USMLE World Psychiatry – Flashcards
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What occurs if pts taking MAO inhibitors eat foods high in tyramine?
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ie. phenelzine and aged cheese hypertensive crisis
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How does cocaine/amphetamine intoxication present?
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dilated pupils HTN tachycardia (psychosis seen in amphetamine use and not often in cocaine use)
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How does somatization disorder present?
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multiple recurrent somatic complaints that have persisted for several years and that have been evaluated by healthcare providers to no avail. presents before age 30 and most frequently occurs in females
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How is Tourette syndrome tx?
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typical antipsychotics such as haloperidol or pimozide
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What is the mechanism of action of antipsychotic medications?
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dopamine-D2 receptor blockade added serotonin receptor binding of atypical antipsychotics reduces the likelihood of extrapyramidal side effects
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What medication can cause hyperprolactinemia?
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antipsychotic medications secondary to their dopamine blockade effect
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What is childhood disintegrative disorder?
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rare pervasive developmental disorder (males) period of normal development for at least 2 yrs followed by loss of previously acquired skills in at least two of the following areas: expressive or receptive language, social skills, bowel or bladder control, play and motor skills
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What should be monitored when a patient starts lithium?
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Cr and thyroid function tests Side Effects: - nephrogenic diabetes insipidus - hypothryoidism - Ebstein's anomaly in the fetus
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What are contraindications to bupropion use:
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Seizure disorders eating disorders conditions predisposing to seizures (concurrent alcohol or benzo use)
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What is the timeline for bereavement?
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tapers w/in two months
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What is dysthmic disorder?
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chronic, low-grade depression that lasts years affected individuals don't meet all the criteria for MDD lasts two years or more Tx: antidepressants and/or therapy can improve quality of life
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What is the treatment of choice for adjustment disorder?
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cognitive or psychodynamic psychotherapy
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What is adjustment disorder?
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emotional or behavioral sx that develop w/in three months of exposure to an identifiable stressor and that rarely lasts more than six months after the stressor has ended
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How does PCP intoxication usually present?
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distinct behavioral changes such as physical aggression, severe agitation, impulsivity, impaired judgement, psychosis, paranoia, hallucinations nystagmus, hypertension, tachycardia, ataxia, dysarthria, muscle rigidity, seizures, coma
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What brain imaging pattern is common among schizophrenics?
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increased ventricular size on CT
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What is rationalization?
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defense mechanism offering a rational, logical reason for an upsetting event rather than the real reason
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What is dissociative fugue?
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sudden and unexpected travel, inability to remember his past, confusion about personal identity assume new identities altogether
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What is dissociative amnesia?
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presence of one or more episodes of inability to recall important personal information. Memory disturbance related to traumatic/stressful event and is too extensive to be considered ordinary forgetfulness
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What are indications for psychiatric hospitalization?
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- homicidal ideation - suicidal ideation - grave disability - gross disorganization - agitated or threatening behavior - severe sx of substance intoxication or withdrawal
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What are first line agents to treat bipolar disease?
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lithium, lamotrigine, olanzapine, quetiapine valproic acid and aripiprazole are second line acute mania: antipsychotics ie haloperidol
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What comorbid psych condition is found in Tourette syndrome?
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ADHD and OCD
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How are panic attacks treated acutely?
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benzos SSRIs for longterm tx
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What is circadian rhythm sleep disorder?
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pt with insomnia who often travels between different time zones
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What is given to treat alcohol withdrawal syndrome?
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long-acting benzos: diazepam
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What should be monitored in pts taking olanzapine?
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fasting glu and lipids all atypical antipsychotics, including olanzapine, can cause weight gain, hyperglycemia, dyslipidemia, and HTN.
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What is delusional disorder?
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involves one or more non-bizarre delusions in an otherwise high-functioning individual
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What is schizoaffective disorder?
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pt has time periods in which psychotic sx are present w/ and w/o mood sx
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What is a SE of clozapine use?
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agranulocytosis monitor WBC also lowers seizure threshold
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What is conversion disorder?
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sudden-onset neurologic sx preceded by an obvious stressor pts with conversion disorder can be hysterical or strangely indifferent to their sx
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How is social phobia tx?
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assertiveness training (CBT) and SSRIs
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what is the treatment of choice for schizophrenics who suffer relapses due to treatment noncompliance with oral meds?
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depot antipsychotics (fluphenazine, risperidone, paliperidone, and haloperidol)
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What can be given to slow the cognitive decline in AD?
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reversible actylcholinesterase inhibtors: - donepezil - rivastigmine - galantamine - tacrine
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How does OCPD present?
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need for perfection, over attention to detail, stubbornness, and need to strictly follow rules
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How does bulimia present?
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1) recurrent episodes of uncontrolled binge eating followed by feelings of extreme disgust/guilt 2) repeated compensatory behavior to prevent weight gain after binging (e.g. induced vomiting, laxative abuse, diuretic abuse, fasting, excessive exercise) 3) binging episodes that occur at least 2x/wk over a three mo period 4) normal or slightly above normal BMI 5) dissatisfaction with body weight and shape
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What is alcohol hallucinosis?
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type of alcohol withdrawal syndrome that typically develops w/in 12-24hrs of last drink and resolves w/in 24-48hrs unlike DT, sensorium is intact and vital signs are usually normal
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What are the guidelines of lithium tx?
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1) single manic episodes require long-term maintenance for a period of at least one year 2) three or more relapses require tx with lifelong maintenance lithium must be tapered
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what is schizophreniform disorder?
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full-blown schizophrenic sx (e.g. hallucinations, delusions) that have been present for one to six mo
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What is intellectualization?
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defense mechanism - transformation of unpleasant event into a purely intellectual problem with no emotional component
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What is factitious disorder?
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pts present to healthcare setting with s/sx that they have deliberately and consciously produced for no obvious reason other than to gain admission to the hospital and adopt the sick role
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what is the risk of taking lithium during pregnancy?
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1st trimester: ebstein's anomaly 3rd trimester: goiter and transient neonatal neuromuscular dysfxn
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How are specific and simple phobias tx?
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benzos (short-acting)
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What is the neurotransmitter alteration that is related to OCD?
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serotonin
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What are the different subtypes of schizophrenia?
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catatonic - predominance of physical sx, immobility or excessive motor activity and the assumption of bizarre postures - unresponsive or demonstrate extreme negativism or mutism undifferentiated - mixed sx Paranoid - preoccupation w/ delusions or auditory hallucinations w/o prominent disorganized speech or inappropriate affect Residual: - previous dx but no longer have prominent psychotic sx. persistent sx include eccentric behavior, emotional blunting, illogical thinking, or social withdrawal Disorganized: - disorganized behavior, disorganized speech, flat or inappropriate affect - rambling speech and his inappropriate behavior (masturbation in public, laughing at strange times)
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What is tardive dyskinesia?
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involuntary perioral movements: biting, chewing, grimacing, tongue protrusions atypical antipsychotic med that causes EPS: reisperidone Tx: replace with clozapine
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How long should pts with one episode of major depression be treated?
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6mo after pt's response if multiple episodes, maintenance therapy will need to be continued for a longer period
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What is passive-aggressive behavior?
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defense mechanism - individual expresses his aggression toward another person w/ repeated, passive failures to meet the other person's needs
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What is NMS?
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life-threatening condition that occurs after admin of antipsychotic medication - fever - rigidity - AMS - autonomic instability
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How is performance related anxiety tx?
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propranolol
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What is displacement?
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defense mechanism individual displaces negative feelings assoc with an unacceptable object or situation onto a "safer" object or situation
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When should bereaved pts consider psychotherapy?
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at least 2 weeks of sx of depression 6-8wks after major loss - consider psychotherapy and a trial of antidepressants
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What is the risk of bipolar disorder in a pt who has an individual w/ a first degree relative with the disease?
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5-10%
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**What are complications that women with previous dx of anorexia nervosa at risk for if pregnant?
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**miscarriage IUGR hyperemesis gravidarum premature birth C-section postpartum depression
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What medication can be given to reduce EPS effects of antipsychotics?
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anticholinergic meds like benztropine diphenhydramine (benadryl) works too
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How is schizophreniform differentiated from schizophrenia?
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schizophreniform: >1mo but 6mo
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When is hospitalization recommended for anorexia nervosa pts?
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evidence of medical complications and/or when they weight less than 75% of average body weight for their age, sex, and height
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What are common SE of methylphenidate (CNS stimulant)?
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nervousness decreased appetite weight loss insomnia abd pain
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How is NMS tx?
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dantrolene and supportive care
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What should be done if child abuse is suspected?
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1. complete PE 2. radiographic skeletal survey (if necessary) 3. coagulation profile (if multiple bruises present) 4. report to CPS 5. admittance to the hospital (if necessary) 6. consultation with psychiatrist and evaluation of family dynamics
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What is reaction formation?
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defense mechanism transformation of an unwanted thought or feeling into its opposite
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What is selective mutism?
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verbal and talkative at home, but refuse to speak in select settings (school, public events, etc)
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What is stranger anxiety?
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normal finding in children until three years of age. Persistent fear of strangers after that is generally attributable to other causes
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How is narcolepsy tx?
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scheduled daytime naps psychostimulants (modafinil) combination of antidepressants and psychostimulants
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How is GAD tx?
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buspirone
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When should lithium be avoided to tx bipolar disorder?
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if pt has renal dysfxn alternatives: valproic acid and carbamazepine
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How does cannabis abuse present?
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behavioral changes and two or more of the following sx: dry mouth, tachycardia, increased appetite, conjunctival injection
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What type of benzo use can cause withdrawal?
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abrupt cessation of short-acting benzo like alprazolam
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What is fantasy?
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defense mechanism substitutes less disturbing view of the world in place of reality as a means of resolving conflict
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Pts with panic disorder have increased risk of suffering from what conditions?
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depression agoraphobia GAD substance abuse
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What is displacement?
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defense mechanism unacceptable feelings about one object or person are displaced onto another, "safer" object or person i.e. after an argument with his wife, he left eh house and wrecked the car she had given him as a present
