Snw's Psychiatry Review (Usmle Step 3)

Front 1

Criteria for involuntary hospitalization

Back 1

mentally ill or developmentally delayed

imminent potential danger (to oneself or others)

Front 2

Tx of bipolar I

Back 2

manic sxs:

benzos, anti-psychotic, or valproic acid

depressive sxs:

lithium, lamotrigine (assoc with steven-johnson syndrome), quetiapine, or lurasidone (particularly in pregnant woman)

Front 3

Testing prior to lithium

Back 3

pregnancy test

BUN and creatinine

TSH

Front 4

Bipolar type I vs II

Back 4

Type I- mania

Type II- hypomania

Front 5

Manic episode

Back 5

distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week & present most of the day, nearly every day

can have delusions of grandeur

lack of inhibition

flight of ideas

decreased sleep

Front 6

Hypomanic episode

Back 6

not severe enough to cause marked impairment in social & occupational functioning

hospt not necessary

no psychotic features

Front 7

Cyclothymic disorder

Back 7

chronic dz (>2 yrs) of fluctuating mood disturbances involving hypomanic periods and depressive periods

does not meet criteria for major depression

Front 8

Proposed mechanism of action of lithium

Back 8

prevents recycling of inositol (decreasing PIP2) by blocking inositol monophosphatase and decreasing cAMP

Front 9

Lithium toxicity

Back 9

have to monitor levels & should be around "1.0"

initially assoc with GI sxs (n/v cramping)

can progress to tremulousness, hyperreflexia, ataxia, & cardiac dysrhythmias (T-wave flattening)

Syndrome of irreversible lithium effectuated neurotoxicity (SILENT)- cognitive impairment, sensorimotor peripheral neuropathy, & cerebellar dysfunction

nephrotoxic

can lead to hypothyroid

diabetes insipidus

Front 10

Lithium & nephrogenic DI

Back 10

inhibits action of ADH on distal renal tubule, impairment Na and water reabsorption

tx with amiloride

Front 11

Lithium & hypothyroid

Back 11

lithium is rapidly taken up in thyroid cells --> blocks thyroid hormone release from thyroglobin preventing TSH from stimulating thyroid cells via TSH receptor

also inhibits the activity of 5' deiodinase

Front 12

Agoraphobia

Back 12

fear of open places and open spaces

ppl with panic attacks can develop this bc they dont know when the panic attacks will occur

Front 13

Panic attacks

Back 13

abrupt surge of intense fear or intense discomfort that reaches a peak within minutes during which 4 or more of the following occur:

palpitations, sweating, trembling, SOB, feelings of choking, chest pain, nausea, dizziness, chills or heat sensations, paresthesia, derealization, fear of losing control, & fear of dying

freq of attacks may vary widely

Front 14

Panic disorder

Back 14

recurrent unexpected panic attacks

at least 1 attack followed by >1 month of 1 or both of:

1) persistent concern about the attacks or their consequences

2) significant change in behavior related to attacks

Front 15

Tx of panic disorder

Back 15

panic disorder --> multiple panic attacks so is a chronic dz

acute sxs --> benzos (alprazolam, lorazepam, clonazepam)

chronic sxs --> SSRIs or SNRIs & second line is TCAs or MAOIs

can also get psychotherapy

Front 16

SSRI side effects

Back 16

headache

GI effects

weight gain

insomnia

sexual side effects

Front 17

Delusional disorder

Back 17

are functional in life

delusions have occurred for at least 1 month

will not have hallucinations

Front 18

Atypical antipsychotics

Back 18

risperidone: less sedation, more movement side effects

ziprasidone: QT prolongation

olanzapine: more weight gain, greater risk for DM

quetiapine: fewer movements side effects

"-pine's" increase risk of DM, metabolic sxs, weight gain (particularly olanzapine)

"-dones" have more movement related side effects, tremors, increase prolactin, dystonia, cardiac issues

Front 19

Schizophrenic associations

Back 19

anatomic:

enlarged ventricles

areas of hypodensitities in frontal lobe

Neurotransmitter:

hyperdopaminergic activity in mesolimbic system

NE, 5-HT, & GABA are likely involved

Immune system:

overactivation of immune system may cause overexpression of inflammatory cytokines leading to an abnormal change of brain structure and function

Front 20

Opiate withdrawal

Back 20

flu like sxs --> fever, chills, runny nose, abd cramps, diarrhea, N/V

pupils are dilated

muscle aches

insomnia

Front 21

Cocaine withdrawal

Back 21

sleep disturbances

appetite disturbances

sxs of depression

suicidal thoughts

Front 22

Tx of opiate withdrawal

Back 22

clonidine or buprenorphine/naloxone or methadone

supportive tx for other sxs

refer to rehab once detox is complete

Front 23

Tx of OCD

Back 23

SSRI: fluoxetine, sertraline, paroxetine, or fluvoxamine

SNRIs can be used but can cause blurry vision & elevated BPs

TCAs are also option but can cause death in o/d & have many side effects

behavioral therapy --> exposure and response prevention

Front 24

Conduct disorder

Back 24

predominantly males in pre-teens - teens

pervasive pattern of disobeying rules of society

aggressive towards others

destroy property

run away from school

four categories:

1) aggression to people & animals

2) destruction of property

3) deceitfulness or theft

4) serious rule violations

Front 25

Oppositional defiant disorder

Back 25

predominantly males in pre-teens -teens

hostility towards authority figures

talk back to parents, teachers, etc

but do not see clear violation of society rules like in conduct disorders

Front 26

Adjustment disorder

Back 26

a stressor changes the behavior of a person

stressor must be within 3 months of change of behavior & behavioral change cannot be for >6 months in length

tx with supportive psychotherapy

Front 27

Adjustment disorder subtypes

Back 27

1) with depressed mood

2) with anxiety

3) with mixed anxiety and depressed mood

4) with disturbance of conduct

5) mixed disturbance of emotions and conduct

6) unspecified

Front 28

Tx of conduct disorder

Back 28

focus on relationship & develop a therapeutic alliance

if child becomes invested in therapy can use variety of techniques such as behavior modification, cognitive restructuring, etc

Front 29

Grief/Bereavement

Back 29

occurs within 1 yr of death of a loved one

exhibit signs of depression but does not affect functioning

tx with supportive psychotherapy, sleep hygiene techniques, behavioral modification (stimulus control)

meds usually not required but if needed --> zolpidem or eszopiclone for <2 weeks

Front 30

Major depressive disorder

Back 30

sxs must occur >2 weeks

sxs are severe enough to affect your functioning

freq think of suicide

helpless/hopeless/cant sleep/energy/appetite/anehedonia

tx with SSRI or SNRI (eg venlafaxine or duloxetine) with TCAs as 2nd line & MAOI as 3rd line

can also tx with bupropion

Front 31

PTSD vs acute stress disorder

Back 31

acute stress disorder is for >3 days but < 1 month

PTSD is > 1 month

tx with SSRIs, psychotherapy that is trauma-focused CBT

Front 32

Persistent depressive disorder (dysthymia)

Back 32

"mild" depression for at least 2 yrs

Front 33

TCA side effects

Back 33

confusion

constipation

dry mouth

cardiac abnormalities

lethal in o/d

Front 34

Anorexia vs bulimia

Back 34

major distinguishing feature is weight:

anorexia --> BMI <17.5

bulimia --> weight is lower than expected but not by a lot

tx with individual and family therapy & can think of SSRI if there is a dimension of depression

Front 35

Eating disorder complications

Back 35

endocrine:

delayed puberty

amenorrhea

increased growth hormone

hypercortisolism

low estrogen states

metabolic:

acidosis

decreased ADH

osteoporosis

hypothermia

hypokalemia

hyponatremia

hypoglycemia

CV:

cardiomyopathy

SVT & ventricular arrhythmias

long QT

bradycardia

heart failure

Front 36

Specific learning disorder

Back 36

child who has problems in school in reading, writing, or math

so must specify a specific difficulty in question stem

Front 37

ADHD

Back 37

child who has problems at home & school

have problems with attention, impulsivity, & hyperactivity

cannot follow directions

are usually fidgety, irritable, with poor grades & accident prone

Front 38

Tx of ADHD

Back 38

methylphenidate, dextroamphetamine, atomoxetine, or clonidine

family therapy

supportive therapy

Front 39

Psychostimulants

Back 39

increase dopamine & norepinephrine

methylphenidate & amphetamine are classic stimulants used in ADHD

common side effects include headaches, insomnia, GI problems

Front 40

Tourette's disorder

Back 40

motor tics usually start around age 7

have both motor & vocal tics

thought to be due to too high dopamine

tx with antipsychotics bc of anti-dopamine effects (eg haloperidol, risperidone, olanzapine, or pimozide) but only if sxs require it

alternative tx can include a2-agonists such as clonidine & guanfacine

Front 41

Tourette's with ADHD and/or OCD

Back 41

high comorbidity

if ADHD also present -> consider antidepressants bc psychostimulants will increase tics

if OCD also present then consider SSRIs

Front 42

Autism spectrum disorders

Back 42

children < age 3

social-interaction difficulties

communication challenges

tendency to engage in repetitive behaviors

deficits in non-verbal communicative behaviors used for social interaction

deficits in developing, maintaining, & understanding relationships

if aggressive --> tx with antipsychotic (eg risperidone or haloperidol)

w/o aggression --> behavioral & family therapy

Front 43

Conversion disorder (functional neurological disorder)

Back 43

a stressor induces a physical change (eg paralysis, blindness, mutism, etc)

"le belle indifference" --> "beautiful indifference" --> not concerned about the sxs

tx with supportive or behavioral therapy