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483 Cards in this Set
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- Back
Monitoring for pts on clozapine (specifics)
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ANC and WBC at baseline, then weekly for 6mo, then biweekly for 6mo, then monthly
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Which pts is ziprasidone contraindicated in and when should it be tested for?
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Long QT syndrome (get EKG if family Hx of SCD <40yo)
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3 phases of schizophrenia
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Prodromal (before first psychotic episode; withdrawn, new interests)
Psychotic Residual (btwn episodes, negative symptoms) |
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Echolalia
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Repeats words or phrases
|
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Echopraxia
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Mimics behavior
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5 subtypes of schizophrenia
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Paranoid
Disorganized Catatonic Residual (prominent negative symptoms) Undifferentiated |
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4 dopamine pathways
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Prefrontal cortical
Mesolimbic Tuberoinfundibular Nigrostriatal |
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Which dopamine pathway is responsible for negative symptoms?
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Prefrontal cortical
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Which dopamine pathway is responsible for positivesymptoms?
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Mesolimbic
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Which dopamine pathway is responsible for EPS when blocked by neuroleptics?
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Nigrostriatal
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Which dopamine pathway is responsible for hyperprolactinemia when blocked by neuroleptics?
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Tuberoinfundibular
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Two drugs of abuse that can cause acute psychosis by activating dopaminergic pathways
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Cocaine
Amphetamines |
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2 other neurotransmitters that are increased in schizophrenia
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Serotonin
Norepinephrine |
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Neurotransmitter that is decreased in schizophrenia
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GABA (might indirectly active dopamine and NE pathways)
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Changes in brain structure of schizophrenic pts seen on CT scans
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Enlargement of ventricles
Diffuse cortical atrophy |
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4 typical neuroleptics
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Chlorpromazine, thioridazine, trifluoperazine, haloperidol
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How long should antipsychotics be tried before determining medication failure?
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4wks
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Which neuroleptics have moer EPS side effects, and which have more anticholingeric side effects?
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High potency (haloperidol, trifluoperazine): EPS
Low potency (chlorpromazine, thioridazine): Anticholingeric |
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3 types of EPS
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Dystonia, Parkinsonism, akathisia
|
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Anticholinergic symptoms
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Dry mouth, constipation, blurred vision
|
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What is tardive dyskinesia?
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Darting or writhing movements of face, tongue, head
|
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Rx for tardive dyskinesia
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Limited, but d/c offending agent and substitute atypical neuroleptic
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Pt on antipsychotics with confusion, high fever, elevated BP, rigid, sweating
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Neuroleptic malignant syndrome
|
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What lab test is elevated in neuroleptic malignant syndrome
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Creatine phsophokinase (CPK)
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How many pts with schizophreniform disorder progress to schizophrenia or schizoaffective
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2/3rds
|
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How to differentiate schizoaffective disorder from mood disorder with psychotic features
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Former has had delusions or hallucinations for 2wks in absence of mood disorder symptoms
|
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3 most common patients who develop delusional disorder
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Older (>40yo)
Immigrants Hearing impaired |
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6 types of delusions
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Erotomanic (love-based), grandiose, somatic, persecutory, jealous, mixed
|
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Two ways in which delusional disorder is distinguished from schizophrenia
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Nonbizarre delusions
Daily funcitoning not significantly impaired |
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Rx for shared psychotic disorder
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Separate pt, psychoterapy, antipsychotics only if symptoms haven't improved in 1-2wks
20-40% recover upon removal from inducing person |
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Culture psychosis in which patient believes penis is shrinking and will disappear, causing his death
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Koro (Asia)
|
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Culture psychosis with sudden unprovoked outbursts of violence (pt has no recollection), often commits suicide afterwards
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Amok (Southeast Asia)
|
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Culture psychosis with headache, fatigue, visual disturbances in male students
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Brain fag (Africa)
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Mental retardation is defined as an IQ less than
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70
|
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Risk of developing antisocial PD among children w/ conduct disorder
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40%
|
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Pharma therapy for conduct disorder (2 classes of symptoms that you're treating)
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Aggression: antipsychotics or lithium
Impulsivity, irritability, mood lability: SSRIs |
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Difference btwn ODD and conduct disorder
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ODD doesn't involve violation of basic rights of others
|
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Most common comorbid conditions with ADHD
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2/3rds of pts also have conduct disorder or ODD
|
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2 subtypes of ADHD
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Inattentive
Hyperactivity-impulsivity |
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When does ADHD onset, and what percentage of patients have symptoms into adulthood?
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By 7yo
20% |
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How does depression often manifest in kids?
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Irritableness
|
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3 CNS stimulants used in ADHD
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Methylphenidate (Ritalin)
Dextroamphetamine (Dexedrine) Pemoline (Cylert) |
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3 categories of autistic symptoms
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Repetitive/ sterotyped behaviors
Impaired communication Problems w/ social interaction |
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Onset of autism
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Usually before 3yo
|
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Difference between Asperger's and autism
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Asperger's has normal language and cognitive development (only has the repetitive behaviors and problems with social interaction)
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When do symptoms of Rett's present?
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5mo-30mo get regression of head circumference and onset of hand wringing
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Medical problems in Rett's include (2)
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Seizures
Cyanotic spells |
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Mutation in Rett's
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MECP2 gene (on X chromosome)
|
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When does childhood disintegrative disorder present?
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Onset 2yo-10yo (loss of previously acquired skills)
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What is coprolalia
|
Repetition of obscene words
|
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3 diagnostic criteria for Tourette's
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Motor AND vocal tics
>1yr w/ symptoms, no tic free period >3 mo Onset prior to 18yo |
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Motor tics typically involve which parts of the body?
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Face and head
|
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Which type of tic onsets later
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Usually vocal (may be years after onset of motor tic)
|
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Common comorbidity with Tourette's
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OCD and ADHD
|
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Rx for Tourette's
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Haldol or pimozide
|
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3 medical conditions to rule out before enuresis is diagnosed
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Seizures
Urethritis Diabetes |
|
Enuresis can be further described by these two categories (2 choices for each)
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Primary vs. secondary
Diurnal vs. nocturnal |
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Diagnostic criteria for enuresis
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>2yo
2x/wk for 3mo |
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Outcome for majority of cases of enuresis
|
Spontaneously resolve by 7yo
|
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2 pharma therapy options for enuresis
|
DDAVP or TCA
|
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3 med conditions to r/o before diagnosing encopresis
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Metabolic (hypothyroid)
Lower GI (fissure, IBD) Dietary |
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Diagnostic criteria for encopresis
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>4yo
1x/mo for 3mo |
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Pharma therapy for separation anxiety disorder
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Low dose antidepressant
|
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Risk of later suicide after hospitalization for MDE
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15%
|
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What % of manic pts have psychotic symptoms
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75%
|
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Predominant mood symptom in pts with mixed episodes
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Irritability
|
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4 things that differentiate hypomania from mania
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>4 days (instead of >7)
No interference w/ functioning Doesn't require hospitalization No psychotic features |
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Rx for seasonal affective disorder
|
Light therapy
|
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Which neuroendocrine is high in depression?
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Cortisol
|
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What % of pts with MDD eventually commit suicide?
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15%
|
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Risk of subsequent MDE after first episode?
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50%
|
|
Major risk w/ monoamine oxidase inhibitors (MAOIs)?
|
Hypertensive crisis when used with sympathomimetics or ingestion of tyramine-rich foods (wine, beer, cheese)
|
|
Danger when combining SSRIs with MAOIs
|
Serotonin syndrome
|
|
Sequelae of serotonin syndrome
|
Autonomic instability, hyperthermia, seizures
Coma and death in severe cases |
|
Most common side effect with MAOIs
|
Orthostatic hypotension
|
|
Procedure for ECT
|
Premed w/ atropine
General anesthesia + muscle relaxant Generalized seizure induced by passing current of electricity across brain (unilateral or bilateral) for <1min |
|
Time frame for initial ECT
|
8 treatments over 2-3 weeks
|
|
Most common side effect with ECT
|
Retrograde amnesia
|
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4 subtypes of depressive disorders
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Melancholic
Atypical Catatonic Psychotic |
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Characteristics of melanocholic depression
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Early morning awakenings, excessive guilt, anorexia
|
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Characteristics of atypical depression
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Hypersomnia, hyperphagia, leaden paralysis, hypersensitivity to rejection
|
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Characteristics of catatonic depressionCharac
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Catalepsy (immobility), purposeless motor activity, extreme negativism/ mutism, bizarre posutres, echolalia
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What is required for the diagnosis of bipolar I?
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Episode of mania or mixed episode (depressive episode NOT required)
|
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What is required for the diagnosis of bipolar II?
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One or more MDEs and at least one hypomanic episode (NO history of manic episodes, otherwise is bipolar I)
|
|
Typical length of untreated manic episodes
|
3mo
|
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Pharma therapy for bipolar disorder (3 options)
|
1) Lithium
2) Anticonvulsants (carbamazepine or valproic acid): also mood stabilizers, useful for rapid cycling and mixed episodes 3) Olanzapine |
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What is rapid cycling?
|
4 or more mood episodes in 1 year
|
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12 side effects of lithium
|
Weight gain
Tremor GI problems Fatigue Arrhythmia Seizures Goiter/ hypothyroid Benign leukocytosis Polyuria/ polydipsia Alopecia Metallic taste Coma |
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Difference between MDD and dysthmic disorder
|
Dysthmic disorder is generally persistent (not episodic), rarely requires hospitalization
|
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What rules out the diagnosis of dysthmia?
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Psychotic features
|
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What is double depression?
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MDD with dysthmic disorder during residual periods
|
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What is cyclothymic disorder?
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Alternating periods of hypomania and periods with mild/moderate depression
|
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Difference btwn cyclothymia and bipolar II?
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No MDEs
Never symptom free for >2mo during last 2yrs |
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Cyclothymia often coexists with which PD?
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Borderline
|
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One third of cyclothymic pts eventually develop which diagnosis?
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Bipolar disorder
|
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Rx for cyclothymia?
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Same as bipolar
|
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Time frame for post-partum depression?
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4wks to 12mo
|
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Autonomic symptoms of anxiety (9)
|
Palpitations
Perspiration Dizziness Mydriasis GI disturbances Urinary urgency/frequency Trembling Tingling in peripheral extremities SOB/ choking sensation |
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Neurotransmitters increased (1) and decreased (2) in anxiety
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NE increased
GABA/ serotonin decreased |
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Typical duration of panic attacks
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Peak in several minutes, last 25 min (rarely >1hr)
|
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Diagnostic criteria for panic disorder
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Panic attack followed by concern/ worry/ avoidance about additional attacks
|
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Panic disorder should always be specified as
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With or without agoraphobia
|
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MI presentation with normal angiogram
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Panic attack
|
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Acute and maintenance treatment of anxiety
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Benzos
SSRIs |
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What side effects are common in panic disorder pts taking SSRIs?
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Activation side effects (anxiety symptoms that mimic those of panic)
|
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Rx for agoraphobia associated w/ panic disorder
|
Usually resolves with SSRI treatment for panic disorder
|
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Most common mental disorders in the US
|
Specific phobias
|
|
Best treatment for performance anxiety
|
Beta blockers
|
|
Rx for specific phobias
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Systemic desensitization (w/ or w/out hypnosis; add benzos/beta blockers in severe cases) and supportive psychotherapy
|
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FDA approved drug for social anxiety disorder
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Paxil (paroxetine)
|
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How to differentiate OCD from OCPD
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OCD is egodystonic
|
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4 common obsessions
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Contamination
Doubt --> checking Symmetry Intrusive thoughts (often sexual/ violent) w/o compulsion |
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Rate of OCD is higher in pts with first degree relatives with this disorder
|
Tourette's
|
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4 most common mental disorders
|
Phobias
Substance-induced disorders Major depression OCD |
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Most common trigger of OCD
|
Stressful life event
|
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2 pharma options for OCD
|
High-dose SSRIs
TCAs (clomipramine) |
|
Behavioral treatment option for OCD
|
Exposure and response prevention
|
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3rd line therapy for refractory OCD
|
ECT or cingulotomy
|
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Prognosis with PTSD
|
50% remain symptom free after 3mo of treatment
|
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3 pharma options for PTSD
|
TCAs (imipramine and doxepin)
SSRIs and MAOIs Anticonvulsants (for flashbacks and nightmares) |
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What is acute stress disorder?
|
Similar to PTSD, except immediately after event occurred, and symptoms last for <1mo
|
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Treatment for acute stress disorder
|
Same as for PTSD
|
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New onset psychosis in a 50yo man
|
Think medical condition associated psychosis
|
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New onset psychosis in an 80yo man
|
Think dementia
|
|
Why should benzos be avoided in treatment of PTSD?
|
They are addictive, and high rates of substance abuse in PTSD pts
|
|
GAD DSM criteria requires association of at least these 3 symptoms
|
Restlessness
Fatigue Difficulty concentrating Irritability Muscle tension Sleep disturbance |
|
Pharma Rx for GAD
|
Buspirone
Benzos (usually clonazepam or diazepam): taper quickly SSRIs Venlafaxine (XR) |
|
What is an adjustment disorder?
|
Maladaptive behavioral or emotional symptoms within 3mo of a stressful (but not life-threatening: that is PTSD) event
|
|
By definition, when do symptoms resolve after adjustment disorder
|
Within 6mo after stressor has terminated
|
|
2 subtypes of anorexia
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Restrictive type (often with OC traits, may vigorously exercise)
Binge eating/ purging type (associated w/ increased incidence of MDD and substance abuse) |
|
What distinguishes anorexia from bulimia?
|
Low body weight for anorexia, normal to high for bulimia
Bulimia is more egodystonic |
|
4 criteria for anorexia
|
Weight 15% nml
Fear of gaining weight Disturbed body image Amenorrhea |
|
What is melanosis coli?
|
Darkened area of colon 2/2 laxative abuse
|
|
Mortality associated w/ anorexia, and 3 typical causes
|
10%
Starvation, suicide, electrolyte disturbance |
|
When should anorexic pts be hospitalized?
|
If >20% below ideal body weight
|
|
2 good SSRIs for adjunctive Rx for anorexia
|
Paroxetine or mirtazapine (help increase weight gain)
|
|
Difference btwn underweight from anorexia vs. MDD
|
No appetite in MDD
|
|
2 types of bulimia
|
Purging (vomiting, laxatives, diuretics)
Nonpurging (excessive exercise or fasting) |
|
Definition of binge eating
|
Excessive food intake within 2hr period accompanied by sense of lack of control
|
|
Most common electrolyte abnormality in anorexia vs bulimia
|
Anorexia: hypochloremic, hyperkalemic alkalosis
Bulimia: hypochloremic hypokalemic alkalosis |
|
Pharma therapy for bulimia
|
SSRIs are first line, then TCAs
|
|
Classification of binge eating disorder
|
Eating disorder NOS
|
|
Diagnostic criteria for binge eating
|
Bingeing 2+ days a week for 6mo, not associated w/ compensatory behaviors, and causes distress
At least 3 of: eating v. fast, until uncomfortably full, large amts when not hungry, alone b/c of embarrassment, feeling disgusted/depressed/guilty afterward |
|
4 neurotransmitters that can be increased in sleep disorders
|
Dopamine (decreased sleep time)
NE (decreased sleep time) ACh (increased sleep time and increased REM) Serotonin (increased sleep time esp delta sleep) |
|
2 types of primary sleep disorders
|
Dyssomnias: disturbances in amt, quality, or timing of sleep
Parasomnias: abnml events in behavior or physiology during sleep |
|
EEG waves when awake
|
Awake: mixed frequency, desynchronized
|
|
EEG waves when awake w/ eyes closed
|
Alpha waves
|
|
EEG waves in Stage 1 sleep
|
Loss of alpha waves
|
|
EEG waves in Stage 2 sleep
|
Sleep spindles and k complexes
|
|
EEG waves in Stage 3-4 sleep
|
Delta waves (low frequency)
|
|
EEG waves in REM sleep
|
Sawtooth waves
|
|
What % of sleep is REM sleep?
|
25%
|
|
What is REM reboun?
|
Increase in amt of REM sleep that occurs after a night of sleep deprivation; slow wave sleep is made up first
|
|
2 diagnostic criteria for primary insomnia
|
Results in daytime drowsiness or difficulty fulfilling tasks
3 or more times per wk for at least 1mo |
|
Rx for primary hypersomnia
|
Amphetamines (maybe SSRIs)
|
|
6 things associated with narcolepsy
|
Cataplexy
Short REM latency Sleep paralysis Hypnagogic Hypnopompic Hallucinations |
|
What are hypnagogic and hypnopompic episodes?
|
Hypnagogic: dream as pt is falling asleep
Hypnopompic: dream persists as pt is waking up |
|
What is cataplexy and what often precipitates it?
|
Collage due to sudden loss of muscle tone
Associated w/ emotion, esp laughter |
|
Rx for narcolepsy
|
Timed daily naps plus stimulant drugs
SSRIs or sodium oxalate for cataplexy |
|
Rx for OSA vs. central sleep apnea
|
CPAP vs. biPAP (mechanical ventilation)
|
|
Rx for shift work sleep disorder
|
Light therapy
|
|
When should melatonin be given for a circadian rhythm sleep disorder?
|
5.5 hrs before desired bedtime
|
|
During which sleep stage do nightmares occur?
|
REM
|
|
Rx for nightmare disorder
|
Usually none (may use tricyclics or other agents that suppress REM sleep)
|
|
During which sleep stage do night terrors occur?
|
Stage 3-4 sleep
|
|
How to differentiate nightmares from night terrors
|
Nightmares: pts fully awaken and remember the episode
|
|
Rx for night terror disorder
|
Usually nothing (but can use low dose diazepam at bedtime)
|
|
During which sleep stage does somnambulism occur?
|
Stage 3-4
|
|
Peak age for prevalence of somnambulism
|
12yo (onset usually at 4-8yo)
|
|
Rx for somnambulism
|
Measures to prevent injury in surrounding environment
|
|
4 criteria for how personality disorders can manifest (pt needs at least 2/4)
|
CAPRI
Cognition Affect Personal Relations Impulse control |
|
3 clusters of personality disorders
|
A: Schizoid, schizotypal, paranoid (MAD)
B: Antisocial, borderline, histrionic, narcissistic (BAD) C: Avoidant, dependent, obsessive-compulsive (SAD) |
|
What is passive-aggressive personality disorder characterized as?
|
PD NOS
|
|
Rx of choice for PDs
|
Psychotherapy
|
|
How to differentiate paranoid PD from paranoid schizophrenia
|
Paranoid PD: no fixed delusions, no frank psychosis
|
|
Difference btwn schizoid and schizotypal
|
Schizoid: loner
Schizotypal: eccentric/ magical thinking |
|
Schizotypal pts may eventually develop which disease?
|
Schizophrenia
|
|
9 criteria for borderline personality disorder
|
IMPULSIVE
Impulsive Moody Paranoid under stress Unstable self image Labile, intense relationships Suicidal (repeatedly) Inappropriate anger Vulnerable to abandonment Emptiness |
|
For which personality disorder is pharmacotherapy most useful?
|
Borderline
|
|
Common defensive mechanism of histrionic patients
|
Regression
|
|
Difference in the underlying fear in avoidant PD vs. social anxiety disorder
|
Avoidant PD: fear rejection (sense of inadequacy)
Social anxiety disorder: fear embarrassment |
|
Pt with a debilitating illness who develops dependence on a caretaker does not have dependent PD because
|
Onset of symptoms not before adulthood
|
|
Frequently making excuses and inefficient procrastinator is what PD?
|
Passive-aggressive
|
|
Lifetime prevalence of substance abuse or dependence in the US
|
17%
|
|
Withdrawal and tolerance are characteristics of
|
Substance dependence
|
|
Most commonly abused substance in the US
|
Alcohol (7-10% rate of alcoholism)
|
|
What neurotransmitter is responsible for the sedating effects of alcohol?
|
GABA
|
|
There is upregulation of which two enzymes in heavy drinkers?
|
Alcohol dehydrogenase (alcohol --> acetaldehyde)
Aldehyde dehydrogenase (acetaldehyde --> acetic acid) |
|
BALs that can cause coma and respiratory depression in the novice drinker, respectively
|
300 mg/dL
400 mg/dL |
|
2 types of poisonings that can present similarly to alcohol overdose
|
Ethylene glycol
Methanol (all 3 cause an anion gap metabolic acidosis) |
|
3 drugs given for acute alcohol intoxication
|
Thiamine
Naloxone (for any opioids that may have been ingested) Folate Glucose (in case their AMS is due to hypoglycemia) |
|
3 drugs used for alcohol abuse
|
Disulfiram (antabuse): causes vomiting b/c inhibits aldehyde dehydrogenase
SSRIs Naltrexone (reduces cravings) |
|
Onset and length of alcohol withdrawal symptoms
|
6-24 hours
2-7 days |
|
3 categories of alcohol withdrawal symptoms
|
Mild: irritable, tremor, insomnia
Moderate: diaphoresis, fever, disorientation Severe: grand mal seizures, DTs |
|
Symptoms of DTs
|
Visual or tactile halluciantions, gross tremor, autonomic instability, fluctuating levels of psychomotor activity
|
|
Mortality of untreated DTs
|
20%
|
|
Rx for DTs
|
Benzos
|
|
Drug for postwithdrawal seizures
|
Magnesium sulfate
|
|
Triad of Wernicke's encephalopathy (acute)
|
Ataxia
Confusion Ocular abnormalities (nystagmus, gaze palsies) |
|
Triad of Korsakoff's syndrome (chronic, irreversible)
|
Impaired recent memory
Anterograde amnesia +/- confabulation (making up answers) |
|
Order of meds given in pt with AMS and + BAL
|
Thiamine always BEFORE glucose, or can precipitate Wernicke-Korsakoff syndrome (b/c is a coenzyme used in carb metabolism)
|
|
3 topographic theories of psychotherapy
|
Unconscious, preconscious, conscious
|
|
3 structural theories of psychotherapy
|
Id, ego, supergo
|
|
Normal development of egos
|
Id at birth, ego present after birth, superego by 6yo
|
|
What is used to control instinctual urges in the ego?
|
Defense mechanisms
|
|
What is used to detect fantasies/ psychoses in the ego?
|
Reality testing
|
|
4 mature defense mechanisms
|
Altruism, humor, sublimation, suppression
|
|
7 neurotic defense mechanisms
|
Controlling, displacement, intellectualization, isolation of affect, rationalization, reaction formation, repression
|
|
What is displacement and what is an example?
|
Shifting emotions from an undesirable situation to one that is personally tolerable (student who is angry at his mom talks back to his teacher the next day and refuses to obey her)
|
|
What is reaction formation and what is an example?
|
Doing the opposite of an unacceptable impulse (man in love w/ his coworker insults her)
|
|
% of incarcerated patients who have antisocial PD?
|
80%
|
|
Difference btwn repression and suppression
|
Former is unconscious
|
|
4 immature defenses
|
Acting out, denial, regression, projection
|
|
What is acting out and what is an example?
|
Giving in to an impulse, even if socially inappropriate, to avoid the anxiety of suppressing it (man who is told his therapist is going on vacation "forgets" his last appt)
|
|
What is projection and what is an example?
|
Attributing objectionable thoughts or emotions to others (husband attracted to other women believes his wife is having an affair)
|
|
2 other defense mechanisms
|
Splitting and undoing
|
|
What is undoing and what is an example?
|
Attempting to reverse a situation by adopting a new behavior (man who briefly fantasizes about killing his wife by sabotaging her car takes the car in for a complete check-up)
|
|
Goal of psychoanalysis
|
Resolve unconscious conflicts by bringing repressed experiences/ feelings into awareness
|
|
Psychoanalysis is ____ oriented
|
Insight oriented
|
|
5 behavioral therapy techniques for deconditioning
|
Systemic desensitization, flooding and implosion, aversion therapy, token economy, biofeedback
|
|
Which technique is used in both systemic desensitization and flooding/implosion
|
Relaxation techniques
|
|
Difference between flooding and implosion
|
Real vs. imagined, respectively
|
|
Foundation of cognitive therapy
|
Identify and replace maladaptive thoughts w/ positive thoughts
|
|
2 common problems addressed in family therapy
|
Boundaries that are too permeable
Triangles (2 people forming an alliance against a 3rd) |
|
4 types of marital therapy
|
Conjoint therapy, concurrent therapy (separate but same therapist), collaborative (seen individually), four-way therapy (2 therapists, common for sexual problems)
|
|
4 topics taught in DBT
|
Mindfulness, interpersonal effectiveness
|
|
How does cocaine cause its stimulant/reward effect?
|
Blocks dopamine reuptake
|
|
3 ways cocaine overdose can cause death
|
Arrhythmia, seizure, respiratory depression
|
|
Cause of MI/CVA in cocaine user
|
Vasoconstriction
|
|
Cocaine intoxication mimics
|
Flight or fight (sympathomimetic)
|
|
Ddx for cocaine intoxication
|
Amphetamines or PCP
Sedative withdrawal |
|
How long will urine tox be positive for cocaine?
|
3 days (longer in heavy users
|
|
Rx for cocaine intoxication
|
Benzos (+ haloperidol for severe agitation/psychosis)
|
|
Rx for cocaine dependence
|
TCAs or dopamine agonists (amantadine, bromocriptine)
|
|
Risk of cocaine withdrawal
|
Really nothing: terrible crash, but not life-threatening
|
|
3 classic and 2 designer amphetamines
|
Dextroamphetamine (Dexedrine)
Methylphenidate (Ritalin) Methamphetamine MDMA (ecstasy) MDEA (eve) |
|
Difference between classic and designer amphetamines
|
Designer release serotonin (in addition to dopamine) and have hallucinogenic properties (in addition to stimulant)
|
|
How long will urine tox be positive for amphetamines
|
1-2 days (though many tests aren't sensitive enough)
|
|
Rx for amphetamine intox/dependence/withdrawal
|
All same as cocaine
|
|
Rotatory nystagmus
|
PCP intoxication
|
|
Which drug intoxication is most likely to cause violence
|
PCP
|
|
Which drug is most similar to PCP?
|
Ketamine
|
|
Mechanism and effect of PCP
|
NMDA glutamate antagonist (and dopamine activator) --> hallucinogen
|
|
Risk of PCP overdose
|
Seizures, coma
|
|
5 components of PCP Rx
|
1) Benzos or dopamine antagonists to control agitation/anxiety
2) Diazepam for spasms/seizures 3) Acidify urine w/ ammonium chloride and ascorbic acid 4) Haloperidol for severe agitation/psychosis 5) Monitor BP, temp, lytes |
|
Ddx for PCP intoxication
|
Psychosis, schizophrenia
|
|
How long is a urine tox screen positive for PCP?
|
>1 wk
|
|
Which lab values are often elevated in PCP use?
|
CPK and AST
|
|
Does PCP have withdrawal symptoms
|
No, but pts may have flashbacks
|
|
How do benzos and barbiturates work
|
Potentiate GABA by increasing the frequency or duration (respectively) of chloride channel opening
|
|
Complication of benzo or barbiturate abuse
|
Respiratory depression
|
|
How long is a urine tox screen positive for sedatives?
|
1 wk
|
|
Rx for sedative overdose
|
Activated charcoal to prevent further absorption
|
|
Rx for benzo overdose
|
Flumazenil (antagonist)
|
|
Risk w/ flumazenil
|
Seizures
|
|
Rx for barbiturate overdose
|
Alkalinize urine w/ sodium bicrb to promote renal excretion
|
|
Withdrawal from sedatives
|
Autonomic hyperactivity, risk of life-threatening seizures
|
|
Rx for sedative withdrawal (2)
|
Long-acting benzo (diazepam) and valproic acid for seizures
|
|
How long is a urine tox screen positive for opiates?
|
12-36hrs
|
|
Triad of opioid overdose
|
Respiratory depression, AMS, miosis
|
|
Which opioid produces midriasis instead of miosis?
|
Meperidine (Demerol)
|
|
Rx for opioid withdrawal
|
Clonidine or buprenorphne; methadone if severe
|
|
3 hallucinogens
|
Mushrooms (psilocybin), mescaline, LSD
|
|
Hallucinogens don't cause
|
Physical dependence or withdrawal
|
|
Rx for hallucinogen intoxication
|
Usually just talking down pt
|
|
Use of marijuana in cancer/AIDS pts
|
Anti-emetic and appetite stimulant, respectively
|
|
How long is a urine tox screen positive for marijuana?
|
4 wks (released from adipose stores)
|
|
Inhalants are CNS ___?
|
Depressants
|
|
Risk w/ inhalant overdose
|
Respiratory depression or arrhythmias
|
|
Long-term inhalant use can damage
|
CNS, PNS, liver, kidney, muscle
|
|
How long is a urine tox screen positive for inhalants?
|
4-10hrs
|
|
Mechanism of caffeine (2)
|
Adenosine antagonist, so increases cAMP
Stimulant via dopaminergic effects |
|
Caffeine intake >1 gram can cause
|
Tinnitus, agitation, arrhythmias
|
|
Caffeine intake >10grams can cause
|
Seizures or respiratory failure --> death
|
|
Neurotransmitter involved in nicotine addition
|
Dopamine
|
|
What is pseudodementia?
|
Depression in elderly --> decrease in memory and cognitive functioning
|
|
Difference btwn demented and pseudodemented pts when they don't know an answer
|
Demented pts confabulate
Depressed pts say "I don't know" |
|
Sundowning is more common w/
|
Dementia
|
|
2 good antidepressants in elderly
|
SSRIs and mirtazapine
|
|
Major antidepressive side effect in elderly
|
Anticholinergic
|
|
Abnormal guilt may involve (3)
|
Hallucinations or delusions
Suicidal ideation Duration >1yr |
|
Sleep cycle changes in elderly (3)
|
Increase number of REM cycles (but no change in total duration)
Increase in Stage 1 and 2 sleep Decrease in Stage 3 and 4 sleep |
|
Prevalence of elder abuse
|
10% of pts >65yo
|
|
Baseline kidney function should be assessed in pts starting which mood stabilizer?
|
Lithium
|
|
Baseline EKG is required in pts starting which antipsychotic?
|
Ziprasidone (Geodon)
|
|
Manic presentation could be due two which two substances?
|
Cocaine or amphetamines
|
|
4 problems commonly associated w/ panic disorder
|
Depression
Aographobia GAD Substance abuse |
|
How long should the intense grieving of bereavement last?
|
<2mo
|
|
CT scan of schizophrenic pt
|
Enlarged ventricles and prominent sulci
|
|
Hyperthermia, autonomic instability, muscular rigidity, altered sensorium
|
Neuroleptic malignant syndrome
|
|
Which drugs cause neuroleptic malignant syndrome?
|
Antipsychotics (dopamine antagonists)
|
|
Complication of neuroleptic malignant syndrome
|
Rhabdomyolysis (--> myoglobinuria --> ARF)
|
|
Rx for NMS
|
Dantrolene (muscle relaxant)
Dopamine agonists (bromocriptine/ amantadine) D/c responsible drug Supportive (fluids, cooling, alkaline diuresis) |
|
What drugs can be used in lieu of antidepressants for MDD and in what scenario?
|
Psychostimulants (e.g. methylphenidate or modafinil)
Short life expectancy (before onset of efficacy of SSRI, for example) |
|
Rx for panic attack/ panic disorder (2)
|
Benzos (e.g. alprazolam) for acute attack
SSRI for long-term prevention |
|
4 dissociative disorders
|
Dissociative amnesia, dissociative fugue, dissociative identity disorder, depersonalization disorder
|
|
Another name for dissociative identity disorder?
|
Multiple personality disorder
|
|
Amnesia due to a stressful life event
|
Dissociative amnesia
|
|
When do pts w/ dissociative amnesia return to normal?
|
Minutes or days
|
|
Rx for dissociative amnesia (and dissociative disorders in general)
|
Hypnosis or Ativan during interview to help patient talk freely (retrieve lost memories)
|
|
What is abreaction?
|
Strong reaction when retrieving traumatic memories
|
|
Sudden travel away from home in which a person takes on a new identity and can't remember the past
|
Dissociative fugue
|
|
Difference in the amnesia between dissociative amnesia and dissociative fugue
|
In dissociative amnesia, pts are aware they've forgotten something
|
|
Prognosis of dissociative fugue
|
Hours to days or longer; afterwards pt will resume old identity and not remember fugue
|
|
Most dissociative identity disorders pts are
|
Women who have experienced prior trauma
|
|
Suicide rate for dissociative identity disorder
|
30%
|
|
What is dissociative identity disorder?
|
2 or more identities that take control of behaviors/ thoughts; unaware of events during prior personality states
|
|
Symptoms of dissociative identity disorder are similar to those of?
|
Borderline personality disorder
|
|
Persistent/ recurrent episodes of being detached from one's body or mind (like an outside observer) but w/ reality testing intact
|
Depersonalization disorder
|
|
Depersonalization disorder has a high comorbidity with
|
Anxiety/ panic
|
|
Rx for depersonalization disorder
|
Anti-anxiety meds or SSRIs for anxiety symptoms
|
|
What is primary gain?
|
Expression of unacceptable feelings as physical symptoms to avoid facing them
|
|
DSM criteria for somatization disorder
|
2 GI, 1 sexual, 1 neuro, and 4 pain symptoms + onset before age 30
|
|
Comorbidities w/ body dysmorphic disorder
|
90% depression, 70% anxiety, 30% psychosis
|
|
Rx for body dysmorphic disorder
|
SSRIs, no procedures
|
|
Two types of pain disorder
|
Acute (<6mo) or chronic (>6mo)
|
|
Ddx for pain disorder
|
Hypochondriasis or malingering
|
|
What must be ruled out w/ all somatoform disorders
|
Hypochondriasis and malingering
|
|
Intentionally producing medical or psychological symptoms to assume role of sick pt
|
Factitious disorder
|
|
Difference factitious disorder and malingering?
|
Factitious disorder involves primary gain
Malingering involves secondary gain |
|
Commonly feigned symptoms in factitious disorder
|
Hallucinations, depression, fever, abdominal pain, seizures, skin lesions, hematuria
|
|
Factitious disorder w/ predominantly physical symptoms
|
Munchhausen syndrome
|
|
Common history of pts with factitious disorder
|
Child abuse or neglect
|
|
Failure to resist aggressive impulses --> assault or property destruction
|
Intermittent explosive disorder
|
|
Aggressiveness is associated w/ this neurotransmitter (low or high?)
|
Low serotonin
|
|
Rx for intermittent explosive disorder
|
SSRIs, anticonvulsants, lithium, propanolol
|
|
Which therapy technique often fails in intermittent explosive disorder?
|
Individual therapy
|
|
5 impulse control disorders
|
Intermittent explosive disorder
Kleptomania Pyromania Pathological gambling Trichotillomania |
|
Kleptomania is often comorbid with
|
Bulimia (1/4 of bulimics)
|
|
Pyromania is often present in
|
Mentally retarded individuals
|
|
Predisposing factors for pathologic gamgling often involve
|
Childhood/ family
|
|
Most effective therapy for pathologic gambling
|
Gamblers Anonymous
|
|
Rx for trichotillomania
|
SSRIs
Antipsychotics Lithium |
|
What is conversion disorder?
|
Neuro symptoms preceded by psychological stressor
|
|
Common symptoms of conversion disorder
|
Shifting paralysis, blindness, mutism, paresthesias, seizures, globus hystericus
|
|
Conversion syndrome in an older adult
|
Suspect neuro deficit
|
|
How do pts with a conversion disorder discuss their symptoms?
|
With calm indifference
|
|
Prognosis of conversion disorder?
|
Recover in 1mo
25% recur |
|
How long must hypochondriasis persist for?
|
6mo
|
|
Difference between somatization and hypochondriasis
|
Somatization disorder pts are concerned about symptoms
Hypochondriacs are concerned about disease |
|
5 stages of sexual response
|
Desire, excitement, plateau, orgasm, resolution
|
|
2 neurotransmitters that affect libido
|
Dopamine enhances libido
Serotonin inhibits libido |
|
2 most common sexual disorders in women
|
Sexual diesire disorder
Orgasmic disorder |
|
2 most common sexual disorders in men
|
Secondary erectile dysfunction
Premature ejaculation |
|
What is second ED
|
Acquired after previous ability to maintain erections
|
|
Rx for female sexual arousal disorder
|
Release of clitoral adhesions
|
|
Rx for female orgasmic disorder
|
Masturbation
|
|
3 Rx methods for premature ejaculation
|
Squeeze technique
Stop-start technique Use side effects of SSRIs/TCAs |
|
3 most common paraphilias
|
Pedophilia, voyeurism, exhibitionism
|
|
3 paraphilias that can occur in women
|
Sadism, masochism, pedophilia
|
|
Sexual pleasure in men from rubbing their genitals against women in crowded areas
|
Frotteurism
|
|
Sexual excitement from calling unsuspecting women
|
Telephone scatologia
|
|
3 Rx options for paraphilias
|
Insight-oriented psychotherapy
Behavior therapy Antiandrogens |
|
Transsexuality is also known as
|
Gender identity disorder
|
|
Gender identity disorder is associated with an increased incidence of
|
MDD, anxiety, suicide
|
|
Gender identity is usually developed by age
|
3yo
|
|
4 exceptions to confidentiality
|
Subpoena
Child abuse Tarasoff duty (harm to others) Suicidal |
|
How many physicians must determine need for involuntary admission?
|
2
|
|
Legal doctrine that allows forcible commitment
|
Parens patriae
|
|
Competence vs. capacity
|
Competence is a legal term
Capacity is a clinical term |
|
Most important factor in predicting violence
|
History of violence
|
|
Criteria for not guilty by reason of insanity (3)
|
Mental illness, doesn't understand right from wrong, didn't understand consequences of actions at time act was committed
|
|
4 Ds fo malpractice
|
Dereliction (negliect) of a Duty that led Directly to Damages
|
|
2 types of damages awarded
|
Compensatory (for medical expenses, lost salary, physical suffering)
Punitive (to punish doctor for gross negligence) |
|
MMSE dysfunction is below what score?
|
<25
|
|
Difference between impairment in dementia and delirium
|
Dementia: memory impairment
Delirium: sensorium impairment |
|
Minimum workup to exclude reversible causes of dementia
|
CBC, Chem, TFTs, RPR, B12, folate, brain CT or MRI
|
|
Dementia w/ obesity, coarse hair, constipation
|
Hypothyroidism
|
|
2 types of delirium
|
Quiet and agitated
|
|
Rx for delirium symptoms
|
Quetiapine or haloperidol (avoid benzos --> confusion)
|
|
What can't you use haloperidol IV
|
Can cause torsades
|
|
Which has EEG changes, delirium or dementia, and what are they?
|
Delirium: fast waves or generalized slowing
|
|
Apraxia
|
Inability to perform purposeful movements
|
|
Agnosia
|
Inability to interpret sensations correctly (e.g. recognize things previously known)
|
|
Life expectancy of Alzheimer's
|
8 years after diagnosis
|
|
Neurotransmitter levels in Alzheimer's ()
|
Decreased acetylcholine and NE
|
|
2 classes or drugs for Alzheimer's and examples
|
NMDA antagonists: memantine
Cholinesterase inhibitors: donepezil (Aricept), rivastigmine (Exelon), tacrine (Cognex) |
|
Rx for mania w/ kidney disease
|
Valproic acid or carbamazepine
|
|
First line for GAD
|
Buspirone
|
|
Rx for agitated mania
|
Haloperidol (acutely; lithium longterm)
|
|
Elevated cholesterol and carotene, prolonged QT, osteoporosis
|
Anorexia
|
|
Fever, rigidity, mental status changes, and autonomic instability
|
Neuroleptic malignant syndrome
|
|
Rx for neuroleptic malignant syndrome
|
D/c antipsychotics
ICU Control hyperthermia Maintain electrolyte balance Dantrolene in severe cases |
|
High fevers, rigidity, diarrhea, restlessness, autonomic instability
|
Serotonin syndrome
|
|
How long should a single MDE be treated for?
|
6mo following response
|
|
2 subtypes of anorexia
|
Restricting
Binge and purge |
|
Pt who meets criteria for anorexia nervosa except has regular menses
|
Eating disorder NOS
|
|
Rx for Tourette syndrome
|
Typical antipsychotics (haloperidol or pimozide)
|
|
Rx for refractory enuresis
|
Desmopressin is first line (better safety profile)
Imipramine is second line |
|
Two tests to get before starting lithium treatment
|
Creatinine
TFTs |
|
Rx for social phobia (2)
|
Assertiveness training (part of CBT) and SSRI (e.g. paroxetine)
|
|
Management if only one parent consents for a treatment for a minor and the other refuses to agree?
|
Proceed! Only need consent from one parent or guardian
|
|
How to distinguish selective mutism and social phobia
|
Selective mutism: child refuses to talk
Social phobia: often 2/2 learning and communication disorders (e.g. stuttering) |
|
When do kids usually grow out of stranger anxiety?
|
3yo (afterwards is generally attributable to another cause)
|
|
Who uses neurotic defense mechanisms?
|
Adults; usually provide short term relief
|
|
3 criteria for emancipated minor
|
Married
Military Lives separately from parents and manages own finances |
|
Abrupt cessation of what anti-anxiety med can caused generalized tonic-clonic seizures and confusion?
|
Alprazolam (short-acting benzo)
|
|
Methylphenidate should not be used in children younger than
|
6yo (safety/efficacy have not been evaluated)
|
|
Dilated pupils, HTN, tachy, psychosis
|
Amphetamine intoxication (similar to cocaine, but psychosis is more common with amphetamines)
|
|
Altered consciousness, respiratory depression, pinpoint pupils
|
Heroin intoxication
|
|
Rx for bereaved pts with continued extreme symptoms 2months after their loss
|
Antidepressant and psychotherapy
|
|
When might ECT be used as first line for MDD?
|
Severe suicidality and psychosis
|
|
Management of acutely suicidal pt whose parents want her to see her pediatrician instead of being hospitalized
|
Hospitalize anyway!
|
|
IVDU who contracts HCV and blames it on inadequate control of HCV within the community is an example of?
|
Distortion (altered perception of reality to make it more acceptable), an immature defense mechanism
|
|
Unfaithful husband who accuses his wife of infidelity
|
Projection (attributes unacceptable emotions to other individuals), an immature defense mechanism
|
|
Pt who was rescued from a burning building and now denies any memory of the event
|
Dissociation (blocking disturbing feelings form consciousness to avoid emotional upset), a neurotic defense mechanism
|
|
Magical thinking is associated with which PD?
|
Schizotypal
|
|
Birth defects associated w/ anticonvulsants (carbamazepine/ valproate)
|
Craniofacial defects
NTDs Genital anomalies |
|
Important diagnostic criteria for adjustment disorder (vs. normal human experience)
|
Functional impairment
|
|
Inheritability of bipolar disorder
|
High: 5-10% for first degree relatives (vs 1% for general population)
|
|
4 antipsychotics available in depot form
|
Haloperidol, fluphenazine (typical)
Risperidone, paliperidone (atypical) |
|
Rx for psychosis if pt has severe EPS
|
Clozapine (or possibly typical antipsychotics)
|
|
Critical aspect of therapy for schizophrenics
|
Family therapy and keeping family conflict to a minimum
|
|
Pt w/ Hx of alcohol dependence presenting w/ auditory hallucinations and stable vitals
|
Alcoholic hallucinosis
|
|
Normal devt for at least 2yrs, then loss of previously acquired language, social, bowel/bladder, or play/motor skills followed by development of autistic symptoms
|
Childhood disintegrative disorder
|
|
How to distinguish autism from childhood disintegrative disorder
|
Autism symptom onset always begins before 3yo; rarely have a "regression" like in childhood disintegrative disorder, where children are normally before symptom onset
|
|
How to distinguish OCPD from OCD?
|
Pts with OCPD don't see it as a problem, and are more focused on perfectionism than particular obsessions/compulsions
|
|
3 subtypes of delusions
|
Grandiose, paranoid, somatic
|
|
4 first line and 2 second line maintenance meds for mania
|
Lithium, lamotrigine, olanzapine, quetiapine
Divalproex, aripiprazole |
|
Most common side effect of ECT
|
Amnesia (anterograde resolves quickly, retrograde may persist)
|
|
Rare side effects of ECT (5)
|
Prolonged seizures, delirium, headache, nausea, skin burns
|
|
When can lithium be tapered?
|
For pts with one manic episode, after 1yr symptom free
|
|
When is lifelong lithium therapy recommended?
|
After 3 or more manic relapses
|
|
Woman who is angry with her husband and throws away his baseball card collection as retaliation is an example of
|
Displacement (neurotic defense mechanism): shifting of emotion associated w/ an upsetting person or object to a safer alternate object/person that represents the original
|
|
Battered woman who believes her husband is right when he says she is worthless
|
Introjection (immature defense mechanism): assimilating another person's attitude into one's own perspective
|
|
Person who needs to follow the rules of a game precisely may have which PD?
|
OCPD
|
|
Rx for adjustment disorder
|
Psychodynamic psychotherapy or CBT
|
|
Thing to be careful of with adjustment disorder
|
Timeline! If develops within 3mo of stressor and hasn't lasted >6mo, can be adjustment disorder and needs therapy, not SSRIs
|
|
Most common comorbid conditions in Tourette disorder (2)
|
ADHD (60%)
OCD (27%) |
|
Rx for narcolepsy
|
Methylphenidate or modafinil (psychostimulants) for daytime somnolence +/- antidepressents for cataplexy
|
|
MAOI + tyramine containing food can cause
|
Hypertensive crisis
|
|
Stating that being fired is a "blessing in disguise" because pt can now spend more time with his family
|
Rationalization (neurotic defense mechanism)
|
|
Most likely atypical antipsychotic to cause EPS
|
Risperdal
|
|
Least likely atypical antipsychotic to cause EPS
|
Clozapine
|
|
Rx for fear of flying
|
Short acting benzo, e.g. alprazolam
|
|
Stepwise loss of function
|
Vascular dementia
|
|
DSM criteria for dementia
|
Memory impairment and at least one of: aphasia, apraxia, agnosia, diminished executive functioning
|
|
Dementia symptoms + focal neuro symptoms (hyperreflexia or paresthesias)
|
Vascular dementia
|
|
Diagnostic test for vascular dementia
|
MRI
|
|
Dementia w/ more personality/behavioral changes
|
Pick's disease/ frontotemporal dementia
|
|
What are Pick bodies?
|
Intraneuronal inclusion bodies
|
|
Prognosis of Huntington's
|
Death 15yrs after diagnosis
|
|
Psychotic depression, muscular hypertonicity, progressive dementia, choreiform movements
|
Huntington's
|
|
MRI in Huntington's shows
|
Caudate atrophy
|
|
2 classes of dementia w/ examples and symptoms
|
Cortical (Alzheimer's, Pick's, CJD): intellectual function declines
Subcortical (Huntington's, Parkinson's, NPH, multi-infarct): affective and movement symptoms |
|
What % of Parkinson's pt develop dementia?
|
30%
|
|
5 causes of Parkinson's disease
|
Idiopathic (most common)
Traumatic Drug-induced Encephalitic Familial |
|
Pharma options for Parkinson's (5)
|
1) Levodopa + carbidopa (former crosses BBB, latter prevents conversion of levodopa to dopamine in periphery)
2) Amantadine (unknown) 3) Anticholinergics (for tremor) 4) Dopamine agonists (bromocriptine) 5) MAO-B inhibitors (selegiline): inhibit breakdown of dopamine |
|
Surgical options for PD
|
Thalamotomy or pallidotomy if refractory
|
|
Iatrogenic cause of CJD
|
Corneal transplant
|
|
Dementia w/ myoclonus, EPS, LMN signs, ataxia
|
CJD
|
|
Prognosis/latency of CJD
|
Long latency btwn exposure and symptom onset, but then usually progresses to death w/in 1yr
|
|
4 other prion disease
|
Kuru
Gerstmann-Hraussler syndrome Fatal familial insomnia Bovine spongiform encephalopathy |
|
What are prions?
|
Proteinaceous infectious particles, normally expressed by healthy nuerons but accumulations --> disease
|
|
EEG in CJD
|
Periodic sharp waves/spikes
|
|
Pathology of CJD
|
Spongiform changes of cerebral cortex, neuronal loss, hypertrophy of glial cells
|
|
Of triad of NPH, which is least likely to improve with shunt treatment
|
Dementia
|
|
Contusion w/ lucid intervals
|
Delirium
|
|
Best Rx for delirium after treating underlying cause
|
Low-dose antipsychotic
|
|
Amnestic disorders are always caused by an underlying ___ condition vs ____ condition
|
Medical, not psychiatric
|
|
Unusual antidepressant choice in pts who can't tolerate typicals meds, and risk of its use
|
Sympathomimetics (amphetamine-based): addiction potential
|
|
What must be assessed before prescribing TCAs?
|
Suicide risk (overdose can be lethal)
|
|
Hallmark of TCA toxicity
|
Widened QRS (>100 msec)
|
|
3 side effect categories of TCAs
|
Antihistaminic (sedation), antiadrenergic, antimuscarinic
|
|
7 examples of TCAs
|
Imipramine
Trimipramine Desipramine Clomipramine Amitriptyline Nortriptyline Doxepin |
|
Serotonin syndrome occurs from combining these two meds
|
SSRIs and MAOIs
|
|
Consideration when switching from SSRI to MAOI
|
Wait at least 2 wks to prevent serotonin syndrome
|
|
Which SSRI doesn't need a taper?
|
Fluoxetine/ Prozac
|
|
Which SSRI has the highest risk of GI disturbances?
|
Zoloft
|
|
Antidepressant also used for SAD and ADHD
|
Bupropion
|
|
Two low potency typical antipsychotics
|
Chlorpromazine and thioridazine
|
|
5 high potency typical antipsychotics
|
Haloperidol
Fluphenazine Trifluoperazine Perphenazine Pimozide |
|
High potency typicals have ___ EPS and ___ anticholinergic/antihistaminic side effects
|
More EPS
Less |
|
Symptoms of NMS
|
FALTER
Fever Autonomic instability Leukocytosis Tremor Elevated CPK Rigidity |
|
What monitoring is required for quetiapine
|
Slit lamp exam q6mo to look for cataracts
|
|
Why do some atypicals have less weight gain?
|
Less anti-histamine action
|
|
Toxic and lethal doses of lithium
|
Toxic >1.5
Lethal >2 |
|
Carbamazepine is best for which two subtypes of bipolar
|
Rapid cycling
Mixed episodes |
|
Carbamazepine is also used to treat which condition
|
Trigeminal neuralgia
|
|
3 long acting benzos (1-3 days)
|
Chlordiazepoxide (Librium)
Diazepam (Valium) Flurazepam (Dalmane) |
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4 intermediate acting benzos (10-20hrs)
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Alprazolam (Xanax)
Clonazepam (Klonopin) Lorazepam (Ativan) Temazepam (Restoril) |
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Common use for Librium
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Alcohol detox
|
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When can dystonia be life-threatening?
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Dystonia of diaphragm --> asphyxiation
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