Psych Flashcards
A patient has had a depressed mood more often than not for the last 2yrs, but has not had any major depressive episodes. What is the likely diagnosis? What is the concern?
Dysthymic disorder
Develop MDD (76%) Develop bipolar disorder (13%)
What are examples of SSRIs?
Fluoxetine Sertraline Paroxetine Citalopram Escitalopram
What significant side effects are associated with SSRIs?
Sexual dysfunction
Decreased platelet aggregation
Blackbox warning
What are examples of SNRIs? When are they used? What are significant side effects?
Venlafaxine and duloxetine
First-line for depression + comorbid neurologic pain
Second-line for depression that doesn’t respond to SSRI
Nausea, dizziness, insomnia, sedation, constipation, HTN…more benign than TCAs
What are examples of TCAs?
Imipramine
Amitriptyline
Desipramine
Nortriptyline
What are significant side effects of TCAs?
Easy to OD…causes prolonged QT
sedation, wt. gain, sexual dysfunction, anticholinergic symptoms
What are examples of MAOIs?
Phenelzine
Isocarboxazid
Tranylcypromine
Selegiline
What are significant side effects of MAOIs?
Dry mouth, indegestion, dizziness
Tyramine (cheese, aged meats, beer) –> HTN crisis
How does bupropion work? What is nice about it?
Inhibits uptake of dopamine and NE
Doesn’t cause sexual dysfunction
What can be used to treat depression with significant insomnia?
Trazodone…does something with serotonin
Mirtazapine…blocks alpha2-receptors and serotonin receptors –> increaseed adrenergic neurotransmission
What is the major difference between ‘manic’ and ‘hypomanic’?
Manic –> significant impairment of ability to function
Hypomanic –> no significant impairment of ability to function
What is cyclothymia?
Rapid cycling of hypomania and mild depression lasting longer than 2 years with no normal mood lasting longer than 2 months
What is a big difference between ‘bereavement’ and ‘adjustment disorder’?
Bereavement does not impair one’s ability to function
Adjustment disorder causes a significant impairment of ability to function
What psychotic disorder is increased in patients with mitral valve prolapse?
Panic disorder
What drug is used for anxiety disorders when abuse or sedation is a concern?
Buspirone…does something with dopamine and serotonin receptors
What is a potential concern for the kid of a woman who was malnourished or ill during pregnancy?
Schizophrenia
What is necessary to diagnose schizophrenia?
2 or more of the following for at least 1 month in the last 6 + impaired social function for at least 6 months
Delusions, hallucinations (auditory), disorganized speech, disorganized or catatonic behavior…these make up the “positive symptoms”
Or negative symptoms: social withdrawal, flat affect, apathy, anhedonia, or lack of motivation
What are examples of atypical antipsychotics?
Clozapine, olanzapine, quetiapine
Risperidone, ziprasidone, paliperidone
Sertindole
Aripiprazole
How do Atypical antipsychotics work? What are significant side effects?
Block dopamine and serotonin receptors
Anticholinergic effects, weight gain, arrhythmias, seizures
Which atypical antipsychotic is most effective?
Clozapine…but causes agranulocytosis…so only for refractory psychosis
What are examples of high-potency neuroleptics?
Haloperidol, droperidol
Fluphenzine, perphenazine, trifluoperazine
Loxapine
Thiothixene
How do high-potency neuroleptics work? When are they used? What are significant side effects?
Block D2 dopamine receptors
Emergency control of psychosis or agitation
Strong positive symptoms
Extrapyramidal effects
Tardive dyskinesia
Neuroleptic malignant syndrome
What are the low-potency neuroleptics? What significant side effects do they have?
Thioridazine, chlorpromazine
Anticholinergic effects…some is seen with high-potency, but not as much
What is schizophreniform?
Symptoms of schizophrenia, but has lasted longer than 1 month and less than 6 months
Return to normal after psychotic episode…often develop true schizophrenia later
What is schizoaffective disorder?
Presence of mood disorder an psychotic symptoms…but does not meet criteria for either diagnosis alone
Psychotic symptoms happen during normal mood for longer than 2 weeks
Treat both disorders
What is delusional disorder?
One or more distinct realistic delusions lasting longer than 1 month
If it is an unrealistic delusion, then it is either schizophreniform or schizophrenia
What is it called when psychotic symptoms last less than a month?
Brief psychotic disorder
A patient has signs of a personality disorder, but can function normally in society. What does this person have?
Personality trait
There are three clusters of personality disorders. How are they broadly classified?
A = weird B = wild C = wimpy/worried
What are the three cluster A disorders?
Paranoid
Schizoid- negative symptoms of schizophrenia
Schiotypal- paranoia, eccentric and inappropriate behavior, social anxiety, odd beliefs
What are the four cluster B disorders?
Antisocial- aggressive to people/animals; no remorse; men
Borderline- fear of abandonment; splitting (all good or all bad); women
Histrionic- Dire need for attention; believes relationships are more intimate than they are
Narcissistic
What are the three cluster C disorders?
Avoidant
Dependent
Obsessive-compulsive- perfectionist
How long does a person have to have a preoccupation with fear of having a serious illness before being diagnosed with hypochondriasis?
6 months
How does fibromyalgia differ from conversion disorder and pain disorder?
Conversion disorder and pain disorder are related to stressful events
A patient develops a pain after a stressful situation, but no specific injury. Are analgesics likely to help?
Not if it is true pain disorder
What should NOT be used to treat delirium or dementia related agitation?
Benzos or anticholinergics
What is required to diagnose ADHD?
6 inattentive symptoms OR 6 hyperactivity or impulsivity symptoms BEFORE 7yo that limit ability to function
What is required to diagnose Conduct Disorder?
Aggressive behavior to people or animals
Destruction of property
Deceitfulness/theft
Violation of serious rules
1+ above if less than 10yo
3+ above if more than 10yo
What is difference between Conduct Disorder and Oppositional Defiant Disorder?
ODD does NOT have illegal or destructive activity
What is required to diagnose Tourette Syndrome?
Tics last longer than 1 yr and start before 21yo
Coprolalia (obscene tics) is seen in 40% of cases
