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71 Cards in this Set
- Front
- Back
Age of onset of schizophrenia
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Men 15-25
Women 25-35 |
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Prevalance of schizoprenia
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1% in most cultures
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List the differences between psychotic disorders
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<1 mo=brief psychotic episode
1-6 months = schizophreniform disorder > 6 month = schizophrenia |
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Why are atypical antipsychotics preferred for maintainence therapy in psychotic disorders?
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less EPS and better effect on negative symptoms
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Onset of dystonia if EPS reaction?
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hours to days
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Treatment of acute dystonia
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- anithistamines (diphenhyd)
- anitcholinergics (benztropine, trihexyphenidyl) |
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Onset of akathisia if EPS reaction
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within days
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Treatment of akathisia
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can try b-blockers
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Onset of parkinsonism if EPS reaction
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within months of treatment
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Parkinsonism from EPS most common in
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older women
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Acute dystonia from EPS most common in
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young men
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Onset of tardive dyskinesia if EPS reaction
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after years of treatment
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Treatment of tardive dyskinesia
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- none
- likely stop antipscyhotic and switch to atypical |
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Features of neuroleptic malignant syndrome
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- rigidity
- high fever (up to 107) - high CPK - sweating - myoglobinuria - mutism - altered mental status (agitated of obtunded) |
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Treatment of neuroleptic malignant syndrome
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- stop antipsychotic
- supportive care for fever and renal - consider giving dantrolene |
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classic side effect of thorazine
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retinal pigment deposits
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classic side effect of clozapine
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agranulocytosis
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Classic side effects of chlorpromazine
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- jaundice
- photosensitivity |
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3 classic side effects of SSRIs
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- insomnia
- anorexia - sexual dysfunction |
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Firs line treatment of depression
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therapy and SSRIs
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Mechanism of action of TCAs
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- NE reuptake block
- serotonin reuptake block - a-adrenergic block - AchM block |
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Why do TCAs cause orthostatic hypotension?
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a-adrenergic block
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MAOIs may be good for
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atypical depression (eating and sleeping more)
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TCA overdose most concerning for
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cardiac arrhythmias
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MAOIs + tyramine =
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HTN crisis
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Age of onset of bipolar disorder
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16-30 years old
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1st line agents for bipolar disorder
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- lithium
- valproic acid (carbamezapine 2nd line) |
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What is bipolar II?
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hypomania with major depression
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What is cyclothymia
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2 years of hypomania with depressed mood without major episodes of either
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4 classic side effects of lithium
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- renal (DI)
- thyroid - tremor - CNS effects |
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Classic side effect of valproic acid
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liver dysfunction
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Classic side effect of carbamazepine
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bone marrow depression
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10 major risk factors for suicide
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- age above 45
- substance use - h/o violence - prior attempts - male - psych history - recent loss - loss of health - unemployment/retirement - not married/partnered |
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Greatest age risk for suicide
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over 65 (15-24 also high)
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Normal grief can last up to
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1 year
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Typical age for panic disorder
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20-40
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Treatment of panic disorder
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SSRIs (fluoxetine)
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Panic disorder is associated with
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agoraphobia
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Describe conversion discorder
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- ppt event
- unexplanable neuro symptoms |
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Key features of somatization disorder
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multiple complaints in multiple organ systems with negative workup
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Treatment of somatoform disorders
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- frequent clinic visits and/or therapy
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Difference between factitious disorder and malingering
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factitious disorder the patient wants to assume role of the patient. It's intentional but no monetary or other gain.
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Key features of paranoid personality disorder
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- everyone's out to get them
- law suits |
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Key features of schizoid personality disorder
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- loner and not interested in having friends
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Key features of schizotypal personality disorder
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- bizarre beliefs
- bizarre way of talking but no psychosis |
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Key features of avoidant personality disorder
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- inferiority complex
- has no friends but wants them |
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Key features of histrionic personality disorder
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- center of attention
- seductive - dramatic and attention seeking |
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Key features of narcissistic personality disorder
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- no empathy
- use others for own gain - sense of entitlement |
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Key features of antisocial personality disorder
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* must have had conduct disorder
- criminal - male - alcohol and drugs - somatization |
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Key features of borderline personality disorder
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- unstable in every realm
- splitting - 2 minutes of psychosis - impulsive - constant crisis |
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Key features of dependent personality disorder
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- cannot be alone
- cannot do anything alone |
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Key features of obsessive-compulsive personality disorder
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* different than OCD
- restricted affect - rules are more important than objectives |
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What is a dissociative fugue?
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patients have amnesia, travel, assume new identity
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Dissociative identity disorder most likely assoicated with
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childhood sexual abuse
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Usually onset of OCD
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adolescents or early adulthood
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Treatment of OCD
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- SSRIs (fluvoxamine
- clomipramine - behavioral therapy |
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Features of narcolepsy
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* decreased REM latency (enter REM as soon as fall asleep)
- cataplexy - hypnopompic or phynagogic hallucinations |
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Treatment of narcolepsy
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modafinil or amphetamines
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Formications are associated with
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cocaine
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Cocaine withdrawl features
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- sleepy
- hungry - irritable/depressed |
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amphetamines are classically associated with ____ symptoms
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psychotic
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Likely drug intoxication if vertical and horizontal nystagmus
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Phencyclidine (PCP)
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Treatment of PCP overdose
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- urine acidification
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Is PCP toxic in overdose
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yes. can cause dealth from consulsions, coma, respiratory arrest.
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Are there withdrawl symptoms from PCP?
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no
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Are withdrawl symptoms from opiods dangerous?
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no
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Typical age for use of inhalants
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11-15 years
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Serious effects of inhalants
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- respiratory depression
- arrhythmia - asphyxiation - nervous system toxic - nephrotoxic |
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Is benzo withdrawl dangerous?
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yes, like alcohol
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3 classic syptoms of caffeine withdrawl
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- headache
- irritability - fatigue |
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6 times when ok to break confidentiality
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- patient's request
- child abuse - court mandate - duty to warn/protect - reportable disease - danger to other |