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PsychSpring_1
| Question | Answer |
|---|---|
| Clinical disorders & other conditions that may be a focus of clinical attention a)Axis I b)Axis II c)Axis III d)Axis IV e)Axis V | A |
| Personality Disorders & mental retardation a)Axis I b)Axis II c)Axis III d)Axis IV e)Axis V | B |
| General Medical Conditions a)Axis I b)Axis II c)Axis III d)Axis IV e)Axis V | C |
| Psychosocial & Environmental Problems that may affect the dx, tx & prognosis of Axis I & II diagnoses a)Axis I b)Axis II c)Axis III d)Axis IV e)Axis V | D |
| Global Assessment of Functioning (GAF) useful in planning tx, predicting outcome, & tracking clinical progress a)Axis I b)Axis II c)Axis III d)Axis IV e)Axis V | E _Should NEVER take into account physical limitations here. |
| Alertness or state of awareness of the environment | Level of consciousness |
| Hypoactive motor behavior might a sign of this | Psychomotor Retardation |
| Sustained emotion that affects a person's view of the world. Pt's subjective description of his or her emotional state in his or her own words | Mood |
| An observable feeling or tone expressed through voice, facial expression & demeanor. Shows emotional responsiveness | Affect _Normal, blunt, exaggerated, flat, constricted, labile |
| Ability to focus or concentrate over time on one task or activity | Attention |
| Childhood memories a_Remote memory b_recent remote memory c_recent memory d_immediate retention & recall | A |
| Current events within past few months a_Remote memory b_recent remote memory c_recent memory d_immediate retention & recall | B |
| What pt had for breakfast a_Remote memory b_recent remote memory c_recent memory d_immediate retention & recall | C |
| Sensory awareness of objects in environment and interrelationships. Also refers to internal stimuli. | Perception |
| False sensory perception not associated with external stimuli. a)Hallucination b)Illusion c)Depersonalization d)Derealization e)Formication | Hallucinations |
| Misperception or interpretation of a real external stimuli a)Hallucination b)Illusion c)Depersonalization d)Derealization e)Formication | Illusions |
| Person's subjective sense of being unreal, strange or unfamiliar a)Hallucination b)Illusion c)Depersonalization d)Derealization e)Formication | Depersonalization |
| Subjective sense that environment is strange or unreal a)Hallucination b)Illusion c)Depersonalization d)Derealization e)Formication | Derealization |
| Feeling of bugs crawling on or under skin a)Hallucination b)Illusion c)Depersonalization d)Derealization e)Formication | Formication |
| Awareness that sx or disturbed behaviors are normal or abnormal. Pt's awareness/understanding of own illness | Insight |
| Process of comparing & evaluating alternatives when deciding on a course of action | Judgement |
| Fixed, false personal beliefs that are not shared by other members of the person's culture. Cannot be corrected via reasoning. _Paranoid, grandeur, nihilistic, ideas of reference, ideas of influence, persecution | Delusions |
| Recurrent, uncontrollable thoughts, images or impulses a_Obsessions b)Compulsions | A |
| Repetitive behaviors or mental acts that a person feels driven to perform a_Obsessions b)Compulsions | B |
| Persistent, irrational exaggerated fear of a specific stimulus or situation accompanied by a desire to avoid the stimulus | Phobia _Acrophobia: fear of heights _Agoraphobia: fear of OPEN spaces |
| 3-10% school aged children, typically in males & more common in 1st degree bio relatives of children with ADHD | ADHD _From DEC dopamine & NE in brain |
| Persistent pattern of INATTENTION a/o HYPERACTIVITY-IMPULSIVITY that is more frequently displayed & more severe than is typically observed in individuals @comparable devo level. | ADHD |
| Fidgets Leaves seat when sitting in seat is expected Runs/climbs excessively at wrong times Difficulty playing in leisurely activities quietly “On the go” Talks excessively Blurts out answers prematurely Diffic awaiting turn Interrupts or intrude | Hyperactivity-Impulsivity |
| >6 sx of inattention or hyperactivity that's occured >6mos _Sx BEFORE age 7! (though hard to dx if <5 since may be appropriate if kids are active) _Sx w/assoc impairment in >2 settings | Dx criteria for ADHD _Sx not better accounted for with another disorder & clinically impairs social, academic or occupational functioning |
| Most common type of ADHD | ADHD Combined type _Meets inattentive & hyperactive-impulsive sx |
| Comprehensive medical, developmental educational, & psychosocial evaluation is needed for this | To confirm ADHD sx, show functional complications, exclude other explanations for symptoms, ID comorbid psych conditions |
| Rating scales for ADHD should be completed when & by whom | At time of dx, during medical titration & at regular med F/U. Completed by parents AND teachers |
| Tx for ADHD | Therapy (Psychotherapy & Family) Behavior Modification Educational Intervention Environment Manipulation Pharm agents |
| FIRST LINE Tx of ADHD | Stimulants which release catecholamines to INC dopa & NE in brain =Methylphenidate & Dextroamphetamine -Adderall is a mixed amphetamine salt |
| Short acting formulation of ADHD drugs | Ritalin, Methylin, Focalin, Dexedrine, Adderall _Must take BID-TID |
| Long acting formulation of ADHD drugs | Methylphenidate-SR, Ritalin-SR & LA, Metadate CD & ER, Concerta, Focalin XR, Daytrana, Adderall XR, Vyvanase _Dosed Qday but side effects can extend longer _More expensive |
| ~70% of patients with stimulant use will have this | DEC in hyperactivity & INC in attention. If patients do not have positive results or have signif side effects try another agent |
| Side effects of stimulant use in ADHD | Anorexia, appetite disturbance Sleep disturbance Wt Loss INC HR/BP SUDDEN CARDIAC DEATH HA Social Withdrawal Nervousness Irritability Stomach Pain Tics Contact Dermatitis |
| Selective NE reuptake inhibitor. NOT a controlled substance, less abuse potential. MORE expensive than methyphenidate & dextroamphetamine | Atomoxetine (Straterra) _Dyspepsia, Severe liver injury, INC suicidal thinking, cardiac risk |
| Other pharmacological agents used if cannot use Strattera or Stimulants in ADHD | Antidepressants (Tricyc or Dopa reuptake inhibitors) Alpha2 adrenergic Agonists (Clonidine, Guanfacine) |
| ADHD patient with hx of substance abuse, you may want to consider using this instead of stimulants | Atomexetine (Straterra) |
| Acute, rapidly progressive change in cognition with INATTENTION & DISTURBANCE where sx fluctuate over 24hrs. -Altered level of arousal -Memory Impaired -Disoriented -Perceptual Disturbance -Language Disturbance/Incoherent Speech | Delirium _Risk Factors: Cognitive impairment, age >70, poor functional status, hearing/visual probs, dehydration, sleep deprivation, metabolic derangement _May INC risk of cardiac events, mortality rates & length of stay |
| 48% of Delirium is what? | A mix of HYPERactive and HYPOactive symptoms |
| What's the least common type of symptom in delirium? | Hypoactive: _Inattention, sedation, depressed, withdrawn, loss of appetite |
| Usually NOT helpful in dx delirium | EEG, CT, cultures w/o known source, lumbar puncture |
| Should you use a CT scan to dx delirium? | It's controversial. The incidence of stroke presenting as delirium is about 3% w/o focal findings. A normal neuro exam has a high predictive value (97%) _Use clinical judgement, if no other focal deficits, look elsewhere first |
| Which of these are not typically involved in mental status testing with Delirium patients a)CAM b)CT scan c)MMSE/Kokmen d)Adjunct Tests | B |
| Asseses 5 Delirium Features: 1)course fluctuation 2)acute 3)inattention 4)disorganized thinking 5)Altered consciousness What would be a positive test? | CAM (Confusion Assessment Method) _Use as screening tool then to follow improvement/progression. POS: 1-3 and EITHER 4 or 5 |
| Includes eval of orientation, recall, registration, attention, concentration & language. Questions have point value, 30 is best. What would an abnormal score be? What's the test? | Mini Mental State Exam <24 is abnormal _Cons: not sensitive, cannot differentiate between delirium & dementia, may miss subtle cases, copyrighted |
| Examines orientation, attention, learning, CALCULATION & recall. Includes CLOCK drawing under "construction" component. Was initially validated in Alz pt's. what's test, abnormal? | Kokmen Short Test of Mental Status _Abnormal <35 |
| Would like a sensitive test for detecting patients with mild cognitive impairment. Which is better to detect cognition changes in people "normal" at baseline? a)Kokmen b)MMSE | Kokmen Short Test of Mental Status _Abnormal <35 |
| Should you use restraints when trying to control a delirious patient? | AVOID restraints!!! _ID at risk meds being used instead and inform family/caregivers _Replace hearing aids/glasses. Get private room w/around the clock watching. Reorient & reestablish a sleep/wake cycle. |
| When should you use pharmacologic agents when dealing with delirium? | Severe agitation, combative behavior or behavior that severely interferes with care |
| DOC for Delirium (use if severe, combative or behavior influences proper care) | Haloperidol (Haldol) _Start with VERY LOW doses (NOT psych doses) -Extrapyramidal side effects & long QT may occur |
| Atypical antipsychotics used in delirium carry a BLACK BOX & used if much needed. What are they? | Quetiapine Risperidone Olanazapine "Start low & go slow." |
| Over prescribed and often will cause delirium. Use for Alcohol/Drug Delirium | Benzodiazepines |
| Special considerations for delirium patients include all but this: a)Pre-op delirium b)Post-op delirium c)Alcohol withdrawal d)Sundowning precipitated by hospitalization, sensory deprivation, meds | A |
| Non-specific early sx of EtOH withdrawal sx: | tachy, diaphoresis, HTN _The underlying HYPERadrenergic drive causes the complications |
| Medical emergency during EtOH withdrawal where see EXTREME autonomic HYPERactivity with delirium. Later signs will involve confusion, psychosis, agitation & seizures. Mainly see in heavy & long standing drinkers w/prior detox, seizures or DT's | Delirium Tremens _Kindling Effect: Prior detox may lead to increased susceptibility for delirium tremens |
| Tx of alcohol withdrawal | Benzos, adjunct meds _Do NOT use EtOH to treat |
| Acquired, chronic, progressive decline consisting of memory impairment & one or more of following: Aphasia Apraxia Agnosia Disturbance in executive function | Dementia _Deficits are severe enough to cause functional impairment. _Delirium NOT present _IRREVERSIBLE! |
| Primary cause of dementia (~50%) a_Vascular dementia b_Alzheimers c_Neurodegen like Lewy body dz, Parkinsons, Pick's d_Medical: Huntingtons, trauma, infections, anoxia, Creutzfeldt-Jakob, HIV | B |
| All dementia dx can come with or without this: | Behavioral Disturbance |
| Typically starts <50 (If under 65=Early Onset), Progressive (lose 3pts/yr on MMSE), higher rates in ppl w/trauma & Downs, myoclonus & gait=late finndings | Alzheimer's Dementia _CT, MRI, Histopath |
| 20-60% of Parkinson's patients. Exacerbated by depression Tremor, rigid, bradykinesia, posture unstable. COGWHEEL, micrographia, slow movements. | Parkinson's Dementia |
| Change in personality/behavior disinhibition. Prominent primitive reflexes on exam. Type of neurodegenerative dementia a_Parkinson's b_Lewy Body c_Pick's Disease | C |
| Vascular risk factors+neuro deficit. Dx via imaging. | Multi Infarct Dementia _Dx via Imaging |
| Triad of dementia, involuntary movements, periodic EEG activity. Caused by prions (transmission of corneal transplant, HGH). 40-60w/o. Handling of CSF. _Devos RAPID over wks to mos. | Creutzfeldt-Jakob Disease _No Tx |
| Autosomal dominant gene with onset late 30s to 40s. Associated movement disorder. BOXCAR VENTRICLES on imaging | Huntington's Dementia |
| HIV may cause dementia. What might be a precipitating cause? | Infection |
| Normal pressure hydrocephalus, B12 defic, HYPOthyroid, depression & syphilis all cause what | Reversible Dementias |
| Memory complaints (subjective) & mild memory impairment (objective) but still preserve cognitive funciton & intact ADLs. INC risk of ALL types of dementia. | Pre-dementia |
| Are there any confirmatory tests for Alzheimer's CLINICALLY? | No. Will need pathologic eval of brain to confirm |
| BEST way to diagnose dementia | History which is often the only way to differentiate between dementias. |
| Fluctuations in cognitive function with SUDDEN onset of Parkinson's a_Lewy Body b_Alzheimers c_Vascular Dementia d_Picks disease e_Creutzfeldt Jakob | A |
| Progressive decline in function a_Lewy Body b_Alzheimers c_Vascular Dementia d_Picks disease e_Creutzfeldt Jakob | B |
| Signs of previous stroke with dementia a_Lewy Body b_Alzheimers c_Vascular Dementia d_Picks disease e_Creutzfeldt Jakob | C |
| Progressive NON-fluent aphasia a_Lewy Body b_Alzheimers c_Vascular Dementia d_Picks disease e_Creutzfeldt Jakob | D |
| Rapid/Progressive, involuntary movements a_Lewy Body b_Alzheimers c_Vascular Dementia d_Picks disease e_Creutzfeldt Jakob | E |
| Is neuroimaging very predictive for dementia? | Low predictive value but a noncontrast head CT or MRI in the routine initial eval of all patients with dementia is recommended. |
| When is a neuropsych eval best in dementia? | When performed on an increased risk population |
| Pharm management of Dementia | Cholinesterase Inhibitors NMDA Antagonists |
| Donepezil, Rivastigmine, Galantamine are all approved for this | Mild to moderate Alzheimers |
| Approved for tx of severe Alzheimers | Donepezil _SE: symptomatic bradycardia, syncope |
| Rivastigmine is also indicated for this (besides mild-->mod Alzheimers) | Moderate dementia w/parkinson's |
| Cholinesterase inhibitor RARELY used | Tacrine (Cognex) _Hepatotoxic |
| Prevention in mild uncharacterized cognitive impairment, multi-infarct dementia, Lewy body dementia are all NON-labelly tx with this | Cholinesterase Inhibitors _with other dementia not listed, no data to support use |
| Side effects of cholinesterase inhibitors used in the tx of dementia | N, V, D Donepezil-symptomatic bradycardia, syncope Galantamine has MORE side GI side effects & INC mortality with MCI |
| Can be used in combo w/cholinesterase inhibitors. Often used in VASCULAR dementia & Alzheimers. Acts on glutamate receptors in the brain. | NMDA Antagonist=Memantine _Dizzy, HA, hallucination, extrapyramidal SE |
| Would you expect to see disturbance of consciousness, sx fluctuation & attention deficit in EITHER dementia or delirium??? | Delirium |
| In order to dx amnestic disorders (confusion, disorientation, confabulation) what must not occur with | In the setting of delirium or dementia |
| Abrupt loss of ability to recall events or remember new info lasting 6-24hrs. Memory will return except for amnesic gap | Transient Global Amnesia |
| Opthalmoplehia, Ataxia, Nystagmus | Wernecke's Encephalopathy caused by EtOH |
| Thiamine deficiency associated with prolonged EtOH use. Irreversible. | Korsakoff's Syndrome |
| “Loss of contact with reality” Delusions: false beliefs Hallucinations: auditory and/or visual* Disorganized thoughts & speech Disorganized or catatonic behavior | Psychosis |
| Lifetime prevalence ~1% worldwide (2.5 million in U.S.*) 1 affected 1st degree relative ~10x higher than gen. pop. Males will develop sx earlier while females have bimodal onset | Schizophrenia |
| Chronic May have abrupt onset, or may have prodrome Negative symptoms often prominent earlier than positive Complete remission is uncommon Some studies have shown decreased life expectancy * must have signs of illness for 6 mos. (criterion C) | Schizophrenia |
| Characteristic symptoms, at least 1 mo.*, 2+ of: 1.Delusions 2.Hallucinations 3.Disorganized speech 4.Disorganized or catatonic behavior 5.Neg sx B. 1+ area of social/occupational dysfunction c: 1 month criterion A sx+Prodrom | Schizophrenia _Must R/O schizoaffective disorder & mood disorder. Also make sure not caused by subatance |
| If pt autistic or PDD how would you dx with schizophrenia. | Must have prominent delusions/hallucinations for at least 1 month |
| Negative Symptoms (5As) of Schizophrenia | Affective flattening Alogia Avolition/apathy Anhedonia/asociality Attention |
| Paranoid Schizophrenia | 1+ delusion or frequent AH Not prominent: disorganized speech/behavior, inappropriate affect |
| Prominent disorganized speech & behavior and flat/inappropriate affect. NOT catatonic. Type of schizophrenia | Disorganized Schizophrenia |
| At least 2: motoric immobility, catalepsy/waxy flexibiliy, stupor excess motor activity(purposeless) extreme negativism(resistance against movement), mutism Bizarre posturing, stereotypies, prominent mannerisms or grimacing echolalia or echopraxia | Catatonic Schizophrenia |
| Meets criteria for schizophrenia, but NOT any subtype | Undifferentiated Schizophrenia |
| Absence of prominent hallucinations, delusions, or disorganized speech/behavior or catatonia Presence of negative symptoms, or 2+ attenuated positive symptoms | Residual Schizophrenia |
| Prognosis for Schizophrenia better if: | Female Later age of onset Acute onset, with precipitating factor Brief duration, early intervention & compliance Positive symptoms Mood disturbance, family hx of mood d/o High SES, married, good support system Good premorbid functioning |
| Essentially identical to Schizo: Delusions, hallucinations, disorganized speech, catatonic behavior, neg sx Shorter: btwn 1 and 6 mos Social fcn may or may not be impaired 1/3 recover, & dx is final 2/3 progress to Dx of Schizophrenia or Schizoaffec | Schizophreniform Disorder _Criteria A, D, E met but NO schizoaffective or mood probs _Episode(prodrome+active+residual phases) last at least 1 month, but LESS than 6!! |
| Sudden onset of at least 1 pos sx Lasts btwn 1 day & 1 month, w/return to normal Emotional, labile, confused Onset in late 20s to early 30s, may be w/marked stressor or postpartum onset Dx rarely seen clinically High suicide risk | Brief Psychotic Disorder |
| High Risk of Suicide Associated with this dx: a)Schizophrenia b)Schizophreniform Disorder c)Brief Psychotic Disorder | C |
| Presence of 1 or more: 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior B. Duration: at least 1 day, BUT <1 month, with eventual full return to premorbid level of functioning | Brief Psychotic Disorder |
| Schizophrenia+Mood Disorder Delusions/Hallucinations for 2+wks with no mood sxs Bipolar or Depressive types Women>Men Less common than schizo, better prognosis. Early Adulthood INC risk of schizophrenia & mood disorders in 1st degree relative | Schizoaffective Disorder _Meet Criteria A for schizo(Pos Sx) & ALSO has major depressive, manic or mixed episode _Muse have @least 2 wks delusions/hallucinations w/o prominent mood sx. Mood sx are present though for a signif portion of illness |
| NON-Bizarre delusions (could actually be true) for at least 1 month, does NOT meet Criteria A for Schizo (pos sx). Hallucinaitons could be related to delusional theme. Psychosocial function NOT impaired. Poor insight. | Delusional Disorder |
| Another person is in love with pt. Usually person of higher status (celeb). Type of delusional disorder a_Erotomanic b_Grandiose c_Jealous d_Persecutory e_Somatic | A |
| Inflated worth, power, knowledge, identity, special relationship to a deity or famous person. Type of delusional disorder a_Erotomanic b_Grandiose c_Jealous d_Persecutory e_Somatic | B |
| Spouse, significant other, sexual partner is unfaithful. Type of delusional disorder. a_Erotomanic b_Grandiose c_Jealous d_Persecutory e_Somatic | C |
| Being treated malevolently.Conspired against, spied one, followed poisoned.Type of delusional disorder. a_Erotomanic b_Grandiose c_Jealous d_Persecutory e_Somatic | D |
| Physical defect or medical condition. Type of delusional disorder. a_Erotomanic b_Grandiose c_Jealous d_Persecutory e_Somatic | E |
| Tx of Delusional Disorders | Neuroleptic=Antipsychotic=Dopamine Antagonist _Haloperidol _Chlorpromazine _Thioridazine _Prochlorperazine |
| Atypical Antipsychotics (2nd generation) | Ariprazole Clozapine Olanzapine Quetiapine Risperidone Ziprasidone |
| First Generation Conventional Antipsychotics | Haloperiodl Chlorpromazine Thioridazine Prochlorperazine |
| Torticollis, jaw spasms, dysphagia, dysarthria, tongue protrusion, oculogyric crisis, abnormal positioning | Acute Dystonic Rxn (Spasms) _Form of extrapyramidal sx caused by antipsychotic drug use |
| Parkinsonism, Akathisia (restlessness), Tardive Dyskinesia & Neuroleptic Malignant Syndrome are all what? | Extrapyramidal Symptoms caused by antipsychotic drug use |
| Abnormal involuntary movements Choreiform: rapid, jerky, nonrepetitive Athetoid: slow, sinuous, continual Rhythmic: stereotypies | Tardive Dyskinesia: Extrapyramidal Symptoms caused by antipsychotic drug use in 20-30% of pts. Worse longer you used. Only 5-40% cases remit. Use AIMS to screen EVERY 6mos!!! |
| This drug can be used in everything but akathasia to tx extrapyramidal side effects from antipsychotic use. | Benztropine or Diphenydramine |
| How must you treat Akathisia. Only unique drug & cannot use Benztropine or Diphenydramine | Propranolol |
| When would you use amantdine to decrease EPS effects from antipsychotic use | Parkinsonism |
| Severe muscle rigidity + elevated temp* Potentially life threatening! _Mental status change(1st sx), autonomic unstable (INC BP/HR), Leukocytosis, INC CK, Electrolyte probs F-Fever E-Encephalopathy V-Vitals Unstable E-Elevated Enzyme-CK R-Rig | Neuroleptic Malginant Syndrome @Risk: dehydration, agitation, high dose, rapid increase, IM injection, hx of NMS. +/- hot, humid, Lithium |
| Tx for Neuropeptic Malignant Syndrome | Dantrolene (but in clinic more often supportive) _**NO neuroleptics for at least 2 wks* |
| Why do you get Parkinson like symptoms as a side effect when using antipsychotics? | They are dopamine antagonists. Remember, Parkinson's is caused by decreased levels of dopamine, therefore an overextension of the effect. |
| INC mortality when tx elderly pts for dementia related psychosis | Black Box warning for antipsychotics (dopamine antagonists) |
| Weight Gain, HYPOtension, QT prolong, Tachy, Hepatic Transaminitis, AGRANULOCYTOSIS, hyperglycemia, dyslipidemia, metabolic syndrome are common side effects of this | Anti-psychotics (dopamine antagonists) |
| Conventional antipsychotics & Risperidone may experience this side effect | hyperprolactinemia & associated gynecomastia, galactorrhea, amenorrhea, decreased libido |
| Pigmentary retinopathy may be caused by chronic use of this antipsychotic | Thioridazine |
| Dose-dependent risk with most conventional antipsychotics & Clozapine | Lowered seizure threshold |
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