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Cheng-Ching > Psych > Flashcards

Psych Flashcards

1
Q

MDD vs depressive episode vs dysthymia vs adjustment disorder

A

-major depressive episode: clear cut episode SIGECAPS 5/9

MDD: 2 episodes, 2 months apart persistent residual symptoms, SI

persistent depressive disorder=dysthymia: insidious, chronic depressive Sx most of the day, hopeless, anhedonia; no SI

-no racial differences in occurrences of depression, 2x F>M
-peak 30s, 40s, more common in low SES + urban areas
-genetics: explain 50-70% mood disorders

adjustment: Sx within 3 months Sx onset, last <6 months beyond stressor
-if bereavement lasts >2 months or more excessive

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2
Q

pathophys depression

A

DLPFC hypometabolic
OFC hypermetabolic - pharmaco can reverse
DBS - cingulate gyrus
-elevated corticotropin releasing hormone

-reserpine: blocks VMAT vesicular monoamine transportes- depletes monoamines -induces depression

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3
Q

Bipolar I
Bipolar II
cyclothymic disorder

A

Bipolar I-one manic episode (don’t need depression)
Bipolar II-one hypomanic episode (don’t need depression)
cyclothymic -2 years hypomania + depressive Sx not meeting criteria

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4
Q

panic attack vs panic disorder

A

panic attack - physical symptom, derealization

disorder - recurrent panic attacks, +/- agoraphobia - fear of being in situation where escape difficult
r/o thyroid, pheochromocytoma, arrhythmia

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5
Q

dissociative amnesia vs dissociative fugue vs depersonalization vs dissociative identity

A

-amnesia - loss of personal experiences
-depersonalization-detachment from oneself as if you are an outsider
-dissociative identity-multiple erpsonality
dissociative fugue - travel away from environment, assume new identity

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6
Q

specific phobia vs social anxiety disorder vs agoraphobia

A

social anxiety=social phobia - fear of social/performance situation-eating, public speaking; fear of potential embarassment; can force themselves into social situation but have Sx

(vs phobia)-panic attack, avoid situation

vs agoraphobia - can’t escape

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7
Q

blood brain barrier

A

BBB: continuous tight junctions (not gap) btw brain cap endothelial, pericapillary glial cells

blood-CSF: tight junctions btw epithelial + choroid plexus
-neurotransmitter metabolites cleared via choroid plexus

-lipophilic, non-ionized drugs penetrate CNS better

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8
Q

schizophrenia vs schizoaffective

A

schizophrenia: 6 months, positive + negative Sx
-low SES a result of schizophrenia -downward drift ;
-equal in men and women;
-positive Sx earlier

schizoaffective: physotic disorder + mood disorder
-depression, manic or mixed + psychotic symptoms at the same time
-2 weeks of psychosis without mood Sx
- mood Sx predominant

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9
Q

antidepressants-TCAs

A

TCAs-not if cardiac conduction abnormality, elderly
tertiary - Amitriptyline (most antimuscarinic effect), doxepin (most antihistamine, sedating), imipramine - inhibit reuptake 5HT+NE

-increase NE->good for pain

secondary amine - Clomipramine - inhibit reuptake 5HT, Desipramine (Norpramin), nortriptyline

-anti-muscarinic (postural hypotension)
histaminergic, alpha1 adrenergic R

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10
Q

5-HT

A

synthesized from tryptophan
metabolized through monoamine oxidase- MAO-A isoform
-MAO-A + MAO-B: detabolizes DA, triptamine
-selegiline: inhibits MAO-B

-raphe nucleus brainstem
-low 5-HIAA -aggressive violent behavior
-vasoconstriction
-antiemetic-ondansetron
-increases intestinal motility, bronchoconstriction

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11
Q

schizophrenia pathophys

A

-**schizophrenia: D2 receptor **overactivity DA-mesolimbic, mesocortical path
(not nigrostriatal, tuberoinfundibulum)
-increased DA R density postmortem

-MRI: ventricle enlargement, frontal/temporal/hippocampal, thalamus atrophy

-PET: hypometabolism DLPFC

-neg Sx: low DA in medial temp lob, DLPFC

-underactive glutamate - glutamate has NMDA R and non-NMDA R
(PCP, ketamine antagonists at NMDA-exacerbate psychosis)

-memantine: NMDA antagonist

-hallucinations induced by lysergic acid diethylamide LSD- serotonin agonist

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12
Q

intellectual disability

A

mild - IQ 55-70; mod 35-55; severe 20-35, profound <20

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13
Q

personality disorders

A

Cluster A - schizoid vs schizotypal vs paranoid- schizoid blunted affect, only immediate family friends; schizotypal=magical thinking

cluster b - histrionic, borderline

cluster C - dependent vs avoidant vs OCD
-avoidant: hypersensitivity to criticism, WANT relationships vs schizoid
-dependent-difficulty making decision, submissive, jump into relationships
OCDs - perfection without being productive, rigid and inflexible; hoarding; no definable obsessions and compulsions

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14
Q

ADHD

A

Sx before age 12
-Tx amphenatime, methylphenidates
-EKG before stimulant

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15
Q

SSRIs

A

-nausea b/c serotonin at 5HT3 in area postrema and GI tract

sertraline - least sedating
paroxetine - most anticholinergic -urinary retention, xerostomia
escitalopram-good for elderly
fluvoxamine -high drug drug interactions; warfarin

hyponatremia: 1st month starting but anytime -SIADH caused by 5HT
-esp fluoxetine, paroxetine

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16
Q

1st gen antipsychotics

A

1st gen-D2 blocker (star gazing “-azine”)
-QT prolongation
-metabolic syndrome
-extra-pyramidal-dystonia, akathesia, parkinsonism
-tardive dyskinesia

high potency FGAs - Haldol, fluphenazine (halo in starry night, flying angel) - high flying in sky
greater D2 blocking=more extra pyramidal
-NMS
-hyper PRL, amenorrhea

low potency D2-low to ground
-chlorpromazine (corneal deposits corn yellow paint),
thioridazine-“Color theory”: thioridazine - (retinal deposits on painters pallet on ground)

-higher antagonism muscarinic, adrenergic, histaminergic (sedating; dry mouth, constipation, blurred vision, orthostatic hypotension)
-less extra pyramidal

prochlorperazine = antiemetic DA blocker (compazine)

17
Q

2nd gen antipsychotics

A

2nd gen -atypical antipsychotics: antagonist at 5-HT2A; and block DA2
“Quite (quetiapine) please Only (olanzapine) Whispering (risperidone) is Appropriate (aripiprazole)”
Ziprasidone zipper, Clozapine closet

-Tx depression, positive + neg Sx schizophrenia better
-effect at muscarinic, adrenergic, histaminergic R
-less EPS b/c less DA2 blocking
-more risk metabolic disorder
-hyper Prolactin, amenorrhea

risperidone-OCD adjunct with SSRI (whispering to Extra pyramidal hat = most risk EPS)

-clozapine: seizures, agranulocytosis, weight gain, myocarditis ; least likely EPS (closet with surreal heart, shaking clock,

quetiapine-sedation, QT prolongation

olanzapine - highest antimuscarinic (urinary retention), weight gain, seizures

ziprasidone - QT prolongation

aripiprazole - least QT prolonging

18
Q

EPS

A

acute dystonia - benztropine, antimuscarinic

tardive dyskinesia - botox; DBS to GPi

19
Q

antiolytics

A

busprione - partial agonist at 5-HT1A
-weak D2 antagonist
-less sedating, less weight gain
SE: HA, dizziness, risk serotonin syndrome

20
Q

5HT syndrome

A

myoclonus, hyperreflexia, tremor
-supportive care

21
Q

glycine, Gaba

A

inhibitory neurotransmitters - glycine (“lie down”)

GABA A - ionotropic R - leads to opening chloride channel

GABA B - metabotropic R - G protein coupled inhibiting adenylyl cyclase - ** baclofen GABA B R agonist**

flumazenil - antagonist of benzos, not barbiturates - risk seizures

22
Q

atypical antidepressants

A

mirtazepine - antagonist at alpha 2; increases norepinephrine
-antagonist at 5-HT

bupropion - increases NE, DA (not serotonin)
-smoking cessation

trazodone, nefazodone - antagonist at 5-HT2
-risk priapism

23
Q

PTSD vs acute stress disorder

A

PTSD - need 4 weeks for Dx; if less than that acute stress

24
Q

excitatory neurotransmitters;

A

glutamate and aspartate
-glutamate - NMDA R (NMDA is agonist) and non-NMDA
-glutamate major neurotransmitter of BG
-glutamate excitotoxicity - ischemia, hypoglycemia

-long term potentiation - NMDA

memantine - NMDA antagonist
PCP, ketamine - NMDA antagonist

25
Q

ECT therapy, TMS therapy, VNS

A

TMS: seizures a risk even if no Hx epilepsy
-use to L DLPFC to Tx MDD

ECT: -goal of seizure

VNS - vagal N - nuc tractus solitarous, raphe nuc - alter serotonergic activity

26
Q

lithium

A

side effect tremor, thyroid, acne, nephrogenic DI ->**hypernatremia **
-contraindicated in sick sinus syndrome

Cheng-Ching (17 decks)

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