Step 2Ck Psychiatry

Front 1

Which class of antidepressants commonly cause sexual dysfunction?

Back 1

SSRIs - including impotence, delayed ejaculation, and decreased libido.

Front 2

Which class of antidepressants cause ELEV blood pressure?

Back 2

SNRIs (serotonin/norepinephrine reuptake inhibitors) like venlafaxine

Front 3

Which class of antidepressants cause orthostatic hypotension?

Back 3

TCAs like amitryptiline

Front 4

Which antidepressant is known to cause priapism?

Back 4

trazodone

Front 5

Which antidepressant is known to cause seizures?

Back 5

bupropion, especially at higher doses

Front 6

A defense mechanism where an individual displaces negative feelings associated with an unacceptable object or situation (i.e. losing one's job) onto a "safer" object or situation (i.e. outburst toward spouse)?

Back 6

displacement - an immature defense mechanism

Front 7

What drugs are helpful in SLOWING the cognitive decline associated with Alzheimer's?

Back 7

REVERSIBLE acetylcholinesteras inhibitors such as donepezil, rivastigmine, galantamine, and tacrine.

Note: Vit E may also be of some benefit, though data is limited

Front 8

Aside from pharmacotherapy, what else greatly reduces the likelihood of relapse in a schizophrenic patient?

Back 8

family therapy to reduce conflicts and stressors in the home. A supportive and non-demanding environment will contribute greatly to the patient's ability to adapt.

Front 9

Two characteristics of bereavement that distinguishes it from major depression?

Back 9

1) Rarely lasts longer than 2 months.
2) Does not cause as much functional impairment as major depression.

Note: It is not uncommon for grieving individuals to think about being with, or transiently seeing or hearing their deceased loved one.

Front 10

How is adjustment disorder different from bereavment?

Back 10

The stressor canNOT be the death of a loved one. It is the emergence of psychiatric symptoms in response to a stressor that occured within the previous 3 months and the distress is IN EXCESS of what is expected.

Front 11

What is dysthymic disorder?

Back 11

Chronically depressed mood that is present most of the time for a period of at least 2 years. Symptoms are milder than those of major depression.

Front 12

What is cyclothymia?

Back 12

Chronic mood disturbance involving repeated hypomanic and mild depressive episodes that do not meet the criteria for mania or major depression, respectively. Lasts for at least 2 years.

Front 13

Criteria for diagonsis of major depression?

Back 13

1) 5 of 8 depressive symptoms
2) symptoms persist for at least 2 weeks
3) significant functional impairment

Front 14

What is the transformation of an unpleasant event into a purely intellecutal problem with no emotional component?

Back 14

intellectualization

Front 15

Difference btn bipolar I disorder and bipolar II disorder?

Back 15

Bipolar I - episodes of SUSTAINED mania, often (but not requried) with depressive EPISODES.

Bipolar II - 1 or more MAJOR depressive episodes with at least 1 hypOmanic episode.

Note: Criteria for mania is at least 3 of the classic DIGFAST symptoms for >/= 1 WEEK!

Front 16

DIGFAST symptoms?

Back 16

Distractibility
Insomnia
Grandiosity
Flight of ideas
Activity (increased goal-oriented behavior)
Speech
Thoughtlessness (high-risk behavior)

Front 17

Criteria for mania?

Back 17

1) at least 3 of the classic DIGFAST symptoms
2) for at least 1 week or longer
3) significant impairment of life

Front 18

Treatment for acute mania (short and long term)?

Back 18

short term - stabilize with haloperidol and hospitalize until stable.

long term - first-line meds include lithium, lamotrigine, olanzapine, and quetiapine. Second line agents include valproic acid and aripiprazole.

Front 19

Criteria for diagnosing narcolepsy?

Back 19

Characterized by episodes of irresistible, REFRESHING sleep during the daytime

plus one or more of the following:
1) cataplexy - diffuse muscle weakness leading to collapse
2) hypnogogic and hypnopompic hallucinations - hallucinations while falling asleep and waking
3) sleep paralysis

Front 20

Treatment for narcolepsy?

Back 20

Psychostimulants such as modanifil or methylphenidate reduce daytime somnolence

Combo therapy with antidepressants and psychostimulants help decr cataplexy.

Front 21

What is a key in making the diagnosis of multi-infarct dementia as opposed to the other types of dementia?

Back 21

the PRESENCE of focal neurological signs with dementia ocurring ACUTELY in a stepwise deterioration.

Front 22

What side effects are common of ALL atypical antipsychotics?

Back 22

weight gain, hyperglycemia, dyslipidemia, and HTN.

Baseline assessment of weight, fasting plasa glucose, BP, and fasting lipid profile should be done BEFOR starting such meds and AGAIN after 12 weeks of treatment.

Front 23

Which 2 antipsychotic meds pose the greatest risk of weight gain?

Back 23

olanzapine and clozapine

Front 24

A baseline ECG should be performed before starting which antipsychotic drug?

Back 24

ziprasidone due to potential for QT prolongation

Front 25

Hyperprolactinemia can occur with which antipsychotic meds?

Back 25

Typicals and risperidone

Front 26

Difference btn malingering and factitious disorder?

Back 26

malingering is for secondary gain whereas factitious disorder is to assume the sick "role."

Front 27

What are the public health lawas regarding disclosure of sexually transmitted diseases or other diseases that pose a public health risk (such as TB)?

Back 27

Report to the local health department and to any known sexual partners.

Note: Encourage pt to inform sexual partners themself.

Front 28

Difference btn rationalization and denial?

Back 28

Rationalization is SUBSTITUTING an alternative rational, logical reason for an upsetting event rather than the real reason whereas denial involves the refusal to accept/believe a disturbing aspect of reality.

Front 29

Antipsychotics cause hyperprolactinemia by blocking dopamine activity along which neural pathway?

Back 29

tuberoinfundibular pathway

Front 30

What is the transformation of an unwanted thought or feeling into its opposite?

Back 30

Reaction formation

Front 31

What is when unacceptable impulses are channeled into more acceptable activities?

Back 31

Sublimation (a mature defense mechanism)

Front 32

What is it when someone intentionally postpones the exploration of anxiety-provoking thoughts by substituting other thoughts?

Back 32

Suppression (a mature defense mechanism)

Front 33

Treatment for severe symptoms of Tourette syndrome?

Back 33

typical antipsychotics such as haloperidol or pimozide

Front 34

When can you expect to see acute dystonia as an adverse side effect of antipsychotic use?

Back 34

abruptly at any point btn 4 hours and 4 days after receiving medication. Tx with antihistamines such as diphenhydramine or anticholinergics such as benztropine or trihexyphenidyl.

Front 35

Treatment for acute dystonia from antipsychotic use?

Back 35

Tx with antihistamines such as diphenhydramine or anticholinergics such as benztropine or trihexyphenidyl.

Front 36

How to treat neuroleptic malignant syndrome?

Back 36

Dantrolene

Front 37

The antidepressant of choice in depressed pts suffering from sexual dysfunction (whether as a medication side effect or as a pre-existing condtition)?

Back 37

Bupropion

Front 38

What can be seen with the abrupt cessation of alprazolam?

Back 38

It is a short-acting benzodiazepine so abrupt cessation can cause significant withdrawal symptoms such as generalized seizures and confusion

Front 39

A personality disorder with an inability to express emotion and social detachment. These people do not enjoy close relationships and prefer to be aloof and isolated. They rarely indulge in any pleasurable activities and appear indifferent to praise/criticism from others.

Back 39

Schizoid personality disorder

Front 40

A personility disorder with a pattern of odd/eccentric behavior and a REDUCED capacity for close relationships. These pts exhibit "magical thinking." They often have paranoid ideation and unusual perceptual experiences.

Back 40

Schizotypal

Front 41

Steps that should be performed when child abuse is suspected:

Back 41

1) COMPLETE physical exam
2) Radiographic skeletal survey if needed
3) Coagulation profile if multiple bruises are present
4) Report to Child Protective services
5) Admit to hospital when necessary
6) Consult psychiatrist and evaluate family dynamics

Front 42

What is it called when one person's delusion is transferred to another person?

Back 42

Shared psychotic disorder or folie a deux - usually occurs when individuals share a close relationship.

Treatment involves separating the individuals before initiating psychiatric treatment. The person who first had the delusion ALWAYS requires treatment whereas the other individual only requires treatment in some cases.

Front 43

What do patients with somatization disorder benefit most from?

Back 43

REGularly scheduled appointments intended to reduce the underlying psychological distress. Do not immediately tell these pts they have a somatization disorder as this can alienate them. Use several visits to strengthen the therapeutic bond before making the pt aware that "there are psychological factors involved that might warrant a psychiatric consult."

Front 44

The atypical antipsychotic most likely and least likely to cause EPS?

Back 44

most likely - risperidone
least likely - clozapine

Note: Clozapine is associated with agranulocytosis.

Front 45

Best management of tardive dyskinesia?

Back 45

discontinue offending drug and replace with clozapine.

Note: Clozapine is associated with agranulocytosis.

Front 46

When can symptoms of EPS due to antipsychotic medication be expected?

Back 46

usually after 4 months and before 4 years and may be IRreversible.

Front 47

Med that provides relief for akathisia (subjective feeling of reslessness0?

Back 47

beta blockers provide some relief

Front 48

EPS includes:

Back 48

akathisia, dystonia, Parkinsonism, tardive dyskinesia, and neuroleptic malignant syndrome.

Front 49

First line drug for treating generalized anxiety disorder?

Back 49

Buspirone

Front 50

What causes seretonin syndrome?

Back 50

SSRI given in combination with MAOIs. Can appear clinically similar to NMS with high fevers and rigidity. However it often begins with diarrhea, restlessness, and autonomic instability.

Front 51

Best treatment for catatonic schizophrenia?

Back 51

benzodiazepines (like lorazepam) or electroconvulsive therapy.

Front 52

What receptors do atypical antipsychotics act on?

Back 52

mainly D2 receptor BLOCKADE plus some serotonin receptor binding (which reduces the likelihood of extrapyramidal side effects).

Front 53

What should be suspected a a pt with sudden onset pseudoNEUROlogic symptoms or deficits involving sensory or voluntary motor systems?

Back 53

conversion disorder - symptoms are preceded by a stressor - common triggers include relationship conflicts or other stressors with an intense emotional component but the symptoms are NOT feigned or purposefully produced. These pts may be hysterical OR strangely indifferent ("la belle indifference") to their new symptoms. Improvement upon administration of sodium AMYTAL (a form of narcoanalysis that is rarely used called the "amobarbital interview") can help support the diagnosis.

Front 54

What may a brain CT show in a schizophrenic pt?

Back 54

increased ventricular size

Front 55

Treatment of choice for any form of alcohol withdrawal?

Back 55

LONG-acting benzos such as diazepam, lorazepam, and chlordiazepoxide. Diazepam and lorazepam given IV are preferred in ill, hospitalized pts since they have active metabolites and result in a smoother course with a lower chance of recurrent withdrawal symptoms or seizures. Massive doses might be necessary to control symptoms in pts with a hx of excessive alcohol abuse.

Front 56

When can you expect delirium tremens in an alcoholic in withdrawal?

Back 56

48-96 hours

Front 57

Some of the more serious adverse effects associated with lithium?

Back 57

NEPHROgenic diabetes insipidus, hypOthyroidism, and Ebsteing's anomaly in the fetus.

Also can cause leukocytosis and psoriasis flares.

Front 58

Long-term treatment of choice for bipolar disorder?

Back 58

Lithium or valproic acid

Front 59

Mechanism by which lithium improves bipolar disorder?

Back 59

inhibits inositol-1-phosphatase in neurons

Front 60

What should be suspected in a pt who is at least 18 years and engages in illegal activities and disregards the rights of others?

Back 60

Antisocial personality disorder - these individuals often display conduct diorder as minors

Front 61

Criteria for dysthymia dx?

Back 61

1) At least 2 depressive symptoms
2) Depressive symptoms lasting the majority of days for at least 2 YEARS.

Note: Although less severe than major depressive disorder, symptoms persist for much longer duration. Pts often say they have felt depressed their "entire life."

Front 62

What is childhood disintegrative disorder?

Back 62

a rare pervasive developmental disorder that occurs more commony in males. it is characterized by a period of normal development for AT LEAST 2 YEARS followed by a loss of previously acquired skills in at least two of the following areas: expressive or receptive language, social skills, bowel or bladder control, or play and motor skills. Etiology unknown.

Front 63

When is the onset of symptoms of autism?

Back 63

prior to the age of 3 years

Front 64

What is Rett syndrome?

Back 64

occurs almost exclusively in females, a rare pervasive developmental disorder characterized by an initial period of normal development (typically until 6 months of age) followed by a loss of hand coordination and development of peculiar stereotyped hand movments.

Other common features include deceleration of head growth, poor coordination, seizures, ataxia, mental retardation, and diminished social interactions.

Front 65

How to distinguish Asperger syndrome from Autism?

Back 65

children with Asperger's have NORMAL cognitive AND language development.

Front 66

What is the first step in management for EVERY pt with symptoms of depression?

Back 66

rule out medical causes such as hypothyroidism.

Also screen for suicidal ideations.

Front 67

Treatment protocol of nocturnal enuresis of children greater than 5 years old?

Back 67

First line - urine alarm devices and behavioral therapy.

Second-line - desmopressin (ADH analogue)

Third-line - Tricyclic antidepressants such as imipramine

Front 68

Greatest risk factor for committing suicide?

Back 68

Past hx of suicide attempts

Front 69

Competent patients have the right to refuse treatment except when doing so would pose a threat to ------?

Back 69

the health and welfare of others (such as in meningococcal meningitis).

Front 70

Aside from the risk of agranulocytosis from clozapine, what else should be taken into consideration?

Back 70

It lowers the seizure threshold.

Front 71

Schizophrenic symptoms that last for more than 1 month and less than 6 months?

Back 71

Schizophreniform disorder

Front 72

Symptoms of schizophrenia that last less than 1 month?

Back 72

Brief psychotic disorder

Front 73

Schizophrenia symptoms PLUS evidence of a mood disorder?

Back 73

Schizoaffective disorder

Front 74

What is it when someone believes they have special powers, extraordinary accomplishments or a special relationship with God?

Back 74

grandiose delusion

Front 75

What is it when someone believes that everyday occurrences have a special implication for them? (i.e. radio/tv speaks to them or newspaper article contains "special message" for them)

Back 75

ideas of reference

Front 76

What is it one someone believes their THOUGHTS can control events not explained by natural cause and effect or attributes casual incidents to supernatural forces?

Back 76

magical thinking

Front 77

OCD results from altered levels of which neurotransmitter?

Back 77

serotonin

DOC=SSRI

Front 78

How long should antidepresant be continued for a pt's FIRST episode of major depression?

Back 78

6 months FOLLOWING a response

Front 79

Another name for dissociative identity disorder?

Back 79

multiple personality disorder

Front 80

Persistent or recurrent feelings of detachment from one's own physical or mental processes in the context of an intact sense of reality?

Back 80

Depersonalization disorder

Front 81

A state of experiencing FAMILIAR persons and surroundings as if they were strange or unreal?

Back 81

derealization disorder

Front 82

Suspect what in a pt with inability to remember his past, confusion about personal identity, and sudden and unexpected travel?

Back 82

dissociative disorder - associated with TRAVEL

Front 83

Dissociative amnesia is similar to dissociative fugue but is triggered by?

Back 83

usually trauma or a stressful event and not associated with sudden/unexpected travel.

Front 84

First step in management of a pt with apparent refractory mania despite therapy with an appropriate mood stabilizer such as lithium?

Back 84

urine tox screen (to look for cocaine/amphetamines/stimulants) AND drug levels (to evaluate noncompliance or insufficient drug levels).

Front 85

Persistent deficiency in both sexual fantasy and desire for sexual activity?

Back 85

hypOactive sexual desire

Front 86

Recurrent/persistent AVERSION to and avoidance of genital sexual contact with a partner? (May be generalized or regarding a specific aspect of sexual activity)

Back 86

Sexual aversion disorder

Front 87

Persistent delay or absence of orgasm following a normal sexual excitemet phase in females?

Back 87

female orgasmic disorder - orgasmic capacity that is less than expected given their age, sexual experience, and the adequacy of the sexual stimulation received.

Front 88

How long should a pt with one manic episode be treated with mood stabilizers such as lithium?

Back 88

Maintenance therapy should be continued for at least 1 year. If there are no relapses and pt has good symptmatic control, lithium can be gradually TAPERED and ultimately discontinued.

Lifelong maintenance is indicated if 3 or more relapses occur.

Front 89

Physicians can provide what type of care to adolescents withOUT parental consent?

Back 89

contraception (including morning after pill), prenatal care, STDs, or substance abuse.

Front 90

Patients suffering from panic disorder have an increased incidence of what co-morbidities?

Back 90

depression (33-50% of pts)

agoraphobia (~40% of pts)

generalized anxiety

substance abuse

Front 91

Three hallmark features of endometriosis?

Back 91

3 D's: dyspareunia, dysmenorrhea, and dyschezia

Front 92

Common findings in anorexic patients?

Back 92

1) osteoperosis**
2) elevated cholesterol and carotene levels
3) cardiac arrhythmias (prolonged QT)
4) euthyroid sick syndrome
5) hypothalamic-pituitary axis dysfunction resulting in anovulation, amenorrhea, and estrogen deficiency
6) hypOnatremia 2dry to excess water drinking (but the presence of other electrolyte abnormalities indicates purging behavior).

Front 93

Suitable alternative to lithium for pts with bipolar disorder that also have renal dysfunction?

Back 93

valproic acid or carbamazepine

Front 94

What is Ebstein's anomaly and when is a pt most at risk?

Back 94

A malformed and INFERIORLY attached tricuspid valve that causes atrialization of the right ventricle and a decrease in the size of the functional right ventricle.

Risk is highest during the 1st trimester.