Psych Flashcards
Wernicke encephalopathy triad
Ophthalmoplegia (double vision)
Ataxia
AMS
Korsakoff syndrome sx
Amnesia
Confabulation
Personality changes
Causes of amnesia
TBI
Encephalitis, esp herpes
Dementia
Thiamine (B1) deficiency
Depersonalization disorder sx
Intact reality / no psychosis
Feel like world isn’t real
Dissociative amnesia disorder
Sudden
Often a stressor
Fugue state
Wandering
Dissociative identity disorder
Females
PTSD link
LSD and PCP
Distinct personalities
Time loss
List the childhood psych disorders
Separation anxiety
Selective mutism
Oppositional defiant
Conduct disorder
Disruptive mood disorder
Tourette’s syndrome
Child abuse
ADHD
Autism Spectrum disorder
Criteria for separation anxiety disorder
Excessive anxiety
4+ weeks
Older than 3 yrs
Treatment for separation anxiety disorder
Cognitive behavioral therapy
Play therapy
Family therapy
Criteria for selective mutism
Less than 5 yrs at onset
Greater than 1 month
Social situations
Treatment for selective mutism
CBT
Play therapy
Family therapy
SSRI (Prozac)
Criteria for oppositional defiant disorder
Greater than 6 months duration
No injury to others /property
Argumentative and defiant
4+: irritable mood, easily annoyed, resentful, argues, deliberately annoys, blames others
mild=1 setting; mod=2 settings; severe=3+ settings
Criteria for conduct disorder
Starts less than 18 yrs old (if continues past 18, dx as antisocial personality)
Violates others rights - aggression, destruction of property, disregard for morals/norms
at least 3 in past 12 months: aggression, bullying, fights, weapon used to cause harm, physically cruel to people or animals, armed robbery, sexual coercion
Criteria for disruptive mood disorder
Explosive outburst out of proportion
Onset less than 10 yrs old
3 /wk for 1 yr
Always irritable
Criteria for Tourette’s syndrome
2 motor, 1 vocal tic minimum
Less than 18 yrs old
3/week for 1 year
Treatment for Tourette’s syndrome
CBT
Alpha 2 receptor agonist (clonidine, tizanidine)
Antipsychotics (haloperidol, risperidone, olanzapine)
Symptoms of serotonin syndrome
Autonomic-diarrhea, diaphoresis, mydriasis, hyperthermia, tachycardia, hypertension
Abnormal muscles-twitching, hyperreflexia, tremor, seizures
AMS- hallucinations, confusion, agitation, coma
Treatment for serotonin syndrome and MOA
Cyproheptadine
Medications that can cause serotonin syndrome
SSRIs, SNRIs
MAOIs
TCAs
Buspirone, vortioxetine, vitazodone
Tramadol
Linezolid
Meperidine
Ondansetron
Triptans
St. John’s wort
MDMA
Dextromethorphan
Causes of neuroleptic malignant syndrome
Antipsychotics
Symptoms of neuroleptic malignant syndrome
FEVER
Fever
Encephalopathy
Vitals unstable- tachy, htn
Enzymes- COK, myoglobin from rhabdo
Rigidity
Does NOT affect pupil size
Causes hyporeflexia
Treatment for neuroleptic malignant syndrome
Dantrolene
Bromocriptine
Causes and Symptoms of acute dystonia
Treatment
Cause - antipsychotics; hours / days
Muscle rigidity and spasms
Laryngospasm
Oculogyric crisis- cant look down
Tx- anticholenergic (benztropine)
Cause, sx, tx for tyramine induced hypertension
MAO inhibitors plus tyramine from wine, cheese
HTN, tachycardia
Phentolamine- alpha 1 and 2 antagonist
Pathophys of delirium tremens
Etoh mimics GABA, causes downregulation of GABA receptors and up regulation of NDMA receptors. Lack of etoh causes overstimulation of NMDA pathways
Sx of delirium tremens
Delirium
Tremors
Hypertension
Diaphoresis
Tachycardia
Insomnia
Nausea/vomiting
Seizures
Agitation
Hallucinations
Tx of delirium tremens
Benzodiazepines
Name the typical (first gen) antipsychotics
Haloperidol
Trifluoparazine
Fluophenazine
Thioridazine
Chlorpromazine
Name the atypical (second gen) antipsychotics
clozapine (Clozaril)
olanzapine (Zyprexa)
quetiapine (Seroquel)
paliperidone (Invega)
risperidone (Risperdal)
lurasidone (Latuda)
ziprasidone (Geodon)
aripiprazole (Abilify)
brexpiprazole (Rexulti)
MOA of typical (first gen) antipsychotics
block dopamine D2 receptors in mesolimbic pathway - improves delusions/hallucinations
can block dopamine receptors in mesocortical pathway- worsens withdrawal, lack of motivation
Which typical (first gen) antipsychotic is associated with corneal deposits?
chlorpromazine
Which typical (first gen) antipsychotic is associated with retinal deposits?
thioridazone
MOA of atypical (second gen) antipsychotics
block dopamine D2 receptors in mesolimbic pathway - improves hallucinations, delusions
block serotonin 5-HT2A receptors in mesocortical pathway - more dopamine = improved motivation and less withdrawal
side effects of typical (first gen) antipsychotics
dystonia
pseudoparkinsonism (face)
wt gain
hyperglycemia, hyperlipidemia
tardive dyskinesia
neuroleptic malignant syndrome
dry mouth, urinary retention
orthostasis
QT prolongation
side effects of atypical (second gen) antipsychotics
dystonia
pseudoparkinsonism
tardive dyskinesia
orthostasis
dry mouth, urinary retention, constipation
QT prolongation
weight gain
neuroleptic malignant syndrome
Which atypical (second gen) antipsychotic is most associated with hyperprolactinemia?
risperidone
Which atypical (second gen) antipsychotic is most associated with agranulocytosis?
clozapine
Criteria for persistent complex bereavement
12 months (6 months in adolescence)
obsessive yearning to be with the person
Criteria for normal grief
less than 6 months
symptoms wax/wane
Criteria for mania
1 week or more duration
3+ symptoms - grandiosity, talkative, flight of ideas, distractable, extreme goals, reckless behaviors, reduced sleep, agitation
Criteria for hypomania
4 days duration
3+ symptoms but milder
no psychosis
Criteria for bipolar I disorder
at least one manic episode
Criteria for Bipolar II disorder
no manic episodes; at least one hypomanic episode
Criteria for cyclothymic disorder
2+ years
fluctuating hypomania / depression
Tx for manic disorders
lithium
anticonvulsants - valproate, lamotrigine
antipsychotics - quetiapine, lurasidone
Which antipsychotics are used to treat manic disorders?
quetiapine
lurasidone
Which anticonvulsants are used to treat manic disorders?
valproate
lamotrigine
SIGECAPS
sleep
interest
guilt
energy
concentration
appetite
psychomotor
suicidal
Workup for depression
B12
folate
TSH
CBC
CMP
UA
UDS
EKG
PHQ-9
Criteria for major depressive disorder
at least 2 weeks duration
at least 5 symptoms (SIGECAPS)
Criteria for MDD with atypical features
MDD
mood improves with happy events
significant rejection sensitivity
Criteria for MDD with seasonal pattern
MDD
at least 2 years with sx in colder months and no sx in warmer months
Criteria for MDD with psychotic features
MDD
hallucinations/delusions while depressed
hallucinations/delusions associated with guilt/punishment
Criteria for MDD with perpipartum onset
MDD
within 1st year
Criteria for persistent depressive disorder
2+ symptoms
2+ yrs in adults, 1+ in adolescents
no period greater than 2 months without sx
Name the SSRIs
fluoxetine (Prozac)
paroxetine (Paxil)
sertraline (Zoloft)
citalopram (Celexa)
escitalopram (Lexapro)
fluvoxamine (Luvox) – OCD
MOA of SSRIs
block uptake receptors for serotonin - increases serotonin in the synapse
Side effects of SSRIs
GI upset
insomnia
sexual dysfunction
suicidal ideation (<25)
mania
dizziness
Hyponatremia
Name the SNRIs
desvenlafaxine (Pristiq)
venlafaxine (Effexor)
duloxetine (Cymbalta)
MOA of SNRIs
Block serotonin and norepinephrine reuptake from the synapse
Side effects of SNRIs
GI
dry mouth
dizziness
suicidal ideation (<25)
sexual dysfunction
mania
Name the MAO inhibitors
selegiline (Emsam)
rasagiline (Azilect)
isocarboxazid (Marplan)
phenelzine (Nardil)
tranylcypromine (Parnate)
Difference between selective and non-selective MAO inhibitor MOA
non-selective inhibit MAO a and b
selective inhibit MAO b only
MAO a = norepinephrine, dopamine, serotonin
MAO b = dopamine only
MOA of monoamine oxidase
break down neurotransmitters - norepinephrine, dopamine, serotonin
Name the atypical medications used to treat MDD
mirtazapine (Remeron) - inhibits presynaptic inhibition
trazodone - SSRI, increases binding of serotonin to receptors
vilazodone (Viibryd) - SSRI, 5HT1 agonist
vortioxetine (Trintellix, Brintellix) - SSRI, 5HT1 agonist
bupropion (Wellbutrin) - NDRi
Which antidepressant can predispose to seizures?
bupropion (Wellbutrin)
Name the tricyclic antidepressants (TCAs)
desipramine (Norpramin)
nortriptyline (Pamelor)
amitriptyline (Elavil)
imipramine (Tofranil)
clomipramine (Anafranil)
MOA of TCAs
selective (desipramine / nortriptyline) - inhibit norepinephrine transporters
non-selective (amitriptyline, imipramine, clomipramine) - inhibit serotonin and norepinephrine transporters
Side effects of TCAs
sedation
orthostasis
dry mouth, urinary retention, constiptation
cardiotoxic!!
prolonged QT
Three Cs - coma, convulsions, cardiotoxicity
List the personality disorders by cluster
Cluster A - eccentric
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder
Cluster B - emotional
Antisocial personality disorder
Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder
Cluster C - anxiety (cowardly, controlling, clingy)
Avoidant personality disorder
Obsessive compulsive personality disorder
Dependet personality disorder
Criteria for Paranoid personality disorder
distrustful
fears manipulation
holds grudges
Criteria for Schizoid personality disorder
avoids social interactions
anhedonia
doesn’t want friendships
Criteria for Schizotypal personality disorder
No delusions
eccentric thinking - magic; symbolic meaning; influences
wants friends, can’t keep them
inappropriate affect
Criteria for Antisocial personality disorder
poor impulse control
no empathy or remorse
hx of conduct disorder
ignores social norms/mores
Criteria for Borderline personality disorder
unstable moods
intense relationships
splitting - sees people / situations as completely good or completely bad
Criteria for Histrionic personality disorder
excessive attention seeking
excessive emotionality
superficial relationships
Criteria for Narcissistic personality disorder
grandiosity
poor response to criticism
arrogant/self-centered
lacks empathy
Criteria for Avoidant personality disorder
low self-esteem
desires friendships
avoids social situations
Criteria for Obsessive Compulsive personality disorder
rigid, inflexible
doesn’t see anything wrong with their behaviors
Criteria for Dependent personality disorder
excessive fear of being alone and independent
Tx for personality disorders
Dialectical behavioral therapy
Criteria for anorexia nervosa
BMI < 18.5
binge/purge or restricting
Symptoms of anorexia nervosa
dyspnea
bradycardia
hypotension / orthostasis
amenorrhea
halitosis
lanugo, dry skin
knuckle changes
loss of dental enamel
Lab changes with anorexia nervosa
hypokalemia
hyponatremia
hypophosphatemia
hypomagnesemia
pancytopenia
Tx for anorexia nervosa
CBT
SSRI
NOT bupropion
Which medication should be avoided in patients with anorexia nervosa?
bupropion (Seizures)
Criteria for bulimia nervosa
BMI > 18.5
binge/purge
> 1 per week for 3 months
Sx of bulimia nervosa
halitosis
dental erosions
parotid swelling
Russell sign - knuckles
Labs in bulimia nervosa
increased amylase
metabolic alkalosis
hypokalemia
hypomagnesemia
hypophosphatemia
hyponatremia
Which SSRI is prefered with bulimia
Prozac
Criteria for binge eating disorder
1+ / week for 3 months
no compensatory behaviors
Criteria for PICA
craving/eating non-food items
Characteristics of malingering
intentional false or exaggerated sx
external incentive
Characteristics of factitious disorder
intentional false or exaggerated sx
no external incentive
wants to appear sick
Examples of inattention in ADHD
careless mistakes
lack of focus
doesn’t listen
doesn’t follow directions
forgets daily activities
disorganized
loses things
examples of hyperactivity in ADHD
fidgets
runs/climbs in inappropriate places
leaves seat inappropriately
can’t wait turns
extended on-the-go time
talks excessively
interrupts
Criteria for ADHD
starts before age 7
6+ symptoms for 6+ months
hyperactivity occurs in 2+ settings
Tx for ADHD
methylphenidate (Ritalin)
dextroamphetamine (Adderall)
lisdexamfetamine (Vyvanse)
Criteria for autism spectrum disorder
deficits in communication and interaction
restricted, repetitive patterns of behavior, interests, activities
sx present early
sx cause impairment
Rett’s disorder - pathophys, sx, etc
genetic disorder-abnormal chromatin
almost exclusively females
4 stages - developmental arrest, rapid regression, pseudostationary, late motor deterioration
Tx for Conduct disorder
carbamazepine
stimulants if ADHD
family therapy
Persistent Tic disorder
pure motor or pure vocal tic(s)
persisted > 1 year
less than 18 yrs old
Provisional tic disorder
tic disorder less than 1 year
less than 18 yrs old
Copralalia
involuntary swearing
Criteria for intermittent explosive disorder
2+ / week for 3+ months
3 outbursts with property/physical damage within 12 months
> 6 yrs old
aggression out of proportion to stressor
mood returns to baseline between episodes
Criteria for kleptomania
Items of little personal/monetary need
sense of tension prior with pleasure after
Which psych disorder has highest rate of suicide?
gambling disorder
Name the impulse control disorders
Trichotillomania
gambling disorder
pyromania
kleptomania
intermittent explosive disorder
Criteria for generalized anxiety disorder
excessive worry about multiple things
majority of days for 6+ months
3 or more: restless, easily fatigued, difficulty concentrating, irritable, muscle tension, sleep disturbance
Tx for generalized anxiety disorder
SSRIs (sertraline, escitalopram, fluoxetine)
buspirone
hydroxyzine (Vistaril)
benzodiazepines
CBT
Criteria for OCD
unwanted recurring thoughts/behaviors
cause anxiety
time consuming and intrusive
Tx for OCD
SSRIs - will need higher dose
Criteria for panic disorder
episodes of intense fear with abrupt onset lasting less than 20 minutes
4+ sx: palpitations, tachycardia, chest pain, short of breath, nausea, sweating, trembling, dizzy/unsteady, depersonalization, fear of dying, paresthesias, chills/hot flashes
Tx for panic disorder
SSRI
short term benzodiazepines
hydroxyzine
increase exercise/avoid stimulants
CBT
Criteria for social anxiety disorder
fear of social/performance situations
fear is excessive
impairs normal function
6+ months
Criteria for agoraphobia
fear of being in a situation that is difficult to escape or help might be unavailable
avoidance of situations
Difference in criteria between acute stress disorder and PTSD
duration < 1 month vs > 1 month
What medication is prescribed for nightmares associated with PTSD?
prazosin
What medications are avoided with PTSD
NO benzodiazepines
how long is an adequate trial of an SSRI
appropriate dose for 6+ weeks
Tx for PTSD
CBT, trauma-focused
SSRIs
What is the washout period for antidepressants prior to beginning MAO inhibitor?
14 days
Symptoms of abrupt SSRI discontinuation
agitation
irritability
headache
dizziness
myalgias
paresthesias
Symptoms of lithium toxicity
GI symptoms
confusion
ataxia
tremor
seizures
Which anticonvulsant that is used with bipolar disorder can cause Stevens-Johnson syndrome?
lamotrigine
Criteria for brief psychotic disorder
delusions/hallucinations
less than 1 month duration
sudden onset, usually related to stressor
full return to baseline
side effects of lithium
hyperparathyroidism
thyroid disorders
nephrogenic DI
chronic kidney disease
teratogenic
Side effects of valproate
neural tube defects
What are the positive psychotic symptoms?
hallucinations
delusions
disorganized speech
abnormal motor behavior / catatonia
What are the negative psychotic symptoms?
decreased eye contact
decreased expression
decreased speech intonations
avolition - decreased interest in activities
asociality - decreased social interactions
alogia - decreased words
anhedonia - decreased enjoyment
Criteria for schizophrenia
2+ symptoms in one month
no major mood disorder symptoms
some symptoms last 6+ months
prodromal, active, and residual sx
Criteria for delusional disorder
1+ delusion for 1+ month
doesn’t meet criteria for schizophrenia
Criteria for brief psychotic disorder
1+ positive and 1+ negative sx
>1 day, but < 1 month
Criteria for schizoaffective disorder
Mood disorder sx (MDD, hypo/mania)
sx occur before or after psychotic sx
psychotic sx at least 2 weeks
Criteria for schizophreniform disorder
Same as schizophrenia, but no sx 6 months duration
Which drug causes nystagmus, violent behavior, ataxia?
PCP (phencyclidine)
Which illicit drug causes miosis, respiratory depression, depressed mental status?
Heroin
What is the first line treatment for PCP intoxication?
Benzodiazepines
Psychosis in Parkinson disease
Likely medication - reduce dose
Hypnagogic
upon falling asleep
Hypnopompic
upon awakening
Characteristics of narcolepsy
cataplexy (sudden muscle tone loss)
daytime sleep
sleep paralysis
hallucinations falling asleep/waking up
low CSF hypocretin-1 level
3+ / week for 3+ months
Characteristics of REM sleep behavior disorder
act out dreams
What medication for Bipolar disorder is safe in pregnancy?
Lamotrigine
What medications for bipolar disorder are a strong teratogen?
Valproate - neural tube defects
carbamazepine - neural tube defects
