Psych USMLE
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| criteria for generalized anxiety d/o | show 🗑
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| show | benzos (clonazepam or diazepam (Valium))
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| show | SSRI (1st line), venlafaxine (Effexor, serotonin-NE RI), buspirone
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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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| onset OCD | show 🗑
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| show | OCD is an Axis I d/o that is ego-dystonic (the behaviors bother them); OCPD is a personality Axis II where it doesn't bother them [ego syntonic]
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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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| define agoraphobia | show 🗑
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| which SSRIs are esp good for OCD | show 🗑
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| show | benzos, ie clonazepam
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| show | N, GI upset, sex dysfxn, agitation, tremor
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| show | generalized anxiety, OCD, PTSD
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| show | sz w chronic use; no tolerance, dependence of withdrawal
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| show | paroxetine and setraline (short acting); fluoxetine can stop cold turkey
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| what are 2 commonly used benzos in psych and their SE, drawbacks | show 🗑
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| how does bupropion work | show 🗑
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| show | venlafaxine (Effexor) and duloxetine (Cymbalta)
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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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| for how long must sympt occur for PTSD | show 🗑
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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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| show | amnesia [memory impairment] + 1 of: aphasia, apraxia, agnosia [4 A 's of dementia]
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| list some causes of dementia | show 🗑
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| name 7 infxs causes of dementia | show 🗑
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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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| pathol dx Alz | show 🗑
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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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| show | AD trinucleotide repeat on Chrom 4 affecting BG (loss of GABA in striatum); caudate atrophy
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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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| show | low Dopa, high Ach
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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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| what dopa agonists are used in Parkinsons | show 🗑
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| how does carbidopa work | show 🗑
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| show | dyskinesias after 5-7y, so may use dopa agonist for a while, also N/V, anorexia, HTN, hallucincations
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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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| key difference delirium v dementia | show 🗑
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| what Rx can help delirium | show 🗑
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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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| show | postpartum, psychotic features, atypical (wgt gain, sleep more), seasonal, dbl depression (on top of dysthmia)
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| show | shouldn't have severe impairment and should resolve within 1yr
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| define dysthmia | show 🗑
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| what Rx can cause depression | show 🗑
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| show | bupropion (Wellbutrin), venlafaxine (Effexor), mirtazapine (Remeron), trazodone
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| show | decrsd sz threshold, NOT for bulimics, NO SEX SE
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| uses for atypical anti-depress | show 🗑
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| CVS SE of venlafaxine | show 🗑
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| SE of trazodone | show 🗑
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| how do TCAs work | show 🗑
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| name 5 TCAs | show 🗑
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| SE of TCA | show 🗑
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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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| show | FALTER=F, autonomic instability (BP), leukocytosis, tremor, elevated CPK, rigidity; also myoglobulinuria and elevated LFTs; give dantrolene or bromocriptine
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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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| which anti-psych Rx work best for negative sympt | show 🗑
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| show | haloperidol most, chlorpromazine (low potency) least
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| 4 MC extrapyramidal SE and tx | show 🗑
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| show | only for treatment resistant, severe tardive dyskinesia, PD w psych
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| show | agranulocytosis, must monitor CBCq wk
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| show | typical anti psych, ie haloperidol, pimozidine or clonidine
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| show | EPS, hyperprolactin, antichol, sz, hypotension, sedation, QT prolong, neuroleptic syn
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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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| show | 1st line mood stabilizer, acute mania, bipolar
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| SE Li | show 🗑
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| show | NSAIDs
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| signs Li toxicity | show 🗑
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| show | N, skin rash and Stevens-Johnson, AV block, NTD, aplastic anemia **CBC biweekly
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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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| gender predilection for bipolar | show 🗑
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| dx of manic episode | show 🗑
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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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| tx of mania | show 🗑
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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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| describe 4 cluster B personality d/o | show 🗑
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| describe 3 cluster C personality d/o | show 🗑
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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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| dx of schizo | show 🗑
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| show | if schizo <6mos
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| show | schizophrenia + depression or bipolar
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| dx of ADHD | show 🗑
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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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| SE ADHD meds | show 🗑
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| differentiate Autism and Aspergers | show 🗑
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| show | tuberous sclerosis and fragile X
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| show | impaired social interact and commun <3yo, impaired spoken language; stereotyped speech and behavior (hand flapping); restricted interests
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| show | neurodegen dz of females; 5mos nml grwth then head grwth stops and lose milestones
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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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| tx for cataplexy | show 🗑
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| factitious v malingering | show 🗑
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| name 5 somatization d/o and key feature v factitious | show 🗑
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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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| gender predilection for hypodchondriasis | show 🗑
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| show | male, older, depressed, prev attempt, substance/EtOH, chronic illness, no spouse/social support
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| how does disulfiram work for EtOH abuse | show 🗑
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