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Psych Flashcards

1
Q

Difference btw schizophrenia, schizophreniform, and brief psychotic disorder

A

brief psychosis < 1 month
Schizophreniform 1-6 months
Schizophrenia > 6 months

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2
Q

Adjustment disorder time frame

A

Occurs within three months of a stressor and lasts no more than six months with anxiety/depression/disturbed behavior

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3
Q

Features of narcolepsy

A 
Sudden naps 3x/week for 3 months
At least one of the following:
1. cataplexy
2. los CSF hypocretin-1
3. shortened REM latency

Associated with hallucinations right before or after sleep and sleep paralysis

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4
Q

Diff btw narcolepsy and hypersomnolence

A

persistent daytime sleepiness that are not refreshed with napping

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5
Q

Difference between classical and operant conditioning

A

Operant conditioning produces a particular action. Classical conditioning elicits a natural response (like salivation

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6
Q

Transference

A

projection of feelings towards other persons onto physician (i.e. treating physician like parent)

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7
Q

Dissociation

A

ego defense: temporary change in personality, memory, consciousness, or motor behavior

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8
Q

Displacement

A

feelings (anger) transferred to another person (vs transference, where you are treating one person as if they are someone else)

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9
Q

Fixation

A

Staying at a childish level

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10
Q

Identification

A

Modeling behavior after another more powerful person

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11
Q

Infant deprivation effects

A

Weak wordless, wanting (socially), and wary

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12
Q

how long infant deprived for irreversible effects?

A

6 months

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13
Q

Peak incidence of child abuse

A

9-12 years

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14
Q

common signs of child abuse

A

retinal hemorrhage
detachment
coup-countercoup head trauma

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15
Q

What is the most common form of child maltreatment?

A

neglect

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16
Q

ADHD onset before age

A

7

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17
Q

brain in ADHD

A

decreased frontal lobe volume

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18
Q

Tx: ADHD

A

methylphenidate, amphetamine, atomoxetine

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19
Q

Oppositional defiant disorder

A

hostile, defiant toward authority, without violating serious social norms (conduct disorder)

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20
Q

How long to have sx to be diagnosed with tourette’s

A

Over 1 year

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21
Q

Coprolalia

A

Involuntary obscene speech

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22
Q

Tourettes associ’d with

A

OCD

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23
Q

Tx: tourette’s

A

antipsychotics/behavioral therapy

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24
Q

Tourette’s onset

A

Before age 18

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25
Q

Age group for separation anxiety disorder

A

7-9 years

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26
Q

Presentation: separation anxiety disorder

A

fear of separation from home or loss of parent. May make up excuses to stay at home

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27
Q

Tx: separation anxiety disorder:

A

SSRI/behavior

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28
Q

Narcolepsy caused by

A

loss of hypocretin-1/2

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29
Q

pointing

A

social development 1 year

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30
Q

Lots of imitation

A

social development 2 year

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31
Q

Parallel play

A

social development 3 year

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32
Q

cooperative play

A

4 yr

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33
Q

pincer development

A

1 yr

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34
Q

walking

A

1 year

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35
Q

says mom or dad

A

1 year

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36
Q

page turn

A

2 yr

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37
Q

draw shapes

A

3 yr

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38
Q

dress self

A

4 yr

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39
Q

jump

A

2 yr

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40
Q

tricycle

A

3 yr

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41
Q

run

A

4 yr

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42
Q

simple sentence

A

3yr

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43
Q

complex sentence

A

4 yr

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44
Q

2 words

A

2 yr

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45
Q

Tx: autism

A

behavioral/supportive

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46
Q

Signs autism

A

language impairment, poor social skills, focus on objects, repetitive behavior

–>usually below normal intelligence

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47
Q

Asperger’s

A

normal intelligence, no verbal deficits

–problems socially, repetitive behavior and all-absorbing interests

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48
Q

Inheritance of rett’s

A

X-linked

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49
Q

Rett’s

A

regression age 1-4
loss of development, verbal skills, and retardation
STEREOTYPED HAND WRINGING
ataxia

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50
Q

Childhood disintegrative disorder

A

2 years of normal development

-Loss of language skills, social skills, bowel/bladder control, play/motor skills

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51
Q

which childhood development disorder is more common in boys

A

Childhood disintegrative disorder and autism

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52
Q

Anxiety neurotransmitters

A

Increased NE
Decreased GABA
Decreased Serotonin

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53
Q

Alzheimer’s neurotransmitters

A

decreased Ach

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54
Q

Huntington’s neurotransmitters

A

Decreased Gaba
Decreased Ach
Increased dopamine

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55
Q

Parkinson’s neurotransmitters

A

Increased serotonin, increased Ach, decreased dopamine

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56
Q

Korsakoff’s amnesia

A

ANTEROGRADE amnesia with confabulations

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57
Q

Dissociative amnesia

A

Forget important personal information after trauma/stress (i.e. borne identity)

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58
Q

Delirium vs dementia

A

Delirium has decreased arousal. Also, more likely reversible and 2ndary cause.

Will see hallucinations, in dementia usually not the case

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59
Q

EEG in delirium

A

Abnormal

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60
Q

Which drugs likely for delirium

A

anticholinergic drugs (atropine, benztropine)

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61
Q

Pseudodementia

A

In elderly pts, depression can present as dementia

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62
Q

EEG in dementia

A

normal

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63
Q

Olfactory hallucination associated with:

A

epilepsy/brain tumor

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64
Q

Tactile hallucinations

A

alcohol withdrawal

Cocaine abusers

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65
Q

Schizophrenic brain

A

decreased dendritic branching

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66
Q

schizophrenia associated with

A

frequent cannabis use

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67
Q

Positive sx in schizo

A

Delusions
hallucinations
disorganized speech
disorganized/catatonic behavior

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68
Q

Negative sx in schizo

A

flat affect
social withdrawal
lack of motivation
lack of speech/thought

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69
Q

Five subtypes of schizo

A 
paranoid
disorganized
catatonic (automatism)
Undifferentiated
Residual
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70
Q

Delusional disorder

A

Fixed false belief lasting > 1 month

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71
Q

Dissociative identity disorder

A

Tamu.

At least 2 personalities

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72
Q

Dissociative identity disorder associ’d with

A

sexual abuse

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73
Q

Persistent feelings of detachment/estrangement from body, social situation, environment

A

depersonalization disorder

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74
Q

Abrupt change in geographic location with inability to recall past, may assume new identity with SIGNIFICANT DISTRESS

A

dissociative fugue

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75
Q

dissociative fugue associated with:

A

natural disaster, wartime, trauma

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76
Q

Manic sx:

A 
DIG FAST
distractible
irresponsible
grandiosity
flight of ideas
agitation/activity
sleep (less needed)
talkative
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77
Q

Criteria for manic episode

A

At least 1 week

  • 3/7 sx
  • OR if hospitalized
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78
Q

Hypomanic episode

A

Same as manic, but less than a week or not enough disturbance to impair/hospitalize

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79
Q

Bipolar disorder always requires

A

depressive sx

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80
Q

What can precipitate a manic episode

A

antidepressants

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81
Q

What r u most worried about in manic episode

A

suicide risk

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82
Q

Tx for bipolar disorder

A

lithium, valproid acid, carbamazepine

atypical antipsychotics

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83
Q

Bipolar I vs bipolar II

A

Bipolar I: 1 manic episode

Bipolar 2: 1 hypomanic episode

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84
Q

cyclothymic disorder

A

mild bipolar, lasting 2 YEARS

-alternating mild depression and hypomania

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85
Q

MDD sx

A 
SIG E CAPS
sleep disturbed
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor agitation/retardation
Suicidal ideation
Oh, and FEELING DEPRESSED
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86
Q

Criteria for MDD:

A

5/9 Sx for at least 2 weeks

Episodes usually last 6-12 months

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87
Q

Dysthymia

A

mild depression lasting at least 2 years

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88
Q

Atypical depression

A

Hypersomnia/weight gain instead of lack of sleep/weight loss

  • leaden paralysis
  • sensitivity to interpersonal rejection
  • reactive mood
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89
Q

Incidence of baby blues

A

50-85%

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90
Q

Incidence of postpartum depression

A

10-15%

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91
Q

Sx of baby blues

A

depressed affect, tearfulness, and fatigue 2-3 days after delivery. MUST RESOLVE in 2 weeks.

92
Q

Tx of baby blues

A

support and follow up

93
Q

Pospartum depression

A

depressed affect, anxiety, and concentration 4 weeks after delivery. Lasts at least 2 weeks-1 year

94
Q

Postpartum psychosis

A

delusions/hallucination. May have homicidal ideation. Lasts days to 4-6 weeks

95
Q

Tx: postpartum psychosis

A

antipsychotics, antidepressants, inpatient hospitalization

96
Q

A post-partum mother says she feels depressed. How do you know if it is regular MDD or postpartum depression?

A

If < 4 weeks after delivery, then postpartum.

97
Q

When would you consider giving ECT?

A

Refractory MDD
Pregnant women with MDD
Catatonic, psychotic
Or acutely suicidal

98
Q

What are the major adverse effects of ECT?

A

amnesia and disorientation, but goes away after 6 months

99
Q

Risk factors for suicide completion

A 
SAD PERSONS
Sex
Age (teen/elderly)
Depression
Previous attempt
Ethanol/drug use
Rational thinking loss
Sickness
Organized plan
No spouse
Social support lacking
100
Q

Prevalence of anxiety disorders

A

30% in women, 19% in men

101
Q

Sx of panic disorders

A 
Palpitations
Paresthesias
Abdominal dispress
Nausea
Intense fear of dying
Lightheadedness
Chest pain
Chills
Choking
Sweating
Shaking
Shortness of breath

PPANICCCSSS

102
Q

Treatment of panic disorder

A

CBT
SSRI
Venlafaxine
Benzo

103
Q

Criteria for panic disorder

A

Discomfort peaking in 10 minutes with at least 4 sx

104
Q

Tx of phobia

105
Q

OCD associated with

106
Q

Treatment of OCD

A

SSRIs, clomipramine

107
Q

Acute stress disorder

A

PTSD: lasts between 2 days and 1 month

108
Q

Sx of PTSD

A

flashbacks, fear, helplessness, horror

-Avoidance of stimuli associated with trauma

109
Q

Criteria for PTSD

A

Disturbance for at least 1 month with significant distress.

110
Q

Treatment for PTSD

A

psychotherapy and SSRIs

111
Q

Generalized anxiety disorder

A

anxiety for at least 6 months

112
Q

Tx for generalized anxiety

113
Q

Adjustment disorder

A

emotional anxiety/depression after a distinct stressor lasting LESS than 6 months

114
Q

Somatization disorder

A

multiple organ system (4 pain, 2 GI, 1 sexual, 1 pseudoneuro like sz or loss of feeling)
-Must occur before the age of 30

115
Q

Conversion disorder

A

Sudden loss of sensory or motor function after an acute stressor. More common in females and adolescents.

116
Q

la belle indifference

A

seen in conversion disorder.

117
Q

How old does pt have to be to dx a personality disorder

118
Q

Cluster A personalities

A

paranoid, schizoid, schizotypal

119
Q

Cluster B disorders

A

antisocial, borderline, histrionic, narcissistic

120
Q

Cluster C personality disorders

A

Avoidant
Obsessive compulsive
dependent

121
Q

cluster A disorders associated with

A

schizophrenia

122
Q

cluster B disorders associated with

A

mood disorder and substance abuse

123
Q

cluster C disorders associated with

A

anxiety disorders

124
Q

avoidant personality

A

wants relationship with others, but inhibited/timid

125
Q

Egosyntonic/egodystonic example

A

OCPD is egosyntonic

OCD is egodystonic

126
Q

Anorexia nervosa associated with

A

depression

127
Q

Bulimia nervosa side efects

A

parotitis, enamel erosion, electrolyte disturbances, alkalosis

128
Q

russell’s sign

A

dorsal hand caluses from induced vomiting

129
Q

signs of substance dependence

A 
tolerance
withdrawal
more taken than desired
persistent desire or attempt to cut down
significant energy spent on getting substance
reduced social/occupational activities reduced
Continued use despite problems
--3+ needed!
130
Q

Substance abuse

A

failure to fulfill major obligations at home/work
use in physically hazardous situations
legal problems
persistent problems, yet continued use

131
Q

sensitive test for alcohol use

A

gamma-glutamyltransferse (GGT)

132
Q

Signs of alcohol withdrawal

A

anxiety, insomnia, tremor.

Severe=autonomic hyperactivity and delirium tremens

133
Q

opoid signs

A

respiratory/CNS depression
Decreased gag reflex
Pupil constriction
Seizures

134
Q

Tx for opioid overdose

A

naloxone/naltrexone

135
Q

Opioid withdrawal

A

dilated pupils, piloerection, fever sweating, rhinorrhea, diarrhea, GI, (flu like sx) YAWNING

136
Q

why would you use benzos before barbiturates?

A

greater safety margin

137
Q

Sign of barbiturate tox

A

Marked respiratory depression

138
Q

barbiturate withdrawal

A

delirium, CV collapse

139
Q

benzo intox:

A

ataxia, mild respiratory depression

140
Q

tx: benzo overdose

A

flumenazil

141
Q

benzo withdrawal

A

anxiety, seizure, sleep disturbance, depression

142
Q

euphoria, grandiosity, pupillary dilation, wakefullness and attention, hypertension, tachycardia, paranoia, fever

A

amphetamines

143
Q

pupillary dilation, hallucinations (tactile), paranoid ideation, sudden cardiac death

144
Q

tx for cocaine o/d

145
Q

anhedonia, increased appetite, hypersomnolence

A

amphetamine withdrawal

146
Q

nictotine withdrawal

A

irritability, anxiety, craving

147
Q

drugs for nicotine withdrawal

A

buproprion/varenicline

148
Q

hypersomnolence, malaise, severe craving, depression/suicidality

A

cocaine withdrawal

149
Q

belligerence, impulsiveness, vertical + horizontal nystagmus, homicidality, psychosis, seizures

150
Q

tx for PCP

A

benzo or antipsychotic

151
Q

depression, anxiety, irritability, restless, anergia, disturbed thoughts/sleep

A

PCP withdrawal

152
Q

anxiety, paranoia, visual auditory distortion, depersonalization

153
Q

how long is MJ detected in urine

154
Q

how long do MJ sx last

A

5-7 days but peak in 48 hours

155
Q

dronabinol

A

prescription MJ, for chemo or appetite stimulant in AIDS

156
Q

Heroin users are at risk for

A

hepatitis, abscess, hemorrhoids

157
Q

Methadone

A

long acting opiate

158
Q

naloxone plus buprenorphine

A

partial agonist do decrease withdrawal. naloxone blocks the opioid receptor and becomes active if injected to prevent buprenorphine from being abused

159
Q

wernicke’s encaphalopathy

A

confusion
opthalmoplegia
ataxia

160
Q

korsakoff’s psychosis

A

loss of memory making capabilities

161
Q

When does DT occur?

A

2-5 days after last drink

162
Q

sx of DT

A

tachy, tremor, anxiety, seizures
THEN
psychotic symptoms and confusion

163
Q

bulimia tx

164
Q

tx: panic disorder

A

SSRI, venlafaxine, benzodiazepine

165
Q

Tx: tourette’s

A

haloperidol, resperidone, other antipsychotics

166
Q

mechanism methylphenidate, destroamphetamine, methamphetamine

A

Increase NE and dopamine at synaptic cleft

167
Q

name the antipsychotics

A

haloperidol, trigluoperazine, fluphenazine, thioridazine, chlorpromazine (haloperidol + azines)

168
Q

Mechanism antipsych

A

block D2 dopamine receptors

–>increased cAMP

169
Q

High potency antipsych

A

Trifluoperazine, fluphenazine, haloperidol

170
Q

Low potency antipsych

A

Chlorpromazine, thioridazine

171
Q

side effects of high potency antipsychotics

A 
extrapyramidal sx:
dystonia (4 hr)
akathisia (4 day)
bradykinesia (4 wks)
tardive dyskinesia (4 mos)
172
Q

chlorpromazine side effect

A

corneal deposits

173
Q

thioridazine side effects

A

reTinal deposits

174
Q

haloperidol side effects

A

tardive dyskinesia and neuroleptic malignant syndrome

175
Q

antipsychotic side effects:

A

endocrine (galactorrhea from dopamine block)
dry mouth, constipation,
hypotension
sedation (histamine receptor block)

176
Q

Neuroleptic malignant syndrome signs

A

rigidity
myoglobinuria
autonomic instability
fever

177
Q

Tx of neuroleptic malignant syndrome

A

dantrolene or

bromocriptine (D2 agonist)

178
Q

Is tardive dyskinesia reversible?

179
Q

Atypical antipsychotics

A 
Olanzapine
Clozapine
quetiapine
risperidone
aripiprazole
ziprasidone
180
Q

Atypical antipsychotic uses

A

bipolar, OCD, anxiety, depression, tourettes

181
Q

olanzapine side effect

A

weight gain

182
Q

clozapine side effect

A

agranulocytosis
seizure
weight gain

183
Q

ziprasidone side effect

A

prolongation of QT interval

184
Q

Lithium side effects

A

LMNOP

Movement
Nephrogenic diabetes insipidus
Hypothyroid
pregnancy problems

185
Q

Clinical use of lithium

A

bipolar

SIADH

186
Q

lithium birth defect

A

ebstein anomaly

malformation of vessels

187
Q

What do you need to monitor with lithium

A

Check serum levels frequently cause narrow therapeutic window. Excreted by kidneys

188
Q

Buspirone: mechanism

A

stimulates serotonin1A receptors

189
Q

buspirone clinical use

A

generalized anxiety disorder

190
Q

benefits of buspirone

A

no addiction/sedation/tolerance. BUT takes 1-2 weeks to work

191
Q

Name the SSRIs

A

fluoxetine
paroxetine
sertraline
citalopram

192
Q

How long does it take for antidepressants to have an effect

193
Q

tox: SSRI

A

GI distress
serotonin syndrome
sexual dysfunction

194
Q

serotonin syndrome

A 
clonus
hyperthermia
tremor
flushing, diarrhea
CV collapse
195
Q

tx: serotonin syndrome

A

cyproheptadine, a serotonin antagonist

196
Q

SNRIs

A

venlafaxine, duloxetine

197
Q

venlafaxine indications

A

depression, anxiety, panic disorder

198
Q

duloxetine indications

A

diabetic peripheral neuropathy.

199
Q

tox of SNRI

A

increased BP, stimulant effect

200
Q

TCAs

A

-tryptyline
-imipramine
doxepin
amoxapine

201
Q

Mechanism of TCA

A

block reuptake of NE and serotonin

202
Q

clinical use of imipramine

A

depression, bed wetting

203
Q

clinical use clomipramine

A

OCD/depression

204
Q

clinical use TCA

A

fibromyalgia/depression

205
Q

Side effect of TCA

A

convulsions, coma, cardiotoxicity

  • postural hypotension
  • atropine like effects
206
Q

which TCA to give to elderly

A

nortriptyline

-fewer anticholinergic side effects causing confusion and hallucinations

207
Q

desipramine effect

A

less sedating higher seizure threshold

208
Q

MAO inhibitors

A

tranylcypromine
phenelzine
isocarboxazid
selegiline

MAO takes pride in shanghai

209
Q

MAO uses

A

atypical depression
anxiety
hypochondriasis

210
Q

MAO side effect

A

hypertensive crisis with tyramine

Contraindicated with SSRI, TCA, st. John’s Wort, meperidine, and dextromethorphan to prevent serotonin syndrome

211
Q

Atypical antidepressants

A

bupropion
mirtazapine
maprotiline
trazodone

212
Q

Mechanism of bupropion

A

Increase Ne and dopamine

213
Q

Bupropion tox

A

tachycardia, insomnia, but NO SEX SIDE EFFECTS

214
Q

who is bupropion contraindicated in?

A

bulimic pts–seizure risk

215
Q

mirtazapine

A

alpha-2 and 5-HT antagonist (increases release of NE and serotonin)

216
Q

tox: mirtazapine

A

sedation
appetite
weight gain
dry mouth

217
Q

maprotiline mech

A

blocks NE reuptake

218
Q

maprotiline tox:

A

sedation, hypotension

219
Q

trazodone mech

A

inhibits serotonin reuptake

220
Q

trazodone use

221
Q

tox: trazodone

A

sedation, nausea, PRIAPISM, hypotension

222
Q

What is Epstein’s abnormality

A

Apical displacement of tricuspid valve with a SMALLER right ventricle. Also atrialization of the right ventricle.

223
Q

Fetal alcohol syndrome

A
  1. facial anomalies
  2. Growth retardation
  3. Mental retardation
224
Q

Schizoaffective disorder

A

at least 2 weeks of stable mood with ONLY psychotic symptoms PLUS a major depressive, manic, or mixed episode.

Differentiate from bipolar disorder/MDD with psychotic features–psychotic features only occur DURING an episode

225
Q

Risperidone side effect

A

Hyperprolactinemia, with breast soreness and amenorrhea.

low dopamine in the brain causes high prolactin. Inhibits GnRH

226
Q

What does carbidopa not reduce in the side effects of levodopa?

A

anxiety and agitation

227
Q

Undoing defense mechanism

A

confession or atonement to nullify unacceptable thought

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