Psychiatry K & S Questions

Front 1

components of medical malpractice?

Back 1

direct causation
duty to provide proper care
negligence to meet standard of care
damages evident

Front 2

what non-psychotic drugs may still cause akathisia? tx for akathisia?

Back 2

SSRI's!!
tx = bblockers or benzos

Front 3

suicide risk factors?

Back 3

Sex = male
Age = >45, <19
Depr feelings (or irritation, or decr Conc, App, Libido, Sleep)
Previous suicide attempt
Excessive alch use
Rat. thinking loss (org brain
syndrome, psychosis,
Sep, divorced, or widowed
Organized plan or serious attempt
No social support
Sickness, chronic disease

Front 4

MDD DSM diagnosis criteria?

Back 4

A) Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure

Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations

1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
4) insomnia or hypersomnia nearly every day
5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6) fatigue or loss of energy nearly every day
7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Front 5

9 criteria for depression?

Back 5

feeling depressed
anhedonia
previous suicide attempt

wt loss/changes
sleep probs
fatigue
motor restlessness or retard

concentration probs
feeling of worthlessness

Front 6

2 causes of ebstein's anomaly?

Back 6

Li in first trimester of birth
wpw syndrome

Front 7

Li toxicity?

Back 7

cong anomalies (ebstein's)
tremor
diarrhea / gi distress
diab insipidus / renal dysfxn
hypoth
cardiac conduction probs

Front 8

haloperidol toxicity?

Back 8

stiffness, dystonia, akathisia, QT prolongation or TdP

Front 9

criteria for autism? 4 main

Back 9

1 impairment in social interaction = eye contact or peer relats
2 impairment in communication
ie poor verbal skills, repetetive speech, or no lang
3 repetetive, inflexible stereotyped patterns
4 delays in these, or in imaginitive/social play

Front 10

tx for rapid cycling bipolar and for mixed affective disorder?

Back 10

carbamazapine or vp acid

Front 11

carbamazapine s/e's?

Back 11

aplastic anemia, agranulocytosis (bm suppression)

Front 12

valproic acid s/e's?

Back 12

ntube defects
alopecia
gi/liver probs

Front 13

other anticonvulsants?

Back 13

lamotrigine (lamictal)
gabapentin
topiramate
tiagabine

Front 14

tx li tremor with?

Back 14

bblocker

Front 15

dont give anticholinergics to?

Back 15

C pt with par ileus
U pt with BPH
B pt w/ acute glaucoma

Front 16

side effects of TCA's?

Back 16

Constip (antichol = CUBD)
Card arrhythmias + ortho hotn
Convulsions!!!
+Wt gain, Sedation (antihist =drymouth, sedation)
+obvious for antidep's=sex dysfxn

Front 17

tx for GAD?

Back 17

buspirone
doxepin(tca) or venlafaxine(snri)

Front 18

insomnia tx

Back 18

zolpidem, zalepton

Front 19

only c/i's to ECT?

Back 19

recent MI (2 weeks),
increased ICP

Front 20

antidepressive causing priaprism?

Back 20

trazodone

Front 21

cong cause of autism?

Back 21

rubella!

Front 22

required for antisocial pd dx?

Back 22

evidence of childhood hx of conduct disorder before age 15 is required !!

Front 23

ritalin s/e's?

Back 23

tremor
tics
growth inhibition for up to first yr tx
abd px, wt loss, anorexia

Front 24

% of anorexics eventually die from complications?

Back 24

10-15%

Front 25

tx for tourettes'?

Back 25

haloperidol

Front 26

2nd line for enuresis?

Back 26

imaprimine

Front 27

73% of fibromyalgia pts also have what psych condition?

Back 27

ptsd

Front 28

concrete thinknig found in?

Back 28

schizo, retardatino

Front 29

ect tx for?

Back 29

elderly depressed
depr refractory to tx
depr with psychotic features/catatonia
when rapid depr tx needed due to suicide risk
pregnantor other pts who can't undergo pharmocotherapy

Front 30

how many mo of cbc tests must be done when giving clozapine?

Back 30

at least 6 mo to establish no agranulocytosis effect

Front 31

what drug never give to MAOI pt?

Back 31

ANY sympathomimetics ie ritalin (methylphenidate), decongestant ie ephedrine, pseudoephedrine, pheylephrine!...will cause tyramine increase = hypertensive crisis, sweating, hache, vomitingetc. Also don't giveSSRI...will cause serotonin syndrome = hyperthermia, flushing, diarrhea, etc.

Front 32

MAOI tyramine incr syndrome vs serotonin syndrome?

Back 32

tyr = hypertensive crisis - stroke-death, hache, sweating, vomiting

sero syndrom (maoi+ssri) = hyperthermia, seizures, coma eath, autonomic instability ie diarrhea

Front 33

atypical side effects?

Back 33

wt gain / dm II
agranulocytosis (clozapine)
seizures
prolactinemia
myocarditis (clozapine)
ortho/post hypotension (only antipsychotic not causing hotn is haloperidol)

Front 34

3 drugs in erectile dysfxn injection?

Back 34

pipaverine, alpha blocker, and PGE1

Front 35

reversible causes of dementia?

Back 35

hypothyroidism
B12 def
Folate def
Hypertensive encephalopathy

Front 36

night madness?

Back 36

delirium getting worse at night = due to medication s/e's

Front 37

% of open heart surg or hip replacement pts get delirious?

Back 37

90%!!!!

Front 38

lobes involved in alzheimer's disease?

Back 38

temporal/parietal lobe size reduction

Front 39

irreversible dementia in kids caused by what behavior?

Back 39

sniffing glue/ other solvents

Front 40

aggressive behavior + dementia..?

Back 40

Lewy body dementia = FRONTAL lobe affected/ decr in size

Front 41

korsakoffe vs wernike's psychosis?

Back 41

k = irrev memory loss with symptom of CONFABULATIONS
w = reversible, ataxia, CN 6 paralysis=opthalmoplegia (+ nystagmus), confusion, memory loss

Front 42

Ataxia
Urin retention
Dementia?

Back 42

normotensive hydrocephalus

Front 43

Ataxia
Urin retention
Dementia
+ feeling of worms under the skin?

Back 43

prions!!!

Front 44

achesterase inhibitors used to tx alzheimer's?

Back 44

tacrine
rivostigmine
galantamine
donepezil

Front 45

only drug approved for kids over 8 y/o?

Back 45

fluoxetine

Front 46

age when sep anxiety persisting = sep anx disorder?

Back 46

age 3+

Front 47

age when superego develops?

Back 47

6

Front 48

diff falling asleep...think ?

Back 48

GAD

Front 49

diff waking up too early or too much?

Back 49

mania or depression

Front 50

m/c epilepsy seen at night?

Back 50

temporal lobe epilepsy

Front 51

2 diseases where anticipation is found?

Back 51

huntington's
fragile x

Front 52

% MR w/ mood disorder?

Back 52

50

Front 53

% autism w/ MR?

Back 53

70%

Front 54

% of those with MR and epilepsy that have autism?

Back 54

30

Front 55

tx for depression durations
1st,2nd,3rd episodes?

Back 55

1st = 9-18 mo
2nd = 2-5 yrs
3rd = life

Front 56

how to tx delayed orgasm due to SSRI?

Back 56

drug holiday = stop for day before sex OR switch drugs to
ie buproprion,
mirtazapine
OR give cyproheptadine!!

Front 57

tx of benzo od? alcoh w/d?

Back 57

flumazanil
alcw/d = thiamine b1 injection, give a benzo,

Front 58

tx for heroin w/drawal?

Back 58

clonidine
buprinorphine (parial mu agonis) or methadone (long acting opoid) to decr w/drawl sx,
naloxone for o/d

Front 59

heroin w/drawal sx?

Back 59

SEVERE flu like sx,
mydriasis,
diarrhea,
rhinorrhea

Front 60

% alcoholics stay free after rehab? heroin addicts?

Back 60

alc = 35%
h = 10%!!

Front 61

% bipolar if both parents have?

Back 61

50-75%!!!

Front 62

can cause ortho hotn? (3 types of psych drugs)

Back 62

low potency antipsychotics,(atypicals also cause hotn)
TCA's
MAOI's

Front 63

acute psychosis in asthma pt?

Back 63

steroid psychosis...
usually mania or depr, sometimes psychotic sx
if in anabolic steroid user mania + aggression (roid rage)

Front 64

MR definition?

Back 64

IQ 70-55 = mild
35-55 = mod
less than 35 = severe/profound

plus dysfxn of 2+ components of : ed, health , work, security, living, self care, etc.

Front 65

causes of MR?inorder of m/c

Back 65

idiopathic
genetic
pre/postnatal
enviro

Front 66

genetic causes of mr?

Back 66

ds,
fragile x
Prader willi
pku
tay sachs

Front 67

peri/postnatal causes of mr?

Back 67

fas
Cp
infection
duchennes md
tsachs
rubella

Front 68

enviro causes of mr?

Back 68

neglect, poor education

Front 69

when MR diagnosed usually?

Back 69

in kindergarten

Front 70

iq formula?

Back 70

mental age / chron age

x 100

Front 71

affective sx of metnal retardation?

Back 71

anger, rage outbursts

Front 72

top 2 uses of respirdal?

Back 72

schiz
anger attacks

Front 73

prevalence of MR?

Back 73

1%

Front 74

question to det'n if child is MR?

Back 74

how long were you in school? what grade last completed?
ever have to repeat yr?

Front 75

m/c cause of autism in males?

Back 75

fragile X

Front 76

% of autistic have MR?

Back 76

70%

Front 77

m/c comorbidity in ptsd?

Back 77

adhd

Front 78

m/c comorbidity in migraine?

Back 78

depression

Front 79

dizziness, fatigue, irritation, conc problems, insomnia, decr tolerance to alcohol in pt 3 mo afer head trauma but normal ct and no residual px?

Back 79

post-concussion syndrome

Front 80

tx for post concussion syndrome?

Back 80

CBT

Front 81

what is mummification?

Back 81

keeping deceased's belongings exactly as they were before they died...
is NOT normal in normal bereavement.

Front 82

drugs that may precipiate mania?

Back 82

bromocriptine, INH, cimetidine, disulfiram

Front 83

% of depressed that will later have recurrences?

Back 83

75%

Front 84

most consistent brain abnormality found in depression?

Back 84

increased freq of abnormal hyperintensities in subcortical reagions ie periventricular regions.

Front 85

mechanism of buproprion?

Back 85

not ser but DOP reuptake inhibitor.

Front 86

alexithymia?

Back 86

inability to describe or be aware of one's own emotions. NOT present in depression (pts can describe and are aware of emotions but are often lacking them)

Front 87

self psychology...
rejection of id, ego, superego
parents must give child sense of self esteem through empathy, validation, and excessive reassurance.
mirroring, twinship, and idealization
self-objects = the self requires "objects" ie others to fulfill these needs
w/o these ie if neglected by parents, and even later in life are needed ,ie w/o others in life who validate you, a person receives a "narcissistic injury to self" and attains sense of worthlessness and fragmentation, and may lead to personality disorders or even anxiety disorders

Back 87

heinz kohut

Front 88

internal object relations throughout life cycle
Infant - Mother relations
first months of life involve projection and introjection: creating a bad mother good mother split. this is a progression from the "paranoid/schizoid" position to the "depressive position" of the psyche..normally, person grows to see bad and good as inseparable, interrelated parts. if poor parenting, pt cannot see good and bad together and only sees object as either irreconcilably good or bad ..this is basis for splitting and borderline personality disorder

Back 88

Melanie Klein

Front 89

cognitive development occurs in 4 stages:
1 sensorimotor 18-24 mo
2 preoperational 2-5/7 yrs
3 concrete operational 6-11yrs
4 formal operational >11yrs

stages have to do w/ approaching and processing information
Kohlberg integrated concepts into 3 major levels of morality: preconventional (punshment/obedience to parent), morality of conventional role-conformity (kids try to conform to gain approval and maintain relats) and morality of self-accepted moral principles: chlidren voluntarily comply w/ rules based on consept of ethicla principles

Back 89

Piaget

Front 90

infant attachment theory
anxiety follows an insecure attachment caused by inconsistent or neglectful parenting
he and hs sullivan developed interpersonal therapy postulating that loss of interpersonal relationships causes depression
problem areas: complicated mourning, role disputes (conflict w/signif other), lack of social skills (interp deficits) and role transition (change in life causing stress) may cause depression

Back 90

john bowlby

Front 91

disciple of freud
Representational images and configurations with universal symbolic meanings make up "archetypes"

the "shadow" contains all unacceptable traits and qualities of an individual that recur in dreams...and are part of the "collective unconscious"
the masculine parts of a woman's personality are the "animus", vice versa are the "anima"
ie for generous person, greed is shadow

Back 91

Carl Jung

Front 92

anaclitic depression occurs in children who are not adequately nurtured, and they become apathetic, withdrawn, and less interested in feeding.

Back 92

Renee Spiz

Front 93

separation-individuation stage of life b/w 6-36 mo = when chilld develops consept of him/herself seperated from mother. this involves:
1 differentiation 6-10 mo (mother is separate person)
2 practicing 10-16 mo ( exploration of surrounding)
3 rapprochement 16-24 mo = need to know wehre mom is and regularly "refuel" by returning to her for affection
4 object constancy 24-36 mo = integration of good and bad parts of images of mother and child...
OBJECT CONSTANCY is especially necessary for later dev of stable and mature relationships

Back 93

Margaret Mahler

Front 94

british pediatrician/psychoanalyst
focused on early mother-child relat
child is only able to develop separate and stable identity if eeds are met by mother's empathy...this is called a "holding environemnt"
moms don't need to be perfect, but must provide a sufficient amt of comfort and constancy.
a "transitional object" helps kid tolerate separation from mom w/o too much anxiety

Back 94

D.W. Winnicott

Front 95

Depression isn't really a disorder or illness, but just an afrfect reflecting conflict and compromise
there are 2 forms of unpleasure:
anxiety = anticipation of danger
depression = calamity already occurred

depression is not always related to object loss or oral wishes...not all depressed persons identify with these
anger turned inward is a RESULT of dpression, not a cause
ppl can experience depressive affect if they feel powerless, punished, or etc. thus, depressive affect is a normal and universal part of the human condition

Back 95

Charles Brenner

Front 96

state of depression is compared to a powerless, helpless child, victimized by superego.
depressed persons have identified with ambivalently regarded lost loved ones
superego becomes sadistic, and self identifies w/ lost loved one
depressed person feels she is at mercy of a sadistic internal tormentor that is unreletning in its victimization.

Back 96

Edith Jacobson

Front 97

8 stages of development that take palce during life cycle

Back 97

Erik Erikson

Front 98

def of double depression

Back 98

2+ MDD episodes (recurrent MDD) with histoyr of dysthymic disorder before its onset w/o any full remission b/w episodes