Psych Flashcards
Too much Dopamine causes?
Schizophrenia
Too little Dopamine causes?
Parkinsonian
27 y/o female is started on an antidepressant and has to try a few different ones until her mood improves. But now, her face flushes and she is more sensitive to hot weather. She reports feeling that her heart is racing and admits to constipation. Which drug is this?
Amitriptyline TCA is as effective of SSRI's but not used as a first line due to it's AE's. Red as a beet (flushing) Dry as a bone (anhidrosis) Hot as hare (overheating due to anhidrosis) blind as a bat (blurry vision) Mad as hatter (hallucination, delirium) Full as a flask (urinary retention)
What syx would be expected in a pt taking a n MAOI would have after consuming tyramine rich foods?
Hypertensive crisis after ingesting red-wine and aged cheese Serotonin syndrome (hyperthermia, flushing, diarrhea)
What AE is associated with Sertaline
Weight gain and sexual dysfunction
A schizophrenia pt being treated with a first gen antipsychotic medication and develops involuntary m. spasms particularly in the face. Which class of drugs should they receive to alleviate this?
Anticholinergic agents (ie Acute dystonia = extrapyramidal AE of antipsychotics. Occurs within 4 hours of therapy. Extrapyramidal effects = dystonia, akathisia, bradykinesia, tardive dyskinesia.
Female presents to her PCP reporting sleep deprivation and depression. despite sleeping 7-9 hours a night. Pt becomes progressively more animated and makes aggressive sexual advances toward the physician and staff. She reports a good mood but not overly elevated. Dx?
Histrionic personality disorder
Manifests early in adulthood as excessive emotionality, attention-seeking, and sexually provocative behavior
Attention seeking behavior = Going to PCP with syx that don’t exist
Pt presents with pain x years over her neck, lower back, hips that interferes with her daily activities. All studies have been negative but reports feeling down. How do you treat?
Behavioral therapy
Pain disorder = pain syx inconsistent with physiologic processes
Tx = rehabilitation (PT, psychotherapy, behavioral therapy, TCAs, and velafaxine)
Syx of cocaine withdrawl?
Acute depression accompanied by fatigue, vivid dreams, hypersomnia, and hyperphagia
How do you treat cocaine withdrawal?
supportive
MOA of the drug that treats panic disorder?
Benzodiazapine
Binds allosterically to the GABA receptor
Increased frequency of Cl ion channel opening
A teenager is argumentative and is defiant towards parents and teachers, deliberately annoys others, blames others for misbehavior, easily annoyed but does not violate the rights of others. Dx?
Oppositional defiant disorder
Side effect of Risperidone and other antipsychotics?
Hyperprolactinemia by blocking D2 receptors on lactotrophs. Elevated prolactin leads to amenorrhea (inhibition of gonadotropin-releasing hormone release), galactorrhea, and breast soreness
Risperidone inhibits D1 and D2
Largest risk factor for a patient’s risk of suicide?
Access to firearms or other lethal methods. Access to firearm triples the mortality rate
Others: decreasing stress, increase psychosocial support, treat underlying psych illness and substance use, and manage pain
First line therapy for PTSD?
SSRI and CBT
Little evidence supports the use of benzo’s and nonbenzo hynpnotics
What would be a stimulus control recommendation for insomnia?
Leave the bedroom if unable to fall asleep within 20 minutes. Stimulus control focuses on eliminating stimulating bedroom activities and getting into bed only when sleepy.
Other recommendations: sleep hygiene, relaxation, sleep restriction, and CBT
21 year old female presents with irregular menses. BMI is 25.6. PE - enlarged parotid glands bilaterally and teeth shows eroded enamel. Dx?
Bulimia nervosa
Look for: bilateral parotid gland enlargement, erosion of tooth enamel, irregular menses, and abn electrolytes
a pt is diagnosed with ADHD and started on methlphenidate. What should the parents be warned about?
decreased appetite and weight loss
Insomnia
Usually mild and can be managed without stopping the medication
Characteristic symptoms of ADHD?
Hyperactivity, impusivity, disorganization causing behavioral problems both at school and at home
Why is methadone helpful in treating heroine addiction?
Long-half life, dose QD to suppress withdrawl symptoms and cravings
What receptor does methadone act on?
Full mu-opioid receptor agonist
What receptor does buprenorphine act on?
Partial agonist used alone or with naloxone. More likely to cause respiratory depression and mortality than methadone
What medication is effective for helping a pt reduce their craving for alcohol?
Naltrexone
Mu opioid receptor blockade
Blocks the rewarding effect of alcohol and reduces the craving
A schizophrenia pt presents with restlessness in her legs. Whats going on?
Akathisia
Extrapyramidal side effect of antipsychotic medication caused by inner restlessness and inability to sit or stand in one postion
A pt is frequently running out of his pain medication too early and claims he takes extra tabs because the medication isn’t working. How should his physician respond?
I can understand that the pain medication is not helping; let’s discuss how you are using it.
According to epidemiology reports, which drug overdose is most likely to cause a pt to die?
Opioids
A woman presents with insomnia and fatigue x 1 month. She reports being depressed, irritable, and hopeless. Weight loss, inability to concentrate. Dx?
Major depressive disorder
2+ weeks with: depressed mood, loss of interest, sleep disturbance, appetite disturbance, loss of energy, psychomotor agitation or retardation, impaired concentration, guilt, and suicidal thoughts
A pt OD’s on amitriptyline. What is the pathophys of his death?
Sodium channel inhibition
Most common COD in TCA OD = cardiac arrhythmias and refractory hypotension. Inhibition of fast sodium channels in cardiac myocytes is the major underlying event
A psych pt reports that she is developing AE’s to her previously well tolerated medication. Syx = constipation, dry skin, hair loss, weight gain. Whats the med?
Lithium
Hypothyroidism and nephrogenic DI are the most common AE’s of long term therapy. TSH and renal function should be monitored regularly
Teenager has a persistent pattern of violating social normas and the rights of others (aggression towards people and animals, deceitfulness of theft, destruction of property, and serious violation of rules
Conduct Disorder
A pt presents with pain saying she only has relief with oxycodone. XR of her spine was normal, but the pt insists her pain is a 10/10. What should be done?
Physician should obtain confirmation of the pts prescription history
By identifying potential opioid misuse, Physicians can make more informed decisions regarding pain prescriptions
A pt presents with OCD like behaviors but she also has some magical thinking. Dx?
schizotypal personality disorder
Long standing pattern of eccentric behavior, odd beliefs, perceptual distortions, and social anxiety despite familiarity
A pt is found unconcious and family reports a history of drug abuse. Pupils are constricted. What was used to treat him and which receptor does it bind to?
Naloxene
Mu opioid antagonist
Binds mu, kappa, and delta, but greatest affinity is at mu
A 13 month old is showing developmental regression (specifically speech) and her head growth is declining. Hypotonic and unable to sit upright without help. Dx?
Rett syndrome
Loss of speech and motor skills, deceleration of head growth, and stereotypic hand movements after a period of normal development
Affects mainly girls, MECP2 gene mutation (X-linked, de novo)
When a pt is taking clozapine, what should be monitored regularly?
Absolute PMN count (agranulocytosis)
Clozapine is used in Schizophrenia
What developmental features should a 2 year old have?
50-200 words with 2 word phrases
Walk up/down stairs, umps
Build 6 cube tower, turn pages
Follows 2 step commands, begin toilet training
What is the most commonly delayed milestone?
Language
Consider a hearing exam in these guys
Pt presents with a painful erection x 6 hours. He is being treated for depression, OCD, and insomnia. Which drug caused this?
Trazodone (serotonin modulator
Highly sedating antidepressant used in insomnia. Priapism is a rare but serious AE of trazodone (persistent erection x at least 4 hours
A teenager presents with non specific abdominal pain. Mother notes that the daughter worried about a party for weeks and ended up not going because she was scared of looking stupid. Pt made little eye contact and gave brief answers during the interview. Dx?
Social anxiety disorder
Excessive fears of scritiny or embarrassment in social or performance situations, resulting in significant distress and functional impairment.
A pt is brought to the ED and his wife says that he is acting crazy. Has not slept x 4 days, taking on many projects and spending lots of money. Pressured speech on presentation and has a history of 2 previous depressive episodes. What medication is appropriate for long term control?
Valproate, Lithium (1st), quitapine
Although it is an anticonvulsant it also has mood stabilizing properties effective for maintenance of bipolar.
What are some of the characteristics of buspirone
Nonbenzodiazepine anxiolytic used to treat general anxiety disorder. Slow onset of action and carries no risk of dependence. NO muscle relaxant or anticonvulsant properties
Not used in anxiety attacks due to slow onset of action
18 year old is brought to clinic due to increasingly bizarre behavior x 2 months. He is out of state at college and stopped attending classes and socializing. He spends most of his time in his dorm and believes the cafeteria food is poisoned. Pt appears unwashed, disheveled, and makes little eye contact. Dx?
Schizophreniform disorder Psychotic symptoms (delusions, hallucinations, disorganized speech and behavior, negative syx) lasting >1 mo but less than 6 months
65 y/o woman with a hx of schizophrenia presents with facial grimacing, lip smacking, and twisting movement of her fingers. Dx?
Tardive Dyskinesia
Involuntary movement sof the mouth, tongue, face, extremities, or trunk with prolonged exposure to antipsychotics.
MOA of cocaine
inhibits pre synaptic re-uptake of NE, DA, 5HT
An elderly woman presents with signs of delirium (able to converse but can’t count backwards, sudden onset). What med should she receive?
Haloperidol
Acute changes in cognition and behavior = delirium.
Low-dose antipsychotics are drug of choice
First line treatment for major depressive disorder?
Antidepressants (SSRI, SNRI)
Major depressive disorder = 2+ weeks with at least 5 of: depressed mood, loss of interest, change in appetite, inosmnia/hypersomnia, psychomotor retardation, low energy, poor concentration, feeling worthless/guilt, Suicidal thoughts
What should be done if a pt requests an unnecessary medication?
Educate the pt in a nonjudgmental manner about the lack of efficacy and adverse effects.
First line therapy for General anxiety disorder?
SSRIs (citalopram) or SNRI’s
Benzos are good for short-term use in undpressed pts with no hx of substance abuse who respond poorly to antidepressants
Why do pts require at least two weeks when d/cing and MAOI (phenelzine) to begin a SSRI (sertaline)?
Allow synthesis of monamine oxidase
coadministration of SSRI and MAOI can produce excessive synaptic serotonin levels secondary to decreased reuptake and decreased degredation. Can lead to the potentially fatal serotonin syndrome.
Syx of serotonin syndrome?
Potentially fatal with restlessness, altered mental status, hyperreflexia and clonus, diaphoresis, and tremors
unconscious shifting of emotions associated with a significant person from one’s past to a person in the present
Transference
A pt taking an SSRI complains of decreased libido and wants to try a different med. What would be a good option?
Bupropion
NE and DA reuptake inhibitor
First line tx for Major Depressive disorder and depression that does not cause sexual dysfunction
Pt presents with depressive syx and hasn’t been responding to antidepressants. What additional syx would make phenylzine a good option?
Mood reactivity
Phenylzine = MAOI, useful in pts with treatment-resistant and atypical depression.
Hallmarks of atypical depression?
Increased appetite, sleep, leaden paralysis, sensitive to rejection, and mood reactivity
Phenylzine (MAOI) is a good option
Best way to approach a pt that is not adhering to their medication protocols?
Show empathy and then ask about what makes it hard for them to take their meds every day
What is factitious disorder?
Intentional falsification or inducement of symptoms with goal to assume a sick role
Basically they fake a dz or intentionally make themselves sick because they want to be sick. Not necessarily conscious of it. More likely to occur in health care workers.
What is malingering?
Falsification or exaggeration of syx to obtain external incentives.
Incentives = financial benefit, time off work etc
Prior to initiating SSRI tx in a pt with a major depressive episode, what is an important piece of history to collect?
History of mania
Need to rule out bipolr disorder as antidepressant monotherapy with precipitate and episode of mania
First line therapy for General Anxiety disorder?
SSRI - prefered due to lack of abuse potential
Benzos for acute attacks
Pregnant woman craves ice all day, has been eating little food, and has lost 5 lbs over 4 weeks and has not been taking her Fe supplements. Fetal exam is WNL. Dx/
Pica
Compulsive consumption of nonfood and/or non-staple food. Common in pregnancy and often see in iron deficiency anemia.
Suspect pica in a pregnant pt with weight loss
Pt presents with nystagmus (horizontal or vertical), violent behavior, dissociation, hallucinations, amnesia, ataxia but recovers 8 hours after initial presentation. Dx?
Phencyclidine (PCP)
Hallucinogen causing dissociative syx, agitation, hallucinations, violent behavior
Ataxia, nystagmus, memory loss are other distinguishing syx of PCP abuse
Pt present with euphoria, depersonalization, visual illusions. Most pts are oriented and perceive that the effects are due to a drug.
Lysergic acid diethylamide (LSD)
Visual hallucination is key
It takes a couple of weeks for SSRI’s to take effect in a General Anxiety disorder pt and benzo’s are recommended. Which benzo would be recommended in a pt that is concerned about avoiding all dependence and also has elevated LFTs?
Lorazepam
Short half life (helps to decrease dependence, vs chlordiazepoxide, diazepam, and flurazepam)
Lorazepam oxazepam and temazepam are preferred to treat old livers
Pt OD’s on amitriptyline. Both pupils are dilated and equally reactive to light. What is the COD?
Sodium channel inhibition
Amitriptyline = TCA
COD = cardiac arrhythmias and refractory hypotension. Inhibition of sodium hannels in the His-Purkinje system is thought to be the main cause
Pt is presenting with delusions and erratic behavior. Previous tx with haloperidol and risperidone have not been successful. What should we try?
Clozapine
Use in treatment-resistant schizophrenia and schizos that are also suicidal
Monitor PMN’s due to agranulocytosis
COD following theophylline OD?
Seizures and tachyarrhytmias
Tx - activated charcoal to reduce absorption
