Psychiatry Shelf

Front 1

Dx Criteria for
Psychosis secondary to a general medical condition (3)

Back 1

1) Prominent hallucinations
2) Symptoms occur outside delirium
3) Evidence to support medical cause from lab data, hx, or physical

Front 2

Dx Criteria for
Psychosis secondary to medication or substance abuse (4)

Back 2

1) Prominent hallucinations
2) Symptoms occur outside delirium
3) Evidence to support medication or substance-related cause from lab data, hx, or phyiscal exam
4) Disturbance is not better accounted for by a psychotic disorder that is not substance-induced

Front 3

Dx Criteria for
Schizophrenia (4)

Back 3

1) Two of: Delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms
2) Must cause significant social or occupational functional impairment
3) 6 month duration
4) Sx not due to medical, neurological, or substance induced disorder

Front 4

Dx Criteria for
Schizophreniform disorder

Back 4

Schizophrenia symptoms for 1-6 months

Front 5

Dx Criteria for
Brief Psychotic Episode

Back 5

Schizophrenia symptoms lasting 1 day to 1 month

Front 6

Dx Criteria for
Schizoaffective disorder (3)

Back 6

1) Have a major depressive, manic, or mixed episode while also meeting criteria for schizophrenia
2) Hallucinations or delusions at least 2 weeks prior to onset of mood disorder
3) Have mood symptoms present for substantial portion of psychotic illness

Front 7

Dx Criteria for
Delusional disorder (2)

Back 7

1) Non-bizarre, fixed delusions for at least 1 month
2) Functioning in life not significantly impaired

Front 8

Difference between bizarre and non bizarre delusions

Back 8

Non-Bizarre: Beliefs that are false but which are plausible
Bizarre: Basically everything else
*Bizarre delusions are pathognomonic for schizophrenia

Front 9

Diagnostic Criteria for

Major Depressive Episode (8)

Back 9

SIG E CAPS

Depressed mood and at least four of the following for 2 weeks:

1) Sleep - Increased/decreased

2) Interest - Anhedonia

3) Guilt - Feelings of worthlessness or guilt

4) Energy - Decreased energy

5) Concentration - Diminished concentration

6) Appetite - Increased or decreased

Phycomotor agitation

7) Suicidal ideation

Front 10

Diagnostic Criteria for
Manic Episode

Back 10

DIG FAST
A period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week and including at least 3 of the following (4 if mood is only irritable):
1) Distractibility
2) Insomnia - Decreased need for sleep
3) Grandiosity - or Inflated self-esteem
4) Flight of ideas - or Racing thoughts
5) Activity/Agitation - Increase in goal directed activity (social, sexual, or work)
6) Speech - Pressured speech or talkativeness
7) Thoughtlessness - Excessive activities of indiscretion

Front 11

Diagnostic Criteria for
Mixed Episode

Back 11

Meets requirements for both depressive and manic episode

Front 12

Diagnostic Criteria for hypomanic Episode (4)

Back 12

Meets criteria for a manic episode and:

1) Lasts at least 4 days

2) Does not markedly impair social or occupational functioning

3) Does not require hospitalization

4) No psychotic features

Front 13

Diagnostic Criteria for
Major Depressive Disorder

Back 13

At least 1 major depressive episode

Front 14

Diagnostic Criteria for
Seasonal Affective disorder

Back 14

Major depressive episodes happen during the winter months

Front 15

Dx
Irritability, Carbohydrate drawing, and Hypersomnia

Back 15

Seasonal Affective disorder

Front 16

Drug cause of serotonin syndrome

Back 16

An SSRI (usually fluoxetine) with an MAOI

Front 17

Dx
Major depression with anhedonia, early morning awakenings, psychomotor disturbance, excessive guilt, and anorexia

Back 17

Melancholic Major Depressive disorder

Front 18

Dx
Major depression with hypersomnia, hyperphagia, reactive mood, leaden paralysis, and hypersensitivity to interpersonal rejection.

Back 18

Atypical Major Depressive disorder

Front 19

Dx
Major depression with immobility (catalepsy), purposeless motor activity, extreme negativism or mutism, bizarre postures, and echolalia

Back 19

Catatonic Major Depressive disorder

Front 20

Dx
Major depression with delusions or hallucinations

Back 20

Psychotic Major Depressive disorder

Front 21

Dx
Schizophrenia with
1) preoccupation with delusions or auditory hallucinations
2) No predominance of disorganized speech, behavior, of inappropriate affect

Back 21

Paranoid Schizophrenia

Front 22

Dx
Schizophrenia with
1) Disorganized speech
2) Disorganized behavior
3) Flat or inappropriate affect

Back 22

Disorganized Schizophrenia

Front 23

Dx
Schizophrenia with at least 2 of:
1) Motor immobility
2) Excessive purposeless motor activity
3) Extreme negativism or mutism
4) Peculiar voluntary movements or posturing
5) Echolalia or echopraxia

Back 23

Catatonic Schizophrenia

Front 24

Dx
Schizophrenia with
1) Prominent negative symptoms with minimal positive symptoms

Back 24

Residual type Schizophrenia

Front 25

Dx
Schizophrenia with
Multiple subtypes or none

Back 25

Undifferentiated Schizophrenia

Front 26

Diagnostic Criteria for

Bipolar I Disorder (3)

Back 26

1) At least 1 manic or mixed episode

2) Can be euthymic, depressed, or hypomanic between frank manic episodes

3) May have psychotic features during either depressive or manic episodes

Front 27

Diagnostic Criteria for

Bipolar II Disorder (2)

Back 27

1) At least 1 major depressive episode

2) At least 1 hypomanic episode (manic episode excludes)

Front 28

Diagnostic Criteria for
Rapid cycling

Back 28

4 or more manic episodes within 1 year

Front 29

Diagnostic Criteria for
Dysthymic disorder (3)

Back 29

1) Depressed mood for the majority of time of most days for 2 years (in children 1 year)
2) 2 of the following: Poor concentration, hopelessness, poor appetite or overeating, insomnia or hypersomnia, low energy, low self-esteem
3) No euthymia of more than 2 months, and no major depressive episode or (hypo)manic episode

Front 30

Diagnostic Criteria for
Double Depression

Back 30

Dysthymic disorder punctuated by major depressive episodes

Front 31

Diagnostic Criteria for
Cyclothymic disorder

Back 31

1) Numerous periods with hypomanic symptoms and periods with depressive symptoms for at least 2 years
2) No symptom free period greater than 2 years

Front 32

Diagnostic Criteria for
Minor Depressive disorder

Back 32

Chronic euthymia punctuated by periods of depressive symptoms that do not meet Major Depressive episode

Front 33

Sx of anxiety

Back 33

Palpitations
Perspiration
Dizziness
Mydriasis (pupil dilation)
GI discomfort
Urinary frequency and urgency

Front 34

Diagnostic Criteria for
Panic Attack (6)

Back 34

PANICS
Palpitations
Abdominal discomfort
Numbness/Nausea
Intense fear of death
Choking, Chills, Chest pain
Sweating, Shaking, SOB

Front 35

Diagnostic Criteria for
Panic Disorder (2)

Back 35

1) Spontaneous recurrent panic attacks with no obvious precipitant
2) At least 1 month of persistent concern about having additional attacks, a significant change in behavior related to attacks

Hint 35

Must specify with or without Agoraphobia

Front 36

3 common substances that exacerbate anxiety

Back 36

Caffeine
Nicotine
Marijuana

Front 37

Tx for
Panic Disorder

Back 37

Paroxetine (Paxil)
or
Sertraline (Zoloft)
Benzos acutely (better than beta blockers)

Front 38

Diagnostic Criteria for
Agoraphobia (2)

Back 38

1) Anxiety about being in places from which escape is difficult or where help is not readily available
2) Above are avoided, endured with severe distress, or with a companion

Front 39

Diagnostic Criteria for

Specific Phobia (5)

Back 39

1) Excessive fear brought on by specific situation or object

2) Exposure to situation or object brings about an immediate anxiety response

3) Pt recognizes fear is excessive

4) Situation is avoided or endured with severe anxiety

5) If pt less than 18, duration must be at least 6 months

Front 40

Diagnostic Criteria for
Social Phobia

Back 40

A specific phobia to social settings in which the pt might be embarrassed or humiliated in front of other people

Front 41

Tx for

Specific Phobia

Back 41

Systematic desensitization

(Beta blockers or benzos acutely in early desensitization) or flooding

Front 42

Tx for
Social Phobia

Back 42

Paroxetine


Beta-blockers for performance anxiety
CBT useful adjunct

Front 43

Diagnostic Criteria for

Obsessive-Compulsive disorder

Back 43

1) a. Obsessions:

i. Recurrent and persistent intrusive thoughts or impulses

ii. Attempts to suppress thoughts

b. Compulsions

i. Repetitive behaviors that reduce distress from obsession, but no realistic link between behavior and distress

2. Pt has insight that obsessions and compulsions are unreasonable and excessive

3. Obsessions are distressful, time consuming, or significantly interfere with daily functioning

Hint 43

Common obsessions and compulsions:1) Contamination and washing2) Doubt and rechecking3) Symmetry 4) Intrusive thoughts wihtout compulsions

Front 44

Tx for
OCD

Back 44

High dose SSRI

Front 45

Diagnostic Criteria for
Posttraumatic Stress disorder (6)

Back 45

1) Having experienced or witnessed a traumatic event.
2) Persistent reexperiencing of event (dreams, flashbacks, recurrent recollections)
3) Avoidance of stimuli associated with event
4) Numbing of responsiveness (diminished affect)
5) Persistent increased arousal (difficulty sleeping, anger, startle response, difficulty concentrating)
6) At least 1 month duration of sx

Front 46

Diagnostic Criteria for

Acute Stress disorder

Back 46

PTSD sx that last less than 1 month after event

Front 47

Diagnostic Criteria for
Generalized Anxiety disorder (3)

Back 47

1) Excessive anxiety and worry about daily events and activities for at least 6 months most days of the week
2) Difficult to control the worry
3) At least 3 of : Restlessness, Fatigue, Difficulty concentrating, Irritability, Muscle tension, Sleep disturbance

Front 48

Diagnostic Criteria for
Adjustment disorder

Back 48

1) Emotional or behavioral sx within 3 months of a stressful event that is not life threatening (i.e. divorce):
a. Abnormally elevated distress that impairs daily functioning
2) Not bereavement
3) Last no longer than 6 months after event

Front 49

Diagnostic Criteria for
Personality Disorder

Back 49

1) Pattern and behavior/inner experience that deviates from the person's culture and is manifested in two or more of the following ways:
1. Cognition
2. Affect
3. Personal relations
4. Impulse control
2) The pattern:
1. Is Pervasive and inflexible in a broad range of situations
2. Is Stable and has an onset no later than adolescence or early adulthood
3. Leads to significant distress in functioning
4. Is not accounted for by another mental/medical illness or by substance use

Front 50

Diagnostic Criteria for
Paranoid Personality Disorder

Back 50

General distrust of others with 4 or more of the following:
1) Suspicion without evidence that others are exploiting or deceiving him or her
2) Preoccupation with doubts of loyalty or trustworthiness of acquaintances
3) Reluctance to confide in others
4) Interpretation of benign remarks as threatening or demeaning
5) Persistence of grudges
6) Perception of attacks on his or her character that are not apparent to others; quick to counterattack
7) Recurrence of suspicions regarding fidelity of spouse or lover

Hint 50

No fixed delusions or frank hallucinations

Front 51

Diagnostic Criteria for
Schizoid Personality Disorder

Back 51

A pattern of voluntary social withdrawal and restricted range of emotional expression with 4 or more of the following:
1) Neither enjoying nor desiring close relationships (including family)
2) Generally choosing solitary activities
3) Little if any interest in sexual activity
4) Taking pleasure in few or no activities
5) Few or no close friends or confidants
6) Indifference to praise or criticism
7) Emotional coldness, detachment, or flattened affect

Front 52

Diagnostic Criteria for
Schizotypal Personality Disorder

Back 52

Eccentric behavior, cognitive or perceptual distortions, and discomfort with close relationships with 5 or more of the following:
1) Ideas of reference
2) Odd beliefs or magical thinking, inconsistent with cultural norms
3) Unusual perceptual experiences (e.g. bodily illusions)
4) Suspiciousness
5) Inappropriate or restricted affect
6) Odd or eccentric appearance or behavior
7) Few close friends or confidants
8) Odd thinking or speech
9) Excessive social anxiety

Front 53

Diagnostic Criteria for

Antisocial Personality Disorder

Back 53

Disregard for others and violation of the rights of others since before age 15 with hx of conduct d/o. Pt must be 18 with 3 or more of the following:

1) Failure to conform to social norms by committing unlawful acts

2) Deceitfullness/repeated lying/manipulating others for personal gain

3) Impulsivity/failure to plan ahead

4) Irritability and aggressiveness/repeated fights or assaults

5) Recklessness and disregard for safety of self or others

6) Irresponsibility/failure to sustain work or honor financial obligations

7) Lack of remorse for actions

Front 54

Diagnostic Criteria for
Borderline Personality Disorder

Back 54

5 of the following: IMPULSIVE
Impulsive
Moody
Paranoid under stress
Unstable self image
Labile, intense relationships
Suicidal
Inappropriate anger
Vulnerable to abandonment
Emptiness

Front 55

Diagnostic Criteria for
Histrionic Personality Disorder

Back 55

Excessive emotionality and attention seeking with 5 of the following:
1) Uncomfortable when not center of attention
2) Inappropriately seductive or provocative behavior
3) Uses physical appearance to draw attention to oneself
4) Has speech that is impressionistic and lacking in detail
5) Theatrical and exaggerated expression of emotion
6) Easily influenced by others or situation
7) Perceives relationships as more intimate than they actually are

Front 56

Diagnostic Criteria for
Borderline Personality Disorder

Back 56

5 of the following: IMPULSIVE
Impulsive
Moody
Paranoid under stress
Unstable self image
Labile, intense relationships
Suicidal
Inappropriate anger
Vulnerable to abandonment
Emptiness

Front 57

Diagnostic Criteria for
Narcissistic Personality Disorder

Back 57

Grandiosity, need for admiration, lack of empathy with 5 of the following:
1) Exaggerated sense of self-importance
2) Preoccupied with fantasies of unlimited money, success, brilliance, etc.
3) Believes that he or she is special or unique and can associate only with other high status individuals
4) Needs excessive admiration
5) Has sense of entitlement
6) Takes advantage of others for self-gain
7) Lacks empathy
8) Envious of others or believes others are envious of him or her
9) Arrogant or haughty

Front 58

Diagnostic Criteria for
Histrionic Personality Disorder

Back 58

Excessive emotionality and attention seeking with 5 of the following:
1) Uncomfortable when not center of attention
2) Inappropriately seductive or provocative behavior
3) Uses physical appearance to draw attention to oneself
4) Has speech that is impressionistic and lacking in detail
5) Theatrical and exaggerated expression of emotion
6) Easily influenced by others or situation
7) Perceives relationships as more intimate than they actually are

Front 59

Diagnostic Criteria for
Avoidant Personality Disorder

Back 59

Social inhibition, hypersensitivity, and feelings of inadequacy with 4 of the following:
1) Avoids occupation that involves interpersonal contact due to a fear of criticism and rejection
2) Unwilling to interact unless certain of being liked
3) Cautious of intrapersonal relationships
4) Preoccupied with being criticized or rejected in social situations
5) Inhibited in new social situations because he or she feels inadequate
6) Believes he or she is socially inept and inferior
7) Reluctant to engage in new activities for fear of embarrassment

Front 60

Diagnostic Criteria for
Narcissistic Personality Disorder

Back 60

Grandiosity, need for admiration, lack of empathy with 5 of the following:
1) Exaggerated sense of self-importance
2) Preoccupied with fantasies of unlimited money, success, brilliance, etc.
3) Believes that he or she is special or unique and can associate only with other high status individuals
4) Needs excessive admiration
5) Has sense of entitlement
6) Takes advantage of others for self-gain
7) Lacks empathy
8) Envious of others or believes others are envious of him or her
9) Arrogant or haughty

Front 61

Diagnostic Criteria for
Dependent Personality Disorder

Back 61

Submissive and clinging behavior due to excessive need to be taken care of with 5 of the following:
1) Difficulty making everyday decisions without reassurance from others
2) Needs others to assume responsibilities for most areas of his or her life
3) Cannot express disagreement because of fear of loss of approval
4) Difficulty initiating projects because of lack of self-confidence
5) Goes to excessive lengths to obtain support from others
6) Feels helpless when alone
7) Urgently seeks another relationship when one ends
8) Preoccupied with fear of being left to take care of self

Front 62

Diagnostic Criteria for
Avoidant Personality Disorder

Back 62

Social inhibition, hypersensitivity, and feelings of inadequacy with 4 of the following:
1) Avoids occupation that involves interpersonal contact due to a fear of criticism and rejection
2) Unwilling to interact unless certain of being liked
3) Cautious of intrapersonal relationships
4) Preoccupied with being criticized or rejected in social situations
5) Inhibited in new social situations because he or she feels inadequate
6) Believes he or she is socially inept and inferior
7) Reluctant to engage in new activities for fear of embarrassment

Front 63

Diagnostic Criteria for
Obsessive-Compulsive Personality Disorder

Back 63

Preoccupation with orderliness, control, and perfectionism at the expense of efficiency with 4 of the following:
1) Preoccupation with details, rules, lists, and organization such that the major point of the activity is lost
2) Perfectionism that is detrimental to the completion of task
3) Excessive devotion to work
4) Excessive conscientiousness and scrupulousness about morals and ethics
5) Will not delegate tasks
6) Unable to discard worthless objects
7) Miserly
8) Rigid and stubborn

Hint 63

OCD is ego-dystonic
OCPD is ego-systonic

Front 64

Diagnostic Criteria for
Dependent Personality Disorder

Back 64

Submissive and clinging behavior due to excessive need to be taken care of with 5 of the following:
1) Difficulty making everyday decisions without reassurance from others
2) Needs others to assume responsibilities for most areas of his or her life
3) Cannot express disagreement because of fear of loss of approval
4) Difficulty initiating projects because of lack of self-confidence
5) Goes to excessive lengths to obtain support from others
6) Feels helpless when alone
7) Urgently seeks another relationship when one ends
8) Preoccupied with fear of being left to take care of self

Front 65

Diagnostic Criteria for
Obsessive-Compulsive Personality Disorder

Back 65

Preoccupation with orderliness, control, and perfectionism at the expense of efficiency with 4 of the following:
1) Preoccupation with details, rules, lists, and organization such that the major point of the activity is lost
2) Perfectionism that is detrimental to the completion of task
3) Excessive devotion to work
4) Excessive conscientiousness and scrupulousness about morals and ethics
5) Will not delegate tasks
6) Unable to discard worthless objects
7) Miserly
8) Rigid and stubborn

Hint 65

OCD is ego-dystonic
OCPD is ego-systonic

Front 66

Diagnostic Criteria for
Substance Abuse

Back 66

Impairment or distress for at least 1 year with 1 of the following:
1) Failure to fulfill obligations at work, school, or home
2) Use in dangerous situations
3) Recurrent substance-related legal problems
4) Continued use despite social or interpersonal problems

Front 67

Diagnostic Criteria for
Substance dependence (7)

Back 67

3 in a 12 months period:
1) Tolerance
2) Withdrawal
3) Using substance more than originally intended
4) Desire or inability to cut down
5) Significant time spent getting, using, or recovering from substance
6) Decreased social, occupational, or recreational activities bc of use
7) Continued use despite subsequent physical or psychological problems

Front 68

Tx for

Acute Alcohol intoxication (4)

Back 68

1) Airway, breathing, circulation

2) FSG to r/o hypoglycemia

3) Thiamine to prevent wernicke's encephalopathy

4) Naloxone to reverse effects of any opioids

Front 69

Dx
Insomnia, anxiety, tremor, irritability, anorexia, tachycardia, hyperreflexia, hypertension, fever, seizures, hallucinations, delirium

Back 69

EtOH withdrawal

Front 70

Timeline of EtOH withdrawal

Back 70

Onset: 6-24 hours from last drink
DTs: with 72 hours

Front 71

Tx for
EtOH withdrawal

Back 71

1) Benzos
2) Thiamine, folic acid, and a multivitamin
3) Magnesium sulfate for postwithdrawal seizures

Front 72

Dx
Ataxia, Confusion, Ocular abnormalities (nystagmus)

Back 72

Wernicke's encephalopathy (thiamine Vit B12 deficiency)

Front 73

Dx
Impaired recent memory, anterograde amnesia, confabulation

Back 73

Korsakoff's syndrome (untreated Wernicke's encephalopathy of thiamine deficiency)

Front 74

Dx
Nausea, dilated pupils, weight loss, psychomotor agitation, chills, and sweating.

Back 74

Cocaine intoxication

Front 75

Acute medical complications of cocaine intoxication (2)

Back 75

MI (from vasospasm)
CVA

Front 76

Tx for
Cocaine intoxication
1. Mild to moderate agitation
2. Severe agitation or psychosis

Back 76

1. Mild to moderate agitation - Benzos
2. Severe agitation or psychosis - Haloperidol

Front 77

Dx
Dysphoria, malaise, fatigue, depression, hunger, constricted pupils, vivid dreams, psychomotor agitation or retardation.

Back 77

Cocaine withdrawal

Front 78

Tx for
Cocaine withdrawal

Back 78

Nothing

Front 79

Diagnosis, withdrawal, and treatment of what drug class is identical to that of cocaine?

Back 79

Amphetamines

Front 80

Method of action of
PCP and Ketamine

Back 80

NMDA (glutamate) antagonists and dopamine agonists

Front 81

Dx
Recklessnes, impulsiveness, impaired judgment, assaultiveness, rotatory nystagmus, hypertension, tachycardia, muscle rigidity, and high tolerance to pain.

Back 81

PCP or Ketamine intoxication

Front 82

Dx
Rotatory nystagmus

Back 82

PCP intoxication

Front 83

Date rape drug

Back 83

GHB

Front 84

Dx
Drowsiness, slurred speech, incoordination, ataxia, mood lability, impaired judgment, nystagmus, respiratory depression.

Back 84

Sedative or Hypnotic Intoxication

Front 85

Tx for
Benzo intoxication (3)

Back 85

1) ABCs
2) Activated charcoal
3) Flumazenil

Front 86

Tx for
Barbiturate Intoxication (3)

Back 86

1) ABCs
2) Activated charcoal
3) Sodium bicarb to alkalinize urine to promote renal excretion

Front 87

Tx for
Benzo or barbiturate withdrawal (2)

Back 87

1) Long acting benzo taper (CWA protocol)
2) Tegretol or Valproic acid for seizure control

Front 88

Dx
Tachycardia, sweating, insomnia, anxiety, tremor, n/v, delirium, hallucinations.
Not EtOH related

Back 88

Benzo or Barbiturate withdrawal

Front 89

Dx
Drowsiness, n/v, constipation, slurred speech, constricted pupils, seizures, and respiratory depression.

Back 89

Opiate intoxication

Front 90

Difference between opiates and opioids

Back 90

Opiates are naturally occuring (morphine), opioids are synthetic (fentanyl)

Front 91

Tx for
Opiate intoxication

Back 91

ABCs

Front 92

Tx for
Opiate overdose

Back 92

Naloxone

Front 93

Tx for
Long term opiate dependence

Back 93

Methadone or suboxone

Front 94

What is the only opiate that dilates pupils?

Back 94

Demerol (Meperidine)
"Demerol dilates pupils"

Front 95

Dx
Dysphoria, insomnia, lacrimation, rhinorrhea, yawning, weakness, sweating, piloerection, n/v, fever, dilated pupils, muscle ache.

Back 95

Opiate withdrawal

Front 96

Tx for
Opiate withdrawal
Moderate -
Severe -

Back 96

Moderate - Clonidine or Buprenorphine
Severe - Methadone taper

Front 97

Dx
Perceptual changes, papillary dilation, tachycardia, tremors, incoordination, sweating, palpitations.

Back 97

Hallucinogen intoxication

Front 98

Tx for
Hallucinogen intoxication

Back 98

Talking down pt, possibly antipsychotics

Front 99

Dx
Euphoria, impaired coordination, mild tachycardia, conjunctival injection, dry mouth, increased appetite.

Back 99

Marijuana intoxication

Front 100

Dx
Impaired judgment, belligerence, impulsivity, perceptual disturbances, lethargy, nystagmus, tremor, muscle weakness, ataxia, slurred speech, euphoria, stupor, or coma.

Back 100

Inhalant intoxication

Front 101

Tx for
Inhalant intoxication

Back 101

ABCs

Front 102

Tx for
Marijuana intoxication

Back 102

None

Front 103

Dx
Anxiety, insomnia, twitching, rambling speech, flushed face, diuresis, GI discomfort, and restlessness.

Back 103

Caffeine intoxication

Front 104

Dx
Tinnitus, severe agitation, and cardiac arrhythmias.

Back 104

Caffeine overdose

Front 105

Dx
Headache, n/v, drowsiness, anxiety or depression.

Back 105

Caffeine withdrawal

Front 106

Dx
Improved attention, improved mood, decreased tension, insomnia, restlessness, anxiety, GI discomfort.

Back 106

Nicotine intoxication

Front 107

Dx
Craving, dysphoria, anxiety, increased appetite, irritability, insomnia.

Back 107

Nicotine withdrawal

Front 108

Minimum workup to exclude reversible causes of dementia (6)
15% of dementia

Back 108

1) CBC
2) Panel 7
3) Thyroid function tests
4) RPR
5) B12 and folate
6) Brain CT or MRI

Front 109

Dx
Dementia with stepwise increase in severity and focal neurological signs

Back 109

Multi-infarct dementia

Front 110

Dx study for
Multi-infarct dementia

Back 110

Head CT/MRI

Front 111

Dx
Dementia, cogwheel rigidity, resting tremor

Back 111

Lewy body dementia or
Parkinson's disease

Front 112

Dx
Dementia, atraxia, urinary incontinence, dilated cerebral ventricles

Back 112

Normal pressure hydrocephalus
(Wild, wet, and wobbly)

Front 113

Dx study for
Normal pressure hydrocephalus

Back 113

Head CT/MRI

Front 114

Dx
Dementia, obesity, coarse hair, constipation, cold intolerance

Back 114

Hypothyroidism

Front 115

Dx
Dementia, diminished position and vibration sensation, megaloblasts on CBC

Back 115

Vitamin B12 deficiency
(Posterior column disease)

Front 116

Dx
Dementia, tremor, abnormal liver function tests, Kayser-Fleischer rings

Back 116

Wilson's disease
(Too much copper)

Front 117

Dx
Dementia, diminished position and vibration sensation, Accomodation Response Present, response to light absent

Back 117

Neurosyphilis
Argyll-Robertson pupils (Accomodation Response Present but response to light absent)
ARP, get it

Front 118

Two types of delirium

Back 118

Quiet delirium: Depressed, failure to thrive
Agitated: Pulling out lines, may be hallucinating

Front 119

Tx for
Delirium

Back 119

Quetiapine (seroquel) or
Haloperidol

Front 120

Differential Diagnosis for
Delirium

Back 120

AEIOU
Alcohol
Electrolytes
Iatrogenic (medications)
Oxygen hypoxia (bleeding, pulmonary cause)
Uremia/hepatic encephalopathy

Front 121

Dx Criteria for
Alzheimer's Dementia (4)

Back 121

Memory impairment plus 1:
1) Aphasia - Disorder of language affecting speech and understanding
2) Apraxia - Inability to perform purposeful movements
3) Agnosia - Inability to interpret sensations correctly (i.e. inability to recognise an object)
4) Diminished executive functioning - problems with planning, organizing, and abstracting

Front 122

Neurophysiologic chagnes in
Alzheimer's Dementia (2)

Back 122

1) Decreased ACh (due to loss of noradrenergic in Locus Ceruleus of brainstem)
2) Decreased Norepi (due to loss of cholinergic neurson in Basal Nucelus of Meynert)

Front 123

Microscopic changes in
Alzheimer's Dementia

Back 123

1) Senile plaques from amyloid Beta protein
2) Neurofibrillary tangles from Tau protein

Front 124

Tx for
Early Alzheimer's Dementia

Back 124

Donepezil (Aricept)
Cholinesterase inhibitor

Front 125

Tx for
Anxiety in dementia

Back 125

Low dose, short acting benzos

Front 126

Tx for
Agitation or psychosis in dementia

Back 126

Quetiapine

Front 127

Dx Criteria for
Vascular Dementia (4)

Back 127

Memory impairment with 1)
1) Aphasia
2) Apraxia
3) Agnosia
4) Diminished executive functioning

Front 128

Dx Criteria for
Mild Cognitive Impairment

Back 128

Normal daily function but abnormal memory functioning relative to age

Front 129

Dx
Aphasia, apraxia, agnosia, with personality and behavior changes usually before memory impairments

Back 129

Frontotemporal Dementia (Pick's Dementia)

Front 130

Microscopic finding in
Frontotemporal Dementia

Back 130

Pick bodies (tau protein)

Front 131

Dx
Progressive dementia, bizare choreiform movements, muscular hypertonicity

Back 131

Huntington's Disease

Front 132

Dx
Bradykinesia, cogwheel rigidity, resting tremor, masked facies, shuffling gait, dysarthria

Back 132

Parkinson's Disease

Front 133

Neurophysiology of
Parkinson's Disease

Back 133

Neuronal loss in Substantia Nigra causing decreased Dopamine to Basal Ganglia

Front 134

Tx for
Parkinson's Disease

Back 134

Levodopa and Carbidopa

Front 135

Dx
Rapidly progressive dementia, 6-12 months after onset of sx, startle myoclonus and possibly ataxia and fasciculations.

Back 135

Creutzfeld-Jakob

Front 136

Dx Criteria for
Creutzfeld-Jakob

Back 136

1) Rapidly progressive dementia
2) Periodic generalized sharp waves on EEG
3) At least 2 of:
a. Myoclonus
b. Cortical blindness
c. Ataxia, pyramidal signs, or EPS
d. Mutism

Front 137

Tx
Normal Pressure Hydrocephalus

Back 137

Shunt to decrease ICP
(Yes, contrary to name the pressure is elevated)

Front 138

Dx
Delirium with hemiparesis or other focal neurological signs and symptoms

Back 138

CVA or mass lesion

Front 139

Dx
Delirium, elevated blood pressure, papilledema

Back 139

Hypertensive encephalopathy

Front 140

Dx
Delirium, dilated pupils, tachycardia

Back 140

Drug intoxication

Front 141

Dx
Delirium, fever, nuchal rigidity, photophobia

Back 141

Meningitis

Front 142

Dx
Delirium, tachycardia, tremor, thyromegaly

Back 142

Thyrotoxicosis

Front 143

Dx
Impairment of memory without other cognitive impairment or altered consciousness.

Back 143

Amnestic disorder
(Hypoglycemia, CVA, seizure, MS, etc)

Front 144

Dx
Decreased muscle mass/increased fat, decreased brain mass with enlarged ventricles, impaired vision and hearing, minor forgetfullness

Back 144

Normal Aging

Front 145

Stages of Dying (5)

Back 145

1) Denial
2) Anger
3) Bargaining
4) Depression
5) Acceptance

Front 146

Dx
Memory and cognitive impairment, emphasizes failures, no sundowning, patient has insight.

Back 146

Pseudodementia
i.e. Depression in the elderly

Front 147

Tx for
Depression in elderly

Back 147

SSRIs

Front 148

Tx for
Depression in elderly with insomnia and decreased appetite

Back 148

Mirtazapine (Remeron)

Front 149

Tx for
Depression in elderly on top of SSRI for psychomotor retardation

Back 149

Methylphenidate

Front 150

Criteria for grief to be pathological (4)

Back 150

1) Weight loss
2) Hallucinations or delusions (not illusions)
3) Suicidal ideation
4) Sx for more than 1 year

Front 151

Dx Criteria for
Mental Retardation

Back 151

1) IQ less than 70
2) Onset before 18

Front 152

Dx Criteria for
Learning Disorder

Back 152

Lower than expected achievement in reading, math, or writing than would be expected given age, level of education, and level of intelligence.

Front 153

Dx Criteria for
Conduct Disorder

Back 153

Violation of the basic rights of others with 3:
1) Aggression towards people or animals
2) Destruction of property
3) Deceitfulness
4) Serious violation of rules or laws

Front 154

Dx Criteria for
Oppositional Defiant Disorder

Back 154

6 months of negativistic, hostile, defiant behavior with 4:
1) Frequent loss of temper
2) Arguments with adults
3) Deliberately annoying people
4) Easily annoyed
5) Anger and resentment
6) Blaming others for mistakes or misbehaviors

Front 155

Difference between ODD and Conduct Disorder

Back 155

ODD does not violate the basic rights of others and children frequently get along with peers but not with authority figures.

Front 156

Dx Criteria for
ADHD (2)

Back 156

1) 6 Sx of inattentiveness, hyperactivity, or both for at least 6 months
2) Onset before 7

Front 157

Dx Criteria for
Autism

Back 157

6 of:
1) Impairment in nonverbal behaviors (facial expressions etc)
2) Failure to develop peer relationships
3) Failure to seek enjoyment from others
4) Lack of social or emotional reciprocity
5) Lack of or delayed speech
6) Repetitive use of language
7) No imaginative play
8) Inflexible rituals
9)Repetitive movements
10) Preoccupation with parts of objects

Front 158

Dx Criteria for
Asperger's Disorder

Back 158

Autism without language delays

Front 159

Dx
Diminished head circumference, stereotyped hand movements, cognitive development halted at 1 year, girl

Back 159

Rett's syndrome

Front 160

Dx Criteria for
Disintegrative Disorder

Back 160

1) Normal development in first 2 years
2) Loss of acquired skills in at least two of: Language, social skills, bowel or bladder control, play, motor skills
3) At least 2: Impaired social interaction, impaired use of language, restricted, repetitive, and stereotyped behaviors and interests

Front 161

Dx
Multiple daily motor and vocal tics with onset before 18.

Back 161

Tourette's Disorder
Otherwise a motor or vocal tic in isolation

Front 162

Dx
Bedwetting

Back 162

Enuresis

Front 163

Tx for
Enuresis

Back 163

Antidiuretics or TCAs

Front 164

Dx
Inappropriate bowel movements for 3 months at least once a month

Back 164

Encopresis

Front 165

Dx
Inability to recall important personal information usually involving a traumatic or stressful event, but can remember obscure details

Back 165

Dissociative Amnesia

Front 166

Dx
Sudden, unexpected travel away from home, accompanied by the inability to recall parts of one's past or identity, usually undertaking a new identity and having no insight.

Back 166

Dissociative Fugue
Usually only lasts a few days, pt will not remember fugue episode

Front 167

Dx Criteria for
Dissociative Identity Disorder (Multiple Personality Disorder)

Back 167

1) Presence of two or more distinct identities which consistently overtake the person's behavior
2) Inability to recall personal information of one personality when the other is dominant

Front 168

Dx
Persistent or recurrent feelings of detachments from one's self, environment, or social situation. Out of body experiences.

Back 168

Depersonalization Disorder

Front 169

Tx for
Depersonalization Disorder

Back 169

SSRI

Front 170

Difference between primary and secondary gain

Back 170

Primary gain - Expression of unacceptable feelings as physical symptoms in order to avoid facing them.
Secondary gain - Use of symptoms to benefit the patient, money, meds, or worker comp, etc.

Front 171

What is a somatoform disorder?

Back 171

Patients with physical symptoms that have no organic cause. The patient's pain is real and is not faking (which would be malingering).

Front 172

Dx
Multiple vague complaints involving many organ systems without an underlying organic cause and resistant to psychiatric referral.

Back 172

Somatization disorder

Front 173

Dx
Patient initiates or exacerbates a true neurological symptom bc of a psychological symptom. Examples include shifting paralysis, blindness, mutism, paresthesias, seizures. Usually spontaneously recover.

Back 173

Conversion Disorder

Front 174

Dx
Prolonged, exaggerated concern about health and potential illness.

Back 174

Hypochondriasis
Pts with hypochondriasis worry about having disease, whereas pts with somatization disorder complain about the symptoms.

Front 175

Dx
Preoccupied with body parts that they deem as ugly or unsightly but which are normal.

Back 175

Body Dysmorphic Disorder

Front 176

Tx for
Body Dysmorphic Disorder

Back 176

SSRIs

Front 177

Dx
Prolonged, severe discomfort, usually co-existent with a medial condition but not directly caused by it.

Back 177

Pain Disorder

Front 178

Dx
Intentional feigning or artificially causing of medical symptoms in order to assume role of sick patient

Back 178

Factitious Disorder
(Munchhausen Syndrome)
Munchhausen can be by proxy if you force your kid to be sick role

Front 179

Dx
Feigning of physical or psychological symptoms for personal gain.

Back 179

Malingering

Different than Factitious in that factitious has no obvious external reward

Front 180

Dx
Failure to resist aggressive impulses that result in assault or property destruction

Back 180

Intermittent Explosive Disorder

Front 181

Dx
Urge to steal when not needed for personal use.

Back 181

Kleptomania

Front 182

Dx
Intentional fire setting not for monetary gain, or expression of anger.

Back 182

Pyromania

Front 183

Dx
Recurrent pulling out of one's hair.

Back 183

Trichotillomania

Front 184

Dx Criteria for
Anorexia Nervosa (3)

Back 184

1) Body weight less than 85% ideal
2) Intense fear of gaining weight or being fat
3) Disturbed body image

Front 185

Indication for inpatient treatment of Anorexia (3)

Back 185

1) Electrolyte disturbances
2) Less than 80% ideal body weight
3) Arrhythmias

Front 186

Dx Criteria for
Bulimia Nervosa (3)

Back 186

1) Recurrent episodes of binge eating
2) Compensating behavior
3) Binge and compensation happen sx per week for 3 months

Front 187

Dx Criteria for
Binge Eating Disorder

Back 187

1) Recurrent binge eating
2) Severe distress over binging
3) Binging 2x/week for 6 months
4) Fast, full, furtively, fallen (feeling disgusted)

Front 188

Difference between Dyssomnias and Parasomnias

Back 188

Dyssomnias - disturbances in amount, quality, or timing of sleep
Parasomnias - Abnormal events in behavior or physiology during sleep

Front 189

Dx
Difficulty initiating or maintaining sleep resulting in daytime drowsiness or difficulty fulfilling tasks.

Back 189

Primary Insomnia

Front 190

Tx for
Primary Insomnia

Back 190

Sleep hygiene
Meds: Benadryl, Zolpidem, Zaleplon, Trazodone

Front 191

Dx
At least 1 month of excessive daytime sleepiness or excessive sleep.

Back 191

Primary Hypersomnia

Front 192

Dx
1) Cataplexy - collapse due to loss of muscle tone associated with emotion especially laughter (70% of pts)
2) Short REM latency
3) Brief paralysis upon awakening (50%)
4) Hypnagogic (falling asleep), or hyponopompic (waking up) hallucinations (30%)

Back 192

Narcolepsy

Front 193

Tx for
Narcolepsy (2)

Back 193

Timed daily naps plus stimulants
SSRIs for cataplexy

Front 194

Dx
HAs, depression, pulmonary HTN

Back 194

Breathing Related Sleep Disorder

Front 195

Dx
Disturbance due to circadian sleep wake cycles

Back 195

Circadian Rhythm Sleep Disorder

Front 196

Dx
Repeated awakenings from REM with recall of extremely frightening dreams that causes significant distress

Back 196

Nightmare Disorder

Front 197

Dx
Repeated episodes of fearfullness during early hours of sleep from which patient does not awaken.

Back 197

Night Terror Disorder

Front 198

Dx
Repeated episodes of ambulation or other activity while sleeping that are not remembered.

Back 198

Somnambulism

Front 199

Neurotransmitters in libido

Back 199

Dopamine increases libido (antipsychotics are inhibitory)
Serotonin decreases libido (SSRIs are inhibitory)

Front 200

Dx
Absence or deficiency of sexual desires or fantasies

Back 200

Hypoactive sexual desire disorder

Front 201

Dx
Avoidance of sexual contact with a sexual partner

Back 201

Sexual aversion disorder

Front 202

Dx
Inability to attain an erection

Back 202

Male Erectile Disorder (primary if never in life; secondary if lost the ability)

Front 203

Dx
Inability to maintain lubrication until completion of sex act (33% of women)

Back 203

Female Sexual Arousal Disorder

Front 204

Dx
Inability to achieve orgasm

Back 204

Orgasmic disorder (30% of women)

Front 205

Dx
Genital pain before, during, or after intercourse

Back 205

Dyspareunia

Front 206

Dx
Involuntary muscle contraction of the outer third of vagina upon insertion

Back 206

Vaginismus

Front 207

Dx
Sexual preference for inanimate objects

Back 207

Fetishism

Front 208

Dx
Sexual gratification from wearing opposite gender's clothing

Back 208

Transvestic Fetishism

Front 209

Dx
Sexual pleasure in rubbing genitals against unsuspecting people

Back 209

Frotteurism

Front 210

Dx
Sexual excitement from being humiliated or beaten

Back 210

Masochism

Front 211

Dx
Sexual excitement from hurting or humiliating others

Back 211

Sadism

Front 212

Dx
Sexual excitement form calling unsuspecting strangers and engaging in sexual conversations

Back 212

Telephone scatalogia

Front 213

Dx
Subjective feeling the patient was born the wrong sex.

Back 213

Gender Identity Disorder (aka Transsexuality)

Front 214

What are the Mature Defense
Mechanisms? (4)

Back 214

HASS
Humor
Altruism
Sublimation
Suppression

Front 215

What are the Neurotic Defense Mechanisms? (7)

Back 215

CDI2R3
Controlling - regulating situations
Displacement - Shifting emotions from situation or person to another
Intellectualization -
Isolation of Affect - Unconsciously limiting the experience of feeling or emotions associated with a stressful life event
Rationalization - Conjuring explanations of an event in order to justify outcomes or behaviors
Reaction Formation - Doing the opposite of an unacceptable impulse
Repression - Preventing a thought or feeling from entering unconscious (repression in unconscious whereas suppression is conscious)

Front 216

What are the Immature Defense Mechanisms? (4)

Back 216

DRAP
Denial
Regression - to an earlier state of development
Acting Out - Giving in to impulse in order to avoid anxiety of suppressing it
Projection - Attributing one's own objectionable thoughts or emotions to others (Claiming other people have acted on your impulses)

Front 217

Other defense mechanisms (2)

Back 217

Splitting
Undoing - attempting to reverse situation by doing a new behavior

Front 218

Elements of informed consent (4)

Back 218

1) Name and purpose of treatment
2) Potential risks and benefits
3) Alternatives to the treatment
4) Consequences of refusing the treatment

Front 219

Requirements to be not guilty by insanity (3)

Back 219

1) Have a mental illness
2) Not understand right from wrong
3) Not understand consequences of action at time of act

Front 220

4 D's of malpractice

Back 220

Dereliction of a Duty that lead Directly to Damages

Compensatory damages are reimbursement for expenses, lost income, or for physical suffering.
Punitive damages are reimbursements to the patient to punish the doctor for gross negligence or carelessness.

Front 221

Citalopram
-Brand name
-MOA
-s/e
-Indications

Back 221

-Brand name: Celexa
-MOA: SSRI
-s/e:
5HT2A/C: Anxiety, insomnia, sexual dysfunction
5HT3/4: GI upset
-Indications: Depression and Anxiety

Front 222

Escitalopram
-Brand name
-MOA
-s/e
-Indications

Back 222

-Brand name: Lexapro
-MOA: SSRI
-s/e:
5HT2A/C: Anxiety, insomnia, sexual dysfunction
5HT3/4: GI upset
-Indications: Depression and Anxiety

Front 223

Fluoxetine
-Brand name
-MOA
-s/e
-Indications

Back 223

-Brand name: Prozac
-MOA: SSRI
-s/e:
5HT2A/C: Anxiety, insomnia, sexual dysfunction
5HT3/4: GI upset
-Indications: Depression and Anxiety

Front 224

Fluvoxamine
-Brand name
-MOA
-s/e
-Indications

Back 224

-Brand name: Luvox
-MOA: SSRI
-s/e:
5HT2A/C: Anxiety, insomnia, sexual dysfunction
5HT3/4: GI upset
-Indications: Depression and Anxiety

Front 225

Paroxetine
-Brand name
-MOA
-s/e
-Indications

Back 225

-Brand name: Paxil
-MOA: SSRI
-s/e:
5HT2A/C: Anxiety, insomnia, sexual dysfunction
5HT3/4: GI upset
-Indications: Depression and Anxiety

Front 226

Sertraline
-Brand name
-MOA
-s/e
-Indications

Back 226

-Brand name: Zoloft
-MOA: SSRI
-s/e:
5HT2A/C: Anxiety, insomnia, sexual dysfunction
5HT3/4: GI upset
-Indications: Depression and Anxiety

Front 227

Desipramine
-Brand name
-MOA
-s/e
-Indications

Back 227

-Brand name: Norpramin
-MOA: SNRI
-s/e:
Anti-H: Sedation, weight gain
Anti-A: Orthostatic hypotension, dizziness, falls
Anti-M: Drymouth, sedation, constipation, urinary retention, blurry vision
Anti-Na channel: Arrhythmia
-Indications: Mood, Anxiety, Alertness

Front 228

Method of action of TCAs

Back 228

Serotonin and Norepinephrine reuptake inhibitors

Front 229

Nortryptiline
-Brand name
-MOA
-s/e

Back 229

-Brand name: Pamelor
-MOA: SNRI
-s/e:
Anti-H: Sedation, weight gain
Anti-A: Orthostatic hypotension, dizziness, falls
Anti-M: Drymouth, sedation, constipation, urinary retention, blurry vision
Anti-Na channel: Arrhythmia (prolonged QT)
-Indications: Mood, Anxiety, Alertness

Front 230

Amoxapine
-Brand name
-MOA
-s/e

Back 230

-Brand name: Asendin
-MOA: SNRI
-s/e:
Anti-H: Sedation, weight gain
Anti-A: Orthostatic hypotension, dizziness, falls
Anti-M: Drymouth, sedation, constipation, urinary retention, blurry vision
Anti-Na channel: Arrhythmia
-Indications: Mood, Anxiety, Alertness

Front 231

Atomoxetine
-Brand name:
-MOA:
-s/e:
-Indications:

Back 231

-Brand name: Strattera
-MOA: Selective Norepinephrine reuptake inhibitor
-s/e: Urinary retention
-Indications: Add to SSRI for Norepi profile

Front 232

Reboxetine
-MOA:
-s/e:
-Indications:

Back 232

-MOA: Selective Norepinephrine reuptake inhibitor
-s/e: Urinary retention
-Indications: Add to SSRI for Norepi profile

Front 233

Venlafaxine
-Brand name:
-MOA:
-s/e:
-Indications:

Back 233

-Brand name: Effexor
-MOA: SNRI
Low dose - mostly serotonin
High dose - mostly NE
-s/e: HTN
-Indications: Mood, Anxiety, Alertness

Front 234

Phenelzine
-Brand name:
-MOA:
-s/e:
-Indications:

Back 234

-Brand name: Nardil
-MOA: MAOI - Serotonin, NE, and Dopamine reuptake inhibitor
-s/e: Tyramine restriction, weight gain, sedation
-Indications: Mood

Front 235

Tranylcyrpromide
-Brand name:
-MOA:
-s/e:
-Indications:

Back 235

-Brand name: Parnate
-MOA: MAOI - Serotonin, NE, and Dopamine reuptake inhibitor
-s/e: Tyramine restriction, weight gain, sedation
-Indications: Mood

Front 236

Isocarboxazid
-Brand name:
-MOA:
-s/e:
-Indications:

Back 236

-Brand name: Marplan
-MOA: MAOI - Serotonin, NE, and Dopamine reuptake inhibitor
-s/e: Tyramine restriction, weight gain, sedation
-Indications: Mood

Front 237

Mirtazapine
-Brand name:
-MOA:
-s/e:
-Indications:

Back 237

-Brand name: Remeron
-MOA: Alpha 2 agonist causing increased Serotonin and NE, also blocks 5HT2A/C, H5T3, and 5HT4
-s/e: Sedation, weight gain (blocking 5HT2 relieves insomnia but causes sedation)
-Indications: Depression especially with weight loss or insomnia

Front 238

Nafazodone
-Brand name:
-MOA:
-s/e:
-Indications:

Back 238

-MOA: 5HT2 antagonist (which indirectly agonizes 5HT1)
-s/e:
-Indications: Depression, no sexual side effects

Front 239

Trazodone
-Brand name:
-MOA:
-s/e:
-Indications:

Back 239

-MOA: 5HT2 antagonist (which indirectly agonizes 5HT1)
-s/e: Priapism, weight gain and sedation
-Indications: Sleep aid, no sexual side effects

Front 240

Bupropion
-Brand name:
-MOA:
-s/e:
-Indications:

Back 240

-Brand name: Wellbutrin
-MOA: DNRI, Dopamine and NE reuptake inhibitor
-s/e: Seizures in anorexics with IR formula
-Indications: Add to SSRI to relieve sexual dysfunction, depression, ADHD, Cigarette cessation

Front 241

Buspirone
-Brand name:
-MOA:
-s/e:
-Indications:

Back 241

-Brand name: Buspar
-MOA: 5HT1A partial agonist, also increases amount of serotonin in neurons by improving recycling
-s/e: none
-Indications: GAD

Front 242

Duloxetine
-Brand name:
-MOA:
-s/e:
-Indications:

Back 242

-Brand name: Cymbalta
-MOA: TCA - 5HT and NE reuptake inhibitor
-s/e: Sedation, weight gain
-Indications: Depression and neuropathic pain

Front 243

Tx for
Delirium

Back 243

Haloperidol
(High potency has no effect on CV or respiratory drive; do not use low potency bc anti-ACh worsens delirium, lowers seizure threshold, and causes hypotension)

Front 244

Tx for
Tourette's

Back 244

Haloperidol

Front 245

Clozaril
Brand name:
MOA:
s/e:
Special considerations:

Back 245

Brand name: Clozapine
MOA: D2, 5HT2A, HAM antagonist
s/e: Wt gain, sedation, constipation, decreased seizure threshold tachycardia, hypotension
Special considerations:
a. Can cause Agranulocytosis! so bi-weekly CBCs
b. Increased salivaiton

Front 246

Olanzapine
Brand name:
MOA:
s/e:
Special considerations:

Back 246

Brand name: Zyprexa
MOA: Blocks D2, 5HT2A, HAM
s/e: Wt gain, diabetes, sedation, dizziness
Special considerations: Lots of weight gain, otherwise a great drug

Front 247

Ziprasidone
Brand name:
MOA:
s/e:
Special considerations:

Back 247

Brand name: Geodon
MOA: Blocks D2, 5HT2A, HA
s/e: Sedation, prolonged QTc
Special considerations: Least likely to cause weight gain

Front 248

Risperidone
Brand name:
MOA:
s/e:
Special considerations:

Back 248

Brand name: Risperdal
MOA: Blocks D2 and 5HT2A (the latter mitigates the EPS sx)
s/e: Galactorrhea, sexual dysfunction, hypotension, tachycardia, sedation, wt gain, insomnia, decreased concentration
Special considerations: Least anti-M activity

Front 249

Quetiapine
Brand name:
MOA:
s/e:
Special considerations:

Back 249

Brand name: Seroquel
MOA: Lower affinity for blocking D2 and 5HT2A, blocks HA
s/e: Sedation, hypotension, insomnia, dry mouth
Special considerations: 1st line atypical bc no EPS without blood draws. Less weight gain, no prolactin elevation.

Front 250

Psychological test for
Depression and/or Anxiety

Back 250

Beck Depression Inventory

Front 251

Psychological test for
short term memory (as for ECT s/e)

Back 251

Brown-Peterson Task

Front 252

Psychological test for
ADLs in moderate to severe dementia

Back 252

Geriatric Rating Scale

Front 253

Psychological test for
Dementia (2)

Back 253

Mini Mental Status Exam (MMSE)
or
Montreal Cognitive Assessment (MOCA)

Front 254

Psychological test for
Level of consciousness

Back 254

Glasgow Coma Scale

Front 255

Psychological test which
Asks patient's friends and relatives about their functional ability in their current environment

Back 255

Blessed Rating Scale

Front 256

Which psychiatric illness can look like dementia in elderly patients?

Back 256

Depression
(Pseudodementia)

Front 257

What does the Wisconsin Cart Sorting Test?
And what disease is it useful for?

Back 257

-Executive functioning (frontal lobe)
-Schizophrenics perform worse than normal as do people with frontal lobe damage

Front 258

Indications for Draw a Person Test?

Back 258

Brain damage

Front 259

What does Bender Gestalt test indicate?

Back 259

Organic causes of brain disease

Front 260

Rorschach, Thematic Apperception Test, Sentence Completion Test, and Draw a Person test are all testing what?

Back 260

Personality

Front 261

Projective tests are based on activity.
Rorschach and Word Association Test -
TAT -
Draw a Person -
Sentence Completion Test -

Back 261

Rorschach and Word Association Test - Associations
TAT - Construction
Draw a Person - Expression
Sentence Completion Test - Completion

Front 262

What does the Stroop Test

Back 262

Concentration
(reading words in different colors)

Front 263

What does the Fargo Map test?

Back 263

Recent and remote spatial memory (basically a geography test)

Front 264

What does the Rey-Osterrieth test show?

Back 264

Redrawing figure with picture and from memory to assess visual spatial nonverbal memory.

-Right parietal lesion -->ignore left part of picture
-Right temporal lesion --> no problems copying, but cannot redraw from memory

Front 265

What does the Boston Diagnostic Aphasia Examination show?

Back 265

Evaluate aphasic disorders and speech problems (i.e. after stroke)

Front 266

What does the serial 7s or world backward test?

Back 266

Concentration

Front 267

A defense mechanism that uses elaborate and reassuring explanations that avoid the actual underlying motives.

Back 267

Rationalization

Front 268

A defense mechanism that deals with stressors by breaking down the usual integration of memory, behavior, and perception.

Back 268

Dissociation

Front 269

A defense mechanism that utilizes reflecting on one's own thoughts and behaviors with appropriate responses.

Back 269

Self-observation

Front 270

Something should be familiar but appears novel and unfamiliar

Back 270

Jamais vu

Front 271

Feeling that you have heard this before

Back 271

Deja Entendu

Front 272

Feeling that you have seen this before

Back 272

Deja vu

Front 273

A defense mechanism that utilizes the formation of thoughts that are opposite to the anxiety provoking feelings

Back 273

Reaction formation

Front 274

A defense mechanism that transfers a feeling toward an object or person that is less threatening.

Back 274

Displacement

Front 275

The recurrence of Sx after abrupt cessation.

Back 275

Rebound

Front 276

The long term return of the original symptoms

Back 276

Recurrence

Front 277

Test used to quantitate the Rorschach

Back 277

Exner Comprehensive System

Front 278

What does the Random Letter test?

Back 278

Concentration, cooperation, and hearing

Front 279

Test to determine prior to ECT the hemisphere in which Language is

Back 279

Wada Test
(Inject sodium amytal to anesthetize hemispheres one at a time and look for aphasia)

Front 280

What is the rate of teenage suicide attempts and who are more likely to succeed?

Back 280

9% of all have attempted.
Boys 5x more likely than girls to succeed.

Front 281

Most frequent suicide attempt method, and most frequent method of success?

Back 281

OD is most common, but firearms are far more likely to succeed so account for more total deaths

Front 282

Strategies for questioning

Back 282

Do not use "but"
Express concern
Use an open ended question

Front 283

In what sleep stage does sleep terror and sleep walking happen?

Back 283

3 and 4 (not REM)

Front 284

First line Tx for
MDD in children and adolescents?

Back 284

SSRI

Front 285

1st line Tx for
Bulimia Nervosa

Back 285

CBT

Front 286

Dx
Markedly limited vocabulary, tense errors, undeveloped sentences, interferes with academic function

Back 286

Expressive Language Disorder

Front 287

Dx study for suspected
Expressive language disorder

Back 287

IQ test (to rule out mental retardation)

Front 288

Dx
Baby not gaining weight after period of nl development, drooling a lot, lots of caretakers

Back 288

Rumination disorder
Baby regurgitates and then chews on food

Front 289

Dx study for
Rumination disorder

Back 289

Esophageal pH measurement (to rule out gastric reflux)

Front 290

Dx
Child does not like school, sleeps in parents bed, repeated physical sx at school

Back 290

Separation anxiety disorder

Front 291

Dx
Emotional concerns manifest as physical symptoms

Back 291

Somatization (defense mechanism)

Front 292

Dx
Repeated speaking of obscene words

Back 292

Coprolalia (as in severe Tourette's)

Front 293

Dx
Eating of feces

Back 293

Coprophagia

Front 294

Dx
Defense mechanism in which an unacceptable impulse is transformed into its opposite

Back 294

Reaction Formation

Front 295

Most common cause of psychosis in children?

Back 295

Substance induced

Front 296

Most common psychiatric emergency in children and adolescents?

Back 296

Suicide

Front 297

What axis is stuff that has psychological and environmental problems that affect the diagnosis, treatment, or prognosis of Axis I?

Back 297

Axis IV
II is personality and MR
III is medical
V is GAF

Front 298

Common differences in MDD in children and adolescents?

Back 298

Kids have PMA
Teens have hypersomnia, hopelessness, weight change, and drug abuse.

Front 299

s/e of
Antidiuretic hormone

Back 299

Headache and nausea

Front 300

Laboratory abnormality in antidiuretic use for enuresis

Back 300

Hyponatremia

Front 301

Comorbidity rate of anxiety disorders and MDD in children
-with ADHD

Back 301

50%
ADHD = 30%

Front 302

Tx for
Lead toxicity -
Iron toxicity -
Acetaminophen toxicity -

Back 302

Lead toxicity - CaEDTA
Iron toxicity - Deferoxamine
Acetaminophen toxicity - Acetylcysteine

Front 303

Dx
Deceleration of head growth, loss of hand skills, stereotyped hand movements, poor gait, and severely impaired expressive and receptive language development with PMR

Back 303

Rett syndrome

Front 304

Common associations with CD.

Back 304

ADHD and substance abuse

Front 305

Explain adjustment disorder

Back 305

Happens after an event within 3 months but lasts no more than 6, looks like depression.

Front 306

Tx for
Tourette's

Back 306

Clonidine is first line
Haldol has better evidence but is now second line

Front 307

Interview strategy for 7 yo boy

Back 307

Play interview

Front 308

Psychiatric illness should be aggressively treated in children with medical illness as it improves medical outcomes.

Back 308

!

Front 309

First sx in
Tourette's

Back 309

Blinking and eye rolling first
then grunting, grimacing, and licking

Front 310

Dx criteria for Tourette's

Back 310

Multiple motor tics and at least one vocal tic before 18 yo

Front 311

Most common time period for MR to develop

Back 311

Early embryonic development (s'somal abnls and prenatal damage)

Front 312

Dx criteria for
Disruptive behavior disorder NOS

Back 312

Meets some but not enough criteria for CD or ODD and causes impairment

Front 313

Which drugs can predispose to tics

Back 313

Stimulants

Front 314

Most commonly associated with learning disorders?

Back 314

ADHD

Front 315

High school drop out rate for learning disabled?

Back 315

40%

Front 316

Tx for
Enuresis

Back 316

Imipramine

Front 317

Efficacy of stimulants for ADHD

Back 317

70%

Front 318

Milestones:
Copy circle -
Age and gender, ride tricycle -
Copy square and identify hands -

Back 318

Copy circle - 2
Age and gender, ride tricycle - 3
Copy square and identify hands - 5

Front 319

Dx
Impaired social interactions and attachments, restricted interests and behaviors, impaired communication

Back 319

Autism

Front 320

Best prognostic indicator for Autism

Back 320

Converse meaningfully with others

Front 321

Dx
Hypercholesterolemia, hypercarotenemia (yellowing of skin), no change in TSH

Back 321

Anorexia Nervosa

Front 322

Dx
Increased ventricular brain ratios, sinus brady

Back 322

Anorexia Nervosa

Front 323

Stranger anxiety is normal and abnormal when?

Back 323

Normal in 8 month old
Absently abnormal in autistics

Front 324

Most helpful distinction between mania and ADHD in children?

Back 324

ADHD kids have low self esteem as opposed to grandiosity

Front 325

Age at which death can be appreciated

Back 325

6-10 yo

Front 326

Defense mechanism in which a thought, impulse or effect is transiently inhibited causing tension or distress

Back 326

Blocking

Front 327

Main s/e of Clonidine

Back 327

Sedation

Front 328

Tx for
ADHD with tics

Back 328

Stimulants anyway

Front 329

Is punishment useful at age 4?

Back 329

No, good modeling will build moral code but right and wrong are not understood well enough for punishment

Front 330

Tx for
Panic Disorder

Back 330

SSRI

Front 331

Process of adopting other people's characteristics

Back 331

Identification

Front 332

A defense mechanism in which emotions are shifted from one idea or object to another that resembles the original but evokes less distress

Back 332

Displacement

Front 333

A defense mechanism in which a person's character or sense of identity is temporarily but drastically modified in order to avoid emotional distress

Back 333

Dissociation

Front 334

Most vulnerable month of pregnancy for mental illness

Back 334

1st

Front 335

Consistent failure to speak a specific social situation despite speaking in other situations

Back 335

Selective mutism

Front 336

Most common abuser of children

Back 336

The mother

Front 337

Must have this before 15 yo

Back 337

CD for Antisocial dx (must be at least 18)

Front 338

Lab changes in Anorexia nervosa

Back 338

1) High cholesterol
2) High corticotropin releasing hormone
3) Hypogylcemia
4) Hypothyroidism
5) Leukopenia

Front 339

Inability to perform learned motor skills

Back 339

Apraxia

Front 340

Inability to recognize objects

Back 340

Agnosia

Front 341

Inability to name objects even after recognizing them

Back 341

Anomia

Front 342

Inability to read

Back 342

Alexia

Front 343

Inability to express or comprehend language

Back 343

Aphasia

Front 344

Infection associated with OCD and Tourette's

Back 344

Group A Strep
(Sreptococcus)

Front 345

Dx
Toxocara and viscereal larva migrans

Back 345

Pica

Front 346

Lab abnormalities in bulimia

Back 346

1) Low K
2) Low Na
3) Low Cl
4) Metabolic alkalosis

Front 347

Dx
Rectal bleeding and anemia

Back 347

Stereotypic Movement Disorder

Front 348

Most likely to abuse substances

Back 348

CD

Front 349

Dx
Chapped, erythematous hands

Back 349

OCD
(from hand washing)

Front 350

Dx study for trouble reading

Back 350

Vision test

Front 351

Dx
Girl reached normal early milestones but now does not speak anywhere

Back 351

Rett

Front 352

Dx
Trouble in school, avoids classmates, odd movements with hands

Back 352

Autism

Front 353

MR cut offs

Back 353

Mild - 70-55
Moderate - 54-40
Severe - 39-25
Profound - Less than 25

Front 354

Nihilistic Delusional Content

Back 354

Cotard Syndrome

Front 355

Believe people are replaced by imposters

Back 355

Capgras Syndrome

Front 356

Most common cause of postpartum psychosis

Back 356

Bipolar disorder

Front 357

Dx
Rapid mood swings, efforts to avoid abandonment, chronic feelings of emptiness, intense anger outbursts, impulsivity, fluctuations between idealization and devaluation, and recurrent self mutilation or suicidality.

Back 357

BPD

Front 358

Dx
Non bizarre delusion, high level of social and occupational functioning

Back 358

Delusional disorder

Front 359

Tx
Severe depression, poor response to many medications, and poor compliance despite attempts

Back 359

ECT

Front 360

What not to prescribe for bipolar disorder

Back 360

Antidepressants (can cause mania)
but you can prescribe if predominantly depressed and carefully

Front 361

What sleep disturbance is most common with depression

Back 361

Early morning awakening

Front 362

Lab results in depression (3)

Back 362

Increased cortisol
Decreased catecholamines
Decreased immune function

Front 363

Tx for
Cyclothymia

Back 363

Same as for bipolar disorder

Front 364

Risk of mood disorder in first degree relatives of bipolar people

Back 364

25% for mood disorder

Front 365

What must always be ruled out in mania?

Back 365

Cocaine or other drug intoxication

Front 366

Dx
Psychotic or mood symptoms with abdominal pain

Back 366

Porphyria

Front 367

Dx
Inpt visual hallucinations

Back 367

Delirium

Front 368

Risk of mood disorder if first degree relative has bipolar

Back 368

25% for mood disorder

Front 369

What must you rule out in mania?

Back 369

Cocaine or other drug intoxication

Front 370

Dx
Psychotic or mood symptoms with abdominal pain

Back 370

Porphyria

Front 371

Dx
Inpt with visual hallucinations

Back 371

Delirium

Front 372

Dx
Docility, lack of fear response, anterograde amnesia, hyperhapgia, hypersexuality

Back 372

Kluver-Bucy

Front 373

Area of Kluver bucy; aggression, sexual behavior, and fear responses

Back 373

Amygdala (need bilateral damage for kluver bucy)

Front 374

Area involved with complex auditory information like language

Back 374

Superior temporal gyri

Front 375

Dx
Binging and purging with less than 85% ideal body weight

Back 375

Anorexia nervosa binging purging type

Front 376

Lab abnormalities in anorexia (5)

Back 376

1) Elevated BUN (from increased catabolism)
2) Increased cortisol
3) TSH and TRH normal
4) Anemia
5) Elevated growth hormone

Front 377

What percentage of MDD patients respond to a dexamethasone challenge?

Back 377

50%

Front 378

Thryoid abnormality in MDD

Back 378

No increased in TSH from TRH challenge (TRH insensitive in 30% of people)

Front 379

Methadone does not cause bone decay or decreased libido

Back 379

Despite popular belief

Front 380

Tx for
Postpartum psychosis

Back 380

Inpt hospitalization

Front 381

s/e
Dry mouth, dizziness, urinary hesitancy

Back 381

TCAs
Imipramine

Front 382

s/e
GI upset, sexual dysfunction, agitation

Back 382

SSRIs

Front 383

s/e
Hypotension, less likely anticholinergic

Back 383

MAOIs
(Phenelzine)

Front 384

s/e
Polyuria, polydipsia, tremor, mental confusion

Back 384

Li

Front 385

s/e
GI upset, sedation, tremor

Back 385

VPA

Front 386

Dx
Hypointensities in subcortical areas

Back 386

Lacunar Strokes

Front 387

Dx
Cerebellar atrophy

Back 387

Congenital disorder or
Alcoholism

Front 388

Lab results in alcoholism (3)

Back 388

1) Increased GGT
2) Increased uric acid, 2:1 AST:ALT
3) Macrocytic anemia

Front 389

ddx between PTSD, Acute stress disorder, and Adjustment disorder

Back 389

PTSD and ASD are the same except if it lasts 4 weeks or less it's ASD.
Adjustment disorder can be either anxiety, conduct, or mood, and must happen within 3 months of an event, that MUST be NON-TRAUMATIC

Front 390

Suicide rates in schizophrenics and general

Back 390

Schizophrenics - 10%
General - less than 1%

Front 391

Feelings and attitudes originating from the treater evoked by the patient

Back 391

Countertransferance

Front 392

Is ECT indicated for psychosis

Back 392

yes

Front 393

ECT sessions for
Catatonia -
MDD -
Mania -
Permanent memory impairment -

Back 393

Catatonia - 2-4
MDD - 6-12
Mania or Psychosis - 20 or more
Permanent memory impairment - 20-40

Front 394

Tx for
OCD

Back 394

SSRIs
1st line

Front 395

Placebo efficacy for MDD

Back 395

30% of pts respond

Front 396

Pharmacotherapy efficacy for MDD

Back 396

65-75% of patients will improve with SSRIs or TCAs

Front 397

Dx
Predominance of motor behaviors and nonverbal forms of communication such as facial experessions in schizophrenia

Back 397

Schizophrenia Catatonic type

Front 398

Dx
Sexual pleasure from experiencing pain, no sexual dysfunction or marked distress

Back 398

No diagnosis
Only pathological if it causes distress or occupational/social dysfunction

Front 399

Dx
Repeated nightmares that cause distress but doesn't fit PTSD

Back 399

Nightmare disorder

Front 400

Dx
Excessive drowsiness and many hours sleeping

Back 400

Primary hypersomnia

Front 401

The risk of completed suicide in MDD is

Back 401

10-15%

Front 402

Tx for
PTSD

Back 402

SSRIs

Front 403

Tx for
Panic Disorder

Back 403

SSRI with CBT

Front 404

Mean age of onset for bipolar disorder

Back 404

30

Front 405

Infarcts of the Left middle cerebral artery to the left frontal hemisphere cause what?

Back 405

Depression

Front 406

Diffuse damage to bilateral frontal hemispheres leads to what?

Back 406

OCD

Front 407

Infarcts to the Right frontal hemisphere lead to what?

Back 407

Euphoria, inappropriate indifference, or mania

Front 408

In men under 50 what percentage of impotence is psychological?

Back 408

90%

Front 409

Neurotransmitter correlation in suiciders, violence, agrees, and impulsivity

Back 409

Decreased 5-HIAA (a serotonin metabolite)

Front 410

Dx
Diffuse white matter plaques affecting frontal lobes

Back 410

MS (w/ depression)

Front 411

Dx
Ventricular enlargment and cerebral atrophy

Back 411

Alzheimer's dementia

Front 412

Worst prognostic indicator for schizophrenia

Back 412

Predominantly negative symptoms

Front 413

Risk of schizophrenia with 1 or 2 parents

Back 413

1 parent = 12%
2 parents = 40%

Front 414

Dx
Short term memory deficits, smooth pursuit eye movement problems, decreased sensory habituation

Back 414

Schizophrenia

Front 415

Tx for
Passive suicidal ideation with recent plan

Back 415

Inpt hospitalization

Front 416

Risk factors for completed suicide

Back 416

1) White
2) male
3) older
4) single
5) Protestant or jewish

Front 417

Believing an event relates to you when it does not

Back 417

Ideas of reference

Front 418

Belief that thoughts from an external entity are placed in your mind

Back 418

Thought insertion

Front 419

Belief that one's body parts are diseased (like rotting)

Back 419

Somatic delusion

Front 420

Belief that others know what you are thinking

Back 420

Thought broadcasting

Front 421

Forgetting of time around a specific event

Back 421

Localized amnesia

Front 422

Forgetting of some aspects of an event, while remembering others

Back 422

Selective amnesia

Front 423

Forgetting everything before a certain event

Back 423

Retrograde amnesia
(Generalized if they've forgotten no parts, but everything from before)

Front 424

Forgetting all events following a trauma except immediate past

Back 424

Continuous amnesia

Front 425

RFs for Schizophrenia
Parent -
Both parents -
Identical twin -
Fraternal twin -
Sibling -

Back 425

Parent - 12%
Both parents - 40%
Identical twin - 50%
Fraternal twin - 12%

Front 426

Thought processes:

Back 426

Circumstantial - superfluous details but gets there
Tangential - relevant but doesn't get there
Flight of ideas - Extreme tangentiality that birdwalks quickly
Loosening of assocations - series of disconnected ideas
Word salad - Completely disorganized

Front 427

Dx
Epileptic like activity but with purposeful movements

Back 427

Pseudoseizure (as seen in stress, personality disorders, or conversion reactions)

Front 428

REM changes in depression

Back 428

1) decresed REM latency
2) REM redistributed to first half of night

Front 429

Transient loss of motor tone associated with strong emotions

Back 429

Cataplexy

Front 430

State of immobility seen in catatonic patients

Back 430

Catalepsy

Front 431

The belief that you have an exact counterpart

Back 431

Doppleganger

Front 432

Belief that you are poisoned by a spirit

Back 432

Cacodemonomania

Front 433

Ascribing of personal meaning or messages that are not intended

Back 433

Delusion of reference

Front 434

Belief that nothing exists, including the patient's body to the point that they feel they are rotting away

Back 434

Cotard syndrome

Front 435

The belief that a single person is impersonating everyone

Back 435

Fregoli syndrome

Front 436

Dx
Formication

Back 436

Cocaine intoxication or
EtOH withdrawal

Front 437

Slowed or absent movement

Back 437

Akinesia

Front 438

Mental activity no in accordance with reality

Back 438

Dereism

Front 439

Abnormal recall of events

Back 439

Hypermnesia

Front 440

Loss of memory without loss of ability to make new memories, usually associated with trauma

Back 440

Dissociative Amnesia

Front 441

Inability to recognize something by touch

Back 441

Astereognosis

Front 442

Uncontrollable or excessive talking as seen in mania

Back 442

Logorrhea

Front 443

Fluent fabrication of fictitious responses in response to memory problems

Back 443

Confabulation

Front 444

irregular pauses between syllables

Back 444

Scanning speech

Front 445

Stopping speech abruptly then picking up with a new topic

Back 445

Derailment

Front 446

The persistence of an image after it has been removed

Back 446

Palinopsia

Front 447

Areas of brain implicated in OCD (3)

Back 447

Caudate nucleus
Frontal lobes
Cingulum

Front 448

Describing things but not naming them

Back 448

Circumlocution

Front 449

Physical manifestations of underlying unconscious motivations or drives

Back 449

Conversion disorder

Front 450

Areas of brain implicated in Schizophrenia
(2)

Back 450

Hippocampus
Amygdala

Front 451

Area of brain involved in anxiety

Back 451

Locus Ceruleus
NE made here

Front 452

Dx
Tachycardia, flushing, fever, hypertension, ocular osscilations, and myoclonic jerks.

Back 452

Serotonin syndrome

Front 453

How long to wait after TCA to start SSRI

Back 453

14 days

Front 454

Where is serotonin made in brain
" " Ne
" " Dopamine

Back 454

Raphe nucleus
Locus ceruleus
Substantia nigra

Front 455

Dx
Ataxia, eye paralysis, nystagmus, confusion, anterograde amnesia

Back 455

Wernicke's encephalopathy
(Vit B1 (thiamine) deficiency)

Front 456

Dx
Anterograde amnesia, retrograde amnesia, confabulation, apathy, lack of insight

Back 456

Korsakoff's Psychosis

Front 457

You can get Wernicke's encephalopathy and Korsakoff psychosis together

Back 457

Usually the delirium of wernicke masks the korsakoff but with thiamine treatment it becomes more apparent

Front 458

If the delusion is short
-if non bizarre
-if bizarre

Back 458

-if non bizarre - Delusional disorder
-if bizarre - brief psychotic episode

Front 459

Greatest predictor of suicide

Back 459

Age over 45 and mood disorder

Front 460

Gluccocorticoids can cause what

Back 460

Reversible psychiatric symptoms of depression and psychosis

Front 461

Difficulty with simple math

Back 461

Dyscalculia

Front 462

Ability to speak a new language

Back 462

Glossolalia

Front 463

Repetitive and meaningless talk

Back 463

Verbigeration

Front 464

Tx for
MAOI caused autonomic excitability

Back 464

IV Lorazepam

Front 465

Contraindicated fro MAOIs

Back 465

Stimulants
Decongestants
L-dopa
Reserpine

Front 466

Dx
Hypersomnia, weight gain, mood reactivity

Back 466

Atypical depression

Front 467

Tx for
Atypical Depression

Back 467

MAOI
(Phenelzine or Tranylcypromide)

Front 468

Minimum trial period for an anti-depressant

Back 468

6 weeks

Front 469

Tx for
Delirium with liver disease

Back 469

Lorazepam or oxazepam
(not metabolized by liver)

Front 470

What do low potency anti-psychotics do to seizure threshold?

Back 470

Lower it

Front 471

Tx for
DTs

Back 471

IV benzos

Front 472

Why do SSRIs take so long

Back 472

Time to downregulate the 5-HT2 receptor

Front 473

Most common sexual side effect of SSRIs in women

Back 473

Anorgasmia

Front 474

Tx for
Akisthesia (walking a lot)

Back 474

1) Reduce neuroleptic agent
2) Propanolol

Front 475

Tx for
Acute dystonia

Back 475

Diphenhydramine

Front 476

Most serious complication of NMS

Back 476

Rhabdo

Front 477

s/e of
Thioridazine (typical antipsychotic)

Back 477

Retinal pigmentation

Front 478

Dx
Retinal pigmentation

Back 478

Thioridazine

Front 479

Tx for
Panic disorder

Back 479

SSRIs, TCAs, or MAOIs

Front 480

Most potent benzo

Back 480

Clonazepam

Front 481

Preliminary tests to start Li

Back 481

1) Electrolytes, BUN, and UA bc Li is renally excreted
2) Thyroid studies bc Li inhibits thyroid production and release
3) CBC is optional bc of benign elevation in WBCs

Front 482

Avoid NSAIDs with Li, switch to what?

Back 482

Aspirin

Front 483

Which nt to block in Tourette's

Back 483

Dopamine
hence use

Front 484

Tx for
Tourette's

Back 484

Haloperidol is more potent
but Clonidine is first line bc no EPS or other s/e

Front 485

Indication for
Busprirone

Back 485

GAD

Front 486

Pharmacotheraphy for
BPD

Back 486

1) Fluoxetine 1st line
2) Add Antipsychotics (haloperidol or clozapine) for impulsiveness
3) Add VPA for mood fluctuations

Front 487

Pharmacotheraphy for
Bulimia

Back 487

Fluoxetine

Front 488

Pharmacotherapy for
Anorexia

Back 488

None indicated, appetite increasers don't work

Front 489

Dx
Dizziness, n/v, fatigue, lethargy, flu like symptoms
Most commonly caused by -
Tx -

Back 489

SSRI discontinuation syndrome
Most commonly caused by - Paroxetine (short half life)
Tx - Add back paroxetine and taper

Front 490

Pharmacotherapy for
MDD with Carbamazepine for epilepsy

Back 490

Paroxetine
(others increase carb levels)

Front 491

What EKG abnormality does Li cause?

Back 491

1) Benign T wave flattening or inversion
2) Then basically every arrhythmia under the sun

Front 492

Which drugs increase Li levels?
(5)

Back 492

1) Thiazide diuretics
2) Spironolactone
3) NSAIDs except asa and sulindac
4) Metronidazole and Tetracycline
5) ACE-Is

Front 493

Pharmacotheraphy for
OCD

Back 493

Clomipramine
(TCA with potent serotonin activity)
SSRIs are second line

Front 494

How does gedon (ziprasidone work)

Back 494

D2 and 5HT2a receptor blockade
Atypical antipsychotic

Front 495

Tx for
Antipsychotic resistant psychosis
Why?

Back 495

Clozaril
Has more blockade activity at D4 than D2, as well as 5HT2a blockade

Front 496

Blocking what causes orthostatic hypotension
and what drugs do it

Back 496

Blocking alpha-1
TCAs block it
Mitzapine does not, it blocks alpha-2

Front 497

Tx for
SSRI resistant depression

Back 497

Venlafaxine (SNRIs)

Front 498

Congenital defects with mood stabilizers
Li -
VPA -
Carbamazepine -

Back 498

Li - Ebstein valve anomaly
VPA - Neural tube defects
Carbamazepine - Neural tube defects

Front 499

Tx for
Agitation in delirious old people

Back 499

Risperidone or other atypical anti psychotics
(Benzos can paradoxically disinhibit, and diphenhydramine can worsen delirium with anticholinergic effects)

Front 500

Tx for
MDD with anorexia and insomnia

Back 500

Mertazapine

Front 501

Avoid TCAs with which CV abnormalities

Back 501

Heart block, wide QRS, BBB

Front 502

Tx for
Delirium in elderly

Back 502

Haloperdiol (least risk of orthostasis)

Front 503

Tx for
Antipsychotic resistant psychosis
Why?

Back 503

Clozaril
Has more blockade activity at D4 than D2, as well as 5HT2a blockade

Front 504

Antipsychotic with least orthostatic effects

Back 504

Haloperidol

Front 505

Blocking what causes orthostatic hypotension
and what drugs do it

Back 505

Blocking alpha-1
TCAs block it
Mitzapine does not, it blocks alpha-2

Front 506

Tx for
PTSD

Back 506

SSRIs

Front 507

Tx for
SSRI resistant depression

Back 507

Venlafaxine (SNRIs)

Front 508

Congenital defects with mood stabilizers
Li -
VPA -
Carbamazepine -

Back 508

Li - Ebstein valve anomaly
VPA - Neural tube defects
Carbamazepine - Neural tube defects

Front 509

Tx for
Agitation in delirious old people

Back 509

Risperidone or other atypical anti psychotics
(Benzos can paradoxically disinhibit, and diphenhydramine can worsen delirium with anticholinergic effects)

Front 510

Tx for
MDD with anorexia and insomnia

Back 510

Mertazapine

Front 511

Avoid TCAs with which CV abnormalities

Back 511

Heart block, wide QRS, BBB

Front 512

Tx for
Delirium in elderly

Back 512

Haloperdiol (least risk of orthostasis)

Front 513

Antipsychotic with least orthostatic effects

Back 513

Haloperidol

Front 514

Tx for
PTSD

Back 514

SSRIs

Front 515

Pharmacotherapy for
Re-experiencing and hyperarousal acutely

Back 515

Clonidine

Front 516

Pharmacotherapy for
Alzheimer's

Back 516

Donepezil (aricept)

Front 517

Tx for
Unknown drug overdose of downers

Back 517

Fluids, naloxone, and thiamine
Not flumazenil (lowers seizure threshold)

Front 518

What do you use to detox from heroin

Back 518

For 1st time detoxers - Clonidine
For repeated relapsers - Methadone

Front 519

Tx for
MDD and smoking cessation

Back 519

Bupropion

Front 520

Tx for
Bipolar disorder with neuropathic pain

Back 520

Gabapentin

Front 521

s/e of Risperidone

Back 521

Blocks 5HT2a, D2, alpha 1 so causes
Weight gain, orthostasis

Front 522

How is Clozaril different than all the other atypicals

Back 522

While atypicals have less EPS s/e than typicals, only clozaril has none. All the others cause EPS at high doses

Front 523

Where do hallucinations happen in brain?
EPS symptoms?
Prolactin problems?

Back 523

Mesolimbic system for hallucinations
Nigrostriatal system for EPS
Tuberoinfundibular for prolactin

Front 524

Pharmacotherapy option for
Impotence

Back 524

Yohimbine

Front 525

Alpha-2 Receptor drugs

Back 525

Mirtazapine - Alpha-2 Antagonist
(indirect 5HT1 agonist and NE agonist)
Clonidine - Alpha-2 Agonist
Yohimbine - Alpha-2 Antagonist (also increased NE)

Front 526

Clozapine =
Clonazepam =

Back 526

Clozapine = Clozaril the antipsychotic
Clonazepam = Klonopin the benzo

Front 527

Mood stabilizer therapy during pregnancy

Back 527

ECT is 1st line but rarely taken
(usually they keep on Li despite cardiac teratogenicity)

Front 528

Which mood stabilizer causes pancreatitis?

Back 528

VPA

Front 529

Which antipsychotic causes hyperglycemia?

Back 529

Clozapine

Front 530

Which antipsychotic interacts with citalopram?

Back 530

Pimozide

Front 531

1st line Depot injection antipsychotic

Back 531

Risperidone (bc atypical), the only other depot being haldol

Front 532

Tx for
Unknown drug overdose of downers

Back 532

Fluids, naloxone, and thiamine
Not flumazenil (lowers seizure threshold)

Front 533

What do you use to detox from heroin

Back 533

For 1st time detoxers - Clonidine
For repeated relapsers - Methadone

Front 534

Tx for
MDD and smoking cessation

Back 534

Bupropion

Front 535

Tx for
Bipolar disorder with neuropathic pain

Back 535

Gabapentin

Front 536

s/e of Risperidone

Back 536

Blocks 5HT2a, D2, alpha 1 so causes
Weight gain, orthostasis

Front 537

How is Clozaril different than all the other atypicals

Back 537

While atypicals have less EPS s/e than typicals, only clozaril has none. All the others cause EPS at high doses

Front 538

Pharmacotherapy for
Re-experiencing and hyperarousal acutely

Back 538

Clonidine

Front 539

Pharmacotherapy for
Alzheimer's

Back 539

Donepezil (aricept)

Front 540

Which drug causes nephrogenic diabetes insipidus?

Back 540

Li (causes pissing)

Front 541

Which antipsychotic has highest risk of metabolic syndrome?

Back 541

Olanzapine

Front 542

Minimum and recommended trial length for first antidepressant in life

Back 542

6 month minimum with
10 month recommendation

Front 543

Tx for
Sialorrhea from clozapine

Back 543

Propylthiouracil

Front 544

Tx for
Clozapine induced tachycardia

Back 544

Propanolol (not labetalol which can exacerbate hypotension)

Front 545

Contraindications for ECT (2)

Back 545

1) Recent MI
2) Brain occupying lesion (brain stem herniation risk)

Front 546

Only antipsychotic known to decrease suicidality in schizophrenia?

Back 546

Clozapine

Front 547

Aplastic anemia is a s/e of what?

Back 547

Carbamazepine

Front 548

HTN is a s/e of what?

Back 548

Venlafaxine

Front 549

Opisthotonos -
Pleurothotonos -
Torticollis -
Oculogyric crisis -
Laryngospasm -

Back 549

Opisthotonos -
Pleurothotonos - Arching of back
Torticollis - SCM spasm pulling neck to one side
Oculogyric crisis - Spasm of extraocular muscle
Laryngospasm - Spasm of tongue or throat, can lead to respiratory distress

Front 550

Antidepressant that works for diabetic neuropathy

Back 550

Duloxetine (an SNRI)

Front 551

Spasm of the eyelid

Back 551

Blepharospasm

Front 552

Rapid movement of the lips is an EPS s/e called?

Back 552

Rabbit syndrome

Front 553

Orthostatic hypotension is caused by blockade of what?

Back 553

Alpha1

Front 554

Dx
Yellow skin with chlorpromazine

Back 554

Obstructive jaundice

Front 555

Dx
Lack of ejaculation on antipsychotics

Back 555

Retrograde ejaculation (not anorgasmia like with SSRIs)

Front 556

When does alcohol withdrawal strike?

Back 556

48-96 hours

Front 557

Alcohol and benzos agonize which GABA receptor?

Back 557

GABA-A

Front 558

MAOIs increase NE, 5HT, and DA.
What is A and B

Back 558

MAO-A = 5HT and NE
MAO-B = DA (antiparkinson)

Front 559

What cardiac effect do TCAs have?

Back 559

Torsades de pointes

Front 560

Special TCA indications:
Pain syndromes -
OCD -
Enuresis -
Elderly Depression -

Back 560

Pain syndromes - Amytriptyline
OCD - Clomipramine
Enuresis - Imipramine
Elderly Depression - Nortriptyline

Front 561

Useful as adjunctive therapy for depression.

Back 561

Buspirone (partial 5HT1 agonist)
Also Bupropion

Front 562

Fatal s/e of
Nefazadone

Back 562

Fatal hepatitis

Front 563

Lithium
Range:
S/e:
Teratogenicity:

Back 563

Range: 0.8-1.0
S/e: Neurotoxicity, hypothyroid, diabetes insipidus, leukocytosis, GI
Teratogenicity:Ebsteins anomaly

Front 564

Carbamazepine (Tegretol)
Range:
S/e:
Teratogenicity:

Back 564

Range: 8-12
S/e: Autoinducer at liver (VPA will decrease with acclimation in a few weeks), SJ rash, Aplastic anemia
Teratogenicity:Craniofacial defect

Front 565

Valproate
Range:
S/e:
Teratogenicity:

Back 565

Range: 80-120
S/e: Heptatitis, aplastic anemia, sedation, weight gain
Teratogenicity: Neural tube defect

Front 566

Lamotrigine (Lamictal)
Range:
S/e:
Teratogenicity:

Back 566

S/e: SJ RASH is big
Teratogenicity:

Front 567

Tx for Opiate withdrawal

Back 567

Methadone, suboxone, buphrenorphine, naltrexone/naloxone

Front 568

Alcohol withdrawal therapy

Back 568

Acamprosate (decrease glutamate response)
Naltrexone
Disulfiram

Front 569

Dementia Tx meds

Back 569

Donepezil (ACh-esterase inhibitor)
Memantine (NMDA receptor antagonist)

Front 570

Specific to
Olanzapine

Back 570

Worst metabolic side effects, sedating.
Must be combined with fluoxetine for mood stabilization.

Front 571

Specific to
Risperidone

Back 571

Most typical of the atypicals, available in dec shot

Front 572

Specific to
Seroquel

Back 572

Extremely sedating, causes orthostasis

Front 573

Specific to
Ziprasidone

Back 573

QT prolongation issue

Front 574

Specific to
Aripiprazole

Back 574

Partial DA agonist (even though anti-psychotic), weakest of all

Front 575

Specific to
Clozapine

Back 575

Aplastic anemia (agranulocytosis), seizures, cardiomyopathy, hypotension,
Only antipsychotic to decrease suicide with Li

Front 576

Depression, agoraphobia, GAD, and substance abuse are associated with what?

Back 576

Panic Disorder

Front 577

Requirements for panic disorder

Back 577

3 attacks in 3 weeks
No stimulus
Peak of sx within 10 minutes

Front 578

Mgmt
Adolescent with change in behavior

Back 578

Drug screen

Front 579

Mgmt
Refractory mania on a mood stabilizer

Back 579

Blood levels of mood stabilizer

Front 580

Dx
Sudden onset neurological complains with obvious stressor

Back 580

Conversion disorder

Front 581

Dx
Impaired sleep, poor concentration, easy fatigability, irritability, muscle tension

Back 581

GAD

Front 582

1st line therapy for
Tourette's

Back 582

Pimozide or
Haloperidol

Front 583

Tx for
Anorexia nervosa

Back 583

1) If under 75% body weight --> hospitalize
2) CBT is helpful
3) SSRIs for weight maintenance, depression, and binging/purging

Front 584

Dx
Auditory, visual hallucinations, with normal vital signs and intact sensorium

Back 584

Alcoholic hallucinosis

Front 585

Cannot make acute psychotic episode dx if drugs or alcohol are likely contributors to symptoms

Back 585

!

Front 586

When to stop Li for young people with manic episodes?

Back 586

1 manic episode - 1 year of Li then taper off
3 or more manic episodes - Lifelong Li

Front 587

Risks of pregnancy with current or previous dx of anorexia (5)

Back 587

1) Miscarriage
2) Intrauterine growth retardation
3) Premature birth
4) C section
5) Post partum depression

Front 588

Common findings in Anorexia (6)

Back 588

1) Osteoperosis
2) Elevated cholesterol and carotene levels
3) Prlonged QT
4) Euthyroid sick syndrome
5) Anovulation, amenhorrhea, and low estrogen
6) Hyponatremia from excess water drinking

Front 589

Dx
Loss of normal skills after 2 years in language, social, sphincter control, or motor skills

Back 589

Childhood disintegrative disorder
(looks like autism, except autistics have sx before age 3 always if observed properly)

Front 590

Mgmt
Suicidal patient who doesn't want inpt, and neither do parents

Back 590

Hospitalize anyway

Front 591

1st line Tx for
Enuresis

Back 591

Desmopressin

Front 592

Difference between adjustment d/o and normal human life with mild depressive sx to a stressor

Back 592

If affects level of functioning than adjustment disorder

Front 593

Dx
Replacing a less disturbing view of the world in place of reality to ease distress

Back 593

Fantasy (defense mechanism)

Front 594

Tx for
Somatization disorder

Back 594

Frequent regularly scheduled visits with their PCPs to reduce underlying psychological distress

Front 595

Monitoring for all atypicals

Back 595

Weight, glucose, and lipids
and BP

Front 596

Defense mechanism in which a person assimilates another person's attitudes into one's own perspective

Back 596

Introjection

Front 597

Defense mechanism in which a person expresses his aggression toward another person with repeated failures to meet the other person's needs

Back 597

Passive-aggressive

Front 598

Difference between PCP and LSD intoxication

Back 598

LSD has more visual hallucinations and intensified perceptions
While PCP has more aggression

Front 599

Tx for
Bipolar w/ renal insufficiency

Back 599

VPA or Carbamazepine

Front 600

Associations with Tourette's (2)

Back 600

ADHD and OCD

Front 601

Attributing excessive negative qualities to another

Back 601

Devaluation

Front 602

Process by which repressed material particularly painful kinds are brought back to consciousness

Back 602

Abreaction

Front 603

Process of disclosing suppressed feelings, ideas, or events to other group members

Back 603

Ventilation
similar to catharsis without the emotional overtones both before or after

Front 604

Hypnosis should not be used in which disorders?

Back 604

Psychosis

Front 605

Systematic desensitization uses what?

Back 605

Reciprocal inhibition

Front 606

Dx
Abducent nerve palsy, nystagmus, ataxia, global confusion
Cause?

Back 606

Wernicke's encephalopathy
caused by thiamine (B1 deficiency)

Front 607

Dx study for suspected
Wernicke's encephalopathy

Back 607

Head CT

Front 608

Mgmt for
Command hallucinations

Back 608

Inpt hospitalization

Front 609

Fatal part of alcohol withdrawal

Back 609

Seizures

Front 610

Tx for
Agitation in delirious elderly patient

Back 610

Low dose haldol
(Anticholinergics and lose potency typicals exacerbate delirium)
Benzos cause paradoxical inhibition

Front 611

Dx
Complaints with at least one pain and one neurological

Back 611

Somatization disorder

Front 612

Tx for
MDD with delusions but not hallucinations

Back 612

Still an antipsychotic and an antidepressant

Front 613

Tx for
Adjustment disorder

Back 613

Psychotherapy

Front 614

Dx
Neurologic symptoms with no clear pathology

Back 614

Conversion disorder

Front 615

S/e of Pimozide
Monitoring test

Back 615

Pronlonged QT
Get EKG

Front 616

Dx
Sensory aurus and automatic behaviors

Back 616

Complex partial seizure

Front 617

Dx
HTN, diaphoresis, palpitations, anxiety fear

Back 617

Pheochromocytoma
or
Panic Attack

Front 618

Dx
Dementia, weakness, imbalance, congitive decline, social withdrawal

Back 618

HIV associated dementia

Front 619

Dx
Depressive, mild cognitive impairment especially with math,tremor, brisk reflexes

Back 619

Hyperthyroid

Front 620

Dx
Recent change in personality, angry, headaches, pains, fever

Back 620

SLE associated lupus psychosis

Front 621

Dx
Tachy, tremor, HTN, seizure

Back 621

Hypoglycemia

Front 622

Delirium work up

Back 622

CBC
Chem 7
PRP
B12/Folate
TSH
Ca/Mg
UDS
LFTs
O2 sat

Front 623

Dx
Nystagmus, HTN, tachy, pain tolerance, muscular rigidity

Back 623

PCP

Front 624

Dx
Dysphoria, SI, unpleasant dreams, hunger, fatigue

Back 624

Cocaine withdrawal

Front 625

Dx
Dysphoria, fever, nausea, vomiting, muschle aches,

Back 625

Opiate withdrawal

Front 626

Wernicke's encephalopathy signs (3)

Back 626

ACE
Ataxia
Confusion
Eye movements

Front 627

Lesions in Korsakoff are where

Back 627

Mamillary bodies and Thalamus

Front 628

The delusions that are mood congruent can sometimes be attributed to depression with psychosis

Back 628

.

Front 629

Lesions in Korsakoff are where

Back 629

Mamillary bodies and Thalamus