Psych Test2 Set2

Front 1

Epidemiology of
a)anorexia (2)
b)bulimia (2)
c)eating disorder not otherwise specified (4)
d)binge eating (2)

Back 1

a)90% are female
a)presents in late adolescece (avg age 17)

b)90% are female
b)onset in adolescence or early adulthood

c)NOT meet criteria for specific ED
c)classified by DSM
c)occurs in 4.7% of population
c)50% recieve inpt care

d)1/4 of pts are male
d)usually occurs in adults (over 40yo)

Front 2

Presentation of Eating disorders (in general) (3)

Calorie counts for
a)AN/BN/binge

Back 2

1)30-65% present w/ anorexia and bulimia together
2)may present w/ either anorexia or bulimia (and switch b/w disorders)
3)comorbidities COMMON (OCD, depression, schizophrenia)

a)AN is 600-900/d
a)BN is 1200/d (retained)
a)3400-4800 per episode

Front 3

Consequences of Eating disorders (5)

Back 3

1)metabolic/electrolyte disturbances
2)cardiac abnormalities (even sudden death, girl had MI @ 17yo)
3)endocrine complications
4)dental problems
5)brain atrophy

Front 4

Presentation/symptoms of Anorexia (9)

Back 4

1)refusal to maintain normal body wt
2)distorted body image
3)psychiatric comorbidities common (75%)
4)obsession and fear about eating and gaining wt
5)complaints of feeling full
6)denial of s/sx
7)low self-esteem
8)amenorrhea
9)incr risk of premature delivery

Front 5

Signs of Anorexia (might just look over) (10)

Back 5

1)lethargy/weakness
3)cachexia, vomiting, restricted food intake
4)delayed gastric emptying and constipation
5)bradycardia/hypotension
6)lanugo, brittle hair, dry skin
7)electrolyte disturbance
8)EKG changes
9)anemia
10)elevated cholesterol

Front 6

Bulimia clinical presentation (8)

Back 6

1)concerned about body image but NOT driven to lose wt
2)binging followed by self-induced vomiting (atleast 2x/wk for 3mon) and guilt/depression afterwards
3)wt fluctuation common
4)depression common (80%)
5)salivary gland inflammation/erosion of dental enamel/callus on dorsum of hand
6)do NOT eat regular meals or feel full @ end of meals
7)laxative abuse
8)social isolation, troubled relationships, substance abuse

Front 7

Clinical presentation of Eating Disorder NOT otherwise specified (3)

Back 7

1)meet criteria for AN, but have regular menses
2)maintain a normal wt
3)binge eating w/ inappropriate compensatory mechanisms (occurs less than 2x/wk or for less than 3mon)

Front 8

Clinical presentation of Binge Eating (3)

Back 8

1)binging w/o compensatory purging
2)usually overwt
3)binging episodes are atleast 2x/wk for long periods of time

Front 9

Goals of tx in Eating disorders (4)

Nonpharma (4)

Back 9

1)improve distorted body image
2)re-establish/maintain healthy body wt and normal eating patterns
3)improve psychological/physical issues
4)prevent relapse

1)behavioral management
2)CBT and interpersonal/family therapy
3)nutritional counseling
4)MOST HELPFUL IN anorexia

Front 10

Pharma tx of Anorexia
a)antidepressants
b)antipsychotics (2)
c)other drugs (4)

Back 10

a)NO ROLE except use SSRIs for depression, anxiety, OCD persists after normal wt maintained

b)used if resistant to wt gainig and severe obsessive thought
b)may be used in acute illness

c)metoclopramide for GI disturbances and satiety
c)Ca supplements to decr risk of osteoporosis
c)bzd's when anxiety limits eating (use low dose, SA)
c)estrogen to restore menses

Front 11

Bulimia pharm tx
a)antidepressants (3)
b)antipsychotics
c)mood stabilizers (3)
d)misc

Back 11

a)used for acute/maintenance in combo w/ nonpharma tx
a)SSRIs preferred (fluoxetine has FDA indication)
a)takes 4-6wks for effect and tx for 6-12mon

b)NO ROLE

c)Li and anticonvulsants (zonisamide)
c)reserved for concomitant bipolar disorder
c)use Li w/ caution b/c CI in Na depletion/dehydration

d)BZD's when anxiety limits eating (avoid long term due to risk of dependence)

Front 12

Binge Eating pharm tx
a)antidepressants
b)anticonvulsants
c)appetite suppressants (2)

Back 12

a)SSRIs have efficacy in acute illness

b)helps w/ impulse control and promotes wt loss (zonisamide)

c)reduce binging frequency and promote wt loss
c)use sibutramine or orlistat

Front 13

DSM criteria for Schizophrenia (6)

Back 13

2 or more of the following for atleast 1mon
a)delusions, hallucinations
b)disorganized speech
c)disorganized/catatonic behavior
d)negative s/sx

Other criteria
a)social/occupation dysfxn for sig portion of time since onset of disturbance
b)continuous s/sx of disturbance for atleast 6mon

Front 14

(+) Schizophrenia s/sx (5)

Cogntive deficits of Schizophrenia (4)

Back 14

a)delusions/hallucinations
b)disorganized speech
c)disorganization
d)aggression
e)paranoia

1)poor []
2)memory disturbances
3)poor abstraction
4)imparied executive fxn

Front 15

(-) Schizophrenia s/sx (5)

Back 15

1)alogia
2)flat affect
3)anhedonia
4)social isolation
5)lack of motivation

Front 16

Schizophrenia Subtypes
a)paranoid
b)Disorganized (3)
c)catatonic (3)
d)undifferentiated

Back 16

a)delusions/hallucinations w/ relative perservation of cognitive fxn and affect

b)disorganized speech and behavior
b)flat or inappropriate affect
b)worse outcomes

c)immobility or stupor
c)excessitve activity, peculiar movement or mannerisms
c)negative or mutism

d)s/sx do NOT meet criteria above

Front 17

Neurodevelopmental model of development of Schizophrenia (4)

Back 17

1)in-utero disturbance in 2nd trimester can lead to abnormalities in brain cell migration
2)brain CT abnormalties occur w/o the presence of proloferation of glial cells
3)obstetric complication w/ predisposition could activate glutamatergic cascade resulting in incr neuronal pruning
4)abnormalities in brain fxn occur long beofer sx

Front 18

Schizophrenia
a)environmental risk theories (3)
b)genetics (3)

Back 18

a)in utero flu or toxoplasmosis infxn, perinatal injury
a)Rh incompatbiility or serious CNS viral infxn in childhood (mumps,CMV)
a)marijuana/alcohol use in adolescence when brain is developing

b)adoption studies show risk lies in biologic parents
b)loci have been ID on chromosomes 6,8,13,22
b)polymorphism of VAL/MET alleles of COMT gene explains frontal lobe defects

Front 19

Schizophrenia tx
a)first line
b)pick based on.... (3)
c)response predictors (6)

Back 19

a)2nd gen Antipsychotics

b)past respnse or ADRs to individula agents and # of tx failures
b)pt/MD preference
b)problems w/ EPS/TD

c)previous med use and outcome
c)substance abuse
c)presentation/age of onset
c)duration of illness
c)(-)/neurocognitive s/sx associated w/ poor response
c)initial dysphoria associated w/ poor response

Front 20

Tx'ing Schizophrenia (2)

Drug that does it all (3)

Back 20

1)don't tx schizophrenia globally, target s/sx
2)persons experiencing a first break appear more susceptible to EPS

1)CLOZAPINE (2nd gen antipsychotic)
a)since atypical is will be better for (-) s/sx, less TD, less effect on prolactin
b)is higly lipophilic/protein bound (=high Vd) and highly metabolized by 2D6

Front 21

Clozapine and Schizophrenia (6) (2nd gen antipsychotic)

Back 21

1)NOT first line due to monitoring
2)slow titration needed
3)lowest risk of TD w/ this
4)useful is AGGRESSION is target sx
5)FDA approved for recurrent suicidal behavior
6)AGRANULOCYTOSIS ADR

Front 22

Other 2nd Gen Antipsychotics used for Schizophrenia
a)Olanzapine (2)
b)Quetiapine (3)
c)Risperidone/Paliperidone
d)Ziprasidone
e)Aripripazole

f)Class warning (3)

Back 22

a)has incr in wt/lipids
a)sedation

b)recomendation of eye exams
b)NO IRL problems
b)rapid on-off @ receptors

c)can cause incr in prolaction

d)may prolong QTc (so need baseline cardiac eval)

e)take w/ food


f)onset/worsening of DM
f)incr mortality in elderly w/ dementia
f)lipid/cardiac effects

Front 23

Tx phases of Schizophrenia
a)initial tx or acute episode (first 7d) (3)
b)stabilization phase (6-12wks post initiation)
c)maintenance phase (3)

Back 23

a)will decr hostility, agitation, anxiety, tension, eating and sleeping probs
a)initiate pharmacotx and titrate to effective dose over next several days
a)if no benefit consider if pt is actually taking meds and change dosage form if necessary

b)change in cognition may take 6-8wks

c)goal is to prevent relapse
c)stabilize initial break then cont. for 12mon (for 5y if get robust response)
c)if chronic tx continuously

Front 24

When to use depot formulation for Schizophrenia (5)

Back 24

1)to solve compliance issues
2)for convenience
3)to avoid peaks/valley that may cause ADRs
4)Risperidone (overlap w/ tablets)
5)can also use Haldol (must adjust dose if smoker) or Fluphenazine

Front 25

2nd Gen Antipsychotics ADRs and which drugs have less/more
a)wt gain (2)
b)DM2/incr glc levels (2)
c)EKG changes (3drugs and 1thing)
d)elevated TG/TC (3 w/ less, 1 w/ more)

Back 25

a)ziprasidone/abilify have minimal wt gain

b)greater risk w/ clozapine/olanzapine

c)thioridazine, clozapine, ziprasidone
c)use these w/ caution if pt on diuretics, CV disease, or on other meds w/ QT prolongation

d)risperidone, ziprasidone, abilify
d)olanzapine has more

Front 26

2nd Gen Antipsychotics ADRs and which drugs have less/more
a)anticholingeric s/sx (2)
b)akathisia (2)

Back 26

a)clozapine, olanzapine have most (antiCOlinergic)

b)quetiapine, clozapine have least

Front 27

Presenting s/sx of Neuroleptic Malignant Syndrome (NMS) (8)

Back 27

1)fever over 38C (100.4F)
2)altered level of consciousness
3)diaphoresis
4)tachycardia
5)incontinence
6)rigidity
7)leukocytosis
8)incr CK/ALT/AST/LDH/myoglobinuria

Front 28

Tx of Neuroleptic Malignant Syndrome (3)

Back 28

1)dc antipsychotic
2)bromocriptine reduces fever, rigidity, CK
3)Dantrolene effects temp, HR, RR, CK

Front 29

Schizophrenia tx
a)drug interaxns (2)
b)switching antipsychotics (4)

Back 29

a)tegretol and barbiturates incr CL of antipsychotics
a)smoking incr CL of haloperidol, chlorpromazine, fluphenazine

3 options
a)immediate switch (not prefered)
b)cross titration (titrate one up and the other down)
c)overlap and taper (titrate 2nd up to therapeutic range, then taper off 1st drug)
d)usually done over 4-5wks (clozapine is months)

Front 30

Tx'ing these ADRs of Schizophrenia tx
a)dystonia/pseudoparkinsonism (4)
b)akathisia (3)
c)TD
d)seizures (3)

Back 30

a)benzotropine
a)diphen
a)lorazepam
a)amantadine (pseudopark only)

b)dose reduction if possible
b)propanolol
b)lorazepam

c)switch to clozapine

d)switch to lower risk agent (risperidone, haloperidol, fluphenazine)
d)decr dose
d)do NOT use anticonvulsants

Front 31

Dopamine tracts and what they are involved in:
a)Nigrostriatal
b)Mesolimbic
c)mesocortical
d)Tuberoinfundibular

Back 31

a)EPS****

b)psychosis

c)psychosis/akathisia

d)prolactin release

Front 32

Clozapine ADRs (6)

The Clozapine like drugs (but dont have agranulo) (2)

Back 32

1)myocarditis/cardiomyopathy
2)siezures
3)sig wt gain
4)sedation
5)AGRANULOCYTOSIS
6)drooling

1)olanzapine
2)quetipaine

Front 33

Specific info w/
b)olanzapine (2)
c)quetiapine (2)
d)risperidone/paliperidone
e)ziprasidone (2)
f)for all

Back 33

b)wt gain
b)monitor lipids/glc

c)rapid on/off @ D2
c)baseline eye exam

d)incr prolactin

e)cardiac fxn (prolong QT)
e)take w/ food

f)incr glc

Front 34

Look at other ADRs and which 2nd gen antipsychotics go w/ them

Back 34

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