High Yield Topics-Psychiatry Flashcards
Characterized by fear, anxiety, or avoidance of separation from major attachment figures; beyond the age-appropriate range; often a precursor to school refusal behavior (false physical complaints)
Separation anxiety disorder
Separation anxiety is, to some extent, developmentally appropriate for children between what age group
< 4 years
Time of duration needed to be diagnosed for shizophrenia
> 6 months
Time of duration needed to be diagnosed for shizophreniform
> 1 month but < 6 months
Time of duration needed to be diagnosed for brief psychotic disorder; usually develops after stressful life-events.
< 1 month
The major difference b/w schizophrenia vs. schizoaffective disorder
In schizoaffective disorder, mood symptoms can be the majority of the illness as a prominent feature in addition to psychotic symptoms. In schizophrenia, mood symptoms are NOT the dominant feature.
Time of duration needed to be diagnosed for schizoaffective disorder
> 2 weeks
A disorder with psychotic symptoms that appear exclusively during manic or depressive episodes
Mood disorder with psychotic features
A disorder with only delusion (false belief) without any other psychotic symptoms
Delusional disorder
Time of duration needed to be diagnosed for Delusional disorder
> 1 month
Time of duration needed to be diagnosed for major depressive disorder
at least 2 weeks
Time of duration needed to be diagnosed for Persistent depressive disorder (dysthymia)
at least 2 years
Manic episodes with or without major depressive episodes
Bipolar I disorder
Hypomanic episodes + major depressive episodes
Bipolar II disorder
Persistent instability of mood involving numerous periods of depression and periods of hypomania
Cyclothymia
Time of duration needed to be diagnosed for Bipolar I disorder
Manic episode lasting ≥ 1 week
Time of duration needed to be diagnosed for Bipolar II disorder
Hypomanic episode lasting ≥ 4 consecutive days + Major depressive episode for at least 2 weeks
Time of duration needed to be diagnosed for Cyclothymia
≥ 2 years
distressing symptoms related to a specific traumatic event and lasting > 1 month following the event
Post-traumatic stress disorder (PTSD)
distressing symptoms related to the traumatic event that last between 3 days to 1 month following the exposure
Acute stress disorder
a maladaptive emotional (anxiety) or behavioral (outburst) response to a stressor, symptoms lasting ≤ 6 months following resolution of the stressor;
Adjustment disorder
pronounced fear or anxiety of being in situations that are perceived as difficult to escape from
Agoraphobia
recurrent spontaneous and unexpected panic attacks that often occur without a known trigger
Panic disorder
Which generation of antipsychotics blocks only positive symptoms of schizophrenia by blocking dopamine receptors
First generation (typical)
Which generation of antipsychotics blocks both dopamine (positive symptoms) and serotonin (negative symptoms) receptors
Second generation (atypical)
Which generation of antipsychotics is used for long term treatment of schizophrenia
Second generation (atypical)
Common endings of second generation (atypical) antipsychotics
- Know them cold!!!
- zapine/pine
- sidone/ridone
- prazole
Mnemonic for second generation (atypical) antipsychotics
CROZAQ
- clozapine
- risperidone
- olanzapine
- ziprasidone
- aripipirazole
- quetiapine
Side effects of second generation (atypical) antipsychotics
Weight gain/metabolic syndrome, EPS (akathisia, dystonia, parkinsonism, and tardive dyskinesia), and prolonged QTc
degrades biogenic amine neurotransmitters (eg, serotonin, dopamine, norepinephrine, epinephrine)
Monoamine oxidase
inhibit the enzymatic activity of monoamine oxidase and thereby increase the synaptic concentrations of these neurotransmitters
Monoamine oxidase inhibitors (MAOIs)
MAOIs are effective for depression and anxiety but are typically used only after other agents have failed because of the risk for what serious adverse effects?
- Hypertensive crisis
- MAOIs decrease peripheral degradation of tyramine (which normally gets degraded by MAO) –> hypertensive crisis can result from tyramine displacing stored monoamines such as dopamine, norepinephrine, and epinephrine from synaptic vesicles - Serotonin syndrome
- Combining MAOIs with other serotonergic agents increases the risk for serotonin syndrome
a cluster A personality disorder that features odd or magical thinking, perceptual disturbances, social isolation (because of mistrust of others), and a constricted affect.
Schizotypal personality disorder
- Know this cold!!
a cluster A personality disorder that manifests with social indifference, social isolation, and a decreased range of emotions
Schizoid personality disorder
- Know this cold!!
the patient is preoccupied with one or more somatic symptoms such that these symptoms disrupt the patient’s daily life
somatoform disorder (aka. somatic symptom disorder)
Act by binding to the allosteric site of GABA receptor –> results in Cl- channel opening and influx of chloride ions into the neurons –> Neuronal hyperpolarization and inhibition of the action potential
Benzodiazepines
Flat affect (ie, reduced emotional expressiveness), decreased attention to personal hygiene, and thought blocking (ie, sudden inability to finish a thought) are findings typical of
schizophrenia
Low self-esteem, psychomotor slowing (ie, slow speech and movements), and social withdrawal are findings typical of
major depressive episode
pressured speech, racing thoughts, and grandiosity are findings typical of
Manic episodes (bipolar disorder)
Intoxication of (stimulant/depressants) present with nonspecific symptoms such as mood elevation, decreased anxiety, sedation, behavioral disinhibition, respiratory depression
depressants
- Alcohol
Opioids (morphine, heroine, methadone)
Barbiturates
Benzodiazepines
Withdrawal of (stimulant/depressants) present with nonspecific symptoms such as anxiety, tremor, seizures, insomnia
depressants
- Alcohol
Opioids (morphine, heroine, methadone)
Barbiturates
Benzodiazepines
Intoxication of ____ presents with emotional lability (changes), Slurred speech, Ataxia, blackouts
Alcohol
What is the sensitive serum indictor of alcohol use?
Increased GGT (y-glutamyltransferase)
What LFT is indicative of alcohol use?
AST: ALT is 2:1 ratio
Withdrawal of ____ presents with
- anxiety, diaphoresis/agitation, tremor, GI upset
- withdrawal seizure
- Hallucinations
- Delirium tremens (tremor)
alcohol
Tx for alcohol withdrawal symptoms including delirium tremens
Benzodiazepines
Long-term tx for alcoholism that reduces cravings
Naltrexone or Acamprosate
Long-term tx for alcoholism that acts as a deterrent by producing unpleasant/negative symptoms when used with alcohol
Disulfiram
Delirium tremens is characterized by electrolyte disturbances and respiratory
alkalosis
- Hyperventilation causes increased loss of PaCO2
Tachycardia, tremors, anxiety, seizures of delirium tremens is characterized by autonomic
hyperactivity
Delirium tremens usually occurs in what setting?
Hospital
*since patient cannot drink when hospitalized
Intoxication of ____ presents with Euphoria, respiratory / CNS depression, Decreased gag reflex, Miosis
Opioids
Withdrawal of ____ presents with seizure, Sweating, Mydriasis, Piloerection, yawning, lacrimation + flu-like symptoms (diarrhea, stomach cramps, nausea)
Opioids
Tx for opioid overdose
Naloxone
a long-acting oral “opiate” used for opioid detoxification or long-term maintenance therapy
Methadone
a long-acting opioid “antagonist” used for relapse prevention once detoxified from opiates
Naltrexone
What mu opioid antagonist must be given parenterally (other than orally) to avoid inactivation by 1st pass metabolism through mouth
Naloxone
What drug intoxication presents as respiratory and CNS depression, pinpoint pupils and decreased gag reflex?
Opioids
What drug combination may be used for maintenance therapy following opioid detoxification?
Buprenorphine (opioid partial agonist) + naloxone
- naloxone is added to lower IV abuse potential
What drug class is the most common cause of drug overdose death?
Opioids
Opioid withdrawal presents with pupillary
Mydriasis (dilation)
Opioid intoxication presents with pupillary
Miosis (constriction)
Intoxication of ____ presents with marked respiratory depression
Barbiturates
Withdrawal of ____ presents with delirium and life-threatening cardiovascular collapse
Barbiturates
Intoxication of ____ presents with ataxia
minor respiratory depression
Benzodiazepines
Withdrawal of ____ presents with Sleep disturbance and depression
Benzodiazepines
Tx for Benzodiazepines overdose
Flumazenil
MOA of Flumazenil
Benzodiazepine receptor antagonist
Why is flumazenil rarely used to treat Benzodiazepines overdose
b/c it can cause seizure
Intoxication of (stimulant/depressants) present with nonspecific symptoms such as euphoria, insomnia, arrhythmias, tachycardia, anxiety
stimulants
*amphetamines, cocaine, caffeine, nicotine
Withdrawal of (stimulant/depressants) present with nonspecific symptoms such as depression, lethargy, post-use crash, vivid nightmares
stimulants
*amphetamines, cocaine, caffeine, nicotine
Intoxication of ____ presents with grandiosity, mydriasis, hyperalertness, HTN
Amphetamines
Withdrawal of ____ presents with depression, lethargy, post-use crash, vivid nightmares
Amphetamines
What skin finding can be found with Amphetamines overdose?
skin excoriations (rash and ulcers)
- Methamphetamine especially!
Tx for Amphetamine overdose agitation and seizure
Benzodiazepines
Intoxication of ____ presents with palpitation, agitation, tremor, insomnia
Caffeine
Withdrawal of ____ presents with HA, can’t concentrate
Caffeine
Intoxication of ____ presents with impaired judgment, pupillary dilation, hallucinations, paranoid ideations, angina, sudden cardiac death
Cocaine
Withdrawal of ____ presents with psychomotor retardation, depression, lethargy
Cocaine
What unique finding is associated with chronic use of cocaine?
- HINT: sniffing
perforated nasal septum
- caused by vasoconstriction –> ischemic necrosis –> perforation
Tx for Cocaine overdose
- Benzodiazepines
- mixed a/B blocker (labetalol)
Intoxication of ____ presents with restlessness
nicotine
Withdrawal of ____ presents with increased appetite
Irritability
Anxiety
Can’t concentrate
nicotine
Tx for nicotine withdrawal that inhibits BOTH NE and D2 reuptake
bupropion
What antidepressant can also be used as a tx for smoking cessation and has low risk of ED as an adverse effect?
bupropion
Tx for nicotine withdrawal that acts as a nicotinic receptor PARTIAL AGONIST
varenicline
- STUDY AID: sketchypharm (very clean)
Intoxication of ____ presents with perceptual distortion (visual, auditory), depersonalization, “flashbacks”
- HINT: think about the drug’s “colorful” stickers!
LSD (Lysergic Acid Diethylamide)
What category of drugs present similar to stimulant overdose + hallucinations when intoxicated?
Hallucinogens
- LSD, Marijauna, MDMA, PCP
Intoxication of ____ presents with conjunctival injection (red eyes), euphoria, perception of slowed time, social withdrawal, increased appetite, dry mouth, hallucinations
Marijauna
Withdrawal of ____ presents with irritability, depression, decreased appetitie
Marijauna
Intoxication of ____ presents with hallucinations, increased thirst, bruxism, HTN, tachycardia, and hyperthermia.
MDMA (methylenedioxy-methylamphetamine)
aka. Ecstasy
MDMA overdose can present with what life-threatening effect by activating serotonin receptors?
Serotonin syndrome
MDMA is aka.
Ecstasy
Bruxism is aka.
teeth grinding
Withdrawal of ____ presents with depression, can’t concentrate
MDMA
Intoxication of ____ presents with violence, impulsivity, analgesia (can’t feel pain), nystagmus, and psychosis
Phencyclidine (PCP)
- violent and dangerous!
What is the most common complication of Phencyclidine (PCP) overdose?
Trauma (b/c of its violence, impulsivity, analgesia adverse effects)
What condition presents with a triad of encephalopathy (confusion), ophthalmoplegia, and ataxia?
Wernicke Encephalopathy
What condition presents with irreversible retrograde and anterograde memory loss, personality change, and confabulation?
Korsakoff syndrome
Tx for Wernicke0Korsakoff syndrome
IV B1 (thiamine) BEFORE dextrose!
Caused by any drug that ↑ 5-HT, leading to ↑ neuromuscular activity (hyperreflexia, hypertonia, seizure), autonomic instability (diarrhea, diaphoresis, hyperthemia), and altered mental status
Serotonin syndrome
In order to avoid Serotonin syndrome, what is required after discontinuing a MAOI and before initiating SSRI therapy?
2 week washout period to allow time for monoamine oxidase (MAO) regeneration
Tx for serotonin syndrome
Cyproheptadine (5-HT receptor antagonist)
