Psychiatry Usmle 2

Front 1

What are the 5 Axes in the Multiaxial Classification?

Back 1

Axis I: Clinical Disorders, "Chief complaint";
Axis II: Personality Disorders,
Mental Retardation;
Axis III: General Medical Conditions;
Axis IV: Psychosocial and Environmental Problems;
Axis V: Global Assessment of Functioning

Front 2

What is the most commonly known (preventable) cause of Mental retardation?

Back 2

Fetal Alcohol Syndrome

Front 3

(2) MC genetic causes of Mental Retardation

Back 3

Down's Syndrome

Fragile-X Syndrome

Front 4

Define the (4) levels of mental retardation w/ IQ and brief summary

Back 4

70-50 IQ: Mild - self-supporting (6th grade level)

49-35 IQ: Moderate - Trainable but needs supervision
(2nd grade level)

34-20 IQ: Severe - can learn to communicate; basic habits

< 20 IQ: Profound - needs highly structured environment

Front 5

(2) possible causes of specific Learning Disorders

Back 5

Focal Cerebral Injury

or

Neurodevelopmental Defect

Front 6

MC Learning Disorder

Back 6

Reading Disorder

(more common in boys)

Front 7

(4) Pervasive Developmental Disorders

Back 7

Autistic disorder;

Rett's disorder;

Childhood Disintegrative disorder;

Asperger's disorder

Front 8

What are the (3) basic signs of Autism?

Back 8

1. impairment in Social interaction
(failure to develop social smile, eye-to-eye gaze, etc)

2. impairment in Communication

3. Restrictive, Repetitive or stereotyped patterns of behavior, interests or activities
(preoccupation of an interest, inflexible adherence to rituals, whole body rocking, etc)

Front 9

A female w/ normal development the first 5 months after birth, then head circumference decreases, skills are lost such as language, social interactions and appropriate gait.
Dx?

Back 9

Rett's disorder

Front 10

what is the trade Name and class:

Fluoxetine

Back 10

Prozac

(SSRI)

Front 11

what is the trade Name and class:

Sertraline

Back 11

Zoloft

(SSRI)

Front 12

what is the trade Name and class:

Paroxetine

Back 12

Paxil

(SSRI)

Front 13

what is the trade Name and class:

Fluvoxamine

Back 13

Luvox

(SSRI)

Front 14

what is the trade Name and class:

Citalopram

Back 14

Celexa

(SSRI)

Front 15

what is the trade Name and class:

Escitalopram

Back 15

Lexapro

(SSRI)

Front 16

what is the trade Name and class:

Venlafaxine

Back 16

Effexor

(SNRI)

Front 17

what is the trade Name and class:

Duloxetine

Back 17

Cymbalta

(SNRI)

Front 18

What are the (2) Serotonin receptor agonists and antagonists?
Use?

Back 18

Trazodone

Nafazodone

Use: Anti-depressants

Front 19

What is the NE-DA reuptake inhibitor used for depression?
(generic and trade name)

Back 19

Bupropion (Wellbutrin)

Front 20

What is the difference b/t Typical and Atypical Antipsychotics with relation to NT?

Back 20

Typical = Dopamine Antagonists

Atypical = Dopamine and Serotonin Antagonists

Front 21

Aside from Schizophrenia, what are (5)* other uses for Haloperidol?

Back 21

PHAT T:

PCP overdose;
Huntington's Dz (and other movement disorders);
Acute Mania;
Tx-resistant Bipolar d/o;

Tourette's d/o

Hint 21

PHAT T

Front 22

What dopamine tracts are responsible for the patient's psychosis? (2)

Where in the brain does it arise from?

What is the only drug that treats just these two tracts without affecting the others?

Back 22

Mesocortical and Mesolimbic tracts

from Ventral Tegmental area of the brain

Clozapine
(only works on these tracts)

Front 23

What is the only Atypical antipsychotic not also approved for Bipolar disorder?

Back 23

Clozapine

Front 24

what is a possible side effect of blocking the tubuloinfundibular tract of Dopamine (using any type of dopamine blocker aside from Clozapine)?

Back 24

Increased Prolactin levels

(Glactorrhea, amenorrhea and gynecomastia can occur; it is usually a side effect of Typical antipsychotics)

Front 25

A patient from Europe moved to the USA and needed to be placed on antidepressant medication. The physican gave him a SSRI without knowing of his previous medication. Within a few days the patient began to become restless, confused, hyperthermic and have severe muscle rigidity.
Dx?

Back 25

Serotonin Syndrome

(from mixing a SSRI and a MAOI)

Front 26

Aside from blocking Dopamine, what else is blocked with the use of Antipsychotics? (5)

Back 26

Muscarinic receptors (causing anticholinergic sx);

Alpha receptors (causing hypotension);

NE uptake;

Serotonin receptors;

Histamine receptors (sedation)

Front 27

What are the adverse Metabolic effects of Atypical antipsychotics?
(3)

Back 27

Weight Gain;

Adult-onset Diabetes;

Dyslipidemia

Front 28

What is the evolution of Extra-Pyramidal Symptom side effects of Antipsychotics in hours, days, weeks and months?

Back 28

4 hours: Acute Dystonia

4 days: Akinesia

4 weeks: Akathisia

4 months: Tardive Dyskinesia
(often irreversible)

Front 29

A man that just began taking medication for schizophrenia begins to get muscle spasms in his head and neck and rolling of his eyes upward.
Dx?
Tx?

Back 29

Acute Dystonia

Tx: Anticholinergic
(Benztropine)

Front 30

How do you treat neuroleptic-induced Parkinsonism?
(2)

Back 30

1. Oral Anticholinergics

2. Amantidine
(a DA releasing agent)

Front 31

A few weeks after starting neuroleptics a patient begins to get an inner restlessness in his legs and cant remain still.
Dx?
Tx? (2 possible)

Back 31

Dx: Akathisia

Tx:
1. Beta-blocker
2. Benzodiazepine

Front 32

A few days after starting neuroleptics a patient gets tachycardia, HTN, rigidity, agitation and a clouding of consciousness. His labs show an increased CK, Myoglobinuria, WBC and LFT.
Dx?
Tx? (3 possible)

Back 32

Dx: Neuroleptic Malignant Syndrome

Tx:
ir could be "BAD" if you dont give either Bromocriptine, Amantidine or Dantrolene

Front 33

An elderly woman on neuroleptics for a few years begins to get involuntary movements of the tongue, face, neck and upper extremities.
Dx?
Tx?

Back 33

Dx: Tardive Dyskinesia
(often irreversible)

Tx: (no cure)
1. Don't abruptly stop meds, switch to atypicals
2. give Clozapine to help Sx

Front 34

What neuroleptic (antipsychotic) drug causes Agranulocytosis?
What must every patient do on this durg?

Back 34

Clozapine

Patient must have Weekly WBC

(never use as first line due to AE...only in patient who has failed other medication and has a lot of negative Sx)

Front 35

what type of Sx do Typical and Atypical antipsychotics treat?

Back 35

Typical: Positive Sx only
(DA receptor blocker)


Atypical: Positive and Negative Sx
(DA and Serotonin receptor blocker)

Front 36

What drugs should be used first-line for antipsychosis?
(3)

Back 36

Risperidone;

Olanzapine;

Quetiapine

(these atypicals are DOC before Haloperidol and Clozapine)

Front 37

where does the serotonin system arise from in the brain?

Back 37

Raphe Nuclei

Front 38

What antidepressant is also prescribed for sleep disorders?

Back 38

Trazodone

Front 39

What is the main side-effect of a SSRI (causing people to stop using it)?

Back 39

Sexual Dysfunction:

Anorgasmia, ED and Diminished Libido

Front 40

what is the best Tx for Depression?

What are the contraindications?

AE? (3)

Back 40

Electroconvulsive Therapy

(usually done to patient that is severely suicidal and cant wait for drugs to set in)

CI: No contraindications! Good for everyone

AE: Memory, Seizures and Increases ICP

Front 41

What can Lithium cause in an unborn child?

Back 41

Ebstein's Anomaly

(cardiac malformation of the tricuspid valve)

Front 42

DOC for an Acute Mania attack

Back 42

Haloperidol

Front 43

what non-Rx Tx is used for Treatment-refractory major depression?

Back 43

Vagus Nerve Stimulation

Front 44

Name the (5) main drugs used as Mood Stabilizers

Back 44

Lithium;
Valproic Acid;
Lamotrigine;
Carbamazepine;
Gabapentin

Front 45

what drug can be used in acute episodes of bipolar disorder but has AE of blood dyscrasia, impaired liver function, thrombocytopenia and prolonged coagulation times?

Back 45

Valproic Acid

Front 46

what is a second-line agent for Bipolar disorder if the patient does not respond to lithium?
(2 possible)

Back 46

Carbamazepine

(or Valproic Acid)

Front 47

what drug used for Bipolar disorder renders birth control pills ineffective?

Back 47

Carbamazepine

Front 48

what drug for bipolar disorder induces P450?

Back 48

Carbamazepine

Front 49

what drug is used for the maintenance phase of bipolar I disorder (depressive phase) and can cause an allergic rash leading to Stevens-Johnson's syndrome?

Back 49

Lamotrigine

Front 50

What is the main drug class that treats anti-anxiety (Anxiolytics)?

Back 50

Benzodiazepines

Front 51

what do you treat a benzodiazepine overdose with?

Back 51

Flumazenil

Front 52

what is the generic Name and class:

Alprazolam

Back 52

Xanax
(Benzo)

Front 53

what is the trade Name and class:

Chlordiazepoxide

Back 53

Librium

(Benzo)

Front 54

what is the trade Name and class:

Diazepam

Back 54

Valium

(Benzo)

Front 55

what is the generic Name and class:

Lorazepam

Back 55

Ativan

(Benzo)

Front 56

what is the generic Name and class:

Temazepam

Back 56

Restoril

(Benzo)

Front 57

Main treatment for Generalized Anxiety Disorder that does not cause dependence, sedation or anorgasmia.

Back 57

Buspirone

Front 58

Which Benzos can be given to patients with liver failure?
(3)

Back 58

Outside The Liver:

Oxazapam,

Lorazapam,

Temazapam

Front 59

(3) main AE of Benzos

Back 59

Sedation;

Dependence;

Memory impairments
(not good for elderly)

Front 60

Benzo used for a Panic attack

Back 60

Alprazolam

Front 61

what separates ADHD from other conduct disorders?

Back 61

Child must have Sx in at least two areas
(such as home and school)

Front 62

(2) AE of Methphenidate to children

Back 62

1. Growth Hormone Supression

2. Tremor

(recommended to take holiday from drugs during summer)

Front 63

Tourette's is associated w/ what (2) comorbid psychiatric illnesses?

Tx? (3 possible)

Back 63

ADHD and OCD

Tx:
1. Haloperidol
2. Pimozide
3. Clonidine

Front 64

Tx of choice for patient w/ Anorexia that is not life-threatening?
(2 in order)

Back 64

Tx:

1. Monitor calories, weight and serum electrolytes
(counseling)

2. SSRI (Fluoxetine)
(also for Bulimia)

Front 65

What internal substance can commonly induce a panic attack in those that are predisposed to having them?
(2)

Back 65

Sodium Lactate

or

Carbon Dioxide

Front 66

What can rapid refeeding after anorexic starvation precipitate?

Back 66

Hypermetabolic HypoPhosphatemia

Front 67

What musculoskeletal complaint frequently is reported in bulemics?
Why?

Back 67

Muscle Spasms

(due to low serum Potassium and Sodium)

Front 68

A high GGT and MCV indicates what type of substance abuse?

Back 68

Chronic Alcohol abuse

Front 69

What is the best way to approach acute pharmacotherapy for GAD?

Back 69

Give a Benzo-Buspirone combo immediately along w/ having them start a SSRI. In about 3 weeks, when the SSRI begins to work, ween them off the Benzo-Buspirone combo

Front 70

How is GAD different from Panic disorder?

Back 70

Panic Disorder: Discrete episodes of Anxiety

GAD: Consistent worry about all aspects of their life

Front 71

What is the behavior therapy and medical Tx (2) for Panic Disorder?

Which med is for Acute Sx?
Chronic?

Back 71

Tx:

1. Cognitive Behavior Therapy

2. Benzo (Aprazolam) for Acute Sx

3. SSRI (first-line) for Chronic Sx

Front 72

what is the Behavioral therapy for Specific phobias?
(2)

Back 72

Systematic Desensitization
(incorporates relaxation)

or

Flooding
(no relaxation techniques)

Front 73

What is the Tx for stage fright?

Back 73

Beta-Blocker

Front 74

What type of behavior therapy is good for OCD?

What are the (2) medications and classes that Tx it?

Back 74

BT:
Exposure-Response Therapy
(make them dirty and prevent them from washing hands)

Meds:
1. SSRI: Fluoxetine
2. TCA: Clomipramine

Front 75

MCC of Post-traumatic Stress D/o in Men? Women?

Back 75

Men: Combat

Women: Rape

Front 76

A 10yo boy was raped by his uncle. Whenever he thinks of the rape he goes to the sink and washes his hands 100 times.
Dx?
First line Tx?

Back 76

Post-Traumatic Stress Disorder

(This is a "Repetition Compulsion" to decrease the boy's level of anxiety; it is a repetitive behavior that stems from an INCIDENT, not like OCD)

First line Tx: SSRI

Front 77

Marty is a 30-year-old male who lives with his mother. He works as a night-time cleaner in a large store since he dropped out of college many years ago. He complains of being “nervous all of the time” and would like to “get his life back”. He stated that he would like to change jobs but prefers his current job because he does not have any contact with other employees.
He did not have many friends in high school or in college, mostly due to his feeling “self-conscious”. When among strangers, he would feel nervous and would “break out in a sweat”. He had what he described as “nervous attacks”, which came on suddenly and lasted for a few seconds to minutes. These attacks only came on when in the presence of strangers. Since these episodes increased in intensity and frequency, he dropped out of college.
Dx?

Back 77

Social Phobia

(not a panic attack, which occurs “out of the blue” versus someone uneasy around strangers)

Front 78

What is seen on a CT/MRI and PET-scan to indicate Schizophrenia?

Back 78

CT/MRI: Increase in size of Ventricles

PET-scan: Hypoactivity of Frontal Lobes

Front 79

Schizophrenia type:

presence of delusions of grandeur or persecution
(example: think they are followed by FBI)

Back 79

Paranoid

(MC type)

Front 80

Schizophrenia type:

marked regression to primitive, disinherited, and disorganized behavior, worst prognosis, early onset; "Facial Grimacing" or "silly affect"; most inappropriate of all types

Back 80

Disorganized

Front 81

Schizophrenia type:

Patient is running around and jumping on tables, then finally collapsing in exhaustion; may become rigid or have bizarre postering

Back 81

Catatonic

Front 82

Schizophrenia type:

characteristics of more then one other type

Back 82

Undifferentiated

Front 83

Schizophrenia type:

frequent auditory hallucinations

Back 83

Paranoid

Front 84

Schizophrenia type:

patient meets criteria for schizophrenia in the past but now lacks delusions or hallucinations

Back 84

Residual

Front 85

what is the difference in Type I or Type II schizophrenia?

Back 85

Type I: Positive and Negative Sx
(Tx: Typical or Atypical Anti-psych)

Type II: Negative Sx only
(Tx: Atypical Anti-psych)

Front 86

What is this an example of:

"I am the King of Budapest"

Back 86

Delusion

(fixed false belief)

Front 87

What is this an example of:

Patient describing the trees looking like scary monsters

Back 87

Illusion

(sensory misconception)

Front 88

If an unstable patient in the ER mentions he is having visual hallucinations, what is you first thought of Dx?

Back 88

Drugs

(visual is more related to drugs and auditory is more related to schizophrenia)

Front 89

Aside from time, what is the difference between a Brief Psychotic Disorder and other Schizophrenic disorders?

Back 89

BPD involves a Stressor that initiates the Sx

(stressor could include giving birth; time from 1 day to 1 month)

Front 90

what is the difference b/t Delusional disorder and Schizophrenia?

Back 90

Delusional disorder:
Delusions are non-bizzare and could be possible;
Delusions occur of at least 1 month

Front 91

Type of Delusional Disorder:

the individual is being harassed or malevolently treated

Back 91

Persecutory

Front 92

Type of Delusional Disorder:

the individual posses exaggerated power, money or knowledge

Back 92

Grandiose

Front 93

Type of Delusional Disorder:

thinks that another person, usually of higher status, is in love with the individual

Back 93

Erotomanic

Front 94

Type of Delusional Disorder:

that the individuals partner is unfaithful

Back 94

Jealous

Front 95

Type of Delusional Disorder:

that the individual has a physical defect or a medical condition

Back 95

Somatic

Front 96

what is a "Clang Association"?

Back 96

a Rhyming of words seen in schizophrenics

Front 97

a patient has sudden loss of muscle tone and drops to the floor, only to be in REM within 10 minutes.
Dx?
Tx?
(2 possible)

Back 97

Dx: Cataplexy

Tx:
1. Imipramine + stimulant
2. SSRI + stimulant

Front 98

What is the definition of hallucinations when falling asleep?
Waking up?

Back 98

GOing to sleep: HypnaGOgnic

Waking up: Hypnopompic

Front 99

(2) Drug Tx for Narcolepsy

Back 99

1. Methphenidate

2. Modafinil

Front 100

How is Narcolepsy waking different from waking after passing out from alcohol?

Back 100

Narcolepsy patients feel refreshed after waking

Front 101

A middle-aged overweight businessman complains of being tired all day.
Dx?
Tx?

Back 101

Dx: Sleep Apnea

Tx: Continuous Positive Ariway Pressure
(C-PAP)

Front 102

A patient has depressed Sx during winter months but feels fine during the summer.
Dx?
Tx?

Back 102

Dx: Seasonal Affective Disorder

Tx: Phototherapy

Front 103

A 22-yo female was arguing with her boyfriend and the next day she has a depressed mood.
Dx?
Tx?

Back 103

Dx: Adjustment Disorder
(characterized by the development of symptoms in response to an identifiable stressor occurring within 3 months of the onset of the stressor; examples: car accident, divorce, etc; NOT berevement)

Tx: Supportive Psychotherapy

Front 104

What is the term for a condition similar to post-traumatic stress disorder, but Sx occur w/i 1 month of the traumatic event and last from 2 days to 1 month?

Back 104

Acute Stress Disorder

Front 105

A 30-year-old female was fired from her job about 1 month ago. Since then, she has complained of depressed mood and sleep problems. She denies any appetite or weight problems. She denies any suicidal ideation or plan. Her concentration is good and her memory is intact.
Dx?

Back 105

Adjustment Disorder

Front 106

what (3) sleep changes are common in depressed patients?

Back 106

1. Decreased Slow-Wave Sleep
2. Decreased REM
3. Early-morning Awakening

Front 107

what is the difference b/t Substance Dependence and Abuse?
(3)

Back 107

Abuse leads to Dependence

Dependence also has:
Tolerance;
Withdrawal;
Inability to control ETOH use

Front 108

A 15yo boy builds model airplanes. What is most likely drug of abuse?

Back 108

Alcohol

(Alcohol is always most abused)

Front 109

Number one risk factor for Suicide

Back 109

Psychiatric illness

(then: Previous Attempt)

Front 110

what is the highest rate of suicide for any age group?

Back 110

Elderly (>65) Men

Front 111

What is the highest ethnicity for suicide?

Back 111

Native American Adolescents

Front 112

Most common way to commit suicide?

Back 112

Gun

Front 113

How can you tell the difference b/t a cocaine/amphetamine user and paranoid schizophrenia?

Back 113

Drug test

(Cocaine stays in system for 2 - 3 days)

Front 114

Substance Abuse Buzz words:

Paranoia

Back 114

Cocaine or Amphetamines

Front 115

Substance Abuse Buzz words:

Arrhythmia

Back 115

Cocaine or Amphetamines

Front 116

Substance Abuse Buzz words:

Depression

Back 116

Cocaine withdrawal

(worry about suicide)

Front 117

Substance Abuse Buzz words:

Severe Violence

Back 117

PCP

(also vertical nystagmus)

Front 118

Substance Abuse Buzz words:

Pinpoint pupils

Back 118

Opiate overdose
(Heroin)

Front 119

Substance Abuse Buzz words:

Flu-like Sx

Back 119

Opiate Withdrawal

Front 120

Substance Abuse Buzz words:

Seizures
(2)

Back 120

1. Benzodiazepine intoxication


2. Opioid withdrawal (?)

Front 121

Substance Abuse Buzz words:

Death

Back 121

Barbiturates

Front 122

Substance Abuse Buzz words:

Tremors after hospital admit

Back 122

Alcohol

Front 123

What are the steps of treating Alcohol withdrawal?
(4)

Back 123

1. Rule-out Medical complications (hepatic dysfunction or Wernicke's encephalopathy) by Lab tests and exam
2. Diazepam (Benzodiazepine)
3. Multi-vitamins w/ Thiamine and Folate
4. Control electolytes and fluids (inc Glucose)

Front 124

what is given to manage cocaine/amphetamine intoxication?
(2 possible meds)

Back 124

Haloperidol

or

Benzodiazepine

Front 125

A pateint enters the ER w/ confusion, ophthalmoplegia, ataxia with memory loss and a personality change and smells of alcohol.
Dx?

Back 125

Wernicke-Korsakoff syndrome

Front 126

A patient presents complaining about multiple problems in various organ systems.
Dx?
Tx? (2 in order)

Back 126

Dx: Somatization Disorder

Tx:
1. Continue to Treat w/ brief monthy visits
(fearing that if you deny Tx, then they may go to someone else costing the patient time and money)
2. Slowly begin to tell patient that Sx are psychological
(never refer to psychiatrist)

Front 127

A 50yo woman was referred by her husband’s psychiatrist because of “attacks of dizziness” that have been occurring for more than 10 years. Every day, at about 3pm, the attacks occur. They leave her helpless and, when her husband arrives, she is unable to attend to him. She remains in bed until 8pm when the attacks subsided then falls asleep. She describes her husband as someone who repeatedly abused her and their children, which resulted in their leaving home at an early age, and moving in with their grandmother. He would make comments about the house, dinner, etc. Many times, these verbal comments were followed by actual episodes of violence, several of which have resulted in her hospitalization.
Dx?
Tx?

Back 127

Dx: Conversion Disorder

(One or two neurological symptoms affecting voluntary or sensory function that cannot be explained by any known neurological disorder; as a result of stressor the person has sx like paralysis or blindness or deafness...usually from seeing, hearing or doing something wrong)

Tx: Psychotherapy

Front 128

what is "La Belle Indifference" and what disorder is it seen in?

Back 128

Seen in: Conversion Disorder

Lack of concern about being paralyzed, blind or deaf

Front 129

A patient believes that she has a specific disease, giving the actual name of the disease, regardless of reassurance that the person is healthy.
Dx?

Back 129

Hypocondriasis

Front 130

A patient believes a body part is abnormal, defective, or misshapen.
Dx?
Tx? (2 together)

Back 130

Dx: Body Dismorphic Disorder

Tx:
1. Psychotherapy
2. SSRI (or a TCA or MAOI)

Front 131

A patient with conscious production of signs and symptoms of a medical or mental disorder (example: placing blood in urine test to alter labs) to assume a sick role.
Dx?

Back 131

Factitious Disorder (Munchausen's syndrome)

If doing it to a child it is Factitous by proxy
(illness caused by a parent).
Parent should be reported to child abuse.

Front 132

A person who has conscious claims of a medical problem for a specific gain
Dx?

Back 132

Malingering

(Different from Factitious disorder b/c it is for a specific gain and not attention)

Front 133

A patient cannot remember what his name is, but remembers what he had for lunch. He is otherwise healthy.
Dx?

Back 133

Dissociative Amnesia

(This clinical picture is exactly the reverse of the one seen in dementia, in which patients may remember their names but forget general information, such as what they had for lunch. Except for their amnesia, patients with dissociative amnesia seem completely intact and function coherently. By contrast, in most amnesias due to a general medical condition (such as postictal and toxic amnesias), patients may be confused and behave in a disorganized manner. Other types of amnesias (e.g., transient global amnesia and postconcussion amnesia) are associated with an ongoing anterograde amnesia, which does not occur in patients with dissociative amnesia. This Amnesia deals with forgetting something of a stressful nature)

Front 134

Definition:
The invention of false information to cover up a gap in memory

Back 134

Confabulation

Front 135

Dx:
an acute and transient retrograde amnesia that affects recent memories such as date and location, but maintains personal information like name. Although patients are usually aware of the amnesia, they may still perform highly complex mental and physical acts during the 6 to 24 hours that the episodes usually last.

Back 135

Transient Global Amnesia

(can be due to a TIA, migraine, or seizure)

Front 136

Dx:
A patient physically travel away from their customary homes or work situations and fail to remember important aspects of their previous identities (name, family, occupation).

Back 136

Dissociative Fugue

(Such patients often, but not always, take on an entirely new identity and occupation, although the new identity is usually less complete than the alternate personalities in dissociative identity disorder, and the old and new identities do not alternate, as they do in dissociative identity disorder)

Front 137

Dx:
A patient has two or more distinct personalities, each of which determines behavior and attitudes during any period in which it is dominant. Its cause typically involves a traumatic event, usually childhood physical or sexual abuse

Tx? (2)

Back 137

Dissociative Identity disorder
(multiple personality disorder)

Tx:
Psychotherapy
Hypnotherapy

Front 138

Dx:
A persistent or recurrent alteration in the perception of the self to the extent that a person's sense of his or her own reality is temporarily lost. Patients may feel that they are mechanical, in a dream, or detached from their bodies.
Next step?

Back 138

Depersonalization Disorder

Next step: Neurologic testing
(The fact that depersonalization phenomena may result from gross disturbances in brain function underlies the necessity for a neurological evaluation, especially when the depersonalization is not accompanied by common and obvious psychiatric symptoms. In particular, the possibility of a brain tumor or epilepsy should be considered. The experience of depersonalization may be the earliest presenting symptom of a neurological disorder)

Front 139

Define:

Anterograde Amnesia

Retrograde Amnesia

Back 139

Anterograde: Ability to learn new information

Retrograde: Ability to recall previously remembered knowledge

Front 140

What type of amnesia is assoc w/ ECT?

Back 140

Retrograde (a few minutes before Tx)

and

Anterograde (for up to 5 hours after Tx)

Front 141

A 50-year-old man presents to an ED w/ a one day Hx of bilateral tremor in his hands, diaphoresis, anxiety, headache, and the sensation that "my skin is crawling". He denies other symptoms. He takes hydrochlorothiazide for HTN. He states that he sees a psychiatrist for bipolar disorder and anxiety, and that he takes three psych meds, the names of which he can not remember. He ran out of his meds three days ago. His temperature is 37 C (98.6 F), blood pressure is 150/100 mm Hg, pulse is 115/min, and respirations are 20/min. Physical examination is notable for diaphoresis and tremulousness.
What drug is the most appropriate initial step in this patient's care?

Back 141

Lorazepam

(The patient takes an unknown anxiety medication, and is most likely experiencing benzodiazepine withdrawal symptoms. Commonly observed symptoms of benzodiazepine withdrawal include: anxiety, diaphoresis, irritability, insomnia, fatigue, headache, myalgias, nausea, perceptual disturbances, tremors, and seizures. The most appropriate management step would be parenteral administration of a short-acting benzodiazepine, such as lorazepam)

Front 142

A 61-year-old woman, who has been treated with amitriptyline for depression, is brought to her psychiatrist by her family. The woman is confused, disoriented, and hallucinating, and her skin appears dry and warm. The family noticed that she took more pills than prescribed.

Dx?

Back 142

Anticholinergic delirium

(caused by the use of anticholinergics or other drugs with anticholinergic properties, like tricyclic antidepressants. In elderly patients, the symptoms can be present even with usual doses. Overdosing results in clouding of consciousness, as well as constipation, urinary retention, dry mouth, elevated temperature, dry flushed skin, worsening of glaucoma, and tachycardia)

Front 143

A 63-year-old white male who has recently retired from work as a plumber for over 30 years returns to his family physician saying that he has been feeling very down lately, and has been having decreased appetite and a loss of interest in activities that used to give him pleasure. He is a smoker, drinks no alcohol, and is being treated by his family physician for moderate essential hypertension. What is the most appropriate next step in management?

Back 143

Review the patient's medication history

(Many medications used to control hypertension, such as propranolol, and in the past, reserpine, are known to occasionally lead to depressive symptoms. By evaluation of the patient's medication record, the physician can evaluate which medications were started at what time and can make adjustments to dosage or switching to alternative medications to control hypertension)

Front 144

A woman who attends weekly psychotherapy sessions becomes furious at her psychiatrist, who is about to leave for vacation and is not willing to reveal where he is going. She angrily says that he is just like her father, who always had his own "own life" outside the family. What best describes this patient's reaction?

Back 144

Transference

(Transference is defined by psychoanalysts as a patient's unconscious feelings and behavior toward the analyst that are based on infantile wishes the patient has toward parental figures)

Front 145

A 44-year-old, HIV-positive patient has been treated for Pneumocystis carinii pneumonia in the hospital. He has a prior history of depression and was treated with paroxetine, which was continued in the hospital. While in the hospital, he became delirious and had visual hallucinations. The psychiatry consult team started him on olanzapine. The patient's delirium gradually resolved, but prior to discharge he complained that his urine stream became weak and his bladder felt full. On examination, the physician confirmed lower abdominal distention. What medicine is the most effective treatment?

Back 145

Bethanechol

(Bethanechol is direct-acting cholinergic stimulant effective in reducing the peripheral anticholinergic effects of some psychotropic medications. It can be administered intramuscularly, orally, or subcutaneously to efficiently relieve the symptoms of urinary retention)

Front 146

A 24-year-old man was recently hospitalized in a psychiatric unit, where he was started on olanzapine. Upon visiting his new primary care physician for a routine physical examination prior to participating in a vocational rehabilitation program, his physician notices that his thoughts are quite illogical. For example, when she asks the young man what sort of employment he hopes to work toward, he answers, "if you subtract some yellow from the sky, it becomes greener." After a brief silence, he then states, "telephone bills should never exceed twenty dollars ... according to the Book of Numbers." What mental status examination finding most accurately describes this patient's thought processes?

Back 146

Loose Associations

(His ideas are disconnected and seem to jump from one topic to an unconnected topic. Loose associations are one of the characteristic signs of a primary thought disorder, such as schizophrenia)

Front 147

Dx:
poor ability to think in abstract terms, despite normal intelligence

Back 147

Concrete thinking

Front 148

Dx;
when thoughts and speech halt, often in mid-sentence, as if forgotten. The idea may be picked up later, after a period of apparent confusion

Back 148

Thought Blocking

Front 149

Define:
a person's biological sexual characteristics: chromosomes, external genitalia, internal genitalia, hormonal composition, gonads, and secondary sexual characteristics

Back 149

Sexual Identity

Front 150

A 40-year-old man is admitted to the hospital for evaluation and treatment of depression associated with suicidal thoughts. He denies any past psychiatric history. His medical history is significant for hypertension, for which he currently takes hydrochlorothiazide. He also describes a history of once having a painful erection that lasted for eight hours and had to be treated with intracavernous injections in the emergency room. He states that this was thought to be related to an antihypertensive medication that he used to take. During the treatment of this man's psychiatric condition, what medication should be avoided?

Back 150

Trazodone

(Trazodone is an older antidepressant medication that is commonly used in lower doses for the treatment of insomnia associated with depression. Due to its significant alpha-adrenergic blocking properties, it has been associated with priapism)

Front 151

A 28-year-old man presents to his primary care physician for his yearly physical examination. He currently smokes approximately one pack of cigarettes a day and is interested in quitting. He has no significant past medical history and has no allergies. He is interested in smoking cessation classes, but would like additional help. What medication would be the most appropriate agent for treating nicotine dependence in this patient? (spell it)

Back 151

Bupropion (Wellbutrin)

Front 152

A 72-year-old man with a history of renal dysfunction, congestive heart failure, and previous myocardial infarction is currently undergoing dialysis. Over the past few weeks, he has been feeling increasingly depressed and has begun to act bizarrely, with persecutory delusions that the government is poisoning the chemicals used on him for dialysis. Also in the last few weeks, due to increased stomach pain, his medications have been adjusted and now include cimetidine for stomach ulcers, digoxin, and a baby aspirin daily. He also takes docusate sodium as needed for stool softening and ibuprofen as needed for mild arthritis pain. Which of the medications would be most likely to have induced the symptoms the patient is now experiencing?

Back 152

Cimetidine

(the only drug listed known to cause psychiatric effects of clinical significance, including delusions and psychosis. The exact mechanism is unknown, but is thought to be related to the effects of cimetidine on the H-2 histamine receptor in the brain. The treatment of cimetidine-induced psychosis is to reduce the dosage of the medication, and discontinue it if an alternative therapy is available)

Front 153

A 34-year-old man is admitted to the psychiatric temporary observation unit complaining of depression and suicidal ideation following a cocaine binge. During his stay, he starts feeling as if insects are crawling under his skin. This is most typical of what phenomena?

Back 153

Formication

(a form of haptic hallucinations, associated with the sensation of touch. It is commonly seen in delirium tremens, amphetamine psychosis, and cocaine intoxication)

Front 154

A 20-year-old white man is brought to the emergency clinic by two friends on a Sunday morning after a fraternity party the night before. His friends note that since the party, he has been very belligerent, agitated, and loud. They suspect that he may have used drugs with some friends at the party. His temperature is 37 C (98.6 F), blood pressure is 145/95 mm Hg, pulse is 105/min, and respirations are 20/min. Physical examination reveals slurred speech, unsteady gait, and nystagmus. The patient appears to be responding to auditory hallucinations.
Dx?

Back 154

Phencyclidine (PCP) intoxication

(intoxication is characterized by maladaptive behavioral changes, and may be associated with vertical or horizontal nystagmus, hypertension, tachycardia, numbness or decreased response to pain, ataxia, dysarthria, muscle rigidity, and seizures; not alcohol withdrawal b/c of the nystagmus)

Front 155

A 25-year-old woman presents to the emergency department complaining that she is having auditory hallucinations and tremors, along with associated nausea and vomiting. She feels very anxious. On mini-mental status examination, she scores 22 of 30, and she appears to be obtunded. From what substances is this patient most likely withdrawing?

Back 155

Benzodiazepines, such as alprazolam (Xanax)

(Symptoms include insomnia, tremor, gastrointestinal distress, hallucinosis, and anxiety. Withdrawal from benzodiazepines can also be accompanied by generalized seizures)

Front 156

A 68-year-old woman with hypertension comes to the physician because of decreased appetite, fatigue, insomnia, inability to concentrate, and feelings of worthlessness over the past two months. She states that her grandchildren are coming to stay with her for three weeks and she "wants to get to the bottom of this" before they arrive. Her antihypertensive medication was changed three months ago. What antihypertensive medication is the most likely cause of the patient's new symptoms?

Back 156

Propranolol

(The symptoms of change in appetite, fatigue, insomnia, lack of concentration, and worthlessness for greater than 2 weeks are consistent with depression. Propranolol is one of the most common pharmacological agents to cause depression. Other side effects of propranolol include dizziness, bronchospasm, nausea, vomiting, diarrhea, and constipation. It may also precipitate asthma, congestive heart failure, and hypoglycemia in susceptible patients)

Front 157

A medicine consult is requested on a 32-year-old woman with paranoid schizophrenia who is a patient in a closed psychiatric unit. Several days after the patient's admission, she developed polyuria, vomiting, stupor, diarrhea, and restlessness. She is currently taking risperidone, 10 mg given at bedtime, but no other medications. What is the most likely diagnosis?

Back 157

Water Intoxication

(This patient is showing the symptoms of psychogenic polydipsia, which is the excessive intake of water as a result of a psychiatric disorder. The symptoms of excessive water intake include polyuria, vomiting, and diarrhea. As the patient is on a closed psychiatric unit, the chances of reactions to excessive medications are rare, given the careful monitoring of medication intake on most psychiatric units. Surreptitious water consumption would be easy to overlook in a patient without a previous history)

Front 158

What Dx can occur to an infant if the mother uses Benzodiazepines in the first trimester?

Back 158

Cleft Palate

(During the first trimester of pregnancy, the use of benzodiazepines increases the risk of cleft palate 10-fold)

Front 159

A 29-year-old, previously successful woman was climbing stairs in her new home about a month ago, when the whole house fell apart. She ended up in a hospital with a fractured left femur. The psychiatry team was consulted because the patient complained of nightmares and flashbacks and was afraid to go to sleep as a result. During the interview, she is tearful, and afraid that her fear of falling is preventing her from participating enough in her rehabilitation, and that the team will discharge her from hospital.
Dx?
What is the most appropriate med for this patient?

Back 159

Dx: Posttraumatic Stress Disorder (PTSD), as well as depressive symptoms

Tx: Sertraline - SSRI
(an antidepressant approved for treatment of this disorder. Other antidepressants and anticonvulsants have also been shown to be effective in the treatment of PTSD)

Front 160

A young woman who sustained minor injuries after a motor vehicle accident is admitted to the hospital. During the observation period, the intern notices that the patient's vital signs are all increased, and she seems confused, disoriented, and delirious. On admission, she states she has been using medication to help with anxiety for couple of months. However, she ran out of it 2 days prior to the accident. From what medication is this patient most likely experiencing withdrawal?

Back 160

Alprazolam is a short-acting Benzodiazepine

(It has a rapid onset of action and a relatively short half-life. It is indicated for treatment of panic attacks and anxiety disorders in general. Given its properties, however, it also has a highly addictive potential. The abrupt discontinuation of its use may result in withdrawal delirium, seizures, or death)

Front 161

Abrupt discontinuation of what psychiatric drug class can lead to Flu-like symptoms?

Back 161

SSRI

Front 162

A woman comes to the clinic with her 13-year-old grandson, stating he has had behavioral problems for the past 4 years. He is living with her now because his mother is in drug rehabilitation center. She describes that he has run from home twice and has been kicked off the school bus for threatening other kids and challenging the driver. He is about to be expelled from school, since he was caught extorting money from other children. What is the most likely diagnosis?

Back 162

Conduct disorder

(a childhood/adolescent disorder defined as a pattern of behavior in which the basic rights of others are violated with three or more of the following present in the past 12 months: destruction of property, cruelty to animals and people, deceitfulness or theft, and serious violations of rules. It causes clinically significant impairment in social functioning and it is reserved for patients younger than 18)

Front 163

A parent comes to you to talk about their 16yo who, in the past 7 months, has had a loss of temper, arguments with adults, defying of rules, deliberately annoying other people, blaming others for own faults, presence of vindictive behavior, presence of anger, and resentment.
Dx?

Back 163

Oppositional Defiant Disorder

(a pattern of negativistic and defiant behavior lasting at least 6 months with four or more of the following: loss of temper, arguments with adults, defying rules, deliberately annoying other people, blaming others for own faults, presence of vindictive behavior, presence of anger, and resentment)

Front 164

A 27-year-old woman is 2 weeks' postpartum with her first child. During her first postpartum follow-up visit, she complains to her physician that she has had several crying spells and has been increasingly irritable; however, she has had some spells during which she has felt almost euphoric. She has had these symptoms over the past week. She has not had any previous psychiatric disorders. What is the most likely diagnosis?

Back 164

Maternity Blues

(a normal state of sadness, dysphoria, frequent tearfulness, and dependence that about 20% to 40% of women experience in the postpartum period. It is thought to be derived from rapid changes in women's hormonal levels and the stress of childbirth associated with maternity)

Front 165

A 27-year-old woman is 2 weeks' postpartum with her first child. During her first postpartum follow-up visit, she complains to her physician that she has had several crying spells and has been increasingly irritable; however, she has had some spells during which she has felt almost euphoric. She is also hearing voices which drives her to the point of wanting to commit suicide. She has had these symptoms over the past week. She has not had any previous psychiatric disorders. What is the most likely diagnosis?

Back 165

Postpartum psychosis

(a serious diagnosis that requires the presence of auditory or visual hallucinations in addition to frequent suicidal and sometimes infanticidal ideation)

Front 166

A 43-year-old woman presents to the emergency department complaining of dizziness, tremor, diaphoresis, and shortness of breath. She indicates to the physician that she has come into the hospital with similar complaints twice in the past several weeks. On those occasions, as well as currently, her physical examination, routine laboratory studies, ECG, and cardiac enzymes have all been unremarkable. The patient states that these episodes are starting to concern her greatly and she is worried about going out of her house alone now. What is the most likely diagnosis?

Back 166

Panic Disorder

(This patient's symptoms are all suggestive of panic attacks. Her symptoms do not appear to be related to substance use or a general medical condition. The frequency of her symptoms and her agoraphobia are also indicative of a diagnosis of panic disorder)

Front 167

A 24-year-old graduate student and teaching assistant comes into the student health center after being instructed by his college dean to seek counseling. According to the collateral history obtained from the patient's roommates and instructors, the man exhibits annoyingly grandiose behavior, is frequently demanding of his peers' admiration, and has had to be reprimanded for treating his undergraduate students without empathy or understanding in demanding that their work be submitted in two different forms for each assignment. Given this history, what is the most likely diagnosis?

Back 167

Narcissistic personality disorder

(patients frequently demand constant attention and admiration, and they are often indifferent to criticism. They frequently exhibit grandiosity in behaviors or fantasies, show lack of empathy, often exhibit a sense of entitlement, and frequently exploit whatever interpersonal relationships they have developed)

Front 168

A mother brings her 8-year-old son to a psychiatrist for new-onset enuresis. A prior workup to determine a medical cause was negative. In conversation, it seems that the enuresis started following parental arguments and separation. The boy wets himself at least twice a week and feels upset about it, refusing to go for a sleep-over at his friend's house. What is the most commonly used treatment for this condition?

Back 168

Behavioral therapy

(the most frequently used treatment in children with enuresis. Dry nights are recorded on a calendar and rewarded with a star as a gift)

Front 169

A 35-year-old man is brought to the emergency clinic by his mother because of an episode of slurred speech associated with the uncomfortable sensation that his tongue is thick and curling up. The episode started suddenly 30 minutes ago. The patient is noted to be holding on to his tongue with his thumb and forefinger. When asked about this, the patient responds with dysarthria, saying that his medication has caused this once before and that he needs a shot to make it go away. His mother reports that the patient has had schizophrenia for 10 years and consistently takes two medications prescribed by his psychiatrist. Several days ago he ran out of one of his medications, but has continued to take the other one. What is the most appropriate initial step in the management of this patient?

Back 169

Quickly administer an Anticholinergic meds IM

(The patient is experiencing an acute dystonic reaction, which is a form of extrapyramidal side effect (EPS) associated with antipsychotic medications. These side effects are related to antagonism of dopamine receptors in the nigrostriatal pathway. The patient is likely taking a conventional antipsychotic agent plus a prophylactic anticholinergic agent (such as benztropine, diphenhydramine, or trihexyphenidyl). Upon stopping the anticholinergic, the dystonic reaction was more likely to occur. The appropriate initial management of this patient would include immediate IM administration of an anticholinergic agent, such as 2 mg of benztropine or 50 mg of diphenhydramine)

Front 170

A 45yo woman presents to her physician because of blurred vision for 2 days. She has no medical Hx. She does state that several days ago she started Tx for depression with a psychiatrist, due to a two-month period during which she had several depressive symptoms. She has a dry mouth and dizziness when she stands up from lying or sitting. Her temperature is 98.6 F, BP lying down is 135/75 mm Hg, BP standing is 110/64 mm Hg, pulse lying down is 84, pulse standing is 95, and respiratory rate is 16/min. Examination is unremarkable except for mild mydriasis.
What medication accounts for this patient's symptoms?

Back 170

TCA (Imipramine)

(inhibits norepinephrine and serotonin reuptake. Like most TCAs, imipramine also has antagonistic effects at muscarinic, histaminic, and a-adrenergic receptors. This patient's complaint of blurred vision is most likely due to the antimuscarinic effects of the medication. The blockade of muscarinic acetylcholine receptors causes mydriasis (pupillary dilation) resulting in blurred vision. Dry mouth is also due to the anticholinergic effect of imipramine. Orthostatic hypotension is caused by the a1-adrenergic receptor blockade associated with TCAs)

Front 171

A 19-year-old student is admitted to the psychiatry inpatient unit with the working diagnosis of first-break psychosis. Because of combativeness and threats to others, he is put in seclusion. At first, he refused to take medication by mouth; however, after attacking a nurse he is given haloperidol intramuscularly on two occasions. He has now developed acute torticollis and twitching of the mouth and face on that side. The family is furious, stating that the treatment caused the seizures. What reaction did this patient most likely have?
Tx?

Back 171

Acute Dystonia

(an involuntary spasm of a particular group of muscles that can involve the neck, jaw, tongue, eyes, or the entire body. It can be an early adverse effect of antipsychotics, and it is more common in younger men. It is more common with typical antipsychotics)

TX: parenteral administration of anticholinergics
(Benztropine)

Front 172

A 45-year-old woman returns to her psychiatrist two months after being hospitalized for an episode of major depressive disorder, recurrent, severe with psychotic features. At the hospital, she was started on two meds, an antidepressant and an atypical antipsychotic. At her appointment, she complains to her physician that she has missed her menstrual period for two months. She also complains of tenderness in her breasts, and an occasional small amount of milky discharge from her breasts onto her blouse. She also admits to low libido over the past month. What medication is most likely responsible for this constellation of symptoms?

Back 172

Risperidone

(Although it is an atypical antipsychotic, it is like conventional antipsychotics in its ability to cause significant elevations in plasma prolactin levels. In the tuberoinfundibular dopamine pathway, dopamine inhibits the release of prolactin from the anterior pituitary. Conventional antipsychotics and risperidone can cause hyperprolactinemia due to their dopamine antagonism in this pathway, releasing the tonic dopamine inhibition. Clinical manifestations of hyperprolactinemia may include galactorrhea, sexual dysfunction, menstrual irregularities including amenorrhea, infertility, and weight gain)

Front 173

A 42-year-old, unemployed laboratory technician is admitted to the hospital for nausea, vomiting, and abdominal pain. She tells the physician that she had been diagnosed in the past with disseminated lupus erythematosus and that she had Hodgkin disease. She seems worried that an extensive medical workup failed to confirm any of the previous diagnoses or find a cause of her actual symptoms. She insists on being given meperidine to relieve her pain. On examination, the only physical findings are scars and some abscesses on her thighs. She explains that she had been intentionally injured by the nurses in a previous hospital. What is the most likely diagnosis?

Back 173

Factitious disorder

(the individual deliberately feigns the signs of a medical or mental disorder to assume the "sick" role. The symptoms are under voluntary control and cannot be explained by other underlying condition. External incentives for such behavior are usually absent. The disorder is severely incapacitating to the patients, since they usually have multiple hospitalizations and submit themselves to invasive procedures and surgeries. This is unlike Hypochondriasis which involves the excessive and pervasive preoccupation with the fear of having a serious illness based on a misinterpretation of bodily symptoms. It must be present at least 6 months and causes significant impairment in all areas of life)

Front 174

A 43yo woman w/ a long Hx of Schizophrenia complains of a loss of night vision. What medication is she taking?

Back 174

Thioridazine

Front 175

A 28yo man w/ a Hx of psychiatric admission 6 months previously is seen in the ED w/ a painful erection, which has persisted for 18 hours. What is the next best step?
What drug is he using?

Back 175

Next step: Epinepherine injection into Penis

Drug: Trazodone

Front 176

A 57yo woman complains of feeling dizzy when she gets up in the morning and when standing. She takes imipramine each evening for depression. What physiologically is the cause of her Sx?

Back 176

Alpha-Adrenergic Blockade

Front 177

A 34yo man is seen in the ED w/ HA, dizziness and BP of 210/150. He has no medical problems, states he is feeling fine and says last night he had a nice meal with red wine and french cheese. What possible medications is he taking?
(2)

Back 177

Phenelzine

or

Tranylcypromine

Front 178

A 22yo college student who enjoys drinking beer attempted to take a SSRI for his depression but was upset with the side-effects. He switched to another class and several days later he was admitted to the ED w/ muscle spasms, confusion, fever, tachycardia and HTN. What was the cause?

Back 178

Serotonin Syndrome

(switched from SSRI to MAOI w/o giving enough time between the meds to flush the excess SSRI out of the system. Five weeks should elapse before switching from an SSRI to a MAOI)

Front 179

A 17yo adolescent w/ Bulemia is very depressed. She is also suffering from insomnia and apathy. Why should she avoid Bupropion?

Back 179

It can lower Anorectic effects

(and seizure threshold in person w/ seizure disorder)

Front 180

A 38yo woman is admitted to the hospital for an elective Hysterectomy. On post-op day 3 she experiences auditory and visual hallucinations, tremors and agitation.
What is the best therapy?

Back 180

Benzodiazepine

(she is probably experiencing an alcohol or Benzo withdrawal; this is Tx)

Front 181

A 25yo man w/ bipolar disorder took too many pills, had 2 seizures and is now in a coma.
What is the best therapy?
What drug caused this?

Back 181

Drug: Lithium

Therapy: Dialysis

(Dialysis is used to Tx lithium toxicity, when it is severe and life-threatening)

Front 182

A 38yo Schizophrenic woman feels restless and cannot sit still; her physician thinks this is due to her medication.
What can be given to calm her?
What is this Dx?

Back 182

Tx: Propranolol

Dx: Akathisia

Front 183

A 32yo woman w/ panic disorder and anxiety took an overdose of Diazepam and is taken to the ED w/ somnolence and hypoventilation.
What is the best Tx?

Back 183

Flumazenil

Front 184

A 30yo man being Tx for schizophrenia complains of tremor and a slow gait.
What is the best Tx?
(2)

Back 184

Amantidine or Levodopa

(for the Drug-induced Parkinsonism)

Front 185

After taking a SSRI for weeks to months, what is a side effect a Woman may complain of?

Back 185

Anorgasmia

Front 186

What is the Tx for a patient that develops Neuroleptic Malignant Syndrome?
(3)

Back 186

Mostly supportive therapy, but the following drugs are also used:

Bromocriptine;
Amantidine;
Dantrolene

Front 187

What is the definitive Tx for Tardive Dyskinesia?

Back 187

Nothing--it is a permanent condition

Front 188

what is the best Tx for EPS, such as Dystonic reactions?(2)

Back 188

Tx:

1. Benztropine
(an Anticholinergic med)

2. Reducing the dose of the Antipsychotic

Front 189

A 33yo man thinks he is "going to have a heart attack like his father". He explains his father died at 45 of a MI. He is experiencing angina attacks consisting of nervousness, sweating, palpitations, flushing and numbness in his hands lasting 5 minutes. He is anxious about having these Sx despite negative lab results and ECGs.
Dx?

Back 189

Panic Disorder (w/o Agoraphobia)

Front 190

A 33yo female who is being treated for hypothyroidism is beginning to get panic attacks.
Dx?

Back 190

Dx: Synthroid-induced panic attacks

Front 191

What is a common defense mechanism seen in Dependent Personality Disorder?

Back 191

Idealization

Front 192

(3) Possible drug Tx for Generalized Anxiety Disorder

Back 192

Buspirone
(not good to give after Benzo; starts to work in 2-3 weeks);

Benzodiazepines;

SSRIs

Front 193

Dx:
A person with 4 or more episodes of mania in a year

Back 193

Rapid Cycling Bipolar Disorder

Front 194

What is the drug Tx for someone experiencing acute Mania?
(2 together)

Back 194

Mood Stabilizer and Antipsychotic

(then take patient off the anti-psych as soon as Sx go away)

Front 195

When is ECT used first in a Depressed patient?
(3)

Back 195

Suicidal;

Catatonic;

Not eating or drinking

Front 196

What medication causes sickness to those trying to stop alcohol dependence?

Back 196

Disulfiram
(blocks Acetylaldehyde DH)

Front 197

what medication decreases cravings of alcohol in patients who are alcoholics?

Back 197

Naltrexone

Front 198

How do you know if Wernicke's progresses to Wernicke-Korsakoff?

Back 198

Anterograde Amnesia develops

Front 199

A 32-year-old man is in twice-weekly insight-oriented psychotherapy with a psychiatrist. Recently, the patient has been exploring his thoughts and feelings around his wife's complaint that he is too restricted and inhibited in their sexual activity. The patient admits that he wishes to be more sexually available for his wife, but finds himself maintaining a restricted stance. What defense mechanisms would best describe this patient's tendency in his sexual relationship with his wife?

Back 199

Reaction formation

(often seen in obsessional characters, is the term for the defense mechanism in which an unacceptable impulse is transformed into its opposite. In this case, during insight-oriented psychotherapy, the patient realizes his wish to be freer in his sexual relationship with his wife, an impulse which he finds unacceptable on some level, but finds himself responding in the opposite way by maintaining a restricted stance)

Front 200

What defense mechanism occurs when a socially acceptable means of expressing an impulse replaces one that would be socially unacceptable?

Back 200

Sublimination

(a SUBstitution that allows instincts to be channeled, rather than blocked or diverted)

Front 201

A 26yo man is brought to the ED for schizophrenic symptoms. During examination, the patient appears to be awake, but firmly resists any attempts to be moved. He does not follow instructions, and the nurse was unable to move his arm to obtain a blood pressure measurement without assistance.
What term would best describe this patient's resistance to being moved?

Back 201

Negativism

(a motiveless resistance to all attempts to be moved or to all instructions. Signs of catatonia include stupor, negativism, rigidity, posturing, mutism, stereotypies, mannerisms, waxy flexibility, and catatonic excitement. Catatonia may be associated with schizophrenia of the catatonic type, mood disorders with catatonic features, or general medical conditions)

Front 202

Dx:
a pathological imitation of the movements of one person by another. It can be seen in catatonia, delirium, dementia, and other disorders.

Back 202

EchoPRAxia

(PRActices your behavior; not to be confused w/ Echolalia - repeating words or phrases)

Front 203

Dx:
a repetitive fixed pattern of physical action, movement, or speech. It may be seen in catatonia

Back 203

Stereotypy

Front 204

A 53-year-old woman is admitted for depression with psychotic features. During the examination, the psychiatrist asks her whether she has ever had problems with her heart. The patient responds, "What are you saying? I don't have a heart any more; there is nothing left inside me." What is the patient most likely exhibiting?

Back 204

Nihilistic delusions

(False feelings that the self or others do not exist or are destroyed. It is typical for depression with psychotic features. At its extreme, it is called Cotard's syndrome. The patient complains that he or she has lost possessions, status, strength, heart, blood, and intestines, and that the world has been reduced to nothingness)

Front 205

Hallucination type:
a false sensation of things occurring in or to the body, most frequently of visceral origin

Back 205

Cenesthetic hallucination

Front 206

Dx:
a disorder of thought process in which a patient meaninglessly repeats certain phrases or words

Back 206

Verbigeration

Front 207

A 28-year-old woman with a history of paranoid schizophrenia is brought by a friend to the hospital. The woman had been an inpatient at a psychiatric hospital; for several months after being discharged, she had been maintained on haloperidol decanoate shots. For the past couple of days, after the last injection, she has appeared "strange." She is stiff, cannot swallow or talk, and appears tremulous. The friend is concerned that she has some kind of infection, since she has a fever. On examination, her temperature is 38.7 C (101.7 F), blood pressure is 157/104 mm Hg, pulse is 122/min, and respirations are 24/min. She has increased tone in her neck and extremities, and appears tremulous, diaphoretic, and confused. Her leukocyte count is 19,600/mm3 and the serum creatine phosphokinase is markedly elevated. A workup for infection is negative. What is the most likely diagnosis?

Back 207

Neuroleptic malignant syndrome (NMS)

(A rare complication of neuroleptic therapy that confers high mortality if not recognized and treated promptly. It is defined by the development of severe muscle rigidity and elevated temperature in association with at least two or more of the following: dysphagia, tremor, diaphoresis, tachycardia, change in level of consciousness, leucocytosis, elevated or labile blood pressure, and elevated creatine phosphokinase as an indicator of muscle injury. The predisposing factors include high neuroleptic doses, intramuscular injections, and lithium treatment)

Front 208

A 49-year-old woman, who is being treated with chemotherapy after surgery for breast cancer, presents at the emergency department of the local hospital. She had just started taking prochlorperazine for nausea the day before. She is brought in by the her husband because she has been acting bizarrely over the past 24 hours, with waxy flexibility in her movements and mutism. She has no previous psychiatric history. Her physical examination, laboratory tests, and vital signs are all within normal limits. What is the most appropriate pharmacotherapy?

Back 208

Benztropine

(Prochlorperazine (Compazine) is frequently used to treat nausea and emesis in some patients. Side effects of this medication, including extrapyramidal reactions (e.g., catatonia), are treated best by anticholinergic / antiparkinsonian medications such as benztropine)

Front 209

A patient is seen on the psychiatry consultation liaison service by a medical student. To assess the patient's cognitive functions, the student asks the patient what the proverb "Don't cry over spilled milk" means. The patient answers that if you spill what you cook, you have to do it all over again. What type of thinking is this patient most likely exhibiting?

Back 209

Concrete Thinking

(Literal thinking that shows a lack of understanding of the nuances of meaning. These individuals lack the ability to use metaphors)

Front 210

What is it called when a patient has the ability to appreciate nuances of meaning and the ability to use metaphors and hypotheses appropriately?

Back 210

Abstract Thinking

Front 211

A 30-year-old woman presents to her primary care physician with multiple symptoms of depression. She complains of about 2 months of feeling sad and anxious. She describes difficulty falling asleep at night, decreased appetite with a 15 lb weight loss, diminished interest in her hobbies, and poor concentration. The patient denies any other problems. Physical examination is within normal limits. The patient and her physician discuss initiating treatment with a selective serotonin reuptake inhibitor (SSRI). Aside from sexual consequences, what would be the most important additional information to gather before starting the SSRI?

Back 211

Past history of hypomanic or manic episodes

(This might significantly alter treatment planning. It is likely that all antidepressants, including SSRIs, have a potential to cause a switch into hypomania or mania, or to accelerate cycling in patients with bipolar disorder. If the patient has a history of hypomanic or manic episodes, her depression would be considered a bipolar depression rather than a unipolar depression. In this case, the patient would likely need to be started on a mood stabilizer before beginning treatment with an antidepressant medication)

Front 212

A 40-year-old man is brought in for evaluation by the Coast Guard after the small plane he was piloting crashed into the ocean. The man's wife and two friends were also on the plane. The man has survived the crash with cuts and a broken arm, but he claims he has no memory of the crash or how he escaped the plane. He is also unable to explain how he got his life jacket on. His physical examination now is significant only for minor lacerations and a fractured right humerus, and he has no alteration in consciousness. A CT scan is normal. He is very upset that the fate of his wife is unknown, and he has nightmares for the next several nights while trying to sleep. What is the most likely diagnosis?

Back 212

Dissociative Amnesia

(an extremely stressful event has been followed by localized loss of memory or amnesia of circumstances surrounding the event, making the diagnosis of dissociative amnesia the most likely diagnosis. Dissociative amnesia is often accompanied by nightmares and anxiety concerning the event, both of which this patient also has)

Front 213

A 26-year-old man presents to his primary care physician complaining that he has been more and more afraid to leave his house because he has been having frequent anxiety attacks that occur without warning. He is worried that he will have an attack at some time while he is in public. What is the most appropriate initial medication for this patient in an acute situation?

Back 213

a Benzodiazepine

(This patient's symptoms suggest that he has panic disorder, which is most appropriately treated acutely with a benzodiazepine with a medium length half-life and duration of action, such as clonazepam)

Front 214

A 22-year-old African American male is admitted to a psychiatric unit for stabilization of an acute episode of psychosis. He has experienced several weeks of depressive and psychotic symptoms, and has had periods of anxiety and aggression associated with psychotic symptoms and anger about his involuntary civil commitment. He has been started on an antidepressant, an antipsychotic, and has required additional medications on several occasions for agitation. On the fifth day of his hospitalization, he develops a sustained muscular contraction involving his left neck muscles, with associated pain and distress.
Dx?

Back 214

Acute Dystonia

Front 215

Dx:
A condition in which the patient has signs and symptoms of pregnancy. It is related to conversion symptoms and can be viewed as a psychosomatic disorder.

Back 215

Pseudocyesis

Front 216

A 40-year-old woman is brought to the hospital after overdosing on alcohol and pills. In talking to a psychiatrist, she denies any prior psychiatric problems but says that about a week ago her apartment burned down. She was trying to get a job before that happened, but when she realized that she had lost everything she had, and that moving in with her family would probably not be possible, she decided to take her own life. What is the most likely diagnosis?

Back 216

Adjustment Disorder

(A set of behavioral or emotional symptoms developing as a response to an identifiable stressor within 3 months after exposure to the stressor. The symptoms are excessive compared with what one would expect from the exposure, and they cause marked impairment in social functioning)

Front 217

A 52-year-old man is recuperating in a hospital after having sustained a recent cerebrovascular accident that damaged part of his right temporal lobe. Once the patient has recuperated from the immediate effects of his stroke, to what psychiatric disorder will he be most predisposed?

Back 217

Major Depressive Disorder

(Any event that affects the vasculature, such as a myocardial infarction or a cerebrovascular accident (CVA), has been shown to increase the risk of major depressive disorder in the months following such an event. The pathophysiology of such a development is unclear, but is thought to be related to the effects of serotonin on vascular physiology)

Front 218

A 26-year-old man with schizophrenia comes to the emergency department with a 2-hour history of involuntary contractions of the muscles in his neck. He states that he was watching television and "all of a sudden I turned my head and my neck locked". He began taking a high-potency antipsychotic agent 3 days earlier. Examination shows no abnormalities except torticollis. What is the most appropriate pharmacotherapy?

Back 218

Benztropine

(The treatment of acute dystonia is with anticholinergic medications, such as benztropine or diphenhydramine)

Front 219

A 22-year-old white woman comes to a psychiatrist's office after having been referred by her family physician. She reports no mental problems but tells the psychiatrist that she is concerned about hair loss. Her mother says that the patient has been grooming herself frequently and checking her image in the mirror. Her family physician has examined her several times; there is no evidence of hair loss. He has run multiple tests, but there is no evidence of any abnormality. The woman states that she is embarrassed and tries to avoid going out because everyone "will notice" and ask questions. She denies pulling her hair. Despite this problem, she is still doing well on her job. What is the most likely diagnosis?
Tx? (2 possible)

Back 219

Body dysmorphic disorder

(The preoccupation with an imagined defect in appearance or excessive preoccupation with a slight anomaly present. Patient are often ashamed to present for treatment. They may frequently check their image and try to compensate for the imagined defect. The disorder leads to social isolation secondary to imagined mockery)

Treatment:
1. prevention of iatrogenesis
2. SSRI

Front 220

A 69-year-old patient is admitted to the neurology service following a stroke. During the next few days, the staff observes that the patient has developed the clinical picture of mania. What area of the brain has most likely been affected by the stroke?

Back 220

Right Frontal Lobe

(or other parts of right hemisphere)

Front 221

A 69-year-old patient is admitted to the neurology service following a stroke. During the next few days, the staff observes that the patient has developed catastrophic reactions that include restlessness, hyperemotionality, irritability, and sudden outbursts of emotion. What area of the brain has most likely been affected by the stroke?

Back 221

Left hemispheric lesions including Broca's area

Front 222

A 69-year-old patient is admitted to the neurology service following a stroke. During the next few days, the staff observes that the patient has developed the clinical picture of depression. What area of the brain has most likely been affected by the stroke?

Back 222

Left Prefrontal Cortex

Front 223

A 69-year-old patient is admitted to the neurology service following a stroke. During the next few days, the staff observes that the patient has developed the clinical picture of Peduncular Hallucinosis (dreamlike hallucinations). What area of the brain has most likely been affected by the stroke?

Back 223

Midbrain lesions

Front 224

A 10-year-old boy diagnosed with attention deficit/hyperactivity disorder (ADHD) comes to a new doctor for the first time. His mother reports that they moved recently to the city, but that he was started on a medication for his ADHD by his previous doctor. After learning which medication the patient has been taking, the doctor becomes concerned about the patient's liver function. What medication is the patient most likely taking?

Back 224

Pemoline

(A sympathomimetic agent approved for the treatment of attention deficit/hyperactivity disorder. Given the rate of reported cases of hepatic failure, which ranges from 4 to 17 times higher than expected in general population)

Front 225

A 22-year-old woman with anorexia nervosa and a history of depression, for which she is currently taking bupropion, moves to a new city and presents to a local psychiatrist to establish care in her new location. She tells the doctor that she has been on the same dose of bupropion since she was 18 years old, and that her depression has been stable, but that she has lost 10 pounds over the last month and weighs only 90 pounds (41 kg) now with a height of 5 feet 5 inches (165 cm). What medicine complication should the physician be most concerned?

Back 225

Seizures

(Bupropion is an antidepressant that can lower the seizure threshold for some patients, and as a result should be discontinued or carefully monitored in a patient with anorexia nervosa. Patients with anorexia are at increased seizure risk related to large fluid shifts and electrolyte disturbances caused by bingeing and purging behavior)

Front 226

Thought Process Disorder:

Using Made-up words

Back 226

Neologisms

Front 227

Thought Process Disorder:

the point of conversation is reached after a long, circuitous path

Back 227

Circumstantiality

Front 228

Affect type:

Laughing one second and crying the next

Back 228

Labile affect

Front 229

Delusion Type:

Belief that some event is uniquely related to the individual
("Jesus is speaking to me through TV characters")

Back 229

Ideas of Reference

Front 230

Name (4) Typical Antipsychotics

Back 230

("-AZINEs") + Haloperidol:

ChlorpromAZINE;
ThioridAZINE;
FluphenAZINE;
Haloperadol

Front 231

What are the (2) suffixes (endings) for Atypical Antipsychotics?

Name (4) drugs

Back 231

("-APINE") or ("-IDONE"):

ClozAPINE;
OlanzAPINE;
QuetiAPINE;
RisperIDONE;
(ZiprosIDONE)

Front 232

A 28yo woman taking care of her schizophrenic husband starts believing her husband's claim that he invented the telephone. When she went abroad a few months her belief disappeared.
Dx?

Back 232

Shared Psychotic Disorder

Front 233

Dx:
A type of depression characterized additionally by hypersomnia, hyperphagia, reactive mood, leaden paralysis and hypresensitivity to interpersonal rejection

Back 233

Dx: Atypical depression

Front 234

First-line Tx for Adjustment Disorder

Back 234

Supportive Psychotherapy

Front 235

What is a common defense mechanism of Histrionic Personality Disorder?

Back 235

Regression

(reverting to childlike behaviors)

Front 236

how do you differentiate Dependent Personality Disorder from a dependence of a debilitated person?

Back 236

DPD features must manifest before early adulthood

Front 237

Dx:
An overweight woman starts a diet, loses 5 pounds, and then says she's taking a break from the diet because she "hasn't been feeling well."

Back 237

Passive-Aggressive Personality Disorder

(stubborn, inefficient procrastinators that manipulate others to do their chores or errands while complaining about their own mifortune)

Front 238

What is the Tx of choice for all Personality Disorders?

Back 238

Psychotherapy

Front 239

what controlled substance is commonly seen in cough syrup?

Back 239

Dextromethophan

(Opiate)

Front 240

A patient presents to the ED w/ dysphoria, Rhinorrhea, Piloerection, insomnia, increased lacrimation, N/V, dilated pupils and sweating
Dx?
Tx?

Back 240

Opiate Withdrawal

(piloerection and rhinorrhea are key Sx)

Tx:
if moderate - Clonidine
if severe - Methadone detox

Front 241

withdrawal from what class of drugs in abuse can be life threatening?

Back 241

Sedatives

(Benzos / Barbs)

Front 242

Dx:
a patient has dementia, diminished position and vibration sensation and a pupillary accommodation response without a light response.

Diagnostic test?

Back 242

Dx: Neurosyphilis

Dx test:
CSF Fluorescent Treponemal Ab Absorption test
(CSF FTA-ABS or CSF VDRL)

Front 243

Define:

Inability to perform purposeful movements
(copying a picture)

Back 243

Apraxia

Front 244

Define:

Inability to interpret sensations correctly
(if visual: inability to recognize a previously known object)

Back 244

Agnosia

Front 245

Dx:

progressive dementia, muscular hypertonicity, choreform movements

Genetics?

Back 245

Huntington's Disease

genetics: Autosomal Dominant
(HD is Hereditary Dominant)

Front 246

Dx:
rapidly progressive dementia 6 - 12 months after onset of Sx and myoclonus (muscle spasms), generalized hypertonicity, and profound speech disturbances

what does brain tissue look like?

Back 246

Creutzfield-Jakob Dz (CJD)

brain: Spongiform changes
(and Prions)

Front 247

what are the TORCH toxins that can lead to mental retardation?

Back 247

Toxoplasmosis;
Other (Syphilis, AIDS);
Rubella;
CMV;
Herpes

Front 248

when suspecting a learning disorder, what is the first step?

Back 248

rule-out a Hearing or Visual deficit

Front 249

Another name for Dissociative Identity Disorder

Back 249

Multiple personality Disorder

Front 250

A 33yo nun is astounded when a man claims that he saw her at a strip club the night before. She denies his accusations and has no memory of the event.
Dx?

Back 250

Dissociative Identity Disorder

(multiple personalities)

Front 251

A 68-year-old man is admitted to the hospital for delirium associated with a urinary tract infection. Upon adequate treatment of the infection, the patient's mental status improves significantly, though he is noted to remain partly disoriented. He also has an impairment in short-term memory, difficulties in naming simple objects, and impaired concentration. His family members confirm an 8-month history of gradual progressive decline in cognitive abilities, which they attribute to old-age.Prior to discharge from the hospital, the nursing staff reports that the patient continues to have urinary incontinence, though his infection has resolved. He is also noted to have a very unsteady gait, requiring assistance when walking.
Dx?

Back 251

Normal Pressure Hydrocephalus

(A potentially reversible cause of dementia that causes gait disturbances (unsteady or shuffling gait), urinary incontinence, and dementia. Enlargement of the ventricles with increased cerebrospinal fluid (CSF) pressure is found, and therapeutic lumbar punctures may significantly improve symptoms)

Front 252

Dx:
the excessive and compulsive need for coitus in a man. Its corollary in a female is termed nymphomania.

Back 252

Satyriasis

Front 253

A 29-year-old woman presents to her new primary care physician requesting medication to help with her recent spells of anxiety and depression. She wishes to be started on a medication that will not cause too much sedation. Examination of the patient's old records reveals two previous suicide attempts by overdose, once with acetaminophen at age 16 and another, with aspirin, during college. Given this history, what antidepressant medication would most likely be contraindicated for this patient?

Back 253

Tricyclic Antidepressant

(It is lethal in overdose and is the leading cause of overdose-related deaths in the psychiatric population. Overdose is associated with prolongation of the QT interval, leading to cardiac arrhythmia and death. Given this patient's history of previous overdoses, a TCA would be contraindicated)

Front 254

Dx:
delusion in which a person believes that he or she is being controlled by another person or external force

Back 254

Ideas of Influence

Front 255

Dx:
delusions in which a person has a false belief that others (including people on TV or radio) are talking about him or her. In a broader sense, the behavior of others refers to oneself, other persons, or objects that have special significance and meaning

Back 255

Ideas of Reference

Front 256

Dx:
the feeling of revelation in which a person experiences illumination associated with a sense of being chosen as a leader

Back 256

Noesis

Front 257

A 64-year-old man is undergoing chemotherapy and has occasional nausea and vomiting, which are treated with IV prochlorperazine. After several days of therapy, the patient complains that he feels very restless and agitated and he cannot stop moving his legs. What medication, if given during his initial regimen, might have best prevented this reaction?

Back 257

Lorazepam

(This patient has evidence of akathisia, the feeling of restlessness that sometimes occurs as a reaction to use of neuroleptic medications, such as prochlorperazine and haloperidol. Prevention of akathisia is most reliably maintained by use of a benzodiazepine medication, such as lorazepam given IV during administration of the neuroleptic drug. This is particularly important in a patient whose immune system and metabolic capacity may show signs of compromise)

Front 258

Dx:
mental retardation, short stature, continuous eyebrows, thin downturning lip, microcephaly, small and malformed hands, and hirsutism

Back 258

Cornelia de Lange syndrome

Front 259

A 41-year-old man with a long history of schizophrenia, paranoid type, has been on the inpatient unit for almost 2 weeks. This is his third admission in the past 6 months, and each time he seems to be less responsive to treatment. In the past, he has been on typical antipsychotics and then tried on different combinations, including some atypical ones, with limited success. His family is supportive and makes sure he takes his medication. Given his most recent poor response, what is the most appropriate next step in treatment?

Back 259

Clozapine

(An atypical agent that has been proven to be more effective than conventional antipsychotics in the treatment of patients with resistant schizophrenia. It exerts an antagonistic effect on D1 and D4 receptors, as well as on the alpha-adrenergic, histaminergic, serotonergic, and cholinergic systems. It is 30% effective in the treatment of patients with resistant schizophrenia in the first 6 weeks)

Front 260

A patient is talking to his psychiatrist about a conflict he has with his partner. They argue because the partner complains that the patient is inefficient and procrastinates doing things that are his responsibility. He never completes a task the way in which he was asked to do it, but in his own way and usually much later. What type of defense mechanism is this patient exhibiting?

Back 260

Passive-Aggressiveness

(Aggression toward others is expressed indirectly, usually through procrastination, stubbornness, passivity, and forgetfulness. The manifestations usually affect others more than the person who is doing it)

Front 261

A 12-year-old boy is brought to his pediatrician due to failing grades in school. The boy failed last year and is repeating the sixth grade. His parents have suspected for several years that the boy may have low intelligence due to repeated difficulties in school. The family is referred to a psychologist for psychological testing, including an assessment of intelligence. What test would be most appropriate for evaluating the boy's intelligence and to assist with possible placement in special classes in his school?

Back 261

Stanford-Binet Test

(A comprehensive intelligence test that is used in psychiatry and education. Another widely used intelligence test is the Wechsler Adult Intelligence Scale. Such tests are routine intelligence tests in the assessment of borderline intellectual functioning, mental retardation, and specific learning disorders)

Front 262

A 54-year-old woman presents to her primary care physician for her routine yearly health maintenance examination. She denies any new problems. Her only significant medical history includes a 25-year history of schizophrenia, which has been well-controlled with antipsychotic agents, and a 5-year history of hypertension for which she takes a diuretic. Vital signs and physical examination are within normal limits. However, the patient is noted to have occasional irregular puckering and lip-smacking movements. She denies having noticed the abnormal movements, and her speech is normal.
Dx?

Back 262

Tardive dyskinesia

(The abnormal involuntary movements usually involve orofacial muscles but may include the trunk and extremities)

Front 263

Dx:
the patient often tends to emphasize disability related to memory loss, communicates a strong sense of distress, significant memory loss for both recent and remote events and there is little effort to perform even simple tasks

Back 263

Pseudodementia of Depression

Front 264

A 48-year-old obese woman with a history of psychotic depression is brought to the psychiatric emergency department following a suicide threat. She is difficult to interview because she feels tired and sleepy and states she is on a continuous positive airway pressure (CPAP) machine at home secondary to having obstructive sleep apnea. She reports that she has been on Prozac and other medications, which she got for "the voices." During the interview, the psychiatrist learns she has gained 20 pounds in the past several months. What medication most likely caused this significant weight gain?

Back 264

Olanzapine

(An atypical antipsychotic indicated for the management of psychotic disorders. In placebo-controlled, 6-week studies, 29% of olanzapine-treated patients gained greater than 7% of their baseline weight compared with 3% of placebo-treated patients. Among patients on long-term treatment with olanzapine 56% gained more than 7% of baseline weight)

Front 265

Throughout the session, the patient has a sense of depression and views herself as inadequate and disappointing to the therapist. The therapist makes the following comment, "I notice that on a day without your make-up, you fear that I will find you inadequate, probably much like you perceived your father's disappointment if you didn't win the beauty contest. It seems difficult for you to feel accepted if you do not feel attractive. " What psychotherapeutic technique best describes the therapist's comment?

Back 265

Transference Interpretation

(An interpretation involves making something conscious that was previously unconscious, such as the connection between the patient's sense of depression and her lack of make-up as well as the correlation between her relationship styles with her father and with her therapist. An interpretation is an explanatory statement that links a feeling, thought, behavior, or symptom to its unconscious meaning. In this case, the interpretation directly deals with the transference...the patient's feelings and behavior toward the therapist that are based on earlier wishes with important figures)

Front 266

Dx:
a persisting response to a prior stimulus even though a new stimulus has been presented. It can be verbal or motor, and is seen in cognitive disorders

Back 266

Perservation

Front 267

A 36-year-old woman comes to her gynecologist because of a three-month history of amenorrhea. Until this time, her menstrual periods had been regular. She also complains of decreased sex drive, worsening over the past couple of months. The patient denies any other symptoms. She has no significant medical history, although she started seeing a psychiatrist five months ago after a brief hospitalization during which she was diagnosed with major depressive disorder, severe, with psychotic features. Her depressive symptoms are resolving. What Atypical antipsychotic is most likely responsible for the patient's presenting complaints during her visit to her gynecologist?

Back 267

Risperidone

(The newer atypical antipsychotics have minimal, if any effect on plasma prolactin concentrations, except for risperidone, which is associated with elevated prolactin. Antipsychotic-induced hyperprolactinemia may cause side effects including amenorrhea and infertility, sexual dysfunction, galactorrhea, and weight gain)

Front 268

What common childhood disorder is seen in 10-20% of kids with mental retardation?

Back 268

ADHD

Front 269

Dx:
A child w/ increased head circumference, facial coarsening, joint hyperextensibility, mental retardation and macro-orchidism

What is the most commonly assoc childhood psych illness?

Back 269

Dx: Fragile X syndrome

assoc w/:

ADHD (75%)

Front 270

Dx:

X-linked metabolism disorder assoc w/ mental retardation, microcephaly, gout, seizures and self-mutilation

Back 270

Lesch-Nyhan syndrome

(Purine metabolism causing excess Uric Acid due to deficiency in Hypoxanthine-GPT)

Front 271

Dx:
disorder in amino acid metabolism w/ mental retardation, seizures, hyperactivity, decreased pigmentation and a mousy body odor

Back 271

Phenylketonuria (PKU)

(deficiency in phenylalanine hydroxylase; low levels of Tyrosine)

Front 272

Dx:
child who is a compulsive over-eater, has hyperphagia, obesity and predisposed to Oppositional Defiant Disorder

Back 272

Prader-Willi

(chromosome 15)

Front 273

Which autosomal dominant disorder is characterized by adenoma sebaceum, brain lesions, seizures and mental retardation?

Back 273

Tuberous Sclerosis

Front 274

Dx:
cafe au lait spots, pigmented iris hamartoma, skeletal disorder, schwann cell tumor; 1/3 of these patients have MR

Back 274

Neurofibromatosis

(Von Recklinghausen Dz)

Front 275

Dx:
a 3-9yo child with a seizure disorder and language problem

Back 275

Landau-Keffler Syndrome

(Acquired Epileptic Aphasia)

Front 276

Dx:
child who is normal until the age of 2, then loses skills in language, behavior, bowel/bladder, play or motor

Back 276

Childhood Disintegrative Disorder

(skills begin to "Disintegrate")

Front 277

Definition:

Coprolalia

what Dx is it seen in?

Back 277

"Cursing"

Tourette's Disorder

Front 278

what is the Tx for a mentally retarded girl with worsening behavior?

Back 278

Review Behavior Management Plan

Front 279

when do you start treating a child with Enuresis?

Back 279

Age 5

Front 280

What is most likely to happen to the child who is a hyperactive kid (untreated)?

Back 280

Substance Abuse in future

Front 281

First Tx for a stroke-induced dementia?

Back 281

Tx the Vascular problems first

Front 282

Aside from finding the underlying cause of Delirium, what medication is the first-line of Tx?

Back 282

Haloperidol

Front 283

if patient has alcohol withdrawal w/ hallucinations, what is the additional Tx (specific Rx)?

Back 283

Haloperidol

Front 284

A 5yo child w/ cold-like Sx and hallucinations is being treated by mother w/ OTC medications. What is the cause of the Sx?

Back 284

Benadryl

Front 285

A homeless alcoholic has oxalate crystals in his urine. What is cause?

Back 285

Ethylene Glycol

Front 286

a woman is on corticosteroids for one month for her arthritis. What psych disorder can it lead to?

Back 286

Depression

Front 287

Tx for Premenstrual Dysphoric Disorder

Back 287

SSRI

Front 288

a patient with asthma and a substance abuse problem in his family is anxious about giving a speech. What is the best med?

Back 288

Benzodiazepine

(normally propranolol, but not in an asthmatic)

Front 289

Hyperthyroidism is associated with what psychiatric disorder?

Back 289

Panic Disorder

Front 290

What type of cancer is assoc w/ Depression?

Back 290

Pancreatic CA

Front 291

Dx:
Dementia, visual hallucinations, delusions and parkinson-like features; cause is brain-related

Tx for the delusions/hallucinations?

Back 291

Dx: Lewy Body Disease

Tx for delusions:
Benzodiazepine
(not an antipsychotic b/c it will increase EPS)

Front 292

DOC for Nightmares

Back 292

Tranylcypromine

(MOAI b/c it works in REM)

Front 293

DOC for Night Terrors

Back 293

Benzodiazepine

(works in stage 4)

Front 294

What genetic disorder is assoc w/ Schizotypal Personality disorder?

Back 294

Fragile X (females)

Front 295

After a cocaine binge and detoxification in a hospital thereby resolving his euphoria and paranoia, a patient begins to describe his history of cocaine use for the past 5 years. There were times of sobriety where he felt depressed, but they were infrequent in the constant use the past 5 years. What is the best Tx?

Back 295

Narcotics Anonymous

Front 296

What is the most sensitive test in diagnosing delirium?

Back 296

Electroencephalogram

(shows generalized slowing; if alcohol or sedative-induced it will show fast low-voltage activity; in hepatic encephalopathy it will show triphasic delta waves)

Front 297

What NT is most likely involved in Delirium?

Back 297

Acetylcholine

(why anticholinergics are most commonly a cause)

Front 298

A 16yo woman experienced a depressed mood with anergia, insomnia, and a decreased appetite w/ weight loss since her boyfriend left her 6 weeks ago. She also has decreased energy, suicidal ideation and hears voices that tell her she is "no good." She is well dressed and has good hygiene. She admits to having frequent thoughts of suicide in the past few days but would not act on them because it would be a "sin."
Dx?
Tx? (3 together)

Back 298

Dx: Major Depression w/ Psychotic features

Tx:
1. She should be Hospitalized
2. begin SSRI
3. begin Antipsychotic

Front 299

Psychotic depression is diagnosed in a 14yo boy and he is treated w/ risperidone and an SSRI. Three months later his Sx have resolved and he is no longer psychotic.
What is the next step?

Back 299

The Antipsychotic should be discontinued via a Tapering dose

(children w/ major depression and psychotic features respond to a combo antidepressant and atypical antipsychotic. The atypical antipsychotic should be continued for 3 months and then tapered off. The antidepressant should be continued for 6-9 months and then tapered off over 2-3 months at 33% per month)

Front 300

what action is most appropriate in treating a patient with Conduct Disorder?

Back 300

Patients should receive jail time in keeping in line w/ their behavior

(natural consequences is one of the most effective Tx)

Front 301

A 23yo medical student makes lists of all the tasks he must accomplish in a day, spends hours studying instead of time with classmates, attends every lecture and takes meticulous notes, not trusting others to do so. He and his girlfriend are both doing very well in medical school.
Dx?

Back 301

Obsessive-Compulsive Traits

(his social and occupational functioning are both good, which rules out OCPD)

Front 302

Defense mechanism:

A man comes home to find his wife in bed with another man. When relating the information to his friend, the man can tell of certain details of the scene but appears emotionally unmoved by the event.

Back 302

Isolation of Effect

Front 303

Defense mechanism:

A woman steals a coat and states "it's okay--the store has plenty of money and they wont miss one coat."

Back 303

Rationalization

Front 304

Defense mechanism:

a child avoids stepping on a crack in the sidewalk to avoid "breaking your mother's back."

Back 304

Undoing

Front 305

A 36yo man who survived a serious car accident 4 months ago complains of "jitteriness" when driving to work and is currently using public transportation due to anxiety. He "spaces out" at work and has difficulty concentrating at his job, which has caused his performance to slip. He has trouble sleeping at night and has lost 4 pounds because of a decreased appetite.
Dx?

Back 305

Major Depression

(commonly occurs w/ PTSD as a comorbid condition)

Front 306

Tx for Post-Traumatic Stress Disorder
(3 together)

Back 306

1. SSRI
2. Psychotherapy
3. Social Interventions

Front 307

Tx for Alzheimer's Dementia

Back 307

Acetylcholinesterase Inhibitor

(increasing ACh)

Front 308

what type of behavioral therapy is useful in a patient w/ Dysthymia?

Back 308

Cognitive-Behavioral Therapy

(shown to have better outcome then psychotherapy or supportive therapy)

Front 309

If a patient w/ dementia progresses to become agitated and aggressive, what class of med would help manage his behavior?

Back 309

Antipsychotic (high-potency)

Front 310

What are the steps to medical management in a patient with Depression?
(4 steps)

Back 310

1. start low dose SSRI
2. Increase SSRI dose
(up to max dose for body size)
3. if still not working - try alternate SSRI
4. Change class (TCA or MOAI)

Front 311

What type of amnesia is assoc w/ loss of memory for a few hours to a few days?

Back 311

Localized Amnesia

Front 312

What type of amnesia covers a whole lifetime?

Back 312

Generalized Amnesia

Front 313

What type of amnesia involves forgetting successive events as they occur despite being alert?

Back 313

Continuous Amnesia

Front 314

Describe the DEA Control Levels I - V of drugs

Back 314

I: Not for Rx (LSD)

II: No refills w/o examination

III: Moderate physical dependence but high Psych dependence

IV: Rx must be written after 5 refills (lower abuse potential)

V: Lowest abuse potential

Front 315

Describe the Classes A-X for psychtropic meds during pregnancy

Back 315

A: no risk

B: adverse findings in animals, not humans

C: Risk not ruled out; benefits outweigh risk

D: Positive risk

X: Contraindicated in Pregnancy

Front 316

A 26yo single mother of three is admitted to the neurology service w/ complaints of diminished sensation in both legs. What psychological defense mechanism could this person be suffering from that is assoc w/ a breakdown of consciousness, memory, sensory or motor behavior?

Back 316

Dissociation

Front 317

Definition:

Fear that one's penis is shrinking

Back 317

Koro

Front 318

Definition:

Another name for Voyerism

Back 318

Scopophilia

Front 319

Dx:

Overt compliance by subbordinates masking covert resistance or hostility

Back 319

Passive-Aggressive

Front 320

What meds are useful in reducing aggressive behavior in Antisocial Personality Disorder?
(3)

Back 320

1. SSRI

2. Mood Stabilizers

3. Propranolol

Front 321

what is the best behavior therapy for Antisocial Personality Disorder?

Back 321

Socially-based Interventions
(group therapy)

Front 322

What are the (2) Antisocial Personality Disorder defense mechanisms?

Back 322

1. Acting Out

2. Projective Identification

Front 323

What diagnostic test can be used to confirm a clinical impression of Antisocial Personality Disorder?

Back 323

Electroencephalogram (EEG)

(shows soft neurological signs suggestive of minimal brain damage that occurred in childhood)

Front 324

A 39yo man w/ antisocial personality disorder, incarcerated for murdering a man, has a multitude of medical complaints over the course of several years. Yearly physicals never show anything wrong with him, yet he complains of a variety of aches and pains, neurological symptoms and GI distress. He does not enjoy the time he spends in the jail infirmary.
Dx?

Back 324

Somatization Disorder

(development becomes more common in patients w/ APD as they grow older)

Front 325

A 15yo girl who has a diagnosis of major depression with suicide attempt is treated for this and seems to respond well. Her parents report that for years now she is constantly worried that the cameras in the doctor's office are recording her and she believes that she is being stalked by several boys at her school.
Dx?
Tx?

Back 325

Dx: Schizoaffective Disorder

(Schizophrenia Sx are predominant, w/ depression during the schizophrenic episodes)

Tx: Antipsychotic
(if ineffective, add a SSRI)

Front 326

A 40yo w/ Schizoaffective disorder has been hospitalized for the third time in 5 years. During each episode he becomes non-compliant in taking his meds, develops acute manic Sx and hallucinations and then becomes violent. The patient is prescribed a mood stabilizer and an antipsychotic.
What other medication may be helpful for his acute mania?

Back 326

Lorazepam (or Clonazepam)

(both have been shown to be effective adjunctive Tx for acute mania both in patients with schizoaffective disorder and bipolar disorder)

Front 327

what is the key to diagnosing Schizoaffective disorder?

Back 327

the psychotic episodes occur during the mood episodes
(but the mood symptoms do not always occur during the psychotic episodes)

Front 328

A 24yo woman has olfactory hallucinations several times a week for the past month. She smells burning rubber and rotting flesh. Her friends report seeing her "staring off into space," although she is unaware of this behavior. She has no other psychiatric symptoms. She has a history of a concussion resulting from a car accident 1 year previously.
Dx?
How is it coded?
Tx? (2 together)

Back 328

Dx: Psychosis caused by a General Medical Condition
(Seizure disorder)

Coded:
"Psychosis secondary to a general medical disorder" in Axis I
"Seizure disorder" in Axis III

Tx:
1. Underlying problem
2. Antipsychotics for psychosis

Front 329

(3) main drug treatments for ADHD
(and AE of each)

Back 329

1. Methylphenidate (tics)

2. Atomoxetine (sedation)

3. Pemoline (hepatotoxicity)

Front 330

What drug treats the autonomic symptoms of opioid withdrawal such as HTN, tachycardia, sweating, lacrimation and rhinorrhea?

Back 330

Clonidine

Front 331

Tx in Pain Disorder
(3 together)

Back 331

1. Validate pain and explain psychological factors

2. consider SSRI

3. referral to pain clinic

Front 332

Acute Stress d/o is diagnosed in a 32yo woman who witnessed her fiancee being shot to death in a robbery attempt. She has difficulty sleeping and feels she is not emotionally attached to anything around her. She also has repetitive flashbacks of the event.
What med might help her over the short term?

Back 332

Zolpidem

(a hypnotic for the insomnia)

Front 333

A 42yo woman is determined to kick her heroin habit at home without use of methadone or any prescription drugs. What over-the-counter medication is most likely to be of benefit to the patient as she goes through opioid withdrawal?

Back 333

Acetaminophen

(to relieve the muscle cramps assoc w/ withdrawal)

Front 334

(5)* signs of opioid withdrawal

Back 334

SLUMP:

Salivation / Sweating;

Lacrimation;

Urination / Defication;

Muscle cramps;

Piloerection

Hint 334

SLUMP

Front 335

In a patient with Pain Disorder who suffers from headaches that are "unbearable", what is the suggested treatment?

Back 335

Biofeedback and Relaxation techniques

(analgesics are not helpful in these patients and addicting meds should be avoided)

Front 336

What type mood disorder specifier is Anhedonia, diurnal variation and early morning wakening?

Back 336

Melancholic features

Front 337

what is a neurophysical effect of Autism?

Back 337

Rapid brain growth

Front 338

What gene and allele is a risk for Alzheimer's Dz?

What does it do?

Back 338

APOE gene 4 allele

Decreases the clearance of A-beta 42 amyloid
(not increases production)

Front 339

What medication increases the levels of Lithium?
(2)

What decreases the levels?

What hormone does it affect?

Back 339

Increases:
1. Thiazide Diuretics
2. NSAIDs

Decreases:
other Diuretics

affects: Thyroid Hormone (decreases)

Front 340

Adverse effects of this atypical antipsychotic include:
sedation, increased appetite, tachycardia and hyperlipidemia.

Back 340

Clozapine

(also Agranulocytosis)

Front 341

Adverse effects of this antipsychotic include:
sedation, increased appetite, possible hyperlipidemia and arrhythmias

Back 341

Haloperidol

Front 342

Portion of the brain:

processes info to establish and maintain new and longer lasting memories

Back 342

Medial Temporal region

Front 343

Portion of the brain:

involved in ambiguous learning situations such as gambling

Back 343

Orbitofrontal Cortex

Front 344

Portion of the brain:

involved in Working memory, which allows one to keep several ideas in the mind at once

Back 344

Prefrontal Cortex

Front 345

Drug class with following action on 5-HT receptors:

downregulation of terminal 5-HT 1b autoreceptors after long administration

Back 345

SSRI

Front 346

Drug class with following action on 5-HT receptors:

increases responsiveness of postsynaptic 5-HT 1a receptors

Back 346

TCAs

Front 347

Drug class with following action on 5-HT receptors:

decreased responsiveness of 5-HT 1a receptors

Back 347

MAOIs

Front 348

what occurs physiologically to the hematological system with stress?

Back 348

Platelet aggregation increases

Front 349

What is the adverse effect if mixing a SSRI and an Antispasmotic for IBS?

Back 349

Sedation

Front 350

what atypical antipsychotic is most commonly associated w/ elevated lipids and diabetes?

Back 350

Olanzapine

(also weight gain)

Front 351

what additional diagnosis is a risk factor of developing Tardive Dyskinesia in those treated for schizophrenia?

Back 351

Mood disorders

Front 352

MOA of Disulfiram

Back 352

Acetalydehyde metabolism inhibitor

Front 353

What antipsychotic has the highest risk for QTc cardiac conduction prolongation?

Back 353

Ziprasidone

Front 354

MOA of Amantidine

Back 354

Releases Dopamine

(in substantia nigra, causing antiparkinson effects)

Front 355

MOA of Donepezil

Use?

Back 355

Anticholinesterase inhibitor

Use: Mild Dementia

Front 356

MOA of Haloperidol

Back 356

Block Post-synaptic Dopamine receptors

Front 357

Anticholinergic agent used to treat primary and medication-induced Parkinsonism

Back 357

Trihexyphenidyl

Front 358

First line of Tx for Post traumatic Stress Disorder

Back 358

SSRI

Front 359

low levels of what NT are shown to be assoc w/ impulsiveness and aggression?

Back 359

Serotonin

Front 360

what is a common comorbid disorder with Bulimia?

Back 360

Kleptomania

Front 361

a 40yo businessman states that over the past 2 years he has had trouble staying awake for more then 2 hours before falling asleep. He has a hard time sleeping through the night. Meanwhile his work is suffering.
Dx?
Tx? (3 possible drugs)

Back 361

Dx: Primary Insomnia

Tx:
1. Zolpidem (Ambien)
2. Zaleplon (Sonata)
2. Trazodone (Desyrel)

Front 362

another name for Sleepwalking disorder

Back 362

Somnambulism

Front 363

what NT enhances libido?

what NT inhibits libido?

Back 363

Enhances: Dopamine

Inhibits: Serotonin

Front 364

Dx:

genital pain before, during or after sexual intercourse

Back 364

Dyspareunia

Front 365

Dx:

involuntary muscle contraction of the outer third of the vagina during insertion of the penis or object

Back 365

Vaginismus

Front 366

Conditioning type:

Drugs serve as reinforcers to increase frequency

Back 366

Operant conditioning

(behaviors can be learned when followed by positive or negative reinforcement)

Front 367

Conditioning type:

Drugs play a major role in relapse

Back 367

Classical conditioning

(a stimuli evokes a conditioned response)

Front 368

Behavioral therapy technique:

a patient who is afraid of flying is made to fly on a plane

Back 368

Flooding

Front 369

Behavioral therapy technique:

a patient who is afraid of flying is made to imagine flying

Back 369

Implosion

Front 370

Behavioral therapy technique:

an alcoholic is given Antabuse which makes him ill every time he drinks alcohol

aside from addicitions, what else is this therapy used to treat?

Back 370

Aversion therapy

also Tx: Paraphilias
(necrophilia, S&M, etc)

Front 371

Aside from Depression, what other disorders use SSRIs as the first drug treatment?
(10)*

Back 371

A Bad PMS In A PP Organ:

Anorexia,
Body Dysmorphic Disorder,
Panic Disorder,
Migraines,
Social Phobia,
IBS,
Autism,
PTSD,
Premenstrual Dysphoric d/o,
OCD

Hint 371

A Bad PMS In A PP Organ

Front 372

Aside from Depression, what other disorders use TCAs as a main treatment?
(3)

Back 372

Enuresis,

Neuropathic Pain,

Insomnia

Front 373

Most life-threatening adverse effect of TCA

Back 373

Orthostatic Hypotension

Front 374

What is the first step when suspecting serotonin syndrome?

Back 374

Discontinue Medication

Front 375

MOA of Mirtazepine

common AE?

Back 375

NASA: NE and Serotonin Antagonist

common AE: Weight Gain

Front 376

What drugs cause Anti-HAM effects?
(2)

Back 376

Antipsychotics,

TCAs

(anti-HAM = antiHistamine - sedation; antiAdrenergic - Hypotension; antiMuscarinic - dry mouth, blurred vision, urinary retention)

Front 377

What can be used in a patient w/ Generalized Anxiety Disorder if he is an alcoholic w/ HTN?

Back 377

Buspirone

(Benzos are contraindicated in alcoholics and Venlafaxine is contraindicated in HTN patients)

Front 378

what are the (3) main uses of Benzodiazepines?

Back 378

PIA:

Panic Attacks / Anxiety,
Insomnia,
Alcohol withdrawal/detox

Front 379

difference between Dystonia and Tardive Dyskinesia symptoms around the head?

Back 379

Dystonia:
sustained Contraction of muscles of neck and tongue

TD:
Choreoathetoid (writhing) movements of mouth and tongue

Front 380

what (2) atypical antipsychotics also have FDA approval for Tx of Mania?

Back 380

Quetiapine,

Ziprasidone

Front 381

a 20yo woman comes to see you because her mother says she isnt herself. The patient is dressed in brightly colored clothing and has worn a large amount of makeup for the past 3 weeks. She acts overtly seductive toward her colleagues at work, is more distractible and is easily irritated. She also sleeps less, claiming she no longer needs the sleep.
Dx?

Back 381

Bipolar D/o, Mania

Front 382

What is a good behavioral treatment for insomnia?

Back 382

Deconditioning

(using the bed only for sleep; get up if not able to sleep in a short period of time)

Front 383

(3) meds used to reduce Sx of flashbacks

Back 383

CVC:

1. Clonazepam
2. Valproic Acid
3. Carbamazepine

Front 384

What pathology would be most important to rule out before starting treatment of Tourette's disorder?

Back 384

Environmental Allergies

(they have a presentation most resembling Tourette's disorder)

Front 385

What lab test is most helpful in assessing the severity of starvation in anorexia?

Back 385

Albumin levels

Front 386

what psychiatric disorder is seen in people with Graves Disease?

Back 386

Generalized Anxiety Disorder

(criteria for GAD are met in up to 60% of those w/ Graves)

Front 387

What are the (2) common defense mechanisms of Avoidant Personality d/o?

Back 387

1. Displacement

2. Projection

Front 388

A 30yo woman presents with a chief complaint of being unable to finish a project. She had difficulty finishing college in 4 years as well. She is cannot pinpoint what is wrong with her. She has no long-term love relationship, although she would like to have one. Otherwise tha patient has no psychiatric signs or symptoms. She has no psych Hx and her only medical problem is well-controlled HTN. She has no Hx of drug or ETOH use.
Dx?
Tx?

Back 388

Dx: Neurosis

(not a DSM-IV Dx, "trouble working and loving")

Tx: Insight-oriented Psychotherapy

Front 389

A 24yo man gets excited about sex but has a problem performing sexually. He can have an erection, but it is not maintained when the time for intercourse occurs. There is nothing physically wrong. He seems to be struggling with abandonment issues with his father.

Tx?

Back 389

Tx: Psychodynamic Psychotherapy

(CBT is not likely to elicit the unconscious conflict troubling him)

Front 390

What BT type is best suited for someone with Borderline Personality D/o?

Back 390

Dialectical BT

(patients learn skills to confront and manage the volitile emotions and impulses they are feeling)

Front 391

In what (2) types of psychiatric disorders will you see cognitive thinking?

Back 391

1. Schizophrenia

2. Cognitive d/o (dementia; MR)

Front 392

Hyperarousal symptoms seen in PTSD are thought to be due to a stress-induced, chronic hyperactivity of what area of the brain?

Back 392

Locus Ceruleus

(main noradrenergic nucleus of the brain)

Front 393

what nucleus of the brain degenerates in Alzheimers dementia?

Back 393

nucleus basalis of Meynert

Front 394

A young woman with a history of cutting states that the act calms her and she feels no pain. Self-injury can have this effect b/c it triggers the release of what?

Back 394

Endorphins

(body's defense mechanism to deal with pain)

Front 395

After being struck in the head with a bat, a patient's personality changes. What part of the brain was affected?

Back 395

Frontal lobes

Front 396

A little girl who was underweight and hypotonic at infancy is obsessed with food, eats compulsively and at age 4 is already grossly overweight. She is also argumentative, oppositional and rigid. She has a narrow face, almond-shaped eyes and a small mouth.
Dx?

Back 396

Prader-Willi syndrome

Front 397

what NT regulates mood, sleep, pain and aggression?

what nuclei?

Back 397

Serotonin

Raphe Nuclei

Front 398

An elderly man awakes in a state of aggitation. Although he appears that he wants to communicate, he can only state "See you later" over and over. The right side of his face droops and he seems to have difficulty moving his right arm. A CAT scan shows a recent brain infarct.
Where is the lesion (specifically)?
What vessel?

Back 398

Left Frontal Lobe

(at Broca's area, which presents with nonfluent aphasia and can cause one to repeat)

Middle Cerebral Artery

Front 399

Aggressive behavior is assoc w/ an increase or decrease in what NT?

Back 399

Decrease in Serotonin

Front 400

Where is the brain lesion:

a 22yo woman w/ an inoperable craniopharyngioma has become grossly obese and experiences rapid fluctuation of body temperature.

Back 400

Hypothalamus

(expansion of the tumor)

Front 401

Where is the brain lesion:

an 82yo woman at the late stages of a dementing disorder roams her nursing home touching and licking everything she passes. She is placcid and nothing frightens her.

Back 401

Amygdala

(behavior and personality changes including hypersexuality, placcidity and lack of fear = Kluver-Bucy syndrome)

Front 402

Where is the brain lesion:

a 34yo homeless man w/ a chronic psychiatric d/o hears the voices of angels and believes he is the new savior

Back 402

Mesolimbic circuit

(pathway of positive and negative Sx of schizophrenia)

Front 403

Where is the brain lesion:

a 17yo male cannot remember anything that happened after he had a bout of encephalitis, but he has no difficulty with remote memories

Back 403

Hippocampus

(Herpes encephalitis causes bilateral lesions in the hippocampus causing anterograde amnesia and damages the amygdala causing Kluver-Bucy syndrome)

Front 404

A patient is diagnosed w/ Wernicke-Korsakoff's syndrome. What part of the brain is affected?

Back 404

Mammillary bodies

(dependent on Thiamine)

Front 405

Stimulation of what nucleus reduces appetite?

A dysfunction in this nucleus, causing hyperphagia, is seen in what syndrome?

Which nucleus stimulates appetite?

A dysfunction or ablation of this nucleus can lead to what?

Back 405

Reduces eating: Ventromedial nuclei

dysfunction = Prader-willi

Increases eating: Lateral nuclei

dysfunction = fatal Anorexia

Front 406

A 70yo w/ a dementing d/o dies in a car accident. During the last 5 years his personality changed dramatically. Path exam of the brain shows frontal-temporal atrophy, gliosis of frontal lobe white matter, intracellular inclusions and swollen neurons.
Dx?

Back 406

Pick's Disease

Front 407

A young man smells burnt rubber, then turns his head and upper body to the right, makes chewing movements and fumbles with his clothes. This lasts one minute and he appears dazed.
Dx?
where is the problem?

Back 407

Partial Complex Seizure

Location: Temporal lobe

Front 408

What psychiatric disorder is assoc w/ Cushing's syndrome?

Back 408

Depression

Front 409

a 40yo cognitive functions have deteriorated in the past couple years to the point that she needs a nursing home. Since this began she has become depressed, irritated and is prone to aggressive outbursts. She also has irregular, purposeless and asymmetrical movements of her face, limbs and trunk which get worse when she is upset. Her MRI shows atrophy of the caudal nuclei and putamen.
Dx?

Back 409

Huntington's Dz

Front 410

A healthy 62yo male undergoes a corneal transplant. Three months later he is profoundly demented and his EEG shows periodic bursts of electical activity superimposed on a slow background.
Dx?

Back 410

Creutzfeldt-Jakob Dz

Front 411

A 64yo man completely ignores the left side of his body. He also has difficulty with simple calculations.
Where is the lesion?

Back 411

Parietal Lobe

Front 412

What Drug:

A woman who is treated with an antipsychotic develops an uneven pigmentation over her arms, shoulders and face with a trip to the beach

Back 412

Chlorpromazine

(side effect of low-potency neuroleptics)

Front 413

Drug of Choice:

a patient with schizophrenia has multiple relapse due to non-compliance

Back 413

Haloperidol decanoate

(injectable medications are effective in decreasing the rate of relapse)

Front 414

what are the (2) atypical antipsychotics that are proven to be useful for the negative symptoms?

Back 414

Clozapine

Olanzepine

Front 415

Dx:
A delusional disorder that develops in a person who is in a close relationship w/ another person that has a psychotic disorder w/ delusions

Back 415

Shared Psychotic diosrder

Front 416

Dx:

Atrophy of the Caudate

Back 416

Huntington's Dz

Front 417

DOC:

1. Melancholic Depression

2. Atypical Depression

Back 417

1. TCAs

2. MAOIs

Front 418

(2) drugs used to Tx hyperarousal Sx of PTSD

Back 418

1. Clonidine (alpha-2-agonist)

2. Beta-blocker

Front 419

What medical condition is commonly confused w/ Conversion disorder?

Back 419

Multiple Sclerosis

Front 420

For a Dx of Hypochondriasis, how long do the Sx need to be present?

Back 420

6 months

Front 421

what medication that helps with anxiety can lead to sexual dysfunction?
(2)

Back 421

1. Propanolol

2. SSRI

Front 422

A 27yo female w/ a Hx of bipolar disorder is admitted to the hospital in a manic state. She is 4 weeks pregnant and refuses to take any medication associated with birth deformities in humans.
Which medication is appropriate?

Back 422

Olanzapine

(atypical antipsychotic approved for short-term mania use)

Front 423

Neuro Dx:

Hippocampal atrophy

Back 423

Alzheimer's Dz

Front 424

Neuro Dx:

Occipital Hypoprofusion

Back 424

Lewey Body Dz

Front 425

A 19-year-old man is brought to the emergency room by his distraught parents, worried about his vomiting and profuse diarrhea. On arrival, his pupils are dilated, his blood pressure is 175/105, and his muscles are twitching. His parents report that these symptoms started two hours earlier. For the past couple of days he has been home-bound due to a sprained ankle and, during this time, he has been increasingly anxious and restless, has been yawning incessantly and has had a runny nose.
Dx?

Back 425

Heroin withdrawal

Front 426

Tx for mild Opioid withdrawal Sx?

for general Opioid withdrawal?

Back 426

mild Sx: Clonidine

normal Sx: Naloxone

Front 427

Tx for Alcohol withdrawal

Back 427

Diazepam

Front 428

MOA of cocaine

Back 428

inhibits the reuptake of NT in the synapse

Front 429

what is the therapeutic intervention most likely to be effective in PCP intoxication?

Back 429

Isolate patient in a quiet, dimly lit room to minimize sensory input

Front 430

According to the cognitive model Depression is a consequence of what?

Back 430

Maladaptive negative beliefs

Front 431

What does Cognitive psychotherapy focus on?

Back 431

Faulty ideas and beliefs

Front 432

The parents of a 20-year-old man recently diagnosed with paranoid schizophrenia are having difficulty dealing with their son’s decline in function. Once an honor student with many friends and an active social life, he now spends his days barricaded in his room, surveying the street with binoculars, watching out for his “enemies.”
What is a helpful family therapy intervention?

Back 432

Teaching the parents about the importance of reducing expressed emotions in the family transactions

Front 433

A 34-year-old mathematician
is in psychoanalytic psychotherapy because of anxiety, depression, and marital problems, which seemed to begin shortly after the death of his mother. They had an intensely dependent and ambivalent relationship with each other. When the patient discusses his mother and her death, he is unemotional and detached.
This is an example of what defense mechanism?

Back 433

Isolation of Affect

(splitting off the affective component, usually unpleasant, from an idea or thought)

Front 434

Defense mechanism:
A man visits his domineering and demanding elderly mother at her nursing home. When she starts browbeating him for his “lack of devotion,” he has a sudden urge to shout at her. The next day, when he talks with his therapist about his visit, he minimizes the impact of his mother’s constant badgering and has no memory of his brief moment of rebellion.

Back 434

Repression

Front 435

Defense Mechanism:

A 34-year-old auto mechanic has a lifelong grudge against his more successful older brother, who, in his eyes, was their parents’ favorite, but he has a hard time admitting it even to himself. Instead, he tells his friends that his brother envies his good looks and his success with women.

Back 435

Projection

(the attribution of one person's unacceptable impulses or feelings to others; in this case it is Jealousy)

Front 436

A man who has psychotic depression is placed on imipramine and perphenazine. When he develops Parkinsonian symptoms, benztropine mesylate 2 mg per day is added to the medications he already receives. One week later, his wife reports that the patient has become unusually forgetful and that he appears disoriented when he gets up during the night to use the bathroom. On physical examination, the man appears slightly flushed, his skin and palms are dry, and he is tachycardic. He cannot remember the date and has trouble concentrating.
Dx?

Back 436

Anticholinergic syndrome

(Phenothiazides, TCAs and anti-parkinson agents all have anticholinergic properties; the acton becomes additive when administered together)

Front 437

A middle-aged man w/ depression takes daily doses of warfarin as prophylaxis for pulmonary embolism. His doctor is baffled because the patient’s warfarin dose needs to be readjusted almost every week to maintain an optimal level of anticoagulation.
What antidepressant can cause this effect on Warfarin?

Back 437

SSRIs
(specifically Sertraline, Paroxetine, and Fluvoxamine)

(they can displace warfarin from their binding sites, increasing the levels of biologically active warfarin)

Front 438

An 8-year-old boy with ADHD has been constantly clearing his throat and blinking his eyes for the past three weeks, since he was placed on methylphenidate. These symptoms have been present, on and off, for several years, but they have been greatly worsened by the stimulant. What medication can be used to treat both ADHD symptoms and tics?

Back 438

Clonidine

(Alpha-2 adrenergic agonist that is helpful in the treatment of Tourette's d/o and in the Tx for kids that develop ADHD w/ tics from other stimulants)

Front 439

For several weeks, a 72yo retired physician with Parkinson’s disease and mild dementia has been talking about “those horrible people that come to bother me every night.” He is convinced that someone is plotting against him and has nailed his window shut for fear of intruders. More recently he has started showing signs of thought disorder, mostly in the evening and at night.
What antipsychotic med is least likely to worsen
the patient’s Parkinsonism?

Back 439

Clozapine

(preferred Tx for psychotic Sx in a person w/ Parkinsons)

Front 440

A 72-year-old man with a long history of recurrent psychotic depression is hospitalized during a relapse. He has prostatic hypertrophy coronary heart disease, and recurrent orthostatic hypotension.
Which is the most appropriate antipsychotic medication for this patient?

Back 440

Haloperidol

(high-potency neuroleptics have low anticholinergic side effects)

Front 441

what medication class can be a sedative, but actually supresses REM?

Back 441

TCAs

Front 442

what OTC med can cause severe HTN crisis in someone taking a MAOI?

Back 442

Pseudoephedrine

(a synpathomimetic agent)

Front 443

what is the most worrisome cardiovascular AE of a TCA?

Back 443

Slowing of cardiac conduction

Front 444

what do Cyproeptadine, Bethanecol, Amantidine, Buprpion and Yohimbine have in common with relation to an SSRI side effect?

Back 444

all reverse the effects of SSRI Sexual Dysfunction

Front 445

Tx for Serotonin Syndrome

Back 445

Stop medications

Front 446

a 61yo male is broght to the ED b/c his family states that he has been yelling, spitting and pulling other peoples noses and ears unexpectedly. He also began using foul language and is openly promiscuous. He has no medical or psych Hx. The patient's uncle had similar behavior and died shortly after being placed in a nursing home. During the exam the patient has trouble finding his words and keeps repeating the doctors commands while giggling inappropriately.
Dx?

Back 446

Pick's Disease

(a frontotemporal dementia that presents with behavioral changes initially)

Front 447

Thought disturbance example after being asked how the patient got to the hospital:

"I was reading a great book at home and after I finished it I drove myself to the hospital"

Back 447

Circumstantiality

Front 448

Thought disturbance example after being asked how the patient got to the hospital:

"I started driving but I was thinking about my history. History books are great. I once wrote a paper on Alexander the Great. I do well in college."

Back 448

Flight of Ideas

Front 449

Thought disturbance example after being asked how the patient got to the hospital:

"I really like history books and I was reading one at home today while eating tuna fish."

Back 449

Tangentiality

Front 450

Thought disturbance example after being asked how the patient got to the hospital:

"The spy in the book I was reading was real, and he was watching me through the pages. He knew who I was."

Back 450

Loose Associations

Front 451

MC side effect of Olanzapine

Back 451

Sedation (30%)

Front 452

In what psychiatric disorder will you find "Leaden Paralysis"?

Drug class of choice?

Back 452

Major Depressive d/o w/ Atypical features


DOC: MAOIs

Front 453

when does Stranger anxiety develop fully in infants?

Back 453

8 months (32 weeks)

Front 454

A 35yo woman w/ bipolar d/o has noticed an increase in appetite w/ significant weight gain as well as hair loss. Her thyroid pannel is normal.
What bipolar medication was she prescribed?

Back 454

Valproic Acid

(common AE are nausea, sedation, weight gain, transient hair loss and increased LFTs; rare AE are hepatitis, pancreatitis, and decreased platelets and platelet functions)

Front 455

What are the (8)* stages and ages of Erikson's stages of Ego development?

Back 455

TAG It RISE:
0 - 18 months: Trust vs. Mistrust
18m - 3 years: Autonomy vs. Shame
3 - 5 years: Initiative vs. Guilt
5 - 13 years: Industry vs. Inferiority
13 - 21 years: Identity vs. Role Confusion
21 - 35 years: Intimacy vs. Isolation
35 - 60 years: Generativity vs. Stagnation
60+ years: Ego Integrity vs. Despair

Hint 455

TAG It RISE

Front 456

a 22yo woman w/ a Hx of depression is found groggy and minimally responsive in her home. On exam she is obtunded and complains of blurry vision. She has enlarged pupils and PVCs with a rate of 120. A foley is placed and yields 800ml of urine. An overdose is presumed.
What drug did she take?

Back 456

TCA

(prominent anticholinergic properties - mydriasis, urinary retention and tachycardia; also TCAs cause arrhythmias)

Front 457

What is the initial step in management of a patient with delirium?

Back 457

Protect the patient from unintentional harm

Front 458

A 52yo woman w/ a Hx of mitral valve prolapse, MI and DM has been recently Dx w/ panic d/o. She is obese, has a Hx of alcohol dependence and frequent Hx of Hypoglycemia due to poor control of blood sugar.
What condition has a demonstrated association w/ panic disorder?

Back 458

Alcohol Dependence

(ETOH and substance dependence occurs in about 20 - 40% of all patients w/ panic d/o)

Front 459

A 50yo woman presents with paresthesias, gait disturbance, motor weakness and visual defects.
Dx?
What is affected in the Brain?

Back 459

Multiple Sclerosis

brain: Focal demyelination and Gliosis of Periventricular white matter

(generally begins before age 55 and more common in females)

Front 460

A 25yo attempted to OD on sleeping pills after her boyfriend broke up with her. She tells the intern that he is so caring and competent and that she has never met such a doctor. She complains that no one understands her and that the only one who can really help her is the intern.
What defense mechanism is this?

Back 460

Primitive Idealization

(external objects are unrealistically endowed w/ great power and are either "all good" or "all bad." All good objects are ideal and omnipotent; the badness of the others are also greatly inflated. Splitting difference has the abrupt shifting of an object from good to bad or visa-versa)

Front 461

What (2) types of disorders use Hypnosis as a form of treatment?

Back 461

1. Conversion d/o

2. Dissociative d/o

Front 462

Another name for Childhood Disintegrative d/o?

Back 462

Heller Syndrome

Front 463

An adolescent male presents with hypersomnia, hyperphagia, sexual disinhibition and some psychosis.
Dx?

Back 463

Kleine-Levin syndrome

remember: Calvin KLEIN's male models like sex, sleep and food)

Front 464

what chromosome is Wison's Dz?

Back 464

Chromosome 13

Front 465

Which medication that begins with the letter "P" is for ADHD and contra-indicated in Tourettes?

Which with the letter "P" is for Tourettes and contra-indicated in ADHD?

Back 465

ADHD: Pimoline


Tourettes: Pimozide

(Alphabetical)

Front 466

what are the only (2) meds can be used in both ADHD and Tourettes?
(MOA)

Back 466

1. Clonidine

2. Guanfacine

(both are alpha-2-agonists)

Front 467

Dx:
A child w/ hyperactivity, poor attention, depression, irritability, seizures and a severe language disorder.

Back 467

Landau-Kleffner syndrome (LKS)

(rare childhood epilepsy that results in severe language disorder)

[LKS = Language-Killing and Seizures]

Front 468

Dx:
mental retardation, aggression, impulsivity, possible seizures and hamartomas in the brain, kidney, heart and skin

Back 468

Tuberous Sclerosis

(autosomal dominant)

Front 469

what is the only FDA approved SSRI Tx for depression in kids?

Back 469

Fluoxetine

Front 470

what SSRI has the greatest increase in suicidal rates in kids?

Back 470

Paroxetine

Front 471

Dx:
repeated regurgitation and rechewing of the regurgitated food

How long must it be present?

Back 471

Rumination

(present for 1 month)

Front 472

Dx:
a hereditary dz with the onset in childhood, characterized by dystonia, rigidity, difficulty with gait and speech, seizures and retinitis pigmentosa. Iron deposits are seen in the globus pallidus.

Back 472

Hallervorden-Spatz

Front 473

What is the number 1 predisposing factor of Narcolepsy?

what HLA is it associated with?

Back 473

#1 factor: Dx in a first-degree relative

HLA-DR2

Front 474

Drug that treats Tourettes, Schizophrenia and Chronic Psychosis and has the AE of prolongation of QT intervals
(as well as TD and EPS)

Back 474

Pimozide

Front 475

A 53yo man admitted to the inpatient psych unit for Tx of Bipolar d/o was found lying in the hallway. He is conscious but confused and the staff said has been sedated and confused for the past 24 hours. He was admitted one week ago and restarted on a bipolar med. Then 3 days ago he developed an upper respiratory infection and was treated w/ an Abx.
Dx?

Back 475

Carbamazepine Toxicity

(the antibiotic inhibited the metabolism causing patient's Sx)

Front 476

How is Psychoanalytic Psychotherapy different from other forms of BT with respect to focus and time?
(2)

Back 476

Focus: the Past (ex: early childhood)

Time: Multiple sessions per week are common

Front 477

What drug withdrawal necessitates admission to the hospital (more then any other street drug)?

Back 477

Barbiturates

(withdrawal can lead to death)