w/ thiazide diuretics (not loop), ACE inhibitors, and NSAIDs - Increased proximal tubular resorption of Lithium and Sodium - Lithium can cause hypothyroidism and nephrogenic DI

Psych Flashcards by Imaan Ansari

Hallucinations of recently deceased relatives is:

Normal for children

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Discontinuation of MAOi (washout period)

Give 2 weeks of discontinuing MAOi before giving an SSRI to allow for MAO regeneration to prevent serotonin syndrome

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Kleine Levin

sleeping beauty syndrome, hypersomnia, hyperphagia, hypersexuality

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Kluver Bucy

hyperphagia, hypersexuality

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Neuroleptic Malignant Syndrome

Hyperthermia, muscle rigidity, rhabdomyolisis, mental status changes, muscle rigidity, and autonomic dysfunction
Antipsychotics that block D2 (dopamine) receptors

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Antidepressant Intoxication

MC cause of death is arrhythmia (sodium channel inhibition)

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Treat Serotonin Syndrome w/

Cyproheptadine

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Lithium Toxicity

w/ thiazide diuretics (not loop), ACE inhibitors, and NSAIDs

Increased proximal tubular resorption of Lithium and Sodium
Lithium can cause hypothyroidism and nephrogenic DI

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TCA Toxicity

can cause arrhythmias → treat with NaHCO3

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MAO inhibitors used for:

atypical depression (mood reactivity) and treatment resistant depression

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Schizoaffective DIsorder

Psychotic episodes NOT during mood disturbances

- DIFFERENT from bipolar with psychotic symptoms (where psychotic sx only during mood episodes)

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Tremors, agitation, anxiety, delirium, psychosis, seizures, tachycardia, palpitations,

Alcohol Withdrawal

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Tremor, anxiety, perceptual disturbances, insomnia

Benzodiazapine Withdrawal

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Dilated pupils, yawning, lacrimation, nausea, vomiting, abdominal pain, muscle aches

Heroin Withdrawal

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Increased appetite, hypersomnia, intense psychomotor retardation, “crash”

Cocaine or Amphetamine Withdrawal

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Increased appetite, irritable, anxious

Nicotine withdrawal

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Respiratory and Cardiac depression, miosis, sedation, reduced GI motiliy

Opioid intoxication

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Low Potency vs High Potency Typical Antipsychotics

High: Haloperidol, Fluphenazine, Trifluoperizine
- more extrapyramidal Sx
Low: Thioridazine, Chlorpromazine
- sedation, orthostatic hypotension, and antichol effects

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Classical vs Operant Conditioning

Classical: involuntary response
Operant: voluntary response

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ADHD

Before age 12

Tx: methylphenidate (ritalin), amphetamines, atomoxetine

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Tourette’s

Usually age 7-9 (Onset before age 18 usually)
motor and vocal tics > 1 yr
(coprolalia is if its obscene speech)
- aw/ OCD and ADHD
- Tx: antipsychotics (haloperidol), pimozide

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Separation Anxiety Disorder

7-9 yrs

SSRIs, or relaxation techniques/behavioral interventions

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Rett Disorder

Almost exclusively girls (1-4 yrs) [males die in utero]
X-linked
regression and stereotyped hand wringing

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Orientation: Order of loss

Time then Place then Person

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Manic Episode

at least 1 week

Hypomania Episode

at least 4 consecutive days

Bipolar I

1 manic +/- a hypomanic or depressive episode

Bipolar II

hypomanic + depressive | - use of antidepressants may cause increased mania

Cyclothymic Disorder

dysthymia + hypomania | at least 2 yrs

Dysthymia

at least 2 years

Major Depressive Disorder

at least 2 weeks

Sleep in Depression

Increased total REM (decreased REM latency) Early morning awakenings Less slow wave sleep

Postpartum Blues vs Postpartum Depression

Blues should resolve within 10 days PPD lasts over 2 weeks (hopeless, guilty, etc) [Postpartum psychosis may last 4-6 weeks]

Normal Bereavement

up to 6-12 months

Electroconvulsive Therapy

Safe for treating depression in pregnant women | - temporary headache and partial amnesia that resolves in 6 months

Risks of Suicide

Male, teen or elderly, depression, previous attempt, access to firearms, chronic illness/meds, organized plan, unmarried or no social support

Panic Disorder

Attack followed by 1 month or more of: - persistent concern about additional attacks - worry about consequences of attack - behavioral changes related to attack

Generalized Anxiety Disorder vs Adjustment Disorder

GAD >6 months | Adjustment:

Acute Stress Disorder

Less than one month

PTSD

> 1 month

Tx: OCD

SSRI, Clomipramine

Conversion Disorder

La belle indifference | sudden loss of sensory or motor function (paralysis, blindness, mutism, seizure) after an acute stressor

Personality Disorders

A: Eccentric B: Dramatic C: Anxious

Suboxone= Naloxone + Buprenorphine

Naloxone is not active orally (prevents withdrawal if injected) Buprenorphine: partial agonist

Naltrexone

Long acting opioid antagonists to prevent relapse once detoxified

Disulfiram

Inhibits acetaldehyde dehydrogenase --> increasing hangover sx

Chlorpromazine: specific side effect

corneal deposits

Thioridazine: specific side effect

retinal deposits

Haloperidol, Trifluoperizine, fluphenazine thioridazine, chlorpromazine

Typical Antipsychotics (neuroleptics) (block D2 receptors)

Olanzapine, Clozapine, Quetiapine, Risperidone, Aripiprazole, Ziprasidone

Atypical Antipsychotics (block DA and 5HT receptors)

Adjuncts for depression

Clozapine, quetiapine, aripiprazole

Weight gain

Olanzapine and Clozapine (also agranulocytosis)

Lithium Toxicity

Increased with thiazide diuretics, ACE inhibitors and ARBs | Follows Na+

Buspirone

5HT1A partial agonist (no sedation, addition, or tolerance) 2 weeks for effect no interaction with alcohol

Fluoxetine, Paroxetine, Sertraline, Citalopram

SSRIs (5HT reuptake inhibitors) | 4-8 weeks for effect

Venlafaxine and Duloxetine

SNRI (5HT and NE reuptake inhibitors) Venlafaxine: depression, GAD, panic disorders Duloxetine: depression and also diabetic neuropathy

Amitriptyline, nortriptylne, imipramine, desipramine, clomipramine, doxepine, amoxapine

TCAs (5HT and NE reuptake inhibitors) | - major depression, OCD (clomipramine), fibromyalgia

Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline

MAOi atypical depression, anxiety, hypochondriasis - side effect: hypertensive crisis w/ tyramine ingestion - Contraindicated w/: SSRI, TCA, St Johns Wort, Meperidine, and dextromethorophan to prevent serotonin syndrome

Bupropion, Mirtazapine, Trazodone

Atypical Antidepressants Bupropion: also for smoking (increased NE and DA); no sexual side effects Mirtazapine: helps w/ insomnia (a2-antagonist/ increased NE and 5HT) Trazodone: insomnia also (blocks 5HT2 and a1-adrenergic receptors); side effect: priapism

Aggression, Nystagmus, ataxia, dissociation

PCP

Visual hallucination, euphoria, tachycardia, panic

LSD

Chest pain, seizures, mydriasis, agitation, euphoria

Cocaine

Conjunctival injection, increased appetite, tachycardia, dry mouth,

Marijuana

Tooth decay, violent, psychosis, diaphoresis

Methamphetamine

Tx for TCA Overdose

Sodium Bicarbonate | - corrects cardiac problems caused by TCAs

6 Year Olds idea of Death

- typically understand the finality of death [Infants have no understanding, whereas preschool age children often think of deaths in reversible or metaphorical terms]

Tx of Acute Anxiety

Benzodiazepines (including alprazolam aka Xanax) are effective at treating anxiety conditions - use should be limited to bridge therapy awaiting the efficacy of safer less habit-forming maintenance medications like SSRIs and buspirone