question

Three phases of schizophrenia

answer

1) Prodromal=social withdrawal, irritable 2) Psychotic 3) Residual=between episodes of psychosis

question

Dx of schizophrenia

answer

Two or more of (for 1 month): Delusions Hallucinations Disorganized speech Grossly disorganized or catatonic behavior Negative symptoms Cause social/occupational deterioration

question

Schizophrenia negative symptoms (5 A's)

answer

Anhedonia Affect, flat Alogia (dec. speech) Avolition/apathy Attention poor

question

Ideas of reference

answer

That TV, paper, radio, etc is talking to them

question

Downward drift hypothesis

answer

Those with schizophrenia are unable to fxn in society and enter lower socioeconomic groups

question

Difference between delusional disorder and schizophrenia

answer

Delusional disorder doesn't have: -Bizarre delusions -AH/VH -Impairment to daily fxning

question

Dx criteria for depression

answer

5/9 SIGECAPS for 2 wks+ Sleep Interest Guilt Energy Concentration Appetite Psychomotor Suicide HAS to be depressed or anhedonic HAS to impair pt's life

question

Most common MDD type

answer

Melancholic

question

Tricyclic antidepressants (names, M, T, OD risk, OD tx)

answer

"triptyline" or "ipramine" M-Block reuptake of NE, serotonin T-Antihistamine, anticholinergic, antiadrenergic QRS widening, convulsions, coma, cardiotoxicity Sodium bicarbonate

question

Tertiary vs secondary TCA

answer

amitriptyline vs nortriptyline More vs less side effects

question

MAO-Is (names, M, T)

answer

Tranylcypromine, phenelzine, selegeline, isocarboxazid M-Blocks degradation of NE, serotonin, dopamine T-HTN crisis w/ tyramine foods or sympathomimetics Hypotension, drowsiness, weight gain

question

SSRI: OCD use

answer

Fluvoxamine

question

SSRI: Longest half-life

answer

fluoxetine

question

SSRI (names, T)

answer

Fluoxetine, paroxetine, sertraline, citalopram T-GI, sexual dysfunction, insomnia. Serotonin syndrome

question

SNRI (2, M, T)

answer

Venlafaxine, duloxetine M-Same as TCAs T-HTN

question

Trazodone, nefazodone (M, U, T)

answer

M-SSRI U-Insomnia T-Sedation, priapism

question

Mirtazapine (M, T)

answer

M-alpha2 antagonist (increasing NE, serotonin) and blocks serotonin T-Sedation, weight gain

question

High vs low potency antipsychotics (names, toxicity)

answer

Trifluoperazine, fluphenazine, haloperidol VS chlorpromazine and thioridazine Neurologic toxicity vs anticholinergic, antihistamine, and antiadrenergic effects. ALSO, Thioridazine=reTinal toxicity whereas Chlorpromazine=Corneal toxicity

question

Antipsychotics: EPS sx and their tx

answer

Parkinsonism Akathisia Dystonia (think torticollis) Hyperprolactinemia Tx with sxatically, such as benztropine or benadryl

question

Etiology of tardive diskinesia

answer

Increased dopamine receptor sensitivity, number

question

Neuroleptic malignant syndrome (sx, mortality rate)

answer

FEVER Fever Encephalopathy Vitals Elevated WBCs, CPK Rigidity 20% mortality rate

question

Antipsychotics: Non-EPS sx

answer

Antihistamine: sedation Antiadrenergic: orthostatic hypotension Antimuscarinic: urinary retention, dry mouth, tachycardia, blurry vision, constipation Weight gain TD

question

Atypical antipsychotics (names, M)

answer

clozapine, olanzapine, risperidone, aripiprazole, ziprasidone, quetiapine M-Varied. D2 antagonism and 5HT antagonism

question

Olanzapine toxicity

answer

Hyperlipidemia Glucose intolerance Weight gain!!

question

CNS stimulants

answer

Methylphenidate, dextroamphetamine M-Increase catecholamines in the synapse

question

Lithium (T)

answer

THEN Tremor Hypothyroidism Ebstein's anomaly Nephrogenic diabetes insipidus

question

Buspirone (M, U, T)

answer

M-Serotonin agonist U-GAD T-Very limited. Just some mild hypnosis

question

Antibiotic that can exacerbate serotonin syndrome

answer

Linezolid

question

Buproprion (M, U, T, advantage)

answer

M-Icreases NE and dopamine U-Smoking cessation T-Seizures. No sexual side effects like SSRIs

question

Maprotiline

answer

M-Blocks NE reuptake T-sedation

question

Serotonin syndrome sx, tx

answer

flushing, diaphoresis, hyperthermia tremor/myoclonus Cyproheptadine

question

Opioid withdrawal sx

answer

Mydriasis Sweating Fever Rhinorrhea GI/flu sx

question

Decanoate

answer

Long acting form of drug

question

1013 vs 1014 time

answer

48 hrs vs 5 days

question

Pt's rights under a 1013, and tests that are illegal still w/o approval

answer

Vote Call to complain Floor space HIV, UDS

question

Two things you always put in Axis I

answer

Evaluate for Mood Disorder secondary to general medical condition Evaluate for Mood Disorder secondary to substance abuse disorder

question

How to write BPAD, MDD, GAD, Schiz in Axis I

answer

BPAD: Type, MRE is mania/depressed/mixed, psychosis? MDD: First/recurrent episode, psychosis? GAD: agoraphobia? Schiz: type

question

Why use serotonin after CV surgery?

answer

Makes platelets less sticky Vasodilates

question

Difference between SSI and SSDI

answer

Depends on previous salary vs does not

question

Double depression

answer

MDD but baseline is dysthymia, not euthymia

question

Sleep and nutrients for MDD

answer

8 hrs Omega 3s (Fish oil)

question

5 steps of Rx MDD

answer

SSRI Different SSRI Atypical antidepressant MAOI, TCAs Augmentation/ECT/Stimulants/TH

question

3 steps of Rx manic episode

answer

Li-->valproate-->carbamazepine

question

Rx for BPAD pt in depressed episode

answer

Lamotrigine

question

Carbamazepine (U, T)

answer

U-Trigeminal neuralgia, rapid cycling and mixed episodes T-BM suppression, teratogenic

question

Valproate (T)

answer

Weight gain, hepatotoxicity, BM suppression, teratogenic

question

Short acting benzos

answer

Oxazepam Triazolam

question

Zolpidem, Zaleplon

answer

Short term tx of insomnia Much less SE, dangers of dependence

question

Akathisia tx

answer

BB

question

Propanolol/BB uses in psych

answer

Panic attack sx Akathisia

question

Dystonia (toxicity of?, location of action, danger)

answer

High-potency anti-psychotics neck, tongue, eyes Life threatening if not reversed

question

Medications that can precipitate psychiatric conditions

answer

abx, steroids, NSAIDs, others

question

4 elements of informed consent

answer

Name, purpose of tx Risks, benefits of tx Alternatives to tx Consequences of refusing tx

question

When informed consent for tx of minors is not required from parents

answer

Things you wouldn't want your parents knowing (OB, STDs, substances)

question

Capacity vs competence

answer

Doctor vs judge decides

question

M'Naghten

answer

Stringent test and standard for non-guilty via insanity

question

Malpractice (nature, compensatory vs punitive damage)

answer

Tort/civil wrong, not a crime Reimbursement vs punishment (only if gross negligence seen)

question

3 levels of consciousness

answer

Un Pre Conc

question

Id vs ego vs superego

answer

Unconscious urges vs Mediates id and external stimuli, controls id vs Morals, society

question

4 Mature defenses

answer

Altruism Humor Suppression Sublimation (do something healthy to relieve unhealthy urge)

question

Displacement

answer

Sublimation, except relieve it in an unhealthy manner

question

Reaction formation

answer

Do the opposite of an unacceptable impulse

question

What is psychoanalysis

answer

What you think of in the movies

question

Systemic desensitization vs flooding/implosion

answer

Slowly introduce stressor stepwise vs real or imagined stressor given until pt feels calm

question

Aversion therapy vs token economy

answer

Negative punishment vs positive reinforcement

question

CBT

answer

Take bad thoughts and replace them with better/correct ones

question

DBT

answer

Dialectical behavioral therapy Specific for BPD

question

Panic Disorder

answer

Spontaneous panic attacks Huge fear of having another to the point where it affects one's life

question

NTs involved in anxiety disorders

answer

Inc NE Dec GABA

question

Why start SSRIs slow?

answer

Beware anxiety side effect --> suicide

question

Panic disorder tx

answer

Acute: benzo Chronic: SSRI

question

Agoraphobia (def, tx)

answer

Fear of being in public places alone. Think you may have panic attack and won't be able to escape Tx: SSRIs

question

Most common mental disorder in US

answer

Phobia (social, specific)

question

When you don't know a tx, think

answer

SSRI

question

Tx of OCD

answer

SSRI high dose, but clomipramine sometimes

question

Difference between adjustment disorder and PTSD

answer

Non life threatening vs Life threatening event

question

PTSD vs Acute stress disorder

answer

>1 month vs <1 month

question

Adjustment disorder (timing)

answer

Begins within 3 months of stressor Ends within 6 months of losing stressor

question

Ego-syntonic vs ego-dystonic

answer

Don't realize they have a problem vs Does realize it's a problem (OCPD vs OCD)

question

Passive-aggressive personality disorder (category, def)

answer

Personality Disorder NOS Stubborn procrastinators

question

Substance abuse vs dependence

answer

Dependence has tolerance and withdrawal sx Both damage life

question

Alcohol (NTs, metabolism, screening for abuse

answer

Increases GABA, 5HT, decreases glutamate Acetaldehyde-->acetic acid CAGE questionnaire

question

BAL level for coma, reap depression

answer

300 400

question

CAGE Questionaire

answer

Alcoholism

question

EtOH intoxication (tx)

answer

Manage acid/base status, electrolytes Thiamine

question

Patient comes in altered mental status. What 3 things do you give and why?

answer

1) Thiamine (Wernike's encephalopathy) 2) Glucose (hypoglycemia) ONLY GIVE AFTER thiamine, don't want to precipitate Wernicke's 3) Naloxone (opioid OD)

question

Disulfiram (M)

answer

Inhibits aldehyde dehydrogenase

question

Mild, moderate and severe EtOH withdrawal sx

answer

Mild: Irritability and insomnia Moderate: Diaphoresis, fever disorientation Severe: Seizing, DT (3-5 days post, T/VH, tremor)

question

Mortality rate and prevalence of DT

answer

5% 20%

question

EtOH withdrawal tx

answer

Benzos Thiamine, folic acid and MVI Mg for seizures

question

Wernicke sx, Korsakoff sx

answer

Ataxia, ophthalmoplegia, confusion Amnesia, confabulation

question

Cocaine (M. sx, tx, withdrawal sx)

answer

M: Blocks dopamine reuptake Sx: Sympathomimetic (vasoconstriction, dilated pupils, tachy/bradycardia, BP swing, seizure, arrhythmia, TH,) Tx: Benzos, haldol (if severe), symptomatic. If a long term user, use dopamine agonists Withdrawal: Fatigue, depression, hunger, mitosis, vivid dreams. A "crash"

question

Amphetamines (M, sx, detection caveat, tx)

answer

Releases dopamine Like cocaine (sympathetic stimulation) Neg. UDS does not mean not there Like cocaine

question

Designer amphetamines (names, M

answer

MDMA, MDEA (eve) Releases dopamine and serotonin

question

Phencyclidine (M, derivative, sx, tx, withdrawal)

answer

Antagonizes NMDA glutamate receptors and activates dopaminergic neurons Ketamine Recklessness, assaultiveness, vertical nystagmus, HTN, tachycardia, rigidity, high pain tolerance (dissociative) Acidify urine, benzos, diazepam for muscle rigidity and seizures, haldol if needed No withdrawal syndrome

question

Barb vs benzo tx in overdose

answer

Alkalinize urine vs flumazenil

question

Gamma-hydroxybutyrate

answer

GHB Date rape drugs

question

Opiates (M, endogenous types, sx, withdrawal sx)

answer

Mu/kappa/delta receptor activation as well as dopamine agonism (rewarding) Endorphins, enkephalins N/V, constipation, MIOSIS, resp depression Coryza, sweating, N/V, insomnia, mydriasis

question

Opiate vs opioid

answer

Natural (morphine, codeine) vs Synthetics

question

Long term tx of opiate dependence

answer

Methadone (long half-life)

question

One opiate that causes mydriasis

answer

Meperidine

question

Hallucinogens (names, sx, withdrawal sx

answer

Psylocibin, LSD Don't really cause dependence or withdrawal. Have sx of hallucinations and sympathetic activation

question

THC (M, withdrawal sx)

answer

Cannabinoid receptors bound, inhibit adenylate cyclase Irritability, insomnia, decreased appetite

question

Inhalants (Types, effect, typical user)

answer

Solvents, glue, fuels, isobutyl nitrates CNS Depression Adolescent male

question

Caffeine (M, sx, 1 cup coffee=?mg, 1g and 10g dangers, withdrawal sx)

answer

Adenosine antagonist-->increased cAMP-->stimulation via dopamine Irritability, tachycardia, sweating, 150mg Arrythmias, death, seizures Depression, anxiety, N/V, drowsiness

question

Nicotine (M, withdrawal sx)

answer

nACh receptors, highly dopaminergic Irritability, insomnia, dysphoria, anxiety

question

Perfect vs bad MMSE score

answer

30 25

question

Pseudodementia

answer

MDD in elderly Often misinterpreted as dementia

question

Dementia + obesity + hirsutism + constipation + cold intolerance

answer

Hypothyroidism with dementia

question

Dementia + diminished sensations + megaloblastic anemia

answer

B12 def dementia

question

Delirium (2 types, tx)

answer

Quiet and agitated Quetiapine, haldol but only when needed to sedate. Proper sleep

question

Alzheimer's (epid, hallmark sx, NTs, pathology seen, rx)

answer

5% of people above 65 yo, F>M Loss of memory and language, change in personality Loss of ACh, NE Neurofibrillary tangles (Tau protein), senile plaques (amyloid protein), diffuse atrophy with larger ventricles Memantine (NMDA antagonist), donepezil/rivastigmine/tacrine (AChE inhibitors)

question

Apraxia

answer

Unable to perform common motor functions (copying a picture, tying shoes, etc)

question

Agnosia

answer

Can't recognize things you previously recognized

question

Vascular dementia (sx, difference from Alzheimer's)

answer

Sx are same as Alzheimer's Present with neurological problems elsewhere in the body, more abrupt onset

question

Pick's dz (other name, sx, pathology, tx)

answer

Frontotemporal lobe dementia Similar to Alzheimer's except personality changes are more prominent and more early Pick bodies (intraneuronal bodies)

question

Mild cognitive impairment definition

answer

Normal daily functioning but abnormal memory for age. Usually progresses to Alzheimer's

question

HD (onset, sx, area of damage)

answer

35-50 yo Dementia and depression Choreiform movements (dancelike flailing of limbs) Caudate atrophy

question

Parkinson's dz (area of damage, sx, tx, surgery)

answer

Substantia nigra dopaminergic neuronal loss Bradykinesia, cogwheel rigidity, pill rolling tremor, shuffling gait, dysarthria Levodopa/carbidopa, amantadine, anticholinergics (benztropine), dopamine agonists (bromocriptine), selegiline Thalamotomy or pallidotomy

question

Enzyme that degrades L-dopa to dopamine

answer

dopadecarboxylase

question

Cortical vs subcortical dementias

answer

Decline in intellect vs decline in physical/motor aspects Alzheimer's vs Huntington's

question

CJD (cause, timing of onset, one major sx, EEG)

answer

Prions Long latency between exposure and onset, but a rapid progression myoclonus Sharp waves/spikes

question

Normal pressure hydrocephalus (3 sx, tx)

answer

Wet (incontinence), wacky (dementia), wobbly (gait disturbance)

question

Amnestic disorder (defn, what causes them always, psychiatric counterpart)

answer

Impairment in memory without other cognitive problems Always from an underlying medical condition Dissociative disorders are psychiatric and similar, but without a medical explanation

question

5 stages of grief

answer

Denial Anger Bargaining Depression Acceptance Doesn't need to be in order

question

Pseudodementia vs dementia

answer

Physical symptoms vs none No/real answers to questions vs confabulation

question

When demented patients get more confused

answer

Night "Sundowning"

question

Abnormal Bereavement (timing, sx)

answer

More than one year SIGECAPS sx Psychosis sx

question

Sleep changes in elderly (Primary sleep disorder), tx

answer

Increased REM cycles with decreased duration (so about equal) Increased phase 1, 2 and decreased 3 and 4 causing awakenings Tx with non-Rx first. If needed, Zolpidem

question

Elder abuse (incidence)

answer

10% of seniors

question

Nursing vs old-age home

answer

Rehabilitation vs no attempt to rehabilitate

question

Kaufman Assessment Battery, Weschler Intelligence Scale, Peabody Individual Achievement Test

answer

Tests to assess children's intelligence

question

MR (IQ levels, epid, #1 causes, stuff that can give it prenatally from mother

answer

Below 70. Chunks of 20-25 to go from mild to moderate to severe. Below 25 is profound M>F, 2.5% of population Downs>Fragile X ToRCH (Toxo, Rubella, CMV, HSV), hypoxia, premie

question

Most common dx in outpt child psych

answer

Conduct disorder

question

When unsaid, what tx is best?

answer

Therapy

question

When unsaid, what rx is best?

answer

SSRI

question

Major comorbidity with ODD and Conduct disorder

answer

ADHD

question

ADHD (3 types, % lasting to adulthood, prenatal RF, #1 rx)

answer

Inattentive, hyperactive, combined (most common) 20% FAS Methylphenidate (Ritalin)

question

Difference in MDD between adults and peds

answer

Children get irritability instead of dysphoria. Otherwise the same.

question

PDD (4 types, primary sx)

answer

Autism Asperger's Rett's Childhood disintegrative disorder Trouble with language/social skills

question

Autism (dx, gender, IQ/functioning)

answer

Social interaction, communication, and ritualistic behavior/preoccupation with objects M>F Most are MR (<70). Very few function as adult

question

Asperger's (dx, gender)

answer

NORMAL language and cognition, but similar to autism with the impaired social interaction and obsessions with specific things M>F

question

Rett's disorder (sx, chromosome/gender)

answer

Diminished head circumference, stereotyped hand movements (hand wringing) and loss of function after 12 months old. Seizures, impaired language, social skills X, Females only (males die in utero)

question

Childhood Disintegrative disorder (timing, sx, gender

answer

After 2 yo Loss of previous skills in language, social, motor M>F

question

Tourette's (dx, age, gender, NT, tx)

answer

Tics. BOTH motor and vocal. Multiple times a day for a year without major breaks Before 18 M>F Impaired DA regulation in caudate nucleus Haldol to control DA

question

Coprolalia vs Echolalia

answer

Obscene words Repeat words

question

Enuresis (primary vs secondary, tx)

answer

Child never established continence vs had ad one point Behavior modification (buzzer goes off when they pee bed) and antidiuretics

question

Encopresis (defn, etiology)

answer

Bowel incontinence Stressors, constipation

question

Selective mutism

answer

F>M Not speaking in certain situations

question

Separation anxiety disorder

answer

Fear of leaving parents/those they are attached to

question

Age most likely for sexual abuse

answer

9-12

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