Psych 3 Flashcards
Major side effect of 1st gen antipsychotics
Extrapyrimidal sx:
- Dystonia (spasms) of face, neck, tongue
- Parkinsonism (resting tremor, rigidity, bradykinesia)
- Akathisia (restlessness)
Difference in side effects between high potency and low potency FGA
High potency = more extrapyrimidal side effects
Low potency = more anticholingeric and antiadrenergic side effects
Major side effect of 2nd gen antipsychotics
Metabolic syndrome:
Increased BP, increased blood sugar, excess body fat, abnl cholesterol
DSM Criteria of Schizoaffective Disorder
- Meet criteria for either a major depressive or manic episode during which psychotic sx consistent with schizophrenia are also met
- Delusions or hallucinations for 2 weeks in the absence of mood disorder sx (to differentiate from mood disorder with psychotic features)
Laymens terms: Mood episodes and active symptoms of schizophrenia occurring at the same time + at least 2 week lifetime history of delusions or hallucinations in the absence of prominent mood symptoms
Aka normal schizo sometimes and schizo + mood at other times
DSM criteria and time frame for delusional disorder
- One or more delusions for at least 1 month
- Does not meet criteria for schizophrenia
- Functioning in life not significantly impaired and behavior not obviously bizarre
Average age of onset of delusional disorder
After age 40
Delusion that another person is in love with the individual
Erotomanic type of delusional disorder
Delusions of having great talent
Grandoise type of delusional disorder
Physical delusions
Somatic type of delusional disorder
Delusions of being persecuted
Persecutory type of delusional disorder
Delusions of unfaithfulness
Jealous type of delusional disorder
Tx of delusional disorder
Difficult to treat
Antipsychotics, supportive therapy
Intense anxiety that penis will recede into body, possibly leading to death
Koro
Sudden unprovoked outburts of violence, often followed by suicide
Amok
What is schizotypal personality disorder
Paranoid, odd or magical beliefs, eccentric
What is schizoid personality disorder
distant, detached, unemotional, and prefer to be alone
DSM criteria for major depressive episode (including time frame)
At least 5 of the following sx for at least 2-weeks:
- Depressed mood most of the time
- Anhedonia
- Change in appetite or weight
- Worthlessness or guilt
- Insomnia or hypersomnia
- Diminished conentration
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Recurrent thoughts of death or suicide
DSM criteria of manic episode (including time frame)
Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistenlty increased goal-directed activity or energy lasting at least 1 week (or any duration if hospitalization necessary) and including at least 3 of the following:
- Distractibility
- Inflated self-esteem or grandiosity
- Increase in goal directed activity or psychomotor agitation
- Decreased need for sleep
- Flight of ideas or racing thoughts
- Talkative or pressured speech
- Excessive involvement in pleasure activities
DIG FAST
Distractibility Insomnia/Impulsive behavior Grandiosity Flight of ideas/racing thoughts Activity/agitation Speech pressured Thoughtlessness
Difference between mania and hypomania
Mania lasts at least 7 days vs. hypomania at least 4 days
Hypomania does not cause marked impairment in social or occupational functioning
No psychotic features in hypomania
DSM Criteria for MDD
At least one major depressive episode
No history of manic or hypomanic episodes
What type of sleep disturbance is most common in MDD
Initial and terminal insomnia (hard to fall asleep and early morning awakenings)
Less likely to have hypersomnia
How long do major depressive episodes usually last
6-12 months
Pharmacotherapy for MDD
SSRI, SNRI, TCA, MAOI
Main side effects of SSRI
HA, GI disturbance, sexual dysfunction, rebound anxiety
Side effects of TCAs
Cardiac arrhythmias, sedation, weight gain orthostatic hypotension, anticholinergic effects
Side effects of MAOIs
Hypertensive crisis when used with sympathomimetics or ingestion of tyramine-rich foods, Serotonin syndrome, orthostatic hypotension
Tx of MDD with psychotic features
Antidepressant + atypical antipsychotics
What is mood reactivity
Can be an atypical feature of MDD where mood brightens in response to positive events
What classifies as melancholic features of MDD
Anhedonia, early morning awakenings, depression worse in morning, psychomotor disturbance, excessive guilt, anorexia
What classifies as atypical features of MDD
Hypersomnia, hyperphagia, reactive mood, leaden paralysis, and hypersensitivity to interpersonal rejection
What classifies as mixed features of MDD
Manic/hypomanic sx present during the majority of days of MDE: elevated mood, grandiosity, talkativeness/pressured speech, flight of ideas/racing thoughts, increased energy/goal-directed activity, excessive involvement in dangerous activities, and decreased need for sleep
What classifies as catatonia within MDD
Features include catalepsy (immobility), purposeless motor activity, extreme negativism or mutism, bizarre postures, and echolalia (meaningless repetition of another person’s words)
What classifies as psychotic features within MDD
Presence of delusions and/or hallucinations
What classifies as anxious distress within MDD
Feeling keyed up/tense, restless, difficulty concentrating, fears of something bad happening, and feelings of loss of control
What classifies as peripartum onset of MDD
Onset of MDD sx occurs during pregnancy or 4 weeks following deliver
What classifies as seasonal pattern of MDD
Temporal relationship between onset of MDD and particular time of the year
Triad for seasonal affective disorder:
(1) Irritability
(2) Carbohydrate craving
(3) Hypersomnia
Tx for Seasonal affective disorder
Light therapy
Effective treatment for catatonia
Electroconvulsive therapy (ECT)
Diagnostic criteria for Bipolar I Disorder
Only requirement is the occurrence of a manic episode
Manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes
Components of manic episode
During period of mood disturbance and increased energy, three or more of the following sx present to a significant degree:
DIG FAST:
- Distractibility (attention easily drawn to unimportant stimuli
- Insomnia or decreased need for sleep
- Grandiosity or inflated self esteem
- Flight of ideas or subjective experience that thoughts are racing
- Agitation (purposeless activity) or increased goal-directed activity
- Speech pressured
- Thoughtlessess (e.g. reckless activities)
Pharmacotherapy for Bipolar I
- Lithium (mood stabilizer)
- Anticonvulsants: Carbamazepine and Valproic acid (mood stabilizer)
- Atypical antipsychotics for acute mania
Antidepressants are usually discouraged due to concern for activating mania or hypomania
Pharmacotherapy for Bipolar I
- Lithium (mood stabilizer)
- Anticonvulsants: Carbamazepine and Valproic acid (mood stabilizer)
- Atypical antipsychotics for acute mania
Antidepressants are usually discouraged due to concern for activating mania or hypomania
Best treatment for a pregnant woman who is having a manic episode
ECT
Diagnostic criteria of Bipolar II
One or more major depressive episode + at least one hypomanic episode
If there has been a full manic episode, even in the past, then the diagnosis is Bipolar I not Bipolar II
Tx of Bipolar II
Currently same as Bipolar I (Lithium, Carbamazepine, Valproic acid, atypical antipsychotics)
