimulation of salivary glands) is consistent with causing yourself to vomit - lanugo is seen in anorexia nervosa

Answer 246

Extrapyramidal symptoms (EPSs)

Answer 247

At age 2, a child should be able to use 2-word phrases.

Answer 248

In the kidneys (for example: Thiazide diuretics) | Bc lithium is metabolized in the kidneys

Answer 249

Ataxia and tremor

Answer 250

You get psychosis (like hearing voices) DURING mania (or depressed) states

Answer 251

You get psychotic (like hearing voices) DURING the time you are depressed

Answer 252

Schizophrenia does NOT involve mood issues (no Bipolar/ mania or depression) Schizoaffective shares symptoms of Schizo + mood disorder (bipolar/ mania or depression). It means your are psychotic/ hearing voices (Szhizo symptoms) in the absence of mood symptoms (at times when your mood is stable and you are not manic or depressed), so the Schizo and mood symptoms don’t have to be going on at the same time MDD with psychotic features means you are psychotic/ hearing voices but ONLY WHILE you are depressed (at times when your mood is back to being stable, you’re not getting any more psychosis)

Answer 253

Bipolar (mania) and depression

Answer 254

1. Mesocortical- less activity—> negative symptoms of Schizo (remember cortical sounds like “court” which is a negative thing) *anti-psychotics that block D2 dopamine receptors don’t really affect this pathway 2. Mesolimbic- more activity—> positive symptoms of Schizo (remember limbic sounds like “limbo” which is a positive thing) *anti-psychotics that block D2 dopamine receptors target this pathway, so blocking this pathway means less positive symptoms 3. Nigrostriatal- less activity—> extrapyramidal symptoms (acute dystonia, akathisia, Parkinsonism, tardive dyskinesia) *anti-psychotics block D2 dopamine receptors, and therefore decrease activity of this pathway—> less EPS’s 4. Tuberoinfundibular- less activity—> more prolactin *blocking dopamine= less inhibition on prolactin= more prolactin= dec libido, sexual dysfunction, galactorrhea, gynecomastia in men

Answer 255

Negative symptoms of Schizohrenia

Answer 256

Positive symptoms of Schizophrenia

Answer 257

EPS (extrapyramidal symptoms)

Answer 258

Increased prolactin (—> decreased libido, sexual dysfunction, galactorrhea, gynecomastia in men)

Answer 259

Persistent depressive disorder Milder depression, 2+ depressive symptoms (don’t need 5/9 of the SIG E CAPS), but it’s lasting 2+ years (no more than 2 months w/o depressive symptoms)

Answer 260

Milder form of bipolar. Mild depression + hypomania. Must last 2+ years with symptoms at least half the time (remission no longer than 2 months). *this differs from Bipolar II (depression + hypomania) bc the depressive symptoms are milder and don’t meet the MDD requirements. Also, hypomanic symptoms are milder.

Answer 261

Dysthymic disorder- aka persistent depressive disorder. A milder depression that goes on 2+ years. Cyclothymic disorder- milder bipolar disorder (milder depression + hypomania)

Answer 262

Phenelzine (funnel in Sketchy)= MAO inhibitor (treats atypical depression). She ate pizza= lots of cheese! Cheeses and meats are a no no when you’re on a MAO inhibitor bc MAO inhibitors block MAO. While this prevents degradation of serotonin, NE, and dopamine so there’s more in the cleft, it also prevents breakdown of Tyramine so eating Tyramine-rich products can lead to too much Tyramine floating around in the blood—> HTN crisis. Treat with Phentolamine (Phantom of the Alpha guy in Sketchy)

Answer 263

Phentolamine

Answer 264

Abnormal movement and behavior from schizophrenia or other disturbed mental state

Answer 265

Adjustment disorder with depressed mood (depression symptoms within 3 months of a stressors) (Not MDD bc MDD requires 5/9 SIG E CAPS symptoms for at least 2 weeks. This has only been going on 2 weeks, is due to an acute stressor= breaking up with gf)

Answer 266

Generalized anxiety disorder (GAD)

Answer 267

Just another name for somatic symptom disorder! Patient has a vague symptom and has anxiety over it/ thinks they must have something serious Ex: stomach ache—> think they have pancreatic cancer (*vs. illness anxiety disorder where patient has zero symptoms, but still thinks they’ve got something)

Answer 268

1. LSD (Lysergic acid diethylamine) aka “acid” 2. Marijuana (cannabinoid) aka cannabis aka pot 3. Ecstasy (MDMA) 4. PCP (Phencyclidine)

Answer 269

1. Alcohol 2. Barbiturates 3. Benzodiazepines 4. Opioids

Answer 270

1. Amphetamines (like meth) 2. Caffeine 3. Cocaine 4. Nicotine

Answer 271

Amphetamines (like meth), cocaine, LSD

Answer 272

Yellowed eyes from jaundice

Answer 273

1. GI distress (emperor guy ready to throw up in Sketchy) 2. Inc appetite, weight gain (the emperor is fat) 3. Tremor (guy in the back of the line shaking the baseball bat thing) 4. Liver hepatotoxicity (the liver spot on the cow) 5. Neural tube defects (tarantula teratogen and lady playing tubes with baby on her back) 6. Pancreatitis (squeezing the sponge)

Answer 274

Fetal alcohol syndrome

Answer 275

No. Contraindicated in elderly patients due to severe anti-cholinergic (dry mouth, constipation, blurry vision, urinary retention, confusion...) and anti-histamine effects (sedation, etc.).

Answer 276

Discontinue clozapine treatment Though we want to treat his psychosis, we need to get him off this med first! Then we can figure out an alternate anti-psychotic med. why? He is getting agranulocytosis (a really dangerous side effect of the med). On top of that 2nd gen antipsychotics (like Clozapine) are known for causing metabolic side effects like dyslipidemia and hyperglycemia, making diabetes a worse problem.

Answer 277

Schizotypal- has odd beliefs/ magical thinking | Part of cluster A “weird” side effects

Answer 278

Fragile X syndrome X-linked dominant Trinucleotide repeat in FMR1 gene (Fragile mental retardation gene) CGG repeats—> protruding Chin, Giant Gonads, intellectual disability (2nd most common cause after Downs)

Answer 279

``` Schizoaffective disorder (Schizo symptoms + mood= depression/ mania symptoms, but not always occurring at the same time) ``` *This is NOT MDD with psychotic features. If it were, the guy would be psychotic only when having depression. They would be happening together! (Never psychotic in the absence of depression)

Answer 280

PCP | Nystagmus gives away that it’s PCP intoxication

Answer 281

MAO inhibitor (“try a sip of wine” in Sketchy)

Answer 282

1st gen anti-psychotics or 2nd gen anti-psychotics, especially Risperidone!

Answer 283

Obsessive-compulsive personality disorder

Answer 284

1st gen antipsychotic, low-potency (“color pro” pains in Sketchy)

Answer 285

TCA (tricyclic antidepressant) | Imprint in Sketchy

Answer 286

Atypical antidepressant, also used for smoking cessation (NET DAT ball pro in Sketchy, where ball pro helps you remember Buproprion and NET DAT helps you remember it blocks the NE Transporter and DA/ dopamine Transporter—> inc NE, dopamine in cleft)

Answer 287

A beta-blocker

Answer 288

Inhibits reputable of NE, dopamine, and serotonin (similar to SSRIs, SNRIs, and TCAs) Also vasoconstricts (NE= sympathetic NT, so has this effect on vessels)

Answer 289

Long-actin partial Mu-opioid agonist (blueprint in Sketchy) Used to help patients with opioid addiction taper off of them/ get clean

Answer 290

Long-acting opioid used to attenuate withdrawal symptoms (done timer in Sketchy)

Answer 291

Lithium treatment—> causing DI (nephrogenic diabetes insipidous where the kidneys aren’t responding to ADH, so not retaining water, just peeing it out)

Answer 292

Clozapine This is a “big gun” good for treatment-resistant schizophrenia (you want to use other 2nd/ 1st gen anti-psychotics before you resort to this due to nasty side effects) Monitor neutrophils! Why? Agranulocytosis is a dangerous side effect!

Answer 293

Marijuana (Think of a stoner...red eyes, in la la land/ things are moving slow to them. Remember that Marijuana is the “weird drug” in that it calms you but makes your heart race.)

Answer 294

MS (Multiple Sclerosis) -autoimmune inflammation and demyelination of the CNS—> relapsing and remitting symptoms Focal white matter lesions (makes sense bc white matter= axons, which is the part of the neuron with myelin, and therefore the part affected by demyelination)

Answer 295

TCA (tricyclic anti-depressant)

Answer 296

She’s intoxicated with marijuana (Note the red eyes like a stoner, high HR bc pot causes your heart to race even though you get calmed by it, and it’s acute onset after a party so not a psychiatric diagnosis)

Answer 297

1. Thiazides 2. ACE inhibitors 3. NSAIDs *and any other drug that interferes with renal function Because lithium is excreted by the kidneys!

Answer 298

Lithium toxicity—> seizure From the NSAIDs, which interfere with renal function. These are contraindicated in patients on lithium (along with ACE inhibitors, thiazides, and any other drugs that act on the kidneys) since lithium is excreted by the kidneys!

Answer 299

AChE inhibitor (blocks the ACh Esterase enzyme that breaks down ACh—> more ACh) - this is a cholinergic (ACh) drug - useful because there is found to be decreased ACh levels in AD Here are the specific names of the drugs: Donepezil, Rivastigmine, Galantamine (“Dona River dances at the Gala”) **2nd line= Memantine (NMDA/ glutamate receptor antagonist)

Answer 300

Oxalate crystals (enveloped shaped)

Answer 301

Substantia nigra

Answer 302

Fetal alcohol syndrome (Low birth weight, adopting mom meaning we don’t know her background and if she drank, and distinct facial features point to fetal alcohol syndrome. Don’t let the single palmar crease make you think must be Downs!)

Answer 303

REM sleep behavior disorder (seen in Lewy body dementia)

Answer 304

Vitamin B1/ thiamine He is an alcoholic—> liver cirrhosis—> gynecomatia due to increased estrogen (not getting broken down in the liver), palmar erythema (coag factors not getting made)

Answer 305

A short-acting benzo like Lorazepam (Beta-blockers are first line for performance anxiety, but not suitable for an asthmatic who needs their beta-agonist/ albuterol. Plus an SSRI would take 4-6 weeks to kick in and their speech is in 3 days. Also not appropriate treatment bc the patient doesn’t have Generalized Anxiety Disorder, just anxiety over the speech like social phobia for public speaking)

Answer 306

Any drugs that block dopamine (antipsychotics, GI anti-emetics) Extrapyramidal side effects are just side effects caused by dopamine receptor blockade

Answer 307

The patient is entering REM phase sooner (shorter sleep cycles)

Answer 308

No, probably not. These 2 aren’t associated with psychosis...

Answer 309

Multiple personality disorder

Answer 310

Risk of re-feeding syndrome If you give a bunch of calories to a significantly malnourished patient—> glucose spike—> HUGE increase in insulin (body is in a mode to store all it can since it’s so deprived of calories) that can lead to electrolyte imbalances that can be deadly (low phosphate, low K+, low Mg—> cardiac issues, rhabdo, seizures)

Answer 311

Creutzfeldt- Jakob disease (Spongiform Encephalopathy) | -prion disease (rapidly progressive dementia with myoclonus within weeks to months from prion infection of brain)

Answer 312

Periodic sharp waves

Answer 313

2nd gen anti-pscyhotics (“only” in Sketchy)

Answer 314

Sleep study

Answer 315

Valproic acid (hepatotoxicity is a side effect- remember cow with liver spots in Sketchy) Remember that Valproic acid is a anti-epilepsy drug, but also used as a mood stabilizer (for bipolar). This lady doesn’t have bipolar, but Schizoaffective means Schizo/ psychotic symptoms + mood symptoms (depression or mania). So its reasonable to think Valproic acid could have been given to treat her mania/ mood symptoms—> hepatotoxicity.

Answer 316

A symptom of narcolepsy- loss of muscle tone following a strong emotional stimulus like laughing (you laugh and bam! All the sudden you pass out asleep)

Answer 317

Corticosteroid-induced psychotic disorder | **there is also a such thing as histamine-induced psychotic disorder

Answer 318

Delirium (confusion) due to anticholinergic med He was given an antipsychotic. These block muscurinic receptors—> anti-muscurinic side effects (example: urinary retention bc blocking PNS receptors, so get sympathetic symptoms, no time to pee when running from a bear)

Answer 319

Low ACh | Basal nucelus of Meynert

Answer 320

Basal nucleus of Meynert

Answer 321

Central tegmentum and Substantia nigra (SN pars compacta)

Answer 322

Nucleus acumbens/ caudate nucleus

Answer 323

Locus ceruleus (pons) | Remember people with lots of NE are having an adrenaline high and are loco

Answer 324

Raphe nucleus (medulla) | Remember going to Ralphs to get food makes you happy= serotonin

Answer 325

1. Decreased GABA (less CNS depression) 2. Increased NE (like more adrenaline) 3. Decreased Serotonin (not as happy, why SSRI works)

Answer 326

1. Decreased dopamine 2. Decreased NE 3. Decreased serotonin (Antidepressants raise levels of these)

Answer 327

Increased dopamine | This is why antipsychotics block D2 dopamine receptors

Answer 328

Decreased ACh

Answer 329

1. Decreased ACh (can reason this bc is assoc with dementia) 2. Increased dopamine (aggression that can be misinterpreted as psychosis/ substance abuse) 3. Decreased GABA (degeneration of GABAergic neurons in the caudate nucleus of the basal ganglia)

Answer 330

1. Increased ACh 2. Decreased dopamine (we treat with L-DOPA) 3. Decreased serotonin

Answer 331

``` Huntington’s disease Caudate nucleus (there is degeneration of GABAergic neurons in the caudate nucleus of the basal ganglia) ```

Answer 332

Ventriculomegaly/ enlargement of the ventricles (lateral and 3rd) on CT scan of the head

Answer 333

NMS (neuroleptic malignant syndrome, which includes rhabdo)

Answer 334

``` Super sedated, sitting down (not running around) Breathing slowly (CNS depressant) Constricted pupils (in same class as opioids) ```

Answer 335

Short-acting benzo like Lorazepam (better than a beta-blocker in this case, also consider it’s okay for him to be sedated/ knocked out by a benzo bc he just needs to sit in the plane...you wouldn’t give a benzo for performance or test anxiety bc that would impair performance/ cognition...you’d give a beta-blocker)

Answer 336

Really high fever (>104 degrees)

Answer 337

SSRI (it is a new SSRI!)

Answer 338

Absence seizure

Answer 339

Circadian rhythm sleep disorder (Her sleep cycle is messed up) *not enough criteria met for MDD (she’s emotional/ teary but this could be due to sleep deprivation), not narcolepsy (no hallucinations before bed/ when waking up and she’s not abruptly passing out asleep like after laughing...plus, when she can sleep in she feels fine)

Answer 340

Social phobia

Answer 341

Huntington’s disease (Note the family history and each generation gets it earlier, jerky movements, the type of behavior change/ aggression) Caudate nucleus atrophy

Answer 342

1st gen antipsychotic Blocks D2 dopamine receptors—> decreased binding of dopamine at postsynaptic receptors

Answer 343

Serotonin syndrome SSRI + Tramadol (weak mu-opioid agonist that inhibits NE and serotonin Rey-take—> inc NE and serotonin in cleft...the tram in the distance of the opioid Sketchy) —> too much serotonin! Should NOT be taking Tramadol while on an SSRI

Answer 344

SSRI (citalopram city in Sketchy)

Answer 345

1st line—> SSRIs | 2nd line—> Clomipramine, Venlafaxine (SNRI)

Answer 346

Recommend alcohol rehabilitation Don’t give a benzo when the patient isn’t experiencing withdrawal symptoms and getting off the alcohol (in fact, if you give a benzo and he’s drinking behind your back, you cause worse CNS depression that can be fatal). First step is always to get them to realize they have an alcohol problem. Exception is if he came into the hospital with severe tremors, sweating, having seizures due to alcohol withdrawal. Then you have to give a benzo to supply that CNS depression and prevent these dangerous effects (if no benzo is available, old school way would be give them alcohol bc these symptoms can be fatal).

Answer 347

Cocaine breakdown product He’s intoxicated with cocaine (stimulant) We give him a benzo (does the opposite/ CNS depression)

Answer 348

Lewy body dementia -visual hallucinations, REM sleep behavior disorder (thrashing/ hitting in their sleep), and Parkinsonism (slow movement, shuffling)—> think Lewy body dementia **don’t get fooled by CAD in the history and think it must be vascular dementia! That’s a step-wise progression (ex: get a stroke—> decline in memory, get another stroke—> memory gets even worse...)

Answer 349

1. Lewy body dementia (it is associated with Parkinsonism) | 2. Dementia secondary to Parkinson’s disease (they were diagnosed with Parkinson’s and then got dementia later from it)

Answer 350

Schedule a follow-up in the next month. Remember that SSRIs take 4-6 weeks to reach maximal effect! You can’t say they aren’t working until you wait this time, so don’t go changing the meds yet.

Answer 351

Schizophrenia

Answer 352

``` Any stage (primary, secondary, or tertiary) of syphilis infection! *can present like meningitis ```

Answer 353

Abrupt travel/ wandering around associated with traumatic circumstances (can be seen in dissociative amnesia, where patient cannot remember important personal information following trauma/ stress)

Answer 354

Pulling out one’s own hair | In addition to CBT (cognitive behavioral therapy), can give Clomipramine (TCA) or SSRIs

Answer 355

1. Benztropine 2. Diphenhydramine (Acute Dystonia= extrapyramidal symptom, sudden sustained contraction of muscles like torticollis of the neck or severe back arching)

Answer 356

1. Acute Dystonia—> benztropine, diphenhydramine 2. Akathisia—> benztropine, beta-blocker, benzo 3. Parkinsonism—> benztropine, amantadine 4. Tardive dyskinesia—> atypical antipsychotics (clozapine), valbenazine, deutetrabenazine

U-World: Block 9 (Psych) Flashcards

(393 cards)