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Psychiatry > Disorders > Flashcards

Disorders Flashcards

1
Q

Nigrostriatal tract

A

substantia nigra –> striatum (CN + putamen), D2-R

  • EPS symptoms
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2
Q

Mesolimbic tract

A

ventral tegmental area of midbrain –> limbic system, D4-R

hyperactivity = positive sx

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3
Q

Mesocortical tract

A

VTA –> frontal cortex and cingulate & prefrontal gyri

hypoactivity = neg sx, low mood, poor cognition

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4
Q

tuberoinfundibular tract

A

hypothal –> pituitary

dopamine suppresses PRL … so dop antag = hyperPRL

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5
Q

Symptoms of hyperPRL

A

galactorrhea
gynecomastia
amenorrhea

Group at greatest risk of hyperPRL from antipsychotics = adolescent males

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6
Q

What are the positive & negative sx?

A

POSITIVE: delusions, hallucinations, disorganized speech and behavior

NEGATIVE: anhedonia, avolition, apathy, alogia (poverty of speech), affect flattening, attention deficit

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7
Q

Hallucination vs illusion

A

Hallucination: NO external stimulus
Illusion: misperception of external stimulus

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8
Q

What are Schneider’s first rank symptoms?

A
  1. Audible thoughts
  2. Voices commenting
  3. Voices arguing, discussing
  4. Somatic passivity (passive recipient of bodily sensations from outside forces)
  5. Thought broadcasting, insertion and withdrawal
  6. Delusional perceptions (normal perception, followed by a delusional interpretation)
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9
Q

What are Schneider’s second rank symptoms?

A
  1. Sudden delusional thoughts
  2. Perceptual disturbances
  3. Perplexity
  4. Depressive and euphoric feelings
  5. Emotional impoverishment
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10
Q

What is a delusion?

What are the different kinds of delusions?

A

Fixed, false belief, which is not a shared cultural belief

“JPEGS”

  1. Jealous
  2. Persecutory (most common) - think they will be subject to hostile treatment
  3. Erotomanic (de Clerambault’s) - that someone usually of higher SES is in love with you
  4. Grandiose
  5. Somatic - includes delusional parasitosis
  6. Unspecific
  7. Mixed

Ideas of reference - belief that cues in external environment are uniquely directed towards them

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11
Q

What are the disorders similar to schizophrenia?

How do they differ?

A
  1. Brief Psychotic Disorder
    >/= 1 positive sx
    duration: between 1 day - 1 month
  2. Schizophreniform
    SAME except duration: 1-6 months
3. Schizophrenia
Causes lifestyle dysfunction.
2 + of the following, with at least one of the first three:
-- delusions
-- hallucinations
-- disorg speech
-- grossly disorg or catatonic behavior
-- neg sx
duration: > 6 months
**intact orientation
**lack of insight into their disease
  1. Schizoaffective disorder
    schizophrenia with concurrent MDD sx, with at least 2 weeks of hallucinations/delusions W/O MDD sx
    –> 2 subtypes: bipolar, depressive
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12
Q

Which substances can causes psychosis?

Intoxication and withdrawal?

A
  • intoxication of all substances EXCEPT: caffeine, opioids, nicotine “CON”
  • withdrawal of alcohol, sedatives, hypnotics “ASH”
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13
Q

What are the 3 phases of schizophrenia?

A
  1. Prodromal - decline in functioning (socially withdrawn, physical complaints, declining school/work performance, irritable, newfound interest in religious cult)
  2. Psychotic - perceptual disturbances (illusion, hallucin), delusions, disordered throught process/content
  3. Residual - occurs following an episode of active psychosis … mild hallucinations or delusions, social withdrawal, neg sx
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14
Q

Describe the characteristics of neuroleptic malignant syndrome.

A
  • change in mental status
  • autonomic instability (high fever, labile BP, tachycardia, tachypnea, diaphoresis)
  • “lead pipe” rigidity
  • elevated CPK
  • leukocytosis
  • metabolic acidosis
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15
Q

Medications: Weight gain risk

A

HIGHEST: olanzapine, clozapine
MEDIUM: Wellbutrin (bupropion), Cymbalta (duloxetine)
NEUTRAL: ziprasidone, aripiprazole

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16
Q

What is “rapid cycling” ?

Best treatment?

A

4 + mood episodes in one year
(major depressive, manic, hypomanic)

tx = mood stabilizers: carbamazepine, valproic acid

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17
Q

Define bipolar disease I and II.

A

Bipolar I: only requirement = manic episodes
highest genetic link
tx = lithium (decreased suicide risk), mood stabilizers (c, va), atypical antipsychotics (r, o, q, z)

Bipolar II: MDD + hypomania
*likely better prognosis than bipolar I
tx = same as above

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18
Q

What does the “atypical features” specifier for MDD denote?

A 
Hypersomnolence
Hyperphagia
Reactive mood
Leaden paralysis
Hypersensitivity to interpersonal rejection
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19
Q

“CHASES” of dysthymia?

A 
poor Concentration
Hopelessness
poor Appetite or overeating
inSomnia or hypersomnia
low Energy
low Self-esteem

*for most days, for 2 years
*has not been w/o above sx for >2 months at a time
*never had a hypomanic or manic episode
tx = psychotherapy + pharmacology

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20
Q

Criteria for cyclothymic disorder?

A
  1. hypomanic sx (NOT hypomania) + mild depression for at least 2 years
  2. must not have been sx free for >2 months
  3. NO hx MDD episode, hypomania, manic episode

*approx 1/3 eventually develop bipolar I or II
tx = antimanic agents: mood stabilizers or atypicals

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21
Q

Define criteria for disruptive mood dysregulation disorder (DMDD)

A
  1. Severe, recurrent verbal/physical outbursts out of proportion to situation.
  2. Outbursts 3+ times/week, inconsistent with developmental level
  3. Angry/irritable mood between outbursts
  4. at least 1 year, no >3 months w/o sx
  5. at least 2 settings
  6. dx made bw ages 6-18 BUT sx must have started at <10 years old
  7. no hypomania/mania episodes >1 day or MDD
  8. not due to substance/medical condition
  • high rates of comorbidity
    tx = psychotherapy (ie parent mgmt training)
    other meds to treat primary sx (SSRIs, atypicals, stimulants)
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22
Q

Substances

A
  1. PCP (hallucinogen): NYSTAGMUS, violent behavior, dissociation, hallucin, amnesia, ataxia
  2. LSD (hallucinogen): VISUAL HALLUCIN, dysphoria/panic, tachycardia/HTN
  3. Cocaine (stimulant): CP, SEIZURES, MYDRIASIS, agitation/psychosis, tachy/HTN
  4. Methamphetamine (stimulant): violent behavior, psychosis, diaphoresis, tachy/HTN, choreiform movements, tooth decay
    * bath salt* –> mydriasis/tachy/HTN, agitation, violent behavior
  5. Marijuana (psychoactive): CONJ INJECTION, increased appetite, dysphoria/panic, slow reflexes/impaired time perception, dry mouth … psychomotor impairment (can last for 1 day)
  6. Heroin (opioid): triad: DEPRESSED MENTAL STATUS, MIOSIS, RESP DEPRESSION, constipation

*all of euphoria except methamphetamines and PCP

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23
Q

How can you dx borderline personality disorder?

A

pervasive pattern of unstable relationships, self-image, affects, marked impulsivity, WITH 5+:

  • frantic efforts to avoid abandonment
  • unstable, intense interpersonal relationships
  • markedly and persistently unstable self-image
  • impulsivity in 2+ areas that are potentially self damaging
  • suicidal behavior/ self mutilation
  • mood instability
  • chronic feelings of emptiness
  • inapprop and intense anger
  • transient stress-related paranoia or dissociation

tx =

  1. PSYCHOTHERAPY (best)
  2. ATYPICALS, MOOD STABILIZERS for mood reactivity/transient psychosis
  3. ANTIDEP’s if comorbid mood/anxiety disorder

*common: hx childhood trauma

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24
Q

PTSD

A

trauma and sx <1 month = Acute Stress Disorder

sx for >1 month = PTSD
immediately after trauma or with delayed expression
- INTRUSIVE sx (thoughts, nightmares, flashbacks)
- AVOIDANCE of triggering stimuli
- MOOD CHANGES
- DISSOCIATION
- 2+ sx of INCREASED AROUSAL: hypervigilance, exag startle response, irritability/angry outbursts, insomnia

*50% PTSD recover within 3 months

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25
Q

What are tx options for PTSD?

A
  1. SSRIs or SNRIs
  2. Prazosin (alpha 1 antag) - nightmares, hypervigilance
  3. if severe: augment with atypicals
  4. psychotherapy (ie - cognitive processing therapy) asap after stressor
26
Q

Define ego-dystonic and ego-syntonic.

A

Ego-dystonic: it bothers the person

Ego-syntonic: it doesn’t bother the person

27
Q

Personality disorder criteria

A

CAPRI

Cognition
Affect
Personal Relations
Impulse control

28
Q

Cluster A

A

schizoid: eccentric, reclusive (VOLUNTARY social withdrawal), little interest in sexual activity with another person, taking pleasure in few activities, few close friends, indifference to praise/criticism, flattened affect/emotional coldness
schizotypal: eccentric … 5+: ideas of reference (thinking insignif things have personal significance), odd beliefs, magical thinking, inapprop/restricted affect, suspiciousness, excess social anxiety
paranoid: distrustful, tend to blame their own problems on others, characterized as frequently jealous, reluctance to confide in others, persistence of grudges

29
Q

Paranoid PD vs. Schizophrenia, Social isolation

A

PPD:
no fixed delusions, not frankly psychotic
*CAN be transiently psychotic in stressful situations

Ask others in close contact with the person, who can identify the person as excessively suspicious

30
Q

Schizoid vs. Schizophrenia, Schizotypal, Avoidant

A

SPD:
no fixed delusions or hallucinations

no magical thinking; not the same level of odd behavior/thought/perception

PREFER to be alone

31
Q

Schizotypal vs. Schizophrenia

A

not frankly psychotic, no fixed delusions

*CAN be transiently psychotic

32
Q

What is magical thinking?

A

Belief in telepathy or clairvoyance
Bizarre fantasies, preoccupations
Belief in superstitions

33
Q

Cluster B

A

antisocial (M > F): violate the rights of others w/o showing guilt, exploitive, break rules to meet their own needs, lack empathy, impulsive, skilled at social cues & can appear charming at first, fail to accept responsibility for their own behavior, assault others, arrogant

  • REQUIRE hx conduct disorder (<15 yrs), and be dx’ed with this at age >18 yrs
  • Hx abuse, hurting animals, starting fires
  • Men with alcoholic parents

borderline (F > M): unstable, intense interpersonal relationships; fear abandonment, poorly formed ID, aggression, impulsive, hx suicide/self-mutilation, transient stress-related psychosis

  • Tx: Dialectical behavior therapy (DBT)
  • Often split (good vs bad)

histrionic (F > M): attn-seeking, excessive emotionality, dramatic extroverted; unable to form long-lasting meaningful relationships, sexually inappropriate/provocative
*Regression (revert to childlike behaviors)

narcissistic: sense of superiority, need for admiration, lack of empathy, sense of entitlement, exploitive BUT fragile self esteem
* Greater risk of midlife crisis (emphasis on youth and power)

34
Q

Borderline vs. Bipolar II, Histrionic

A

vs bipolar II: mood swings are rapid, brief, moment-to-moment reactions to perceived environ or psychological triggers

vs histrionic: more likely to suffer from depression, brief psychotic episodes, attempt suicide
(histrionic pts usually more functional)

35
Q

Antisocial vs Narcissistic, Intermittent Explosive Disorder

A

NPD: want status/recognition … if don’t get it, they become depressed
Antisocial: want material gain, or simply dominance of others
*both exploit others

IED: usually no hx of conduct disorder, do not routinely engage in illegal activities
(can only dx IED in absence of antisocial disorder)

36
Q

Cluster C

A

avoidant: social inhibition, intense fear of rejection, hyperSn, avoid jobs with interpersonal contact
(DESIRE companionship but extremely shy)
*Overlap with social anxiety disorder

dependent (F > M): poor self-confidence, fear of separation, need to be taken care of, difficulty making everyday decisions, need others to assume responsibilities, difficulty expressing disagreement, feels helpless when alone

OCPD (M > F): perfectionism, inflexibility, orderliness; unable to finish simples tasks on time; appear stiff, serious, formal with constricted affect; professionally successful but poor interpersonal skills. Unable to discard worthless objects, miserly spending style, stubborn.

37
Q

Avoidant vs.

Schizoid
Social anxiety disorder
Dependent personality disorder

A

vs. schizoid: desire to be social but are shy

vs social anxiety disorder:

  • if sx (fear, avoidance) been a chronic thing and part of patient’s entire life - personality.
  • but if it’s fear in a particular setting - SAD.

vs DPD:

  • both cling to relationships.
  • avoidant pts are slow to get involved, whereas DPD pts actively/aggressively seek relationships
38
Q

Dependent PD vs. Borderline

A

DPD: long-lasting relationships

Borderline / histrionic: dependent on people but unable to maintain a longterm relationship

39
Q

OCPD vs OCD, Narcissisicism

A

vs OCD: no recurrent o or c
OCPD: ego-syntonic
OCD: ego-dystonic

vs narcissisicism:

  • both involve assertiveness and achievement
  • narcissisicism: motivated by status
  • OCPD: motivated by the work itself
40
Q

Which substances can induce depressive disorder?

A 
Alcohol
Antihypertensives
Barbiturates
Steroids
Levodopa
Sedative-hypnotics
Anticonvulsants
Antipsychotics
Diuretics
Sulfonamides
Withdrawal from stimulants (cocaine, etc)
41
Q

Which substances can induce bipolar disorder?

A 
antidepressants
sympathomimetics (ie - phenylephrine)
dopamine
steroids
levodopa
bronchodilators
cocaine / amphetamines
42
Q 
Procainamide, quinidine
Albuterol 
Isoniazid
Tetracycline
Nifedipine, verapamil
Cimetidine
Steroids
A

Procainamide, quinidine: confusion, delirium
Albuterol: anxiety, confusion
Isoniazid: psychosis
Tetracycline: depression
Nifedipine, verapamil: depression
Cimetidine: depression, confusion, psychosis
Steroids: aggressiveness/agitation, mania, depression, anxiety, psychosis

43
Q

What is:
reactive attachment disorder
disinhibited social engagement disorder

A

abuse/neglect in infancy

RAD: pairs too little
DSED: pair too much (overly bonding; cannot diff between stranger and family)

dx: <5 years old … r/o autism
tx: tell caregiver how to parent better OR get kid to place where it can happen
f/u: mood disorder, substance disorders … learning disabilities

44
Q

Adjustment disorder

A

Non life-threatening stressor –> mood changes
(lose child, lose your job, etc)

onset: within 3 months of stressor
duration: < 6 months

  • more severe reaction than expected

mood change that doesn’t qualify for a mood disorder (no SI, HI) –> generally don’t need treatment

45
Q

First line tx, MDD with psychotic features

A

Combination therapy: antidepressant + antipsychotic
or
ECT

46
Q

Catatonia

  • sx of retarded vs excited
  • treatment
  • 3 things for f/u
A

Mood / Bipolar&raquo_space;> Schizophrenia (modifier of illness)

Dx: 3+ of:

  • Retarded catatonia: stupor, catalepsy (can put pt in any position you want), waxy-flexibility, negativitism (resistance to ideas etc), mutism, immobility
  • Excited catatonia: stereotypy (repetitive mvmts), agitation/grimace, echolalia, echopraxia

Dx: Treat with Lorazepam … if goes away, that’s the dx.
** antipsychotics WORSEN catatonia

F/u:

  1. Malnutrition –> albumin
  2. DT ppx (DVT??)
  3. Rhabdo –> ARF (check elevated CK)
47
Q

Malignant catatonia (psych disorder ++ NO meds)

NMS (psych disorder ++ antipsychotic induced)

SS (psych disorder ++ SSRI or w.e. induced)

Malignant hyperthermia (NO psych disorder ++ halothane/anesthesia induced)

A

Sx:

  1. Lead pipe rigidity:
    - muscle breakdown –> high CK
    - strong resistance to mvmt
  2. ANS dysfunction:
    - HTN
    - tachy
    - fever
48
Q

Social anxiety disorder

A

fears related to being publically scrutinized, embarassed, or neg judged in a social context

vs GAD: where there are multiple worries

vs panic disorder: where there are

  1. unexpected panic attacks
  2. patient’s fear is specifically related to the panic sx

vs specific phobia: where stimulus is not related to social anxiety

49
Q

What are some augmentation strategies, if someone’s having a partial response to their current anti-depressant medication?

What if they’re a nonresponder?

A
  1. add anti-depressant with a different MOA
  2. add an atypical (aripiprazole)
  3. add lithium
  4. add T3
  5. psychotherapy

Nonresponder: change to a diff med

50
Q

MDD vs normal grief

A

MDD:

  • persistent sadness, anhedonia
  • excessive guilt
  • self critical ruminations
  • suicidality
  • feelings of worthlessness and hopelessness
51
Q

What is persistent complex bereavement disorder?

Aka complicated grief

A
  • persistent yearning for deceased
  • prolonged emotional pain related to loss (6-12 mo)
  • impaired functioning
  • complicating features:
    • maladaptive rumination
    • dysfunctional behavior (ie - excessively seeking proximity to deceased thru objects)
52
Q

Side effects of lithium?

CI?

A

Acute: tremor, ataxia, AMS, n/v, diarrhea + polyuria, polydipsia, weakness

Chronic: nephrogenic DI, CKD, thyroid dysfxn (usually hypo), hyperparathyroidism (hyperCa)

CI: CKD, CVD, hyponatremia or diuretic use
*esp first tri pregnancy

53
Q

What labs would you want to get before starting lithium?

A 
BMP
TFT
Ca
UA
pregnancy test
ECG if have CAD risk factors
54
Q

Indications for ECT?

A

treats: depression, bipolar mania, catatonia

  1. treatment resistant
    • psychotic features
  3. emergencies (SI, refusal to eat)
  4. CI to pharmacotherapy
  5. pregnancy if can’t use meds
  6. hx of ECT response
  • no absolute CI
55
Q

What are the side effects of ECT?

A

Retrograde + anterograde amnesia
Anterograde: resolves w/in 2 wks of being done
Retrograde: may persist longer

56
Q

What can you use to treat the depressive phase of bipolar?

A

lamotrigine

quetiapine

57
Q

Primary diagnostic features of conduct disorder?

A

Deceitfulness or theft (lying, stealing)
Deliberate property damage (vandalism, setting fires)
Aggression, cruelty towards ppl/animals
Serious violation of rules (truancy, running away)

3+ for >12 months. lack of remorse

Tx:

  1. CBT
  2. Fam therapy
  3. Parent mgmt training
58
Q

Conduct disorder vs ODD

A

ODD: angry/irritable mood + defiant behavior toward authority figures

NO stealing or aggression towards people

59
Q

Somatic symptom disorder
vs
Panic disorder

A

Somatic symptom disorder: physical sx are persistent over time

Panic disorder: more acute attacks

60
Q

What are the sleep changes in depression?

A

Early morning awakening
Multiple awakenings
Decreased REM latency
Decreased restorative sleep

61
Q

Lewy body dementia - what can happen when you use anti-psychotics in these patients?

A
  1. autonomic dysfunction (orthostatic hypotension)
  2. Parkinsonism (bc blocking dopamine)
  3. AMS

Psychiatry (7 decks)

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