psych 1 Flashcards
3 dopamine tracts
- Nigrostriatal pathway- parkinson symptoms
- mesolimbic-mesocortical pathway- psychosis (involved in mediating antipsychotic effects of antipsychotic drugs)
- tuberoinfundibular tract-galactorhea (dopamine inhibits prolactin so if use dopamine antagonist prolactin increases causing galactorhea)
when can you start using adhd meds
6 yrs old
workup before prescribing adhd meds
ekg, bp, tsh, lipids, cbc, cmp, seizure free (good h/o and physical exam for base line…get height and weight to make sure still growing-decrease weight is a side effect)
meds for adhd
methylphenidate (ritaline) (inhibit reuptake of dopamine and Norepi)
dextroamphetamine (adderal)
non stimulant- atomoxetine (strattera) (black box warning- increase risk of suicide)
scale for adhd
vanderbilt scale
signs of death
palor mortis- paleness 15-20 min after death
livor mortis- edema in dependent part of body
algo mortis- decline in body temp
rigor mortis- stiffening of limbs
signs that suggest active dying
no intake of food/water dramatic skin color changes respiratory mandibular movement sunken cheeks, relaxation of facial muscles rattels in chest cheynes-stokes respirations feeble pulse
stages of grief
- shock and denial
- anger
- bargaining
- depression
- acceptance
depression vs grief
mood disturbance (depression- no fluctuations in mood; grief-fluctuations common-ups and downs) shame and guilt- (depression- belief that one is shameful and worthless; grief-regret not doing more for deceased) suicidal ideation- ( depression- threaten suicide more often; grief- claim life is unbearable but don't really want to die) greif lasts usually 6 months to 1 year (some signs can last longer)
risk factors for abnormal grief
Those who suffer a loss suddenly or through horrific circumstances
Those who are socially isolated
Those who believe they are responsible (whether real or imagined)
Those with a history of traumatic losses
Those with an intensely dependent relationship with the deceased
Those who have suffered the death of a child
Those who have suffered from depression
medical conditions that can cause depression
sleep apnea chronic pain hypothyroidism stroke heart disease there are others (ms, cancer, diabetes, copd, dementia, etc) but these are the main ones
meds can cause depression
beta blockers corticosteroids benzodiazepines chantix (varenicline) interferon
depression scales
beck depression scale
quick inventory of depressive symptomatology
bipolar scale
mood disorder questionaire
anxiety scale
hamilton anxiety rating scale
risk factors for suicide
sad persons Sex (male) Age (elderly adolescent) Depression Previous attempts Ethanol abuse Rational thinking loss (psychosis) Social support lacking Organized plan to commit suicide No spouse (divorced, single, widowed) Sickness (physical illness)
tx of disorders
mild depression-psychothearpy
moderate or severe- psychotherapy plus meds (sari)
bipolar- mood stabilizer +/- antidepressant
psychotic- antipsychotic plus antidepressant
diagnosis of depression
5 symptoms in 2 week time
at least one symptom has to be depressed mood most of the day everyday or anhodonia (don’t find pleasure in things anymore)
what goes in each axis
I- psychiatry conditions
II- personality disorders and mental retardation
III- medical conditions
IV- psychological or environmental issues contributing to mental problem
V- GAF
what is go to med for anxiety disorders
Paxil
first line agent for 8 and up depression
prozac (start at 10 mg and taper to 20 mg)
first line agent for 12 and up depression
lexapro (start at 5 mg and taper to 10-20mg)
key to diagnosing hypochondrias
at least 6 months of illness despite medical eval
keys to look for in malingering
Memory loss following head injury is unusual without LOC, and typically the amnesia would involve the accident and events surrounding the accident
Long-term memories are LEAST likely to be affected by mild traumatic injury
Loss of orientation to person without other memory deficits seldom occurs
treatment for somatization
cognitive based therapy
ssri for body dysmorphic
what drug has active metabolite
fluoxetine
what ssri are contraindicated for breast cancer (tamoxifen)
fluoxetine and paroxetine
what ssri carries risk of qt prolongation
citalopram
what ssri can be dosed weely
fluoxetine
if get side effects w/ snri what can you do
take w/ food
main side effects w/ snri
diaphoresis
dizziness
nausea
what snri causes weight gain
cymbalta (duloxetine)
what is perfect patient for wellbutrin
The perfect patient for this is mild depression, very sleepy, can’t concentrate at job (cause it is stimulating)
hunters criteria for serotonin syndrome
Has taken a serotonergic agent PLUS (1)
Spontaneous clonus
Inducible clonus AND agitation or diaphoresis
Ocular clonus AND agitation or diaphoresis
Tremor and hyperreflexia
Hypertonia AND temp > 38C AND ocular clonus or inducible clonus
personality disorders
A- weird (eccentric and odd behavior) paranoid, schizoid, schizotypal B- wild antisocial, borderline, histonic, narcissistic C- wimpy avoidant, ocd, dependent
mneumonic for paranoid
suspect S: spouse fidelity suspected U: unforgiving (bears grudges) S: suspicious of others P: perceives attacks (and reacts quickly) E: œenemy of friend? (suspects associates, friends) C: confiding in others feared T: threats perceived in benign events
pneumonic for schizoid
D: Detached (or flattened) affect I: Indifferent to criticism and praise S: Sexual experiences of little interest T: Tasks (activities) done solitarily A: Absence of close friends N: Neither desires nor enjoys close relations T: Takes pleasure in few activities
mneumonic for schizotypal
M: Magical thinking or odd beliefs
E: Experiences unusual perceptions
P: Paranoid ideation E: Eccentric behavior or appearance C: Constricted (or inappropriate) affect U: Unusual (odd) thinking and speech L: Lacks close friends I: Ideas of reference A: Anxiety in social situations R: Rule out psychotic disorders and pervasive developmental disorder
mnemonic for antisocial
C: Conformity to law lacking
0: Obligations ignored
R: Reckless disregard for safety of self or others
R: Remorse lacking
U: Underhanded (deceitful, lies, cons others)
P: Planning insufficient (impulsive)
T: Temper (irritable and aggressive)
mneumonic for borderline
P-Paranoid R-relationship instability A-anger outburts I-Impulsive S-suicidal E-Emptiness feeling
mneumonic for histrionic
P: Provocative (or sexually seductive) behavior
R: Relationships (considered more intimate than they are)
A: Attention (uncomfortable when not the center of attention)
I: Influenced easily
S: Style of speech (impressionistic, lacks detail)
E: Emotions (rapidly shifting and shallow)
M: Made up (physical appearance used to draw attention to self)
E: Emotions exaggerated (theatrical)
mneumonic for narcisitic
S: Special (believes he or she is special and unique)
P: Preoccupied with fantasies (of unlimited success, power, brilliance, beauty, or
ideal love)
E: Entitlement
C: Conceited (grandiose sense of self-importance)
I: Interpersonal exploitation
A: Arrogant (haughty)
L: Lacks empathy
mneumonic for avoidant
C: Certainty (of being liked required before willing to get involved with others)
R: Rejection (or criticism) preoccupies one’s thoughts in social situations
I: Intimate relationships (restraint in intimate relationships due to fear of being samed)
N: New interpersonal relationships (is inhibited in)
G: Gets around occupational activity (involing significant interpersonal contact)
E Embarrassment (potential) prevents new activity or taking personal risks
S: Self viewed as unappealing, inept, or inferior
mneumnoic for dependant
R: Reassurance required tor decisions
E: Expressing disagreement difficult (due to fear of loss of support or approval)
L: Life responsibilites (needs to have these assumed by others)
I: Initiating projects difficult (due to lack of self-confidence)
A: Alone (feels helpless and discomfort when alone)
N: Nurturance (goes to excessive lengths to obtain nurturance and support)
C: Companionship (another relationship) sought urgently when close relationship ends
E: Exaggerated fears of being left to care for self
mneumnoic for ocd
L: Loses point of activity (due to preoccupation with detail)
A: Ability to complete tasks (compromised by perfectionism)
W: Worthless objects (unable to discard)
F: Friendships (and leisure activities) excluded (due to a preoccupation with work)
I: Inflexible, scrupulous, overconscientious (on ethics, values, or morality, not
accounted for by religion or culture)
R: Reluctant to delegate (unless others submit to exact guidelines)
M: Miserly (toward self and others)
S: Stubbornness (and rigidity)
stages of normal grief
dabda Denial Anger Bargaining Depression Acceptance
tx of paranoid
ssri
tx of schizoid and schizotypal
low dose antipsychotics or antidepressant
tx of borderline personality
dialectical behavior therapy- tx of choice
cognitive behavioral thearpy
tx of histrionic
cognitive behaioral thearpy
postpartum blues
begins w/in 48hrs of delivery
peaks in 3-5 days
lasts about 2 weeks (if lasts more then 2 weeks consider post partum depression)
