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166 Cards in this Set
- Front
- Back
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Childhood disintegrative disorder: more common in males or females?
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Males
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Give the presentation of childhood disintegrative disorder.
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Pt must have normal development for at least two years, followed by a loss of previously acquired skill in 2+ of the following: verbal, social, bowel/bladder, or play/motor skills.
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Difference between autism and childhood disintegrative disorder
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Though symptoms are similar, childhood disintegrative disorder involves developing skills then losing them. Autistic children never develop the skills to begin with
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Sex in a vast majority of Rett syndrome patients
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Female
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Give the primary similarities/differences between autism and Asperger syndromes.
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Both have similar behavior - restrictive, repetitive, stereotyped. Asperger, however, has normal cognitive/language development.
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Three primary signs of Rett syndrome
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Loss of hand coordination w/ mid-line wringing and putting hands in mouth, seizures deceleration of head growth.
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Length of normal development in Rett syndrome
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Up to six months
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Minimum age for use of methylphenidate
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6 years old
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Common side effects of methylphenidate
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Loss of appetite, nausea/abdominal pain, insomnia, tachycardia, nervousness
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Two side effects with prolonged use of methylphenidate
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Growth retardation and weight loss
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Stage of sleep that becomes shorter and eventually dissapears as you age
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Stage 4
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Common changes in sleep patterns of older individuals
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Less sleep at night, awaken more during the night, naps during the day
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Usual sleep complain with Alzheimer's
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Patients wake up frequently during the night (note: also seen with normal aging)
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Reason why atypical antipsychotics are less likely to cause extrapyramidal effects.
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They bind serotonin receptors in addition to dopamine-D2
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Two other receptors, aside from D2, antogonized by risperidone
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Alpha-1 adrenergic + serotonergic (though these do no contribute to antipsychotic effects)
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Can you involuntarily admit a minor for psychiatric purposes against their parents wishes?
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Yes, if they are an acute and significant threat to themselves/others
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DSM-IV criteria for anorexia nervosa
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1) Body weight at least 15% below normal
2) Amenorrhea for 3 months 3) Distortion of body image 4) Fear of becoming fat despite being under weight |
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A pt is severely underweight, lacks menses, and is binging and vomiting. What is the dx?
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Anorexia nervosa, binge and purge subtype. (Bulimia has a normal weight/menses)
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BMI in bulimia nervosa
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Slightly above normal
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Every patient suspected of depression must be asked what question?
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If they have suicidal ideations
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Antipsychotic with increased risk of jaundice
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Chlorpromazine (note the jaundice is not related to hemolysis)
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Antipsychotic associated with pigmentary retinopathy
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Thioridazine
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Antipsychotic associated with cataracts
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Quetiapine
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Antipsychotic least likely to cause extrapyramidal effects
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Clozapine
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How to differentiate conversion disorder from somatization disorder.
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By history. Conversion disorder is sudden-onset neuro symptom(s) preceded recently by an obvious stressor. Somatization disorder involves a longer history of several different complaints.
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Set of symptoms required to dx somatization disorder
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Pain in at least four different sites/actions + two GI symptoms + one sexual symptom + one pseudoneurological symptom all at some point during illness
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A pt provides unnecessarily detailed answers that deviate from the topic of conversation but remain vaguely related and eventually returns to the original subject. What is this though pattern called?
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Circumstantiality
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A pt abruptly deviates from the current subject to a minimally relevant subject and does NOT ever return to the original subject. What is this thought pattern called?
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Tangentiality
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What is meant by "loose associations?"
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A lack of logical connection between thoughts/ideas of an individuals. A more severe form of tangentiality.
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Pt moves rapidly from topic to topic. The subjects of each topic are loosly related. What is this thought pattern called?
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Flight of ideas.
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Three criteria that must be met for panic disorder
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1) At least 3 attacks in a 3 week period
2) No clear stimulus 3) Abrupt onset symptoms (peak within 10 minutes) |
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Common co-morbidities with panic disorder
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Depression, agoraphobia, GAD, substance abuse
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Other than psychiatric reasons, give a situation where you can involuntarily admit a competent adult.
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They have an infection which is harmful to the community (ex: meningococcal meningitis)
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Name the two things that qualify as "magical thinking"
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1) Belief that one's thoughts can control events in a manner not explained by cause and effect.
2) Attributing casual incidents to supernatural forces |
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What is "ideas of reference?"
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Belief that everyday occurences have a special implication for you individually.
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Ideas of reference is common with what psychiatric disorder?
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Schizophrenia
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Explain the difference between an illusion and a hallucination.
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An illusion is a misinterpretation of an external stimulus. A hallucination is perception in the absence of any external stimulus.
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What are the negative symptoms of schizophrenia?
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The five A's: Affect flattened, Alogia, Aparthy, Asociality, Attention loss
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Prefered medications for negative schizophrenia symptoms
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Atypical antipsychotics
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Predominate use for chlordiazepoxide
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Alcohol withdrawal
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Predominate use for Donepezil
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Alzheimer's disease
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Drug class of Sertraline
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SSRI
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Alternate name for frontotemporal dementia
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Pick's disease
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Symptoms more common in Pick's disease versus Alzheimer's
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Behavioral/personality changes
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What is pseudodementia?
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Memory loss in elderly caused by depression. Will improve with treatment
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Antipsychotics available in depot form (IM injection)
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Haloperidol, fluphenazine, risperidone, paliperidone
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In what situation should you consider injectable antipsychotics?
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Patients with a history of noncompliance
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If an antipsychotic has decanoate at the end of the name, what does that mean?
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It's an injectible depot form
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Two most common psychiatric comorbidities with Tourette's
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OCD, ADHD
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Can a pregnant mother be involuntarily treated if lack of treatment would put the fetus at risk?
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No. A fetus is consider part of the mother's body and therefore she has a right to refuse treatment.
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Tx for acute dystonia caused by typical antipsychotics
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Antihistamines or anticholinergics (benztropine = DOC, trihexyphenidyl)
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Define akathisia
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Restlessness, unable to sit still
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Tx for akathisia caused by typical antipsychotics
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Beta-blockers
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Neuroleptic malignant syndrome is a side effect of what class of medications?
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Antipsychotics (esp *first-gen*/typical antipsychotics, which are aka neuroleptics)
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Tx for neuroleptic malignant syndrome (NMS)
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Dantrolene
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Minimum symptom duration to dx dysthymic disorder
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2 years
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Name indications that psychiatric hospitalization is necessary (six listed)
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Suicidal Ideation
Homicidal ideation Grave disability Gross disorganization Agitated/threatening behavior Severe substance intoxication/withdrawal |
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Class of thioridazine, fluphenazine, and chlorpromazine
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Typical antipsychotics (aka first-gen antipsychotics, aka neuroleptics)
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Two receptors blocked by atypical antipsychotics
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Dopamine and 5-HT2
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Reserved for patients who have not responded to other antipsychotics
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Clozapine
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Therapy where patient is asked to identify behaviors that compromise their function and those behaviors are then altered
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Cognitive behavioral therapy
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Main way to choose typical vs. atypical antipsychotic
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Side effect profile (both are equally effective)
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Acronym for symptoms of depression. How many are required for dx?
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Five required from SIG E CAPS:
Sleep Interest Guilt Energy Concentration Appetite Psychomotor retardation Suicidal thoughts |
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Symptom duration required to rx SSRI's for depression
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Two weeks (most of the day, most days)
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PMH that is an absolute contraindication for buproprion
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Seizures
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To dx adjustment disorder, symptoms must begin within what time frame following the stressor?
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Before 3 months
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Two most likely pregnancy complications with hx of anorexia
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Premature birth, small for gestational age
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Tx of choice for adjustment disordder
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Psychotherapy - psychodynamic or cognitive
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Difference between acute stress disorder and PTSD
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Acute stress disorder symptoms last less than a month
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Symptom duration required to dx GAD
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Six months
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Two alternative meds for mania patients with renal dysfunction
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Valproic acid, Carbamazepine
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Antidepressent contraindication in pt's with eating disorders. Why?
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Buproprion. Lowers seizure threshold, pt's with eating disorders are predisposed to seizures
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Two drugs that should not be coadministered with buproprion due to lowered seizure threshold
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Alcohol, Benzo's
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Three physical sign of marijuana intoxication
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Conjuctival injection, dry mouth, tachycardia
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Symptoms of opoid withdrawal
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Nausea/vomiting, diarrhea, muscle spasm, joint pain, abdominal cramps, rhinorrhea, lacrimation, sweating, pupil dilation, autonomic instability (commonly HTN)
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First line drug for GAD
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Buspirone (no physical dependence/withdrawal symptoms)
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Use of propanolol in anxiety
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Prophylatic for performance-related anxiety
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Difference between factitious disorder and malingering
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In factitious disorder, the patient only looks to assume to sick roll. There is no secondary gain
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How to segregate social phobia from selective mutism
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Social phobia in children is often secondary to learning or communication disorders (eg stuttering). There are no communication disabilities in selective mutism
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First differential in any teenager with significant changes in behavior/emotions
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Substance abuse
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Dissociative identity disorder is an alternate name for?
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Multiple personality disorder
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Dx for a patient who suddenly travels far away and then forgets and/or invents a new identity
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Dissociative fugue
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Describe dissociative amnesia
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One or more episodes of inability to recall important personal information, usually related to trauma.
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First line therapy for OCD
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SSRI (paroxetine)
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Second line treatment for OCD
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Climipramine
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Defined by recurrent feelings of detachment from one's own physical mental processes (they are observing themselves from afar)
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Depersonalization disorder
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Defined by experiencing familiar people/surroundings as if they were strange or unreal
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Derealization disorder
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Three of these symptoms are required for a dx of GAD:
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Impaired sleep, poor concentration, easy fatigability, irritability, muscle tension, restlesness
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Avoidant and schizoid personality disorders both have few close relationships. What is an easy way to tell the difference?
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Schizoids have no desire for personal relationships. Avoidants desire them, but don't engage because they fear rejection/inadequacy.
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Particular anomaly at risk with lithium in the first trimester of pregnancy. Explain what it is
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Ebstein's anomoly. The tricuspid valve is malformed and attached inferiorly, making part of the right ventricle functionally atrialized.
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Length of time meds should be continued when treating an initial episode of depression
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Six months
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Three categories of defense mechanisms
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Immature, Neurotic, Mature
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Defense mechanism in which pt dedicates themselves to helping others deal with a similar conflict
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Altruism
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What is reaction formation?
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The person does the complete opposite of what they really feel/desire. Normally a short term response that breaks down
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This category of defense mechanism is effective short term but eventually breaks down
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Neurotic
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Explain the defense mechanism sublimation
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Unacceptable/negative impulses are channeled into more acceptable activities. Example: an angry person taking up athletics
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In this defense mechanism, a person voluntarily withholds unpleasant thoughts/feelings and often substitutes them with others. Example: a person with cancer focuses on their children's needs.
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Suppression
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Explain the defense mechanism rationalization
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Offering a false but rational/logical reason for an upsetting event rather than the true reason
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Defense mechanism that involves separating a thought from it's emotional components. Example: someone remains calm and collecting during a crisis.
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Isolation
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Explain the defense mechanism "resistance"
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Person has intense opposition to bringing unpleasant thoughts to conscious awareness. Example: despite obvious evidence, a woman refuses to consciously conclude that her husband is cheating.
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Class of psych meds that can lead to hyperprolactinemia. Why?
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Antipsychotics - due to dopamine blockade
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Parents refuse chemotherapy for tx of their child's ALL. What is the next step?
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Obtain a court order for the chemotherapy.
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What is "double depression?"
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An episode of major depression superimposed on dysthymia.
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Name for a a chronic (often years long), low-grade depression. Pt may not meet all criteria for major depression
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Dysthymia
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Defense mechanism in which pt substitutes a less disturbing view of the world in place of reality. Example: a pt believes they will survive a terminal illness because an angel told them so.
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Fantasy
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Define hypnogogic and hypnopompic hallucinations
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Hallucination while falling asleep (hypnogogic) or while waking (hypnopompic).
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Other than randomly falling asleep, some other symptoms of narcolepsy
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Cataplexy, hypnogogic/hypnopompic hallucinations, sleep paralysis
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Define cataplexy
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Diffuse muscle weakness leading to collapse
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After an episode of narcoleptic sleep, how will the patient feel?
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Very refreshed and energized
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Tx for narcolepsy
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Psychostimulants (modafinil/methylphenidate), combined with antidepressents if cataplexy is present
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Sleep disorder that melatonin is used for.
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Jet-lag (sometimes other circadian rhythm disorders)
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Class of drugs effective in circadian rhythm sleep disorder, nightmare/sleep terror disorder, and sleepwalking disorder
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Benzo's
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What is female sexual arousal disorder?
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Inability to attain/maintain adequate lubrication or swelling when sexually aroused
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Defined by anxiety about genital sexual contact with a partner (sometimes can be restricted to specific sexual acts).
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Sexual aversion disorder
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Difference between major depression w/psychotic features and schizoaffective disorder.
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In schizoaffective disorder, psychotic symptoms must be present for a minimum of two weeks when mood symptoms are not. In MDD w/psychotic features, psychosis is only present with the mood symptoms.
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Assume a pt has + HIV status and refuses to tell partners. What can you do?
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Inform the health department. You cannot inform partners against the patients wishes, but the health department can.
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Four side effects with increased risk in atypical antipsychotics.
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Weight gain, hyperglycemia, dyslipidemia, HTN.
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Two atypical antipsychotics w/greatist risk of weight gain.
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Clozapine and olanzapine
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Atypical antipsychotic requiring weekly CBC for first six months of treatment (risk of agranulocytosis).
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Clozapine
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Bipolar med which may cause hypothyroidism.
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Lithium
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Pt on antipsychotics develops fever, mental status change, and rigidity. Likely dx?
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Neuroletptic malignant syndrome
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Explain the defense mechanism of displacement
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The pt shifts emotions associated with an object/person to an alternative object/person
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Explain the defense mechanism of projection
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Assigning unacceptable internal thoughts/emotions to others. Ex: an unfaithful husband accuses his wife of cheating
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Term for obscene vocal tics
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Coprolalia
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Drug class of Pimozide
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Typical antipsychotic
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Drug class for tx of Tourette's
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Typical antipsychotic
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Drug use presenting similar to cocaine intoxication, but with more prominent psychotic features
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Amphetamines
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Triad for heroin intoxication
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Altered consciousness, respiratory depression, pinpoint pupils
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Mnemonic for manic episode diagnosis
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DIGFAST (must have three or more):
Distractibility Insominia Grandiosity Flight of Ideas Activity increase (goal-oriented) Speech increased Thoughtlessness (high-risk behavior) |
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Heroin withdrawal symptoms
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Muscle spasm, joint pain, nausea/vomiting, diarrhea, abdominal cramps, rhinorrhea, lacrimation, sweating, irritability, HTN, mydriasis
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Amphetamine withdrawal symptoms
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Depression, irritability, fatigue, increased appetite, psychomotor disturbance
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Most common side effect of olanzapine
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Weight gain
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Pathway of the dopaminergic neurons with suppress prolactin. Causes hyperproloctinemia in pt's taking antipsychotics
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Tuberoinfundibular pathway
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Indications for hospitalizing an anorexic patient
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severe malnutration (< 75% of average body weight), dehydration, starvation, electrolyte disturbances, arrhythmias
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Atypical antipsychotic most likely to cause extrapyramidal symptoms
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Risperidone
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Type of schizophrenia with rambling speech and innapropriate behavioral (ex: laughing at strange times)
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Disorganized
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Drug class used to slow cognitive decline in Alzheimer's
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Acetylcholinesterase inhibitors
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Drug class of donepezil, galantamine, and tacrine
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Reversible acetylcholinesterase inhibitors
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Dx for schizonephrenic symptoms presenting for more than one month but less than six
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Schizophreniform disorderm
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Maximum symptoms duration for a dx of brief psychotic disorder
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One month
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Reason you would not give a diabetic mirtazapine
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Weight gain is a common side effect
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Primary neurotransmitter playing a roll in OCD
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Serotonin
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What can NOT be the stressor preceding adjustment disorder?
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Death of a loved one. In this case you would dx bereavement
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Drug class of choice for social phobia
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SSRI's
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Therapy (not drug) of choice for social phobia
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Assertiveness training
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Neurotransmitter reuptake affected by buproprion
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Norepinephrine and dopamine
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TCA that has potential to cause sexual side effects
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Amitriptyline
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What has to be present to dx delirium tremens as opposed to mild alcohol withdrawal or alcoholic hallucinations?
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Change in vital signs (fever, HTN, tachycardia). Other alcohol withdrawal states have normal vitals.
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Time of onset (since last drink) and symptoms of mild alcohol withdrawal.
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6 hours; Anxiety, trembles, sweating, palpitations
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Though alcoholic hallucinosis can be auditory, visual, or tactile, primarily the hallucinations are?
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Auditory
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Time of onset (since last drink) to delirium tremens
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48-96 hours
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Time of onset (since last drink) to alcoholic hallucinosis
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12-24 hours
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Time of onset (since last drink) to withdrawal seizures
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12-48 hours
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Sexual side effects of SSRI's
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Impotence, delayed ejeculation, decreased libido
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Class of antidepressents which raise BP
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SNRI's
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Side effect unique to trazodone compared to other antidepressents
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Priapism
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Possible indications for electroconvulsive therapy
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Severe depression
Depression in pregnancy Refractory mania Neuroleptic malignant syndrome Catatonic schizophrenia |
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Most common side effect of electroconvulsive therapy
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Amnesia (can be anterograde or retrograde)
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Can prolonged seizures occur after electroconvulsive therapy?
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Yes, though this is rare. Amnesia is more common
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Four first line medications for long-term mania therapy
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Lithium, lamotrigine, olanzapine, quetiapine
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Structural brain changes common in schizophrenics
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Enlarged ventricles and prominent sulci. Decreased cerebral, hippocampal, and temporal mass.
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Two DOC's for bipolar disorder
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Lithium, valproic acid
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Describe delusional disorder
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Fixed, non-bizarre (could occur in real life) false beliefs in an otherwise high function person.
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Three most common types of delusions in delusional disorder
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Erotomanic (person of higher status is in love with them), persecutory (someone is trying to harm them/others), jealous (ex: spouse is cheating)
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First and second line drug for enuresis
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1st: desmopressin
2nd: Imipramine |
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How long uworld says SSRI's take to work
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4-6 weeks
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