1
Q
What must be seen in mental retardation
A
Deficits in both intellectual functioning and social adaptive functions
2
Q
Epidemiology of mental retardation
A
M>F
Highest incidence in school age
3
Q
Level of functioning w/ IQ 50-70
A
6th grade education
Work and live independently
Needs help in stressful situations
4
Q
Level of functioning w/ IQ 30-40 to 50-55
A
2nd grade education
Work w/ supervision
Needs help in mild stressful situations
5
Q
Level of functioning w/ IQ 20-25 to 35-40
A
Little to no speech
Limited in ability to self-care
6
Q
Level of functioning w/ IQ
A
Needs continuous care and supervision
7
Q
Rx Mental retardation
A
Genetic counseling, prenatal care, safe environment for expectant mothers
Rx medical disorder if it’s the cause
Special education
Behavioral therapy
8
Q
What are pervasive developmental disorders
A
Characterized by social interactions behavior and language
Occur before age 3
9
Q
Which childhood developmental disorder has a greater incidence in girls
A
Rett
10
Q
Features of autism
A
Lacks peer relationships and social smile Poor eye contact Absent/bizarre speech Repetitive behaviors Self-injurious
11
Q
Features of Rett
A
Progressive encephalopathy Microcephaly Hand-wringing Loss of speech Ataxia Psychomotor retardation
12
Q
Features of childhood disintegrative disorder
A
NL development for 2 yrs then marked regression
Loss of language, social interaction, motor fn, bladder fn
13
Q
Features of Asperger
A
Problems with social interaction and behaviors
No language or intellectual deficits
Preoccupied with rules
14
Q
Rx Autism
A
Improve relationships
Behavior modification
15
Q
Rx Rett
A
Symptomatic rx
Behavior therapy
Physiotherapy
16
Q
Rx childhood disintegrative disorder
A
Improve relationships
Behavioral modification
17
Q
Rx Asperger
A
Improve relationships
18
Q
What must be ruled out if child doesn’t respond to name being called
A
Deafness
19
Q
ADHD
A
Inattention, short attention span or hyperactivity that interferes with daily functioning for >6mos usually starting at age 7 in 2 locations
20
Q
First line rx ADHD
A
Methylphenidate
Dextroamphetamine
21
Q
Side effects of First line ADHD meds
A
Insomnia
Decreased appetite
HA
22
Q
Second line rx ADHD
A
Atomoxetine - chosen over 1st line due to better side effect profile
23
Q
Who gets oppositional defiant disorder
A
Age 8
Boys before puberty, Equal after
24
Q
Who gets conduct disorder
A
M>F
Parents have antisocial personality disorder and alcohol dependence
25
Features of oppositional defiant disorder
Argue, lose temper, blame others
| Problems with authority
26
Features of Conduct disorder
Break rules
| Bully, cruelty to animals, fighting, use weapons, crime
27
Rx oppositional defiant disorder
Teach parents appropriate child management skills
28
Rx conduct disorder
Behavioral intervention using rewards for prosocial and non-aggressive behavior
29
Tourette
Multiple tics for >1yr before 18
30
Common motor tics in tourette
Head shaking
| Blinking
31
Common vocal tics in tourette
Grunting
Throat clearing
Coughing
32
Epidemiology of tourettes
M>F by age 7
33
Rx Tourette
DA antagonists (risperidone)
34
Major depression
At least 2 weeks of anhedonia + 4 of
- Weight changes
- Sleep changes
- Poor concentration
- Thoughts of death and worthlessness
- Psychomotor disturbances
35
MC medical cause of depression
Hypothyroidism
36
MC neuro cause of depression
Parkinson
| Dementia
37
First line Rx depression
SSRI - Increase the dose if some but not full response
| Psychotherapy
38
SSRI to use if depression + neuropathic pain
Duloxetine
39
SSRI to use if depression who is fearful of weight gain or sexual side effects
Buproprion
40
What are manic symptoms
```
Elevated mood
Increased self esteem
Distractibility
Pressured speech
Decreased need for sleep
Increase in goal-directed activity
Racing thoughts
Excessive involvement in pleasurable activities
```
41
What to r/o in bipolar
Cocaine or amphetamine use
42
Bipolar
Manic sx for at least 1 week
43
How long do hypomanic sx last for
Less than a week
44
Rx acute mania
Lithium
45
Rx bipolar depression
Lithium or lamotrigine
46
Rx acute mania with severe sx
Atypical antipsychotics
47
Dysthymia
Depressed mood lasting throughout the day for 2 or more years
48
Rx dysthymia
Antidepressants
| Psychotherapy
49
Cyclothymia
Hypomanic episodes and mild depression for more than 2 years
50
Rx cyclomania
Li
Valproate
Carbamazepine
Psychotherapy
51
Characteristics of atypical depression
```
Increased sleep
Increased weight
Increased appetite
Worse in evening
Extremities feel heavy
```
52
Rx atypical depression
SSRIs or MAOIs
53
Rx seasonal affective disorder
Phototherapy
| Bupropion
54
Onset of postpartum blues
Immediately to up to 2 weeks after birth
55
Onset of postpartum depression
Within 1-3 months after birth
56
Onset of postpartum psychosis
Within 2-3 weeks after birth
57
Sx postpartum blues
Sadness
Mood lability
Tearfulness
58
Sx postpartum depression
Depressed mood
Wt changes
Sleep changes
Excessive axiety
59
Sx postpartum psychosis
Depression
Delusions
Thoughts of harm
60
Mother wants to harm baby
Postpartum psychosis
61
Rx postpartum blues
Nothing, self-limited
62
Rx postpartum depression
Antidepressants
63
Rx postpartum psychosis
Antipsychotics
Li
Antidepressants
64
Duration of bereavement
Less than 6 months but can go on longer
65
Dx of major depression over bereavement
```
Thoughts of death
Morbid preoccupation of worthlessness
Marked psychomotor retardation
Psychosis
Prolongued functional impairment
Sx last longer than 2 months
```
66
AE TCAs
```
Hypotension
Dry mouth
Constipation
Arrhythmias
Sexual side effects
Wt gain
GI disturbances
```
67
AE MOAs
Hypertensive crisis w/ foods high in tyramine
68
AE SSRIs
HA
Wt changes
Sexual side effects
GI disturbances
69
AE SNRIs
```
HTN
Blurry vision
Wt changes
Sexual side effects
GI disturbances
```
70
AE Bupropion
Seizures
71
AE Trazodone
Priapism
72
AE Mirtazipine
Wt gain
| Sedation
73
AE Lithium
Tremors, wt gain, GI disturbance, nephrotoxic, teratogen
Leukocytosis DI
Confusion, ataxia, lethargy, abnormal reflexes
74
AE Valproic acid
Tremors, wt gain, GI disturbance, hepatotoxic, teratogen
| Alopecia, hyponatremia, coma
75
AE Almotrigine
SJS
76
AE ECT
HA
| Transient memory loss
77
Most effective treatment for depression
ECT
78
When is ECT given for depression
Suicidal pts who don't respond to therapy
79
Sx of serotonin syndrome
Cognitive effects - agitation, confusion, hallucinations
ANS Sx
Somatic effects - tremors, myoclonus
80
Rx serotonin syndrome
Stop SSRI
Rx Sx
Cyproheptadine
81
Duration of brief psychotic episode
>1 day
82
Duration of schizophreniform
>1 mo
83
Duration of Schizophrenia
> 6mo
84
Rx all psychotic disorders
Antipsychotics
85
Important for diagnosing schizophrenia
UDS to rule out cocaine or amphetamines
86
Schizophrenia type with earliest onset and worst prognosis
Disorganized
87
Schizophrenia w/ lack of positive sx
Residual
88
When to hospitalize schizophrenics
Acutely psychotic
89
Schophrenic needs meds in emergency situation w/ IM injection, what to give
Olazapine
| Ziprazidone
90
Rx schizophrenic, non-compliant
Risperidone (long-acting)
91
Rx schizophrenic who don't respond to typical or atypical
Clozapine
92
AE Olanzapine
DM
| Wt gain
93
AE Risperidone
More incidence of Movement disorders
94
AE Quetiapine
Less incidence of Movement Disorders
95
AE Ziprasidone
Prolonged QT
96
AE Clozapine
Agranulocytosis - monitor CBC
97
Onset of acute dystonia
Hrs to days
98
Onset of akathisia
Weeks
99
Onset of tardive dyskinesia
6 months
100
Onset of NMS
No time limit
101
Sx of acute dystonia
Muscle spasms
- Torticollis
- Laryngeal spasms
- Occulogyric crisis
102
Sx akathisia
Restlessness, rocking
103
Sx tardive dyskinesia
Abnormal involuntary movement of head, limb, trunk
| Perioral movements most common
104
Sx NMS
Muscle rigidity
Fever
ANS changes
Agitation, confusion
105
Rx acute dystonia
Benztropine
Trihexyphenidyl
Diphenhydramine
106
Commonly causes acute dystonia
Haloperidol
107
Rx akathisia
Reduce dose
BBs
Switch to atypical
108
Rx tardive dyskinesia
Switch to atypical
| Clozapine has least risk
109
Rx NMS
Dantroline or Bromocriptine
110
What is delusional disorder
Non-bizarre delusions for >1mo and no impairment in level of functioning
111
Do pts w/ delusional disorder have hallucinations
No
112
Rx delusional disorder
Atypical antipsychotics
| Psychotherapy
113
Panic disorder
Intense anxiety w/ feelings of dread and doom
| 4 Sx of ANS hyperactivity lasting
114
What is panic disorder sometimes associated with
Agoraphobia
115
Epidemiology of Panic Disorder
W>M
116
What must be r/o to make the dx of panic disorder
Thyroid disease
Hypoglycemia
Cardiac disease
117
Rx panic disorder
SSRIs
| Benzos (begin w/ both and taper benzo)
118
Rx panic attack
Alprazolam (benzo only)
119
Rx phobia
Behavior modification
| Relaxation techniques
120
Social anxiety
Fear of embarrassment in social situations
121
What are obsessions
Thoughts that are intrusive and increase anxiety
122
What are compulsions
Rituals intended to lower anxiety
123
What can OCD coexist with
Tourette
124
Rx OCD
SSRIs
125
Difference between PTSD and acute stress disorder
PTSD - >1mo
| ASD - >2 days,
126
Rx stress disorders
Paroxetine and sertraline
Prazosin for nightmares
Relaxation techniques
Psychotherapy
127
Main feature of generalized anxiety disorder
Chronic worrying about things that do not merit concern
128
How long do the sx of GAD last
>6mos
129
Rx GAD
SSRIs
| Venlafaxine, Buspirone
130
AE benzos
```
Sedation
Confusion
Memory deficits
Resp depression
Addiction
```
131
AE Buspirone
HA
Nausea
Dizziness
132
Indication for Lorazepam
Emergency (IM)
133
Indication for Clonazepam
Addiction is a concer
134
Indication for Chlordiazepoxide, oxazepam, lorazepam
Alcohol withdrawal
135
Indication for Alprazolam
Panic disorder
136
Indication for Flurazepam, temazepam, triazolam
Hypnotics
137
When is Flumazenil used
OD is acute with NO chronic dependence
138
What can flumazenil cause
Seizure in benzo-dependent pt
139
Define intoxication
Reversible experience causing physio or psychological changes
140
Define withdrawal
Cessation or reduction causes psychological or physiological changes
141
Define abuse
Maladaptive pattern of use leading to adverse consiquences
142
Define dependence
Maladaptive behavior leading to tolerance
Withdrawal when trying to cut down
Continue despite adverse consequences
143
Rx alcohol intoxication
Mechanical ventilation if severe
144
Rx amphetamine/cocaine intoxication
Antipsychotics +/- benzos +/- antihypertensives
145
Rx hallucinogen intoxication
Antipsychotics +/- benzos +/- talking down
146
Rx inhalant intoxication
Antipsychotics
147
Rx opiate intoxication
Naloxone
148
Rx PCP intoxication
Antipsychotics +/- benzos +/- talking down
149
Rx anabolic steroid intoxication
Antipsychotics
150
Sx alcohol withdrawal
Tremors
Hallucinations
Seizures
DTs
151
Sx amphetamine/cocaine withdrawal
```
Anxiety
Tremulousness
HA
Increased appetite
Depression
Risk of suicide
```
152
Sx opiate withdrawal
```
Fever, chills
Lacrimation
ABD cramps
Muscle spasms
Diarrhea
```
153
Sx anabolic steroid withdrawal
Depression
HA
Anxiety
Increased concern over body physical state
154
Rx alcohol withdrawal
Benzos
Thiamine
Multivitamins
Folate
155
Rx amphetamine/cocaine withdrawal
Bupropion +/- bromocriptine
156
Rx opiate withdrawal
Clonidine
Methyldopa
Buprenorphine
157
How long is substance detox in hospital
5-10 days
158
How long is substance rehabilitation
28 days or more
159
Pharma rx for substance abuse
Disulfram
Naltraxone
Acamprosate
160
What are somatoform disorders
Physical sx w/ no medical explanation
161
Somatization disorder
4 Pain
2 GI
1 Sexual
1 Pseudoneuro
162
Hypochondriasis
Believe they have specific disease despite constant reassurance
163
Conversion disorder
Pt unconcerned about own impairment
164
Body dysmorphic disorder
Pt believes some body part is abnormal/defective/misshapen
165
Pain disorder
Presence of pain and has psychological factors associated
166
Rx somatization disorder
Individual psychotherapy
167
Factitious disorder
Fake an illness to get attention
| May even harm themselves
168
Who has factitious disorder
Women with an Hx of being employed in healthcare
169
Malingering
Conscious production of signs and sx for an obvious gain
170
When is malingering diagnosed
Discrepancy between pt complaints and actual physical or lab findings
Lack of cooperation from pt
171
Adjustment disorder
Maladaptive reaction to identifiable stressor
| Sx occur within 3mos of stressor and remit within 6mos of removal of stressor
172
Paranoid personality
Suspicious mistrustful
| Questions loyalty of family/friends
173
Schizoid personality
Happy loner
Chooses to engage in solitary activities
Emotional coldness
174
Schizotypal personality
Magical thinking
| Brief psychotic episodes
175
Histrionic personality
Must be center of attention
176
Antisocial personality
Failure to conform to social rules
Aggressive towards others
Over 18
177
Borderline personality
Feelings of emptiness and inappropriate anger
| "Splitting"
178
Narcissistic personality
Grandiose sense of self
179
Avoidant personality
Unwilling to get involved with people due to feelings of inadequacy
180
Dependent personality
Unable to assume responsibility for day to day decisions
181
Obsessive compulsive personality
Preoccupied with details
182
Rx personality disorders
Individual psychotherapy
| Meds if mood or anxiety present
183
Which personality disorders are associated w/ psychotic symptoms
Borderline
| Schizotypal
184
Features of anorexia nervosa
```
Failure to maintain normal body weight
Body image disturbance
Deny emaciated condition
Great concern with appearance
Purge, fast, laxative and diuretic abuse
Amenorrhea
```
185
Most commonly gets anorexia
Girls 14-18
186
EKG changes in anorexia
Rhythm disorders due to hypokalemia
187
MCC death anorexia
Arrhythmia
188
Rx anorexia
Hospitalization
Psychotherapy
Behavioral therapy
SSRIs
189
Features of bulemia nervosa
Frequent binge eating
Lack of control of overeating episodes
Purging, laxative/diuretic abuse, fasting, excessive exercise
190
Who gets bulemia
Women later in adolescence than anorexia
| Normal wt w/ Hx obesity
191
Rx bulemia
Psychotherapy
| SSRIs
192
What is narcolepsy
Excessive daytime sleepiness and abnormalities of REM
193
Management of narcolepsy
Forced daytime naps
Modafinil to keep awake
Methylphenidate and dextromethorphan GHB at night
194
What are sleep attacks
Irresistible sleepiness
| Refreshed upon awaking
195
What is cataplexy
Sudden loss of muscle tone
196
What are hypnogogic and hypnopompic hallucinations
Hallucinations while going to sleep and waking up
197
What is sleep paralysis
Pt awake but unable to move
198
What is insomia
Inability to initiate or maintain sleep
199
Rx insomnia
Sleep hygiene techniques
| Behavior modification
200
Medical Rx for insomnia
Zolpidem
Eszopiclone
Zaleplon
201
Sexual identity
Based on secondary sexual characteristics
202
Gender identity
Based on person's sense of maleness/femaleness
| Established by age 3
203
Gender role
External patterns of behavior reflecting inner gender identity
204
Sexual orientation
Person's choice of love object
205
Impotence
Inability to attain or maintain an erection
206
Premature ejactulation
Before or just after penetration
| Usually 2/2 anxiety
207
Dyspareunia
Pain associated w/ intercourse
208
Vaginismus
Involuntary contraction of outer 1/3 of vagina preventing penile insertion
209
Rx most types of sexual dysfunction
Psychotherapy
210
Who commonly has paraphilias
Men
211
What are paraphilias
Recurrent sexually arousing occurring for >6months
| Cause distress/anxiety and adversely affect level of functioning
212
Exhibitionism
Expose oneself to strangers
213
Fetishism
Non-living objects
214
Pedophilia
Prepubescent children
215
Masochism
Humiliation
216
Sadism
Physical or psychological suffering of victim is exciting
217
Transvestic fetishism
Cross dressing for sexual gratification
218
Frotteurism
Rubbing genitals against nonconsenting person
219
Rx paraphilias
Individual psychotherapy
Behavior modification
Antiandrogens or SSRIs
220
Gender identity disorder
Persistent discomfort and sense of inappropriateness regarding pt's assigned sex
More often in Men
221
Rx gender identity disorder
Sex reassignment
| Individual psychotherapy
222
MCC death from suicide
Guns
223
Presentation of suicidal individual
Recent attempt
Complaints of suicidal thoughts
Admission of suicidal thoughts
Demonstration of suicidal behaviors
224
RFs for suicide
```
ACCESS TO FIREARMS
Older Men
Social isolation
Psychiatric illness/drug abuse
Perceived hopelessness
Previous attempts
```
225
Rx suicidal pt
Hospitalize
| Take threats seriously
Step 2 CK
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