Psychiatry First Aid Step 2 Ck

Front 1

if fear of EMBARRASSMENT present

Back 1

specific (i.e. urinating in public, speaking in public) or general (social interaction) social phobia

Front 2

What is the difference b/w OCD and OCPD (P for Personality)?

Back 2

in OCPD patient does not recognize the behavior as problematic, i.e. patient is being ego-SYNtonic (vs ego-DYStonic)

Front 3

SSRI's and Buspirone are first line treatment for what disorders?

Back 3

OCD, PTSD, GAD

Front 4

What is the antidote to BZD intoxication?

Back 4

Flumazenil

Front 5

What can be given for muscle spasm?

Back 5

Benzodiazepines

Front 6

What is a characteristic symptom of PTSD and for how long should it be present?

Back 6

REEXPERIENCING of the traumatic event which should be lasting for >1 month

Front 7

What other Rx may be helpful in treating PTSD other than the first line Rx (SSRI and Buspirone)?

Back 7

TCAs and MAO-Is

Front 8

What are the cognitive deficits in deMEntia (MEmory)?

Back 8

Aphasia - ("phage"-eat-mouth-language); Apraxia - inability to perform motor activities; aGNOsia - inability to recOGNize; aMnesia - Mmmemory impairment

Front 9

What is intact in deMEntia?

Back 9

Clear sensorium, yet inability to plan, organize and abstract, i.e. executive fnx is down

Front 10

What does one want to AVOID in a demented patient?

Back 10

BZD (-zolam, -zepam and Chordiazepoxide)! as BZDs may worsen disinhibition and confusion

Front 11

Where does one most often sees deliRIUM?

Back 11

ACUTE occurrence (not gradual) in ICU where patient exhibits deficient sensoRIUM- "WAXING and WANING" of consciousness and cognition

Front 12

What type of hallucinations are present in deliRIUM?

Back 12

mostly visual and tactile (SEE and TOUCH)

Front 13

Name some of the types of a Major Depressive Disorder.

Back 13

with Psychotic features (i.e. w/delusions/hallucinations); Postpartum (within 1 month post birth); Atypical (weight gain, hypersomnolence, rejection sensitivity); Seasonal (often in winter, responds well to light therapy); Double depression (MDD + dysthymia)

Front 14

What is the time-frame within which Adjustment disorder takes place?

Back 14

within 3 months of the stressor and resembles MDD

Front 15

What happens if SSRIs (Fluoxetine, Sertraline, Paroxetine, Citalopram, Fluvoxamine) are used with or shortly after (within 5 weeks of use) MAO-Is(Phenelzine and Tranylcypromine)?

Back 15

Serotonin SYNDROME- fever, myoclonus (twitching of a muscles), mental status change, cardiovascular collapse.

Front 16

Name some of the atypical antidepressants (Heterocyclic Acids) and common side effects.

Back 16

Amoxapine, BuPropion (lowers seizure threshold, i.e. not for bulimics); VenLaFaxiNe (diastolic hypertension); MiRTAzaPine (weight gain (Remerone)); TRAzoDONe (priapism)

Front 17

What common antidepressants can be used for migrane headaches and chronic pain?

Back 17

TCAs: NORtriptyline, DesiPramine, AmitripTyline, ImiPRAmine. Lethal cardiac CONDUCTION arrhythmias!

Front 18

What is the MonoAmine compound that is found in wine, cheese, etc and when used together with MAO-Is (Phenelzine and TraNYLcYPromine) can cause hypertensive crisis?

Back 18

TYRamine - a naturally occurring monoAMINE compound

Front 19

What is a prominent feature in MANIA?

Back 19

IRRItability

Front 20

What is type II bipolar?

Back 20

usu HYPOmanic, i.e. less intense than manic

Front 21

What are the MEDS for MANIA?

Back 21

Antipsychotics (neuroleptics)- typical and atypical; Mood stabilizers (valproic acid, LAMOTRIgine, CARBAmaZEPine, Lithium); BZD if mania is refractory (ECT possible treatment modality if refractory).

Front 22

What is the danger of chronic Li use and Lamotrigine?

Back 22

HYPOthyroidism and NEPHrotoxicity and life-threatening RASH (eg Stevens Johnson)

Front 23

Common Side Effects of ATYPICAL neuroleptics (Clozapine, Risperidone, Quetapine, Olanzapine, Ziprasidone, Aripiprazole) "Orange Cats Are/R in Quiet Zoo"

Back 23

Weight gain, DM2. Yet, currently is the first line Rx for Schitzophrenia. Fewer EPS and anticholinergic SE.

Front 24

What is Li toxicity associated with?

Back 24

Ataxia, dysarthria and deliRIUM. SE: acne, polyuria, thirst, diabetes insipidus, weight gain, seizures, teratogenicity, HYPOthyroidism

Front 25

What 2 psych meds may cause agranulocytosis?

Back 25

Valproic acid and Clozapine

Front 26

If patient is restless, which is becoming distressing to the patient (AKA-THI-sia), what treatment is offered?

Back 26

Lower the neuroleptic and give beta-blocker (propranolol)

Front 27

What SE reminds Parkinsonism? And what should you do to treat it?

Back 27

DYS-ki-nesia. Give antihcolinergic (benZTroPINE) or AMAntiDINE (dopaminergic agonist). Parkinsonism? Need Dopamine. Suppress Ach.

Front 28

What is likely the cause of Tardive Dyskinesia (involuntary movements, especially of the lower face)?

Back 28

dopamine receptor sensitization

Front 29

What is the treatment for Tardive Dyskinesia?

Back 29

D/C or lower neuroleptics, consider switching neuroleptics. Initially with those steps in place Tardive Dyskinesia will likely worsen.

Front 30

Define dystonia

Back 30

Involuntary muscle contraction or spasm (oculogyric crisis, i.e. rotating or 'fixed' eyeballs; torticollis). Tnx: benZTROpine or diPHENhydramine

Front 31

Evolution of EPS

Back 31

4hrs- dystonia
4days- Akinesia
4weeks-Akathisia
4months-tardive Dyskinesia

Front 32

Types of Schitzophrenia and prognosis

Back 32

Best prognosis- paranoid schitz. Worst- disorganized schitz.

Front 33

Examples of negative symptoms in Schitzophrenia

Back 33

poor emotional reactivity, flat affect, anhedonia, lack of purposeful movement

Front 34

What are the clusters for personality disorders?

Back 34

Cluster A, B and C. Weird (paranoid, schizoid, schizotypal), Wild (borderline, histrionic, narcissistic, antisocial), Wimpy (OCD, avoidant, dependent)

Front 35

What is the treatment for ADHD?

Back 35

Psychostimulants: METHYLPHENIDATE, dextroAMPHETAMINE and Antidepressants: SSRI, BuPropion, noRTIPTYline and alpha2-agonists: Clonidine

Front 36

What are the differences b/w Autism and Asperger's?

Back 36

Same repetitive activities, behaviors and interests, but without marked language or cognitive delays

Front 37

A baby girl shows deterioration in growth, esp head growth, language and coordination AFTER 5 months of age. What is the disorder?

Back 37

Rett's disorder

Front 38

What are the meds to target symptoms in an AUTISTIC child?

Back 38

neuroleptics for agression and SSRIs for stereotyped behavior

Front 39

What is Tourette's associated with and how would you pharmaceutically manage it?

Back 39

ADHD, OCD and learning disorders. Rx: DA DopAmine receptor ANTAgonists (Haloperidol, pimozine), alpha2 AGOnist (Clonidine). Do not give stimulants, as they'll precipitate tics

Front 40

What are CAGE questions?

Back 40

Cut down, Annoyed, Guilty, Eye opener in the morning. More than 1 yes? Alcoholism is likely.

Front 41

Important injectives for EtOH abusers

Back 41

administer thiamine (B1) before glucose, as glucose administration depletes thiamine. It will prevent WERNIKE's encephalopathy (ataxia, ophthalmoplegia, confusion, and impairment of short-term memory)

Front 42

Important sings of Anorexia Nervosa

Back 42

Mitral valve prolapse, HYPOtension, BRADIcardia, arRHYTHmia, nephroLITHIzasis, stress fractures, PANCYTOpenia, messed up thyroid. High suicidality or medical causes of death (over 10%)

Front 43

What sleep meds would you prescribe?

Back 43

Trazodone (Desyrel-other antidepressant), diphenhydramine (Benadryl), zolpidem (Ambien) and zaleplon (Sonata)

Front 44

When does a Conversion disorder happen?

Back 44

It is a somatoform disorder that happens in a close temporal proximity to a stress or intense emotion. Resolves spontaneously

Front 45

When does a Somatization disorder happen?

Back 45

It is a somatoform disorder that is significant for multiple GI, sexual, neurologic, and pain complaints - different organ systems. Schedule REGULAR short appointments with 1' caregiver.

Front 46

Explain Hypochondriasis

Back 46

fear of having a serious dz DESPITE reassurance from a doc. Schedule regular appointments

Front 47

Explain Pain disorder

Back 47

Similar to Conversion, yet often associated with depression. Pain out of proportions and can't be explained. Tnx: PT, psychotherapy, behavioral therapy, TCA and VenLAFAXine

Front 48

Differentiate PROJECTION from TRANSFERENCE on examples

Back 48

Projection: тетя Надя обвиняет Ольгу в том, что та проституирует. На самом же деле тетя Надя испытывает позор за Анну. Transference: you want to marry a girl that has the qualities of your mother

Front 49

Reaction formation

Back 49

sad, yet cracking jokes.

Front 50

Identification

Back 50

a brother is killed in Iraq and his little sister wears his military t-shirt

Front 51

Isolation of Affect

Back 51

trying not to cry in front of the kids, as they will be traumatized

Front 52

REpression

Back 52

Subconscious. Too traumatic? Then block it from the memory

Front 53

ForMICation- tactile hallucination

Back 53

in Alcohol withdrawal or Cocaine intoxication

Front 54

Delusion vs Illusion

Back 54

in Illusion there is misperception with a stimulus

Front 55

MOA of Carbamazepine

Back 55

a mood stabilizer that blocks Na channels

Front 56

uses of Carbamazepine

Back 56

due to effective blockade of fast-acting channels, use for TMJ, acute shooting pain, partial or focal seizures

Front 57

What are the Side Effects of Carbamazepine?

Back 57

WBC decrease, hepatotoxic, SIADH (drinking but not peeing ->bloated)

Front 58

types of Monoamine Oxidase

Back 58

MAO-A (inhibitor for anti depression)-> "TIPs": Tranylcypromine, Isocarboxazid, Phenelzine and MAO-B (inhibitor for anti Parkinsonism)->SELEGYLINE

Front 59

What is the occurrence of depression as the number of risk factors goes up?

Back 59

w/1 risk factor->10%(elderly), 2->50% (elderly in hospital), 3->90%(elderly in nursing home). Normal population -1 to 3 %

Front 60

SSRI's. Why are they a DOC in many psychiatric conditions (Eating d/o, OCD, Panic attack, Phobia, PTSD, PMDD i.e.premenstrual depressive d/o)?

Back 60

as they are being selective (5-HT i.e. serotonin is up)->less SE. Careful within first 90 days. Risk of suicide

Front 61

What is the number one reason of noncompliance in SSRI (fluoxetine, sertraline, luvoxetine, paroxetine, citolopram-newest, escitolopram-newest) treatment?

Back 61

most often ANORGASMIA in both men and women (i.e. treatment of premature ejaculation in guys can be considered)

Front 62

MOA of TCA (imipramine, amitryptaline, clomipramine, desipramine, nortryptaline, doxepin) and what is the antidote if OD?

Back 62

block reuptake of catecholamines i.e. NorEpinephrine, Serotonin; Strongly anticholinergic (constipation, dry mouth, blurred vision, dizziness, and slowing of urination); Block alpha1 i.e. hypotensive SE; Block AV conduction in the heart->arrhythmia. Antidote-> bicarb or other base to pee the acid out

Front 63

Describe sleep disturbance in DEPRESSION

Back 63

excessive sleepiness, early awakenings. REM becomes shorter in bursts but more frequent, i.e. increase in REM overall (paradoxical, yet the quality of sleep is low due to short individual REM bursts)

Front 64

What is the number 1 risk of suicide?

Back 64

Hx of previous attempts

Front 65

What is the best treatment for grief?

Back 65

Empathy -try to understand. Sympathy is different and better in a way b/c you have had same experience. The least you can do is EMPATHIZE.

Front 66

What's on Axis I?

Back 66

psychiatric d/o "no one or nothing causes"

Front 67

What's on Axis II?

Back 67

mental retardation, cerebral palsy, PERSONALITY disorders

Front 68

Axis III, IV, V?

Back 68

medical, social/environmental and global functioning assessment.