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Psych Flashcards

1
Q

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?

A

Dysthymic disorder

Develop MDD (76%)
Develop bipolar disorder (13%)
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2
Q

What are examples of SSRIs?

A 
Fluoxetine
Sertraline
Paroxetine
Citalopram
Escitalopram
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3
Q

What significant side effects are associated with SSRIs?

A

Sexual dysfunction
Decreased platelet aggregation
Blackbox warning

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4
Q

What are examples of SNRIs? When are they used? What are significant side effects?

A

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

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5
Q

What are examples of TCAs?

A

Imipramine
Amitriptyline
Desipramine
Nortriptyline

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6
Q

What are significant side effects of TCAs?

A

Easy to OD…causes prolonged QT

sedation, wt. gain, sexual dysfunction, anticholinergic symptoms

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7
Q

What are examples of MAOIs?

A

Phenelzine
Isocarboxazid
Tranylcypromine
Selegiline

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8
Q

What are significant side effects of MAOIs?

A

Dry mouth, indegestion, dizziness

Tyramine (cheese, aged meats, beer) –> HTN crisis

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9
Q

How does bupropion work? What is nice about it?

A

Inhibits uptake of dopamine and NE

Doesn’t cause sexual dysfunction

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10
Q

What can be used to treat depression with significant insomnia?

A

Trazodone…does something with serotonin

Mirtazapine…blocks alpha2-receptors and serotonin receptors –> increaseed adrenergic neurotransmission

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11
Q

What is the major difference between ‘manic’ and ‘hypomanic’?

A

Manic –> significant impairment of ability to function

Hypomanic –> no significant impairment of ability to function

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12
Q

What is cyclothymia?

A

Rapid cycling of hypomania and mild depression lasting longer than 2 years with no normal mood lasting longer than 2 months

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13
Q

What is a big difference between ‘bereavement’ and ‘adjustment disorder’?

A

Bereavement does not impair one’s ability to function

Adjustment disorder causes a significant impairment of ability to function

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14
Q

What psychotic disorder is increased in patients with mitral valve prolapse?

A

Panic disorder

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15
Q

What drug is used for anxiety disorders when abuse or sedation is a concern?

A

Buspirone…does something with dopamine and serotonin receptors

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16
Q

What is a potential concern for the kid of a woman who was malnourished or ill during pregnancy?

A

Schizophrenia

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17
Q

What is necessary to diagnose schizophrenia?

A

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

18
Q

What are examples of atypical antipsychotics?

A

Clozapine, olanzapine, quetiapine
Risperidone, ziprasidone, paliperidone
Sertindole
Aripiprazole

19
Q

How do Atypical antipsychotics work? What are significant side effects?

A

Block dopamine and serotonin receptors

Anticholinergic effects, weight gain, arrhythmias, seizures

20
Q

Which atypical antipsychotic is most effective?

A

Clozapine…but causes agranulocytosis…so only for refractory psychosis

21
Q

What are examples of high-potency neuroleptics?

A

Haloperidol, droperidol
Fluphenzine, perphenazine, trifluoperazine
Loxapine
Thiothixene

22
Q

How do high-potency neuroleptics work? When are they used? What are significant side effects?

A

Block D2 dopamine receptors

Emergency control of psychosis or agitation
Strong positive symptoms

Extrapyramidal effects
Tardive dyskinesia
Neuroleptic malignant syndrome

23
Q

What are the low-potency neuroleptics? What significant side effects do they have?

A

Thioridazine, chlorpromazine

Anticholinergic effects…some is seen with high-potency, but not as much

24
Q

What is schizophreniform?

A

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

25
Q

What is schizoaffective disorder?

A

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

26
Q

What is delusional disorder?

A

One or more distinct realistic delusions lasting longer than 1 month

If it is an unrealistic delusion, then it is either schizophreniform or schizophrenia

27
Q

What is it called when psychotic symptoms last less than a month?

A

Brief psychotic disorder

28
Q

A patient has signs of a personality disorder, but can function normally in society. What does this person have?

A

Personality trait

29
Q

There are three clusters of personality disorders. How are they broadly classified?

A 
A = weird
B = wild
C = wimpy/worried
30
Q

What are the three cluster A disorders?

A

Paranoid
Schizoid- negative symptoms of schizophrenia
Schiotypal- paranoia, eccentric and inappropriate behavior, social anxiety, odd beliefs

31
Q

What are the four cluster B disorders?

A

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

32
Q

What are the three cluster C disorders?

A

Avoidant
Dependent
Obsessive-compulsive- perfectionist

33
Q

How long does a person have to have a preoccupation with fear of having a serious illness before being diagnosed with hypochondriasis?

A

6 months

34
Q

How does fibromyalgia differ from conversion disorder and pain disorder?

A

Conversion disorder and pain disorder are related to stressful events

35
Q

A patient develops a pain after a stressful situation, but no specific injury. Are analgesics likely to help?

A

Not if it is true pain disorder

36
Q

What should NOT be used to treat delirium or dementia related agitation?

A

Benzos or anticholinergics

37
Q

What is required to diagnose ADHD?

A

6 inattentive symptoms OR 6 hyperactivity or impulsivity symptoms BEFORE 7yo that limit ability to function

38
Q

What is required to diagnose Conduct Disorder?

A

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

39
Q

What is difference between Conduct Disorder and Oppositional Defiant Disorder?

A

ODD does NOT have illegal or destructive activity

40
Q

What is required to diagnose Tourette Syndrome?

A

Tics last longer than 1 yr and start before 21yo

Coprolalia (obscene tics) is seen in 40% of cases

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