First Aid Flashcards
psychosis
distorted perception of reality
delusions
fixed, false beliefs despite evidence to the contrary
nonbizzare vs bizarrre
one is believable, other is not
delusions of persecution/paranoia
“CIA is after me” - one is being persecuted
delusion of ideas of reference
belief that external enviornmental are related to individual -TV is talking to me
delusion of control
thoughts can be heard of or by others
delusions of grandeur
super powers
delusions of guilt
guilty for something
somatic delusions
infected with a disease
illusion
misinterpretation of sensory stimulus (mistake show for a cat)
associations of hallucinations
auditory = schizophrenia visual = drug, alcohol withdrawal, delirium olfactory = aura for epilepsy tactile = withdrawal
delusion vs illusions vs hallucination
delusion = false belief illusion = misinterpretation of external stimulus hallucination = perception in absence of stimulus
criteria for psychosis due to medical condition
- prominent hallucinations/delusions
- symptoms do not occur only during delirium
- evidence of another cause
most common cause of psychosis in elderly
delirium
positive symptoms of schizophrenia
- hallucinations
- deulsions,
- bizarre behavior
- disorganized speech
- responds to meds
negative symptoms of schizophrenia
- flat or blunted affect, anhedonia, apathy, alogia and lack of interest
- treatment resistent
phases of schizophrenia
- prodromal - decline in funcitoning
- psychotic
- residual
criteria for schizophrenia
- delusions
- hallucinations
- disorganized speech
- disorganised or catatonic behavior
- negative symptoms
- problem with functioning for at least 6 months
echolia
repeated words or pharases
echopraxia
mimic behavior
findings in schizo exam
- disheveled, flat affect, disorganized thought
- intact memory and orientation
- auditory hallucinations
- paranoid delusions
- ideas of reference
- lack on insight
downward drift hypothesis
unable to function in society, end up in lower classes
neurotransmitter in schizo
dopamine
Less so:
high serotonin, high norepi, low GABA, low glutamate
pathways in schizo
- prefrontal
- mesolimbic = positive symptoms
- tuberoinfundibular - affected with antipsychotics
- nigrostriatal = EPS symtpoms
neolosigm
made up words, seen in schizophrenia
treatment of schizophrenia
no difference between first and second generation for efficacy
- should be taken for 4 weeks
dystonia
spasms
parkinsonism
resting tremor, rigidity, bradykinesia
akathisia
feeling of restlessness
treatment for EPS
benztropine and diphenhydramine, benzos/beta blockers
treatment for tardive dyskinesia
benzos, botox and vitamin E
symptoms of NMS
fever, labile blood pressure, tachycardia, tachypnea, diaphoresis, lead pipe rigidity, elevated CPK, leukocytosis, metabolic acidosis
thioridazine side effects
irreversible retinal pigmentation at high doses
chlorpromazine side effects
deposits in lens and cornea
schizoaffective disorder
- meet criteria for major depressive or manic episode with psychotic symptoms
- delusions for 2 weeks with no mood symptoms
- mood symptoms present for majority of psychosis
- not dus to substance
differences in delusional disorder vs schizophrenia
non bizarre delusions, daily functioning not impaired, does not meet schizophrenia criteria
erotomanic deulsion
deulsion that someone else is in love with person
Koro
penis into body in southeast asia
amok
outburst of violence followed by suicide, malaysia
brain fag
disturbances in male students in Africa
MDD criteria
- depressed mood
- anhedonia
- change in appetite or weight
- worthlessness or guilt
- insomnia or hypersomnia
- diminished concentration
- psychomotor agitation or retardation
- fatigue or loss of energy
- recurrent thoughts of death or suicide
Mania criteria
- distractibility
- inflated self-esteem or grandiosity
- increase in goal directed activity
- decrease need for sleep
- flight of ideas or thoughts
- pressured speech
- excessive pleasure with risks
- lasting 1 weeks
poor response to mixed mood disorder
lithium, valproic acid is preferred
hypomania vs mania
mania = 7 days, social impairment, hospital, psychotic features hypo = 4 days, no functional impairment, no hospital, no psychosis
stroke patients = mood disorder
depression
MDD criteria
- major depressive episode
- no mania or hypomania
sleep with MDD
multiple awakenings, terminal insomnia, hypersomnia is less common, REM earlier and for longer
etiology of MDD
increased sensitivity of beta-adrenergic receptors, high cortisol, abnormal thyroid, etc
most common sleep disturbances in MDD
trouble falling sleep and early awakenings
time for antidepressants
4-6 weeks
fist line in patients with MDD with psychotic features
atypical antipsychotics
ECT
- premeidated with atropine
- general anesthesia with methohexital
- muscle relaxant
melancholic features
anhedonia, early morning awakenings, depression worse in morning, psychomotor disturbance, excessive guilt and anorexia
atypical features of MDD
hypersomnia, hyperphagia, reactive mood, leaden paralysis, hypersensitivity to interpersonal rejection
bipolar I
manic episodes with or without depression, only requires one episode of mania
bereavement
not a DSMV diagnosis
highest genetic link of psychiatric disorders
bipolar I
rapid cycling
4 or more mood episodes in 1 year
lithium in bipolar
reduces suicide risk
drugs useful for rapid cycling
carbamazepine and valproic acid
avoid _____ in mania
antidepressants
bipolar II
one or more depressive episode with at least one hypomanic episode
treatment for mania in pregnancy
ECT
dysthymia
persistent depressive disorder - for at least 2 years
- not without symptoms for greater than 2 months
cyclothymia
alternating periods of hypomania and periods with mild to moderate depressive symptoms
disruptive mood dysregulation disorder
chronic, severe, persistent irritability occurring in childhood and adolescence
most common psychopathology
anxiety
psychopathology with SOD
social and or occupational dysfunction
anxiety bridge med
benzos
Bs to block the Ps
beta blockers for panic attacks and performance anxiety
PRN anxiety use….
non addictive diphenhydramine or hydroxazine
buspirone
5-HT agonist, anxiolytic, not efficacious
risk factor for panic attacks
smoking
SSRI in panic disorders
start slowly because meds can worsen anxiety at first
social phobia
fear of scrutiny by others or fear of acting in a humiliating or embarrassing way
most common psychiatric disorder by gender
women = phobias men = substances
obsessions and compulsions
obsessions = recurrent, intrusive undesired thoughts that increase anxiety compulsions = repetitive behaviors or mental rituals
most serotonin selective TCA
clomipramine
trichotillomania
hair pulling risorder
acute stress vs PTSD
PTSD = greater than 1 month and trauma at any time, stress = less than 1 month
adjustment disorder
within 3 months of event and resolve within 6
cognitive processing
CBT where thoughts, feelings and meanings of event are revisited and questioned
paranoid personality disorder
- pervasive distrust and suspiciousness of others
- blame own problems on others, angry and hostile
- jealous and cheating
schizoid personality
social withdrawal, eccentric and reclusive
- prefer to be alone, no desire for close relationship
schizotypal personality
eccentric behavior, peculiar thought patterns, strange and odd
- seen in families with schizophrenia
antisocial personality
exploitie of others, lack empathy, compassion and remorse, impulsive deceitful and break law
antisocial differential
can be caused by drug abuse
borderline personality
unstable moods, behaviors and interpersonal relationships, poorly formed identity, intense attachment, agression is common
splitting seen in…
borderline
drugs most useful in what personality disorder
borderline
histrionic personality
attention seeking, emotional, dramtic, flamboyant and extroverted
electrolyte abnormality in alcohol withdrawal
hypomagnesium, should be corrected early
natrexone
opioid receptor blocker, decreases cravings and high
acamprosate
modulate glutamate transmission
- started post detox
- used in liver, not renal disease
disulfiram
blocks aldehyde dehydrogenase, causing averse reactions
topiramate
potentiates GABA and inhibits glutamate
lab effects of alcohol
macrocytosis and high LFTs
Wernickes
ataxia, confusion, ocular abnormalities, nystagmus, gaze palsies
Korsakoff
chronic amnesitc syndrome
cocaine hallucinations
tactile
deadly side of cocaine
vasoconstrictive MI, intracranial hemorrhage or stroke
danger in MDMA
serotonin syndrome with SSRI
PCP MOA
antagonize NMDA glutamate receptors
rotary nystagmus =
PCP intoxication
GHB
commonly date rape drug along with ketamine
drug withdrawal with highest mortality rate
barbituates
sedatives detox
sodium bicarb with barbituates
flumazenil with benzos
opioid use disorder treatments
- methadone - long acting opioid agonist, once daily, can cause Qtc
- buprenorphine - partial opioid agonist, sublingual, plateau, comes as suboxone (with naloxone)
- naltrexone - competitive antagonist, compliance is issue
caffeine MOA
adenosine antagonist causing increase in cAMP release
delirium is a disorder of…
attention and awareness (like acute brain failure)
three types of deliurm
- mixed - most common
- hypoactive - undetected
- hyperactive - in withdrawal
medications avoided in delirium
benzos, unless due to alcohol or benzo withdrawal
MMSE
sensitive for major neurocognitive disease if score is less than 25
testing attention
serial 7s
long half life anti depressant
fluoxitine
antipsychotics and dementia
carry black box warning for early death
stepwise loss of function
vascular dementia
domains affected in small vessel disease
complex attention and executive funciton
visual hallucinations and EPS
Lewy body dementia
core features of Lewy body
- waxing and waning of cognition in areas of attention and alertness
- visual hallucinations
- EPS
suggestive features of Lewy body
- REM sleep behavior disorder
2 pronouced antipsycotic sensitivity
movement problems in huntingtons
chorea and bradkinesia
rapidly progressive cognitive decline and myoclonus
creutzfeldt-Jakob disease
pseudodementia
the appearence of being demented in an elederly depressed patient
MCD vs pseudodementia when asked a question
MCD confabulate, depression says they dont know
sundowning
confusion at night, common in dementia
visual hallucination in early dementia suggest….
Lewy body
global developmental delay is for patient under…
5
comorbid ADHD disorders
ODD, conduct, learning disability
coprolalia
obscene taboo words as an brupt sharp bark or grunt
first choice for tourettes
alpha 2 agonists guanfacine and lconidine
treatment for enuresis
alarm then desmopressin or imipramine
abreaction
strong emotional reaction patients may experience when retrieving traumatic memories
depersonalization vs derealization
person = separation for oneself real = separation from outside surroundings
procedural memory
knowing how to do things, preserved in deissociative amnesia
dissociative identity disorder
more than one distinct personality
depersonalization vs derealization disorder
not feeling like yourself “out of body” or feeling like you are in a dream
somatic symptom disorder
one or mor symptoms, distressing and disrupting, exessive thoughts about for at least 6 months
conversion disorder
neuro symptom that cant be epxlained, clam and unconcerned
illness anxiety
concern over aquiring an illness
brain association with intermittent explosive disorder
low levels or serotonin in CSF
types of anorexia
- restricting - acheived through diet, fasting and exercise
2. binging/purging - binges followed by vomiting
anorexia vs bullemia
anorexia = very low weight, bullemia = normal weight
only medication approved for bullemia
fluoxetine
akathasia is treated with…
propranolol
