Psych 5 Flashcards
What are the 3 clusters of personality disorders?
Cluster A = weird
Cluster B = wild (B = bad)
Cluster C = worried
What are the 3 types of Cluster A
Paranoid, Schizoid, Schizotypal
What are the 4 types of Cluster B
Antisocial, borderline, histrionic, narcissistic
What are the 3 types of Cluster C
Avoidant, Dependent, Obsessive-compulsive
Tx of personality disorders
Very difficult to treat because patients are not aware they need help
Psychotherapy is usually most helpful
Personality disorder: emotional, sexual, attention seeking
Histrionic
PD: eccentric, magical thinking
Schizotypal
PD: grandiosity, lack of empathy, demands the “best”
Narcissistic
PD: voluntarily avoidant and content with social isolation
Schizoid
PD: hypersensitive to rejection, socially timid but desires relationships with others
Avoidant
PD: suspicious, distrusting, hypervigilant
Paranoid
PD: disregard for and violation of rights of others without guilt or remorse; criminal; impulsive
Antisocial
PD: want things perfectly but don’t see a problem with it
Obsessive-compulsive
PD: unstable, self-mutilation, suicidal, use splitting as major defense mechanism, unstable and intense personal relationships
Borderline
PD: submissive and clingy
Dependent
Diagnostic criteria for schizophrenia
2 or more of the following must be present for at least 1 month:
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative sx
Describe a person with antisocial personality disorder
Exploitive of others and break the rules to meet their own needs. Lack empathy and remorse. Impulsive, deceitful and violate the law. Skilled at reading social cues and can appear charming and normal to others
Diagnose a 15 y/o with all signs of antisocial personality disorder
Conduct disorder (must be 18 y/o to be diagnosed with Antisocial personality disorder)
Tx of choice for borderline personality disorder
Dialectical Behavior Therapy (DBT)
At what blood alcohol level (BAL) do signs of intoxication begin
BAL > 100 = some signs of intoxication
BAL > 150 = obvious signs of intoxication
How long does it take to for symptoms for alcohol withdrawal to begin
6-24 hours
At what point of alcohol withdrawal do seizures occur
12-48 hours
At what point of alcohol withdrawal does delirium tremens occur?
48-96 hours
Tx of alcohol withdrawal seizures
Benzodiazepines (e.g. Ativan/Lorazepam)
Sx of delirium tremens
Delirium, hallucinations, agitation, gross tremor, autonomic instability, fluctuating levels of psychomotor activity
Tx of delirium tremens
Benzos
What supplements should be given to a pt with alcohol withdrawal
Thiamine, folic acid, and multivitamin to treat nutritional deficiency (“banana bag”)
How many average drinks per day / per week = heavy drinking for men
> 4 drinks / day
> 14 drinks / week
How many average drinks per day / per week = heavy drinking for women
> 3 drinks / day
> 7 drinks / week
First line tx for alcohol use disorder
Naltrexone (opioid receptor blocker, decreases desire/craving and “high” from alcohol)
What is potential fear of Naltrexone use
Will precipitate withdrawal in patients with dependence
How does Disulfiram/Antabuse work?
Blocks aldehyde dehydrogenase, causing aversion to alcohol
How does Topiramate work?
Anticonvulsant that potentiates GABA and inhibits glutamate receptors
Reduces cravings for alcohol and decreases alcohol use
Describe presentation of Wernicke’s encephalopathy
Ataxia, confusion, ocular abnormalities
Can be reversed with Thiamine therapy
Describe presentation of Korsakoff syndrome
Impaired recent memory, anterograde amnesia, compensatory confabulation
Reversible in only about 20% of pts
How can cocaine intoxication lead to death?
Vasoconstrictive effect may result in MI, intracranial hemorrhage, or stroke
What are other dangerous effects of cocaine intoxication
Respiratory depression, seizures, arrhythmias, hyperthermia, paranoia, hallucinations
Sx of cocaine withdrawal
“Crash” = fatigue, hypersomnolence, depression, anhedonia, hunger, constricted pupils, vivid dreams, psychomotor agitation or retardation
Dangers of amphetamine overdose
Hyperthermia, dehydration (especially after dancing), rhabdomyolysis, renal failure
Tx of amphetamine overdose
Rehydrate, correct electrolyte balance, treat hyperthermia
MOA of Phencyclidine
PCP is a dissociative, hallucinogenic drug that antagonizes NMDA receptors
Presentation of PCP intoxication
Agitation, depersonalization, hallucinations, synesthesia (one sensory stimuli evokes another), impaired judgement, memory impairment, assaultiveness, nystagmus, ataxia, HTN, tachycardia,high tolerance to pain
Dangers of PCP overdose
Seizures, delirium, coma, death
Describe withdrawal of PCP
No withdrawal syndrome, but “flashbacks: can occur (recurrence of intoxication due to release of drug from lipid stores)
Tx of barbiturate overdose
ABCs, activated charcoal to prevent further absorption
Alkalanize urine with NaHCO3 to promote renal excretion
Tx of benzo overdose
ABCs, activated charcoal
Flumazenil
Tx of barb or benzo withdrawal
Benzo taper
What type of drug is heroin?
Opioid
Clinical presentation of opioid intoxication
Drowsiness, nausea/vomiting, constipation, slurred speech, constricted pupils, seizures, respiratory depression
Tx of opioid overdose
Naloxone (opioid antagonist)
Will improve respiratory depression but may cause severe withdrawal
Name 3 drugs used to treat opioid use disorder
(1) Methadone
(2) Buprenorphine
(3) Naltrexone
MOA of Methadone
Long-acting opioid receptor agonist
MOA of Buprenorphine
Partial opioid receptor agonist
MOA of Naltrexon
Competitive opioid antagonist
Can precipitate withdrawal if used within 7 days of heroin use
Withdrawal sx of opiates
NOT life-threatening
Anxiety, insomnia, anorexia, fever, rhinitis, piloerection, sweating, lacrimation, yawning
Withdrawal sx of hallucinogens
None. But long-term LSD use may cause “flashbacks”
Sx of marijuana overdose
No overdose symptoms
Can cause cannabis-induced psychotic disorder with paranoia, hallucinations, and/or delusions
Withdrawal sx of marijuana
Irritability, anxiety, restlessness, aggression, strange dreams, depression, headaches, sweating, chills, insomnia, and decreased appetite
Tx of Nicotine dependence
Varenicline/Chantix = nicotinic cholinergic receptor partial agonist
Bupropion = antidepressant that is an inhibitor of dopamine and NE reuptake
