Notes On Psych Qbank

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Phencyclidine (PCP) is a hallucinogenic drug, which
Psychiatric/Behavioral & characteristically causes vertical nystagmus. It can also cause
2653 Medicine
Substance Abuse dissociative feelings, psychotic and violent behavior, severe
hypertension, and hyperthermia.
Alcohol withdrawal should be suspected in any hospitalized patient
with a history of alcohol abuse. Early symptoms include anxiety,
Psychiatric/Behavioral & insomnia, tremors, and diaphoresis. Hallucinations and withdrawal
2661 Medicine
Substance Abuse seizures can also occur with progression to delirium tremens within
48-96 hours if left untreated. Benzodiazepines are the treatment of
choice for patients with alcohol withdrawal.
Social Sciences Medical information should be shared with family members only with
3232 Medicine
(Ethics/Legal/Professional) the patient's permission.
Physicians should respond politely but firmly to inappropriate patient
Social Sciences
3237 Medicine requests. Maintaining professional boundaries is an important
(Ethics/Legal/Professional)
component of the physician-patient relationship.
Confidential patient information should be disclosed only to fellow
health care workers who are directly involved in the patient's care.
Social Sciences Physicians should avoid discussing a patient's medical condition in
3238 Medicine
(Ethics/Legal/Professional) public areas where comments might be overheard. Inappropriate
inquiries from collegues curious about a patient's medical condition
should be politely but firmly rebuffed.
A physician has a moral responsibility to act in the patient's best
Social Sciences
3240 Medicine interests. When a physician's mistake is discovered, the facts
should be clarified and the truth told to the patient.
Social Sciences A living will communicates the patient's own wishes if he or she
3388 Medicine
(Ethics/Legal/Professional) becomes incapacitated, and it overrules the wishes of the family.
The Health Insurance Portability and Accountability Act protects
health information by requiring verbal or written authorization for
release of information. Hospitals and pysicians' offices frequently
Social Sciences
3614 Medicine have additional policies requiring written forms for release of
information and procedures to verify the identity of phone callers. It
is important that health care providers be familiar with these rules
and disclose only the minimum necessary information.
Patients have the right to know their diagnoses. If family members
Social Sciences request that the diagnosis not be revealed to the patient, the
3615 Medicine
(Ethics/Legal/Professional) underlying reasons should be explored before deciding how to
proceed.
In the absence of an advance directive, a life-saving blood
Social Sciences
3616 Medicine transfusion can be given to a Jehova's Witness who lacks
decision-making capacity.
When a patient refuses potentially life-saving treatment, it is
Social Sciences
3617 Medicine important to fully discuss the specific reasons for the decision
before honoring it.
Patients have the right to refuse treatment except when doing so
Social Sciences poses a serious threat to public health. In these cases, the
3625 Medicine
(Ethics/Legal/Professional) physician is justified in restricting individual liberties until the
public's health is no longer at risk.
Social Sciences When a patient is interested in alternative therapy, the physician
3749 Medicine
(Ethics/Legal/Professional) should first inquire as to why.
Pts who are victims of suspected physical abuse should be
approached with empathic interviewing techniques. The physician
should ask open-ended questions to allow pts to describe their
Social Sciences situation on their own terms. The first priorities are to obtain an
3792 Medicine
(Ethics/Legal/Professional) accurate and thorough understanding of the abuse and take any
necessary action to ensure pt safety. Additional steps may then be
needed to address concurrent emotional symptoms and satisfy legal
reporting requirements.
When dealing with difficult patients, the physician must maintain
Social Sciences
3805 Medicine professional conduct and responsibilities while addressing their
medical and psychological needs.
When dealing with an angry patient, the most appropriate response
Social Sciences
4066 Medicine is to remain nondefensive, ackknowledge that the patient is upset,
and begin the discussion with an open-ended question.
Social Sciences Brain death refers to a total loss of brain function and is a legally
4653 Medicine
(Ethics/Legal/Professional) acceptable definition of death.
Poor sleep hygiene is a common cause of insomnia. Strategies to
improve sleep hygiene include maintaining a regular sleep schedule
Psychiatric/Behavioral &
8822 Medicine and a quiet, dark, and comfortably cool bedrooml avoiding late
Substance Abuse
afternoon naps and exposure to electronic devices before bedtime;
and avoiding nicotine, caffeine, and heavy meals in the evening.
Delayed sleep phase syndrome is a circadian rhythm disorder
characterized by the inability to fall asleep at "normal" bedtimes,
8823 Medicine resulting in sleep-onset insomnia and excessive daytime sleepiness.
Substance Abuse
Patients sleep normally if allowed to follow their internal circadian
rhythm and slee until late morning.
Hospice is a palliative, interdisciplinary model of care for patients
Social Sciences
8942 Medicine with a prognosis of =< 6 months. The focus is on symptom control;
quality of life; and psychosocial, spiritual, and bereavement care.
According to ethical guidelines, permission must be obtained from
Social Sciences
8957 Medicine the family (or from the patient prior to death) before procedures can
be performed on a newly deceased patient for training purposes.
Communication failures between physicians during patient handoffs
Social Sciences
10660 Medicine are a large contributor to medical errors and adverse patient
outcomes.
Checklists are an important tool to prevent undesired medical
Social Sciences
10661 Medicine outcomes that result from physician communication failures during
the patient handoff process.
Returning combat veterans are at high risk for developing PTSD.
Psychiatric/Behavioral & Common presenting symptoms include sleep disturbance,
11811 Medicine
Substance Abuse nightmares, emotional numbing and detachment, intrusive
flashbacks, amnesia, and hypervigilance.
"Bath salts" have amphetamine properties that can cause severe
agitation, combativeness, delirium, and psychosis. Tachycardia is
11815 Medicine often present. In contrast to other stimulants and hallucinogens,
Substance Abuse
which have a much shorter duration of effect, the effects of bath salt
intoxication may take several days or weeks to subside.
Accepting gifts from interested third parties can influence a
physician's practice in subtle or subconscious ways. Only
Social Sciences
11911 Medicine nonmonetary gifts that are of minimal value and that directly benefit
the patient, such as unbiased educational material or drug samples,
should be considered.
Alcoholic hallucinosis is a type of alcohol withdrawal syndrome that
Psychiatric/Behavioral & typically develops within 12-24 hours of the last drink and resolves
2349 Psychiatry
Substance Abuse within 24-48 hours. Unlike delirium tremens, sensorium is intact
(alert) and vital signs are usually stable
Sleep disturbances are commonly seen in depression. New-onset
2350 Psychiatry Nervous System insomnia in elderly pts who have associated symptoms of
depression should rise concern for major depressive disorder.
Loss of a loved one can trigger the onset of a major depressive
Psychiatric/Behavioral & episode. Bereaved pts who develop major depression should be
2351 Psychiatry
Substance Abuse considered for treatment with both psychotherapy and a trial of
antidepressants.
Bullimia nervosa involves recurrent binge eating and restrictive or
Psychiatric/Behavioral & purging compensatory behaviors. In contrast to pts w/anorexia
2354 Psychiatry
Substance Abuse nervosa, those w/ bullimia are normal weight to overweight.
***Low body weight is generally considered to be BMI <18.5kg/m2
First-line treatments for acute mania include antipsychotics, lithium,
Psychiatric/Behavioral & and valproate. Patients experiencing severe mania with acute
2355 Psychiatry
Substance Abuse agitation commonly receive an antipsychotic alone or in combination
with initiation of a mood stabilizer to manage symptoms effectively.
Long-term side effects of lithium include nephrogenic diabetes
Psychiatric/Behavioral & insipidus, hyperparathyroidism with hypercalcemia, and thyroid
2356 Psychiatry
Substance Abuse dysfunction. Calcium, renal function, and thyroid function should be
monitored prior to starting lithium and periodically during therapy.
Lithium & valproate are 1st line options for bipolar disorder
Psychiatric/Behavioral & maintenance tx.
2357 Psychiatry
Substance Abuse Valproate is preferred in pts w renal dysfunction due to the potential
nephrotoxic effects of lithium.
Antisocial personality disorder (ASPD) involves a pervasive pattern
of violating the rights of others and lack of remorse. Individuals must
be at least age 18 for diagnosis and have a history of conduct
Psychiatric/Behavioral & disorder symptoms before age 15.
2358 Psychiatry
Substance Abuse Intermittent explosive disorder involves isolated episodes of
assaultive or destructive behavior, but there is usually no hx of
childhood conduct disorder or other features of ASPD. Should be dx
only in the absence of ASPD.
All depressed pts should be screened for suicidal ideation, intent, &
2360 Psychiatry plan. Actively suicidal pts with intent & plan will often need to be
Substance Abuse
hospitalized for stabilization & to maintain their safety.
Nicotine replacement therapy, bupropion, and varenicline are 1st line
2387 Psychiatry tx for smoking cessation. They should be used in conjunction w
Substance Abuse
counceling & supportive therapy.
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder
(PMDD) are characterized by physical (eg, fatigue, bloating, breast
tenderness) and psychological (eg, mood swings, irritability)
2419 Psychiatry symptoms that occur in the week prior to menses & resolve during
Substance Abuse
the follicular phase. ASsessment should begin with a menstrual
diary to determine the relationship of symptoms to menstrual cycle
phase.
Conduct disorder is characterized by a repetitive pattern of violating
Psychiatric/Behavioral & basic social norms and the rights of others. It must be differentiated
2482 Psychiatry
Substance Abuse from attention-deficit hyperactivity disorder and oppositional defiant
disorder, which may be comorbid conditions.
Adequate duration of an antidepressant trial is at least 4-6 weeks.
2494 Psychiatry Physicians should continue antidepressants at therapeutic dosages
Substance Abuse
for at least 4-6 weeks before considering the next step in treatment.
Bipolar disorder is a highly recurrent illness that requires
maintenance pharmacotherapy. In patients not adequately controlled
2495 Psychiatry with monotherapy, the combination of lithium or valproate and a
Substance Abuse
second generation antipsychotic is typically used as first-line
treatment.
Benzodiazepines provide rapid relief of anxiety and are indicated for
Psychiatric/Behavioral & the management of acutely symptomatic and functionally impaired
2496 Psychiatry
Substance Abuse patients with panic disorder. Antidepressants and
cognitive-behavioral therapy are preferred for long-term treatment.
Antipsychotic medications can cause hyperprolactinemia secondary
to their dopamine blockade effect. Risperidone has a high frequency
2497 Psychiatry of prolactin elevation. In comparison to antipsychotics,
Substance Abuse
prolactinomas are capable of producing very high levels of prolactin
(>200ng/mL)..
Psychiatric/Behavioral & Anterograde and retrograde amnesia are common side effects of
2498 Psychiatry
Substance Abuse ECT but are generally short-lived.
2nd generation antipsychotics are serotonin 2A and dopamine D2
2499 Psychiatry antagonists. The added serotonin receptor binding of 2nd generation
Substance Abuse
antipsychotics reduces the likelihood of extrapyramidal side effects.
Neuroleptic malignant syndrome is a rare but potentially
life-threatening emergency assoc w the use of antipsychotics
2501 Psychiatry (neuroleptics). Pts who do NOT improve w cessation of the
Substance Abuse
antipsychotic & intensive support care can be tx w DA agonists
(bromocriptine) and dantrolene.
Performance-related anxiety is classified as performance-only
2502 Psychiatry social anxiety disorder. Pharm tx include as-needed beta blockers
Substance Abuse
or benzodiazepines in pts without substance abuse hx.
Patients who do not respond to SSRIs may benefit from switching to
another class of antidepressant medication. The norepinephrine and
Psychiatric/Behavioral & dopamine reuptake inhibitor bupropion has a favorable side effect
2503 Psychiatry
Substance Abuse profile (no weight gain or sexual side effects) and activating effects,
making it a good choice for patients with weight gain or SSRI-related
sexual side effects.
Methylphenidate is a central nervous system stimulant that is
Psychiatric/Behavioral & frequently used to treat attention-deficit hyperactivity disorder.
2504 Psychiatry
Substance Abuse Common side effects include decreased appetite, weight loss, and
insomnia.
Acute dystonia is a type of extrapyramidal symptom associated with
Psychiatric/Behavioral & antipsychotic treatment. It is most commonly seen with
2505 Psychiatry
Substance Abuse high-potency first-generation antipsychotics & is best treated with
anticholinergics (benztropine) or antihistamines (diphenhydramine).
Psychiatric/Behavioral & Exposure and response prevention-based psychotherapy and SSRIs
2506 Psychiatry
Substance Abuse are first-line treatments for obsessive-compulsive disorder.
Clozapine is indicated for the treatment of psychotic patients who do
Psychiatric/Behavioral & not respond to other antipsychotics. Patients must undergo regular
2507 Psychiatry
Substance Abuse monitoring of white blood cell and absolute neutrophil counts due to
the risk of leukopenia (neutropenia) and agranulocytosis.
Schizophreniform disorder is differentiated from schizophrenia by
the duration of symptoms.
Psychiatric/Behavioral & In schizophreniform disorder, symptoms must las for >1 month but
2508 Psychiatry
Substance Abuse <6 months.
The dx of schizophrenia requires symptoms to be present for >=6
months.
Bipolar I disorder includes manic episode(s) with or without a history
of major depressive episodes. Bipolar II is distinguished from bipolar
2510 Psychiatry I by hypomanic episodes (less severe, less functional impairment,
Substance Abuse
no psychotic symptoms) and a history of one or more depressive
episodes.
Psychiatric/Behavioral & The greatest risk factor for future suicide attempts is a past hx of
2517 Psychiatry
Substance Abuse suicide attempt(s).
Tardive dyskinesia occurs after prolonged exposure to antipsychotic
drugs and is characterized by abnormal involuntary movements of
Psychiatric/Behavioral & the mouth, tongue, face, trunk, or extremities. When discontinuing
2518 Psychiatry
Substance Abuse the antipsychotic is not feasible, switching to clozapine is preferred.
NORMAL lithium therapeutic range: 0.8-1.2mEq/L

Borderline personality disorder is characterized by a persistent
Psychiatric/Behavioral & pattern of unstable relationships, mood lability, impulsivity, and
2520 Psychiatry
Substance Abuse recurrent suicidal behavior. Treatment involves psychotherapy with
a behavioral focus.
Somatic symptom disorder involves excessive preoccupation and
2521 Psychiatry overestimation of the seriousness of >=1 somatic complaints and is
Substance Abuse
associated with high levels of medical care utilization.
Malingering is the intentional production or exaggeration of physical
or psychological symptoms for secondary gain. Malingering should
2522 Psychiatry be suspected when a patient is reluctant to be examined or treated,
Substance Abuse
there is a discrepancy between the symptoms and objective
findings, or in any medico-legal situation.
It is important that physicians have an appropriate strategy for
delivering bad news. Helpful steps may include setting up a
Psychiatric/Behavioral & face-to-face meeting, assessing how the patient perceives the
2642 Psychiatry
Substance Abuse medical condition and wants to receive the information, providing
understandable information, addressing patient's emotional reaction
to serious news, and formulating a treatment plan.
Patients who have decision-making capacity have the right to refuse
Psychiatric/Behavioral & procedures & treatment. The physician should address any
2665 Psychiatry
Substance Abuse modifiable obstacles to treatment. If the patient still refuses,
services should be offered if the patient reconsiders.
Tricyclic antidepressant (TCA) overdose is characterized by mental
status changes, seizures, cardiac conduction delay, &
Psychiatric/Behavioral & anticholinergic toxicity (dilated pupils, hyperthermia, flushed & dry
3126 Psychiatry
Substance Abuse skin, intestinal ileus). QRS duration >100 msec has been associated
with an increase risk of arrhythmias &/or seizures & is an indication
for tx with sodium bicarbonate.
Pts w anorexia nervosa and bullimia nervosa have distorted body
image & can engage in purging behaviors. Key distinction is that
those w anorexia have significantly low body weight.
3140 Psychiatry Distinction b/w dx is impp due to differences in potential
Substance Abuse
complications (bradycardia, refeeding syndrome in anorexia) and
utility of pharmacotx (SSRIs are effective in bulimia but NOT in
anorexia).
Schizotypal personality disorder is characterized by a long-standing
pattern of eccentric behaviors and social anxiety despite familiarity.
3143 Psychiatry Pts with this disorder typically exhibit magical thinking and odd
Substance Abuse
perceptual disturbances that are subthreshold for a psychotic
disorder.
Narcissistic personality disorder is characterized by an exaggerated
3144 Psychiatry sense of self-importance, need for admiration, feelings of
Substance Abuse
entitlement, and lack of empathy.
Psychiatric/Behavioral & Dependent personality disorder- excessively dependent and
3145 Psychiatry
Substance Abuse submissive behaviors, indecisiveness, & fear of being left alone.
Individuals w schizoid personality disorder are socially detached &
prefer to be alone. They can be differentiated from individuals w
Psychiatric/Behavioral & avoidant personality disorder, who desire relationships but avoid
3146 Psychiatry
Substance Abuse them due to fears of rejection. They also lack the eccentric
cognitions and perceptual distortions characteristic of schizotypal
personality disorder.
Avoidant personality disorder is characterized by shyness, feeligs of
Psychiatric/Behavioral & inferiority, & intense fear of embarrassment or rejection. These
3147 Psychiatry
Substance Abuse characteristics frequently override the individual's desire for
friendship & relationships.
Patients with a history of alcohol who develop tremulousness,
unstable vital signs, &/or seizures shortly after hospital admission
Psychiatric/Behavioral & should be assessed for alcohol withdrawal. Lorazepam, an
3187 Psychiatry
Substance Abuse intermediate-duration benzodiazepine available in intravenous form,
is preferred in the inpatient setting, particularly in patients with
comorbid liver disease.
Heroin (opioid) withdrawal should be suspected in patients with
Psychiatric/Behavioral & muscle and joint aches, nausea, diarrhea, abdominal cramping,
3189 Psychiatry
Substance Abuse rhinorrhea, and pupillary dilation. These subjective symptoms are
often severe but generally not life-threatening.
Amphetamine intoxication can present w psychiatric symptoms
(irritability, agitation, & psychosis). Common physical signs:
tachycardia, htn, hyperthermia, diaphoresis, & mydriasis.
Psychiatric/Behavioral & Delusions are unlikely in opioid withdrawal. Sxs of opioid withdrawal
3190 Psychiatry
Substance Abuse and a manic episode would be unlikely to subside during a brief ED
visit (opioid withdrawal sxs often last 3-5 days).
Delirium is more likely than isolated pschotic sxs in anticholinergic
poisoning.
PCP and lysergic acid diethylamide (LSD) intoxication present
Psychiatric/Behavioral & similarly, but agitation, aggression, and nystagmus occur more often
3191 Psychiatry
Substance Abuse in pts using PCP. Visual hallucinations and intensified perceptions
are hallmarks of LSD use.
Dissociative amnesia involves isolated impairment in
Psychiatric/Behavioral & autobiographical memory. The dissociative fugue subtype is
3372 Psychiatry
Substance Abuse characterized by either seemingly purposeful travel or wandering in
a dissocated state.
The diagnosis of schizoaffective disorder requires assessing the
longitudinal course of the illness and determining if the patient has
Psychiatric/Behavioral & had at least 2 weeks of psychotic symptoms in the absence of a
3376 Psychiatry
Substance Abuse mood episode. Schizoaffective disorder is distinguished form
schizophrenia by the presence of mood symptoms for a significant
portion of the illness.
Loss of cortical tissue volume with enlargement of the lateral
cerebral ventricles, and decreased volume of hippocampus and
amygdala are some of the neuroimaging findings in schizophrenia.
Psychiatric/Behavioral & Atrophy of the caudate is associated with Huntington disease.
3378 Psychiatry
Substance Abuse Accelerated head growth during infancy and increased total brain
volume have been found in autism.
Structural abnormalities in the orbitofrontal cortex and basal ganglia
(eg, striatum) are associated with OCD.
Adjustment disorder involves symptoms causing marked distress
and impairment that develop within 3 months in response to a
Psychiatric/Behavioral & stressor. It is not diagnosed if symptoms meet the criteria for
3382 Psychiatry
Substance Abuse another specific disorder (eg, major depressive disorder). The
treatment of choice is psychotherapy that focuses on improving
coping skills and promoting a return to functioning.
Venzodiazepines should be used with extreme caution in the elderly
3383 Psychiatry Nervous System population due to increased risk of cognitive impairment, falls, and
paradoxical agitation.
Kleptomania is an impulse control disorder characterized by an
inability to resist the impulse to steal objects that are of low
Psychiatric/Behavioral & monetary value or not needed for personal use.
3385 Psychiatry
Substance Abuse Tx: Psychotherapy involves a CBT orientation, focusing on
techniques to resist & manage urges & anxiety. Meds that have
been used: SSRIs, opioid antagonists, lithium, and anticonvulsants.
Gambling disorder is the likely diagnosis in an individual with a year
Psychiatric/Behavioral & or longer history of preoccupation with gambling and an inability to
3387 Psychiatry
Substance Abuse stop. Significant financial losses and damaged relationships are
common consequences of this behavior.
Narcolepsy-excessive daytime sleepiness, cataplexy,
hypnagogic/hypnopompic hallucinations, & sleep paralysis. Tx:
sleep hygiene, scheduled naps, & avoidance of alcohol & drugs that
3470 Psychiatry Nervous System
cause drowsiness. When meds are needed to decrease daytime
somnolence, wakefulness-promoting agents such as modafinil are
preferred.
Psychiatric/Behavioral & Passive-aggressive behavior involves dealing with conflict by
3535 Psychiatry
Substance Abuse indirectly expressing aggression or anger in a passive or covert way.
Intellectualization is the transformation of an emotionally difficult
3536 Psychiatry event into a purely intellectual problem to avoid confronting its
Substance Abuse
uncomfortable emotional components.
Patients with psychiatric diagnoses can give informed consent as
Psychiatric/Behavioral & long as they have capacity, meaning that their judgment and
3638 Psychiatry
Substance Abuse decision-making abilities are determined to be intact at the time of
treatment.
Bupropion is associated with an increased seizure risk. It is
3702 Psychiatry contraindicated in patients with seizure disorders, anorexia, and
Substance Abuse
bullimia nervosa.
Conversion disorder- sudden onset of neurological sxs and clx
findings that are incompatible w recognized neuro conditions. Often
precipitated by stress, & pts can present as hysterical or strangely
3719 Psychiatry indifferent (ie, "la belle indifference") to their sxs.
Substance Abuse
Tx: 1st line- education, encouragement, & support for pts & family
members about the disorder and self-help techniques.
2nd line- CBT
Under the Health Insurance Portability and Accountability Act,
Social Sciences
3742 Psychiatry patients have the legal right to obtain copies of their medical records
within a specified timeframe.
Patients with somatic symptom disorder benefit from regularly
3750 Psychiatry scheduled appointments, which establish a strong physician-patient
Substance Abuse
relationship and limit diagnostic testing or subspecialty referrals.
Body dysmorphic disorder involves excessive preoccupation with a
slight or imagined bodily defect and is best treated with medication
3751 Psychiatry &/or psychotherapy (not surgery). Management requires an
Substance Abuse
empathic approach that takes into account the patient's level of
insight and conveys concern that surgical tx is unlikely to be helpful.
Active suicidality is associated with intent and plan for self-harm.
Psychiatric/Behavioral & The first step in the care of patients with active suicidality is to
3759 Psychiatry
Substance Abuse ensure their safety by admitting them to a psychiatric unit
(involuntarily, if necessary).
Abrupt cessation of alprazolam, a short-acting benzodiazepine, is
3762 Psychiatry associated with significant withdrawal symptoms, including
Substance Abuse
generalized seizures and confusion.
Acutely psychotic patients should be assessed for
suicidal/homicidal ideation, command hallucinations to hurt self or
3794 Psychiatry others, and ability to care for self. Indications for involuntary
Substance Abuse
psychiatric hospitalization include being a danger to self or others
and/or grave disability.
Rationalization-offering a rational, logical reason for an upsetting
event or behavior rather than admitting the true reason in order to
avoid anxiety or protect self-esteem.
3799 Psychiatry Repression (blocking upsetting feelings from entering conscious
Substance Abuse
awareness) can be differentiated from suppression in that it occurs
subconsciously.
Denial-failure to accept a disturbing aspect of external reality.
DEFENSE MECHANISMS (DM)
Displacement-displaces neg feelings assoc w a person or situation
onto a "safer" more acceptable object or situation
Psychiatric/Behavioral & Acting out-expressing unacceptable feelings through actions
3806 Psychiatry
Substance Abuse Denial-behaving as if an aspect of reality does not exist
Intellectualization-using intellect to avoid uncomfortable feelings
Passive aggression-avoiding conflict by expressing hostility covertly
Projection-attributing one's own feelings to others
Social anxiety disorder is characterized by anxiety and fear of
scrutiny in social situations, resulting in avoidance, distress, and
3839 Psychiatry social-occupational dysfunction. The preferred pharmacological
Substance Abuse
treatment is a SSRI or SNRI. Cognitive-behavioral therapy can also
be used as first-line treatment.
Patients with a single episode of major depressive disorder should
continue antidepressants for an additional 4-9 months following
3843 Psychiatry acute response to reduce the risk of relapse. Patients with
Substance Abuse
recurrent, chronic, or severe episodes should be considered for
maintenance treatment (1-3 years or indefinitely).
Minimizing conflict and stress in the home decreases the risk of
Psychiatric/Behavioral & relapse in pts with schizophrenia. Family psychosocial interventions
3844 Psychiatry
Substance Abuse are indicated for patients with a recent psychotic episode who have
significant ongoing contact with family members.
Somatic symptom disorder involves excessive and disproportionate
preoccupation w somatic symptoms, resulting in high health care
3845 Psychiatry utilization and functional impairment. B/c sxs often worsen during
Substance Abuse
periods of stress, pts whould be asked about their current emotional
stressors & counseled regarding stress reduction.
Generalized anxiety disorder is characterized by excessive anxiety
Psychiatric/Behavioral & symptoms about multiple issues, in conjunction with 3 or more of the
3995 Psychiatry
Substance Abuse following symptoms for at least 6 months: restlessness, fatigue,
poor concentration, irritability, muscle tension, and impaired sleep.
Cocaine abuse should be suspected in an individual with weight
4041 Psychiatry loss, behavioral changes, and erythema of the turbinates and nasal
Substance Abuse
septum.
Bipolar disorder is a highly recurrent illness that requires long-term
4043 Psychiatry maintenance pharmacotherapy to decrease the risk of recurrent
Substance Abuse
mood episodes.
Cancer patients may have somatic symptoms that overlap those of
depression (eg, sleep disturbance, appetite change, poor energy).
Psychiatric/Behavioral & However, if there are additional symptoms such as guilt, loss of
4045 Psychiatry
Substance Abuse interest, feelings of hopelessness, or suicidal thoughts, major
depression should be considered, with a low threshold for beginning
treatment.
4046 Psychiatry Weight gain is a common adverse effect associated with olanzapine.
Substance Abuse
Persistent depressive disorder (dysthymia) refers to a depressed
Psychiatric/Behavioral & mood lasting most days for >=2 years. It includes patients with pure
4051 Psychiatry
Substance Abuse dysthymia and those with intermittent or persistent major depressive
episodes.
Schizoaffective disorder is characterized by a significant mood
Psychiatric/Behavioral & episode (depressive or manic) with concurrent psychotic symptoms
4055 Psychiatry
Substance Abuse in addition to psychosis without mood symptoms for at least 2
weeks.
Seratonergic antidepressants (eg, SSRIs) are the 1st line tx for
obsessive-compulsive disorder. The seratonergic TCA,
clomipramine, is generally used 2nd line as it is less well tolerated.
Psychiatric/Behavioral & ACh: involved in attention, memory, & executive fxs
4063 Psychiatry
Substance Abuse DA: 1ry target for antipsychotic meds
GABA: 1ry target of benzodiazepines
NE: catecholamine involved in mood, anxiety, alertness, learning, &
memory.
Antipsychotic medication nonadherence is a common cause of
Psychiatric/Behavioral & relapse and rehospitalization in patients with schizophrenia.
4067 Psychiatry
Substance Abuse Long-acting injectable antipsychotics are useful in patients who are
chronically nonadherent but have responded to oral antipsychotics.
SSRIs & SNRIs are 1st line meds for tx GAD that can also
potentially treat comorbid major depression.
4141 Psychiatry
Substance Abuse Benzodiazepines should be reserved for nondepressed pts without a
hx of substance abuse who fail to respond to or cannot tolerate
antidepressants.
Delusional disorder is characterized by one or more persistent
4195 Psychiatry delusions and no other prominent psychotic symptoms. Apart from
Substance Abuse
the impact of the delusion(s), functioning is not markedly impaired.
Pts w cannabis intoxication typically present with conjunctival
4215 Psychiatry injection, dry mouth, tachycardia, & increased appetite.
Substance Abuse
Psychomotor impairment, anxiety, and paranoia may also occur.
Panic disorder involves recurrent unexpected panic attacks, fears of
Psychiatric/Behavioral & future attacks, and avoidance behavior. Dx requires differentiation
4285 Psychiatry
Substance Abuse from other anxiety disorders that may include triggered panic atacks
and ruling out medical and substance-induced causes.
Neuroleptic malignant syndrome (NMS) typically presents w altered
mental status, fever, muscle rigidity, and autonomic instability.
Stopping the causative medication (ex. antipsychotics) is the most
4522 Psychiatry critical intervention.
Substance Abuse
Dantrolene, a muscle relaxant, & dopamine agonists (bromocriptine,
amantadine) can be considered in pts who do not respond to
discontinuation of the causative agent & supportive care.
Anabolic-androgenic steroids are used to improve physique and
athletic performance but are associated with numerous adverse
4670 Psychiatry effects, including acne, baldness, gynecomastia, hepatic
Substance Abuse
dysfunction, altered lipid profiles, virilization, testicular failure, and
possible mood and behavior changes.
Normal age-related cognitive changes include occasional
4674 Psychiatry forgetfulness and word-finding difficulty that do NOT impact
Substance Abuse
activities of daily living.
Cognitive deficits that interfere with independence in everyday
activities are a key feature that distinguishes dementia (major
4675 Psychiatry neurocognitive disorder) from normal age-related changes.
Substance Abuse
Pts with dementia have functional impairments that necessitate
assistance.
Obsessive-compulsive personality disorder involves a pattern of
Psychiatric/Behavioral & preocupation with orderliness, perfectionism, and control. It is
4815 Psychiatry
Substance Abuse differentiated from obsessive-compulsive disorder by the lack of tru
obsessions and compulsions.
Persistent depressive disorder is characterized by chronic
depressed mood & >=2 other depressive symptoms lasting >= 2
4816 Psychiatry years.
Substance Abuse
Tx w antidepressants &/or therapy can improve symptoms & quality
of life.
Antipsychotic medications exert their antipsychotic effects through
dopamine antagonism. The blocking of dopamine results in
Psychiatric/Behavioral & hyperprolactinemia, which can lead to galactorrhea, amenorrhea,
4848 Psychiatry
Substance Abuse and infertility.
The 2nd generation antipsychotic RISPERIDONE is most likely to
increase prolactin.
Sleep terrors are a common, and usually benign, parasomnia of
Psychiatric/Behavioral & childhood. They occur during non-REM sleep and are characterized
4869 Psychiatry
Substance Abuse by fear, crying or screaming, decreased level of consciousness, and
amnesia of the event.
Pts who are an acute threat to themselves should be hospitalized
4877 Psychiatry (involuntarily, if necessary) for tx and stabilization. This principle
Substance Abuse
also applies to minors, even without parental or guardian consent.
Patients may be reluctant to discuss sensitive issues in the
4878 Psychiatry presence of family members. Patients of all ages should be given
Substance Abuse
the opportunity to meet with the physician alone.
Patients taking monoamine oxidase inhibitors (MAOIs) such as
4879 Psychiatry phenelzine should avoid foods rich in tyramine as the interaction of
Substance Abuse
such food-drug combinations can result in hypertensive crisis.
A major depressive episode can be dx if symptoms following loss of
a loved one are sufficiently severe to meet dx criteria. Compared to
4881 Psychiatry normal grief, major depression is associated with more persistent
Substance Abuse
and pervasive sadness, feelings of hopelessness and
worthlessness, and suicidal ideation.
Patients with situationally triggered depressive symptoms should be
Psychiatric/Behavioral & assessed for major depressive and adjustment disorders. Normal
4883 Psychiatry
Substance Abuse stress reactions are distinguished by lower severity and absence of
significant functional impairment.
Bupropion is an antidepressant with mild stimulant properties that
Psychiatric/Behavioral & can be particularly helpful for depressed patients with low energy,
4884 Psychiatry
Substance Abuse impaired concentration, hypersomnia, and weight gain. It can also be
used to aid smoking cessation.
2nd generation antipsychotics cause metabolic side effects (eg,
weigh gain, hyperglycemia, dyslipidemia) to varying degrees.
4885 Psychiatry Routine monitoring for the development of these side effects is
Substance Abuse
recommended in pts taking these medications.
Olanzapine and clozapine are associated with the greatest risk.
Antipsychotics may cause drug-induced parkisonism, a type of
Psychiatric/Behavioral & extrapyramidal symptom. Treatment options include antipsychotic
4886 Psychiatry
Substance Abuse dose reduction (if feasible) and treatment with benztropine or
amantadine.
Neuroleptic malignant syndrome is a potentially life-threatening
condition that can occur after administration of antipsychotic
4887 Psychiatry medications. Symptoms include high fevers, lead-pipe rigidity,
Substance Abuse
altered mental status, and autonomic instability. Creatine kinase
level and white blood cell count may be elevated.
In shared psychotic disorder, the dominant person's ddelusion is
transferred to a more submissive partner. It is important to separate
4888 Psychiatry the individuals to determine the degree of impairment in each.
Substance Abuse
Separation can also be used as a therapeutic measure to break the
cycle of mutual reinforcement.
Antipsychotic medications are 1st line tx for psychosis. 2nd
generation antipsychotics are generally preferred due to a
4895 Psychiatry Nervous System comparatively lower risk of extrapyramidal side effects & tardive
dyskinesia. Due to the risk of agranulocytosis, clozapine is reserved
for pts who have failed at least 2 antipsychotic trials.
Acutely psychotic patients with no insight are unable to determine
that their psychotic experiences are not real. To build rapport, it is
important to acknowledge the patient's experience and distress
without endorsing specific delusions or hallucinations.
Delusional disorder involves one or more delusions & the absence of
4897 Psychiatry other psychotic symptoms in an otherwise high-functioning
Substance Abuse
individual.
Antipsychotics cause hyperprolactinemia by blocking dopamine
activity in the tuberoinfundibular pathway.
Clinical effects of hyperprolactinemia include amenorrhea,
galactorrhea, gynecomastia, & sexual dysfunction.
Specific phobia-fear of a specific object or situation.
1st line tx is behavioral therapy which involves exposure to the
phobic stimulus in a controlled setting. Exposure is typically
Psychiatric/Behavioral & performed in a gradual manner (systematic desensitization), which
4905 Psychiatry
Substance Abuse result in decreased anxiety over time through habituation &
extinction. Although in vivo exposure is optimal, imaginal & virtual
reality exposure are also effective & may be more feasible.
Behavioral tx>farm in specific phobia.
Adjustment disorder is characterized by the development of
Psychiatric/Behavioral & emotional or behavioral sxs in response to an identifiable stressor
4906 Psychiatry
Substance Abuse that occurs within 3 months of the stressor. The dx is appropriate
when the pt does not meet the criteria for another mental disorder.
GAD is characterized by multiple worries lasting >= 6 months w sxs
4907 Psychiatry of restlessness, fatigue, difficulty concentrating, irritability, muscle
Substance Abuse
tension, and sleep disturbance.
Panic disorder is characterized by recurrent, unexpected panic
attacks and fears about future attacks and/or maladaptive behavior
6978 Psychiatry related to the attacks. Some patients will develop agoraphobia,
Substance Abuse
which is the avoidance of situations in which escape or obtaining
help may not be possible.
The slightly increased risk of antidepressant-related suicidality in
child and adolescent pts whould be weighed against the established
7289 Psychiatry efficacy of antidepressants. Depressed pts should be carefully
Substance Abuse
monitored for worsening depression and suicidality at the beginning
of antidepressant therapy.
Medically ill patients who develop comorbid depression can benefit
7723 Psychiatry from treatment with antidepressant medications and psychotherapy
Substance Abuse
to improve theri quality of life.
Patients with factitious disorder intentionally produce signs and
Psychiatric/Behavioral & symptoms for the purpose of assuming the sick role. Factitious
7728 Psychiatry
Substance Abuse disorder should be differentiated from malingering, which involves an
external incentive.
Clozapine is a uniquely effective antipsychotic medication. Due to
7957 Psychiatry the risk of agranulocytosis, it is reserved for patients with
Substance Abuse
treatment-resistant schizophrenia.
Patients who fail to respond to an initial antidepressant trial should
Psychiatric/Behavioral & be considered for a switch to another first-line antidepressant. Other
8841 Psychiatry
Substance Abuse options include augmenting with a second agent or switching to or
adding psychotherapy.
Hoarding disorder is characterized by difficulty discarding
8875 Psychiatry possessions regardless of their actual value. It is best treated with
Substance Abuse
cognitive-behavioral therapy.
Social anxiety disorder is characterized by fear of one or more
social situations and anxiety about acting in a way that will be
8909 Psychiatry humiliating or embarrassing. It should be differentiated from other
Substance Abuse
DSM-5 anxiety disorders such as panic disorder (unexpected panic
attacks) and specific phobias (specific phobic stimulus).
Patients with depression or underlying psychiatric issues frequently
Psychiatric/Behavioral & come to their primary care physician with physical complaints.
8913 Psychiatry
Substance Abuse Evaluation should include obtaining psychiatric history and
assessing psychiatric symptoms.
Psychiatric/Behavioral & Survivors of sexual assault are at high risk for developing
8915 Psychiatry
Substance Abuse posttraumatic stress disorder, depression, and suicidality.
CBT focuses on reducing automatic negative thoughts and
Psychiatric/Behavioral & avoidance behaviors that cause distress. It is effective as
8938 Psychiatry
Substance Abuse monotherapy or in combination with medication for a wide range of
psychiatric disorders.
Access to firearms is the greatest risk in completing homicide.
Other important risk factors include: young male, unemployed,
9841 Psychiatry impoverished, substance abuse, antosocial personality disorder, hx
Substance Abuse
of violence or criminality, hx of childhood abuse, & impulsivity.
Parents should be advised to limit acces to firearms.
The most effective strategy to prevent firearm injuries is to remove
Social Sciences all firearms from the home. Families who choose to keep firearms in
9848 Psychiatry
(Ethics/Legal/Professional) the home should be advised to store unloaded firearms and
ammunition in separate, locked containers.
Help-rejecting pts who are hopeless about tx can lead the dr to
Psychiatric/Behavioral & become frustrated and desire t refer the pt to another provider. Clear
10065 Psychiatry
Substance Abuse expression of empathy and a collaborative approach w limited goals
are the most effective approaches.
Physicians are ethically obligated to protect patient confidentiality.
10162 Psychiatry Unless a patient is active risk to self or others, physicians cannot
Substance Abuse
disclose information to family members without the patient's consent.
Drs should understand tht stillbirth (fetal death after 20 weeks
Psychiatric/Behavioral & gestation) is a traumatic experience for parents that must be
10753 Psychiatry
Substance Abuse approached initially with a direct expression of empathy and
ackknowledgment of loss.
Psychiatric/Behavioral & Teenagers with serious suicidal ideation MUST be hospitalized &
10754 Psychiatry
Substance Abuse their parents INFORMED of the situation.
Meds that block dopamine (D2) receptor (eg, antipsychotics,
metoclopramide) may cause extrapyramidal symptoms, including
10780 Psychiatry acute dystonia, parkisonism, akathisia, and tardive dyskinesia.
Substance Abuse
Drug-induced parkisonism typically presents with bradykinesia,
rigidity, and tremor.
Medication-induced psychosis is charact by delusions &/or
hallucinations that are temporally assoc w the use of a new med &
Psychiatric/Behavioral & rapid onset of sxs while med is being used.
11790 Psychiatry
Substance Abuse Glucocorticoids, particularly at high doses, are often implicated in
new-onset psychotic sxs in pts who may have no current underlying
psychiatric illness.
Inhalant abuse usually occurs in boys age 14-17 & may involve
Psychiatric/Behavioral & multiple common household chemicals. The effects are often rapid &
11794 Psychiatry
Substance Abuse transient but can be life-threatening. Users may also display
characteristic perioral skin changes (glue sniffer's rash).
ECT is an evidence-based treatment for major depression that
carries low risk for complications. It is a first-line treatment for
11827 Psychiatry major depression with psychotic features and appropriate for
Substance Abuse
severely depressed geriatric patients who are not eating or drinking
and require a rapid intervention.
MDMA (3,4-methylenedioxy-methamphetamine) is a synthetic
amphetamine with hallucinogenic properties. It can cause euphoria,
11853 Psychiatry increased sexual desire, & empathy. Intoxication may lead to
Substance Abuse
hypertension, tachycardia, hyperthermia, serotonin syndrome, &
hyponatremia. Coma, seizures, and death may occur.
Stimulant meds (methylphenidate, amphetamines) are 1st line tx for
ADHD in school-aged children.
ADHD dx requires onset of several symptoms bedore age 12 and
Psychiatric/Behavioral & impairment in >1 setting.
11857 Psychiatry
Substance Abuse Nonstimulant tx options include NSRI atomoxetine & alpha-2
adrenergic agonists.
TCA antidepressants (ex.desipramine)-risk of cardiotoxicity.

Postpartum psychosis is a medical emergency characterized by
Psychiatric/Behavioral & delusions, hallucinations, and mood symptoms. Management
11876 Psychiatry
Substance Abuse includes hospitalization to ensure safety (suicide, infanticide) and
antipsychotic medication.
Psychotherapy is the 1st line tx for borderline personality disorder.
11882 Psychiatry Psychotropic meds are used as adjuncts to psychotherapy to target
Substance Abuse
specific symptom clusters.
Brief psychotic disorder is characterized by sudden onset of
11883 Psychiatry psychotic symptoms lasting >= 1 days and =< 1 month. It is
Substance Abuse
associated with full return to previous level of functionting.
2nd generation antipsychotics (eg, quetiapine, lurasidone) are
11884 Psychiatry effective in the depressed phase of bipolar illness. Antidepressant
Substance Abuse
monotherapy should be avoided in patients with bipolar I disorder.
Early intervention for autism spectrum disorder (ASD) in the
preschool and school-age years has been shown to significantly
11886 Psychiatry improve outcomes. If there is any concern about ASD, thorough
Substance Abuse
screening & evaluation should be undertaken &
educational/behavioral services offered as soon as possible.
Bipolar II disorder is characterized by episodes of hypomania and
Psychiatric/Behavioral & major depression. It should be differentiated from bipolar I disorder
11893 Psychiatry
Substance Abuse (manic episodes) and the mood instability seen in borderline
personality disorder.
Patients with panic disorder may be misdiagnosed with a somatic
symptom disorder due to a preoccupation with unexplained
11894 Psychiatry symptoms and a history of high health care use. The recurrent
Substance Abuse
abrupt onset of characteristic physical symptoms that resolve within
minutes should raise clinical suspicion for panic disorder.
Neuroleptic malignant syndome (NMS): life-threatening condition
Psychiatric/Behavioral & associated with the use of antipsychotics. It is characterized by
11897 Psychiatry
Substance Abuse delirium, high fever, autonomic instability, severe rigidity, elevated
creatine kinase, and leukocytosis.
Akathisia should be considered if a psychotic patient worsens
Psychiatric/Behavioral & clinically as the dose of antipsychotic is increased. Tx includes
11898 Psychiatry
Substance Abuse antipsychotic dose reduction & treatment with propranolol or
lorazepam.
Delirium-induced psychosis is differentiated from primary psychotic
Psychiatric/Behavioral & disorders by fluctuating levels of consciousness, acuity of onset,
11905 Psychiatry
Substance Abuse and association with an underlying condition and/or offending
medications.
Sudden onset of psychosis in a child or adolescent is rare, & it is
imp to search for potentially reversible conditions such as medical
11967 Psychiatry disorders or substance use. Common medical conditions to r/o:
Substance Abuse
SLE, thyroiditis, metabolic or electrolyte disorders, cns infection, &
epilepsy.
Nightmare disorder involves recurrent awakenings from REM sleep
Psychiatric/Behavioral & associated w full alertness & dream recall. It should be differentiated
12002 Psychiatry
Substance Abuse from non-REM sleep terrors, which are characterized by partial
arousals, unresponsiveness, & lack of dream content.
Narcolepsy is characterized by excessive daytime sleepiness,
12003 Psychiatry cataplexy, and REM sleep-related phenomena (eg,
Substance Abuse
hypnagogic/hypnopompic hallucinations, sleep paralysis).
Chronic methamphetamine abuse can cause psychotic symptoms,
including paranoid delusions and auditory, visual, and tactile
12140 Psychiatry hallucinations (bugs crawling under the skin). Other signs include
Substance Abuse
marked weight loss, severe tooth decay, and excoriations due to
skin picking.
Catatonia is a syndrome seen in severe psychiatric and medical
Psychiatric/Behavioral & illness & is characterized by immobility, mutism, & posturing.
12145 Psychiatry
Substance Abuse Benzodiazepines and ECT (in pts who do not improve) are the tx of
choice.
Acute stress disorder is a severe anxiety response characterized by
Psychiatric/Behavioral & re-experiencing of trauma, disoociation, negative mood, avoidance,
12185 Psychiatry
Substance Abuse and hyperarousal lasting >= 3days and =< 1month after exposure to
a traumatic event.
Psychiatric/Behavioral & Trauma-focused cognitive-behavioral therapy and SSRIs/SNRIs are
12186 Psychiatry
Substance Abuse 1st line tx for PTSD.
Postpartum blues: a self-limited condition that begins several days
Psychiatric/Behavioral & postpartum and typically resolves without intervention within 2
12190 Psychiatry
Substance Abuse weeks. Women with depressive symptoms persisting beyond 2
weeks should be evaluated for postpartum depression.
Cyclothymic disorder is a chronic mood disturbance characterized
Psychiatric/Behavioral & by >=2 years of numerous periods of hypomanic and depressive
12191 Psychiatry
Substance Abuse symptoms that are sub-threshold for diagnosing major depressive or
hypomanic episodes.
Normal age-related sleep changes include decreased total sleep
Psychiatric/Behavioral & time, increased nighttime awakenings, sleepiness earlier in the
12195 Psychiatry
Substance Abuse evening with earlier morning awakening, and increased daytime
somnolence (napping).
Gender dysphoria is the persistent and intense desire to be the
opposite sex, which causes significant distress and is often
12253 Psychiatry associated with comorbid depression and anxiety. Physicians
Substance Abuse
should provide nonjudgmental support and encourage the
involvement of supportive family/friends as early as possible.

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NORMAL lithium therapeutic range: 0.8-1.2mEq/L

TCA antidepressants (ex.desipramine)-risk of cardiotoxicity.

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