Psych- First Aid for the Wards

question

Symptoms of depression
answer

SIG E CAPS: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor changes, Suicidal ideation
question

Serotonin syndrome
answer

SSRIs and MAOIs spread 5 wks apart fever, myoclonus, mental status change, CV collapse
question

SSRI side efx
answer

Sexual side efx, insomnia, headache, tremor
question

Atypical antidepressants side efx
answer

Sedation, Weight change, Dec seizure threshold (bupropion), Priapism (trazodone)
question

TCA MOA
answer

Block reuptake of norepinephrine and 5-HT
question

TCA uses
answer

Depression, bed-wetting, OCD, chronic pain
question

TCA side efx
answer

Anticholinergic, sedation, orthostatics, arrhythmias, seizures, resp depression, confusion, hallucinations
question

TCAs toxicity
answer

Tri-C’s: Convulsions, Coma, Cardiotoxicity (arrhythmias); resp depression, hyperpyrexia Nortriptyline in elderly
question

MAOI drugs
answer

phenelzine, tranylcypromine, isocarboxazid
question

MAOI clinical
answer

Atypical depression, anxiety, hypochondriacs
question

MAOI side efx
answer

hypertensive crisis, headache, dizziness, insomnia, othostatic hypotension, weight gain
question

Treat TCA overdose
answer

sodium bicarbonate
question

Signs and symptoms of mania
answer

DIG FAAST, Distractibility, Insomnia, Grandiosity, Flight of ideas, Activity, Agitation, pressured Speech, Thoughtlessness
question

Personality disorder criteria
answer

CAPRI- Cognition, Affect, Personal Relations, Impulse Control
question

Personality Disorder Clusters
answer

A:schizoid, schizotypal, paranoid/ B: antisocial, borderline, histrionic, narcissistic/ C:avoidant, dependent, ocd
question

Paranoid Personality Disorder
answer

At least 4 of: (1) suspects exploiting, harming, or deceiving (2) doubts about the loyalty or trustworthiness (3) reluctant to confide in others (4) reads hidden demeaning or threatening meanings into benign remarks or events (5) bears grudges (6) perceives attacks on his or her character, quick to react angrily or to counterattack (7) has recurrent suspicions of fidelity of spouse or sexual partner
question

Schizoid personality disorder
answer

four: (1) neither desires nor enjoys close relationships/ family (2) chooses solitary activities (3) has little interest in sex (4) takes pleasure in few activities (5) lacks close friends or confidants (6) appears indifferent to the praise or criticism of others (7) shows emotional coldness, detachment, or flattened affectivity
question

Schizotypal personality disorder
answer

five: 1) ideas of reference 2) odd beliefs or magical thinking 3) unusual perceptual experiences 4) odd thinking and speech 5) paranoid ideation 6) inappropriate or constricted affect 7) behavior or appearance that is odd, eccentric, or peculiar 8) lack of close friends 9) excessive social anxiety assoc w/ paranoid fears
question

Antisocial personality disorder
answer

three: 1) failure to conform to lawful behaviors 2) repeated lying, use of aliases, or conning others for personal profit or pleasure 3) impulsivity or failure to plan ahead 4) irritability and aggressiveness, repeated physical fights 5) reckless disregard for safety of self 6) consistent irresponsibility 7) lack of remorse
question

Borderline personality disorder
answer

five: 1) efforts to avoid real or imagined abandonment 2) unstable and intense interpersonal relationships alternating extremes 3) identity disturbance: markedly and persistently unstable self-image or sense of self 4) impulsivity in two self-damaging areas 5) recurrent suicidal behavior, gestures, or threats 6) affective instability, reactivity of mood 7) chronic feelings of emptiness 8) inappropriate, intense anger or difficulty controlling anger 9) transient, stress-related paranoid ideation or severe dissociative sx
question

Histrionic personality disorder
answer

five: 1) is uncomfortable when not the center of attention 2) sexually seductive or provocative behavior 3) shifting and shallow expression of emotions 4) uses physical appearance to draw attention 5) speech is impressionistic and lacking in detail 6) self-dramatization, theatricality, and exaggerated expression of emotion 7) suggestible, easily influenced by others 8) considers relationships to be more intimate than they are
question

Narcissistic personality disorder
answer

five: 1) grandiose sense of self-importance 2) fantasies of unlimited success, power, brilliance, beauty, or ideal love 3) believes he’s “special” and unique and can only be understood by other special people 4) requires excessive admiration 5) has a sense of entitlement 6) is interpersonally exploitative, i.e., takes advantage of others 7) lacks empathy 8) often envious or believes others are envious 9) arrogant, haughty
question

Avoidant personality disorder
answer

four: 1) avoids occupations that involve interpersonal contact, because of fears of criticism, disapproval, or rejection 2) unwilling to get involved with people unless certain of being liked 3) restraint in intimate relationships, fear of being shamed or ridiculed 4) preoccupied with being criticized or rejected socially 5) is inhibited in new interpersonal situations, inadequacy 6) views self as socially inept, personally unappealing, or inferior 7) reluctant to take personal risks or to engage in any new activities, may prove embarrassing
question

Dependent personality disorder
answer

five: 1) difficulty making everyday decisions 2) needs others to assume responsibility for most major areas of his or her life 3) difficulty expressing disagreement with others, fear of loss of support or approval 4) difficulty initiating projects or doing things on his or her own 5) excessive lengths to obtain nurturance and support from others, do things that are unpleasant 6) uncomfortable or helpless when alone 7) seeks another relationship for care and support when relationship ends 8) unrealistically preoccupied with fears of being left to take care of himself
question

Obsessive-compulsive personality disorder
answer

four: 1) preoccupied with details, rules, lists, order, organization, or schedules 2) perfectionism that interferes with task completion 3) devoted to work and productivity to the exclusion of leisure activities and friendships 4) overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values 5) unable to discard worn-out or worthless objects 6) is reluctant to delegate tasks or to work with others unless they submit to her way 7) adopts a miserly spending style toward both self and others; money is hoarded 8) shows rigidity and stubbornness
question

Substance abuse
answer

1) failure to fulfill major role obligations at work, school, or home 2) Recurrent substance use in situations in which it is physically hazardous 3)Recurrent substance-related legal problems 4) Continued substance use despite having persistent or recurrent social or interpersonal problems
question

Substance dependence
answer

1) Tolerance 2) Withdrawal 3) substance taken in larger amounts 4)There is a persistent desire or unsuccessful efforts to cut down or control substance use 5) A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover 6)Important social, occupational, or recreational activities are given up or reduced because 7) The substance use is continued despite knowledge of having a persistent physical or psychological problem
question

Alcohol MOA
answer

Activates GABA and serotonin receptors in the CNS. Inhibits glutamate receptors.
question

Alcohol metabolism
answer

Alcohol> acetaladehyde> acetic acid alcohol dehydrogenase, aldehyde dehydrogenase
question

Def conversion disorder
answer

A change or loss of physical function. Recent psychologic stressor or conflict. Unconsciously produces the symptom. Cannot be explained by organic etiology. Not limited to pain or sexual dysfunction.
question

Alcohol withdrawal
answer

autonomic hyperactivity, hallucinations, and fluctuating activity levels, ranging from acute agitation to lethargy chlordiazepoxide PO or lorazepam IV or IM
question

olfactory and other unusual types of hallucinations, derealization episodes, mood lability, irritability, intermittent anger, and behavioral dyscontrol
answer

Tumors of the temporal lobe
question

Avoidant personality disorder
answer

intense need for connection and social interaction with others, coupled with an intense fear of rejection
question

good prognosis in schizophrenia
answer

late onset of the disease, obvious precipitating factors/stressors, acute onset, good premorbid functioning, the presence of mood disorder symptoms, the patient being married, a family history of mood disorders, good support systems, and the presence of positive symptoms
question

Dx Schizophrenia
answer

Two for 6 mo: 1) Delusions 2) hallucinations 3) Disorganized speech 4) Disorganized/ catatonic behavior 5) Negative sx
question

Negative sx schizophrenia
answer

5 A’s Anhedonia, Affect (flat), Alogia, Avolition (apathy), Attention (poor)
question

Subtypes of schizophrenia
answer

paranoid, disorganized, catatonic, undifferentiated, residual
question

Dopamine pathways affected in schizophrenia
answer

Prefrontal cortex (neg sx), Mesolimbic (pos sx)
question

Dopamine pathways affected by neuroleptics
answer

Tuberoinfundibular: hyperprolactinemia-> gynecomastia, galactorrhea Nigrostriatal: extrapyramidal side efx
question

Schizoaffective disorder dx
answer

Criteria for schizophrenia and MDD, manic, mixed Delusions or hallucinations for 2 wks w/o mood disorder
question

Delusional disorder dx
answer

1. Non bizarre fixed delusions 1mo, 2. Not meet criteria for schizophrenia, 3. Function not significantly impaired
question

Koro
answer

Patient believe penis is shrinking and will disappear causing his death
question

Amok
answer

Sudden unprovoked outbursts of violence which person has no recognition
question

Brain fas
answer

Headache, fatigue, visual disturbances in males
question

Major depressive episode dx
answer

Five in 2 wks: 1. Depressed mood, 2. Anhedonia, 3. Change in appetite, 4. Feelings of worthless ness, 5. Insomnia or hypersomnia, 6. Diminished concentration, 7. Psychomotor change, 8. Fatigue or loss of energy, 9. Recurrent thoughts of death or suicide
question

Manic episode dx
answer

1. Distractible, 2. Grandiosity, 3. Inc goal activity, 4. Dec sleep, 5. Flight of ideas, 6. pressured speech, 7. Involved in activities with high risk
question

Mixed episode dx
answer

Criteria met for both manic and depressed, >1 wk
question

Hypomanic
answer

elevated, expansive, irritable mood, no impaired function, >4 days, no psychotic features
question

Major depressive disorder (MDD)
answer

At least one MD episode, No hx of mania or hypomania
question

Sleep problems assoc w/ depression
answer

difficulty falling asleep, early morning awakening
question

stages of grief
answer

Denial, Anger, Bargaining, Depression, Acceptance
question

Rapid cycling
answer

4 or more mood episodes in 1 year
question

Types of depressive disorders
answer

Melancholic, Atypical, Catatonic, Psychotic
question

Psychoanalysis not indicated for:
answer

ppl who have problems with reality testing, psychotic patients, severe cluster A or B personality disorders
question

Mature defenses
answer

altruism, humor, sublimation, suppression
question

Sublimation
answer

Satisfying socially objectionable impulses in an acceptable manner
question

Neurotic defenses
answer

Controlling, Displacement, Intellectualization, Isolation of affect, Rationalization, Reaction formation, Repression In OCD, hysterical, adults under stress
question

Immature defenses
answer

Acting out, Denial, Regression, Projection In children, adolescents, pscyhotics
question

Psychoanalysis is used in
answer

Cluster C pd, Anxiety disorders, OCD, problems coping, Anorexia, Sexual disorders, Dysthymic disorder
question

Psychoanalytically oriented psychotherapy and brief dynamic psychotherapy
answer

Similar to psychoanalysis, but briefer weekly for 6m-1.5y, face to face sessions
question

Focuses on development of social skills to help treat certain psychiatric disorders
answer

Interpersonal therapy – once weekly for 3-6m, improve interpersonal relations
question

Help patient feel safe during a difficult time
answer

Supportive psychotherapy, healthy individuals in a crisis, focus on empathy, understanding and education
question

Helping patients change behaviors that contribute to their symptoms
answer

Behavioral therapy
question

Classical conditioning
answer

Pavlov’s dog
question

Operant conditioning
answer

positive or negative reward
question

Patient performs relaxation techniques while being exposed to anxiety provoking stimulus
answer

Systemic desensitization (behavioral conditioning) – phobias
question

Patient is confronted with anxiety stimulus and not allowed to withdraw
answer

Flooding and implosion (behavioral conditioning) – phobias
question

Negative stimulus paired with specific behavior
answer

Aversion therapy (behavioral conditioning) – used to treat addictions or paraphilias
question

Rewards are given after specific behaviors to positively reinforce
answer

Token economy (behavioral conditioning) – used for ADLs in disorganized or mentally retarded individuals
question

Physiological data given to patients as they try to ctrl physiological states
answer

Biofeedback (behavioral conditioning)- migraines, HTN, chronic pain, asthma, incontinence, agoraphobia,
question

Seeks to correct faulty assumptions and neg feelings
answer

Cognitive therapy- patient taught to identify maladaptive thoughts – depressive and anxiety disorders, paranoid pd, OCD, somatoform, eating disorders
question

Focuses on a patients sx by examing the connection btw thoughts and behaviors
answer

CBT- protocol or manual with homework depression, anxiety, substance abuse
question

TCA overdose
answer

IV sodium bicarbonate
question

major complications of TCAs
answer

3Cs- Cardiotoxicity, Convulsions, Coma
question

MAOIs more effective in
answer

atypical depression, hypersomnia, Inc appetite and Inc sensitivity to interpersonal rejection
question

Common side effects of TCAs
answer

Dry mouth, retention, fatigue, blurry vision (anticholinergic)
question

What to monitor when prescribing lithium
answer

lithium, creatinine, thyroid levels
question

Clozipine monitoring
answer

WBC ct – agranulocytosis
question

Chlorpromazine side efx
answer

Orthostatics, bluish skin, photosensitivity (typical antipsychotic)
question

Thioridazine assoc w/
answer

retinitis pigmentosa (typical antipsychotic)
question

Treat extrapyramidal side efx
answer

Reduce dose of antipsychotic, anticholinergic (Benztropine), antihistaminergic (Diphenhydramine/ Benadryl), antiparkinsonian (Amantadine)
question

FDA approved for mania
answer

quetiapine, olanzapine, aripiprazole, risperidone, ziprasidone
question

Benzos not metabolized by liver
answer

(LOT of them) Lorazepam, Oxazepam, Temazepam
question

Benzo overdose
answer

flumazenil, but inducing w/d quickly can lead to death
question

lesion to the right prefrontal area
answer

laughter, euphoria, and a tendency to joke and make puns
question

lesion to the left prefrontal area
answer

abolishes the normal mood-elevating influences of this area and produces depression and uncontrollable crying
question

Supportive psychotherapy
answer

close alliance, define current problems, solutions, shore up ego adjustment disorders, acute emotional crisis, chronic schizophrenia
question

Insight-oriented psychotherapy
answer

recognize transference/ countertransference, uncover unconscious wishes and defenses Anxiety, Depression, Somatoform, Dissociative, Personality, Neuroses, Trauma
question

Cognitive therapy
answer

Major depression, turn automatic thoughts into diff behavior
question

deficiencies of planning, monitoring, flexibility, and motivation, lesion
answer

Lesions in the dorsolateral area
question

Increases after nonepileptic seizures
answer

prolactin
question

peak withdrawal heroin
answer

48 hrs, starts 8-12
question

Peak withdrawal methadone
answer

3-8th day, starts 1-3 days
question

Partial complex seizures originate
answer

usually (90% of the time) originate in the temporal lobe.
question

Auras that consist of unpleasant odors often originate in the
answer

uncus, an area at the tip of the temporal lobe that is involved in processing olfactory sensations
question

Neurotransmitter associated with alzheimers
answer

Acetylcholine
question

Dysfunction of the orbitofrontal area causes
answer

disinhibition, irritability, lability, euphoria, and lack of remorse. Insight and judgment are impaired; patients are distractible

Get instant access to
all materials

Become a Member