Psych 15 Flashcards
Likely diagnosis: delirium + elevated BP + papilledema
Hypertensive encephalopathy
Time frame of somatic sx disorder
At least 6 months
Time frame of illness anxiety disorder
At least 6 months
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
What other disorder do 65% of patients with kleptomania have?
Bulimia nervosa
Medication other than Dantrolene used to treat NMS
Bromocriptine (dopamine agonist)
Is lack of precipitating factors/stressors a good or poor prognosis of schizophrenia?
Poor
Time frame for delusional disorder
1 month
Think of crazy girl with erotomatic delusions celebrating her one month anniversary with celebrity
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)
Tx of catatonia
Lorazepam or ECT
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
Is rapid onset of schizophrenia a good or poor prognostic factor?
Good
Insidious onset is bad
What psychotic feature is almost purely seen in psychiatric disorders (vs. medical causes of psychosis)
Auditory hallucinations
What percentage of patients with a single psychotic episode will relapse off medication within 5 years
80%
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
Belief that familiar persons have been replaced by identical imposter who behave exactly like the original person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
Delusion that the person is a werewolf or other animal
Lycanthropy
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
Psychotic disorder in which one person develops psychotic symptoms similar to the ones a long-term partner has been experiencing
Folie a deux
What drug is Seroquel
Quetiapine
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
