COMBANK Psych COMAT Flashcards
symptoms of tricyclic antidepressant (TCA) overdose
wide complex tachycardia, hyperthermia, hypotension, flushed and dry skin, hypoventilation
confusion, agitation
Tx of TCA overdose
Sodium bicarbonate as soon as IV access is obtained
factitious disorder
intentionally feigning of sx for secondary gain of assuming the sick role
malingering disorder
intentionally feigned s/sx for primary gain (benefit to self - ex/ money, housing, obtaining drugs).
functional neurological sx disorder
- aka conversion disorder
- voluntary motor or sensory sx that suggest neuro illness
- not intentionally produced but can’t be explained by med condition, substance effect, cultural behavior, or experience
- sx often preceded by stress
bulimia nervosa dx
- binging + purging
- normal weight
bulimia tx
CBT > ssri/snri
both better
repression defense mechanism
unconscious prevention of an undesirable thought or feeling from reaching consciousness
suppression defense mechanism
consciously ignores unacceptable impulses or emotions in order to achieve a desired outcome
- mature defense mechanism
isolation of affect defense mechanism
unconscious limitation of the feeling of emotion associated with a stressful life event
– but still consciously aware the feeling exists
MDD SIGECAPS
S = decreased or increased sleep *I = decreased interest in most activities G = increased feelings of worthlessness or guilt E = decreased energy or fatigue C = decreased concentration on tasks or activities or in decision-making A = decreased or increased appetite and weight loss or weight gain P = psychomotor agitation or retardation S = recurrent thoughts of death or SI
*Have to have I or depressed mood as one of the sx to make dx
PTSD dx timeline
sx > 1 month
Ganser’s syndrome
- *- approximate answers to questions (paralogia)
- may have pseudohallucinations, clouded consciousness, and somatic complaints
- Ganser so close to answer but not quite.
Briquet’s syndrome
- aka somatization disorder
- throw a brick at em and they’ll think it hurts
Munchausen syndrome
- sub-type of factitious disorder
- involves traveling from hospital/clinic to hospital/clinic
- habitual lying about extensive histories
Munchausen syndrome by proxy
- aka factitious disorder by proxy
- individual intentionally produces physical s/sx in someone under their own care
Wernicke’s encephalopathy sx
nystagmus
ataxia
ophthalmoplegia (ex/ horizontal nystagmus, lateral orbital palsy, gaze palsy)
confusion
difference between conduct disorder and antisocial personality disorder
- antisocial PD is the progression of conduct disorder as pt ages. It is dx’d at or above 18yo
distinguishing features of sleep terror disorder
- unresponsiveness during the event
- amnesia after the event
- occurs during NREM sleep (stage III or IV)
Danger of TCA overdose
may cause QTc prolongation and widened QRS complexes, leading to possibly fatal arrhtyhmias.
tx of TCA overdose
sodium bicarb (anti-arrhythmic)
schizotypal personality disorder
- magical thinking, bizarre, borders on psychosis (ex/ Lady Gaga)
- eccentric behavior
- social and interpersonal deficits
- – impairment in self function (confused boundaries, distorted self concept, emotional expression off, unrealistic goals)
- – impairment in interpersonal functioning (misinterpretations, can’t develop closer relationships)
- some typa lady
schizoid personality disorder
- loner, happy that way (ex/ night shift toll booth worker)
- social withdrawal, reduced range of affect, no interest in sexual relationships
- schizoid like an android
paranoid personality disorder
- distrustful, suspicious
- interprets others as malicious
histrionic personality disorder
- theatrical, attention-seeking, uses physical appearance
- dramatic, flamboyant
- shallow expression of emotions that can be rapidly shifting (similar to borderline)
- usually women
- Ex/ marilyn monroe
borderline personality disorder
- unstable, rapid changes in mood, suicidal gestures
- impulsive, promiscuous, emotional emptiness
- usually women
anti-social personality disorder
- criminal, lacks remorse
- must be >18yo (otherwise is conduct disorder)
- manipulative, impulsive, no regard for rights of others
avoidant personality disorder
- wants relationships but doesn’t pursue them out of fear of rejection and criticism
- passes on promotions
countertransference
- rxn the provider has towards the dr-pt relationship
- can be positive or negative
pseudocyesis
false pregnancy
reaction formation defense mechanism
- pt develops a socialized attitude or an interest that is the direct antithesis of an infantile wish, desire, or impulse that is harbored consciously or unconsciously
- ex/ businessman engaged in fraud to earn money and then donates large sum of money to charity (unconsciously to avoid guilt)
sublimation defense mechanism
- energy associated with unacceptable impulses or drives is diverted into personally and socially acceptable channels
tx of status epilepticus (sz state over 30min)
- initially benzos: lorazepam, diazepam, midazolam
- second line = phenytoin then phenobarbital
- if still no relief then pentobarbital, midazolam, or propofol
Capgras syndrome
illusion of doubles
- delusion of misidentification that a familiar person has been replaced by an imposter
- seen after sudden brain damage
- is it a cap, is it gras? its two things! but not really…
Cotard syndrome
- aka nihilistic delusional disorders
- believe the world around them has been reduced to nothingness and that they’ve lost everything (including their own organs)
- precursor to schizophrenic or depressive episode
serotonin syndrome sx
hyperthermia muscle rigidity tremors altered mental status fever autonomic instability hyperreflexia
frotterism
- recurrent and intense sexual fantasies, urges or behaviors that involve rubbing against or touching a non-consenting person
- frotternizes (fraternizes) up against ppl
fetishism
- sexual fantasies, urges, or behaviors focused on nonliving objects such as shoes, stockings, or gloves
voyeurism
recurrent and intense preoccupation with observing an unsuspecting person who is disrobing, naked, or engaged in sexual activity
- aka scopophilia
- voyages to spy on naked ppl
psych meds where you often see anticholinergic toxicity with overdose
atypical antipsychotics»_space; typical antipsychotics (according to combank but not actually)
also TCAs
s/sx anticholinergic toxicity
red as a beet dry as a bone hot as a hare blind as a bat mad as a hatter full as a flask
haloperidol overdose s/sx
lethargy
tremors
dystonia
(mayyy cause anticholinergic toxicity)
lithium overdose s/sx
nephrogenic DI hyperreflexia tremor ataxia nystagmus SZs
Can you switch immediately from MAOi to SSRI?
No, have to wait at least 14d after stopping MAOi to avoid serotonin syndrome
s/sx of narcolepsy
- cataplexy (sudden, transient, bilateral weakness or paralysis. usually triggered by strong emotions… perplexed cat)
- sleep paralysis (on falling asleep or waking up)
- sleep-onset REM sleep attacks
- hypnagogic hallucinations
common laxatives
bisacodyl
cascara
senna
high fiber supplements
Russell sign
bulimia nervosa
= callus formation on the back of the index and long fingers
– occurs secondary to self-inflicted vomiting
Waddell signs
malingering
brain area associated with anxiety
- amygdala - increased activity
- anterior cingulate cortex
- insula
neuroleptic malignant syndrome s/sx
severe muscular rigidity hyperthermia AMS tachyC HTN
neuroleptic malignant syndrome labs
elevated CK metabolic acidosis hyperkalemia leukocytosis myoglobinuria
NMS tx
- supportive care
- dantrolene (muscle relaxant. for muslce rigidity and hyperthermia)
- bromocriptine (reverse loss of dopaminergic tone)
Calcium channel blocker overdose sx
profound bradycardia
hypotension
preserved or mildly depressed mentation
opioid/narcotic OD sx
AMS bradycardia miosis respiratory depression hypotension hypothermia ithcing, nausea, constipation
EtOH intoxication sx
hypotension (due to vasodilation) with reflex tachycardia
Bupropion OD sx
HTN
TachyC
SZ
tx of acute bipolar mania
valproate, lithium, antipsychotics (haloperidol, olanzapine)
- benzos if particularly agitated
illness anxiety disorder
- aka hypochondriasis
- disease preoccupation and conviction despite medical reassurance
- > = 6mo
MAOi’s MOA
prevent breakdown of dopamine but also of tyramine, which acts as an indirect sympathomimetic, causing increased release of endogenous catecholamines
biggest distinction between schizotypal PD and schizoid
schizotypal has MAGICAL thinking/odd beliefs. Schizoid is just weird by society standards
best option for maintenance tx for bipolar
quetiapine + lithium or valproate
sometimes use olanzapine
Tourette’s disorder
- onset before age 18
- motor and vocal tics
- – tic = sudden, rapid, recurrent, non-rhythmic, sterotypic motor movement or vocalization
- ex/ repetitive eye blinking, facial grimacing, shoulder shrugging, and head jerking
- sx waxes and wanes
Huntington’s chorea
- genetic movement disorder, AD
- appears in adulthood
- choreiform movements (rapid, involuntary, non-repetitive or arrhythmic movement), cognitive decline (dementia), neuropsych sx (attention, judgment, depression, apathy, social withdrawal, irritability)
Tardive dyskinesia
- movement disorder seen in older adults chronically on anti-psychotics
- mainly mouth and tongue
- blepharospasm, lip smacking, sucking, facial grimacing
- axial or tuncal choreoathetosis or dystonia
Wilson’s disease
- error of copper metabolism
- dystonias (ex/ torticollis, blepharospasm, cramps), chorea, ataxias, wing-beating tremors, mood disorders, psychosis, intellectual decline
- Keyser Fleischer rings, liver dysfunction
Sydenham’s chorea
- self-limited consequence of strep infection or ARF
- childhood
- choreiform movements (involuntary brief, random and irregular movements of limbs and face)
- emotional lability, hypotonia, muscle weakness, loss of fine motor control
Common SSRI side effects
- abnormal bleeding -> acute microcytic hypochromic anemia
- sexual disturbances, GI, agitations, insomnia, tremor
- beware serotonin syndrome
most common OCD compulsion
excessive grooming, hand washing, tooth brushing, etc
60% pts
loose associations
- disruption of logical connection between thoughts expressed sequentially
- pt unaware
- thoughts difficult to understand
Tangentiality
- extra ideas are included, never actually answering a question
- logical connections between thoughts remain
word salad
- incoherent illogical speech that lacks meaningful connection between words
- extreme form of loose association
circumstantiality
- extra and unnecessary details included before ultimately answering a question
- clear link between ideas expressed
circumstantiality vs tangentiality
- C answers the question, T does not
- both have logical connections
loose associations vs tangentiality
T still has logical connections, L doesn’t
- neither answers the question
tx for dissociative fugue
- psychodynamic psychotherapy (to deal with stressor and minimize recurrence risk)
- supportive care
what is interpersonal therapy used for
- focuses on 4 main areas:
1. grief over loss
2. interpersonal disputes
3. role transitions
4. interpesronal skill deficits
sympathetic viscerosomatic reflex for thyroid gland
T2
- associated with an upper thoracic flexion hump
cyclothymic disorder dx
hypomania + dysthymia
PCP intox sx
psychosis unpredictable violent behavior horizontal and vertical nystagmus pupillary constriction (miosis) tachyC
LSD intoxication sx
anx, depression
pupillary dilation
delusions, visual hallucinations, flashbacks
synesthesias (haering colors, seeing sounds)
panic
methamphetamine intox sx
fatigue, apprehension, trouble with concentration
HTN
pupillary dilation
fever
euphoria
possible psychosis, restlessness, irritability
prolonged wakefulness
salvia intox sx
hallucinations
euphoria
perceptual distortions
lasts 1-2hrs
CAGE scoring
1 point - at risk for dependency
2-3 = highly suspicious
4 = diagnostic for alcohol abuse disorder
borderline tx
dialectical behavioral therapy with adjuvant meds
best tx for alcohol abuse
brief intervention with follow-up visits (motivational enhancement therapy)
delerium tremens sx
tachyC psychomotor agitation combativeness HTN fever
meds with greatest risk for serotonin syndrome
MAO-Is when taken with other serotonergic meds, herbal supplements, or tyramine- and tryptophan-containing drinks/food
childhood disintegrative disorder
- normal development until age 2 then loss of previously acquired skills
- onset between 2-10
- boys > girls
Rett’s disorder
- normal dev until age 5mo
- disintegration in previously acquired milestones onset between 5mo-48mo
- girls only
drugs with pupillary constriction (miosis)
opiates intox
PCP intox
drugs with pupillary dilation (mydriasis)
cocaine intox
amphetamine intox
LSD intox
opiate withdrawal
cocaine intox sx
agitation
autonomic hyperactivity
pupillary dilation (mydriasis)
psychosis
- exact same as amphetamines so differentiate via urine drug screen
neurotransmitter that promotes REM sleep
acetylcholine
sx of vascular dementia
- manifest cognitive impairments and memory problems in a step-wise, progressivev way
- focal sensory or motor deficits
normal pressure hydrocephalus (NPH) sx
wet wacky wobbly
urinary incontinence
dementia
“magnetic gait”
Sx of alzheimer’s dementia
memory impairment + cognitive disturbance
- aphasia
- apraxia (inability to execute learned purposeful movements)
- agnosia (inability to recognize objects)
- disturbance in executive functioning
wernicke-korsakoff syndrome sx
confusion ataxia ophthalmoplegia vestibular problems confabulation anterograde amnesia
cri-du-chat sx
high-pitched cat-like crying low birth weight FTT hypotonia psychomotor retardation severe intellectual disabilities microcephaly hypertelorism
prader-willi syndrome sx
upslanting, almond-shaped eyes thin upper lips down-turned mouth light skin small hands and feet hypogonadism prominent low tone FTT in infancy hyperphagia -> obesity high pain threshold psych: obsessions, compulsions, temper tantrums, skin-picking, anx, depr, psychosis
angelman syndrome sx
severe intellectual disabilites postnatal microcephaly SZ frequent laughter and smiling excitable personalities hypermotoric behaviors attention problems decreased speech or absence of speech output ataxia
fragile x syndrome sx
large head with long face, prominent jaw and forhead, large ears
large-sized testes
Connective tissue dz
hypotonia
Psych: mod-sev mental retardation, pervasive developmental disorder, ADHD, mood lability
alcohol withdrawal timeline
- early: 8-9h after last drink, tremulousness, face flushed, mild anx, HA, GI upset, insomnia, hallucinations, diaphoresis, grand mal SZ, mild disorientation
- late/acute: 48-96h after last drink. Delirium tremens
SI tx for pregnant pt
ECT very effective for acute tx of depressive episode
anti-depressants assoc with orthostatic hypoT
TCAs - mainly Imipramine
adverse effects of trazodone
hypotension
sedation
priapism
adjustment disorder timeline
sx begin within 3mo of the change and stop w/in 6mo
concrete thinking
- age 7-11
- characterized by actual things, events, and immediate experience, rather than by abstractions
- seen in young children and ppl who can’t generalize (schizophrenia, and certain cognitive disorders)
formal operation
- age 12-adulthood
- deductive logic and emergence of ability to use abstrct thought for hypothetical situations
sleep-related eating disorder can be caused by …
hypnotics, ex/ zolpidem
Charles Bonnet Syndrome
- onset of complex visual hallucinations in an otherwise health blind pt with no psych hx and no other evidence or psych or mood disorder
- pts know hallucinations aren’t real
narcolepsy tx
- maintain regular sleep schedule
- timed daily naps
- moderate exercise
- emotional support
- stimulant drugs if needed
benzo withdrawal sx
*HTN
*TachyC
anxiety
SZ
aud or vis hallucinations
insomnia
PCP intox tx
Diazepam or lorazepam
- then haloperidol or risperidone if sx don’t improve
ADHD associated with development of
conduct disorder -> antisocial personality disorder
absolute contraindication to bupropion use
- SZ disorder (b/c lowers sz threshold)
- MAOi use w/in 14d
- anorexia or bulimia
- linezolid or IV methylene blue use
bupropion common adverse effects
tachyC
insomnia
headaches
