Psych Flashcards
Time course difference in schizo, schizophreniform, brief psychotic.*
Brief Psychotic: present < 1 mo
Schizophreniform: 1-6 mo
Schizophrenia: 6 mo
Schizoaffective: 2 wks of just psychosis
Difference between conversion vs. somatization disorder
Conversion: unconscious NEURO sx after a life stressor, la belle indifference
Somatization: 4 pain, 2 GI, 1 sex, 1 neuro “so many probs”
What benzodiazepine has a short half life?
Triazolam
Acute Stress vs. PTSD time frame?*
Acute Stress: < 4 wks
PTSD: >/= 4 wks
Time course for postpartum blues, depression, psychosis.
Blues: 2-3 days up to 10 days
Depression: > 2 wks; antidepressants
Psychosis: typically days - 4-6wks postpartum; antipsychotics
In what cases are MAOI particularly useful?
Atypical depression (mood reactivity, leaden paralysis, increased sleep and appetite, rejection sensitivity)
Treatment resistant depression
Narcolepsy - Mech and Tx
Sx: excessive daytime sleepiness, cataplexy, hypnogogic, hypnopompic hallucinations
Mech:
Dec. hypocretin-1 secretion by lateral hypothalamus
Tx:
- Daytime stimulants (modafinil, amphetamine)
- PM sodium oxybate (GHB)
What is the “on-off” vs. “wearing off” phenomenon of Parkinson’s tx?
“On-off” = UNPREDICTABLE, dose-independent.
- sudden loss of anti-parkinson effects of L dopa, and can be worse than pt’s original symptoms
“Wearing off” = more predictable
- progressive destruction of nigrastriatal dominergic neurons.
What is common adverse effect in SSRI?
sexual dysfxn.
Globus Hystericus Vs. Pseudobulbar Paresis
Globus Hystericus: “lump in the throat” without accompanying physical, endoscopic, radiographic, or esophageal findings of obstruction. Emotions trigger it.
Pseudobulbar Paresis: dysarthria, dysphagia, dysphonia, impaired movement of the tongue and facial muscles. Caused by conditions such as multiple sclerosis.
Most common cause of death with TCA? Mech?
Cardiac Arrhythmia (prolongation of QRS, neg inotrope) and Refractory Hypotension (due to dec. contractility, direct anti-alpha1 effect)
Blocks Cardiac Fast Na channels!
Lithium Side Effects. Toxicity increased with what drugs?
LMNOP: Lithium Side effects: Movement (tremor) Nephrogenic Diabetes Insipidous HypOthyroidism Pregnancy Probs - Ebstein's Anomaly.
Increased Toxicity with
- HCTZ
- ACEi
- NSAIDS
Tx of Serotonin Syndrome
Cyproheptadine - 1st generation antihistamine with nonspecific 5HT-R antagonist properties
HTN crisis after a wine and cheese party - what med is he on?
MAOI
Tyramine containing foods = wine, cheese, sausage.
EPS side effects in terms of time frame
4 hr acute dystonia
4 day akathisia
4 wk bradykinesia/parkinson
4 mo tardive dyskinesia.
High Potency vs. Low Potency antipsychotics
High: “try to fly high”
trifluoperazine
fluphenazine
haloperidol
Low: “cheating thieves are low”
chlorpromazine - Corneal deposits
thioridazine - reTinal deposits
Impt side effects for atypical antipsychotics
Olanzapine/Clozapine = weight gain
Clozapine = agranulocytosis
Risperidone = increase prolactin - irregular menstruation, fertility issues.
Ziprasidone = prolong QT
Side effects of Lithium
LMNOP: Li side effects: Movement (tremor) Nephrogenic Diabetes Insipidous HypOthyroidism Preg probs - Ebsteins.
Excreted by kidneys.
Increased toxicity with:
- HCTZ
- ACEi
- NSAIDS
How to treat serotonin syndrome?
Cyproheptadine 5HT2-R antagonist.
TCA side effects
Tri-C:
Convulsions
Coma
Cardiotoxicity
Tx: NaHCO3
What are the MAOIs?
MAO Takes Pride In Shanghai
Tranylcypromine
Phenelzine
Isocarboxazid
Seleginine
Bupropion
DNRI
Smoking cessation
No sexual side effects
Tox:
stimulatory effects
seizure in bulimics
Mirtazapine
alpha2 antagonist - Inc. NE and 5HT
Tox:
sedation - good for depressed with insomnia
inc. appetite
weight gain - good in old, anorexic peeps
dry mouth
Trazodone
blocks 5HT2 and a1-R
Insomnia
Tox:
priapism, hypotension.
