Psych Flashcards by Elisa Phillips

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

How well did you know this?

Not at all

Perfectly

Clinical triad of ADHD

inattentiveness, hyperactivity, and impulsivity occurs in 2+ settings (home and school)

Associated with dec frontal lobe volume/metabolism

How well did you know this?

Not at all

Perfectly

Patient has hypnagogic (just before sleep) and hypnopompic (just before awakening) hallucinations

Narcolepsy

How well did you know this?

Not at all

Perfectly

Who is autism more common in?

Boys

Children with genetic disorders like Down syndrome, Fragile X, Rett syndrome

How well did you know this?

Not at all

Perfectly

What part of the brain is implicated in reward? What neurotransmitter is involved?

Nucleus accumbens and dopamine

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Ego dystonic

In OCD, patients realize their compulsion or obsession is irrational, but they are unable to stop

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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 well did you know this?

Not at all

Perfectly

How long do episodes of Major Depressive Disorder last?

At least 2 weeks

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Neurotransmitter changes in Huntington’s

Inc dopamine

Dec GABA and dec ACh

How well did you know this?

Not at all

Perfectly

Neurotransmitter changes in Parkinson’s

Dec dopamine

Inc ACh

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

Neurotransmitter changes in depression

Dec NE, serotonin, and dopamine

How well did you know this?

Not at all

Perfectly

Neurotransmitter changes in schizophrenia

Inc dopamine

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

Types of Personality Disorders

Clusters A, B, and C

“The weird, the wild, and the worried”

How well did you know this?

Not at all

Perfectly

Patient has an eccentric appearance and has magical thinking

Cluster A: Schizotypal

t= thinking

How well did you know this?

Not at all

Perfectly

Patient thinks that the rules don’t apply to them. Other people think he is charming.

Cluster B: Antisocial

How well did you know this?

Not at all

Perfectly

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