High Yield Psychiatry Shelf Exam Review Flashcards

Comprehensive vocabulary flashcards covering the High Yield Psychiatry Shelf Exam Review lecture by Emma Holliday Ramahi.

Bipolar I Diagnosis

A diagnosis made when a patient experiences a manic episode, often cycling with depressive episodes.

Manic Episode Incidence

Approximately $1\%$ of the population.

Genetic Risk for Bipolar in Identical Twins

An $80\text{-}90\%$ risk if one twin is diagnosed.

Mania in Elderly (First-time)

Look for a medical cause, specifically a right frontal hemisphere stroke.

Medications to Avoid in Bipolar

SSRIs and TCAs, as they can trigger mania.

Acute Agitation or Delusion Treatment (Bipolar)

Haloperidol or clonazepam.

Lithium Maintenance Medications

Lithium, valproic acid, or carbamazepine.

Lithium Toxicity Precipitants

NSAIDs like Advil; preferred pain medications are aspirin or sulindac.

Lithium Toxicity EKG Findings

T-wave flattening or inversion and U waves.

Lithium Toxicity Treatment

Fluid resuscitation; emergent dialysis is required if levels are $> 4\,mmol/L$ or if kidney disease is present.

Lithium MOA

Suppresses inositol triphosphate.

Lithium Therapeutic Levels

$0.6\text{-}1.2\,mEq/L$, monitored with Lithium levels every $4\text{-}8$ weeks.

Ebstein’s Anomaly

A malformed tricuspid valve that atrializes part of the right ventricle, caused by taking Lithium during the 1st trimester.

Valproate Side Effects

Elevated LFTs, hepatitis, n/v/d, and skin rash.

Lamotrigine Major Risk

Steven’s Johnson Syndrome.

Carbamazepine Agranulocytosis Monitoring

Check CBC regularly; monitor closely if ANC is $< 2000$, and discontinue the medication if ANC is $< 1000$.

Fetal Complication of Valproate/Carbamazepine

Neural Tube Defects (NTD); Repro-age females should take $4\,g$ of folic acid daily.

Valproate Therapeutic Level

$$60\text{-}120\,mcg/mL$$

Carbamazepine Therapeutic Level

$$6\text{-}12\,mcg/mL$$

Suicidal Ideation Risk Factors

Prior attempt (most important), age $> 45$, white male, serious illness, detailed plan, and lack of support.

MDD Polysomnogram Findings

Shortened REM latency and increased frequency of REM.

Dexamethasone Suppression Test

An atypical lab test for MDD where there is a failure to suppress cortisol.

Adjustment Disorder

Symptoms occur within $3$ months of a stressor, are out of proportion, and do not persist longer than $6$ months.

Atypical Depression

Characterized by eating more, weight gain, sleeping more, and leaden paralysis; best treated with MAOIs.

Uncomplicated Bereavement

Normal grief with no suicidal ideation or psychosis (except seeing/hearing the loved one); rarely treated with antidepressants.

SSRI with Most Drug-Drug Interactions

Paroxetine.

SSRI with Fewest Drug-Drug Interactions

Fluoxetine (also does not require tapering due to long half-life).

$5HT$ Discontinuation Syndrome

Symptoms like headache, n/v/d, and dizziness caused by stopping SSRIs suddenly, most common with sertraline and fluvoxamine.

$5HT$ Syndrome

Characterized by myoclonic jerks, tachycardia, high BP, hyperreflexia, and n/v/d; occurs if SSRI and MAOI are combined.

Bupropion (DA/N-RI)

Indicated if SSRIs cause loss of erection/ejaculation; contraindicated in bulimics, alcoholics, and epileptics.

Priapism in Antidepressant use

An erection lasting $> 3$ hours, likely caused by trazodone.

Mirtazapine

Antidepressant good for 'old, skinny, sad ladies' due to side effects of increased appetite and sleep.

Hypertensive Crisis (MAOI)

Caused by eating tyramine-rich foods (cheese, red wine); treated with $5\,mg$ IV phentolamine.

Tricyclic Antidepressant (TCA) Overdose

Presents with dry mouth, tachycardia, seizures, and widened QRS complexes/prolonged QT interval.

TCA Overdose Treatment

Activated charcoal if within $1\text{-}2$ hours; IV sodium bicarbonate for cardioprotection and acidosis.

Schizophrenia (Paranoid Type)

The most common type with the best prognosis.

Schizophrenia Neurobiology

Positive symptoms are caused by excess DA in the limbic area; negative symptoms are caused by decreased DA in the prefrontal cortex.

Brief Psychotic Disorder

Psychotic symptoms lasting $> 1$ week but $< 1$ month.

Schizophreniform Disorder

Psychotic symptoms lasting $> 1$ month but $< 6$ months.

Schizoaffective Disorder

Delusions or hallucinations for $> 2$ weeks in the absence of mood symptoms.

Delusional Disorder (Erotomanic Type)

A man convinced a celebrity is in love with him but he is otherwise functional.

Low Potency Typical Antipsychotics

Chlorpromazine and Thioridazine; associated with less EPS and more anti-ACh effects.

High Potency Typical Antipsychotics

Haloperidol and Fluphenazine; associated with more EPS.

Pigmentary Retinopathy

A side effect specifically associated with Thioridazine.

Acute Dystonia

Occurs within $< 12$ hours of antipsychotic use; treated with benztropine or diphenhydramine.

Akathisia

Feeling the need to move constantly; treated with propranolol (1st line) or benzodiazepines.

Neuroleptic Malignant Syndrome (NMS)

Symptoms include temperature of $103\,^{\circ}F$, rigidity, and autonomic instability; treated with dantrolene sodium or bromocriptine.

Risperidone

Atypical antipsychotic with the highest risk for EPS and increased prolactin.

Clozapine

Used for treatment-refractory schizophrenia; potential dangerous side effects include agranulocytosis and decreased seizure threshold.

Clozapine Monitoring

Weekly CBC for ANC for 6 months, then every 2 weeks for 6 months; stop if $WBC < 3000$ or $ANC < 1500$.

Acute Benzo Withdrawal

Presents with temperature of $101\,^{\circ}F$, convulsions, and confusion; treated with diazepam or chlordiazepoxide.

Specific Phobia

Best treated with CBT featuring flooding or exposure/extinction.

Social Phobia

Best treated with propranolol to stop hyperarousal or benzodiazepines.

Generalized Anxiety Disorder (GAD)

Best treated with Buspirone ($5HT_{1a}$ partial agonist).

Obsessive Compulsive Disorder (OCD)

Clomipramine is the gold standard for treatment, but SSRIs are first line.

Post Traumatic Stress Disorder (PTSD)

Treated with sertraline or paroxetine; Prazosin is used specifically for nightmares.

Munchausen Syndrome

A severe factitious disorder where patients induce symptoms for primary gain.

Malingering

Intentional production of symptoms for secondary gain; associated with antisocial personality disorder.

Anorexia Vital Signs

Hypotension, bradycardia, and hypothermia.

Re-feeding Syndrome

A complication of treating anorexia characterized by low $PO_4$, low $Mg$, low $Ca$, and fluid retention.

Restless Leg Syndrome (RLS)

A dyssomnia treated with ropinirole or pramipexole (DA-agonists).

Obstructive Sleep Apnea (OSA) Monitoring

Diagnosed via polysomnogram showing $> 10$ hypopneic/apneas per hour; treated with CPAP.

Narcolepsy Treatment

Scheduled naps and Modafinil.

Personality Disorder Clusters

Cluster A (Weird: Paranoid, Schizoid, Schizotypal), Cluster B (Wild: Antisocial, Borderline, Histrionic, Narcissistic), Cluster C (Worried: Avoidant, Dependent, OCPD).

Schizoid vs. Avoidant PD

Schizoid patients do not want relationships; Avoidant patients want them but fear rejection.

Alzheimer's Dementia Pathology

Global brain atrophy, $\beta$-amyloid plaques, or tau tangles.

Lewy Body Dementia

Presents with visual hallucinations and shuffling gait; pathology shows alpha-synuclein inclusions.

Normal Pressure Hydrocephalus (NPH)

Triad of incontinence, gait disturbance, and dementia; treated with ventriculoperitoneal shunt.

Delirium Tremens (DTs)

Usually starts $48\text{-}72$ hours after the last drink.

Alcohol Metabolism

Zero-order kinetics at approximately $25\,mg/hr$.

Wernicke Encephalopathy

Nystagmus, ataxia, and confusion caused by thiamine deficiency; treat with thiamine first, then glucose.

Opiate Overdose

Presents with respiratory depression and track marks; treated with naloxone.

PCP Intoxication

Presents with horizontal nystagmus, dilated pupils, and acute psychosis; treated with haloperidol.

Cocaine Intoxication HTN Treatment

Calcium channel blockers; beta-blockers are contraindicated.

Fragile X Syndrome

X-linked dominant (CGG repeats) causing macrocephaly, long face, and macroorchidism; most common cause of inherited MR.

Down's Syndrome Cancer Risk

$10\times$ increased risk of ALL.

Prader-Willi Syndrome

Deletion on paternal Chr15 causing hypotonia, hypogonadism, and hyperphagia.

Fetal Alcohol Syndrome

The most common cause of mental retardation, featuring a smooth philtrum and microcephaly.

Rett Syndrome

Exclusively in girls; normal development for $6\text{-}8$ months followed by regression and handwringing.

Tourette's Disorder Timeline

Tics must occur at least once a day for $1$ year without a tic-free period longer than $3$ months.