laracrystalo's version from 2015-07-31 03:05


Question Answer
dysthymia in kids1 yr of sx, no more than 1 months of OK
dysthymia in adults2 yr of sx, no more than 2 months of OK
atypical depression sxmood reactivity, hyperphagia, hypersomnia, leaden paralysis, hypersensitivity to interpersonal stressors
brief psychotic3 days - 1 month
schizophreniform1-6 months
schizophreniagreater than 6 months. 1 month of active dysfunction and 2/4 criteria A
Acute stressstart in less than 1 month of stressor and lasts to 1 month of symptoms
PTSDgreater than 1 month of symptoms (onset anytime)
GAD6 months of symptoms
Panic disordergreater than or equal to 1 panic attack and anxiety obout recurrence. NO TRIGGER
Maniagreater than or equal to 7 days OR required a hospitalization
Hypomania4-7 days
schizoaffective disorderpsychosis and mood sx most of the time but greater than 2 weeks of JUST psychosis
anorexiaBMI less than 18.5, egosyntonic, anxiety/fear. CONTROL
bulimianormal/increased BMI, egodystonic, guilt/shame. Binging
ADHD sx beginbefore 12
Enuresis normal until age5
Encopresis normal until age4
substance induced depression TOXMJ, EtOH, benzos, opiates, barbs
substance induced depression WITHDRAWALcocaine, amphetamines
substance induced mania TOXcocaine, amphetamines
substance induced psychosis TOXMJ, LSD, PCP, K2
substance induced psychosis WITHDRAWALalcohol, benzos


Question Answer
fewest sexual side effectsbuproprion, mirtazapine
washout period ssri to maoi2 wks, except fluoxetine 5 wks
dietary restrictions?MAOi (tyramine)
self-tapers when stopped?fluoxetine long half life
increase seizure riskbuproprion
contraindicated with meperedineMAOi
highest likelihood of discontinuation symptomsparoxetine and venlafaxine
activating ADfluoxetine and buproprion
OCD indication medsclomipramine, fluvoxamine
problem with sleep?mirtazapine, trazodone
problem with anxiety?buspirone
problem with sex dysfunction?buproprion
psychosis with depression?aripiprazole, lithium
avoid in high bp?venlafaxine
persistent pulmonary hypertension of the newbornSSRI use while pregnant
SSRI most likely to cause discontinuation syndrome?Paroxetine bc shortest half life. Restart and then taper.
valproic acid and lamotrigine?lamotrigine tox, so lower the dose
lamotrigine and oral contraceptive pills?both can render each other less effective...increase the doses
recommended length of treatment for unipolar depression?at least 6 months (usually 8-12)


Question Answer
increase seizure thresholdclozapine
mood stabilizerquetiapine
highest likelihood EPSrisperidone
AP that are weight neutralaripiprazole, zeprasidone, lurasidone
worst for metabolic syndromeclozapine, olanzapine
adjunct to ADaripiprazole
life-threatening effects of clozapineagranulocytosis, myocarditis, seizures
prolong Qtcziprasidone
retinal pigmentation and eventual blindnessthioridazine at high doses
how to treat the sialorrhea in clozapine?add clonidine to help reduce volume of saliva
how to treat the tachycardia in clozapine?add propranolol
least likely to cause metabolic syndrome?aripiprazole, ziprasidone
rapid movements of the mouth but not tongue with smacking lipsrabbit syndrome

MS and other AEDs

Question Answer
increase lithium level?HCTZ, furosemide, NSAIDS, spironolactone, ethacrynic acid, triamterene, metronidazole, tetracycline
coarse tremorlithium tox
lithium toxcoarse tremor, N/V, diarrhea, AMS, ataxia
benign leukocytosislithium lab abnormality
lithium lab abnormalitiesbenign leukocytosis and hypothyroid
EKG on lithiumflattened T waves
flattened T waveslithium
first degree AV blocklithium
valproate lab abnormalitiesLFTs (tolerate 3x normal), thrombocytopenia
decreases birth controlcarbamazepine, lamotrigine
auto inducercarbamazepine
SJScarbamazepine, lamotrigine
weight losstopiramate
ebstein anomalylithium
spina bifidavalproate
cleft lip/palatebenzos
fingernail hypoplasiacarbamazapine
nystagmus (not just end stage)valproate toxicity
cognitive dullingtopiramate
SIADHcarbamazepine, SSRI in elderly
fatal hepatotoxicitydivalproex sodium
alternative pain treatments when a patient is on Lithium?aspirin or sulindac are OK!
increased risk of pancreatitis?valproic acid
kidney stonesTopiramate
cognitive bluntingTopiramate
oxcarbazepine side effecthyponatremia, so check serum electrolytes


Question Answer
what do you check before using lithium?electrolytes, creatinine, BUN
what do you check before using antipsychotics?fasting glucose and lipids, possibly CBC depending on which
what do you check before using divalproex sodium?liver function tests, and serum ammonia levels (it can cause elevation), electrolytes


Question Answer
MDDSSRI first, ECT last
Bipolarmood stabilizer and atypical antipsychotic
Panic disorderSSRI or CBT
acute panic attackalprazolam
OCDSSRI with or without TCA, then luvoxamine/fluvoxamine, then cloripramine, then cingulotomy
GADSSRI with or without buspirone
Atypical DepressionMAOi gold standard, but start with SSRI
CatatoniaBenzo or ECT
anorexiano evidenced based, none of the above
bulimiafluoxetine, topiramate that controls appetite to decrease binging

Side effects and/or adverse reactions

Question Answer
akathisiaby aripiprazole, treat with propranolol or clonazepam
dystoniabenztropine, diphenhydramine
tardive dyskinesiastop med and add low dose clozapine or atypical
SSRI discontinuation syndromerestart SSRI


Question Answer
resp alk with metabolic acidaspirin
tx aspirin overdosesodium bicarb
hyperthermic, dry flushed skin, agitated, stumbling arounddiphenhydramine
diphenhydramine overdose txphysostigmine
coarse tremor, AMS, diarrhea, n/vlithium tox
tx lithium toxfluids and dialysis
widened QRSTCA tox
treat TCA tox?sodium bicarb, magnesium
abdominal pain, n/v, jaundice, elevated LFTsacetaminophen tox
tx acetaminophen tox?N acetyl cysteine


Question Answer
elevated CPKNMS
extreme hyperthermiaNMS
lead pipe rigidityNMS
treat NMS?cooling, fluids, dantrolene, bromocriptine
myoclonus and flushingserotonin syndrome
treat serotonin syndrome?supportive care, Tylenol, fluids, cyproheptadine
most common side effects of methylphenidate?difficulty falling asleep, decreased appetite, which can lead to slowed growth (hence need for medication vacations). Also increased systolic bp
treatment of tics or tourettes?Clonidine or haloperidol for more severe cases
treatment of delirium and irritation in the elderly?avoid benzos and diphenhydramine (anticholinergic s/e). Choose low dose atypical antipsychotic like risperidone
treatment for acute agitation in elderly?haloperidol (and least likely to cause falls!) UNLESS there is prolonged QTc, in which case you should use a low dose antipsychotic like olanzapine
reduce alcohol cravings?Naltrexone and acamprosate (GABA agonist)
how to treat nightmares in patients with PTSD?Prazosin (alpha 1 blocker)
meds for alzheimers?Memantine, Donepezil, Galantamine, Rivastigmine, Tacrine (not used much bc hepatotoxic)
what do you administer to any patient found unconscious suspicious of substance overdose?dextrose D50, naloxone, thiamine
best med for opioid detox?Buprenorphine mixed opioid antagonist and agonist
this treats depression, neuropathic pain, and fibromyalgiaduloxetine (SNRI)
bipolar and trigeminal neuralgia treatment?Carbamazepine
short term treatment of insomnia?zolpidem
side effect of TMSheadache
bipolar in pregnancy treatment?clonazepam
Antidepressant with fewest drug drug interactions?citalopram
Antidepressant with most drug drug interactions?paroxetine
sedation is number one side effectolanzapine
when should you avoid benzos?COPD, asthma, elderly, addicts
primary gainfactitious disorder
secondary gainmalingering
treatment for severe disinhibition for frontotemporal dementiaolanzapine
recent corneal transplant and startle response?creuzfeld jakob
triphasic bursts on EEGcreuzfeld jakob
most specific test for EtOH consumption in the past 10 days?carbohydrate-deficient transferrin
tx for wernicke encephalopathy?thiamine first, then glucose with fluids
tx for acute opioid withdrawal?clonidine for ANS, ibuprofen for muscle cramps, loperimide for diarrhea
tx for long term opioid dependence?methadone, buprenorphrine, naltrexone
tx PCP intoxication?haloperidol for acute psychosis
tx of HTN and tachycardia in cocaine tox?Calcium channel blockers! (AVOID beta blockers)
first line for tourettes?clonidine, but most effective is haloperidol or pimozide
pimozide and citalopram combination?prolonged QTc
treatment of GAD in a patient on Warfarin?clonazepam

med conditions present psychiatrically

Question Answer
B12dementia, depression
neurosyphilispsychosis, dementia
acute intermittent porphyriapsychotic, stomach pain, exacerbated by light
Wilsonpersonality change , executive dysfunction, mvmnt changes
Huntington'sdepression first, then personality change and disinhibition

common meds and psych conditions

Question Answer
steroid long termdepression
Accutane (isotretinoin)depression
steroid short termpsychosis
benzos in elderlypsychosis


Question Answer
serotonindorsal raphe
NElocus ceruleus
DAVTA, substania nigra
AChnucleus basalis of meynert
caudate nucleus damageHuntington


Question Answer
everyone is an impostercapgras
everyone is the same in different disguisefregoli
nihilistic delusion that all my organs are being taken outcotard
first line for tourettesclonidine
nonstimulant for ADHDatomoxetine
increased amylasebulimia
dementia with visual hallucinations and narrow gaitlewy body
bilateral facial paralysisMobius syndrome
amotivation syndromeweed smoking
decrease suicidelithium and clozapine
heroin addiction in pregsmethadone
decreased 5HIAA in CSFpeople who have attempted suicide
sensitivity to lactate infusionpanic attacks
narcolepsy findingdecreased hypocretin (orexin) in CSF
penis shrinking into bodykoro
body is offensive to otherstaijin kyofusho
delusional belief of possession by a spiritzar
treatment for middle insomnia?falling asleep and waking up in the middle of the night ---> treat with zaleplon (nonbenzo hypnotic)


Question Answer
jacksonian marchfrontal lobe seizure
olfactory and auditory hallucinationstemporal lobe seizure
episodic intense emotiontemporal lobe seizure
episodic language changetemporal lobe seizure
episodic disinhibitionfrontal lobe seizure
OCD brain related areacaudate nucleus, cingulum
decreased 5HIAA in CSFpeople who have attempted suicide
anxiety brain related arealocus ceruleus
Tourette brain areacaudate and frontal lobe atrophy
brain changes in autismincreased total brain volume and increased head growth
brain changes in OCDorbitofrontal cortex and striatum (BG)
brain changes in panic disorderdecreased amygdala volume and L temporal lobe volume
brain changes in PTSDdecreased hippocampal volume

Substance abuse or dependence?

Question Answer
failure to meet expectations at work or school?abuse
risky behaviorabuse
legal problemsabuse
heavier use than intendeddependence
desire or attempts to cut backdependence
use of substance alone?neither
frequency of use?neither
social problemsabuse
continued use despite medical problemsdependence

childhood development

Question Answer
birth - 1 yrtrust vs mistrust, sensorimotor - control motor, freud's oral phase
1 - 3 yrsautonomy vs shame, function - object permanence, freud's anal phase
3 - 5 yrsinitiative vs guilt, preoperational - egocentric, freud's phallic phase
6 - 11 yrsindustry vs inferiority, concrete operational - death is permanent, freud's latent phase
11 yrs - adolescenceidentity vs role diffusion, Formal Operational - thinking abstractly, freud's genital phase
21 - 40 yrsintimacy vs isolation, deductive reasoning, hypothetical thinking
40 - 65 yrsgenerativity vs stagnation
greater than 65 yrsintegrity vs despair


Question Answer
primary insomniaintrusive worries about inability to sleep with learned sleep preventing behaviors
secondary insomniapulmonary disease, pain, heart failure, stimulant medications (caffeine, albuterol, theophylline, fluoxetine, bupropion, venlafaxine, calcium channel blockers, beta blockers, steroids)
bad sleep causes which psych disorder most?substance use disorder
problems initiating sleep?caffeine
problems maintaining sleep?diuretics, needing to pee
problems with early morning awakenings?depression
melatonin peak?3AM
Process Shomeostatic regulation, related to time since last sleep
Process Ccircadian regulation, unrelated to last sleep, cued by light/dark
delayed sleep phase syndromesleep cycle shifted but still appropriate amount of sleep
anxiety disorderstrouble falling asleep
PTSDsleep maintenance
best treatment for insomniabehavioral therapy, CBT
OTC sleep aidsdiphenhydramine
Benzo effect on sleepdecreased latency, decreased relative REM, increased N2 sleep, increased total sleep time
metallic tasteeszopiclone
not OK for long term usezaleplon, zolpidem
OK for long term usezolpidem E, eszopiclone
complex sleep related behaviors?taking zolpidem and staying awake
dosing zolpidem?LOWER dosage for WOMEN! bc they metabolize it more slowly (women get 5, men get 10)
ramelteondirect melatonin agonist, can take right before bed. No side effects, not controlled.
clinical features of narcolepsycataplexy, hypnogogic/pompic hallucinations, sleep paralysis, daytime sleepiness
treat cataplexy?gamma hydroxybutarate (GHB)--> aka sodium oxybate, modafinil, stimulants
treat sleep terror?timed awakenings, clonazepam
sleep walking and terrors occur when?N3
acting out dreams?REM sleep behavior disorder
lack of atonia in REM?REM sleep behavior disorder
REM sleep behavior disorder related to which diseases?Lewy body dementia 80%, and Parkinson's disease, often seen in PTSD
Restless leg syndrome?painful, creeping, itching, jittery sensation in legs (physical sensation of restlessness)
RLS vs akathisiaRLS is physical sensation, and akathisia is subjective restlessness
treat RLS?dopamine agonist (Ropinirole or pramipexole)
Periodic Limb Movement Disorderrhythmic jerk while asleep often in RLS, often causes middle insomnia
RLS has what association?iron deficiency anemia
check what levels with RLS?iron