Psych Flashcards
Patient presents with excessive daytime sleepiness, cataplexy, sleep paralysis, and hallucinations. What is this and what causes it?
Narcolepsy
Due to a loss of orexin aka hypocretin-2 (promotes wakefulness, secreted by the hypothalamus) via an autoimmune reaction
Clinical triad of ADHD
inattentiveness, hyperactivity, and impulsivity occurs in 2+ settings (home and school)
Associated with dec frontal lobe volume/metabolism
Patient has hypnagogic (just before sleep) and hypnopompic (just before awakening) hallucinations
Narcolepsy
Who is autism more common in?
Boys
Children with genetic disorders like Down syndrome, Fragile X, Rett syndrome
What part of the brain is implicated in reward? What neurotransmitter is involved?
Nucleus accumbens and dopamine
Patient presents with anxiety for 8 months that is unrelated to a specific person, situation or event
Generalized anxiety disorder: anxiety for longer than 6 months
Ego dystonic
In OCD, patients realize their compulsion or obsession is irrational, but they are unable to stop
PTSD vs Acute Stress Disorder
PTSD is diagnosed if S/S have persisted for over 1 month, Acute Stress Disorder is diagnosed if the S/S last between 3 days and 1 month
Manic Episodes vs Hypomanic episodes
Manic – 1 week of the following: DIG FAST – Distractibility, Irresponsibility, Grandiosity (high self esteem), Flight of idease, Activity increase/Agitation, Sleep deficit, Talkativeness
Hypomanic episode: like a manic episode but not severe enough to cause marked impairment or to necessitate hospitalization
o Lasts at least 4 days
Major Depressive Disorder symptoms
5/9 of the following plus reported depressed mood.
SIG E CAPS: Sleep disturbance Interest loss Guilt Energy loss Concentration problems Appetite/weight changes Psychomotor slowing Suicidal ideations
How long do episodes of Major Depressive Disorder last?
At least 2 weeks
What is dysthymic disorder
Depressed mood that is experienced most days for at least a 2 year period (less severe depressed mood than Major Depressive Disorder)
Type 1 vs Type 2 Bipolar Disorder
Type 1: at least one manic episode (w/ or w/o an episode of hypomania or depression)
Type 2: presence of a hypomanic and a depressive episode
Neurotransmitter changes in Huntington’s
Inc dopamine
Dec GABA and dec ACh
Neurotransmitter changes in Parkinson’s
Dec dopamine
Inc ACh
Neurotransmitter changes in anxiety. Treatment?
Inc NE
Dec GABA, Dec serotonin (5-HT)
Treat with Buspirone to inc serotonin (takes a couple weeks to kick in)
Neurotransmitter changes in depression
Dec NE, serotonin, and dopamine
Neurotransmitter changes in schizophrenia
Inc dopamine
What kind of hallucination is most common in a psychiatric illness?
Auditory > visual
*Schizophrenic hallucinations are present whether the patient’s eye are open or not
(visual hallucinations are more common in drug intoxication)
Diagnosis of schizophrenia
2+ of the following lasting >6 months: Delusions (firmly held beliefs) Hallucinations (usually auditory) Disorganized speech Disorganized/catatonic behavior Negative symptoms- flat affect, social withdrawal, lack of motivation, lack of speech
**Requires functional decline
Malingering vs Factitious disorders
Malingering: consciously fake an illness to attain a specific secondary (external) gain like avoiding work or obtaining compensation
Factitious disorder: consciously fake an illness to assume a “sick role” and to get medical attention (primary [internal] gain)
Types of Personality Disorders
Clusters A, B, and C
“The weird, the wild, and the worried”
Patient has an eccentric appearance and has magical thinking
Cluster A: Schizotypal
t= thinking
Patient thinks that the rules don’t apply to them. Other people think he is charming.
Cluster B: Antisocial
Patient has a history of self mutilation and engages in impulsive acts. Jumps from relationship to relationship.
Cluster B: Borderline
Patient withdraws from society (and does not want social interaction) and has limited emotional expression
Cluster A: Schizoid
Treatment for acute Alcohol Withdrawal (Delirium Tremens)
Benzodiazepines (diazepam, lorazepam)
Inc frequency of GABA channel opening
Which illicit drug can cause hemorrhagic and ischemic strokes? How?
Cocaine: causes small artery spasms and hypertension
Patient presents with dilated pupils, tachycardia, euphoria and hallucinations. What drug do you suspect he abused?
Cocaine: prevents the reuptake of dopamine and norepinephrine
Patient presents with constricted pupils, bradycardia, sedation/relaxation, and inc body temp. What drug do you suspect he abused?
Opiates: morphine, heroin, and methadone
Prevent release of pain neurotransmitters (glutamate, substance P) by binding to opioid receptors (GPCRs). Prevent influx of Ca2+ into the presynaptic terminal and open K+ channels for K+ efflux (leading to hyperpolarization). Also act at the postsynaptic terminal by opening K+ channels for K+ efflux
What is the key neurotransmitter involved in memory?
Acetylcholine
What antidepressant does not cause sexual side effects?
Buproprion
“Allows you to have proper sex”
Tardive dyskinesia
Stereotypical oral-facial movements (lip smacking) as a result of long term antipsychotic use
Due to blockage of D2 dopamine receptors
What drug can cause priapism in men? What is the drug normally used for?
Trazodone (think trazobone)
Used to tx insomnia- blocks serotonin and a1 adrenergic receptors
Akathisia
Seen in schizophrenics undergoing treatment with neuroleptic antipsychotics: restlessness, inability to sit still
What drugs do you use to treat OCD?
SSRIs and clomipramine (TCA) and atypical psychotics
What drugs do you use to treat bipolar disorder?
Lithium, Valproic acid, atypical antipsychotics
What drugs do you use to treat bulimia?
SSRIs
Patient presents with left leg weakness that started 3 days ago when she was dumped by her fiance. What is she suffering from?
Conversion disorder: loss of sensory or motor function often following an acute stressor
Patient has been hospitalized for surgery. After a few days in the hospital he develops diarrhea, sweating, dilated pupils, stomach cramps, and yawns often. What is he in withdrawal from?
Opioids (heroin, methadone, morphine)
Patient is in withdrawal and has the following symptoms: inc appetite, existential crises, and hypersomnolence. What drug is he in withdrawal from?
Amphetamine
Patient is arrested for attempting to kill his fiancé when high on drugs. He has nystagmus, tachycardia, psychosis, and fever. He is extremely agitated. What drug did he most likely take?
PCP (NMDA antagonist)
What drug withdrawal causes depression and suicidal ideation
Cocaine
What is a common side effect of SSRIs?
Sexual dysfunction/decreased libido
Sertaline, fluoxetine, paroxetine, citalopram
What do you need to monitor in a patient taking clozapine?
Neutrophil levels: can cause agranulocytosis and seizure
Serotonin syndrome
Cause?
S/S?
Treatment?
use of SSRI with any drug that inc serotonin (MAO inhibitors, SNRI, TCAs) leads to hyperthermia, confusion, myoclonus, flushing, diarrhea, and seixures
Tx with cyproheptadine (serotonin receptor antagonist)
Use of what drug can cause lithium toxicity in a bipolar patient?
use of thiazide diuretic
Side effect of Risperidone?
Inc prolactin → galactorrhea.
An atypical antipsychotic
Psych patient is being treated with a medication causing hair loss, weight gain, dry skin, constipation, tremor, and polyuria. What are they taking?
Lithium
Causes hypothyroidism, nephrogenic diabetes insipidus, and tremor
TCA toxicity
atropine-like (anticholinergic): tachycardia, flushing, urinary retention, dry mouth
Long QT
Arrhythmias
Respiratory depression
Why do you have to be careful when eating meats, wine, and cheese while on MAOI’s?
Can lead to hypertensive crisis due to ingestion of tyramine
Who do you have to be careful giving Bupropion to? Why?
Anorexic/bulemic patients –> can cause seizures
Child is brought in by mom for a well child check. She states that she is worried because her child hit all the necessary developmental milestones for the first 14 months of life and was able to walk and say her first words. Now the child is having trouble walking as well and is unable to say words that she previously knew. On exam the child is wringing her hands continuously.
Rett syndrome
(X linked dominant)
Most common in girls
Normal development until 5-18 months and then loss of motor/language skills with the development of stereotypical hand movements (hand wringing).
Classic feature: head growth deceleration
Buspirone
Used for tx of generalized anxiety disorder
Slow onset of action: 2 weeks
Pica
the compulsive consumption of a nonfood for >1 month. Commonly seen in pregnant women and schoolchildren. Usually earth/soil substances, raw starch such as flour or cornstarch, and ice
What antidepressant has atropine-like side effects?
Tricyclic antidepressants (Amitriptyline)
Causes tachycardia, urinary retention, dry mouth and flushing
Can prolong the QT – give patient sodium bicarb to prevent arrhythmia
Patient begins to see doctor as a parent figure. What is this called?
Transference
patient projects feeling about formative or other important person onto physician (sees doctor as parent)
The belief that people are all good or all bad
Splitting
What are some signs of possible child abuse?
Posterior rib fractures, spiral long bone fractures, bruises or fractures in different states of healing, subdural hematomas (shaken baby), retinal hemorrhages
Neuroleptic malignant syndrome (NMS) symptoms and treatment
life-threatening adverse reaction to anti-psychotic medications, which block dopamine in the brain
Diffuse muscle rigidity, high fever, autonomic instability, altered sensorium, rhabdo
Treat with Dantrolene or Bromocriptine
Reaction formation
responding in a manner opposite to one’s actual feelings
Projection
attributing one’s own feelings to others
Displacement:
transferring feelings to a more acceptable object
Splitting
seeing others as all good or all bad
o Common defense mechanism in borderline personality disorder
Sublimation
Mature defense mechanism
channeling impulses into socially acceptable behaviors
Suppression
Mature defense mechanism
putting unwanted feelings aside to cope with reality
• Chronic tic disorder
either vocal or motor tics (but not both) for >1 year
Atypical depression characteristics
mood reactivity (feeling better in response to positive events) leaden paralysis (patient’s arms and legs feel very heavy) rejection sensitivity (sensitive to criticism) inc sleep and appetite
Which benzodiazepines are best to use in a patient with impaired hepatic metabolism?
LOT – Lorazepam, Oxazepam, Temazepam
Treatment of delirium
Haloperidol
Damage to the frontal lobe (left vs right)
o Left: apathy and depression
o Right: disinhibited behavior
Which antibiotic can cause serotonin syndrome if used in combo with antidepressants?
Linezolid
Avoid giving this to patients on antidepressants
Disruption of what dopaminergic pathway leads to extrapyramidal symptoms?
Nigrostriatal pathway
Disruption of what dopaminergic pathway leads to sexual dysfunction and galactorrhea?
Tuberoinfundibular pathway
Disruption of what dopaminergic pathway leads to negative symptoms? (flat affect, limited speech)
Mesocortical pathway
Disruption of what dopaminergic pathway leads to positive symptoms? (delusions, hallucinations)
Mesolimbic pathway
