Clerkships: PSYCHIATRY Flashcards
Define universalization vs group cohesion vs validation vs
?
optimal treatment for panic disorder
SSRI (paroxetine) + benzodiazepine (alprazolam)
In parkinsons, antipsychotic of choice? Why
Clozapine (atypical?)
Spares nigrostriatal pathway and is anticholinergic
Grand mal seizures are followed by a spike in…?
Prolactin
Drug of choice for ECT sedation/anesthesia?
Methohexital (barbiturate)
What are alternative names for AST and ALT?
AST = SGOT (serum glutamic oxaloacetic transaminase) ALT = SGPT (serum glutamic pyruvic transaminase)
MOA:
amphetamine cocaine benzo/barb PCP antipsychotics
increased catecholamine RELEASE
decreased catecholamine REUPTAKE
potentiates gaba by increasing affinity for GABA receptors
NMDA aspartate receptor activation
dopamine receptor BLOCK
Supportive therapy hallmark
ABSENCE of interpretations
tx for neuroleptic malignant syndrome (NMS)
Bromocriptine + dantrolene
What’s responsible for cocaine’s addictiveness?
DOPAMINE (even though MOA is E/NE)
Why is naloxone useful?
Not orally bioavailable, therefore lower abuse potential
Digoxin overdose psych manifestation?
Yellow-blue visual hallucinations (Gogh vision)
Schizophrenic well controlled on clozapine but then experiences seizures. What do you do?
Stop clozapine temporarily, start PHENOBARBITAL, then restart clozapine at 50% original dose and titrate up
In someone with suicidal ideation, what is probably diminished in the CSF?
5-HIAA (serotonin metabolite)
Neuroimaging seen in depression? What sleep changes would you see?
decreased frontal lobe perfusion and metabolism on PET scan.
Depressed patients show DECREASED REM latency (time it takes between falling asleep and entering REM)
Temporal Lobe Epilepsy
Doesn’t need jerky movements; characterized by hypOsexuality, perseverative approach to interactions (viscosity), emotional intensity
a) Planning, monitoring, flexibility, motivation.
b) Schizophrenia
c) Tourrette’s
d) OCD***
e) PTSD
f) Panic Attack
g) depersonalization
h) shadow following behind
i) “docile, dirty, and dim” (apathy, poor grooming, decreased attention)
j) “explode into orbit” (withdrawl, fear, explosive mood)
k) language, motion, memory
l) recall of proper names
m) “happy psychotic” (euphoria + primary psychosis, hallucinations, etc. )
n) dysphoria, loss of artistic sense, irritability
o) verbal processing
P) visuospatial processing (lesion: anosognosia)
Which region of the brain?
[postcardiotomy delirium]
[specific learning disorder]
a) Dorsolateral frontal lobe
b) enlarged ventricles
c) caudate nucleus atrophy; decreased frontal lobe mass
d) caudate nucleus hypertrophy; increased? frontal lobe metabolism
e) decreased hippocampal volume
f) decreased amygdala volume, dysfunction of the locus ceruleus (NE)
g) right angular gyrus stimulation
h) left angular gyrus stimulation
i) dorsal prefrontal cortex
j) orbitomedial frontal cortex
k) temporal lobe
l) rostral (left) temporal lobe
m) DOMINANT temporal lobe
n) NON-dominant temporal lobe
o) DOMINANT parietal
p) NON-dominant parietal
Classic Picture of Meperidine Toxicity (pupils)
Meperidine usually doesn’t constrict pupils, but eventually they will constrict if toxic levels are reached:
1) respiratory suppression leads to
Most common ADR of ECT?
headache
What is the most effective HDL-raising drug? What is a common side effect of this drug and the MoA behind the reaction? How would you combat this?
Niacin, flushing, prostacyclin, take aspirin before
Methadone length of duration. Single dose? Multiple dose?
4-6 hours, 22-48 hours
Which ATYPICAL antipsychotic is most likely to give EPS
risperidone
tx MDD w/ psychotic features
BOTH SSRI+antipsychotic
Which cerebrovascular disease causes symptoms of depression? Mania?
Left-MCA stroke
Right-MCA stroke
