Psych USMLE
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| show | anxiety on most days for 6mos + 3 of: restlessness, diff concentrating, irritabil, mscl tension, sleeping problems
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| acute tx generalized anxiety | show 🗑
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| long term Rx tx generalized anxiety (3) | show 🗑
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| gender predilection for OCD | show 🗑
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| show | clomipramine (TCA) or SSRI [+ cognitive behavioral therapy +/- desensitization]
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| show | usu adolescence or early adult
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| key differences OCD v OCPD | show 🗑
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| show | lasts <25min and incl 4 of: CP, palpitations, sweating, chills or hot flashes, tachypnea/SOB, choking, nausea, dizziness, trembling, depersonalization, fear of dying or going crazy
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| show | at least 1mo worrying abt having another and changing their behavior to avoid. Must specify if w agorophobia (30-50%)
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| show | fear of being alone in public places
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| which SSRIs are esp good for OCD | show 🗑
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| show | benzos, ie clonazepam
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| what are SE of SSRIs | show 🗑
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| what are the 1st line uses of SSRIs | show 🗑
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| show | sz w chronic use; no tolerance, dependence of withdrawal
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| which Rx most likely to cause SSRI wdrawal sympt? | show 🗑
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| what are 2 commonly used benzos in psych and their SE, drawbacks | show 🗑
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| show | inhibits reuptake of NE and Dopa
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| what are names of serotonin-NE reuptake inhibitors | show 🗑
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| when are b blockers used in psych? Which? Which be careful for? | show 🗑
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| show | low dose SSRI
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| show | for >1mo
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| show | 30; <25
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| 2 MC forms of dementia | show 🗑
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| show | depression
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| dx of dementia | show 🗑
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| show | DEMENTIAS=Degen,Endo=thyr, parathyr, Metabol=EtOH, B12, glu, hepatic/renal, Wilson, Exogen=Lead, CO, Rx; Neoplasia; Trauma=subdural; Infxs=mening/enceph, syph, HIV, Prion, Lym; Affect=pseudodementia, Alz; Stroke/Structure vasculit, nml pressure hydroceph
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| show | syph, HIV, prion, Lyme, mening, enceph, sepsis
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| show | CBC, lytes, TFTs, VDRL/RPR, B12, folate, brain CT or MRI
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| key feature nml pressure hydroceph | show 🗑
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| show | cholinesterase inhib (tacrine, donepezil, galantamine); avoid benzos
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| Alzheimers more common in males or females | show 🗑
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| show | diffuse atrophy w flattened sulci, senile plaques w amyloid, neurofib tangles from Tau proteins (also nml aging and Downs)
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| show | NMDA antagonists (memantine), cholinesterase inhib (tacrine--but hepatic dysfxn), donepezil, galantamine)
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| what NT are abnl in Alz | show 🗑
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| if looks like Alz, but personality/behavioral changes present early think of…; pathol | show 🗑
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| mechanism of Huntington (incl genetics) | show 🗑
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| show | Wilsons
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| mechanism of Parkinsons | show 🗑
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| pathology of Parkinsons | show 🗑
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| which NT are altered in Parkinsons | show 🗑
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| clinical characteristics of Parkinsons | show 🗑
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| show | 1) carbidopa-levodopa; 2) dopa agonist (bromocriptone, pergolide, pramipexole), 3) amantadine (unkn mech, transient help); 4) amitryptyline (helps as anti-chol w tremors and anti-depress; 5) MAOI (selegeline)
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| how does selegeline help Parkinsons, what type of Rx | show 🗑
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| show | pramipexole (MC), bromocriptone, pergolide
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| show | inhibits dpadecarboxylase preventing levodopa from becoming dopa before reaches brain
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| SE of carbidopa-levodopa | show 🗑
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| show | neuroleptic (haloperidol, chlorpromazine), metoclopramide (gastro Rx), reserpine (anti HTN and anti-psych)
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| show | CJD, see periodic spikes and waves [Alz just see generalized background slowing]
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| what unique clinical features help differentiate CJD | show 🗑
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| show | nml pressure hydroceph
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| show | waxing/waning, impaired attn, psych, altered sleep-wake and sun downing
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| show | low dose quetiapine (Seroquel) or haloperidol for agitation and psychotic sympt
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| show | Sleep, interest, guilt (worthlessness, inapprop guilt), energy, concentration, appetite, psychomotor agitation or retardation, suicidal
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| dx criteria for major depressive episode | show 🗑
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| name some subtypes of depression | show 🗑
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| show | shouldn't have severe impairment and should resolve within 1yr
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| show | milder, chronic depression w depressed mood most of the time >2yr, no mania/hypomania or psychosis. Tx resistant
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| what Rx can cause depression | show 🗑
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| name 4 atypical anti-depressants | show 🗑
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| key adv/disadv bupropion | show 🗑
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| uses for atypical anti-depress | show 🗑
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| show | diastolic HTN
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| SE of trazodone | show 🗑
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| how do TCAs work | show 🗑
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| show | nortriptyline, amitriptyline, imipramine, clomipramine, desipramine
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| show | lethal OD from cardiac arrhythmias [toxicity 3 Cs: convulsion, coma, cardiac arrhyth], sex SE. Anti chol: dry mouth, constipation, urinary retention, sedation
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| uses for TCAs | show 🗑
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| show | phenelzine, tranylcypromine; depression esp atypical
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| show | HTN crises if taken w high tyramine (cheese, red wine, smoked meats); can't give w SSRI (serotonin syndrome), or meperidine (Demerol, an opioid). Sex SE, orthostatic hypotension, wgt gain
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| show | SSRI [TCA anti chol and sedating, MAOI have hypotension]
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| components neuroeleptic syn; tx | show 🗑
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| show | Anxiety=high NE, low GABA and 5HT; depression=low NE and 5HT
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| features of serotonin syndrome | show 🗑
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| elderly w pyschotic sympt, what start | show 🗑
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| show | atypical/2nd gen (ie ripseridone, olanzapine (zyprexa), clozapine
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| which anti-psych have most extra pyramidal SE? least? | show 🗑
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| show | 1) acute dystonias 1st hrs/days; antichol (benztropine), anti His (benadryl); 2) akthisis, restlessness in 1st days; b blocker benzo or antichol; 3) dyskinesias/Parkinson in 1mos; 4) tardive dyskensia, decr dose, antichol, switch to clozapine)
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| when clozapine used in psych | show 🗑
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| SE clozapine | show 🗑
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| tx Tourettes | show 🗑
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| SE typical anti psych | show 🗑
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| unique SE of thioridazine | show 🗑
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| show | clozapine, risperidone, quetiapine (Seroquel), olanzapine (Zyprexa)
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| show | fewer EPS, wgt gain, DMII, somnolence/sedation, QT prolong
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| use of Li | show 🗑
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| SE Li | show 🗑
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| Li levels incrs w what OTC | show 🗑
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| signs Li toxicity | show 🗑
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| SE carbamzepine | show 🗑
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| name 4 mood stabilizers | show 🗑
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| show | GI (N/V), tremor, sedation, alopecia, wgt gain, NTD; rarely: pancreatitis, decrsd plts, agranulocytosis, fatal hepatotoxicity
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| show | equal m, f
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| show | 1 wk of persistently elevated or irritated mood + 3 DIGFAST
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| components DIGFAST | show 🗑
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| show | 1=at least 1 manic or mixed episode, 2=at least 1 major depressive episode and 1 hypomanic; cyclothmic=chronic and less severe w episodes of hypomania and mod depression >2yrs
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| show | anti psych and mood stabilizer
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| name personality disorder clusters | show 🗑
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| show | Paranoid-distrustful, see others as malevolent m>f; schizoid-loners don't want relationship, cold affect, m>f, schizotypal: odd bheaviors, perceptions incl cults
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| show | borderline: unstable mood relationships, feel empty/alone, impulsive h/o suicide, f>m; histrionic: attn seeking, dramatic, f>m; narcissitic: self imptc, uses others, lack of empathy; antisocial=deceitful, reckless, no remorse m>f
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| show | OCPD: perfectionism, inflexible, orderly m>f, avoidant: fear rejection so avoid social even though want relationships; dependent: f>m
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| gender predilection for schizo | show 🗑
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| show | paranoid-best px, presents late; disorganized (speech, behavior), poor contact w reality, presents earlier and worse px; catatonic-rare, peculiar posturing; residual-mostly negative sympt; undifferentiated (mltpl character)
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| show | halluc, delusions, disorganized speech, bizarre behavior, thgt d/o
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| show | flat affect, decrsd emotional reactivity, poverty of speech, lack of purposeful action, anhedonia
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| show | 2 or more present for 6mos causing dysfxn
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| show | if schizo <6mos
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| show | schizophrenia + depression or bipolar
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| show | 6 or more sympt from ea inattn and hyperactivity categories in at least 2 settings for 6mo; some sympt must be present before 7yo
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| show | must be >18 and have had sympt of conduct d/o as child
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| tx ADHD | show 🗑
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| show | insomnia, irritability, anorexia, tic exacerbat, decrd grwth (nmlzes when stop)
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| differentiate Autism and Aspergers | show 🗑
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| show | tuberous sclerosis and fragile X
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| characteristics autism | show 🗑
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| describe Retts | show 🗑
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| show | violating basic rights of others or social norms for 1yr; can be aggressive or nonagressive. Most progress to conduct d/o
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| describe oppositional defiant d/o | show 🗑
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| describe features of narcolepsy | show 🗑
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| show | scheduled naps, stimulants (amphetamines), SSRIs for cataplexy
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| show | SSRIs
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| show | factitious the gain is the medical attn, malingering there's 2ry gain
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| show | key: pt has no control over sympt; 1) somatization (mltpl complaints in mltpl organs); 2) conversion (motor or sensory s/p stressful event); 3) hypochondriasis-fear of having dz despite negative tests/reassurance; 4) body dysmorphic; 5) pain d/o
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| show | analgesics not helpful, TCAs and venlafaxine can help
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| show | motor/sensory complaint occurring close to stressful event; usu resolve spont, f>m
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| show | m and f equal
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| show | male, older, depressed, prev attempt, substance/EtOH, chronic illness, no spouse/social support
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| show | inhibits acetaldehyde dehydrogenase needed for breaking down EtOH; get flushed, tachycardic, hypotension, SOB, N/V, HA
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