Psychiatry

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Author:
shosh114
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162094
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Psychiatry
Updated:
2012-07-11 13:23:55
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step II
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  1. What are the timeframes for the schizophrenia-spectrum disorders?
    • Brief psychotic episode--less than 1 mo
    • Schizophreniform--1 to 6 mo
    • Schizophrenia--6 mo
  2. What are the negative symptoms of schizophrenia?
    • Anhedonia
    • Flat affect
    • Apathy
    • Avolition
    • Alogia
    • Poor attention
  3. What is the incidence of schizophrenia?
    1% of the population
  4. Low potency typical antipsychotic
    Chlorpromazine
  5. Atypical antipsychotics
    • Risperidone
    • Quetiapine
    • Olanzapine
    • Aripiprazole
    • Ziprasidone
  6. Side effects of typical antipsychotics
    • Acute dystonia
    • Akathisia
    • Parkinsonism
    • Tardive dyskinesia
  7. Management of akathisia in a patient on neuroleptics
    Beta blockers--but don't always work
  8. Management of a patient on typical antipsychotics who develops Tardive dyskinesia
    Stop the drug, switch to an atypical
  9. Signs of NMS
    • Rigidity
    • Mutism
    • Fever
    • High CPK
    • Myoglobinuria

    Treat with dantrolene
  10. Side effect of thioridazine
    Retinal deposits
  11. Side effect of chlorpromazine
    Corneal deposits
  12. Which atypicals cause serious weight gain?
    Olanzapine, quetiapine
  13. Which atypicals cause prolonged QT?
    Ziprasidone, paliperidone
  14. What are the two first line mood stabilizers?
    • Lithium
    • Valproate (give to patients with renal disease)
  15. Side effects of lithium
    • Renal dysfunction
    • Diabetes insipidus
    • Thyroid dysfunction
    • Tremor
  16. Cyclothymia
    Hypomania + depressed mood for at least 2 years
  17. Bipolar II
    Hypomania + MDD
  18. What age group has the highest suicide rates?
    Age over 65
  19. Adjustment disorder
    • Distress and impaired functioning following a stressor
    • Does not meet the criteria for MDD
  20. Dysthymia
    Depressed mood most of the time for at least 2 years
  21. What is the problem with giving antidepressants as monotherapy to a bipolar patient?
    They can trigger mania
  22. Side effects of tricyclics
    • Orthostatic hypotension
    • Anticholinergic (dry mouth, blurred vision, constipation, urinary retention)
    • Sedation
    • Low seizure threshold
    • Cardiac arrhythmias
  23. Which antidepressants is known for lowering the seizure threshold?
    Buproprion (so do NOT give to an anorexic)
  24. List three SNRIs
    • Venlafaxine
    • Duloxetine
    • Desvenlafaxine
  25. List two MAOIs
    • Phenelzine
    • Tranylcypromine
  26. Antidepressants that are good for atypical depression (hypersomnia, hyperphagia)
    MAO inhibitors
  27. Timline for normal grief
    • One year
    • Worst symptoms last for 2 months
    • Illusions or hallucinations are normal
  28. Signs that distinguish pathological grief from normal bereavement
    • Feelings of guilt or worthlessness
    • Psychomotor retardation
    • Suicidal ideation
  29. What psych disorder is strongly associated with panic disorder?
    Agoraphobia
  30. First line tx for panic disorder
    SSRIs (e.g. fluoxetine)
  31. Management of GAD
    • CBT
    • Meds--buspirone (non-addicting, non-sedating, but slow), SSRIs, benzos (addictive and sedating)
  32. Symptoms of PTSD
    • Re-experiencing
    • Avoidance
    • Hyperarousal
  33. What are the four major somatoform disorders?
    • Somatization disorder--multiple complaints in many organ systems over many years
    • Conversion disorder--inexplicable neuro signs following a stressor (blindness, mutism, paralysis)
    • Hypochondriasis--intense fear of having a disease, despite extensive workup
    • Body dysmorphic disorder--preoccupation with an imagined physical defect
  34. Factitious disorder
    The patient deliberately fakes being sick in order to assume the sick role
  35. Malingering
    The patient fakes being sick for some secondary gain (e.g. time off of work, money)
  36. Which psychiatric disorder is most likely to be associated with a childhood history of sexual abuse?
    Dissociative personality disorder
  37. Borderline personality disorder
    • Unstable moods, behaviors, and relationships
    • Splitting
    • Hx of multiple suicide attempts
    • Impulsive, constantly in crisis
  38. Management of OCD
    • SSRIs (OCD is associated with low serotonin)
    • Clomipramine
    • CBT
  39. When can a patient be hospitalized unwillingly?
    Danger to self or others
  40. Signs of narcolepsy
    • Daytime sleepiness
    • Cataplexy
    • Hypnopompic and hyponogogic hallucinations
    • Characterized by loss of REM latency (patients go immediately into REM sleep)
  41. How is narcolepsy treated?
    Modafinil or methylphenidate
  42. Signs of autism
    • Impaired social interaction
    • Impaired communication skills--strange words, babbling, repetition
    • Restricted activities--head banging, strange movements
  43. What is the childhood version of antisocial personality disorder?
    Conduct disorder--antisocial PD can only be diagnosed after age 18, and requires a history of conduct disorder before age 15
  44. Way to distinguish oppositional-defiant disorder from conduct disorder
    Kids with ODD behave badly to adults, but normally to peers.  Kids with conduct disorder behave badly to everyone.
  45. Criteria for anorexia
    • Body weight at least 15% below normal
    • Fear of gaining weight/feeling fat
    • Amenorrhea (missing 3 consecutive periods)
  46. Treatment for Tourette's
    Typical antipyschotics (haldol, pimozide)
  47. At what age can a diagnosis of encopresis be made?
    • After age 4
    • (enuresis can be diagnosed after age 5)
  48. What drug of abuse is associated with conjunctival injection?
    Marijuana
  49. Signs of cocaine intoxication
    Sympathetic stimulation--insomnia, mydriasis, tachycardia, HTN, diaphoresis
  50. Signs of opiod intoxication
    • Euphoria, analgesia, drowsiness
    • Pinpoint pupils
    • CNS depression--dangerous!

    Treat with naloxone
  51. Signs of LSD intoxication
    Hallucinations and nystagmus
  52. Difference between PCP and LSD intoxication
    • Both are associated with nystagmus and hallucinations
    • People on LSD are pretty happy
    • People on PCP can be aggressive, confused, and agitated
  53. Management of a benzo overdose
    Flumazenil
  54. Symptoms of caffeine withdrawal
    AAAGGGHHH!  I KILL YOU!!!!

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