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437- Psychiatric > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

acetylcholine decrease- diseases

A

alzheimers
impaired memory

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2
Q

acetylcholine increase- disease

A

parkinsonian symptoms

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3
Q

dopamine decrease- dis

A

substance abuse
anhedonia (An inability to experience pleasure from activities usually found enjoyable) (depression)
parkinson’s disease

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4
Q

dopamine inc- dis

A

schizophrenia
psychosis

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5
Q

norepinephrine (fight or flight)
decrease- dis

A

depression

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6
Q

norepinephrine (fight or flight)
increase- dis

A

anxiety

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7
Q

GABA (aminobutyric acid) decrease- dis

A

anxiety disorders

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8
Q

glutamate inc- dis

A

bipolar
psychosis

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9
Q

glutamate dec- dis

A

memory and learning difficulty
negative symptoms of schizophrenia (apathy, lethargy, withdrawal)

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10
Q

serotonin inc- dis

A

inc aggression/ psychosis w/ schizo

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11
Q

serotonin dec- dis

A

depressions

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12
Q

schizo- population characteristics

A

earlier peak onset in men
diagnosis before age 10 or after age 60 very rare

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13
Q

schizo- genetic cause

A

inc apoptosis and dec neurogenesis

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14
Q

schizo- environmental risk factors

A

childhood trauma
preg complications
winter births (low vitamin d)
urban city
inc paternal age
inc NMDA (N methyl d aspartate) antibodies - lead to psychosis

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15
Q

schizo- sociocul risk factors

A

poverty
stressful life events
cannabis

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16
Q

schizo- complications (general systems)

A

cognitive processes
perception**
affect, emotions and beh
social-occupational

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17
Q

schizo- social tendencies

A

pt look to isolate and withdrawal
if no support- patterns go unnoticed- become depression- inc risk self harm/suicide

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18
Q

schizo- frontal region s/s

A

function- critical thinking

difficulty planning actions and organizing thoughts

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19
Q

schizo- basal ganglia s/s

A

function- mvmnt/ sensory information

paranoia hallucinations

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20
Q

schizo- auditory system s/s

A

function- hear and understand speech

auditory halluc

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21
Q

schizo- limbic system s/s

A

function- emotion

agitation

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22
Q

schizo- occipital lobe s/s

A

function- visual information

visual hallucinations, trouble interpreting complex images or recognizing motion

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23
Q

schizo- hippocampus s/s

A

function- learning and memory

dec learning and memory

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24
Q

schizo- neurotransmitters affected

A

dopamine- inc lvls= positive symptoms

serotonin- inc lvls= positive and neg. symp

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25
Q

schizo- phases

A

1- premorbid
2- prodromal
3- schizophrenia
4- residual

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26
Q

schizo- premorbid phase

A

1
first noticed in school and w/ family (identify first)
poor peer relationships and poor academic performance
* can be misdiag for ADHD

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27
Q

schizo- prodromal phase

A

2
depressive s/s
social withdrawal
cognitive impairment!!!
OCD

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28
Q

schizo- schizophrenia phase

A

3
dev of psychotic s/s
delusions, hallucinations
disorganized speech

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29
Q

schizo- residual phase

A

4
active psychotic phase s/s no longer present
flat affect

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30
Q

relationship btw schizo and psychosis

A

not all psychotic episodes are caused by schizo
= cant automatically diagnose w/ schizo
ex. other causes of mania/psychosis
drug induced
liver failure (ascites, inc ammonia, cognitive changes)

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31
Q

schizo- positive s/s- delusions
persecution, grandiose, referential and somatic

A

persecution- belief one will be harmed by others

grandiose- belief that person has exceptional greatness

referential- belief that everything is r/t them and a sign

somatic- belief that centers on one’s own body
ex. i feel sick, take me to the ER

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32
Q

schizo- positive s/s- religiosity, paranoia, magical thinking

A

religiosity, paranoia, magical thinking

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33
Q

schizo- positive s/s- associative looseness

A

shift ideas from one unrelated topic to another
ex. “I love your hair, did you get it done at Blue Beach Salon?”
person will talk about sand on the beach in florida

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34
Q

schizo- positive s/s- neologisms

A

made up words that only have meaning to the person

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35
Q

schizo- positive s/s- concrete thinking

A

literal interpretations of the environment
often not accurate
ex. paranoia about someone whispering bc they think the people are talking about them

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36
Q

schizo- positive s/s- clang associtaions

A

choice of words governed by sound
rhyming

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37
Q

schizo- positive s/s- circumstantiality

A

delay in reaching point of communication bc of unnecessary details

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38
Q

schizo- positive s/s- tangentially

A

introduce many topics, can’t get to the point

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39
Q

schizo- positive s/s- mutism

A

refusal/ inabil to speak

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40
Q

schizo- positive s/s- echolalia

A

repeating words that are heard

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41
Q

schizo- positive s/s- perseveration

A

repetition of same word or idea to, despite change in question topics

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42
Q

schizo- positive s/s- perception/ hallucinations

A

auditory- most common, voice commanding person to do something
visual
tactile
gustatory (foul taste)
olfactory (smell)

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43
Q

schizo- positive s/s- sense of self

A

person lacks feeling of uniqueness or individuality
-causes ppl to isolate bc uncomfortable

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44
Q

schizo- positive s/s- echopraxia

A

repeating movements observed

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45
Q

schizo- positive s/s- identification and imitation

A

taking on the form of behavior observed in other people

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46
Q

schizo- positive s/s-

A
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47
Q

schizo- positive s/s- depersonalization

A

feelings of unreality
see self from a distance

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48
Q

schizo- positive s/s- motor behavior

A

hyperactivity
agitation
catatonia (fast and strange mvmnts)
unusual posturing

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49
Q

schizo- negative s/s- inappropriate affect

A

emotions do not match situation
usually deny condition and downplay s/s

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50
Q

schizo- negative s/s- bland/ flat

A

weak emotional tone

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51
Q

schizo- negative s/s- apathy

A

disinterest in the environment

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52
Q

schizo- negative s/s-volition

A

impairment in ability to initiate goal directed activity

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53
Q

schizo- negative s/s- emotional ambivalence

A

contradicting emotions at same time towards object, person or situation

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54
Q

schizo- negative s/s- anergia

A

dec energy

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55
Q

schizo- negative s/s- waxy flexibility

A

even degree of resistance to passive movement

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56
Q

anosognosia

A

impairs ability to understand and perceive ones own illness

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57
Q

schizo- general trtmnt

A

multidisciplinary
meds, and therapy

58
Q

schizo- prognosis (factors that inc good prognosis)

A

high lvl functioning before diag (premorbid)
female
later age at onset
no structural brain abnormalities
compliancy
no family hx of schizo
associated mood disorder

59
Q

delusional disorder- definition

A

existence of prominent, non-bizarre delusions
* can be s/s of dev of schizo

60
Q

delusional disorder- erotomanic

A

person believes someone of higher status is in love with them

61
Q

delusional disorder- grandiose type

A

person thinks they have some amazing power or special relationship with God/ someone famous

62
Q

delusional disorder- jealous type

A

thinks partner cheated

63
Q

delusional disorder- persecutory type

A

thinks they have been done wrong (cheated on, stolen from etc)

64
Q

delusional disorder- somatic type

A

person feeling imaginary physical sensations (bug crawling on skin)

65
Q

delusional disorder- mixed type

A

combo of multiple types

66
Q

brief psychotic disorder

A

sudden onset
duration < 1 month
return to premorbid functioning
can be drug induced psychosis

67
Q

substance-induced psychotic disorder- causes

A

stimulants (meth)
psychoactive sub (bath salts, LSD)
substance withdrawal (DT’s form etoh)

68
Q

hallucinations/ delusions- non schizo causes

A

brain tumor
parkinsons
AIDS
alzheimers dementia
hepatic disease

69
Q

schizophreniform disorder

A

same as schizo but lasts btw 1-6 months
if > 6 months = full blown schizo

70
Q

schizoaffective disorder

A

schizo s/s w/ mood disorders (mania or depression)

71
Q

catatonic features

A

muscle rigidity/ waxy flexibility (even degree of resistance to movement)
negativism- resists all requests to move
purposeless movement
echolalia and echopraxia (mimicking mvmnts)
stupor

72
Q

schizo- downside of behavior therapy

A

can’t generalize community setting after pt discharged from trtmnt

73
Q

schizo- milieu therapy

A

use w/ med therapy
pt can be mobile, not restrained to room

74
Q

antipsychotics- function

A

dec agitation and psychotic symp

75
Q

1st gen typical antipsychotic agents- list

A

haldol, loxapine (loxitane), pimozide

76
Q

1st gen typical antipsychotic agents- ae

A

EPS, tardie dyskin, NMS (fever, tachy, muscle rigidity), weight gain, GI upset, agranulocytosis, dec seizure threshold

77
Q

1st gen typical antipsychotic agents- contraindications

A

prolonged QT
CNS depressant
liver, renal or cardiac disease

78
Q

1st gen typical antipsychotic agents-action

A

suppress dopamine, histamine and acetylcholine

79
Q

2nd gen atypical antipsychotic- Zyprexa
purpose

A

schioz maintenance
acute agitation assoc. w/ schizo (dec agitation 30 min)

80
Q

2nd gen atypical antipsychotic- Zyprexa
ae

A

weight gain, tardive dyskin, NMS, hypotension, periph edema

81
Q

2nd gen atypical antipsychotic- Zyprexa
contraindications

A

unstable cardiovasc. status

82
Q

2nd gen atypical antipsychotic- Zyprexa
action

A

affects b/ positive (delusions, hallucinations) and negative symptoms (anhedonia, apathy)
weak dopamine antagonist
serotonin 5HT2A antagonist

83
Q

2nd gen atypical antipsychotic- Clozaril
purpose/considerations

A

one week of medication at a time
for acute trtmnt only
only use after tried at least 3 o/ antipsych.
1-6 wks for effectiveness

84
Q

2nd gen atypical antipsychotic- Clozaril
ae

A

inc salivation, tachycard, dizziness, sedation, ha
seizurs, NMS,
PE
agranulocytosis

85
Q

2nd gen atypical antipsychotic- Clozaril
monitoring

A

CBC every =week for 6 months
and then monthly forever
monitor WBC, EKG, LFT

86
Q

general antipsychotic ae- life threatening

A

tardive dyskin
agranulocytosis (dec in neutrophils)
EPS
NMS
prolonged QT

87
Q

agranulocytosis- s/s and trtmnt

A

concerning w/ 2nd gen
clozaril
trtmnt- antib or antifungal
s/s- sore throat, fever, malaise, mouth ulcers

88
Q

tardive dyskinesia- assessment

A

report immedi
can be reversed
assess w/ AIMS- abnormal involuntary movement scale

89
Q

dystonia
akathisia
akinesia

A

dystonia- involv musc mvmnt
akathisia- restless/ fidgeting
akinesia- muscle weakness

90
Q

medications to trt EPS

A

Cogentin (benztropine)(antimuscarinic) , Artane (antimuscarinic) and Benadryl (antihistamine)

91
Q

antipsychotic med pt ed

A

sunscreen
risk for ae
montior glucose, lipids- can cause dm 2

92
Q

schizo- LEAP acronym

A

listen
empathize
agree
partner

93
Q

neurotransmitter- cholingergic function

A

sleep and arousal
pain
memory retention
coordination mvmnt

94
Q

neurotrans- norepinephrine function

A

fight or flight
cognition/perception
regulation mood

95
Q

neurotrans- dopamine

A

regulation mvmnt
regulation emotions
decision making (pleasure v reward seeking beh)
attention/learning

96
Q

neurotransmi- serotonin

A

sleep/arousal
libido
appetite
aggression
body temp

97
Q

amino acid- gaba function

A

interrupts progression of impulse at synpase
inhibtory neurotransmitter

calms, inhibits act. of nerve cells

98
Q

neuropeptide- substance p

A

found in gut
regulation pain, inflamm, memory and mood

99
Q

neuropep- somatostatin

A

growth inhib hormone
involved in rapid reproduction of normal and tumor cells

100
Q

amino acid- glutamate function

A

excitatory neurotrans

GAS

cognition, learning and memory

101
Q

pituitary gland- posterior lobe function

A

vasopressin- regulates hr
oxytocin

102
Q

pituitary gland- anterior lobe

A

GSH
TSH
prolactin

103
Q

positron emission tomography (PET) v single photon emission computed tomography (SPECT)

A

PET- detects changes in bodys metab and chemical activities- color coded

SPECT- uses gamma-emitting radioactive sub.
creates 3D pictures

104
Q

Timeline of dev of psych meds

A

lithium (mania), neuroleptics (seizures/ mood stabilizer), antidepressant, injectable antipsychotics

105
Q

neuronal synapse action- antipsychotics

A

block dopamine

106
Q

neurotransmitter action- antidep

A

block reputake serotonin and norepinephrin

107
Q

benzodiazepine

A

facilitate transmission of gaba (block neurotrans)
depressants
trt anxiety, insomnia and seizures

108
Q

neuronal synapse action- psychostimulants

A

inc release norepinephrine, serotonin and dopamine

109
Q

2nd gen atypical antipsych assessment considerations- before admin

A

height, wt, waist girth (measure BMI)
has inc risk dev DM2 if taken long term
*effects metabolism

110
Q

list SSRI

A

setraline (zoloft)
fluoxetine (prozac)
escitalopram (lexapro)

111
Q

SSRI ae

A

inc effects beta blockers, haldol, clozapine and warfarin
dec effects digoxin

serotonin syndrome, NMS, sexual dysfunction

112
Q

SSRI action

A

blocks serotonin reputake

113
Q

SNRI list

A

trintellix , cymbalta, pristiq

114
Q

SNRI interactions

A

NMS w/ concurrent use MAOI
SS w/ concurrent use other serotonin blocking medications

115
Q

SNRI contraindications- alcohol, Wellbutrin, trazodone

A

inc risk liver injury w/ alcohol
inc risk toxicity w/ duloxetine or wellbutrin (inc risk of seizures w/ etoh)
altered effect of warfarin w/ wellbutrin
inc risk seziures (wellbutrin) w/ concurrent use other antidepres
priapism ( erection > 4hrs) w/ trazodone

116
Q

heterocyclics (antidepressants) list + action

A

wellbutrin, trazodone
block norepinep. and dopamine receptors

117
Q

tricyclic interactions

A

inc effect w/ PPI (cimetidine), haldol, SSRIs
hyperpyretic crisis w/ MAOI
hypertensive crisis w/ clonidine

118
Q

antidep- tricyclic def and list

A

not first line bc lots ae
can also be used as sleep aids

norpraamin, tofranil

119
Q

tricyclic OD

A

lethal!
only first option for OC anxiety

120
Q

antidepressant- monoamine oxidase inhibitors- MAOIs
list, ae, contraindications and education

A

marplan, nardil
ae- tremor, sweating, hypertensive crisis, seizures, hypotension, hypoglycemia
contraindications CNS depress, OTC cold meds, antihistam, tricyclic antidepres, antihypertensive, and barbituates
education- avoid cheese, wine/beer, pickled foods, and processed meat (foods that are high in tyramine)

121
Q

MAOI washout period

A

minimum 2 week period before start of MAOI or end
system has to be completely clear before starting new meds after ending maoi

122
Q

antianxiety med list

A

benzodiapines
valium, clonazepam
act on GABA receptors

123
Q

antianxiety
action, contraindicated, ae, interactions

A

action- depression of cns
contraindicated- coma, shock, pregnancy, o/ cns depressants
interactions- inc effect w/ etoh and antipsychotics, antidepress, antihistam,
dec effects w/ caffeine and smoking
ae- orthostatic hypoten, n/v, confusion, drowsiness, lethargy

124
Q

mood stabilizer list

A

lithium, depakote, tegretol, topamax

125
Q

topamax- considerations

A

mood stabilizer
action- dec compulsivity
alters metabolism of Ca in kidneys (kidney stones)

126
Q

mood stabilizers
indications
action
interaction
contraindications

A

indication- prev/ trtmnt mania assoc. w/ bipolar
action- effects all neurotransmitters
interactions- caffeine inc effects
etoh inc dizziness and drowsiness while taking med
inc risk toxicity w/ dehydration- changes in fluid vol alter serum blood lvl of lithium rapidly
contraindic- kidney disease

127
Q

lithium- ae

A

dry mouth, hypotension, fine hand tremors, dehydration, ha, weight gain, polyuria

128
Q

lithium action

A

accum in reward center of brain
can also trt anxiety in low doses

129
Q

lithium- therap range mania v maintenance

A

mania- 1-1.5 meq
maint- 0.6-1.2 meq

130
Q

lithium toxicity symptoms

A

usually appear at 1 meq
blurred vision, tinnitus, persistent n/v, severe diarrhea

131
Q

anticonvulsants- ae

A

severe rash w/ lamotrigine (starts around face/eyes)
n/v
prolonged bleeding time w/ valpronic acid
dec efficiancy w/ oral contraceptives

132
Q

verapamil- ae

A

Ca ch blocker- used for anxiety, ha
bradycardia, hypotension, dizziness

133
Q

anti-parkinson’s agents list

A

carbidopa levodopa (dopamin antagonist)
cogentin- anticholinergic
MAOB inhib (prevent dopamine brkdwn)

134
Q

anti-parkinsons indication, action, contraindications and interactions

A

indication- parkinsons and eps
action- alters acetylchol and dopamine (inc)
contraind- thyroid disturbance, gi obstructions
interactions- inc lvl of antichol and dec lvl of antipsych w/ use of haldol
increases cns depression

135
Q

anti-parkinsons ae

A

n/ gi upset, exacerb of psychoses, orthostatic hypotension

136
Q

list sedative hypnotics

A

phenobarbital (anticonv)
pentobarbital (pre op)

137
Q

sedative hypnotic ae

A

confusion, lethargy, orthostatic hypoten, dry mouth, n/v

138
Q

role of dopamine in adhd

A

meds activate dopamine d4 recep in basal ganglia/thalamus
which depresses motor activity

139
Q

adhd- clonidine v atomoxetine action

A

clonodine- stim alpha adrenergic recep in brain (dec sympath stim from cns)
atomoxetine- inhibit reuptake norepinep, blocks uptake serotonin, norepin and dopamine

140
Q

adhd med list

A

stimulants- adderall, ritalin, concerta, strattera
wellbutrin
clonidine

141
Q

adhd contraindications

A

pts with advanced arterioscler, cardiovasc dis, htn, hyperthyroidism, hx drug use, less than 14 days since using maoi

bupropion (wellbutr)/ strattera (atomoxetine) - seizures, acute MI, bulimia/anorexia
renal/ hepatic insuff, Cardiovasc dis, SUICIDAL pts, urinary retention

142
Q

adhd general ae

A

weight loss, insomnia, palpitations, liver damage (strattera) , seizures (wellbut)
rebound syndrome (alpha agonists (clonadine))

437- Psychiatric (3 decks)

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