Step 2 Ck: Psychiatry

Front 1

Axis I

Back 1

Mood/anxiety/substance

Front 2

Axis II

Back 2

Personality

Front 3

Axis III

Back 3

Medical

Front 4

Axis IV

Back 4

Psychosocial

Front 5

Axis V

Back 5

GAP

Front 6

Dx criteria: MDD

Back 6

5+ SIGECAPS
One must be depressed mood or anhedonia
>2 weeks duration

Front 7

Risk factors for successful suicide attempts

Back 7

Age > 45
Violent bx
Drug use
Hx suicidal bx
Has a plan
Male
Recent loss
Depression
Unemployed
Unmarried/widowed/divorced

Front 8

Dx criteria: dysthymia

Back 8

Depressed mood
2+ SIGECAPS
On most days
> 2 years

Front 9

Dx criteria: mania

Back 9

Elevated mood or irritability
> 7 days
3+ DIG FAST
Functional impairment

Front 10

Mania DIG FAST mnemonic

Back 10

Distractibility; irresponsibility; grandiosity; flight of ideas; activity increased; sleep decreased; talkative

Front 11

Dx criteria: hypomania

Back 11

Elevated mood or irritability
>4 days
3+ DIG FAST
NO FUNCTIONAL IMPAIRMENT

Front 12

Which SSRIs should be avoided in patients with heart disease?

Back 12

Citalopram/escitalopram = QT prolongation

Front 13

Trazodone side effects

Back 13

Hypotension, sedation, priapism, seizure

Front 14

Lithium toxicity

Back 14

Hypothyroid, polyuria, tremor/ataxia/confusion, weight gain

Front 15

4 mood stabilizers to consider with mania/hypomania

Back 15

Lithium, valproate, carbamazepine, atypical antipsychotics

Front 16

Dx: cyclothymia

Back 16

Hypomania and depressive symptoms
No more than 2 months sx free
>2 years

Front 17

Adjustment disorder vs. bereavement

Back 17

Adjustment = functional impairment

Front 18

Dx: adjustment disorder

Back 18

Mood/bx changes w/in 3 mo of distressing event
Functional impairment/depressed mood
Remission w/in 6 mo

Front 19

Dx: panic disorder

Back 19

Sudden onset extreme fear/anxiety
Recurrent
Fear of attacks happening again

Front 20

Tx: specific phobia

Back 20

Exposure tx

Front 21

Tx: social phobia

Back 21

Psychotherapy
BB
SSRI

Front 22

Tx: OCD

Back 22

Psychotherapy
SSRI
Clomipramine

Front 23

Dx: PTSD

Back 23

Anxiety dx w/in 3 months of stressful exposure
Reliving: vivid dreams, intrusive thoughts
Avoidance of associations
Increased arousal: insomnia, irritability, etc.
>1 mo = acute; >3 mo = chronic

Front 24

Tx: PTSD

Back 24

SSRI/SNRI
a-blockers (e.g. prazocin)
CBT

Front 25

Dx: GAD

Back 25

Persistent, excessive global anxiety
Impaired function
More days than not
>6 mo

Front 26

Tx: GAD

Back 26

CBT
SSRI/SNRI
TCA/benzos/buspar

Front 27

Pts with schizophrenia are at high risk for ___ and ___

Back 27

Substance abuse and suicide

Front 28

Positive schizophrenic symptoms

Back 28

Hallucination, delusion, disorganized speech

Front 29

Negative schizophrenic symptoms

Back 29

Flattened affect, apathy, social withdrawal, low energy

Front 30

Dx: schizophrenia

Back 30

2+ symptoms (positive/negative/cognitive/etc)
Sx 1+ month duration
Impaired function 6+ months

Front 31

____ schizophrenic symptoms are much more difficult to treat

Back 31

Negative

Front 32

Tx: schizophrenia

Back 32

Neuroleptics
Psychoeducational therapy

Front 33

Schizophrenia subtype: “catatonic”

Back 33

Rigid posturing, poor response to stimuli, poor interaction

Front 34

Schizophrenia subtype: “disorganized”

Back 34

Flat affect, disorganized speech and behavior

Front 35

Schizophrenia subtype: “undifferentiated”

Back 35

Doesn’t fit any other type

Front 36

Schizophrenia subtype: “residual”

Back 36

Prominent negative symptoms

Front 37

Two main low-potency neuroleptics

Back 37

Thioridazine, chlorpromazine

Front 38

High-potency neuroleptics have much greater potential for ___ symptoms and much lower potential for ___ symptoms than low-potency neuroleptics

Back 38

Greater potential for extrapyramidal
Lower potential for anticholinergic

Front 39

Dx: schizophreniform d/o

Back 39

Schizophrenic sx >1mo but <6mo

Front 40

___ of patients dx with schizophreniform d/o will ultimately develop schizophrenia

Back 40

2/3

Front 41

Dx: delusional d/o

Back 41

Realistic delusions
>1 mo
No other psychotic sx
No functional impairment

Front 42

Dx: brief psychotic d/o

Back 42

Psychosis < 1mo duration

Front 43

Dx: shared psychotic d/o

Back 43

Second pt accepts/participates in delusions of pt

Front 44

Tx: schizophreniform d/o

Back 44

Antipsychotics, psychotherapy

Front 45

Tx: schizoaffective d/o

Back 45

Antipsychotics
SSRIs
Mood stabilizers

Front 46

Tx: delusional d/o

Back 46

Antipsychotics
Psychotherapy

Front 47

Tx: brief psychotic d/o

Back 47

Short-term antipsychotics
Psychotherapy

Front 48

Tx: shared delusion d/o

Back 48

Group psychotherapy
Antipsychotics

Front 49

MC extrapyramidal side-effect of antipsychotics

Back 49

Akathisia

Front 50

Tx: antipsychotic-induced akathisia

Back 50

Benzo > propranolol > benztropine

Front 51

Tx: antipsychotic-induced parkinsonism

Back 51

Benztropine > amantadine

Front 52

Tx: antipsychotic-induced dystonia

Back 52

Benztropine or diphenhydramine

Front 53

Tx: tardive dyskinesia

Back 53

D/c med if possible, switch to clozapine, botox if local, tetrabenazine

Front 54

Personality disorder cluster mnemonic

Back 54

Cluster A: “Weird”
Cluster B: “Wild”
Cluster C: “Wimpy” or “Worried”

Front 55

Component personality disorders: cluster A

Back 55

Paranoid, schizoid, schizotypal

Front 56

Component personality disorders: cluster B

Back 56

Antisocial, borderline, histrionic, narcissistic

Front 57

Component personality disorders: cluster C

Back 57

Avoidant, dependent, O/C

Front 58

3 broad features of all personality disorders

Back 58

Persistent, inflexible
Impaired function
Begin late adolescence

Front 59

Features of paranoid personality disorder

Back 59

Persistent distrust of others; misinterpretation of stimuli as harmful or deceptive; reluctant to share information

Front 60

Features of schizoid personality disorder

Back 60

Pervasive lack of interest in social engagements; solitary lifestyle; blunted affect; few if any close friends; indifferent to praise and criticism

Front 61

Features of schizotypal personality disorder

Back 61

Social anxiety, peculiar mannerisms, paranormal/superstitious beliefs, highly eccentric

Front 62

Features of antisocial personality disorder

Back 62

Aggressive behavior toward people and animals; property destruction; illegal activity; lying; lack of remorse

Front 63

Features of borderline personality disorder

Back 63

Unstable relationships; low self-esteem; impulsive; suicidal; all good/all bad thinking

Front 64

Features of histrionic personality disorder

Back 64

Desperate need for attention; inappropriate theatrical/seductive bx; shallow relationships; dramatic speech; believes that relationships are more intimate/meaningful than they actually are

Front 65

Features of narcissistic personality disorder

Back 65

Grandiosity; fantasies of success; arrogance; expectations of admiration; lack of empathy; believes self to be “special”

Front 66

Features of avoidant personality disorder

Back 66

Severe fear of criticism and embarrassment; preoccupied by pervasive fear of rejection; social withdrawal; fear of intimacy

Front 67

Features of dependent personality disorder

Back 67

Difficulty making decisions; fear of having responsibilities; inability to disagree with others; requires constant close relationships

Front 68

Features of O/C personality disorder

Back 68

Ego-syntonic OCD

Front 69

Tx: paranoid personality disorder

Back 69

Psychotherapy
Antipsychotics

Front 70

Tx: schizoid personality disorder

Back 70

Psychotherapy
Antipsychotics

Front 71

Tx: schizotypal personality disorder

Back 71

Psychotherapy
Antipsychotics
Benzos

Front 72

Tx: antisocial personality disorder

Back 72

Psychotherapy
SSRIs

Front 73

Tx: borderline personality disorder

Back 73

Psychotherapy
SSRIs
Mood stabilizers

Front 74

Tx: histrionic personality disorder

Back 74

Psychotherapy

Front 75

Tx: narcissistic personality disorder

Back 75

Psychotherapy

Front 76

Tx: avoidant personality disorder

Back 76

Psychotherapy
SSRIs

Front 77

Tx: dependent personality disorder

Back 77

Psychotherapy

Front 78

Tx: O/C personality disorder

Back 78

Psychotherapy

Front 79

CAGE questionnaire

Back 79

Desire to CUT down
ANNOYANCE over others’ suggestions to quit
GUILT over usage
EYE-opener i.e. using when you first get up

Front 80

Define: substance abuse

Back 80

Repeat substance use with negative consequences

Front 81

Define: addiction

Back 81

Chronic substance abuse with psychologic and physical dependence; tolerance; feelings of loss of control; a substantial amount of time spent getting the substance

Front 82

Tx: alcohol abuse

Back 82

Group counseling e.g. AA
Naltrexone
Disulfiram

Front 83

Dx: euphoria, conjunctival injection, psychomotor retardation, appetite, xerostomia

Back 83

Marijuana intoxication

Front 84

Dx: euphoria, impulsiveness, aggressive, nystagmus, hyperreflexia

Back 84

PCP intoxication

Front 85

Potential S/Sx in anorexia nervosa

Back 85

Amenorrhea, cold intolerance, hypothermia, dry skin, lanugo, bradycardia

Front 86

Tx: anorexia nervosa

Back 86

Refeeding
Psychotherapy
SSRI if comorbid mood d/o

Front 87

Complications of anorexia nervosa

Back 87

Cytopenias, electrolyte abnormalities, arrhythmias, etc.

Front 88

Anorexia vs. bulimia

Back 88

Anorexia = impaired body image
Bulimia = lack of control w/ regard to eating bx

Front 89

Classic s/sx of bulimia

Back 89

Enamel erosions, scars on hands, parotid enlargement

Front 90

Tx: bulimia nervosa

Back 90

Psychotherapy
SSRIs >TCAs > MOAIs

Front 91

Dx: somatization disorder

Back 91

2 Gi sxs
1 sexual sx
1 pseudoneurologic sx
Pain at multiple sites

Front 92

Tx: somatization disorder

Back 92

Psychotherapy
SSRI

Front 93

Tx: conversion disorder

Back 93

Psychotherapy

Front 94

Dx: hypochondriasis

Back 94

Misinterpretation of minor symptoms as representing underlying disease
> 6 mo

Front 95

Tx: hypochondriasis

Back 95

Group psychotherapy
SSRIs for comorbid mood/anxiety disorder

Front 96

Dx: pain disorder

Back 96

Focal pain sxs preceded by stressor

Front 97

Tx: pain disorder

Back 97

Psychotherapy
Biofeedback
SSRIs

Front 98

Tx: BDD

Back 98

Psychotherapy
SSRI

Front 99

Drug of choice in a pt complaining of both mood/anxiety sx and pain

Back 99

SNRI

Front 100

Factitious disorder vs. malingering

Back 100

Malingering: fake sx for external benefit e.g. financial gain
Factitious: fake sx for internal benefit e.g. attention

Front 101

Features of the refeeding syndrome

Back 101

Cardiovascular collapse, rhabdo, seizure

Front 102

Abnormal MMSE score

Back 102

<25

Front 103

Delirium vs. dementia

Back 103

Delirium: acute AMS, fluctuating course
Dementia: chronic, consistent course w/o AMS, per se

Front 104

Three MCC of dementia

Back 104

AD>vascular>Parkinson

Front 105

Three As of cortical dementia

Back 105

Aphasia, apraxia, agnosia

Front 106

Dx: ADHD

Back 106

6 inattentive or hyperactive/impulsive sx
Before age 7
Impaired function

Front 107

Tx: ADHD

Back 107

Stimulants are first-line in kids age 6+
Bx intervention first-line in kids <6

Front 108

Stimulants in ADHD

Back 108

Amphetamines, atomoxetine, A2 agonists

Front 109

Bx intervention in ADHD

Back 109

Setting tight routines
Minimizing distractors
Setting small, attainable goals

Front 110

Dx: conduct disorder

Back 110

Aggressive/destructive/violent/illegal sx
Kids <10: 1+ above sx
Kids >10: 3+ above sx

Front 111

Dx: oppositional defiant disorder

Back 111

Argumentative, disobedient, but not illegal/violent/etc.

Front 112

Tx: conduct disorder

Back 112

Psychotherapy
SSRIs
Atypical APs

Front 113

Dx: Tourette syndrome

Back 113

Motor and phonic tics
>1 year duration
Before age 21

Front 114

True tics diminish during ____ and ____

Back 114

During sleep and focused activity

Front 115

Tx: Tourette syndrome

Back 115

Psychotherapy
Fluphenazine, pimozide, or tetrabenazine

Front 116

Dx: learning disorder

Back 116

Normal intelligence with impairment in one or more academic domains

Front 117

Dx: autism

Back 117

6+ sx of impaired interpersonal interaction
2 must be social
1 must be communication
1 must be behavioral

Front 118

Three domains of autism

Back 118

Social: relationships, reciprocity, etc.
Communication: language, imitation, etc.
Behavior: inflexible, repetitive