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Psych > Mood, Anxiety, and Personality Disorders > Flashcards

Mood, Anxiety, and Personality Disorders Flashcards

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1
Q

What is the goal of treatment of psychodynamic psychotherapy?

A

to “make the unconscious conscious” resulting in resolution of conflicts and greater personal insight

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2
Q

What is the central technique of psychodynamic psychotherapy?

A

the therapist does not give advice and focuses on patient introspection and analysis through transference

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3
Q

What is displacement?

A

redirecting upsetting feelings about one person/situation onto another safer person/situation

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4
Q

What is the role of norepinephrine in anxiety?

A

poorly regulated noradrenergic system leads to anxiety

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5
Q

What non-psychiatric medical conditions are treated with antidepressants?

A

IBS, enuresis, chronic pain, fibromyalgia, migraines

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6
Q

What are the indications for cognitive behavioral therapy?

A

anxiety disorders, insonia, chronic pain

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7
Q

What is the half life of lithium? When are peak levels reached?

A

half life: 24 hours

peak levels: 1-2 hours

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8
Q

What is reaction formation?

A

converting unwanted or dangerous thoughts into their opposites

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9
Q

What are the general characteristics of schizotypal personality disorder?

A

acute discomfort in close relationships

cognitive or perceptual distortions

eccentricities of behavior

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10
Q

What are the nonpharmacological therapeutic interventions for mood disorders?

A

chronic disease management

sleep/circadian manipulation

social rhythms therapy

phototherapy

exercise

psychotherapies

neuromodulation

support groups

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11
Q

What brain activity changes are associated with major depressive disorder?

A

decreased activity in left prefrontal cortex

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12
Q

What birth defect is associated with maternal lithium use?

A

Ebstein’s anomaly

still a low risk overall, but higher than in the general population

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13
Q

What is the dosing of lithium?

A

1-3 times per day

extend release formulation can be taken once per day

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14
Q

Describe serotonin synthesis.

A

synthesized in the brain

made from the dietary amino acid tryptophan

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15
Q

Which personality disorders can and cannot be diagnosed in adolescents?

A

all can except antisocial personality disorder

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16
Q

How should you assess if a patient is at risk of suicide?

A

ask them directly

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17
Q

What are the diagnostic criteria for panic attacks?

A

four or more of the following symptoms for at least 10 minutes:

palpitations

trembling

sensation of choking

abdominal distress

derealization or depersonalization

fear of dying

chills or hot flashes

sweating

sensation of SOB

chest pain

dizziness

fear of losing control

parasthesias

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18
Q

What is the prognosis for someone with OCD? Social phobia?

A

both are treatable and chronic

social phobia has a better prognosis

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19
Q

What other disruptions are associated with bipolar disorders?

A

circadian disruption

neurocognitive impairment

can have psychosis

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20
Q

What risks of birth defects are associated with valproic acid?

A

contraindicated

increased risk of neural tube defects, lower IQ, autism

if pregnant, requires high doses of folic acid

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21
Q

What factors should play a role in selection of a first line antidepressant?

A

side effect profile, past responses to treatment, comorbid medical/psychiatric problems

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22
Q

What are the risks of not treating peripartum depression?

A

preterm labor

small or gestational age

impaired bonding

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23
Q

What is somatization?

A

turning an unacceptable feeling into a physical symptom

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24
Q

What are protective factors for suicide?

A

social support, access to and engagement with treatment, personal sense of family responsibility, religious or cultural sanctions against suicide, good insight, skills in problem-solving and dispute resolution

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25
Q

What is dissociation?

A

when a person loses track of self in terms of reality and instead develops an alternative representation of self

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26
Q

What is the mechanism of action of lithium?

A

mechanism is still unclear

works through second-messenger signal transduction systems

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27
Q

What are the DSM-5 criteria for major depressive episodes?

A

five or more depressive symptoms (SIGECAPS) for a 2 week period

symptoms cause significant distress or impairment in social, occupational, or other areas of functioning

symptoms that are not attributable to physiological effects of a substance or other medical condition

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28
Q

Which of these neurotransmitters is not a monoamine?

a) serotonin (5HT)
b) acetylcholine
c) norepinephrine
d) dopamine

A

b) acetylcholine

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29
Q

What drug interactions are associated with carbamazepine?

A

inducer of hepatic enzymes

decreases levels of other medications (COCs, warfarin, anticonvulsants)

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30
Q

Which age groups are at highest risk of suicide?

A

women: ages 45-64
men: age 75+

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31
Q

What is the underlying theory of psychodynamic psychotherapy?

A

problematic thoughts, feelings, and behaviors stem from unresolved childhood conflicts

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32
Q

What are the general treatment uses for mood stabilizers?

A

treatment of manic/hypomanic episodes

treatment of depressive episodes

prevention of manic and depressive episodes

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33
Q

What are the indications for deep brain stimulation?

A

mostly for Parkinson’s disease

can also possibly be used for depression or OCD

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34
Q

What risks of birth defects are associated with maternal lithium use?

A

increased risk for Ebstein’s anomaly, but not substantially more than general population

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35
Q

What are the general characteristics of obsessive compulsive personality disorder? How is it different from obsessive compulsive disorder?

A

preoccupation with orderliness, perfectionistic, controlling

different from OCD because patients with OCPD think these traits are positive and not a problem (egosyntotic)

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36
Q

What pregnancy risks are associated with SSRIs/SNRIs?

A

no increased risk of congenital malformations

increased risk of preterm labor, but not compared to untreated depression

no association with autism

slower initial milestones, but catches up

neonatal adaptation syndrome

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37
Q

What are examples of mature (adaptive) defense mechanisms?

A

suppression - consciously putting aside unpleasant feelings

humor - expression of otherwise unacceptable feelings/ideas into acceptable ones

altruism - unselfishly helping others in order to avoid negative personal feelings

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38
Q

What is the activity level of the locus ceruleus in anxiety states?

A

hyperactive in anxiety states

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39
Q

What are the diagnostic criteria for depression with atypical features?

A

A) mood reactivity (fleeting positive affect)

B) two or more of the following:

  • weight gain or increase in appetite
  • hypersomnia
  • leaden paralysis
  • long standing pattern of interpersonal rejection sensitivity
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40
Q

What is splitting?

A

believing one situation or person is “all good” or “all bad” and holds the opposite view about someone/something else

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41
Q

What is the differential diagnosis in people with panic symptoms?

A

hyperthyroidism, pheochromocytoma, caffiene intoxication, amphetamines/cocaine intoxication, cardiac or respiratory conditions, neurologic conditions

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42
Q

What are the most common mental health diagnoses of pregnancy/peripartum period?

A

MDD, GAD, OCD, panic disorder, bipolar disorder

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43
Q

Which of the following conditions should NOT be treated with antidepressant monotherapy?

a) bipolar disorder
b) major depressive disorder
c) posttraumatic stress disorder
d) panic disorder
e) generalized anxiety disorder

A

a) bipolar disorder

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44
Q

What are the general characteristics of dependent personality disorder?

A

submissive, clinging behavior, excessive need to be cared for

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45
Q

What are the major modifiable and unmodifiable risk factors for suicide?

A

unmodifiable: prior attempt (biggest), family history, history of impulsivity or aggression, recent loss, cultural/religious beliefs
modifiable: mental illness (biggest), physical illness, isolation, hopelessness, barriers to care, access to lethal means, local “epidemics”

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46
Q

How long does it take for antidepressants to be maximally effective?

A

3-8 weeks

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47
Q

What are side effects of valproic acid?

A

GI side effects

sedation, tremor, ataxia, alopecia

increased PCOS risk

hepatotoxicity, pancreatitis, thrombocytopenia (rare but dangerous)

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48
Q

What are the general characteristics of paranoid personality disorder?

A

distrust and suspiciousness of others

interpretation of motives of others as malevolent

pervasively applied, not just to specific individuals/situations

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49
Q

What is the mechanism and side effects of trazodone?

A

mechanism: inhibits serotonin reuptake, blocks 5HT2 and alpha-1

side effects: sedation, headache, priapism

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50
Q

What imaging findings are associated with major depressive disorder?

A

inconsistent

some findings show volume reduction in basal ganglia, hippocampus, and frontal cortex

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51
Q

What are the indications for electroconvulsive therapy?

A

used to treat severe, treatment-resistant depression

can also be used for bipolar disorder or schizophrenia

gold standard treatment for catatonia

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52
Q

What is the utility of lamotrigine as a mood stabilizer?

A

used for maintenance treatment of bipolar disorder

also used for management of bipolar depression

not effective for acute mania

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53
Q

What are the general characteristics of schizoid personality disorder? How is it distinguished from autism spectrum disorder?

A

pattern of detachment from social relationships and restricted range of emotional expression

differs from ASD bc ASD also includes restricted/repetitive interests/behaviors

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54
Q

What are the general characteristics of borderline personality disorder?

A

instability in personal relationships and self image

affective lability

marked impulsivity

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55
Q

What is the risk of recurrence of depression?

A

increases with each episode

50% after first episode, rises to 80-90% after second episode

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56
Q

What is dialectical behavioral therapy?

A

a form of therapy that focuses on balancing of strong/opposing emotions and helping patients manage them

combination of CBT and mindfulness

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57
Q

What are the side effects of transcranial magnetic stimulation?

A

discomfort at the site of the magnet, muscle tingling, headache, lightheadedness, rare seizures

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58
Q

What are the symptoms of paranoid personality disorder?

A

SUSPECT

4/7 needed for diagnosis

Spouse infidelity suspected

Unforgiving (bears grudges)

Suspicious of others

Perceives attacks (and reacts quickly)

Enemy or friend (suspects associates/friends of being enemies)

Confiding in others is feared

Threats perceived in benign events

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59
Q

What are the major drug interactions for valproic acid?

A

interacts with other protein-bound medications (warfarin, other anticonvulsants)

also increases levels of other drugs metabolized by hepatic enzymes (decreases their dose)

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60
Q

What are the most common reasons for antidepressant treatment resistant disorders?

A

non-therapeutical trial (too low dose, too little time)

non-compliance

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61
Q

What is the mechanism and side effects of mirtazapine?

A

alpha2-adrenergic receptor antagonist –> increases NE and 5HT

side effects: sedation, weight gain, dizziness, dry mouth, constipation

no sexual dysfunction, lower risk of switch to mania,

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62
Q

What are the general characteristics of histrionic personality disorder?

A

excessive emotionality and attention seeking behavior

historically rooted in sexism

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63
Q

What are the symptoms of schizotypal personality disorder?

A

ME PECULIAR

5/9 required for diagnosis

Magical thinking or odd beliefs

Experiences unusual perceptions

Paranoid ideation

Eccentric behavior or appearance

Constricted (or inappropriate) affect

Unusual (odd) thinking/speech

Lacks close friends

Ideas of reference

Anxiety in social situations

Rule out psychotic disorders and pervasive development disorders

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64
Q

What is the main difference between a diagnosis of Bipolar I and Bipolar II?

A

Bipolar I = manic episodes

Bipolar II = hypomanic episodes

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65
Q

What is parasuicidal behavior?

A

behavior that may not be just a failed true attempt and may be a gesture used in an effort to solve interpersonal crises or communicate dysphoric affect

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66
Q

What are the three clusters of personality disorders?

A

Cluster A: “odd” group

Cluster B: “erratic” group

Cluster C: “anxious” group

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67
Q

What is denial?

A

refusing to accept an idea as if the painful thought or action does not exist

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68
Q

How does generalized anxiety disorder differ from panic disorder?

A

characterized with chronic worry rather than attacks, typically less disabling but can be more difficult to treat

generalized anxiety overlaps more with depression than panic disorder

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69
Q

What is the main utility of fluvoxamine?

A

OCD

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70
Q

What is the psychoanalytic theory of anxiety?

A

anxiety is a signal of danger/conflict in the unconscious in situations of incomplete repression

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71
Q

What antidepressants are used for ADHD?

A

buproprion

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72
Q

Which diagnosable mental illnesses increase risk of completed suicide?

A

depression

alcohol use disorder

personality disorders

psychotic disorders

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73
Q

What antidepressants are used for insomnia?

A

mirtazepine, trazodone, TCAs

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74
Q

What is regression?

A

reversion to an earlier, safer environment

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75
Q

Which of the following best describes bipolar disorder in contrast to unipolar major depressive disorder:

a) bipolar disorders are less likely to respond adversely to sleep deprivation
b) bipolar disorders have an earlier age of onset
c) bipolar disorders are less likely to be psychotic
d) bipolar disorders are more likely to have a positive response to antidepressant medications
e) bipolar disorder has less concordance between monozygotic twins than is seen for major depressive disorder

A

b) bipolar disorders have an earlier age of onset

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76
Q

What is the “black box warning” on antidepressants?

A

increased risk of suicidal thinking and behavior, but less so than untreated depression/psychiatric disorders

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77
Q

What is acting out?

A

using extreme behavior to express otherwise unacceptable feelings

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78
Q

What is the typical course of bipolar disorder?

A

onset usually adolescence or early adulthood

episode frequency increasing over time

can be associated with atypical depression

can be rapid cycling (4 or more episodes per year)

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79
Q

What mood descriptors are associated with depressive episodes?

A

depressed, sad, despondent, “empty” or “blue”

can also include anxiety, irritability, and lack of interest in pleasurable activities

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80
Q

What moods, behaviors, and cognitions are associated with mania?

A

mood: expansive, euphoric, grandiose, irritable, hostile
behavior: decreased need/capacity for sleep, extravagance, agitation, impulsivity, high pursuit of pleasurable activities, pressured speech, loud
cognition: racing thoughts, distractibility, poor judgement, possible delusions, hallucinations

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81
Q

What is intellectualization?

A

overemphasis on intellectual understandings rather than acknowledging emotional reactions

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82
Q

What is the heritability of bipolar I disorder?

A

complex - genes and environments

increased likelihood of development if close relatives had it

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83
Q

Which is not a symptom of hypomania:

a) excessive sleeping
b) increase in goal directed behaviors
c) overactive thoughts
d) irritable mood
e) distractibility

A

a) excessive sleeping

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84
Q

What are the general characteristics of avoidant personality disorder?

A

social inhibition, feelings of inadquacy, hypersensitivity to negative evaluation

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85
Q

What are the main drug interactions with lithium?

A

many drugs can increase serum lithium levels

NSAIDS, diuretics, ACE inhibitors, calcium channel blockers

some antibiotics can decrease serum lithium levels

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86
Q

What considerations are important for psychiatric medication prescription during pregnancy?

A

medications cross placenta and fetal blood brain barrier

can also transfer to breast milk

hepatic metabolism can change during pregnancy

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87
Q

What are public health suicide prevention strategies?

A

reduce access to common lethal means (ex. firearms)

media guidelines to prevent contagion

improve access to care

promote social connectedness

improve economic opportunity

88
Q

What is the difference between carbamazepine and oxcarbazepine?

A

oxcarbazepine is less well studied for bipolar and has fewer drug interactions, but is overall very similar

89
Q

What is the role of cortisol in depression?

A

persistent hypercortisolemia may predict relapse (possibly related to hippocampal atrophy)

hypocortisolemia associated with atypical depression

90
Q

What are the diagnostic criteria for depression with melancholic features?

A

either of the following during the most severe period of the current depressive episode: loss of pleasure in all/most activities, loss of reactivity to usually pleasurable stimuli

+

three or more of the following:

  • distinct quality of depressed mood (despondency, despair, moroseness)
  • depression regularly worse in the morning
  • early morning wakening
  • marked phychomotor changes
  • significant anorexia/weight loss
  • excessive or inappropriate guilt
91
Q

What are the DSM-5 criteria for manic episodes?

A

A) at least 1 week of abnormally and persistently elevated expansive or irritable mood and persistently elevated activity/energy

B) 3 or more symptoms of mania during this period (DIGFAST)

C) symptoms cause marked impairment in functioning

D) symptoms not attributable to physiological effects of a substance or other medical condition

92
Q

All of the following have been described in association with major depression disorder except:

a) decreased activity in the right prefrontal cortex
b) blunted TSH response to TRH
c) short allele of serotonin transport protein
d) volume reduction in hippocampus
e) decreased BDNF

A

a) decreased activity in the right prefrontal cortex

93
Q

What is supportive therapy? crisis therapy?

A

both are short-term therapy aimed at shoring up patient’s coping techniques

supportive = therapy for lower functioning individuals

crisis = therapy to intervene in crisis situations

94
Q

What conditions are commonly comorbid with highly recurrent mood disorders (MDD or BP)?

A

alcohol/substance abuse

OCD and anxiety disorders

other medical illnesses

95
Q

What are common side effects of carbamazepine?

A

weight gain, sedation, ataxia, rash (can become SJS)

agranulocytosis and aplastic anemia

hepatitis, hyponatremia/SIADH, SJS-TEN

96
Q

What are the clinical uses of lithium?

A

treatment of manic episodes

maintenance of bipolar disorder

bipolar depression

  • mania efficacy > depression efficacy*
  • decreases risk of suicide*
97
Q

What disorders are in cluster B (“erratic” cluster) of personality disorders?

A

antisocial, narcissistic, histrionic, borderline

98
Q

What does exposure and response prevention aim to do for patients diagnosed with specific phobias?

A

to decrease or abolish maladaptive behavior in response to excessive fears (typically avoidance)

99
Q

What is the stress-diathesis model of depressive episodes?

A

a model for depression where the first episodes are often associated with stressors (ex. loss or separation) and then subsequent episodes are less clearly associated with stressors

100
Q

What classes of drugs are venlafaxine, desvenlafaxine, and duloxetine?

A

SNRIs

101
Q

What are the indications for transcranial magnetic stimulation?

A

treatment for treatment resistant major depression

102
Q

What is rationalization?

A

providing a different explanation for an event because the actual reason is threatening

103
Q

What is the utility of carbamazepine as a mood stabilizer?

A

treats acute mood episodes and for maintenance

may be more effective for treating manic and mixed episodes than depressive episodes

104
Q

What are examples of cognitive distortions?

A

all-or-nothing thinking - seeing things in absolutes

overgeneralization - drawing conlusions from one experience to all

mental filters - dwelling on a single event

labeling - labeling self as if it is a fact

should statements - how you think you should be

fortune telling - thinking you cna predict the future

catastrophizing/minimizing - blowing out of proportion

personalizing - thinking things are about you

emotional reasoning - jumping to conclusions based on emotion

the comparison game - comparing to others

105
Q

What factors are associated with risk of relapse/recurrence of depression?

A

greater with (+) family history

greater with incomplete treatment response

greater with neuroticism (nervousness personality trait)

greater with hypercortisolemia

106
Q

Describe monoamine release and ruptake in the synapse?

A

released into the synapse

released NTs signal to the presynaptic neuron to not release more NTs and bind to plasma membrane transport proteins to be taken back up into the nerve terminal

107
Q

What is idealization?

A

denying the negative aspects of a situation because holding complex feelings is threatening

108
Q

What is the utility of antipsychotics as mood stabilizers?

A

haloperidol and chlorpromazine manage agitation and psycosis in manic episodes acutely

second-generation antipsychotics have mood stabilizing properties

109
Q

What are the gender differences in suicides?

A

women 3x more likely to attempt

men 4x more likely to die

110
Q

What are common features of all SSRIs?

A

selectively block 5-HT transporter (but can have different effects at other receptors)

once daily dosing

very low toxicity

111
Q

What classes of antidepressants are used for social anxiety?

A

SSRIs, SNRIs, MAO-Is

112
Q

What is the role of serotonin in anxiety? Dopamine? GABA?

A

serotonin - decreases associated with anxiety

dopamine - increases associated with anxiety

GABA - decreases associated with CNS hyperactivity

113
Q

Which of the following is a core symptom of atypical depression?

a) expansiveness
b) hypersomnolence
c) loss of appetite
d) anhedonia
e) thought racing

A

b) hypersomnolence

114
Q

What are the unique characteristics of sertraline?

A

higher risk of GI side effects

preferred agent in pregnancy

115
Q

What are the mechanisms, indications, and side effects of SNRIs?

A

increases 5HT and NE

helpful for neuropathic pain and depression

risk of hypertension at high doses

116
Q

What are the neuroanatomic/neurocircuitry components of bipolar pathogensis?

A

neuroanatomic reductions

hypoactive prefrontal cortex, hyperactive anterior cingulate and subcortical structures

117
Q

What monitoring tests should be done with valproic acid treatment?

A

liver function tests, CBCs checked regularly

serum levels monitored

118
Q

What antidepressants are used for bulemia?

A

SSRIs

119
Q

When does anxiety become pathologic?

A

when it causes functional impairment and/or clinically significant distress

120
Q

What are the main side effects of lamotrigine?

A

few side effects generally well tolerated

can cause a benign hypersensitivity rash that can evolve into stevens-johnson syndrome and toxic epidermal necrolysis (can be fatal)

121
Q

Which monoamine neurotransmitters are synthesized from tyrosine?

A

catecholamines (dopamine and norepinephrine)

122
Q

A 65-year old banker jumps to his death after an economic crisis and wipes out his entire family fortune. According to Durkheim, what type of suicide has he committed?

a) egotistical
b) altruistic
c) anomic
d) fatalistic

A

c) anomic

123
Q

What is the utility of valproic acid for mood stabilization?

A

effective at treating acute mania and as a maintenance treatment

more effective than lithium for mixed episodes and rapid cycling

works more rapidly than lithium

124
Q

What are the symptoms of histrionic personality disorder?

A

PRAISE ME

5/8 required for diagnosis

Provocative (or sexually seductive) behavior

Relationships (considered more intimate than they are)

Attention (uncomfortable when not the center of attention)

Influenced easily

Style of speech (impressionistic, lacks detail)

Emotions (rapidly shifting and shallow)

Made up (physical appearance to draw attention to self)

Emotions exaggerated (theatrical)

125
Q

How are panic disorders managed?

A

pharmacotherapy: SSRIs, benzodiazepines, TCAs, MAO-I
psychotherapy: education, anxiety management, behavioral, cognitive

126
Q

How can social context play a role in suicide risk?

A

stressors can increase risk

acute: breakup, financial loss, job loss, etc.
chronic: social isolation, traumatic background, poor health, etc.

127
Q

A 36 year old man has moderate symptoms of depression and wants to start an antidepressant. He has mild hypertension and is slightly overweight. He has no anxiety symptoms and says he is sleeping more than usual. He smokes a pack a day of cigarettes and would like to quit. He does not drink alcohol. What medication would be best to recommend?

a) paroxetine
b) doxepin
c) buproprion
d) venlafaxine
e) mirtazapine

A

c) buproprion

128
Q

How long should you try one antidepressant before switching to another?

A

wait until you reach an adequate dose (unless there are intolerable side effects) before switching

129
Q

What is identification with the aggressor?

A

unconsciously modeling one’s behavior after someone who is more powerful

130
Q

What are the symptoms of schizoid personality disorder?

A

DISTANT

4/7 needed for diagnosis

Detached or flattened affect

Indifferent to criticism and praise

Sexual experiences of little interest

Tasks done solitarily

Absence of close friends

Neither desires nor enjoys close relations

Takes pleasure in few activities

131
Q

What is the model of cognitive behavioral therapy?

A

therapist actively directs patients on how to receive goals by identifying cognitive distortions/automatic thoughts/triggering cues and to extinguish them by education or desensitizing exposures and generate adaptive behaviors

132
Q

What is undoing?

A

attempting to take back/undo an unacceptable behavior

133
Q

What statement is true regarding suicide epidemiology?

a) suicide rate in the US has decreased over the past 20 years
b) overdose is the most common lethal means of suicide
c) suicide causes more death than homicides
d) women have higher rates of completed suicide than men and transgender individuals
e) suicide is not a major cause of premature mortality among young adults

A

c) suicide causes more death than homicides

134
Q

What are the symptoms of dependent personality disorder?

A

RELIANCE

5/8 required for diagnosis

Reassurance required for decisions

Expressing disagreement difficult

Life responsibilities need to be done by others

Initiating projects difficult

Alone makes them uncomfortable

Nurturance is sought after

Companionship sought urgently

Exaggerated fears of being left to care for self

135
Q

What is the DSM-5 criteria for a hypomanic episode?

A

A) a distinct period of abnormally and persistently elevated, expansive, or irritable mood and persistently increased activity/energy for at least 4 consecutive days

B) during the period, 3 or more manic symptoms (DIGFAST)

C) unequivocal change in functioning uncharacteristic of individual when not symptomatic

D) change is observable by others

D) not severe enough to caused marked impairment in social or occupational functioning or to require hospitalization

E) not attributable to physiological effects of a substance or other medical condition

136
Q

What classes of antidepressants are used for OCD?

A

SSRIs, clomipramine

137
Q

Serotonin syndrome is:

a) the basis for the monoamine hypothesis of depression
b) most often caused by medications
c) a benign illness characterized by mild manic symptoms
d) a potentially lethal illness with a slow, indolent course
e) a transient, early phase of SSRI withdrawal

A

b) most often caused by medications

138
Q

What are the symptoms of obsessive compulsive personality disorder?

A

LAW FIRMS

4/8 required for diagnosis

Loses point of activity (preoccupied with detail)

Ability to complete tasks compromised by perfectionism

Worthless objects cannot be discarded

Friendships/leisure excluded due to preoccupation with work

Inflexible, scrupulous, overconscientious

Reluctant to delegate

Miserly towards self and others

Stubbornness and rigidity

139
Q

What are the symptoms of lithium toxicity?

A

increased severity forms of side effects

neurologic, GI, renal, cardiovascular

140
Q

What classes of antidepressants are used for panic disorder?

A

all antidepressants

141
Q

What are the symptoms of antisocial personality disorder?

A

CORRUPT

3/7 needed for diagnosis

Conformity to law lacking

Obligations ignored

Reckless disregard for safety of self or others

Remorse lacking

Underhanded (deceit, lies, conning)

Planning insufficient

Temper (irritable and aggressive)

142
Q

What is the role of the hypothalamic-pituitary-thyroid axis in major depressive disorder?

A

blunted TSH response to TRH

possible sub-clinical hypothyroidism

143
Q

What is serotonin syndrome?

A

A syndrome that results from excess 5-HT activity in the brain, usually after combining multiple serotonergic drugs

symptoms: mental status change, autonomic hyperactivity, neuromuscular symptoms

can range from barely perceptable to fatal

144
Q

What are the general characteristics of antisocial personality disorder?

A

deceit

disregard for, and violation of, the rights of others

manipulation

145
Q

What are the unique characteristics of citalopram?

A

dose dependent QTc prolongation

146
Q

What is the role of GABA in anxiety?

A

blockade of GABA binding produces anxiety and panic

147
Q

Buproprion:

a) is part of the SSRI class of antidepressants
b) is the primary treatment for depression with anxiety
c) carries an elevated association with new onset seizures
d) has no CYP drug interactions
e) is never used as primary treatment for depression

A

c) carries an elevated association with new onset seizures

148
Q

What is repression?

A

unconscious blocking of unacceptable thoughts, feelings, experiences

149
Q

What are the unique characteristics of fluoxetine?

A

longest half-life (no need to taper)

150
Q

What is the role of immune function in major depressive disorder?

A

decreased immune functioning

elevated TNF-alpha, IL-6, CRP, etc.

151
Q

What are the general characteristics of narcissistic personality disorder?

A

grandiosity, need for admiration, lack of empathy

152
Q

What are the mechanisms, indications, and side effects of tricyclic antidepressants?

A

mechanism: inhibit NE and 5HT reuptake
indications: chronic pain, second line for depression/psychiatric disorders

side effects: sedation, weight gain, anticholinergic side effects, cardiovascular side effects, risk of seizures, lethal in overdoses

153
Q

What disorders are in cluster C (“anxious” cluster) of personality disorders?

A

dependent, obsessive-compulsive, and avoidant

154
Q

What risks of birth defects are associated with lamotrigine?

A

no risk compared to other antiepileptics

155
Q

What are the symptoms of mania?

A

DIGFAST

Distractability

Insomnia

Grandiosity

Flight of ideas

Activities that are goal directed

Speech is pressured

Thoughtlessness (risky behaviors)

156
Q

What birth defects may be associated with maternal antipsychotic use?

A

usually none (except for risperidone/paliperidone)

can be associated with neonatal adaptation syndrome or early slow motor development

157
Q

What are the symptoms of avoidant personality disorder?

A

CRINGES

4/7 required for diagnosis

Certainty of being liked required before attempting relationships

Rejection preoccupies thoughts

Intimate relationships restrained

New interpersonal relationships

Gets around occupational activitys that require contact

Embarrassment potential prevents doing things/taking risks

Self viewed as unappealing, inept, or inferior

158
Q

What is effect of sodium lactate infusion?

A

increases NE levels and produces anxiety/panic symptoms in people with panic disorders

159
Q

What are the neurotransmitter components of bipolar pathogensis?

A

involvement of NE and DA through second messengers

altered glutamatergic neurotransmission in hippocampus, thalamus, and other structures

circadian dysregulation

disrupted cellular and membrane metabolism

160
Q

What birth defects are associated with valproic acid?

A

neural tube defects

161
Q

What is the biological etiology of suicide?

A

associated with low central serotonin, genetic predisposition

162
Q

How is OCD managed?

A

pharmacotherapy: SSRIs, clomipramine
psychotherapy: education, behavioral therapy, supportive therapy
psychosurgery: cingulotomy, subcaudate tractotomy, anterior capsulotomy

163
Q

What is deep brain stimulation?

A

a treatment where a pair of electrodes are implanted into the brain and provides continuous stimulation

164
Q

What is the role of serotonin in anxiety?

A

serotonin may attenuate the activity of the locus ceruleus and reduce anxiety

165
Q

What is the mechanism of electroconvulsive therapy?

A

It causes a 25-60 second seizure that relieves depression through an unknown mechanism

166
Q

What classes of drugs are phenelzine, tranylcypromine, isocarboxazid, selegiline?

A

Monoamine oxidase inhibitors

167
Q

What thoughts and behaviors are associated with depressive episodes?

A

thought: hopelessness, pessimism, lack of self esteem, guilt, suicidality, slowed mentation
behavior: agitated or retarded, sleep and appetite disturbances

168
Q

What are the DSM-5 criteria for postpartum depression?

A

patients meet diagnostic criteria for a depressive episode with symptoms beginning during pregnancy and up to 4 weeks postpartum

169
Q

What are healthcare based suicide prevention strategies?

A

hospitalization of people at acute risk

routine monitoring of symptoms

treatment of psychiatric illness

treatment of substance use disorders

address modifiable risks

170
Q

What is the neurobiology of OCD?

A

serotonin neuronal systems, caudate nuclei, orbital gyri, and cingulate gyri implicated

no change with yohimbine, caffiene, or lactate

171
Q

What are the classical depressive symptoms?

A

SIGECAPS

Sleep disturbance

Interest reduced

Guilt and worthlessness

Energy loss and fatigue

Concentration problems

Appetite problems

Psychomotor agitation or retardation

Suicidality

172
Q

Different SSRI antidepressants:

a) show a wide range of efficacy, from poor to excellent
b) are very similar to each other in terms of CYP interactions
c) never have beneficial side effects
d) are the most efficaceous among antidepressants
e) all have a black box warning for suicide

A

e) all have a black box warning for suicide

173
Q

What are the diagnostic criteria for obsessive-compulsive disorder?

A

presence of either obsessions or compulsions that can cause distress or are time consuming

174
Q

What is cyclothymic disorder?

A

subcategory of bipolar disorders with recurrent mild depressive symptoms and hypomanias lasting 2 years or more but does not involve fully syndromal major depressive episodes

175
Q

What does it mean for a diagnosis to be “with mixed features”?

A

It means that there are at least three subthreshold symptoms from the opposing pole present during a mood episode (ex. 3 subthreshold manic symptoms during a major depressive episode)

176
Q

What classes of antidepressants are used for PTSD?

A

SSRIs, venlafaxine

177
Q

What is projection?

A

attribution of one’s own feelings onto someone else because the feeling is too difficult to contain within oneself

178
Q

What is the mechanism and side effects of bupropion?

A

mechanism: norepine-dopamine reuptake inhibitor

side effects: worsened anxiety, increased risk of seizures, insomnia, weight loss, dry mouth

does not cause sexual dysfunction, lower risk of switch to mania, weight neutral

179
Q

Which classes of antidepressants are used for GAD?

A

SSRIs, SNRIs, TCAs

180
Q

What is transcranial magnetic stimulation?

A

A treatment where a MR-strength magnetic field is applied to the scalp, which generates electric current over an area of the brain that is involved in mood regulation

181
Q

What are the symptoms of borderline personality disorder?

A

AM SUICIDE

5/9 required for diagnosis

Abandonment fears

Mood instability

Suicidal/self-injurious behavior

Unstable, intense relationships

Impulsivity

Control of anger poor

Identity disturbance

Dissociative/paranoid symptoms

Emptiness

182
Q

What classes of drugs are amitryptiline, Imipramine, clomipramine, doxepin, nortriptyline, desipramine, amoxapine?

A

tricyclic antidepressants

183
Q

What are the main side effects of therapeutic lithium levels?

A

renal: polyuria, polydipsia, diabetes insipidus, renal insufficiency
neurologic: impaired cognition, ataxia, dysarthria
endocrine: hypothyroidism
cardiac: conduction problems (sinus bradycardia, SA node block)

in pregnancy: increased risk of Ebstein’s anomaly

184
Q

What are the DSM-5 criteria for persistent depressive disorder?

A

A) depressed mood most of the day, for more days than not, over at least 2 year period

B) presenting with two or more depression symptoms (SIGECAPS)

C) during the 2 year period, never without symptoms for more than 2 months + never had manic/hypomanic episode or cyclothymia

185
Q

What antidepressants are used for smoking cessation?

A

buproprion

186
Q

What are the unique characteristics of paroxetine?

A

potent CYP26 inhibitor –> drug-drug interactions

anticholinergic side effects (sedation, constipation, weight gain)

shortest half life (bad discontinuation)

187
Q

What are the most common serotonin/NE based side effects of antidepressants?

A

GI upset, anxiety, agitation, insomnia, headache, sweating, sexual dysfunction

188
Q

What is the therapeutic window for lithium?

A

0.6 mEq/L to 1.2 mEq/L

level just below 1.0 is ideal

189
Q

What is the mechanism and side effects of monoamine oxidase inhibitors?

A

mechanism: irreversibly inhibit MAO-A and MAO-B enzymes, preventing degradation of NE, 5HT, dopamine, and increased levels of monoamines

side effects: orthostatic hypotension, drowsiness, serotonin syndrome (higher risk), requires special diet (avoid tyramine rich foods) to prevent hypertensive crisis

190
Q

What are the criteria for panic disorder?

A

recurrent attacks

at least one month of concern

no organic cause

191
Q

How is lithium metabolized?

A

entirely through the kidney

192
Q

What is the role of serotonin in depression?

A

alterations in serotonin receptor and transporter density associated with depresson and low levels of CSF serotonin

193
Q

What is the neurotrophic hypothesis for depression?

A

the thought that atrophy, cellular damage/death, and stressures in vulnerable individuals contributes to depression through reduced neurogenesis (and decreased BDNF)

194
Q

Why are women less likely to die from attempted suicide?

A

they are less likely to use firearms (the most lethal means)

195
Q

A 75-year old man with a history of bipolar disorder comes for a routine medical check up. He has sciatic back pain but is otherwise in good physical health. His wife died about one year ago and his adult son lives out of state. He is not sure if he can afford to pay his rent without her income. He is having trouble sleeping. He is tearful for part of the encounter. How should you assess his suicide risk?

a) ask him directly if he is having thoughts that life is not worth living, wishes he was dead, or thoughts about killing himself
b) do not ask directly about suicidal thoughts because this may give him the idea to commit suicide - rather, ask him how he is coping
c) you do not need to ask directly about suicidal thoughts because you can reasonably determine that he is at increased risk of suicide because of his age & gender, bipolar diagnosis, acute symptoms of depression, physical pain, financial problems, and social isolation - admit him for inpatient psychiatric hospitalization

A

a) ask him directly if he is having thoughts that life is not worth living, wishes he was dead, or thoughts about killing himself

196
Q

What are the four Durkheim’s etiologies of suicide?

A

egotistical - rooted in social isolation

altruistic - rooted in social integration (ex. suicide bombers)

anomic - rooted in acute disrupted social integration

fatalistic - rooted in unrewarding life

197
Q

Electroconvulsive therapy is most effective in the treatment of:

a) catatonias
b) epilepsy
c) cardiac arrests
d) migraines

A

a) catatonias

198
Q

What is compartmentalization?

A

a lesser form of dissociation where part of the self is separated from the other parts

199
Q

Which racial/ethnic groups are at highest risk of suicide?

A

american indian and white men at highest risk

200
Q

What are the drug interactions of lamotrigine?

A

does not affect metabolism of other drugs, but carbamazepine (and other enzyme inducers) can lower levels of lamotrigine

valproic acid inhibits lamotrigine metabolism (so a lower dose is used)

201
Q

What are the side effects of electroconvulsive therapy?

A

headache, nausea, muscle aches

memory problems

202
Q

Of the following patients, which is at highest risk for completing suicide?

a) patient takes small number of aspirin and immediately tells a friend
b) patient attempts to slash wrist with a piece of glass while at home alone
c) during an argument, patient shouts, “I am going to jump” and lunges for the balcony
d) patient buys a gun and rents a hotel room under a false name

A

d) patient buys a gun and rents a hotel room under a false name

203
Q

What is the treatment for lithium toxicity?

A

discontinuing medication

if mild: rehydrate with normal saline

if severe: dialysis

204
Q

Which mood stabilizers are associated with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis?

A

mostly lamotrigine

also carbamazapine (more rarely)

205
Q

What is neonatal adaptation syndrome?

A

0-30% of infance exposed to psychiatric drugs (esp. SSRIs) in utero leading to fussiness, jitteriness, poor feeding, breathing problems

206
Q

What is interpersonal therapy?

A

short-term therapy designed to help people face challenges and communication issues in four areas: role transitions, grief/loss/abandonment, interpersonal disputes, developmental deficits

207
Q

What is the general mechanism of action of mood stabilizers?

A

decreases activity of excitatory neurotransmitters (glutamate)

increases activity of inhibitory neurotransmitters (GABA)

208
Q

What disorders are in cluster A (“odd” cluster) of personality disorders?

A

paranoid, schizoid, schizotypal

209
Q

What is the role of the amygdala/locus coeruleus in anxiety?

A

area of the brain containing the most noradrenergic neurons

neurons project ot areas of the brain that play a role in human emotion

locus coeruleus plays a pivitol role in regulating the sympathetic release during fear and axiety states

210
Q

Which monamine neurotransmitter is synthesized from tryptophan?

A
211
Q

What is the fetal risk associated with benzodiazepines?

A

maybe small increased risk of clefts

withdrawal symptoms after birth

sedating effects of breast milk

212
Q

What are the symptoms of narcissistic personality disorder?

A

SPEEECIAL

5/9 needed for diagnosis

Special (believes he or she is special and unique)

Preoccupied with fantasies

Envious of others (or thinks they are envious of them)

Entitlement

Excess admiration required

Conceited

Interpersonal exploitation

Arrogant (haughty)

Lacks empathy

213
Q

What are some precipitating factors for lithium toxicity?

A

dehydration

decreased sodium intake

intrinsic renal disease

congestive heart failure

214
Q

What are the common factors that extend across types of psychotherapy?

A

goal: symptom remission
techniques: using therapeutic alliance to identify dysfunction patterns, develop self-awareness, and achieve goals

therapist characteristics: genuine, warm, empathetic, experienced

215
Q

What is the role of yohimbine in anxiety?

A

an alpha2 antagonist that causes increased symptoms of panic disorders

Psych (6 decks)

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