Psych Flashcards
MDD vs depressive episode vs dysthymia vs adjustment disorder
-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
pathophys depression
DLPFC hypometabolic
OFC hypermetabolic - pharmaco can reverse
DBS - cingulate gyrus
-elevated corticotropin releasing hormone
-reserpine: blocks VMAT vesicular monoamine transportes- depletes monoamines -induces depression
Bipolar I
Bipolar II
cyclothymic disorder
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
panic attack vs panic disorder
panic attack - physical symptom, derealization
disorder - recurrent panic attacks, +/- agoraphobia - fear of being in situation where escape difficult
r/o thyroid, pheochromocytoma, arrhythmia
dissociative amnesia vs dissociative fugue vs depersonalization vs dissociative identity
-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
specific phobia vs social anxiety disorder vs agoraphobia
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
blood brain barrier
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
schizophrenia vs schizoaffective
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
antidepressants-TCAs
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
5-HT
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
schizophrenia pathophys
-**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
intellectual disability
mild - IQ 55-70; mod 35-55; severe 20-35, profound <20
personality disorders
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
ADHD
Sx before age 12
-Tx amphenatime, methylphenidates
-EKG before stimulant
SSRIs
-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
1st gen antipsychotics
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)
2nd gen antipsychotics
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
EPS
acute dystonia - benztropine, antimuscarinic
tardive dyskinesia - botox; DBS to GPi
antiolytics
busprione - partial agonist at 5-HT1A
-weak D2 antagonist
-less sedating, less weight gain
SE: HA, dizziness, risk serotonin syndrome
5HT syndrome
myoclonus, hyperreflexia, tremor
-supportive care
glycine, Gaba
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
atypical antidepressants
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
PTSD vs acute stress disorder
PTSD - need 4 weeks for Dx; if less than that acute stress
excitatory neurotransmitters;
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
ECT therapy, TMS therapy, VNS
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
lithium
side effect tremor, thyroid, acne, nephrogenic DI ->**hypernatremia **
-contraindicated in sick sinus syndrome
