question

Fixed false belief-

answer

Delusion

question

misinterpretation of an external stimuli

answer

illusion

question

Sensory perception without an external stimuli

answer

Hallucination

question

_______: is exemplified by either delusions, hallucinations or severe disorganized thought/behavior

answer

psychosis

question

_____ hallucinations are most commonly exhibited by schizophrenia patients

answer

auditory

question

Increasing duration of a schizophrenia like diagnosis (3 things)

answer

1. Brief psychotic disorder (6m)

question

Criteria for schizophrenia

answer

1. Hallucinations 2. Delusions 3. Disorganized speech 4. Disorganized thought 5. Negative symptoms - At least two of the following with one from (1-3) - Duration of illness 6 months - Significant social, occupational or self-care deterioration

question

____: treatment for schizophrenia when all else fails. Can cause agranulocytosis. Monitor WBC and ANC counts regularly

answer

Clozapine

question

Most drugs that are effective in treating schizophrenia are dopamine receptor _____. Some of the atypical antipsychotics also anatagonize _____

answer

antagonists; seritonin

question

Brain image findings in people with schizophrenia

answer

- enlarged ventricles - diffuse cortical atrophy - reduced brain volume

question

Side effects from: typical antipsychotics- atypicals-

answer

extrapyramidal symptoms- tremor rigidity, bradykenisia, slurred speech, akathisia, tardive dyskenesia. Metabolic syndrome

question

_______ a disorder that results in involuntary, repetitive body movements. This may include grimacing, sticking out the tongue or smacking of the lips.

answer

tardive dyskenisisa

question

Metabolic syndrome:

answer

HTN, dyslipidemia, inc blood sugar, inc waist circumference.

question

_____ characterized by fever, labile BP, tachycardia, tachypnea, diaphoresis, muscular rigidity (lead pipe rigidity), altered mental status, and autonomic dysfunction. Typically as a result of treatment with high-potency first gen antipsychotics). Treatment is to discontinue meds and medical management.

answer

neuroleptic malignant syndrome

question

Schizoaffective disorder: _______ + ______

answer

mood disorder + schizophrenia

question

Types of delusions:

answer

Erotomanic; grandiose; somatic; persecutory; jealous; mixed.

question

Criteria for schizoaffective disorder:

answer

- Meet criteria for MDD or manic episode during which psychotic symptoms consistent with schizophrenia are also met. - Delusions or hallucinations for 2 weeks in the absence of mood disorder symptoms - Mood disorder symptoms present for the majority of the psychiatric illness

question

Deluisonal disorder criteria

answer

- 1 or more delusions at least 1month - do not meet criteria for schizophrenia - Function not impaired, no obvious bizarre behavior

question

_______ (PD): solitary activities, lack enjoyment from social interactions, no psychosis.

answer

schizoid

question

______ (PD): paranoid, odd or magical beliefs, eccentric, lack of friends, social anxiety.

answer

schizotypal

question

Criteria for MDE

answer

- Must include 5 of the following for at least a 2 week period: - M SIGE CAPS (must include either M or I)

question

Criteria for Manic episode

answer

- Persistent elevated mood for at least 1 week (or any duration if hosp reqd) - At least 3 of the following: DIG FAST, 4 of these reqd if mood only irritable

question

Mania: - lasts at least __ days - Causes severe social impairment or occupational functioning - May nessecitate hosp - may have ____ features Hypomania: - lasts at least __ days - _____ impairment in social/occup function - Does not req hosp - No psychotic features

answer

7; psychotic; 4

question

Symptoms of Mania- DIG FAST meaning

answer

Distractibility Insomnia/Impulsive behavior Grandiosity Flight of ideas Agitation Speech pressured Thoughtlessness

question

_____ inability to experience pleasure

answer

anhedonia

question

MDD criteria

answer

- previous MDE - No history of mania/hypomania

question

Side effects of SSRIs

answer

GI intolerance, sexual dysfunction.

question

TCA side effects

answer

cardiac arrthymias; weight gain; orthostatic hypotension; anticholinergic effects

question

Seasonal affective disorder triad:

answer

1. Irritability 2. Hypersomnia 3. Carbohydrate craving

question

Bipolar 1 involves episodes of mania and a of major depression however, episodes of major depression are _____ reqd for diagnosis. Only mania reqd.

answer

not

question

______ has the highest genetic link of all major psychiatric disorders

answer

Bipolar 1

question

_____ is the best treatment for a pregnant woman who is having a manic episode.

answer

ECT

question

Lithium has a ____ therapeutic window and many side effects such as: weight gain, tremor, GI disturbance, fatigue.

answer

narrow

question

Bipolar 2 criteria

answer

- At least one MDE and at least one hypomanic episode. (Cannot have past Manic episode if so then Bipolar 1)

question

Criteria for Persistent Depressive Disorder

answer

- 2 Ds- depressive disorder or 2 years, never asymptotic for 2 months, and 2 of the following: Hoplessness Energy low 'Self esteem low 2 Sleep Appetite Decision making impaired/low conc - May have major depression episode or meet criteria for major depression continuosly

question

Cyclothymic disorder

answer

- Over 2 years patient have periods of hypomanic symptoms and depressive symptoms but do not meet criteria for (hypomania or MDE) - pt cannot be symptom free for more than 2 months

question

Dysruptive Mood Dysregulation Disorder (DMDD) crtieria

answer

- Outbursts out of proportion to sit - ;3 outburtst per wk - Btwn outburst angry/irritable mood - Symptoms in at least 2 settings - Symptoms before age 10 - Must be present for 1 yeat, cannot go more than 3 months without symptoms

question

Panic disroder criteria:

answer

- recurrent, unexpected panic attacks with no identifiable trigger

question

_______: is intense fear of being in public places where escape or obtaining help may be difficult

answer

agorophobia

question

________: intense fear of a specific object or situation that is out of proportion to the threat.

answer

specific phobia

question

______: fear of scrutiny by others or fear of acting in a humiliating or embarrassing way

answer

social anxiety disorder

question

specific phobia/SAD criteria

answer

- fear out of proportion to threat - exposure to situation triggers fear response - situation avoided or tolerated with intense fear - significant social/occupation dysf - duration ;6 months

question

_____: failure to speak in specific situations for at least 1 month, despite the ability to comprehend and use the language.

answer

selective mutism

question

Stranger anxiety occurs between _____ months; Separation anxiety from _____ months

answer

6-9m 12-18m

question

_______: are recurrent, intrusive, undesired thoughts that increase anxiety.

answer

obsessions

question

______: repetitive behaviors or mental acts that pt feels driven to perform.

answer

compulsions

question

OCD criteria

answer

- experience obsessions and/or compulsions that are time-consuming and last ;1h daily or cause significant distress or dysfunction.

question

PTSD criteria:

answer

Traumatic event Reexperience Avoidance Unable to function Month or more of symptoms Arousal increased - symptoms last for at least one month

question

_____ treat nightmares in those with PTSD

answer

prazosin

question

Acute stress disorder: Trauma occured ___ 1m ago symptoms last ___ 1m In PTSD trauma may have occurred any time in the past.

answer

less, less

question

In PTST the stressful event is ____ threatining. in adjustment disorder the stressful event is not life threatining.

answer

life

question

Adjustment disorder criteria:

answer

- emotional or behavioral symptoms within 3 months of a stressful life event - stressful event not life threatining - marked distress in excess to what is expected - significant impairment in daily functioning - not part of normal berevement - symptoms resolve within 6 months after stressor has terminated

question

Categories of personality disorders

answer

Cluster A- Weird Cluster B- Wild Cluster C- Whimpy

question

Cluster A personality disorders:

answer

Paranoid, Schizoid, Schizotypal

question

Cluster B personality disorders

answer

Antisocial, Borderline, Histrionic, Narcissitic,

question

Cluster C personality disorders

answer

Avoidant; Dependent; Obsessive-Compulsive PD

question

Criteria for Personality disorders

answer

- Enduring pattern of behavior/inner experience that deviates from the persons culture, manifested by at least 2 of the following: - CAPRI- Cognition; Affect; Personal relations; Impulse control - The pattern of personality is pervasive, inflexible and stable

question

_________: general distrust, suspicious

answer

paranoid PD

question

_________: no desire for close relationships. loners.

answer

Schizoid PD

question

________: strange, eccentric, magical thinking

answer

schizotypal PD

question

_______: violates the rights of others without showing guilt. Childhood behavior consistent with conduct disorder. Must be ;18y.

answer

antisocial PD

question

_______: unstable, impulsive, moody, suicidal guestures, feeling of emptiness.

answer

borderline PD

question

Borderline patients often use mechanism of ____- they view others and themselves as all good or all bad.

answer

spliting

question

_______: colorful, dramatic, must be center of attention, use physical appearance to draw attention, perceive relationships are more intimate than they are, easily influenced by others.

answer

histrionic PD

question

_______: inflated sense of worth, demands special treatment, want their own way.

answer

narcissitic PD

question

________: desire companionship but are extremely shy and easily injured. Fear of rejection.

answer

avoidant PD

question

_______ prefer to be alone. _____ want be with others but are too scared of rejection.

answer

schizoid, avoidant

question

______: excessive need to be taken care of that leads to submissive and clinging behavior. Fear of being alone. difficulty making decisions on their own.

answer

dependent PD

question

________: perfectionism, inflexible, orderliness. Preoccupied with unimportant details so and trouble completing tasks in timely fashion.

answer

obsessive-compulssive PD

question

Withdrawl symptoms for a drug are usually _____ of its intoxication effects

answer

opposite

question

_____________________:characterized by a problematic pattern of substance use.

answer

substance use disorder

question

Alcohol is a CNS ______. Alcohol ______ inhibitory GABA receptors and _____ excitatory Glutamate receptors

answer

depressant; activates; inactivates

question

Symptoms of alcohol withdrawal: insomnia, anxiety, irritability, hand tremor, nausea/vomiting, autonomic hyperactivity (diaphoresis, _______cardia, hypertension)

answer

tachy

question

Treatment of alcohol withdrawal

answer

Thiamine, folate, benzo

question

Symptoms of DT- _____ hallucinations, agitation, tremor, autonomic instability, fluctuating levels of psychomotor activity.

answer

visual

question

_______________: opioid receptor blocker. Works by decreasing desire/craving and decrease"high" associated with alcohol

answer

naltrexone

question

__________ (antabuse) blocks the enzyme aldehyde dehydrogenase and causes aversive rxn to alcohol

answer

Disulfiram

question

All patients should be given _____ before glucose to to prevent precipitating Wernikes-Korsakoffs

answer

Thiamine

question

Wernikes encephalopathy caused by _______(vitamin B1) deficiency. Triad of symptoms ____, ____, _____

answer

thiamine; ataxia, confusion, occular abnormalities

question

_________: if Wernike's left untreated. Can also occur on own. Reversible in 20%. Chronic amnestic syndrome. Impaired recent memory, anterograde amnesia, compensatory confabulation

answer

Korsakoffs

question

______ nystagmus is strongly suggestive of PCP intox

answer

rotary

question

Benzo intoxication- ______ is a very short acting benzo antagonist used to treat overdose

answer

Flumazenil

question

Barbituates overdose- _______ urine with sodium bicarb to promote renal excretion

answer

alkalinize

question

Withdrawl of ____ + _____ can be life threatening. Treat with benzos. ____ withdrawl is not life threatening

answer

alcohol, benzo, opioid

question

In general withdrawal from ______ drugs is life threatening. While withdrawal from _____ is not.

answer

sedating, stimulants

question

Examples of opioids:

answer

oxycodone, codeine, dextromethorphan, morphine, methadone, meperidine.

question

Triad of Opioid overdose

answer

Resp depression, Altered mental status, Miosis

question

________ (opiod antagonist) is the treatment of choice for opioid overdose

answer

Naloxone

question

The 6 cognitive domains:

answer

complex attention; executive function; learning and memory; language; perceptual motor skills; social cognition

question

Types of delirium: (5 types)

answer

- Substance intox delirium - Substance withdrawal delirium - Medication induced delirium - Delirium due to another medical con - Delirium due to multiple etiologies

question

______ : cognitive deficits in attention, abstraction, planning, and problem solving. Disinhibited verbal, physical or sexual behavior. No memory impairment.

answer

Frontaltemporal dementia

question

rapidly progressive cognitive decline with myoclonus is suggestive of ________

answer

Creutzfeldt-jacob disease

question

_________: Triad of wet, wobbly and whacky

answer

NPH

question

Anticholinergic side effects:

answer

Can't see, pee, spit, shit. Hot as a hare, dry as a bone, red as a beet, mad as a hatter, blind as bat.

question

Criteria for Intellectual disability:

answer

- Deficits in intellectual functioning and adaptive functioning - Onset during developmental period - Intellectual deficits confirmed by clinical assessment and standardized intelligence testing (2 SD) - Ongoing support reqd for ADLs

question

Prenatal causes of mental retardation. Infections and toxins- TORCH (meaning)

answer

Toxoplasmosis Other (syphillis, AIDS, Alcohol/drugs) Rubella Cytomegalovirus (CMV) Herpes Simplex

question

Genetic syndromes causing ID: _______: epicanthic folds, flat nasal bridge, palmar crease _______: macrocephaly, joint hyperlaxity, macroorchidsm, males;female. Most common inherited ID. _______: obese, small stature, almond shaped eyes, male.

answer

Down syndrome Fragile X syndrome Prader-Willi syndrome

question

Three features of Fetal Alc Syndrome

answer

1. Growth retardation 2. CNS involvement 3. Facial dysmorphology (smooth philtrum, short palpebral fissures, thin vermillion border)

question

Three types of ADHD

answer

1. Predominantly inattentive 2. Predominantly hyperactive/impulsive 3. Combined

question

_______: inattention and hyperactivity in two different settings for ; 6 months. Onset before age 12 but can be diagnosed retroactively.

answer

ADHD

question

First line treatment for ADHD

answer

stimulants- methylphenidate, dextroaphetamine, mixed aphetamine salts.

question

Criteria for Autism Spectrum Disorder

answer

- Impairment in social interaction and restricted/repetitive (behaviors, activities, interests) - Abnormalities in function in early developmental period

question

Most important predictors of adult outcome in someone with ASD: 2 things

answer

Intellectual functioning Language impairment

question

Treatment for ASD

answer

Early intervention Remedial education Behavioral therapy Psychoeducation Low dose antipsychotic

question

Delirium is a disorder of _____ and awareness that develops _______. Symptoms _____ over the course of the day.

answer

attention; acutely; fluctuate

question

Typical symptoms of delirium: ____ attention span, disorientation, fluctuations in level of consciousness, ______ hallucinations, impairment in recent ______.

answer

short; visual; memory.

question

Investigations to determine cause of delirium

answer

- blood glucose, pulse ox, abg, ECG - Labs- CBC, lytes, urinalysis, urine cult - Urine drug screen, BAL, therapeutic drug levels, hepatic panel, thyroid, - Chest xray, head CT or MRI, EEG, lumbar puncture.

question

__________: gradual progressive decline in cognitive function. Primary cognitive domains affected are memory, learning and language. Impairment in one or more neurocognitive domains. Definitive diagnosis not established until postmortem.

answer

Alzheimer's disease

question

________: progressive cognitive decline. Visual hallucinations. Development of extrapyramidal signs. Day time sleepiness.

answer

lewy body dementia

question

______- sudden, rapid, repetitive, stereotyped movements or vocalizations.

answer

Tic

question

__________: AD inheritance. Avg age of diagnosis is 40. Triad of motor, cognitive and psychiatric symptoms. Executive function is the primary cognitive domain affected.

answer

Huntington's Disease

question

_______- utterance of obscene, taboo words as an abrupt, sharp bark or grunt

answer

Coprolalia

question

____- repeating other peoples words.

answer

Echolalia

question

Fact- Tic disorder is one of the few psych disorders where diag criteria do not require symptoms to cause significant distress.

answer

-

question

Treatment for tics:

answer

- Behavioural interventions - Alpha 2 agonists- guafacine

question

______- single or multiple motor or vocal tics (but not both) and have never met criteria for Tourettes. ____: single or multiple motor and/or vocal tics ; 1 year

answer

Persistent (Chronic) motor or vocal tic disorder Provisional Tic Disorder

question

Criteria for Oppositional Defiant Disorder:

answer

- Anger/Irritable mood, argumentative/defiant behavior, Vindictiveness - Symptoms present for 6 months - Symptoms associated with distress to individual or others

question

ODD often preceds ______.

answer

conduct disorder

question

Unlike CD, ODD does not involve physical aggression or violating others basic human ____

answer

rights

question

Treatment for ODD

answer

behavioural modificaiton

question

Enuresis criteria:

answer

- Reccurrent urination into clothes or bed-wetting - occurs 2x wk for ;3 consecutive months or results in clinical distress or marked impairment

question

Encopresis criteria:

answer

- Reccurent defacation into inappropriate places (clothes, floor) - Occurs ; or equal 1x per months for ; or equal to 3 months

question

Treatment for enuresis

answer

- alarm - DDAVP, imipramine

question

____________: disruption in the continuity of an individual's memory. Patients report gaps in the recollection of particular events, usually traumatic ones. Treatment is psychotherapy.

answer

Dissociative amnesia

question

______: lapses in autobiographical info

answer

amnesia

question

_________ is the most severe of the tic disorders. Characterized by multiple motor tics and at least one vocal tic last > 1 year. (not reqd to co occur)

answer

Tourette syndrome.

question

_______: feelings of detachment from one's surroundings

answer

derealization

question

_______: feelings of detachment from one's self. Experiences of unreality or detachment from one's body, thoughts, feelings or actions.

answer

depersonalization

question

Criteria for somatic symptom disorder:

answer

- One or more somatic symptoms that are distressing - Extensive thoughts, feelings or behaviors related to somatic symptoms - Lasts at least 6 months

question

Treatment for somatic symptom disorder:

answer

- Regularly scheduled vistis with single primary care provider

question

Criteria for conversion disorder

answer

- At least one neuro symptom (sensory or motor) - Incompatibility btwn symptom and recognized neuro or medical conditions - Common symptoms: blindness, paralysis, weakness, mutism, sensory complaints, seizures. - Treatment with CBT

question

Criteria for illness anxiety disorder

answer

- preoccupation with having or acquiring a serious illness - Somatic symptoms not present or if present are mild in intensity - High level of anxiety about health - Persists at least 6 months - Treatment with scheduled visits with one doc and CBT

question

_________ syndrome is another older name for factitious disorder.

answer

Munchhausen

question

Criteria for factitious disorder

answer

- Falsification of physical or physiological signs or symptoms in order to assume sick role - Absence of external rewards - Treat- collect collateral. Collaborate with family doc. Confrontation in non threatening way

question

___________: Intentional reporting of symptoms in order to achieve personal gain. Symptoms improved once they get their desired objective.

answer

Malingering

question

______ most serious disruptive behaviors, which violate the human rights of other humans or animals. Inflict cruelty or harm through physical and sexual violence. Lack remorse, lack empathy.

answer

Conduct Disorder

question

__________: patients believe they are ill and do not intentionally produce or feign symptoms. __________: patients intentionally produce symptoms of a psychological or physical illness because of a desire to assume the sick role, not for external rewards. __________: Patients intentionally produce or feign symptoms for external rewards.

answer

somatic symptom disorder factitious disorder malingering

question

4 core qualities of impulse control disorders

answer

1. Repetitive or compulsive engagement 2. Little control over behaviour 3. Anxiety or craving of behavior 4. Relief or satisfaction after completing behavior

question

Criteria for intermittent explosive disorder

answer

- Recurrent behavioral outbursts resulting in verbal and/or physical aggression against people or property - Either: - Frequent small verbal/physical outburst 2x wk for 3 months - ;3/year resulting in physical damage to others, animals or property - Grossly out of proportion to stressor - Not premeditated - Marked distress or impairment in functioning

question

Treatment for intermittent explosive disorder

answer

SSRIs, anticonvulsants or Li - CBT in combo with meds - Group/family therapy may be useful to create behavior plans to help manage episodes

question

_________: subtype of dissociative amnesia. Sudden, unexpected travel away from home, accompanied by amnesia for identity or other autobiographical info.

answer

Dissociative fugue.

question

Low levels of _____ in the CSF has been shown to be associated with impulsiveness and agression

answer

seritonin

question

Criteria for Kleptomania

answer

- failure to resist uncontrollable urges to steal objects - Increasing tension immediately prior to theft - Pleasure or relief while stealing and often intense guilt and depression often reported - treatment with CBT and SSRI

question

Criteria for pyromania

answer

- At least two attempts and deliberately starting fires - Tension or arousal experienced before the act - Curiosity/fascination with fire

question

Criteria and treatment for Dissociative Identity Disorder (Multiple Personality Disorder)

answer

- Disruption of identity, two or more distinct personality states - features of as amnesia, depersonalization, derealization - predominantly develops in those with history of significant childhood trauma - Treat with: psychotherapy. SSRI for comorbid PTSD.

question

Presentation of anorexia nervosa- ____cardia, orthostatic hypotension, arrhythmias,___ prolongation, ____ changes, anemia, leukopenia

answer

brady; QT; ST

question

Anorexia and bulima are characterized by a desire for ______. Both may binge and purge. Anorexia involves ___ body weight and _____ of caloric intake which distinguishes it from bulimia.

answer

thinness; low; restriction

question

_________:Neuro symptom incompatible with any known neuro disease. Often acute onset. Often patient calm and unconcerned

answer

conversion disorder

question

Two types of anorexia

answer

Restrictive type Binge/Purge type

question

Criteria for Anorexia Nervosa

answer

- Restriction of energy intake --> low BW - intense fear of gaining weight or becoming fat - Disturbed body image

question

Physical manifestations of anorexia:

answer

Ammenorrhea, cold intolerance, hypotension, bradycardia, arrhythymia, acute coronary syndrome, cardiomyopathy, MVP, constipation, lanugo, alopecia, edema, dehydration, peripheral neuropathy, seizures, hypothyroidism, osteopenia, osteoporosis.

question

Laboratory abnormalities of anorexia

answer

hyponatremia, hypochloremic hypokalemic alkalosis (if vomiting), QT prolongation, hypercholesterolemia, transaminitis, leukopenia, anemia (normocytic, normochromic), elevated BUN, elevated cortisol, elevated GH, reduced FSH/LH, hypothyroidism, hypoglycemia, osteopenia.

question

__________ syndrome refers to electrolyte and fluid shifts that occur when severely malnourished patients are refed too quickly.

answer

refeeding

question

People with bulimia usually maintain a ____ body weight

answer

normal

question

Criteria for Bulimia

answer

- Episodes of binge eating - Inappropriate attempts to compensate for overeating - Binge eating and compensatory behaviour occur at least 1x wk for 3m - Self worth influenced by BW + shape

question

physical manifestations of bulimia

answer

salivairy gland enlargement (sialadenosis), dental erosion/carries, callous/abraisons on dorsum of hand (russell's sign), petechiae, peripheral edema, aspiration.

question

labratory manifestations of bulimia

answer

hypocholermic hypokalemic alkalosis (if vomitting), metabolic acidosis (laxative abuse), elevated bicarb (compensation), hypernatremia, elevated BUN, elevated amylase, altered thyroid hormone, cortisol homeostasis and esophagitis.

question

______ is often elevated in patients with anorexia

answer

cortisol

question

_____ is an effective medication for bullimia

answer

fluoxetine

question

Bulimia has a _____ prognosis compared to anorexia

answer

better

question

Treatment for bulimia

answer

fluoxetine + therapy

question

_________- eating excessive amount of food in a 2hr period associated with a lack of control

answer

binge eating

question

Criteria for binge eating disorder

answer

- Binge eating with at least 3 of following: - eating rapidly - until uncontrollably full - eating large amounts when not hung - eating alone due to embarsment - feeling disgusted/depressed/guilty after eating - stress over binge eating - Occurs at least 1x wk for 3months - Binge eating not associated with compensatory behaviours

question

Treatment for binge eating

answer

- CBT - Meds--> stimulants, topiromate, Orlistat

question

Two stages of normal sleep-

answer

REM and NREM

question

NREM sleep alternates with REM every ____ mins

answer

90

question

During REM sleep, brain wave patterns resemble EEG of a _____ person

answer

aroused

question

_________: insufficient, excessive, or altered timing of sleep

answer

Dyssomnias

question

_______: unusual sleep related behavior

answer

Parasomnias

question

Dyssomnias include: ______- difficulty falling or remaining asleep ______- day time sleepiness

answer

insomnia, hypersomnia

question

Criteria for Insomnia disorder:

answer

- Difficulty intiating/maintaining sleep or early morning awakenings with inability to fall back to sleep - Occurs 3day/wk for 3 months - Causes sig distress or impairement in function -

question

Treatment for Insomnia

answer

- Sleep hygiene - CBT - Pharmacotherapy - Benzos - Non benzos--> zolpidem (ambien), eszopiclone (Lunesta) - Antidepressents- Trazadone, amitryptiline, doxepin

question

Criteria for hypersolmnolence disorder

answer

- Excessive sleepiness despite 7 hrs of sleep with at least one of the following: reccurent periods of sleep within same day; prolonged, nonrestorative sleep >9hr; difficult being fully awake after awakening - Occurs 3x/wk for 3 months - Causes distress or impairement in functioning

question

Treatment for hypersolmenesce

answer

- Life long therapy with modafinil, methylphenidate, amoxetine - Scheduled napping

question

Features of sleep apnea

answer

- Excessive daytime sleepiness - Apnic or hypoapenic episodes during sleep - Snoring - Frequent awakenings due to gasping - Nonrefreshing sleep - Morning headaches - Hypertension

question

RF for Sleep apnea

answer

Obesity, increased neck circumference,

question

Treatment for OSA

answer

- CPAP - Weight loss and exercise - Surgery

question

Causes of central sleep apnea- 2things

answer

- Idiopathic with Cheyne stokes breathing - Due to opiod use

question

____________- pattern of periodic cresendo-decresendo variation in tidal volume due to HF, stroke or renal failure.

answer

Cheyne-Stokes

question

Treat central sleep apnea

answer

- Treat underlying condition - CPAP/BiPAP - Supplemental O2

question

__________________- polysomnography demonstrates decreased respiration and elevated CO2 levels. Frequently comorbid medical or neuro disorders. treat underlying condition. CPAP/BiPAP.

answer

Sleep related hypoventilation.

question

"tetrad of narcolepsy,"

answer

cataplexy sleep paralysis hypnagogic hallucinations excessive daytime sleepiness

question

_______ hallucination: when going to sleep _______ hallucination: when transitioning from sleep.

answer

hypnaGOgic hyponopomic

question

Criteria for narcolepsy

answer

- Recurrent episodes of need to sleep, lapsing into sleep, napping during the day. Occurs 3x per wk for 3 months. And at least one of the following: - Cataplexy - Hypocretin deficiency in CSF - Reduced REM sleep latency on polysomnography

question

Treatment for narcolepsy

answer

sleep hygiene, scheduled naps, aphetamines

question

Treatment for narcoleptic cataplexy

answer

sodium oxybate

question

__________ in the hypothalmus coordinates 24h or circadian rhythmicity

answer

suprachiasmatic nucleus

question

_________: Delay in sleep onset and wake up times with preserved sleep quality and duration. _________: Normal duration and quality of sleep with sleep onset and awakening times earlier than desired. _________: working shift work. _________: sleep disturbances associated with travel across multiple time zones

answer

Delayed sleep phase disorder Advanced sleep phase disorder Shift-work disorder Jet lag disorder

question

NREM sleep arrousal disorders. Occur during first third of the sleep episode. Include _____ + _____

answer

sleep walking and sleep terrors.

question

Features of sleepwalking

answer

- Repeated episodes of simple to complex behaviors that occur during the slow wave of sleep - Eye usually open with glassy look - Difficult to arpuse - Amnesia of the episode - benign self limited condition

question

Features of sleep terrrors

answer

- Episodes of sudden terror arousals usually beginning with screaming or crying that occur during slow wave sleep - Difficulty arousing during episode - Amnesia of the episode - benign self limited

question

Nightmare disorder

answer

- Reccurrent frightening dreams, occur during second half of sleep episode - Terminate in awakening with vivid recall - No confusion or disorientation on awakening - Causes distress or impairment in functioning - Imagery rehersal therapy- is a form of treatment

question

___________- involves the use of mental imagery to modify the outcome of a reccurrent nightmare, writing down the improved outcome and mentally rehearsing it in a relaxed state

answer

Imagery rehearsal therapy

question

_____ treatment for nightmares in person with PTSD

answer

prazosin

question

REM sleep behaviour disorder

answer

- Arousals of sleep associated with vocalization or complex motor behavior occuring during REM sleep. Treatment with clonazepam is efficacious in most patients.

question

Treatment for restless leg syndrome

answer

Iron replacement if low ferritin. Dopamine agonists and benzos are first line treatments

question

4 stages of sexual response cycle

answer

Desire Excitement/Arousal Orgasm Resolution

question

Most common 2 causes of sexual dysfunction in men:

answer

Erectile dysfunction, premature ejaculation

question

Most common 2 causes of sexual dysf in women

answer

interest/arousal disorder female orgasmic disorder

question

Class of drug used to treat erectile disorder

answer

Phosphodiesterase-5 inhibitors

question

________: oral med enhances blood flow to penis. Require physcological or physical stimulation to achieve erection.

answer

Sildenafil

question

______: either injected into corpora cavernosa or transeuthral, acts locally; produces erection in 2-3 mins, works in absence of sexual stimulation

answer

Alprostadil

question

Treatment for premature ejaculation

answer

SSRI; TCAs

question

Treatment for hypoactive sexual desire in men and women

answer

Men- testosterone if testosterone low Women- low dose testosterone, vaginal estrogen replacement if vagina dry

question

_______:Incongruence btwn ones experienced and assigned gender

answer

gender dysphoria

question

___________ disorder: engagement in unusual sexual activities and/or preoccupation with unusual sexual urges or fantasies for at least 6 months.

answer

paraphilias

question

Three most common types of paraphilias

answer

Pedophillia Voyeurism Exhibitionism

question

Topograpic theory: _____: repressed thoughts that are out of ones awareness ____: contains memories that are easy to bring into awareness but not unless consciously retrieved. _____: current thoughts and secondary process thinking

answer

Unconcious Preconcious Concious

question

Structural Theory: ____: unconcious involves instictual sexual/aggressive urges ____: Moral conscience and ego ideal ____: Serves as mediator between Id and Superego. Uses defence mechanisms.

answer

Id Superego Ego

question

___________: are used by the ego to protect oneself and relieve anxiety by keeping conflicts out of awareness. They are mostly unconscious processes. healthy when used in moderation.

answer

defense mechanisms

question

Types of defense mechanisms:

answer

mature- healthy and adaptive in high functioning patients. neurotic- seen in people with obssessive compulsive patients immature- seen in children

question

examples of mature defenses

answer

altuism humor sublimation suppression

question

examples of neurotic defenses

answer

controlling displacement intellectualization isolation of affect rationalization reaction formation repression

question

_____ is conscious, repression is unconscious

answer

suppression

question

examples of immature defenses

answer

acting out denial regression projection

question

_____: labeling people as all good or all bad

answer

splitting

question

__________: resolve unconscious conflicts by bringing repressed experiences and feelings into awareness and integrating them into the patients conscious experience. Treatment is usually 3-5 days per week for many years.

answer

psychoanalysis

question

psychoanalysis can be useful in treating:

answer

Cluster B + C personality disorders anxiety disorders problems coping with life events sexual disorders persistent depressive disorder

question

_________: the patient is asked to say whaterever comes into his or her mind during therapy sessions

answer

free association

question

__________: projection of unconscious feelings about important figures in the therapists life onto the patient

answer

countertransferance

question

________: giving a reward for a desired behavior ________: encouraging a behaviour by removing a aversive stimulus.

answer

positive reinforcement negative reinforcement

question

Behavioral therapy techniques: ________: pt learns to relax while exposed to an increasing dose of the phobia. _____: confronted with the real or imagined anxiety provoking stimuli. Not allowed to withdraw until feel calm. ____: negative stimulus paired with a specific behaviour. _____: rewards are given for specific behaviours ____: physical data are given to patients as they try to mentally control physiological states.

answer

systematic desensitization flooding and implosion aversion therapy token economy biofeedback

question

_____ focuses on a patients current symptoms and problems by examining the connection btwn thoughts, feelings and behaviours. Effective in treating depression, anxiety, schizophrenia and substance abuse disorders.

answer

CBT

question

pillars of DBT

answer

DIME Distress tolerance Interpersonal effectiveness Mindfulness Emotional regulation

question

DBT is effective in treatings ______

answer

borderline PD

question

Group therapy is especially useful in the treatment of :

answer

substance abuse disorder adjustment disorder personality disorder

question

HAM side effects

answer

Anti Histamine- sedation, weight gain Antiadrenergic- hypotension Antimuscarinic- dry mouth, blurred vision, urinary retention, constipation

question

HAM side effects seen in :

answer

TCAs and low dose antipsychotics.

question

__________: Confusion, flushing, diaphoresis, tremor, myoclonic jerks, hyperthermia, hypertonicity, rhabdo, renal failure. Classically occurs when SSRIs and MAOIs are combined.

answer

seritonion syndrome

question

__________: caused by a build up of stored chatecholamines; caused by a combination of an MAOi with tyramine rich foods (ex. wine, cheese, chicken liver, cured meats.)

answer

hypertensive crisis

question

EPS can be caused by: It is reversible. Symptom onset in hours to days of starting meds or increasing dose.

answer

first gen antipsychotics.

question

Hyperprolactinemia caused by:

answer

high potency, typical antipsychotics and risperidone

question

Tardive dyskinesia due to:

answer

occurs after years of antipyscotic use (more likely high potency typical antipsychotics). Usually changes are irreversible.

question

__________: mental status changes, fever, tachycardia, htn, tremor, elevated creatinine phosphokinase (CPK), lead pipe rigidity. Caused by antipsychotic.

answer

Neuroleptic malignant syndrome

question

Approx _____ respond to antidepressant meds

answer

60-70%

question

_________ (SSRI): - longest half life - Safe in pregnancy - Safe in children and adolescents - SE: insomnia, anxiety, sexual dys

answer

Fluoxetine (Prozac)

question

_______ (SSRI): - Higher risk of GI side effects - SE: insomnia, anxiety, sexual dys

answer

Sertraline (Zoloft)

question

_______ (SSRI): - short half life (withdrawl phenomenon if not taken consistenly) - SE: anticholinergic effects, sexual dysf

answer

Paroxetine (Paxil)

question

_______ (SSRI): - approved only for use in OCD - SE: Nausea and vomitting

answer

Fluvoxamine (Luvox)

question

_______ (SSRI): - fewest drug-drug interactions - Dose dependent QTc prolongation

answer

Citalopram (Celexa)

question

_______ (SSRI): - Dose dependent QTc prolongation

answer

Escitalopram (Ciprolex, lexapro)

question

Common SSRI side effects: - Fewer side effects than TCAs + MAOIs because they do not act on HAM receptors - Much safer in overdose - Common side effects: GI disturbance, insomnia, headache, anorexia. Often resolve in days to wks - Other side effects: Sexual dysfunction, restlessness, seritonin syndrome, hypnatremia

answer

-

question

________ (SNRI): - Used to treat depression and anxiety disorders - Similar SE to SNRI. Can cause high BP in high doses

answer

Venlafaxine (Effexor)

question

________ (SNRI): -used to treat depression, neuropathic pain - SE similar to SSRI but more dry mouth and constipation

answer

Duloxetine (Cymbalta)

question

__________ (Nonepnephrne-Dopamine Reuptke inhib) - Lack of sexual side effects compared to SSRIs - Effectiveness for smoking cessation - Can increase risk of seizures

answer

Buproprion (Wellbutrin)

question

________ (TCA): -useful in treatment of OCD

answer

Clomipramine

question

Major complications of TCAs

answer

3 Cs: Cardiotoxicity Convulsions Coma

question

FACTs Side effects of TCAs: - SE mostly due to lack of specificity - HAM SEs

answer

-

question

Side effects of MAOIs - Seritonin syndrome, wait at least 2 weeks before switching from SSRI to MAOI - Hypertensize crisis- MAOI and tyramine rich foods

answer

-

question

Treatment of seritonin syndrome

answer

- discontinue medications - Then provide supportive care and benzos -the seritonin antagonist cyproheptadine can also be used

question

Tx for OCD

answer

high dose SSRI, TCA clomipramine

question

Tx for PTSD

answer

SSRI

question

Tx for enuresis

answer

TCAs (imipramine)

question

Tx for neuropathic pain

answer

TCA (amitriptyline and nortrytyline), SNRI

question

Tx for chronic pain or fibro

answer

SNRI

question

Tx for premenstrual dysthmic disorder

answer

SSRI

question

Tx for insomnia

answer

Mirtazapine, Trazadone

question

______ block dopamine (D2) receptors ______ block both D2 and seritonin receptors

answer

typical antipsychotics atypical antipsychotics

question

High potency antipsychotics are often given as an intramuscular injection to treat acute ______ or psychosis

answer

agitation

question

Positive symptoms of schizophrenia are treated by action of the mediators in the _______ dopamine pathway

answer

mesolimbic

question

Negative symptoms of schizophrenia are thought to occur due to decrease dopaminergic action in the ______ pathway

answer

mesocortical

question

Side effects of typical antipsychotics: - EPS: Parkinsonism, Akathisia, Dystonia - Hyperprolactinemia - Anti HAM side effects - Tardive dyskinesia - Neuroleptic malignant syndrome - Seizures

answer

-

question

There is roughly a ____% chance of developing tardive dykinesia for each year treated with a typical antipsychotic

answer

5

question

______: - choreoathetoid movements of tongue - old age is risk factor - 50% of cases remit spontaneously with discontinuing antipsychotic, however most cases permanent change

answer

Tardive Dyskinesia

question

Neurleptic malignant syndrome is a medical emergency. Often occurs in young males early in treatment with antipsychotic. What are symptoms

answer

FLAT REED Fever Leukocytosis Autonomic instability (tachy, htn, diaphore Tremor Rigidity (Lead pipe) Elevated CPK Excessive sweating Delerium - Treatment is supportive- cooling/hydration

question

Onset of antipsychotic side effects - NMS: ___ - Acute dystonia:___ - EPS:____ - TD:____

answer

anytime but usually early hours to days days to weeks months to years

question

Atypical antipsychotics block both dopamine and seritonin receptors. Less likely to cause EPS, TD or NMS more likely to cause _____

answer

metabolic syndrome

question

While on atypical antipsychotic these lab values should be monitored:____

answer

Fasting glucose, lipids, LFTs

question

Atypical antispychotics names:

answer

Clozapine (Clozaril) Risperidone (Risperdal) Quetiapine (Seroquel) Olanzapine (Zyprexa) Aripiprazole (Abilify) Ziprasidone (Geodon) Paliperidone (Invega)

question

____________: - less likely to cause TD - used in treatment of refractory schizophrenia - more anticholinergic side effects compared to other antipsychotics - 1% incidence of agranulocytosis - must be stopped if ANC drops below 1500/microliter - only antipsychotic that reduces suicide risk - Blood draws to check WBC and ANC

answer

Clozapine (Clozaril)

question

_____: - Can cause increase prolactin

answer

Risperidone (Risperdal)

question

______: - much less likely to cause EPS - sedation and orthostatic hypotension common side effects

answer

Quetiapine (Seroquel)

question

____: - Common side effects weight gain and sedation

answer

Olanzapine (Zyprexa)

question

____: - More likely to be activating - Less potential for weight gain

answer

Aripiprazole (Abilify)

question

____ is the only mood stablizer shown to decrease suicidality

answer

lithium

question

Two main drawbacks with lithium

answer

- high incidence of side effects - narrow therapeutic index

question

Blood levels are useful when monitoring these drugs:

answer

- Lithium - Valproic acid - Carbamazapine - Clozapine

question

Factors that increase Li levels:

answer

NSAIDs, Aspirin, thiazide diuretics, dehydration, salt deprivation, sweating, impaired renal function

question

Side effects of lithium:

answer

- regularly monitor blood levels of lithium, thyroid func, kidney function - Fine tremor; GI disturb; Weight gain; sedation; EKG changes; benign leukocytosis; nephrogenic diabetes insipidus - Ebsteins anomaly- a cardiac defect in babies born to mothers taking lithium

question

SE of ________: - most common side effect are GI and CNS (drowsiness, ataxia, sedation, confusion) - rare side effect- Stevens- Johnson Syndrome - Teratogenic- (neural tube defects)

answer

Carbamazepine (Tegretol)

question

Lamotrogine most serious side effect _____

answer

Stevens Johnshon Syndrome

question

Topirimate most beneficial side effect _____. And most limiting side effect is _______

answer

weight loss; cognitive slowing

question

Benzos that are safe to give to chronic alcoholics or liver disease as they are not metabolized by the liver.

answer

Lorazepam Oxazepam Temazepam

question

_______: - work by potentiating effects of GABA - they reduce anxiety and can be used to treat akathisia

answer

Benzos

question

Long acting benzos (Half life >20 hours) Intermediate (half life 6-20 hours) Short acting (half life <6 hours)

answer

LA- Diazepam (valium), Clonazepam IA- Alprazolam (xanax), Lorazepam (ativan), Oxazepam, Temazepam. SA- Triazolam, Midazolam

question

____- used during detox from alcohol

answer

diazepam

question

Treatment for benzo overdose:

answer

flumazenil

question

Side effects of benzos: - withdrawal ______ - Toxicity: ____

answer

can be life threatening and cause seizures respiratory depression in overdose, especially when combined with alcohol

question

Psychostimulants, two broad categoies

answer

DextroAmphtamines (Adderal, Dexedrine) Methylphenidate (Ritalin, Concera)

question

Sides effects of dextroamphetamines and methylphenidate

answer

- anorexia, insomnia, exacerbation of tics, decreased seizure threshold

Psychiatry NBME – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards