Psych -Stepup -Comlex Step2

Front 1

components of a FULL mental status examination

Back 1

ABC STAMP LICKER

Appearance, behavior, cooperation

speech

thought processes

affect

mood

perceptions

level of consciousness

insight and judgement

cognition

knowledge

endings

reliability

Front 2

DSM-IV Axes

Back 2

I - clinical psych disorders - eg. mood, anxiety, psychosis, delirium

II - personality and developmental disorders - MR, borderline

III - organic medical problem - hypothyroid

IV - psychosocial stressor -environment, relationships, work?

V - global 100pt assessment of functioning.

Front 3

MDD lasts for?

Back 3

>2 weeks

Front 4

MDD is defined as what symptoms for >2 wks.

Back 4

5/8 SIGECAPS symptoms lasting >2 weeks

S -sleep issues
I- interest loss/anhedonia
G- guilt
E- energy reduction/fatigue
C-concentration impairment
A-appetite changes
P-psychomotor disturbance -impaired motor
S- suicidal ideation - always assess and know when to admit

Front 5

risk factors for successful suicide attempt?

Back 5

>45 yo male, recently left alone and is violent or IVDA, w/ hx of attempt and depression, unemployment.

Front 6

Dysthmia definition

Back 6

chronic mood problem lasts >2yrs with depressed moods on most days and 2 of the following symptoms and no history of full blow depression

need 2 of these:

feelings of hopelessness

change in sleep

fatigue

inability to concentrate

low self esteem

change in appetite

Front 7

intital tx for dysthmic disorder

Back 7

psychotehrapy CBT

Front 8

bipolar disorder classification

Back 8

bipolar I - depression with hx of one manic episode

bipolar II - despression with hx of one hypomanic episode

manic episode lasts >1 week (need 3 of the DIGFAST)

D-distracted
I-irritable
G- grandiose thoughts

F-fight of ideas = rapid transitions b/t ideas
A-goal oriented ACTIVITY
S-pressured speech
T-taking risks - sexual

hypomanic episode lasts > 3 days

Front 9

biggest difference between hypomaniac and maniac episodes?

Back 9

hypo - does NOT interfere with daily functioning

manic - interferes with daily functioning

Front 10

MDD with psychotic features vs. schizoaffective disorder?

Back 10

MDD w/ psy - mood disorder then later psychosis



schizoaffective - the psychosis (schizo) precedes the mood disorder. At least 2 weeks of psychosis without mood disorder

Front 11

why is it so important to r/o bipolar in MDD pts before starting them on Fluoxetene (SSRI)?

Back 11

b/c any pt with manic episodes (bipolar) who is not on a mood stabilizer as well will have induced manic episodes when on the SSRI

Front 12

first line mood stabilizer in bipolar

Back 12

lithium

Front 13

what to watch out for in Li?

Back 13

LFTs, TFTs,BUN/CR (RFT high), teratogenesis and wt gain

Front 14

what is cyclothymia?

Back 14

it's the dysthmia of bipolar (typeII)...

>2 yrs with mild mood disorder and hypomanic symptoms (cycling of shuffling of moods)

Tx : mood stabilizer or psychoT

Front 15

adjustment disorder w/ depressed mood vs bereavement vs depression and the tx's?

Back 15

bereavement - lasts 6 months, following a death, does not impair normal life. tx- time

adjustment disorder w/ depressed mood - starts 3 mo w/in inciting incident (death, loss) and resolves 6 mo after stressor is removed.impairs function and self isolation is common, Tx -therapy

depression - lasts for >6 mo, can happen post death or loss but will effect life and impairment is key, pt is irritable and mistrusting of others, etc. tx - ssri, cbt

Front 16

Tx for acute anxiety?

Back 16

BDZ specifically Xanax (alprazolam)

Front 17

Tx for chronic anxiety, PTSD, GAD?

Back 17

GAD spec - BuSPar (atypical anxiolytic)

others for chronic anxiety - SSRI

Front 18

OCD tx?

Back 18

behavorial/psychoT and SSRI over TCA d/t anti-ach side effects.

Front 19

agorapobia tx?

Back 19

B-b for the tachy and SSRI and Imipramine.

Front 20

social speaking phobia, treatments?

Back 20

b-b

Front 21

shchizophrenia defined as?

+ symptoms? and - symptoms?

Back 21

limits fnxn and severe psychosis, worsens over time.

+symptoms = delusions, hallucinations, disorganized thoughts

- symptoms = anhedonia, echololia,flat affect, social withdrawal

Front 22

how is schiZophrenia dx MADE?

Back 22

2 or more sx in a 1 6 mo period for atleast 1 mo. and impairment for 6+mo.

Front 23

what are the main EPS sx we worry about with high potency antipsychotics?

Back 23

akesthesia = restlessness

acute dystonia - d/t anti-ach issues, hand wringing movements, writhing, spastcity, contractions, torticolis

dyskinesia = parkinsonism

tardive dyskinesia = facial tics, irreversible. after several months, lip smacking also seen.

Front 24

good prognosis in schizophrenia can be seen with

Back 24

underlying mood or substance abuse and predom + symptoms. good support

Front 25

schizo drug classes -typical?!!

Back 25

Typicals - block mesolimbic dopamine rr, non specific. Have strong side effect profile, alleviate + symptoms.

Haloperidol - most potent.

Fluphenazine - high

perphenazine = medium

Thioridazine -

Chlorpromeazine - least potent, more ach side effx


**with these high potent drugs, see lots of EPS, little AntiACH advefx.

** use when want depot or if atypical fails.

Front 26

NMS? will see most with?

Back 26

lead pipe rigidty, ams, get ck (elv), fever

tx - dantrolene, STOP OFFENDING AGENT


will see with MOST OFTEN HIGH POTENCY TYPICALS antipsychotics.

Front 27

atypical antipsychotics? (These are now first line)

Back 27

risperidone

olanzapine

quetiapine

aripeprazole

Zeprazadone

**specific, lower sidefx profile - more prolnged QT, DM, wt gain, DKA.

**block dopamine and serotonin (nonspecfic)

Front 28

clozapine (the prototypical atypical)

Back 28

spec for D2 receptor antagonism , best drug to control both + and - symptoms.

dont use bc of AGRANULOCYTOSIS = super neutropenia, BESOPHILOPENIA, EOSINPENIA.



reserved for refractory psychosis

Front 29

which antipsychotic is best for emergency control of psychosis or for acute? situation?

Back 29

haldol, or traditional typical high potency.

Front 30

what are the main antiACH symptoms we worry about with neuroleptics?

Back 30

sedation
constipation
urinary retention
hotn
confusion
sexual dys
hyperPTL - due to effect on the TI

EPS due to effect at SN (Substantia niagra)

Front 31

Schizo spectrum disorders (5) + 2 personality disorders.

Back 31

earliest to latest or Acute to Chronic.....

brief psychotic - sudden onset due to stress of psychosis lasts total <1 mo. tx = psychoT and neuroleptics short term


schizophreniform - >1 but <6 mo. (between 1-6mo.) of shchizo type behavior, pts return to normal functioning but may develop full blow psychosis. tx - antipsy and mood stab.


schizoaffective - psychosis precedes mood disorder, must see psychosis with normal mood first for >2 weeks. same as above tx.

**delusional- >1 mo of realistic delusions w/o any other psychosis present.

folie a deux (shared psychosis) - one takes on and shares the psychosis of the other, tx - grp therapy.

CLUSTER A - personality disorders of relevance

schizoid -inability to be close, flat affect

schziotypal - "wierd like a pickle, magical thinking, odd beliefs and paranoia"

Front 32

CAGE questionaire

Back 32

C- cut down?
A - annoyance from others suggesting you to stop
G- guilt
E -eye opener to wake up in the AM?

1+ risk for abuse.

Front 33

which substances dilate pupils? tox

Back 33

amphtemaines

cocaine

hallucinogens

Front 34

which substances constrict pupils? tox

Back 34

miosis with opiates/narcotics/heroin/codone/morphine

Front 35

ideal pt presentation for anorexia

Back 35

14-18 yo teenage girl who is a good student and good kid has negative body image and are <85% ideal body wt and prevent wt gain may induce emesis too, and they have hypothyroid like symptoms: hair loss, amenorrhea, dry clamy skin, brady

Front 36

co morbid conditons with anorexia and most common cause of death

Back 36

screen them for MDD and possibly start on SSRI

will have vitD def and osteoepenia with diz.

most common cause of death : V arrythmia.

Front 37

presentation for ideal bulemic pt?

Back 37

normal body wt, they are egodystonic meaning they know they are doing this, they are unhappy and they want help. commonly have russel's sign - mark of knuckles from constantly gagging oneself... will have increase amylase and hyperplasia of the parotids, erosion of enamel from emesis, and will binge and purge >2wks for 3 mo. usually fat female, laxative abuse is common (bisacodyl)

Front 38

what constitutes refeeding syndrome in anoerxic pts

Back 38

HYPOPHOSPHATEMIA

CV COLLAPSE

RHABDOMYLOSIS

CONFUSION

SEIZURES

in anorexics who resume eating and have a sudden shift from fat to carb metabolism.

Front 39

treatment for DTs (etoh withdrawal)

Back 39

bdz taper and bdz prn for seizures.

Front 40

what vaccines do alcoholics need?

Back 40

hepA
hepB
FluA/B
pneumovax

Front 41

most common cause of pneumonia in alcoholics?

Back 41

klebsiella

Front 42

sx of etoh abuse?

Back 42

diaphoretic, nv, anxious and tremor can lead to DT if in withdrawal - tactile hallucination (bugs), ams, nv, tremor, seziure.

Front 43

presentation of amphetamines/nmda abuse?

Back 43

hyperactvity, mydriasis, tachycardia, agitation, htn, psychosis

Front 44

tx from amph/nmda abuse?

Back 44

bdz or IM haldol

Front 45

tx for etoh intoxication/abuse?

Back 45

nalaxone, d50 (glucose) give thiamine before!!!

then let them sleep it off. Give thiamine to prevent Wernicke-korskaoff (full korsakoff when confab and mammilary bodies destroyed on CT)


GROUP THERAPY FOR LONG TERM - only effective therapy - if true abuser.

anatbuse - disulfaram, get sick if they take it with etoh.

Front 46

wernickes, tx?

Back 46

HIGH DOSE thiamine (vitamin b1) and then d50

Front 47

korsakoff sx ?

Back 47

etoh induced dementia, irreversible. will most likely see cirrhosis, this pt is chronic abuser of etoh.

Front 48

bdz cause delirium in the

Back 48

elderly

Front 49

what is the date rape drug?

Back 49

bdz

Front 50

tx for bdz withdrawal?

Back 50

bdz taper

Front 51

tx for seziures when on bdz abuse?

Back 51

tx like etoh induced seizure, any drug induced seizure - tx with benzo

Front 52

bdz od tx?

Back 52

flumazenil

Front 53

problem with bdz od treatment?

Back 53

flumazenil lowers the seizure threshold

Front 54

best drug for onset sleep problems?

Back 54

zolpidem - short acting (Ambien)

Front 55

best drug for sleep maintenance (help them sleep through the night)
??

Back 55

bdz - estazolam - long acting

Front 56

h/p of a narcotic abuser (intox)?

Back 56

track marks, miosis, euphoria, resp depression

Front 57

narcotic abuser tx?

Back 57

methadone for withdrawal and for abuse.

Front 58

cocaine h/p?

Back 58

an upper, angina, htn crisis (at worst), can show as - psychomotor agitation, dilation of pupils, depression as they come off

Front 59

narcotic OD tx?

Back 59

nalaxone, can bring the pain back, nv - for acute od

Front 60

narcotic withdrawal sx?

Back 60

yawning, lacrimation,sweating, itching, pain, restlessness

Front 61

cocaine OD tx?

Back 61

alpha blockade before beta blockade, can cause htn crisis.

Front 62

Cocaine withdrawal tx?

Back 62

ccbs and benzos

Front 63

pcp sx?

Back 63

aggressive behavior, vertical and horz nystagmus, violence and abnormal strength

Front 64

pcp abuse tx?

Back 64

acidify urine w/ ascorbic acid bdz or haldol

Front 65

lsd, ketamine or other hallucinogens?

Back 65

haldol benzos

Front 66

care for nmda abuse/withdrawal?

Back 66

supportive care

Front 67

what to never use in bulemics?

Back 67

bupropion

Front 68

name the types of somatization disorders? (7)

Back 68

somatsization

conversion disorder

hypochondriasis

pain disorder

BDD

Munchausen's disorder

Malingering

Front 69

what are the criteria for somatoform disorder?

Back 69

need 4 of these for dx

2 gi sx
1 sexual
1 neuro
pain at multiple body regions

Front 70

criteria for converiosn disorder?

Back 70

psudoseziures follow stressful events - sensory and motor deficits/

Front 71

name some drugs that can cause AMS especially in elderly

Back 71

etoh*

anticholinergics*

ISN

steroids*

nsaids

chemo

antihistamine

digoxin

Front 72

which pt would be succiptible to sun downing phenomenon?

Back 72

pts with dementia hx present,see a decrease in behavior after sun down

Front 73

what condition is elderly can cause in house delerium?

Back 73

UTI

Front 74

major reasons for dementia

Back 74

alz

muti infarct

Front 75

mmse score of __________ a/w cognitive dysfunction

Back 75

<25

Front 76

delerium is often reversible but a/w loss of _______& ________ (mmse)

Back 76

P P T - mmse

know person


loss of place and time

Front 77

how would u treat agitation/anxiety and psychosis in an elderly demented patient?

Back 77

DONT USE ANTIACH or BDZ

USE - HALDOL OR ANTIPSY drugs

Front 78

dementia is usually non reversible, what are some causes where it would be reversible?

Back 78

MIND HATS

M - metabolic - electrolytes

i -infection/uti

N -poor PO nurtition

d - DRUGS

h- NPH

a - atheroscelerosis

t -tumors

s- sensory/vision/hearing

Front 79

dx of adhd is made by what criteria?

Back 79

need 6 hypersx byt age 7 and must be limiting ability to function

Front 80

tx for adhd?

Back 80

use stimulants : dextrometorphan, m-phenidate and atomoxetine,

Front 81

conduct disorder is defined as damage to property, animals and illegal activty after age 18 it is termed?

Back 81

antisocial PD

Front 82

tx for tourette's?

Back 82

haldol, antiPSY, tetrabenzine,

Front 83

tetrad for autism

Back 83

impaired communication -conversation delayed, lack of imaginative play

impaired social interaction - impaired use of nonverbal behaviors

restricted behavior -preoccupations with things or activities

impaired interpersonal interaction

Front 84

buzzwords for autism on exam

Back 84

hand flapping (not asterixis)

lining up objects

rocking back and forth

Front 85

defense mechanism review (next 15 cards)

You can't remember your father's funeral.

Back 85

repression - Burying a painful feeling or thought from your awareness though it may resurface in symbolic form. Sometimes considered a basis of other defense mechanisms.

Front 86

You are arrested for drunk driving several times but don't believe you have a problem with alcohol.

Back 86

denial - Not accepting reality because it is too painful.

Front 87

You and your roommate have get into an argument so you stomp off into another room and pout

Back 87

regression- Reverting to an older, less mature way of handling stresses and feelings

Front 88

You get really mad at your husband but scream that he's the one mad at you.

Back 88

projection - Attributing your own unacceptable thoughts or feelings to someone or something else

Front 89

You think your best friend is absolutely worthless because he forgot a lunch date with you.

Back 89

splitting - Everything in the world is seen as all good or all bad with nothing in between.

Front 90

Acting aloof and indifferent toward someone when you really dislike that person

Back 90

isolation of affect -Attempting to avoid a painful thought or feeling by objectifying and emotionally detaching oneself from the feeling

Front 91

When you get mad at your sister, you break your drinking glass by throwing it against the wall.

Back 91

displacement - Channeling a feeling or thought from its actual source to something or someone else. ** dont confuse for projection

Front 92

When you say you're not angry when you really are.

Back 92

reaction formation - Adopting beliefs, attitudes, and feelings contrary to what you really believe

Front 93

I always study hard for tests and I know a lot of people who cheat so it's not a big deal I cheated this time

Back 93

rationalization - Justifying one's behaviors and motivations by substituting "good", acceptable reasons for these real motivations

Front 94

After your wife dies, you keep yourself busy by volunteering at your church.

Back 94

altruism - Handling your own pain by helping others.

Front 95

A person's treatment for cancer makes him lose his hair so he makes jokes about being bald.

Back 95

humor - Focusing on funny aspects of a painful situation.

Front 96

Intense rage redirected in the form of participation in sports such as boxing or football

Back 96

sublimation - Redirecting unacceptable, instinctual drives into personally and socially acceptable channels

Front 97

You are attracted to someone but say that you really don't like the person at all

Back 97

suppression - The effort to hide and control unacceptable thoughts or feelings, *** dont confuse with reaction formation

Front 98

You have feelings of dislike for someone so you buy them a gift

Back 98

undoing - Trying to reverse or "undo" a thought or feeling by performing an action that signifies an opposite feeling than your original thought or feeling

Front 99

thought disorder symptoms (next 7 cards)

Excessive speech at a rapid rate that involves fragmented or unrelated ideas

Back 99

flight of ideas

Front 100

An inability to answer a question without giving excessive, unnecessary detail.[7] This differs from tangential thinking, in that the person does eventually return to the original point.

Back 100

circumstantiality

Front 101

Ideas slip off the topic's track on to another which is obliquely related or unrelated.[7] e.g. "The next day when I'd be going out you know, I took control, like uh, I put bleach on my hair in California."

Back 101

derailment or loose association

Front 102

During mid speech, the subject is changed in response to a stimulus. e.g. "Then I left San Francisco and moved to... where did you get that tie?"

Back 102

distractable speech (adhd speech)

Front 103

Speech that is unintelligible because, though the individual words are real words, the manner in which they are strung together results in incoherent gibberish,[7] e.g. the question "Why do people comb their hair?" elicits a response like "Because it makes a twirl in life, my box is broken help me blue elephant. Isn't lettuce brave? I like electrons, hello please!"

Back 103

word salad aka. incoherent speech

Front 104

Failure to follow a train of thought to a natural conclusion.

Back 104

loss of goal

Front 105

Wandering from the topic and never returning to it or providing the information requested.[7] e.g. in answer to the question "Where are you from?", a response "My dog is from England. They have good fish and chips there. Fish breathe through gills."

Back 105

tangential speech