Psych 15 Flashcards by Giselle McIntyre

Likely diagnosis: delirium + elevated BP + papilledema

Hypertensive encephalopathy

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Time frame of somatic sx disorder

At least 6 months

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Time frame of illness anxiety disorder

At least 6 months

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What laboratory finding is associated with intermittent explosive disorder

Low levels of serotonin (5-HIAA) in the CSF

Recurrent behavioral outbursts resulting in verbal and/or physical aggression against people or property

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What other disorder do 65% of patients with kleptomania have?

Bulimia nervosa

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Medication other than Dantrolene used to treat NMS

Bromocriptine (dopamine agonist)

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Is lack of precipitating factors/stressors a good or poor prognosis of schizophrenia?

Poor

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Time frame for delusional disorder

1 month

Think of crazy girl with erotomatic delusions celebrating her one month anniversary with celebrity

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What is catatonia

o Diagnosis includes 3 or more of the following:
♣ Catalepsy (immobility)
♣ Stupor
♣ Waxy flexibility
♣ Mutism
♣ Negativism (resisting attempts to move patient and does opposite to what is asked)
♣ Posturing
♣ Mannerism
♣ Stereotypy (repetitive behavior)
♣ Agitation not influenced by external stimuli
♣ Grimacing
♣ Echolalia (meaningless repetition of another person’s spoken words)
♣ Echopraxia (meaningless repetition of the movements of others)

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Tx of catatonia

Lorazepam or ECT

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Which antipsychotics are available as long acting injectables

THINK: How Ridiculous, Paying For A hOle

H = Haloperidol
R = Risperidone
P = Paliperidole
F = Fluphenazine
A = Aripiprazole
O = Olanzapine

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Is rapid onset of schizophrenia a good or poor prognostic factor?

Good

Insidious onset is bad

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What psychotic feature is almost purely seen in psychiatric disorders (vs. medical causes of psychosis)

Auditory hallucinations

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What percentage of patients with a single psychotic episode will relapse off medication within 5 years

80%

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What psychiatric symptom is seen in 90% of all terminally ill patients

Delirium

Delusions, anxiety, and depression may also occur, but not with such overwhelming frequency

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Belief that familiar persons have been replaced by identical imposter who behave exactly like the original person

Capgras syndrome

Imposter wearing a cap has the real person hid in a cell in the backyards covered in grass

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Delusion that the person is a werewolf or other animal

Lycanthropy

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The false perception of having lost everything, including money, status, strength, health, and internal organs

Cotard syndrome

THINK: Dad CUT you off from trust fund and you also had organs CUT out

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Psychotic disorder in which one person develops psychotic symptoms similar to the ones a long-term partner has been experiencing

Folie a deux

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What drug is Seroquel

Quetiapine

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Visual hallucination of a transparent phantom of one’s own body

Autoscopic psychosis

Auto = self
Scope = seeing
Seeing onself

What drug is Prozac

Prozac/Fluoxetine

What drug is Zoloft

Zoloft/Sertraline

Diagnostic criteria/time frame for panic attacks

♣ Recurrent unexpected panic attacks (periods of intense fear and discomfort) without an identifiable trigger
♣ One or more panic attacks followed by > 1 month of continuous worry about future attacks

Defense mechanism: • Regulating situations and events of external environment to relieve anxiety

Controlling

Defense mechanism: • Unconsciously replacing warded-off feelings by emphasis on its opposite • Doing the opposite of an unacceptable impulse

Reaction formation

Defense mechanism: • Giving in to an impulse, even if socially inappropriate, in order to avoid the anxiety of suppressing that impulse • E.g. Man who has been told his therapist is going on vacation “forgets” his last appointment and skips it

Acting out

Defense mechanism: • Modeling behavior after another person who is more powerful • E.g. Abused child becomes an abuser

Identification

* Consciously replacing an unacceptable wish with a similar but acceptable course of action * E.g. Redirection of aggression towards father into sports

Sublimation

* Attempting to reverse a situation by adopting a new behavior * E.g. Man who has had a brief fantasy of killing his wife by sabotaging her car takes the car in for a complete checkup

Undoing

* Separating feelings from ideas and events * Unconsciously limiting the experience of feelings or emotions associated with a stressful life event in order to avoid anxiety * E.g. Describing murder in detail without an emotional response

Isolation of affect

Classical vs. Operant conditioning

- Classical conditioning = A stimulus can evoke a conditioned response (e.g. Pavlov’s dog) - Operant conditioning = Behaviors can be learned when followed by positive or negative reinforcement (e.g. rat learns to press lever when it receives food)

4 components of DBT

* Mindfulness = being fully aware and present in the moment * Distress Tolerance = tolerating pain in difficult situations * Interpersonal Effectiveness = how to ask for what you want and say no while maintaining self-respect and relationships with others * Emotion Regulation = changing emotions that you want to change

What disorders do psychoanalysis work best for

* Cluster B and C personality disorders * Anxiety disorders * Problems coping with life events * Sexual disorders * Persistent depressive disorder

Longest and shortest half-life SSRI, and shortest popular SSRI

Longest = Fluoxetine Shortest = Fluvoxamine Most common shortest = Paroxetine

What SSRI has the highest rate of QTc prolongation

Citalopram/Celexa But Escitalopram is an isomer of Citalopram that works almost exactly the same but you can use half the dose and still be as effective

What do you give to a male patient on an effective SSRI but with erectile dysfunction

Add Bupropion/Wellbutrin

What SSRI should you give to non-compliant patients

Fluoxetine (because it has the longest half-life)

Most common side effect of stimulants

Appetite suppression

Do you start with short- or long-acting stimulants in ADHD

Long acting

Why do drug-reps say that Vyvanse cannot be abused

Because Vyvanse is a pro-drug - needs to be processed by the liver before it becomes active drug

Risk factors for ADHD

Genetics (#1), in utero exposure to alcohol or nicotine, low birth weight

Effects in adulthood of untreated ADHD

Higher rate of substance use, depression, anxiety disorders, oppositional defiant disorder

What defines "rapid cycling" bipolar disorder

Presence of at least 4 mood episodes in the past 12 months that classify as either manic, hypomanic, or depressive

What is valium

Diazepam

What is Klonopin

Clonazepam

What is Xanax

Alprazolam

What is Ativan

Lorazepam

Rank the non-benzo hypnotics based on half-life, shortest to longest

Zaleplon < Zolpidem < Eszoplicone

MOA and uses of Hydroxyzine

Non-benzo anxiolytic | Antihistamine

Drug to treat narcolepsy

Modafinil - sleeping scout hitting sleep MODE

MOA of Atomoxetin

NET inhibitor