Psych

Front 1

Tx panic disorder

Back 1

Acute: benzo
Longterm: SSRI/TCA (clomipramine/imipramine)

Evt respiratory training, cognitive/behavior therapy

Front 2

Tx generalized anxiety disorder

Back 2

Buspirone, evt betablocker

biofeedback,relaxation techniques, cognitive/behav tx

Front 3

Tx specific phobia

Back 3

Desensitization

Front 4

Tx social phobia

Back 4

1)assertiveness training and SSRI
2)phenelzine

Front 5

Tx public speaking fear

Back 5

beta blocker

Front 6

Tx OCD

Back 6

1)SSRI
2)clomipramine

Front 7

Tx hypochondriasis

Back 7

1) enquire about stressors
2) benzo if severe

Front 8

Tx somatization

Back 8

regular dr appointments

Front 9

Tx Depression - how long?

a) also insomnia
b) also sexual dysfunction
c) also insomnia and sexual dysfunction
d) also generalized anxiety
e) also psychotic sx
f) in kids

Back 9

1) SSRI
2) TCA
3) MAOi

If first episode: min 6mo
If second or more: indefinitely

a)trazodone
b)bupropion
c)nefazodone
d)venlafaxine
e)antipsych (start with these)
f)esp family therapy

Front 10

Tx bipolar I

a) how long?
b) also agitation?

Back 10

1) lithium -> min 1yr
2) Carbamazepine/valproate

a)min 1yr
b)benzo untill lithium kicks in

Front 11

Tx adjustment disorder

a) also anxiety
b) also depressive sx

Back 11

psychotherapy (psychodynamic or brief cognitive)

a)add buspirone/pam
b)add SSRI

Front 12

Tx schizophrenia

a) noncompliant
b) catatonic type
c) insomnia

Back 12

1) risperidone
2) clozapine
Also: behavioral and family therapy (minimize stress at home)

a) injection typical -> fluphenazine or haloperidol
b) benzo and/or ECT
c) olanzapine

Front 13

Tx narcolepsy

Back 13

psychostimulants (moldenafil/methylphenidate)

Front 14

Tx tourette

Back 14

haloperidol or pimozide (classic antypsych)

Front 15

Tx enuresis

Back 15

imipramine or desmopressin

Front 16

When should you hospitalize pts with anorexia

Back 16

always

Front 17

What is a risk in elderly using benzo's and why?

Back 17

slower metabolism: more cognitive impairment and risk paradoxical agitation

Front 18

What is the risk of concurrent use of nicotine patch and bupropion?

Back 18

Hypertension-> monitor tension regularly

Front 19

What tx for mania is ass with these pregnancy complications:

a) craniofacial, neural tube, genital#

b)Ebstein, goiter, transient neuromuscular dysfunction

Back 19

a) carbamazepine and valproate

b) lithium
NB Ebstein 20x risk, but still only 1/1000

Front 20

Tourette is associated with....

Back 20

OCD, ADHD

Front 21

Bulimia is associated with....

Back 21

borderline

Front 22

Panic disorder is associated with....

Back 22

depression (60%) and agoraphobia (40%). Many others to lesser extent

Front 23

What DD if child develops nl till 3/4 yrs and then looses milestones?

Back 23

childhood disintegrative disorder (also autistic sx), or Rett (only girls, stereotyped hand movements

Front 24

What is eating disorder, not otherwise specified?

Back 24

Not:

anorexia = amenorrea and too low BMI

bulimia = min 2xpw binge with guilt/compensation, nl weight and no amenorrea, min 3mo

-> combi: eg binging with low BMI or 1xpw binging etcetc

Front 25

Risks for previous anorexic who wants to become pregnant

Back 25

SGA and prematurity.
Also hyperemesis, miscarriage, cs, pp depres.

Front 26

How do you treat pt on antipsych with:

a) restlessness
b) sudden muscle spasms
c) rigidity, high temp, delirium and autonomic instability
d) slow movements and expressionless
e) involuntary movements tongue, fingers, then rest

Back 26

a) akathisia (4wk) -> lower dose and give benzo/betablocker
b) acute dystonia (4hr)-> antichol or antihist
c) NMS -> stop med, give dantrolene (prevents CA release sarcoplasmic reticulum)
d) parkinsonism -> dopamine agonist, benztropine(?)
e) tardive dyskinesia -> stop med

Front 27

What is mechanism antipsych therapy vs adverse events?

Back 27

therapy: D2 antagonist

adverse events:
D2 antagonist: EPS, gynecomastia, galactorrea, amenorrea
5HT2 antagonist: sedation
alpha antagonist: hypotension
antichol: dry mouth etc

Front 28

What labs should you do before starting lithium?

What are major causes of noncompliance?

What adversities does valproate have?

Back 28

Creat -> can cause nephrogenic diabetes insipidus

Pregnancy -> teratogenic

TSH -> can cause hypothyroidy

Noncompliance: acne and weight gain

Valproate: hepatotox. Also sedation, cognitive#, gi#, tremor

Front 29

What is the disease with largest genetic component?

Back 29

Bipolar disorder:
1 1st degree -> 5-10%
2 1st degree -> 60%
monozygotic twin -> 70%

Front 30

What is absolute contra-indication use bupropion?

Back 30

seizures/epilepsy

Front 31

Tx premature ejaculation

Back 31

squeeze technique

evt psychotherapy, SSRI

Front 32

Tx fibromyalgia

Back 32

amitriptyline

Front 33

What is a danger if stopping short acting benzo's too fast?

Back 33

seizures, confusion

Most with alprazolam, less with clonazepam

Front 34

DD specific vs generalized anxiety

Back 34

Specific: 1 thing

Generalized: >1 event and 3 of #: sleep, concentration, fatigue, muscle tension, restless

Front 35

Convulsions, cardiotox, coma - which intoxication?

What tx?

Back 35

TCA

sodium bicarbonate (protects heart)

Front 36

Tx rapid cycling bipolar disorder

Back 36

Divalproex (valproate)

Front 37

Tx insomnia longer term

Back 37

eszopidone - can be used up to 6 mo

Front 38

DD bipolar I and II

Back 38

I: mania - manic sc >1w
II: hypomania - manic sx <4d
Both also depression

Front 39

DD depression vs dysthymic

Back 39

Depression: SIGECAPS >2w

Dysthymic: >2yr, mostly mood#

Front 40

DD grief vs depression

Back 40

grief: shorter duration, waxing and waning, less guilt/shame, less suicidality

Front 41

DD denial - blocking - suppression - repression

Back 41

Denial: avoid becoming aware
Blocking: temp forgetting
Suppression: conscious forgetting
Repression: unconscious forgetting

Front 42

DD projection - introjection - displacement

Back 42

Projection: attribute ones own wishes/etc to somebody else
Introjection: features of external world made ones own
Displacement: turn emotion/drive towards somebody ino something that resembles that somebody

Front 43

DD reaction formation - undoing - sublimation

Back 43

Reaction formation: impulse into opposite character trait
Undoing: impulse into opposite act
Sublimation: impulse channeling from unacceptible to acceptible

Front 44

DD postpartum blues vs depression

Back 44

Depression: no care self or baby, >2w

Front 45

Are there # on a CT scan in pt with schizophrenia?

And on PET scan?

Back 45

Yes:
enlarged ventricles and sulci
smaller cerebral/hippocampal/temporal mass

Pet: decr activity frontal lobes, incr activity basal ganglia

Front 46

DD delusional disorder vs paranoid type schizophrenia

Back 46

Delusional disorder: 1 delusion, not bizarre, >1mo, nl functioning
Paranoid schizo: >6mo, 1 or more delusions, bizarre, not nl functioning

Front 47

What is the term for:
a)unnecessarily detailed answer that is only somewhat related to question
b)rapid changing from topic to topic
c)abrupt permanent deviation of topic
d) changes of topic with NO connections

Back 47

a) circumstantiality
b) flight of ideas
c) tangentiality
d) loos associations

Front 48

DD brief psychosis, schizophreniform, schizoaffective, schizoid, schizotypal

Back 48

Brief psychosis: <30d

Schizophreniform: 1mo-6mo

Schizoaffective: also mood# with delusions/hallucinations >2w in absence of mood# (otherwise mood# with psychotic sx)

Schizoid: don't like people
Schizotypal: don't like people, like supernatural

Front 49

DD acute stress disorder, PTSD, adjustment disorder

Back 49

1 stressor:
Flashbacks/dreams
* start withing 1 mo, last <1mo -> acute stress disorder
* last >1mo -> PTSD
No flashbacks, start <3mo, disappear <6mo -> adjustment disorder

Front 50

Conversion vs somatization vs hypochondria

Back 50

Conversion: neuro# with indifference

Somatization: supermany sx

Hypochondria: keep thinking they have 1 life threatening disease, despite negative tests

Front 51

Pain disorder is associated with...

Back 51

depression

NB evt secondary gain, but not faked

Front 52

What are the physiologic sx of anorexia?

Back 52

osteoporosis
incr che/carotene
arrhytmias
euthyroid sick syndrome
hypo-pit axis#
hypoNA (if more electrolyte#: purging)

Front 53

DD pseudodementia - dementia

Back 53

Dementia: confabulations, insidious, pretents nothing is going on

Pseudodementia: acute, will admit to deficits, no confabulations to answers they don't know, treat with antidepressants

Front 54

Which sleep stages: EEG and their#?

Back 54

awake: fully=beta, drowsy=alpha
1: theta
2: K, spindles
3/4: delta -> sleepwalking/night terrors
REM: sawtooth -> nightmares

NB sleeptalking: all stages

Front 55

Tx paraphilias

Back 55

psychotherapy

SSRI, antiandrogens to reduce sex drive

evt averse conditioning

Front 56

Adversities SSRI

Back 56

agitation, loss appatite, N/V, headache, diarrhea, sexual dysfunction

Front 57

Adversities MAOi

Back 57

sedation, weight gain, orthostatic hypotension, hepatotox, sexual#

hypertensive crisis if used with tyramine rich foods, nasal decongestants, antiasthma meds, amphetamines

Front 58

What intox should always be ruled out if susp mania?

Back 58

cocaine, amphetamines

Front 59

What are adversities of ECT?

Back 59

Most common: amnesia

incr intracranial pressure -> caution if intracranial lesions

Front 60

Panic attack versus phobia

Back 60

Panic attack unexpected

Phobia: panic attach in specific setting

Front 61

OCD vs OCPD

Back 61

OCD: recognize their absurdity
OCPD: see nothing wrong with their behavior

Front 62

Tx PTSD

What should NOT be given and why?

Back 62

TCA/SSRI
exposure therapy, relaxation techniques

DO NOT give benzo - very high association substance abuse

Front 63

What are sx alcohol withdrawal and how do you prevent it?

Back 63

tremore, seizures, delirium tremens (hallucinations) -> prevent with benzo (chlordiazepoxide- long acting = librium)

Front 64

What are axis I-V?

Back 64

I: clinical psych dz
II: personatity disorder/mr
III: medical dz
IV: environment/social
V: level of functioning

Front 65

PCP vs alcohol intox

Back 65

PCP: nystagmus, ataxia -> with hallucinations, paranoia, psychosis
Alcohol: nystagmus, ataxia