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Psych Flashcards

1
Q

mature defenses

A 
mature adults wear a SASH
sublimation - social unacceptable impulses are unconsciously transformed into social acceptable ones
altruism
suppression
humor
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2
Q

infant deprivation effects

A

…
reactive attachment disorder - infant withdrawn/unresponsive to comfort
deprivation for 6+ mo –> irreversible changes

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3
Q

child abuse

A

child avoid eye contact during exam
usu biological mother
40% of deaths occur in kids < 1 yo

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4
Q

ADHD

A

treat with stimulant = methylphenidate +/- CBT
alternatives - atomoxetine (NE reuptake inhibitor), guanfacine (a2 receptor antagonist, so it can also treat HTN), clonidine (a2 agonist)

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5
Q

Rett syndrome

A

XD, seen in girls (affected males die utero)
de novo mutation in MECP2 (important for normal function of nerve cells)
around age 1-4 - regression, loss of verbal abilities, ID, ataxia, stereotyped hand-wringing

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6
Q

Tourettes

A

tics persist for > 1 yr
associated with OCD and ADHD
use typical antipsychotics for intractable, distressing tics - fluphenazine & pimozide antipsychotics, tetrabenazine (anti-chorea drug)

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7
Q

disruptive mood dyregulation disorder

A

~temper problems seen in kids younger than 10 yo

treat with psychostimulant, antipsychotic, CBT

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8
Q

orientation

A

order of loss: time –> place –> person

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9
Q

Korsakoff syndrome

A

anterograde > retrograde amnesia

anterograde - means decreased ability to form new memories

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10
Q

dissociative amnesia

A

dissociative amnesia - usu subsequent to trauma or stress

dissociative fugue - abrupt travel or wandering…

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11
Q

delusional disorder

A

fixed, persistent false belief system lasting 1+ mo
-erotomaniac, grandiose, persecutory, jealous, somatic (believing bodily functions and sensations are abnormal)

psychotic features absent

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12
Q

manic episode

A

lasting at least 1 week - elevated/irritable mood with increased energy/activity

ddx requires hospitalization of 3/DIG FAST
Distractibility
Irresponsibility
Grandiosity - inflated self-esteem
Flight of ideas - racing thoughts
Activity/psychomotor agitation
Sleep - decreased 
Talkativeness/pressured speech

pts with 1(+) lifetime manic episode are ddx with BPD1

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13
Q

hypomanic episode

A

no psychotic features

lasts at least 4 consecutive days

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14
Q

postpartum psychosis

A

treat with hospitalization and atypical antipyschotic

ECT is a second line

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15
Q

grief

A 
denial
anger
bargaining
depression
acceptance
pathological grief (6+ mo) is persistent and causes functional impairment --- major depressive episode
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16
Q

ECT

A

grand mal seizure in anesthetized pt
adverse effects - …partial anterograde/retrograde amnesia resolving in 6 months
safe in pregnancy

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17
Q

panic disorder

A

treatment: CBT, SSRIs, venlafaxine

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18
Q

OCD

A

CBT, SSRIs, and clomipramine (=TCAD)

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19
Q

PTSD

A

treatment: CBT, SSRIs, venlafaxine (same as for panic disorder)
prazosin can reduce nightmares

v.s. acute stress disorder - similar, lasts 3d-1 mo

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20
Q

conversion disorder

A

aka functional neurologic symptom disorder - under the somatic symptom/related disorders
loss of sensory or motor function, following acute stressor
- internal inconsistency of symptoms

pt is aware of but sometimes indifferent toward symptoms

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21
Q

anorexia

A

…
refeeding syndrome - increased insulin –> hypophosphatemia –> cardiac complications
-refeeding involves giving glucose –> increases insulin –> insulin shifts K and P into the intracellular space

buproprion contraindicated

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22
Q

sexual dysfunction

A

drug side effects - antihypertensives, antipsychotics/SSRIs, ethanol

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23
Q

sleep terror

A

occurs during slow-wave/deep (stage N3 sleep)

occurs during non-REM sleep - so no memory of arousal episode

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24
Q

narcolepsy

A

caused by decreased hypocretin (orexin - regulates arousal, wakefulness, and appetite) production in lateral hypothalamus

  • associated with hypnagogic or hypnopompic (just before awakening) hallucinations
  • nocturnal and narcoleptic sleep episodes that start with REM sleep = sleep paralysis
  • cataplexy - loss of muscle tone following ex laughter

strong genetic component
treatment: daytime stimulants (amphetamines, modafinil - weak dopamine reuptake inhibitor) and nighttime sodium oxybate (GHB)

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25
Q

stages of change

A
  1. ) precontemplation
  2. ) contemplation - acknowledging there is a problem but not yet ready/willing to make a change
  3. ) preparation/determination
  4. ) action/willpower
  5. ) maintenance
  6. ) relapse
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26
Q

alcohol withdrawal

A

alcohol binds to GABAa receptors - chronic alcoholics have decreased GABA sensitivity
- alcohol withdrawal decreases inhibitory tone

6-48hrs - withdrawal seizures
12-48hrs - alcoholic hallucinosis, visual, delirium
48-96hrs - delirium tremens, classically occurs post-surgery
-delirium tremens - autonomic hyperactivity, electrolyte disturbances, respiratory alkalosis, fever

alcoholism - …peripheral neuropathy, testicular atrophy

  • treat with… benzos, acamprosate (helps with withdrawal), naltrexone
  • benzos - chlordiazepoxide, lorazepam, diazepam
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27
Q

opioids

A

use - pinpoint pupils
OD - seizures
withdrawal - muscarinic stimulation
- develop tolerance to everything but constipation and miosis

long term use

  • increased turnover of receptor downregulation and decoupling
  • upregulation of NMDA receptors
  • -> tolerance and opioid-induced hyperalgesia (due to increased pain sensitivity)
  • partial agonists such as buprenorphine can precipitate withdrawal - because it binds strongly (can prevent the binding of other opioid agonists) but has low activity
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28
Q

barbiturates

A

low safety margin! - dont mess with Barb
treat OD with symptom management
withdrawal - delirium, life threatening CV collapse

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29
Q

benzos

A

greater safety margin
treat OD with flumazenil - but flumazenil can cause seizures

withdrawal - anxiety, perceptual disturbances, psychosis, etc.

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30
Q

stimulants

A

amphetamines, cocaine, caffeine, nicotine

withdrawal - includes sleep disturbance, vivid nightmares

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31
Q

amphetamines

A

use - …pupillary dilation
OD - cardiac arrest, seizures
treat with benzos

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32
Q

cocaine

A

inhibits NE uptake by pre-synaptic neurons –> NE binds to a1 receptors on vascular smooth muscle –> vasospasm
use - pupillary dilation, hallucinations (tactile),
treat with a-blockers, benzos, DONT give b-blockers
- b-blockers are withheld from cocaine users with heart disease
- why? - b-blockers can exacerbate vasospasm, unopposed a effect and b2 receptors blocked –> vasodilation inhibited

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33
Q

hallucinogens

A

PCP, LSD, marijuana, MDMA (ecstacy)

34
Q

PCP

A

violence –> trauma is the most common complication
nystagmus
treat with benzos

35
Q

LSD

A

perceptual distortion, psychosis

36
Q

droNABINOl

A

uses - antiemetic, appetite stimulant (AIDS)

37
Q

MDMA

A

…teeth clenching

life-threatening effects - HTN…, hyperthermia, hyponatremia, serotonin syndrome

38
Q

buprenorphine

A

NOT buproprion
buprenorphine (partial mu opioid receptor antagonist) + naloxone - sublinguinal
-naloxone = antagonist, not orally available, added to reduce abuse potential

39
Q

BPD

A

Li, valproate, carbamazepine, lamotrigine, atypical antipsychotics

40
Q

CNS stimulants

A

increased catecholamines in synaptic cleft - esp NE and dopamine

caffeine - adenosine receptor antagonist (prevents drowsiness)

41
Q

serotonin syndrome

A

obvious: SSRIs, SNRIs, TCADs, MAOIs, ondansetron, triptans
others: tramadol, linezolid, MDMA, dextromethorphan

Autonomic stimulation - hyperthermia, diaphoresis, diarrhea
Activity - NM hyperactivity
Agitation
treat with cyproheptadine - 5HT2 receptor antagonist

42
Q

bupropion

A

atypical antidepressant
inhibits NE and D reuptake
seizures in anorexic/bulimic pts
may help alleviate sexual dysfunction

43
Q

mirtazapine

A

atypical antidepressant
a2-ANTAgonist (increased release NE and 5HT)
potent 5HT2 and 5HT3 receptor antagonist
H1 antagonist
tox - sedation (may be desirable in pts with insomnia), increased appetite, weight gain (helpful in elderly or anorexics), dry mouth

44
Q

trazodone

A

atypical antidepressant, aka traZZZoBONE (tox is priapism - prolonged erection)
blocks 5HT2, a1, H1 receptors
weakly inhibits 5HT reuptake
insomnia –> high doses - antidepressant

45
Q

vareniciline

A

NAch receptor partial agonist
smoking cessation
tox - sleep disturbance, may depress mood

46
Q

vilazodone

A

inhibits 5HT reuptake, 5HT1A receptor partial agonist
used for major depressive disorder and GAD (off-label)
tox - headache, diarrhea, nausea, increased weight, anticholinergic effects
may causes serotonin syndrome if taken with other serotonergic agents

47
Q

vortioxetine

A

inhibits 5-HT reuptake, 5HT1a receptor agonist and 5HT3 receptor antagonist
major depressive disorder
tox - nausea, sexual dysfunction, sleep disturbances (abnormal dreams), anticholinergic effects
may cause serotonin syndrome

48
Q

atypical antidepressants

A

buproprion - NE/D reuptake inhibitor
varenicline - NACh partial agonist
-smoking cessation, buproprion is contraindicated in anorexics/bulimics

traZZZobone - blocks 5HT, H1, a receptors
mirtazabine - blocks 5HT, H1, a receptors
-sedation, depression

vilazodone, vortioxetine - major depressive disorder

  • inhibits 5HT reuptake
  • 5HT1 partial agonist
49
Q

MAOIs

A

MAO Takes Pride In Shanghai - tranylcypromine, phenelzine, isocarboxazid, selegiline
-MAO located in axon

uses - atypical depression, anxiety, Parkison’s (selegiline)

ADRS: CNS stimulation, hypertensive crisis

  • contraindicated with SSRIs, TCAs, St. Johns wort, meperidine, dextromethorphan
  • wait 2 weeks after stopping MAOIs before starting serotonergic drugs

pt has to have intact memory, cognition - there are a lot of foods you have to avoid when you are taking MAOIS

50
Q

TCADs

A

amitriptyline, nortriptlyine, imipramine, desipramine, clomipramine, doxepin, amoxapine
-inhibits NE and 5HT reuptake

uses - major depression, OCD (clomipramine), peripheral neuropathy, chronic pain, migraine prophylaxis, nocturnal enuresis (imipramine, ADRs may limit use)

ADRs - sedation, a1-blocking effects (postural HTN), atropine-like (anticholinergic) effects (3rd gen like amitriptyline have greater anticholinergic effects than second gen like nortrip)
-prolonged QT interval!!

Tri-Cs: convulsions, coma, cardiotox (arrhythmia due to Na+ channel inhibition), respiratory depression, hyperpyrexia

  • NaHCO3 to prevent arrhythmia
  • confusion and hallucinations in elderly - due to anticholinergic effects, use nortrip in elderly
51
Q

SSRIs

A

-tines, -prams, sertraline (aka zoloft)
uses - depression, GAD, panic disorder, OCD, bulimia, social anxiety disorder, PTSD, premature ejaculation, premenstrual dysphoric disorder
-takes 4-8 weeks to have an effect

ADRs - fewer than TCAs, GI distress, SIADH, sexual dysfunction

52
Q

SNRIs

A

venlafaxine, -praN
uses - depression, GAD, diabetic neuropathy
-venlafaxine - social anxiety disorder, panic disorder, PTSD, OCD
-duloxetine - fibromyalgia

ADRs - increased BP

53
Q

Li

A

something about inhibition of phosphoinositol cascade

mood stabilizer for BPD, blocks relapse and acute manic events

ADRs - LiTHIUM, low thyroid, heart (Ebstein anomaly - tricuspid valve is displaced towards apex), DI, unwanted movements (tremor)

54
Q

buspirone

A

stimulates 5HT1A receptors
GAD - no sedation, addiction, or tolerance
-1-2 weeks to take effect
-doesnt interact with alcohol (v.s. barbiturates, benzos)

55
Q

NE reuptake inhibitors

A

TCADs SNRIs

56
Q

5HT reuptake inhibitors

A

TCADs, SSRIs, SNRIs, trazadone

57
Q

typical antipsychotics

A

haloperidol, pimozide, -azines (ex fluphenazine)

block D2 receptor - increase cAMP
schizophrenia (primary positive symptoms), psychosis, bipolar disorder, delirium, Tourette syndrome, Huntington’s dz, OCD

high potency - time to fly high, Trifluoperazine, Fluphenazine, Haloperidol - neuro side effects (anticholinergic, anti-histamine), extrapyramidal symptoms

low potency - cheating thieves are low, Chlorpromazine, Thioridazine - anticholinergic, antihistamine, a1-blockade effects
- chlorpromazine lowers seizure threshold

ADRs - lipid soluble, takes a long time to be eliminated

  • endocrine - hyperprolactinemia
  • metabolic - dyslipidemia, weight gain, hyperglycemia
  • antimuscarinic
  • anithistamine - sedation
  • a1-blockade - orthostatic hypotension
  • cardiac - QT prolongation
  • ophthalmologic - chlorpromazine (corneal deposits), thioridazine (reTinal deposits)

extrapyramidal symptoms - ADAPT

  • hours-days - Acute Dystonia (muscle spasm/stiffness, oculogyric crisis - looks like you keep trying to roll your eyes back)
  • esp occurs with rapid dose escalation of first gen (like haloperidol)
  • d-mo - Akathisia (restlesness**, dont increase dose, decrease dose if possible), Parkinsonism (bradykinesia)
  • mo-yr - Tardive dyskinesia (orofacial chorea, can be irr)
  • treat with benzotropine (anticholinergic, used to treat parkisonism), benzos, b-blockers (akathisia)

neuroleptic malignant syndrome

58
Q

neuroleptic malignant syndrome

A

Malignant FEVER
myoglobinuria, fever, encephalopathy, unstable vitals, increased enzymes, muscle rigidity

treat with dantrolene (muscle relaxant) or D2 agonist (bromocriptine)

59
Q

atypical antipsychotics

A

-apine, -peridone, aripiprazole (aka abilify)
most are D2 antagonists, varied effects on other receptors

uses - schizophrenia (positive and negative symptoms), BPD, anxiety, depression, mania, Tourettes
-clozapine!! - for treatment resistance schizophrenia

ADRs - prolonged QT, fewer EPS and anticholinergic side effects than typical antipsychotics

  • apines- metabolic syndrome
  • clozapine - agranulocytosis (monitor WBCs) and seizures (dose related)
  • risperidone - hyperprolactinemia
  • ziprasidone - long QT

strangely enough prolactin levels are not regularly monitored

60
Q

delirium

A

waxing and waning level of consciousness

  • rapid decrease in attention span and level of arousal
  • disorganized thinking, hallucinations (visual), illusions, misperceptions, disturbance in sleep-wake cycle, cognitive dysfunction

most common presentation of altered MSE in inpt setting
-commonly, diffuse slowing EEG

may be caused by anticholingerics - esp in the elderly

reversible

61
Q

Dementia

A

decrease in intellectual fx - NO effects on level of consciousness

irreversible causes - Alzheimers, Lewy body dementia, Hungtingtons, Pick disease, cerebral infarct, Wilson disease, CJD, chronic substance abuse (due to neurotox of drugs), HIV

reversible causes - hypothyroid, depression, B1/B3/B12 deficiency, normal pressure hydrocephalus, neurosyphilis

increased incidence with age - EEG usually normal

62
Q

psychosis

A

distorted perception of reality - delusions, hallucinations, and/or disorganized thought/speech

63
Q

disorganized thought

A

word salad, tangential, or derailed (loose associations)

64
Q

hallucinations

A

olfactory - often occur as an aura of temporal love epilepsy (burning rubber) and brain tumors

gustatory - rare, but seen in epilepsy

tactile - alcohol withdrawal and stimulant use

65
Q

cluster A

A

weird = accusatory, aloof, awkward
-no psychosis

paranoid

schizoid = aloof

schizotypal - odd beliefs or magical thinking, interpersonal awkwardness (think Quentin)

66
Q

cluster B

A

wild - bad, borderline, flamBoyant, must be Best

antisocial - conduct disorder if < 18

borderline - … unstable, impulsive, self-mutilation, sucidality, sense of emptiness, treatment is dialectical behavior therapy
unstable relationships, self-image and affects, impulsive
-depression, suicidal, impulsive in the setting of feeling rejected
-mood shifts that occur in response to interpersonal stressors

histrionic

narcissistic

67
Q

cluster C

A

worried = cowardly, OC, clingy

avoidant - desires relationships with others (v.s. schizoid), timid

OC

dependent - pts often get stuck in abusive relationships

68
Q

schizophrenia

A

6+ months - psychosis, declining function

ddx 2/5 + 1/first three, first 4 are positive symptoms (positive symptoms are feelings/behaviors that are not normally present)

1) delusions
2) hallucinations
3) disorganized speech
4) disorganized or catatonic behavior
5) negative symptoms - affective flattening, avolition, anhedonia, asociality, alogia

  • frequent cannabis use is associated with psychosis/schizophrenia in teens
  • presents earlier in men (teens -20s), later in women (20s-30s)
  • pts are at increased risk for suicide

ventriculomegaly on brain imaging

Atypical antipsychotics are first-line (ex risperidone) -negative symptoms often persist after treatment

69
Q

brief psychotic disorder

A

less than 1 mo, usu stress related

would not see mood symptoms (like mania)

70
Q

schizophreniform

A

1-6 mo

71
Q

schizoaffective disorder

A

meets criteria for schizophrenia + major mood disorder (major depressive disorder or BPD)

pt must have major mood disorder with >2 weeks of hallucinations or delusions with major mood episode (v.s. major mood disorder with psychotic features)

72
Q

BPD

A

BPD1 - manic episode +/- hypomanic or depressive episode
-depressive episodes are not required for ddx

BPD2 - hypomania + depressive episode
-pts mood and functioning can return to normal between episodes

treat with mood stabilizers - Li, valproic acid, carbamezepine, lamotrigine, atypical antipsychotics

73
Q

cyclothymic disorder

A

mild BPD = mild depressive symptoms + hypomania

2(+) years

74
Q

major depressive disorder

A

5/9 SIGECAPS + 2 - last 2(+) weeks
treat with CBT and SSRIs, ECT in select pts
**note - adjustment disorder is NOT ddx if pt meets criteria for major depressive disorder (adjustment disorder is ddx of exclusion - lasts for less than 6 mo)

persistent depressive disorder - milder depression - 2(+) yrs

sleep changes

  • decreased slow-wave sleep
  • decreased REM latency
  • increased REM in early sleep cycle
  • increased total REM sleep
  • repeated nighttime awakenings
  • early-morning awakening (terminal insomnia)
75
Q

depression with atypical features

A

mood reactivity - can experience improved mood in response to positive events

hypersomnia, hyperphagia, long-standing interpersonal rejection sensitivity, *leaden paralysis

most common subtype of depression

treat with CBT and SSRIs, MAO are effective but not first line due to their high risk profile

76
Q

derealization

A

experiencing ones surroundings as unreal

reality testing is intact during depersonalization/derealization - person feels detached from body but knows this is not true

77
Q

medical conditions with anxiety symptoms

A

hypoglycemia

other more obvious ones - hyperthyroidism, pheo, hypercortisolism, arrhythmias

withdrawal from sedative-hypnotics, stimulant intoxication

78
Q

stimulant withdrawal

A

increased appetite, hypersomnia, intense psychomotor retardation, severe depression (crash)

cocaine withdrawal - vivid dreams, minor PHYSICAL symptoms (v.s. depressant withdrawal)

79
Q

nicotine withdrawal

A

increased appetite

80
Q

2 antidepressants that dont cause sexual side effects

A

bupropion

mirtazapine

81
Q

psychotic spectrum

A

brief psychotic disorder (less than 1 mo) - schizophreniform disorder (like schizophrenia but shorter) - schizophrenia

schizoaffective disorder

delusional disorder - 1 month or more of delusions, no other psychotic symptoms

82
Q

neonatal opioid withdrawal

A

irritability, tremors, sweating, yawning, feeding difficulties

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