1
Q
psychosis
A
distorted perception of reality
2
Q
delusions
A
fixed, false beliefs despite evidence to the contrary
3
Q
nonbizzare vs bizarrre
A
one is believable, other is not
4
Q
delusions of persecution/paranoia
A
“CIA is after me” - one is being persecuted
5
Q
delusion of ideas of reference
A
belief that external enviornmental are related to individual -TV is talking to me
6
Q
delusion of control
A
thoughts can be heard of or by others
7
Q
delusions of grandeur
A
super powers
8
Q
delusions of guilt
A
guilty for something
9
Q
somatic delusions
A
infected with a disease
10
Q
illusion
A
misinterpretation of sensory stimulus (mistake show for a cat)
11
Q
associations of hallucinations
A
auditory = schizophrenia visual = drug, alcohol withdrawal, delirium olfactory = aura for epilepsy tactile = withdrawal
12
Q
delusion vs illusions vs hallucination
A
delusion = false belief illusion = misinterpretation of external stimulus hallucination = perception in absence of stimulus
13
Q
criteria for psychosis due to medical condition
A
- prominent hallucinations/delusions
- symptoms do not occur only during delirium
- evidence of another cause
14
Q
most common cause of psychosis in elderly
A
delirium
15
Q
positive symptoms of schizophrenia
A
- hallucinations
- deulsions,
- bizarre behavior
- disorganized speech
- responds to meds
16
Q
negative symptoms of schizophrenia
A
- flat or blunted affect, anhedonia, apathy, alogia and lack of interest
- treatment resistent
17
Q
phases of schizophrenia
A
- prodromal - decline in funcitoning
- psychotic
- residual
18
Q
criteria for schizophrenia
A
- delusions
- hallucinations
- disorganized speech
- disorganised or catatonic behavior
- negative symptoms
- problem with functioning for at least 6 months
19
Q
echolia
A
repeated words or pharases
20
Q
echopraxia
A
mimic behavior
21
Q
findings in schizo exam
A
- disheveled, flat affect, disorganized thought
- intact memory and orientation
- auditory hallucinations
- paranoid delusions
- ideas of reference
- lack on insight
22
Q
downward drift hypothesis
A
unable to function in society, end up in lower classes
23
Q
neurotransmitter in schizo
A
dopamine
Less so:
high serotonin, high norepi, low GABA, low glutamate
24
Q
pathways in schizo
A
- prefrontal
- mesolimbic = positive symptoms
- tuberoinfundibular - affected with antipsychotics
- nigrostriatal = EPS symtpoms
25
neolosigm
made up words, seen in schizophrenia
26
treatment of schizophrenia
no difference between first and second generation for efficacy
- should be taken for 4 weeks
27
dystonia
spasms
28
parkinsonism
resting tremor, rigidity, bradykinesia
29
akathisia
feeling of restlessness
30
treatment for EPS
benztropine and diphenhydramine, benzos/beta blockers
31
treatment for tardive dyskinesia
benzos, botox and vitamin E
32
symptoms of NMS
fever, labile blood pressure, tachycardia, tachypnea, diaphoresis, lead pipe rigidity, elevated CPK, leukocytosis, metabolic acidosis
33
thioridazine side effects
irreversible retinal pigmentation at high doses
34
chlorpromazine side effects
deposits in lens and cornea
35
schizoaffective disorder
- meet criteria for major depressive or manic episode with psychotic symptoms
- delusions for 2 weeks with no mood symptoms
- mood symptoms present for majority of psychosis
- not dus to substance
36
differences in delusional disorder vs schizophrenia
non bizarre delusions, daily functioning not impaired, does not meet schizophrenia criteria
37
erotomanic deulsion
deulsion that someone else is in love with person
38
Koro
penis into body in southeast asia
39
amok
outburst of violence followed by suicide, malaysia
40
brain fag
disturbances in male students in Africa
41
MDD criteria
1. depressed mood
2. anhedonia
3. change in appetite or weight
4. worthlessness or guilt
5. insomnia or hypersomnia
6. diminished concentration
7. psychomotor agitation or retardation
8. fatigue or loss of energy
9. recurrent thoughts of death or suicide
42
Mania criteria
1. distractibility
2. inflated self-esteem or grandiosity
3. increase in goal directed activity
4. decrease need for sleep
5. flight of ideas or thoughts
6. pressured speech
7. excessive pleasure with risks
- lasting 1 weeks
43
poor response to mixed mood disorder
lithium, valproic acid is preferred
44
hypomania vs mania
```
mania = 7 days, social impairment, hospital, psychotic features
hypo = 4 days, no functional impairment, no hospital, no psychosis
```
45
stroke patients = mood disorder
depression
46
MDD criteria
- major depressive episode
| - no mania or hypomania
47
sleep with MDD
multiple awakenings, terminal insomnia, hypersomnia is less common, REM earlier and for longer
48
etiology of MDD
increased sensitivity of beta-adrenergic receptors, high cortisol, abnormal thyroid, etc
49
most common sleep disturbances in MDD
trouble falling sleep and early awakenings
50
time for antidepressants
4-6 weeks
51
fist line in patients with MDD with psychotic features
atypical antipsychotics
52
ECT
- premeidated with atropine
- general anesthesia with methohexital
- muscle relaxant
53
melancholic features
anhedonia, early morning awakenings, depression worse in morning, psychomotor disturbance, excessive guilt and anorexia
54
atypical features of MDD
hypersomnia, hyperphagia, reactive mood, leaden paralysis, hypersensitivity to interpersonal rejection
55
bipolar I
manic episodes with or without depression, only requires one episode of mania
56
bereavement
not a DSMV diagnosis
57
highest genetic link of psychiatric disorders
bipolar I
58
rapid cycling
4 or more mood episodes in 1 year
59
lithium in bipolar
reduces suicide risk
60
drugs useful for rapid cycling
carbamazepine and valproic acid
61
avoid _____ in mania
antidepressants
62
bipolar II
one or more depressive episode with at least one hypomanic episode
63
treatment for mania in pregnancy
ECT
64
dysthymia
persistent depressive disorder - for at least 2 years
| - not without symptoms for greater than 2 months
65
cyclothymia
alternating periods of hypomania and periods with mild to moderate depressive symptoms
66
disruptive mood dysregulation disorder
chronic, severe, persistent irritability occurring in childhood and adolescence
67
most common psychopathology
anxiety
68
psychopathology with SOD
social and or occupational dysfunction
69
anxiety bridge med
benzos
70
Bs to block the Ps
beta blockers for panic attacks and performance anxiety
71
PRN anxiety use....
non addictive diphenhydramine or hydroxazine
72
buspirone
5-HT agonist, anxiolytic, not efficacious
73
risk factor for panic attacks
smoking
74
SSRI in panic disorders
start slowly because meds can worsen anxiety at first
75
social phobia
fear of scrutiny by others or fear of acting in a humiliating or embarrassing way
76
most common psychiatric disorder by gender
```
women = phobias
men = substances
```
77
obsessions and compulsions
```
obsessions = recurrent, intrusive undesired thoughts that increase anxiety
compulsions = repetitive behaviors or mental rituals
```
78
most serotonin selective TCA
clomipramine
79
trichotillomania
hair pulling risorder
80
acute stress vs PTSD
PTSD = greater than 1 month and trauma at any time, stress = less than 1 month
81
adjustment disorder
within 3 months of event and resolve within 6
82
cognitive processing
CBT where thoughts, feelings and meanings of event are revisited and questioned
83
paranoid personality disorder
- pervasive distrust and suspiciousness of others
- blame own problems on others, angry and hostile
- jealous and cheating
84
schizoid personality
social withdrawal, eccentric and reclusive
| - prefer to be alone, no desire for close relationship
85
schizotypal personality
eccentric behavior, peculiar thought patterns, strange and odd
- seen in families with schizophrenia
86
antisocial personality
exploitie of others, lack empathy, compassion and remorse, impulsive deceitful and break law
87
antisocial differential
can be caused by drug abuse
88
borderline personality
unstable moods, behaviors and interpersonal relationships, poorly formed identity, intense attachment, agression is common
89
splitting seen in...
borderline
90
drugs most useful in what personality disorder
borderline
91
histrionic personality
attention seeking, emotional, dramtic, flamboyant and extroverted
92
electrolyte abnormality in alcohol withdrawal
hypomagnesium, should be corrected early
93
natrexone
opioid receptor blocker, decreases cravings and high
94
acamprosate
modulate glutamate transmission
- started post detox
- used in liver, not renal disease
95
disulfiram
blocks aldehyde dehydrogenase, causing averse reactions
96
topiramate
potentiates GABA and inhibits glutamate
97
lab effects of alcohol
macrocytosis and high LFTs
98
Wernickes
ataxia, confusion, ocular abnormalities, nystagmus, gaze palsies
99
Korsakoff
chronic amnesitc syndrome
100
cocaine hallucinations
tactile
101
deadly side of cocaine
vasoconstrictive MI, intracranial hemorrhage or stroke
102
danger in MDMA
serotonin syndrome with SSRI
103
PCP MOA
antagonize NMDA glutamate receptors
104
rotary nystagmus =
PCP intoxication
105
GHB
commonly date rape drug along with ketamine
106
drug withdrawal with highest mortality rate
barbituates
107
sedatives detox
sodium bicarb with barbituates
| flumazenil with benzos
108
opioid use disorder treatments
1. methadone - long acting opioid agonist, once daily, can cause Qtc
2. buprenorphine - partial opioid agonist, sublingual, plateau, comes as suboxone (with naloxone)
3. naltrexone - competitive antagonist, compliance is issue
109
caffeine MOA
adenosine antagonist causing increase in cAMP release
110
delirium is a disorder of...
attention and awareness (like acute brain failure)
111
three types of deliurm
1. mixed - most common
2. hypoactive - undetected
3. hyperactive - in withdrawal
112
medications avoided in delirium
benzos, unless due to alcohol or benzo withdrawal
113
MMSE
sensitive for major neurocognitive disease if score is less than 25
114
testing attention
serial 7s
115
long half life anti depressant
fluoxitine
116
antipsychotics and dementia
carry black box warning for early death
117
stepwise loss of function
vascular dementia
118
domains affected in small vessel disease
complex attention and executive funciton
119
visual hallucinations and EPS
Lewy body dementia
120
core features of Lewy body
1. waxing and waning of cognition in areas of attention and alertness
2. visual hallucinations
3. EPS
121
suggestive features of Lewy body
1. REM sleep behavior disorder
| 2 pronouced antipsycotic sensitivity
122
movement problems in huntingtons
chorea and bradkinesia
123
rapidly progressive cognitive decline and myoclonus
creutzfeldt-Jakob disease
124
pseudodementia
the appearence of being demented in an elederly depressed patient
125
MCD vs pseudodementia when asked a question
MCD confabulate, depression says they dont know
126
sundowning
confusion at night, common in dementia
127
visual hallucination in early dementia suggest....
Lewy body
128
global developmental delay is for patient under...
5
129
comorbid ADHD disorders
ODD, conduct, learning disability
130
coprolalia
obscene taboo words as an brupt sharp bark or grunt
131
first choice for tourettes
alpha 2 agonists guanfacine and lconidine
132
treatment for enuresis
alarm then desmopressin or imipramine
133
abreaction
strong emotional reaction patients may experience when retrieving traumatic memories
134
depersonalization vs derealization
```
person = separation for oneself
real = separation from outside surroundings
```
135
procedural memory
knowing how to do things, preserved in deissociative amnesia
136
dissociative identity disorder
more than one distinct personality
137
depersonalization vs derealization disorder
not feeling like yourself "out of body" or feeling like you are in a dream
138
somatic symptom disorder
one or mor symptoms, distressing and disrupting, exessive thoughts about for at least 6 months
139
conversion disorder
neuro symptom that cant be epxlained, clam and unconcerned
140
illness anxiety
concern over aquiring an illness
141
brain association with intermittent explosive disorder
low levels or serotonin in CSF
142
types of anorexia
1. restricting - acheived through diet, fasting and exercise
| 2. binging/purging - binges followed by vomiting
143
anorexia vs bullemia
anorexia = very low weight, bullemia = normal weight
144
only medication approved for bullemia
fluoxetine
145
akathasia is treated with...
propranolol
Psychiatry
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