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55 Cards in this Set

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what's the difference between pain and somatization disorders?
somatization disorder lasts for years and will involve a patient with lots of complaints, having seen lots of doctors, before age 30, from lots of organ systems, and NOT LIMITED TO PAIN - they'll have deaf/blind/nausea/dizzyness, in addition to gi/headaches/sexual pain.

pain disorder is specifically pain in multiple systems.
if you get asked about side effects of olanzapine, what are they going for?
weight gain - can also cause dyslipidemia and DM.
what's the difference between delusional disorder and schizo?
delusional disorder delusions are possibly true things.

also, the timing - these have to be present for only 1 month.

treatment is similar - atypical antipsychotics and therapy good.
what's the difference between OCD and obsessive compulsive personality disoroder?
OCD people are extremely anxious and deal with it by having weird habits. recognize that disease is harmful.

personality disorder people have extreme need for order - not the same ticks, and they don't see there's any problem with their behavior.
what are reaction formation, sublimation, and altruism?
reaction formation is primitive = deciding that something you hated before is the best thing ever.

sublimation = taking bad urges and turning toward something good. rageoholic becomes a competitive athlete.

altrusim = mature = getting involved to help other people with the problem you have.
other than NMS, what other acute condition can develop when taking typical anti-psychotics, and what do you do?
dystonia = single muscle contraction. treat with anticholinergics or antihistamines (diphenydramine, benztropine, trihexyphenyldyl).

note that if parkinsonian symptoms develop, same deal - give benztropine.
what's trichotillomania?
ripping out hair. pt has to get relief from it and have trouble stopping.
what's trichotillomania?
ripping out hair. pt has to get relief from it and have trouble stopping.
what antipsychotics should be used for non-compliant outpatient schizos?
injectable depots - fluphenazine or haldol
when do you use propranolol in psych?
in anxiety (public speaking) or in akathesia side effects from typical antipsychotics.
what's enuresis defined as and how do you treat it? second line?
persistent bed wetting after age 5.

behavior stuff, pee alarms, are 1st line.

then DESMOPRESSIN (adh), then imipramine (3rd line).
how can you tell between adjustment disorder and PTSD?
both involve a specific event.

adjustment disorder usually lasts <6mo and has less specific symptoms - they react specifically to the stressors (avoiding driving after accident).

ptsd, they have to give you flashbacks or dreams about it.
how can you tell schizoaffective from depressed with psychotic features?
schizoaffective must have at least 2 weeks of psychotic symptoms without being depressed. they'll have to give you in the question the onset of psychosis before depression.

depression with psychotic features go together, and the psychosis is syntonic (depressed hallucinations).
how can you tell schizoaffective from depressed with psychotic features?
schizoaffective must have at least 2 weeks of psychotic symptoms without being depressed. they'll have to give you in the question the onset of psychosis before depression.

depression with psychotic features go together, and the psychosis is syntonic (depressed hallucinations).
what's the treatment for tourett's?
TYPICAL antipsychotics - haldol or pimozide. They need to have their dopamine blocked.
what's the primary treatment for adjustment disorder? second line?
adjustment disorder is an exagerated reaction to an event, lasting less than 6 months. can look like depression or anxiety.

treatment = TALK THERAPY (psychodynamic), second line is SSRI.

think that the primary problem isn't an organic chemical imbalance, it's something that happened. need to talk it over.
a schizo with mostly negative symptoms should be treated with what?
atypicals work best on negative symptoms, typicals work best on positive symptoms.
pt with bipolar - how long should they stay on meds?
if they've had 3 manic episodes, for life.

if they've just had one, try it for a year before tapering it off.
how do you treat tartive dyskinesia in someone taking an atypical?
probably taking risperidone as it's the least likely to have EPS. if they do occur, D/C the risperidone and REPLACE WITH CLOZAPINE (it has the least likely chance of causing EPS, but agranulocytosis is worry)
what brain nucleus is involved in PTSD? alzheimer's? Depression?
PTSD = autonomic control = locus cerulens.

Alzheimer's = basal nucleus of Myenert.

depression = raphea nuclei = seratonin secretors all over the CNS.
what's a super weird and common reaction to parkinsons mediations?
hallucinations - increasing dopamine makes you schizo. have to decrease the L-dopa to make them go away.
if someone comes in complaining of a very recent seizure, what test can you do to confirm?
prolactin. it doubles in a real seizure but subsides within a hour, so you have to do it fast.
what psych med doesn't cause weight gain? what's the problem with it?
geodon = ziprazodone. does cause GI upset (take with food) and LONG QT, which is unique for the atypicals.
tell apart pseudo and real dementia:
in real dementia, people try and hide it (ashamed of the really bad thing), they have problems with basic stuff like orientation, and they have way more problems with recent memory than old memories.

pseudodementia (due to depression) pts really frustrated about memory loss and express it (no hiding), trouble with both recent/past memory, but NO trouble with basic ADLs and orientation.
difference between transference and projection?
transference is when patient has unresolved feelings for parents and feels the same way about the therapist.

projection is when internal urges are thought to be coming from outside (blaming others for your
what's the difference between conduct disorder and oppositional defiant disorder?
oppositional defiant kids will argue but not break social norms - no fighting/stealing.

conduct, they have to give you violence/theft.
how do you treat OCD?
ssri, new one is FLUVOXAMINE, second line = clomipramine
someone's bipolar and having a super manic episode. what's the treatment?
HALDOL - if they're grandiose/hypersexual/hurting themselves, start with the antipsychotics first.

lithium/valproate are good for maintenance, not for acute
define adjustment disorder:
maladaptive behavior to a stress, doesn't fit any other diagnosis (not bad enough for MDD/GAD), response within 3 months of stressor. note that it shouldn't go beyond 6 months - so if they give you a question about someone with depressed symptoms 1 yr after something happened, it's MDD.
if on fluoxitine and you want to start and MAOI like phenylzine, how long do you wait and why?
fluoxitine = wait 5 weeks so you washout and don't get seratonin syndrome.

going backwards (phenylzine to SSRI), only have to wait 10 days.
what's the difference between social phobia and agoraphobia?
agoraphobia is a fear of PANIC ATTACKS in an area where you can't leave, not simply fear of social situations. they'll have to give you panic attacks.

social phobia is about performance or social situations, no panic attacks.
what can you do for someone with bipolar who's having a depressive swing?
can use SSRI's but only briefly as they can trigger mania. Bupriorpion is popular for this.
why might typical antipsychotics be good in old men?
the typicals have low anti-cholinergic effects, so BPH won't matter. Also causes less hypotension.
why are antidepressants helpful in cataplectic narcolepsy?
SSRI, TCA, MAO-i's all decrease REM sleep which causes people to fall over during the day.
what's displacement?
taking out your anger at someone/something on something associated with the person.

throwing out someone's baseball cards you're mad at.

note this is not projection, which is where you blame internal feelings on outside source.
what's introjection?
taking someone else's opinion and using it as your own. battered woman taking husband's perspective that she's useless.
what antidepressant can cause NMS?
AMOXIPINE - this is a metabolite of loxapine (a typical antipsychotic). amoxipine is a TCA.
someone has a manic break while in early pregnancy. what do you give them?
atypical antipsychotics can be used as monotherapy (substitution for mood stabilizers) in mania - and especially good if psychotic.

they aren't teratogenic.

lithium/depakote and the other anti-seizure meds (carbamazpine/lamotragine) might be, so don't give.
differentiate wernike's and korsakov's
korsakoff = amnesia and confabulation, usually irreversible.

Wernike's = reversible encephalopathy with delerium, 6th nerve palsy, ataxia.

both from thiamine defieincy.
what's the treatment for hospital delerium? diagnosis?
find the cause - look at all the meds, make sure he can see a window, turn on the TV. make sure there aren't underlying other medical problems (especially cardiovascular).

low doses of high-potency typical antipsychotics (haldol, droperidol) are great - less orhostasis (which makes it worse) and less anticholinergics (also make it worse). atypicals have a BLACK BOX for the elderly.

if it's due to withdrawal, benzos good.

diagnosis: EEG will show slow waves in delerium and will be different for alzheimer's vs. hepatic enceph (triphasic deltas).
hypocondriasis vs. somatiform disorder?
hypocondriasis patients are worried about having a specific disease or set of diseases, and this can change over the years as they come to realize they don't have one.

somatiform are generalized pain, no preoccupation on a certain disease (they don't think they might have cancer, they just have pain).
what's pain disorder, how do you treat it?
one of the somatiform - pain in one or more locations beyond what medicine can explain.

SSRI's, therapy, gradual return of function rather than pain relief are the goals.

biofeedback good too
details of night terrors? treatment?
don't remember them, happen during delta wave slow wave sleep early in the night, self-limited in kids. do nothing but protect them from hurting themselves.

note - can be related to sleep disorders like disordered breathing/RLS - if so, fix this problem and the night terrors go away.
what drugs for sleep are good?
primary insomnia diagnosed after 1 month. 1st line is sleep hygene, then remelteron (melatonin agonist), then the zolpidem types.
tourett's - what are the dx criteria and how do you treat it? what comorbid conditions to watch out for?
before age 18, both motor and vocal (throat clearing counts). remember strep makes it worse (PANDAS), co-morbid with ADHD and methylphenidate can cause ticks (take off).

treatment = alpha 2 agonists (clonidine, guanfesine), relaxation, then atypicals - typicals
serious alcoholic with cirrhosis needs detox - which benzo to use?
lorazepam - it's not metabolized by the liver (like librium) - it's met by glucuronidation.
chlorpromazine and carbamazapine - what are the classic side effects?
carbamazapine - BM suppression.

Chlorpromazine = jaundice/photosensitivity.
Bipolar 2: what is it, what is the disease like it?
Bipolar 2 = hypOmania (no interference with work, no psychosis) combined with MDD.

CYCLOTHYMIA = hypomania plus dysthymia...needs to be around for 2 years. so not full blown depression OR mania
for anorexia, what are the random presenting effects?
long QT, osteoperosis, even after healthy babies are likely to be low weight.
what's the major risk with ECT?
amnesia - retrograde can last awhile, antrograde tends to go away fast.
how do you treat catatonic schizophrenia?
benzos. weird.
what are the lithium toxicities?
low TI

- messes with thyroid, tremors, hypotension, low HR, nephrotoxic, then seizures.
lady gets limp and passes out at stressful situations - what should you do to treat?
cataplexy = narcolepsy. first line is forced naps.

also, for cataplexy, SSRI's are common (lower REM)

regular stimulants, modafenil...
circumstantiality, tangentiality, flight of ideas, loose associations...what's the difference?
circumstantiality = takes awhile, but gets to answer. opposite of tangentiality, where someone goes off and never gets back.

flight of ideas = ideas have a loose connection to each other.

loose association = ideas in a row with NO CONNECTION.
review the defense mechanisms: projection, displacement, repression, suppression, identification,
projection = blame someone else for your internal thoughts.

displacement = take out on object representing person you're mad at.

repression : immature, involuntary keeping ideas out of consciousness.

suppression = conscious decision not to think about USMLE.

identification: modeling after more powerful person