First Aid 2010: Psychiatry

Front 1

Define

Mental retardation
severe MR
profound MR

Back 1

MR: IQ < 70
severe: IQ <40
profound: IQ <20

Front 2

Define

negative reinforcement

Back 2

removal of aversive stimulus elicits behavior (mouse presses button to avoid shock)

Front 3

Define punishment.

Back 3

application of aversive stimulus extinguishes unwanted behavior

Front 4

Define extinction

Back 4

discontinuation of reinforcement eliminates behavior

Front 5

Define continuous reinforcement.

Back 5

reward received after every response. Rapidly extinguished.
(think Vending machine)

Front 6

Define variable ratio reinforcement.

Back 6

reward received after randome number of responses. slowly extinguished.

think slot machine

Front 7

Define transference

Back 7

patient projects feelings about formative or other important persons onto physician

Front 8

define countertransference

Back 8

doctor projects feelings about formative or other important persons onto patient

Front 9

Define Id

Back 9

primal urges, food, sex, and aggression. Instinct. Entirely subconscious.

Front 10

Define Ego

Back 10

mediator bt primarl urges and behavior accepted in reality

Front 11

Define superego

Back 11

moral values, conscience; can lead to self-blame and attacks on ego

Front 12

define shaping (social learning)

Back 12

behavior achieved following reward of closer and closer approximations of desired behavior
(e.g a child learning to write is praised when makes a letter, even though it is not formed perfectly)

Front 13

What are 4 mature ego defenses?

Back 13

mature women wear a SASH

Sublimation
Altruism
Suppression
Humor

Front 14

Define following ego defense mechanism:

Dissociation

what disorder is this associated with?

Back 14

temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress.

can result in dissociative identity disorder (multiple personality disorder)

Front 15

Define following ego defense mechanism:

Fixation

Back 15

partially remaining at a more childish level of development

men fixating on sports games

Front 16

Define following ego defense mechanism:

identification

Back 16

modeling behavior after another person who is more powerful (though not necessarily admired)

abused child identifies himself/herself as an abuser

Front 17

Define following ego defense mechanism:

projection

Back 17

an unacceptable internal impulse is attributed to an external source

a man who wants another woman thinks his wife is cheating on him

Front 18

Define following ego defense mechanism:

repression

Back 18

involuntary withholding of an idea or feeling form conscious awareness

not remembering a conflictual or traumatic experience; pressing bad thoughts into the unconscious

Front 19

Define following ego defense mechanism:

splitting

what disorder is associated?

Back 19

belief that people are either all good or all bad a different times due to intolerance of ambiguity. Seen in borderline personality disorder

Front 20

Define following ego defense mechanism:

sublimation

Back 20

process whereby one replaces an unacceptable wish with a course of action that is similar to the wish but does not conflict with one's value system

actress uses expereince of abuse to enhance her acting.

Front 21

Define following ego defense mechanism:

suppression

Back 21

voluntary withholding of an idea or feeling from conscious awareness (vs repression)

choosing not ot think about the USMLE until the week of the exam

Front 22

Define anaclitic depression

Back 22

depression in an infant attributable to continued separation from caregiver. Infant becomes withdrawn and unresponsive. Reversible, but prolonged separation can result in failure to thrive or other developmental disturbances.

Front 23

Compare and contrast:

Empathy vs support

Back 23

Empathy: physician's understanding of the pt's experiences or difficulties. Requires vicarious experiencing of a pt's situation

support: expressing concern independent of understanding

Front 24

ADHD

gross finding?
tx?

Back 24

associated with decreased frontal volume

tx: Methyphenidate (Ritalin), Amphetamine (Dexedrine), atomoxetine (nonstimulant SNRI)

Front 25

Conduct disorder

Define.
dx after 18?

Back 25

Repetitive and pervasive behavior violating social norms (physical aggression, destruction of property, theft)

after 18, dx as antisocial personality disorder

Front 26

Tourette's syndrome

Describe.
Association?
tx?

Back 26

characterized by sudden, rapid, recurrent, nonrhythmic, stereotyped motor mvmt or vocalizaitons (tics) that persist for >1 yr

associated with OCD
tx: antipsychotics (e.g. haloperidol)

Front 27

Autism

Describe.
tx?

Back 27

severe language impairment and poor social interactions. Greater focus on objects than on people. characterized by repetitive behavior and usually below-normal intelligence. Rarely, may have unusual abilities (savants)

tx: behavioral and supportive therapy

Front 28

Asperger's disorder

Describe

Back 28

a milder form of autism.
Characterized by all-absorbing interests, repetitive behavior, and problems with social relationships. Children are of normal intelligence and lack verbal or cognitive deficits. No language impairment

Front 29

Rett's disorder

Describe.

Back 29

X-linked disorder seen almost exclusively in girls. Normal to age 1, followed by regression characterized by loss of development, MR, loss of verbal abilities, ataxia, and stereotyped hand-wringing.

Front 30

Describe neurotransmitter changes with following diseases.

Anxiety
Depression
Schizophrenia

Back 30

Anxiety: high NE, low GABA, Low 5HT
Depression: low NE, 5HT, DA
Schizophrenia: high NE

Front 31

Describe Korsakoff amnesia.

Back 31

classic anterograde amnesia caused by thiamine deficiency. Leads to bilateral destruction of mammillary bodies. May also lead to some retrograde amnesia. seen in alcoholics, and associated with confabulations.

Front 32

Describe dissociative amnesia.

Back 32

inability to recall important personal information, usually subsequent to severe trauma or stress.

Front 33

What is the most common psychiatric illness on medical and surgical floors?

describe it.

Back 33

Delirium

waxing and waning level of consciousness with acute onset. Abnormal EEG

check for drugs with anticholinergic effects. Often reversible

Front 34

Define illusions.

Back 34

misinterpretations of actual external stimuli (e.g. seeing a light that thinking that it is the sun)

Front 35

Define delusions.

Back 35

false beliefs not shared with other members of culture/subculture that are firmly maintained in spite of obvious proof to the contrary. (e.g. thinking the CIA is spying on you)

Front 36

Define loose associations (derailment).

Back 36

disorders in the form of thought (the way ideas are tied together)

Front 37

Tactile hallucinations

commonly found in what 2 groups?

Back 37

alcohol withdrawal (e.g. formication: the sensation of ants crawling on one's skin)

cocaine abusers

Front 38

Schizophrenia

Describe.
risk factor in teens.
change in NT
tx?

Back 38

periods of psychosis and disturbed behavior with a decline in functioning lasting > 6 months.

Marijuana use -> risk factor in teens

high DA

tx with typical and atypical antipsychotics (neuroleptics)

Front 39

Schizophrenia

how do you diagnose?

Back 39

requires 2 or more of the following:

1. delusions
2. hallucinations (often auditory)
3. disorganized speech (loose associations)
4. disorganized or cataonic behavior
5. negative sxs: flat affect, social withdrawal, lack of motivaiton, lack of speech or thought

Front 40

Schizophrenia time course

Back 40

Brief psychotic disorder: < 1 month, usually stress related
Schizophreniform disorder: 1-6 months
Schizophrenia: > 6 months

Front 41

Schizoaffective disorder

describe

Back 41

at least 2 weeks of stable mood with psychotic sxs, plus a major depressive, manic, or mixed (both) episodes

2 subtypes: bipolar or depressive

Front 42

Schizophrenia

5 subtypes?
complication?

Back 42

subtypes
1. paranoid (delusions)
2. disorganized (with regard to speech, behavior, and affect)
3. catatonic (automatisms)
4. undifferentiated (elements of all types)
5. residual

increased risk for suicide

Front 43

dissociative identity disorder

Back 43

formerly, multiple personality disorder

presence of 2 or more distinct identities or personality states. more common in women. associated with hx of sexual abuse

Front 44

Describe a manic episode.

Back 44

distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week. Often disturbing to patient.

Front 45

How do you diagnose mania?

Back 45

dx requires 3 or more of the following are present during mood disturbance: (DIG FAST)
1. Distractibility
2. Irresponsibility (seeks pleasure w/o regard to consequences; hedonistic)
3. Grandiosity: inflated self-esteem
4. Flight of ideas (racing thoughts)
5. increased in goal-directed Activity/psychomotor Agitation
6. Decreased need for Sleep
7. Talkativeness or pressured speech

Front 46

Major depressive episode.

How do you dx?

Back 46

at least 5 of the following 9 sxs for 2 weeks (sxs must include pt-reported depressed mood or anhedonia): (SIG E CAPS)
1. Sleep disturbance
2. Loss of Interest (anhedonia)
3. Guilt or feelings of worthlessness
4. Loss of Energy
5. Loss of Concentration
6. Appetite/wt changes
7. Psychomotor retardation or agitation
8. Suicidal ideations
9. depressed mood

Front 47

Major depressive disorder

describe

Back 47

requires 2 or more major depressive episodes with a sx-free interval of 2 months

Front 48

Define Dysthmia

Back 48

milder form of depression lasting at least 2 yrs

Front 49

Define Bipolar I disorder

Back 49

at least 1 manic episode and depressive sxs that occur eventually.

Front 50

Define Bipolar II disorder

Back 50

at least 1 hypomanic episode and depressive sxs that occur eventually.

Front 51

tx for bipolar disorders

Back 51

mood stabilizers: lithium, valproic acid, and cabamazepine

atypical antipsychotics

Front 52

cyclothymic disorder

Back 52

milder form of bipolar disorder lasting at least 2 yrs.

Front 53

Describe the sleep patterns of depressed pts.

Back 53

1. Decreased slow-wave sleeps (stages 3, 4)
2. decreased REM latency (time spent in REM)
3. increased REM early in sleep cycle
4. increased total REM sleep
5. repeated nighttime awakenings
6. early-morning awakening (important screening Q)

Front 54

atypical depression

Back 54

characterized by hypersomnia, overeating, and mood reactivity (the ability to experience improved mood in response to positive events vs persistent sadness).

associated with wt gain and sensitivity to rejection.

Front 55

tx for atypical depression

Back 55

MAO inhibitors, SSRI

Front 56

which sex is more successful at completing suicide?

which sex is try more often?

Back 56

men succeed more often

women try more often

Front 57

tx for panic disorder

Back 57

congnitive behavioral therapy
SSRI, TCAs, benzodiazepines

Front 58

tx for specific phobia?

tx for social phobia?

Back 58

specific phobia: systematic desensitization

social phobia (social anxiety disorder): SSRIs

Front 59

OCD

associated disorder?
tx?

Back 59

associated with Tourette's disorder

tx: SSRIs, clomipramine

Front 60

Define panic disorder

Back 60

defined by the presence of recurrent periods of intense fear and discomfort peaking in 10 minutes with at least 4 of the followings: (PANICS)
Palpitations, Paresthesias
Abdominal distress
Nausea
Intense fear of dying or losing control, LIght-headedness
Chest pain, Chills, Choking, disConnectedness
Sweating, Shaking, SOB

Front 61

tx for depression

Back 61

SSRIs, SNRis, TCAs

Front 62

tx for depression with insomnia

Back 62

mirtazapine

Front 63

What is the diagnostic difference b/t PTSD and acute stress disorder?

Back 63

PTSD: disturbance lasts > 1 months

acute stress disorder: lasts b/t 2 days and 1 month

Front 64

tx for PTSD

Back 64

psychotherapy, SSRIs

Front 65

Maligering

describe.
how is it different form factitious disorder?

Back 65

Pt consciously fakes or claims to have a disorder in order to attain a specific secondary gain. Avoid tx by medical personnel

complaints cease after gain (vs factitious disorder)

Front 66

Maunchausen's syndrome by proxy

Back 66

when illness in a child is caused by the caregiver. motivation is to assume a sick role by proxy.

A form of child abuse (report to child protective services)

Front 67

somatization disorder

Back 67

variety of complaints in multiple organ systems (at least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic) over a period of years

Front 68

Conversion

Back 68

motor or sensory sxs, often following an acute stressor; pt is aware of but indifferent toward sxs ("la belle indifference")

Front 69

pain disorder

Back 69

prolonged pain with no physical findings

Front 70

Cluster A personality disorders

Describe and list 3 types

Back 70

"Weird" (Accusatory, Aloof, Awkward)
Odd or eccentric; inability to develop meaningful social relationships. No psychosis; genetic association with schizophrenia

Paranoid, schizoid, schizotypal

Front 71

Paranoid personality

Back 71

pervasive distrust and suspiciousness; projection is major defense mechanism

Front 72

Schizoid personality

Back 72

voluntary social withdrawal, limited emotion expression, content with social isolation (vs. avoidant)

Front 73

Schizotypal personality

Back 73

eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness.

(schizoid + odd thinking)

Front 74

Cluster B personality disorders

Describe and list 4 types

Back 74

"wild" (Bad to the Bone)

Dramatic, emotional or erratic; genetic association with mood disorders and substance abuse

Antisocial, borderline, histrionic, narcissistic

Front 75

Antisocial personality

Back 75

disregard for and violation of rights of others, criminality; males > females; conduct disorder if < 18 YO

Front 76

Borderline personality

Back 76

unstable mood and interpersonal relationships, impulsiveness, self-mutilation, sense of emptiness
females > males; splitting is a major defense mechanism

Front 77

Histrionic personality

Back 77

excessive emotionality and excitability, attn seeking, sexually provocative, overly concerend with appearance

Front 78

Narcissistic personality

Back 78

grandiosity, sense of entitlement; lacks empathy and requires excessive admiration; often demands the "best" and reacts to criticism with rage

Front 79

Cluster C personality disorders

Describe and list 3

Back 79

Worried (Cowardly, Compulsively, Clingy)

Anxious or fearful; genetic association with anxiety disorder

avoidant
obsessive-compulsive
dependent

Front 80

avoidant personality

Back 80

hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with other (vs schizoid)

Front 81

obsessive-compulsive personality

Back 81

preoccupation with order, perfectionism, and control; ego syntonic: behavior consistent with one's own beliefs and attitudes

Front 82

dependent personality

Back 82

submissive and clinging, excessive need to be taken care of, low confidence

Front 83

Anorexia nervosa

Back 83

excessive dieting +/- purging

intense fear of gaining wt, body image distortion, and increase exercise, leading to body wt <85% below ideal body wt. associated with decreased bone density. severe wt loss, metatarsal stress fractures, amenorrhea, anemia, and electrolyte disturbances. Seen primarily in adolescent girls. Commonly coexists with depression

Front 84

Bulimia nervosa

Back 84

binge eating +/- purging

followed by self-induced vomiting or use of laxatives, diuretics, or emetics. body weight often maintained within normal range.

Associated with parotitis, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand calluses from inducing vomiting (Russell's sign)

Front 85

tx for anorexia/bulimia

Back 85

SSRIs

Front 86

What drug intoxication is associated with pinpoint pupils? (1)

What drug intoxication is associated with dilated pupils? (3)

Back 86

pinpoint pupils (constricted): opioids

dilated pupils: amphetamines, cocaine, LSD

Front 87

List sxs of opioid intoxication.

tx?

Back 87

CNS depression, nausea, and vomiting, constipation, pupil constriction, seizures (life-threatening)

tx: naloxone, naltrexone

Front 88

List sxs of alcohol withdrawal.

tx?

Back 88

tremor, tachycardia, HTN, malaise, nausea, seizures, delirum tremens, tremulousness, agitation, halluciations (including tactile)

tx: chlordiazepoxide, diazepam

Front 89

List sxs of PCP intoxication.

Back 89

BELLIGERENCE, impulsiveness, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycadia, ataxia, homicidality, psychosis, delirium

Front 90

List sxs of LSD intoxication

Back 90

marked anxiety or depression, delusions, visual hallucinations, FLASHBACKS, pupillary dilation

Front 91

What are 2 most immediate sxs of smoking marijuana?

Back 91

conjunctival injection (red eye), tachycardia

Front 92

Suboxone

indication?
MOA?
advantage over the alternative?

Back 92

for tx of heroin addiction

naloxone + buprenorphine (partial agonist); long acting with fewer withdrawal sxs than methadone.

Naloxone is not active when taken orally, so withdrwal sxs can occur only if injected (lower abuse potential)

Front 93

Delirum tremens (DT)

what is it?
sxs?
tx?

Back 93

life-threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink.

sxs in order of appearance: autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures), psychotic sxs (hallucinations, delusions), confusion

tx: benzodiazepines

Front 94

Antipsychotics

List high potent neuroleptics.

List low potent neuroleptics

Back 94

typical antipsychotics; haloperidol + -azines

high potent (neurologic side effects): haloperidol, trifluoperazine, fluphenazine

low potent (non-neurologic side effects): thioridazine, chlorpromazine

Front 95

toxicities of antipsychotics (6)

Back 95

1. lipid soluble -> stored in fat -> slow metabolism
2. EPS side effects
3. hyperprolactinemia -> galactorrhea
4. block muscarinic (dry mouth, constipation)
5. block alpha (hypotension)
6. block histamine (sedation)

Front 96

special toxicity of Chlorpromazine and thioridazine

Back 96

Chlorpromazine: Corneal deposits

Thioridazine: reTinal deposits

Front 97

Evolution of EPS side effects with antipsychotics.

Back 97

4 hr acute dystonia (muscle spasm, stiffness, oculogyric crisis)
4 day akinesia (parksonian sxs)
4 wk akathisia (restlessness)
4 mo tardive dyskinesia (steretypic oral-facial mvmt); irreversible

Front 98

Neuroleptic malignant syndrome (NMS)

cause?
sxs?

Back 98

caused by antipsychotics

sxs: think FEVER
Fever
Encephalopathy
Vitals unstable (autonomic instability)
Elevated enzymes
Rigidity for muscles

Front 99

List atypical antipsychotics.

Back 99

it's atypical for Old CLOsets to QUIETly RISPER from A to Z

Olanzapine
Clozapine
Quetiapine
Risperidone
Aripiprazole
Ziprasidone

Front 100

Olazapine

class/MOA?
indication?
adverse effect?

Back 100

atypical antipsychotics
blocks 5HT2, alpha, H1, and DA receptors

used for schizophrenia (+ and - sxs), OCD

weight gain

Front 101

Clozapine

class?
toxicity?

Back 101

atypical antipsychotic

weight gain
agranulocytosis (requires weekly WBC monitoring)

Front 102

Lithium

indication?

Back 102

mood stabilizer for bipolar disorder, also SIADH

Front 103

Lithium toxicity

Back 103

LMNOP
Lithium side effects:
Movement (tremor)
Nephrogenic DI
hypOthyroidism
Pregnancy problems: Ebstein anomaly

Front 104

List drugs that increase serum Lithium level and increase proximal tubular Na absorption.

Back 104

NSAIDs, thiazide, ACE inhibitors

Front 105

Buspirone

MOA?
indication?
advantage over alternatives?

Back 105

5HT1a agonist

used in generalized anxiety disorder.

Minimal hypnotic effects, addiction, or tolerance. Does not interact with alcohol (vs barbiturates, Benzodiazepine)

Front 106

imiprimine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin, amoxapine

class?
indication?

Back 106

TCA

major depression, bedwetting (imipramine), OCD (clomipramine), fibromyalgia

Front 107

List 3 major toxicities of TCA.
how do you treat one of the toxicities?

Back 107

tri-C's
Convulsion, Coma, Cardiotoxicity

NaHCO3 for CV toxicity

Front 108

what TCA is preferred in the elderly? why?

Back 108

Nortriptyline (secondary TCA)

less anticholinergic effect -> decrease in confusion and hallucinations (anticholinergic side effects)

Front 109

Fluxetine, paroxetine, sertraline, citalopram

class?
indications?

Back 109

SSRIs

depression, OCD, bulimia, social phobia

Front 110

List main toxicities of SSRIs.

Back 110

GI distress, sexual dysfxn (anorgasmia), serotonin syndrome (hyperthermia, muscle rigidity, CV collapse, flushing, diarrhea, seizures)

Front 111

What is serotonin syndrome? what drugs are associated?

Back 111

associated with any drug that increase 5HT: SSRIs, SNRIs, MAO inhibitors

sxs: hyperthermia, muscle rigidity, CV collapse, flushing diarrhea, seizures.

Front 112

tx for serotonin syndrome?

Back 112

cyproheptadine (5HT2 receptor antagonists)

Front 113

Venlafaxine, duloxetine

class?
indications?

Back 113

SNRIs

depression
Venlafaxine: also used for generalized anxiety disorder
duloxetine: also used for DM peripheral neuropathy

Front 114

Phenelzine, tranylcypromine, isocarboxazid

class?
indications?

Back 114

nonselective MAO inhibitors: increase amine NTs (NE, 5HT, DA)

atypical depression, anxiety, hypochodriasis

Front 115

Selegiline

class?
indication?

Back 115

selective MAO-B inhibitor

used in Parkinson's disease in conjunction to L-dopa

Front 116

Phenelzine, tranylcypromine, isocarboxazid

toxicity?

Back 116

hypertensive crisis with tyramine ingestion (in foods such as wine and cheese) and beta agonists.
CNS stimulation
can cause serotonin syndrome with SSRIs or meperidine

Front 117

hypertensive crisis

causative drug?

Back 117

MAO inhibitors with tyramine or Beta agonists

Front 118

What 2 drugs are contraindicated with MAO inhibitor administration. why?

Back 118

SSRI and meperidine

can cause serotonin syndrome

Front 119

what drug is indicated in pts with depression that do not want sexual dysfunction?

Back 119

Bupropion (Wellbutrin)

Front 120

Mirtazapine

MOA?
indication?

Back 120

alpha2 agonist (relealse NE and 5HT), 5HT2 and 5HT3 antagonists.

for depression with insomnia

Front 121

Trazodone

MOA?
indication?
toxicity?

Back 121

inhibits 5HT reuptake
used for insomnia, as high doses are needed for antidepressant effects.

TrazoBONE; causes priapism