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126 Cards in this Set
- Front
- Back
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To treat anxiety, what is one drug and one drug class that cannot be used with MAOIs? |
1. Buspirone (Buspar) 2. SSRIs |
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What are 3 drug classes and one standalone drug used to treat anxiety? |
1. SSRIs (1st line) 2. beta-blockers 3. benzodiazepines 4. buspirone (Buspar) |
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What is the key difference between obsessive/compulsive disorder (OCD) and obsessive/compulsive personality disorder (OCPD)? |
in OCD, patients recognize the obsessions and want to be rid of them.
in OCPD, patients do NOT recognize the behaviors as problematic (ego syntonic). |
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What is the 1st line pharmacologic treatment for OCD?
What is the other good treatment? |
SSRIs
CBT is another good, nonpharmacologic therapy |
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For how many months must panic attacks be occurring? |
at least 1 month |
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1. What is the ideal short-term treatment for panic attacks? 2. What are the 2 drug classes for long-term control? 3. What is another good treatment? |
1. benzodiazepines (usually short-mid acting) 2. SSRI (1st line), TCA 3. CBT |
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What disease is characterized by a "fear of embarassment in social or performance situations, with patients recognizing that the fear is excessive?" |
Social phobia |
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What is "fear of being alone in public places (fear of the marketplace)?" |
agoraphobia |
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1. What is the ideal treatment for social phobia or specific phobias?
2. What are 3 drug classes that can be used specifically in social phobia? |
1. CBT is ideal treatment. Usually will gradually expose to feared object/situation
2. SSRIs, low dose BZDs, or beta blockers can be used for social phobia. |
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For how long must symptoms persist for PTSD? |
at least 1 month |
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What are 3 drug classes and 1 drug used longterm to treat PTSD?
What 2 drug classes are useful in PTSD to treat associated anxiety? |
1. SSRIs (1st line) 2. TCAs 3. MAOIs 4. buspirone (Buspar)
For anxiety, can use beta-blockers or alpha2 agonists (clonidine) |
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What are the 2 most common causes of dementia? |
1. Alzheimer's (65%) 2. vascular dementia (20%) |
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What mnemonic is useful for the causes of dementia? |
DEMENTIAS
Degenerative disease (Parkinsons, Huntingtons) Endocrine (thyroid, pituitary, adrenal) Metabolic (alcohol, electrolytes, B12 def, hepatic, renal, Wilson disease) Exogenous (heavy metals, carbon monoxide) Neoplasia Trauma (subdural hematoma) Infection (meningitis, encephalitis, endocarditis, syphilis, HIV, Lyme disease) Affective disorders (pseudodementia) Stroke/Structure (vascular dementia, vasculitis, normal pressure hydrocephalus) |
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What are the 4 A's of dementia (the order and progression of cognitive impairment)? |
1. amnesia 2. aphasia 3. apraxia (can't do motor activities) 4. agnosia (can't recognize ppl, things, etc) |
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1. What is the first line pharmacotherapy for dementia?
2. What other class can be used in cases with agitation or psychotic symptoms?
3. What drug class should be avoided in dementia because it makes it worse? |
1. cholinesterase inhibitors (donepezil, galantamine, rivastigmine)
2. low dose antipsychotics
3. avoid benzodiazepines |
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What mnemonic is used for causes of delirium? |
I WATCH DEATH
Infection Withdrawal Acute metabolic/substance Abuse Trauma CNS pathology Hypoxia Deficiencies Endocrine Acute vascular/MI Toxins/drugs Heavy metals |
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What is one of the most common occult causes of delirium in elderly, and how do you diagnose this cause? |
occult UTI, so check UA |
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What is the definitive treatment for delirium? |
treat the underlying cause |
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What drug class is usually used to treat delirium? |
low dose antipsychotics |
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1. What class of disorders affects memory, orientation, judgment, and attention?
2. What are 2 common diagnoses in this category? |
1. Cognitive Disorders
2. Dementia and Delirium |
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1. What is another name for mood disorders?
2. What are 2 common diagnoses in this category? |
1. affective disorders
2. major depressive disorder and bipolar disorder |
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What are the 3 criteria over what period of time to diagnose major depressive disorder (MDD)? |
1. depressed mood/anhedonia 2. at least 5 SIGECAPS symptoms nearly every day 3. impaired function
occurring at least over 2 week period |
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What mnemonic is used for symptoms of depression? |
SIGECAPS
Sleep Interest loss Guilt Energy decrease Concentration Appetite Psychomotor agitation or retardation Suicidal ideation |
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What mnemonic is used for signs of TCA toxicity? |
CCC (Tri Cs)
Convulsions Coma Cardiac arrhythmias |
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What is the strongest combined treatment for major depressive disorder? |
antidepressent + psychotherapy |
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What treatment is reserved for refractory major depressive disorder, and what is a common side effect? |
ECT, commonly causes anterograde amnesia |
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What disorder consists of "emotional and behavioral symptoms that develop in response to an identifiable stressor, lasts between 1-6 months, and does not have 5 or more SIGECAPS symptoms?" |
Adjustment disorder |
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What disease is "mild chronic depression with depressed mood present most of the time for at least 2 years and is often resistant to treatment?" |
dysthymia |
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What is "sadness, moodiness, emotional lability, no thoughts of hurting baby, occuring within 2 weeks of delivery?" |
postpartum "blues" |
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What is "delusions and depression, may have thoughts of hurting baby, occurring within 2-3 weeks of delivery?" |
postpartum psychosis |
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What is "sadness, moodiness, emotional lability, possible thoughts of hurting baby, and sleep disturbances or anxiety, occuring within 1-3 months after delivery?" |
postpartum depression |
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What are 3 atypical anti-depressants and side effects of each? |
1. buproprion - decreased seizure threshold (contraindicated in patients with eating disorders or seizures) 2. mirtazapine - weight gain, sedation 3. trazodone - highly sedation, priapism |
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What is difference between Bipolar I and Bipolar II? |
Bipolar I - at least 1 manic or mixed episode
Bipolar II - at least 1 MDE and 1 hypomanic episode (less intense than mania). Used for patients who don't meet full criteria for bipolar I |
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What is rapid cycling bipolar disorder? |
involves 4 or more episodes of MDE, manic, mixed, or hypomanic in 1 year |
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What is cyclothymic bipolar disorder? |
chronic and less severe type of bipolar with alternating periods of hypomania and moderate depression for >2 years |
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What mnemonic is useful for symptoms of mania? |
DIG FAST
Distractability Insomnia Grandiosity
Flight of ideas Activities/psychomotor Agitation Sexual indiscretions Talkativeness |
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What drug class might trigger manic episodes in people with bipolar disorder? |
anti-depressants |
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What is the definition of a manic episode? |
1 week or more of persistently elevated, expansive, or irritable mood + 3 DIG FAST symptoms (may also have psychotic symptoms) |
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How does hypomania compare to manic episodes? |
hypomania does not have marked functional impairment or psychotic symptoms and does not require hospitalization |
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1. What is the acute therapy for bipolar mania?
2. maintenance therapy? |
1. antipsychotics 2. mood stabilizers (lithium, carbamazepine, valproate, lamotrigine) |
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What is the treatment order for bipolar depression and why? |
start with mood stabilizer (lithium, carbamazepine, valproate, lamotrigine), then add antidepressant. If you start with antidepressant, you can precipitate mania. |
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Is mania a true psychiatric emergency? |
Yes, almost always requires hospitalization because they are a threat to themselves and others |
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Is lithium teratogenic? |
yes, but only in first trimester |
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What is the first and second line treatment for personality disorders? |
1st - psychotherapy 2nd - pharmacotherapy |
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What are the 3 Cluster A "Weird" personality disorders and descriptions? |
1. Paranoid - distrustful, interpret others' motives as malevolent 2. Schizoid - isolated, "loners," restricted emotional expression 3. Schizotypal - odd behavior, "magical thinking", ideas of reference |
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What are the 4 Cluster B "Wild" personality disorders and descriptions? |
1. Borderline - unstable mood, relationships, and self-image, impulsive, history of suicidal ideation 2. Histrionic - excessively emotional and attention-seeking, hypersexual, theatrical 3. Narcissistic - grandiose, need admiration, sense of entitlement, lack empathy 4. Antisocial - violate rights of others, rules, norms. Impulsive, lack remorse |
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What type of Cluster B personality disorder often starts in childhood as Conduct Disorder? |
Antisocial personality disorder |
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What are 3 Cluster C "worried and wimpy" personality disorders and descriptions? |
1. Obsessive compulsive - perfectionist, likes order and control, inflexible, doesn't think they are abnormal and doesn't interfere with life 2. Avoidant - socially inhibited because they fear rejection, fear ridicule or being disliked 3. Dependent - submissive, clingy, need to be taken care of, feels helpless |
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What are 3 types of psychotic schizophrenia based on symptom duration and one type of schizophrenia with affective disorder? |
1. brief psychotic disorder (1 day - 1 month) 2. Schizophreniform disorder (1 - 6 months) 3. Schizophrenia (> 6 months)
4. schizoaffective disorder (schizophrenia + major affective disorder) |
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What type of personality disorder is a "magical thinker?" |
schizotypal PD (Cluster A) |
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What type of personality disorder is a "loner?" |
schizoid PD (Cluster A) |
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What are 4 important diagnostic criteria for ADHD? |
1. 6 or more symptoms 2. 6 or more months 3. in at least 2 settings 4. before age 7 |
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What are 4 major side effects of typical antipsychotics?1 |
1. extrapyramidal symptoms (acute dystonia, dyskinesia, akathisia, tardive dyskinesia) 2. hyperprolactinemia 3. anticholinergic side effects 4. NMS |
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What are 3 major side effects of atypical antipsychotics? |
1. agranulocytosis 2. weight gain 3. QTc prolongation |
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What are the 4 A's of extrapyramidal symptoms seen in order with typical antipsychotics? |
1. Acute dystonia (hours) 2. Dykinesia (days) 3. Akathisia (weeks) 4. Tardive dyskinesia (months) |
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What are 4 types of Pervasive Developmental Disorders seen in kids before age 3? |
1. Autistic disorder 2. Asperger's syndrome 3. Rett disorder 4. childhood disintegrative disorder |
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What 2 associated congenital conditions should you think about when you see a child with one of the Pervasive Developmental Disorders? |
1. Tuberous sclerosis 2. Fragile X Syndrome |
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What are 2 pediatric Disruptive Behavioral Disorders and their descriptions? |
1. Conduct disorder - violating basic rights of others or rules for 1 year or more 2. Oppositional defiant disorder - negativistic, defiant, disobedient, hostile behavior for at least 6 months. May progress to conduct disorder |
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What can conduct disorder (only seen in kids) progress to as adults? |
antisocial personality disorder (Cluster B) |
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With what 3 things is Tourette's Syndrome associated? |
1. ADHD 2. learning disorders 3. OCD |
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What is the drug class of choice for treating Tourette's? |
dopamine receptor antagonists (haloperidol, pimozine) or clonidine |
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1. failure to fulfill responsibilities at home, school, work 2. legal problems 3. continued substance use despite problems with relationships, etc. due to substance
1 or more of these 3 criteria within 1 year yields what diagnosis ? |
Substance abuse |
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1. tolerance (using more to get same effect) 2. withdrawal symptoms 3. failed attempts to cut back 4. significant time to obtain substance 5. isolation from life 6. consumption of more than intended 7. continued use of substance despite secondary consequences
3 or more of these criteria within 1 year yields what diagnosis? |
Substance dependence |
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What 2 things do you give to patient with acute alcohol intoxication to prevent Wernicke's encephalopathy? |
1. thiamine (necessary to give before glucose) 2. folate |
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What are 2 differences between anorexia nervosa and bulimia nervosa? |
anorexia - pts underweight, pts not distressed by illness and harder to treat
bulimia - pts normal weight, pts distressed by symptoms and easier to treat |
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What 3 abused substances have pupillary dilatation? |
amphetamines, cocaine, LSD |
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What substance of abuse causes assaultiveness, vertical/horizontal nystagmus? |
PCP (phencyclidine hydrochloride) |
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What substance of abuse has visual hallucinations, anxiety, depression, heightened senses (colors become more intense)? |
LSD |
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What are the 2 types of anorexia nervosa? |
1. restricting type 2. binge/purge type |
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What antidepressant can't be used in eating disorder patients because of lowered threshold for seizure in emaciated state? |
buproprion |
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What are skin manifestations of eating disorders? |
lanugo (downy hair) |
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What sleep disease frequently has cataplexy (sudden loss of mucle tone leading to collapse)? |
narcolepsy |
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What are the 2 types and definitions of hallucinations seen in narcolepsy? |
1. hypnagogic - occurs while falling asleep 2. hypnopompic - occurs while awakening |
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What disease is "patients have no conscious control over symptoms," of which there are 5 types? |
somatoform disorder
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What are the 5 types of somatoform disorders and descriptions? |
1. Somatization disorder - multiple chronic somatic symptoms from different organ systems 2. Conversion disorder - symptoms or deficits of voluntary motor or sensory function (blindness, can't walk, fake seizures) 3. Hypochondriosis - preoccupation with fear of having disease 4. Body Dysmorphic disorder - preoccupation with idealized body image 5. Somatoform pain disorder - intensity of pain is inconsistent with physiologic process |
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What disease iS "patients fabricating symptoms or causing self-injury to assume the sick role?" |
facitious disorder |
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What disease is 'a form of chronic factitious disorder, leading to excessive testing or surgery?" |
Munchausen's syndrome |
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What is it when "someone else causes harm to someone under their care in order to take on the role of the concerned onlooker?" |
munchausen's synrome by proxy |
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What is it when "patients intentionally cause or feign symptoms for secondary gain, financial gain, housing gain, etc?" |
malingering |
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Name the defense mechanism a mother who is angry at her husband yells at her kid |
displacement |
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Name the defense mechanism a pedophile enters a monastery |
reaction formation |
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Name the defense mechanism a woman calmly describes gruesome murder |
isolation |
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Name the defense mechanism a hospitalized 10 year old begins to wet the bed |
regression |
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Name the association antidepressants associated with hypertensive crisis |
MAOIs |
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Name the association galactorrhea, impotence, menstrual dysfunction, decreased libido |
dopamine antagonists |
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Name the association 17 year old girl has left arm paralysis after her boyfriend dies in a car crash. no medical cause is found. |
conversion disorder |
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Name the association life-threatening fever, muscle rigidity, and rhabdomyolysis |
neuroleptic malignant syndrome |
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Name the association the most serious side effect of clozapine |
agranulocytosis |
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What are 3 key side-effects of atypical antipsychotics? |
1. weight gain 2. DM 2 3. QT prolongation |
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what are 2 treatments for acute dystonia, usually occurring after antipsychotic administration? |
1. benztropine 2. diphenhydramine |
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Name the association a violent patient has horizontal and vertical nystagmus |
PCP intoxication |
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Name the association A woman who was abused as a child frequently feels outside or detached from her body |
depersonalization disorder |
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Name the association a man with MDD is counseled to avoid tyramine-rich foods with his new medication |
MOAIs |
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Name the defense mechanism a functioning alcoholic denies he has a drinking problem, pointing to how well he functions in his job and relationships |
denial |
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Name the defense mechanism channeling aggression into playing a heavy contact sport such as football or rugby |
sublimation |
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What is "believing that everyday occurrences have a special implication for them, like TV speaking directly to them?" |
ideas of reference |
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What is "a misinterpretation of an external stimulus, like perception that a tree in the dark is a menacing creature?" |
illusion |
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What is "loosely associated thoughts that rapidly move from topic to topic?" |
flight of ideas |
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What is "a fixed, false belief not consistent with cultural norms, like special relationships with God, special powers, etc?" |
delusion |
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What class of drugs are desvenlafaxine (Pristiq), venlafaxine (Effexor), and duloxetine (Cymbalta)? |
SNRI |
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What class of drugs are doxepin (Sinequan), clomipramine (Anafranil), amitriptyline (Elavil), and nortriptyline (Pamelor)? |
TCA |
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What class of drugs are phenelzine (Nardil) and tranylcypromine (Pamate)? |
MAOI |
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What class of drugs are buproprion (Wellbutrin), mirtazapine (Remeron), and trazodone (Deseryl)? |
atypical antidepressants |
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What defense mechanism is described? easing unacceptable feelings by behaving badly |
acting out |
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What defense mechanism is described? behaving as if an aspect of reality does not exist |
denial |
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What defense mechanism is described? transferring feelings to a more acceptable object or person |
displacement |
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What defense mechanism is described? disrupting memory, identity, and consciousness to cope with an event |
dissociation |
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What defense mechanism is described? altering perception of upsetting reality to be more acceptable |
distortion |
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What defense mechanism is described? substituting imaginary scenarios |
fantasy |
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What defense mechanism is described? using intellect to avoid uncomfortable feelings |
intellectualization |
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What defense mechanism is described? separating a thought from its emotional components |
isolation of affect |
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What defense mechanism is described? avoiding conflict by expressing hostility covertly |
passive aggression |
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What defense mechanism is described? attributing one's own feelings to others |
projection |
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What defense mechanism is described? justifying behavior to avoid difficult truths |
rationalization |
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What defense mechanism is described? responding in a manner opposite to one's actual feelings |
reaction formation |
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What defense mechanism is described? reverting to earlier developmental stage |
regression |
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What defense mechanism is described? blocking upsetting feelings from entering consciousness |
repression |
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What defense mechanism is described? transforming emotional conflicts into physical symptoms |
somatization |
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What defense mechanism is described? seeing others as all bad or all good |
splitting |
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What defense mechanism is described? avoiding negative feelings by helping others |
altruism |
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What defense mechanism is described? using humor to avoid uncomfortable feelings |
humor |
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What defense mechanism is described? channeling impulses into socially acceptable behaviors (sports, etc) |
sublimation |
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What defense mechanism is described? putting unwanted feelings aside to cope with reality |
suppression |
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What is the medication effect of antipsychotics on mesolimbic dopamine pathway? |
antipsychotic activity (desired effect occurs through mesolimbic pathway) |
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What is the medication effect of antipsychotics on nigrostriatal dopamine pathway? |
extrapyramidal symptoms (acute dystonia, akathisia, parkinsonism) |
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What is the medication effect of antipsychotics on tuberoinfundibular dopamine pathway? |
hyperprolactinemia |
