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Psych Flashcards

1
Q

What is the key difference between classical and operant conditioning?

A
  • classical involves an involuntary response

- operant involves a voluntary response

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2
Q

What is operant conditioning?

A

learning which occurs because the given action produces a punishment or reward

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3
Q

What are the unconditioned and conditioned stimuli and response in a case of classical conditioning?

A
  • US: ring the bell
  • UR: eat
  • CS: ring the bell
  • CR: salivate
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4
Q

What is reinforcement?

A
  • the act of following a target behavior with either a desired reward or removal of an aversive stimulus
  • remember, both positive and negative reinforcement are meant to increase the frequency of the response
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5
Q

What is the difference between positive and a negative reinforcement?

A
  • both are meant to increase the frequency of the response

- postive means providing a reward whereas negative means removing an aversive stimulus

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6
Q

The opposite of reinforcement is what?

A

punishment

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7
Q

What is negative punishment?

A

the removal of a desired stimulus used to extinguish an unwanted behavior

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8
Q

What is extinction?

A

a phenomenon of both classical and operant conditioning in which discontinuation of reinforcement, positive or negative, eventually leads to elimination of the associated behavior

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9
Q

What is transference?

A

a situation in which the patient projects feelings about a formative or important person onto the physician (e.g. psychiatrist is seen as a parent)

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10
Q

What is countertransference?

A

a situation in which the doctor projects feelings about a formative or other important person onto the patient (e.g. patient is seen as younger sibling)

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11
Q

What are ego defenses? List several mechanisms.

A
  • they are mental processes, both conscious and unconscious, used to resolve conflict and prevent undesirable feelings
  • includes acting out, denial, displacement, dissociation, fixation, idealization, and identification
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12
Q

What is meant by acting out in the context of ego defenses?

A

expressing unacceptable feelings and thoughts through actions

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13
Q

What is meant by denial in the context of ego defenses?

A

avoiding the awareness of some painful reality

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14
Q

What is meant by displacement in the context of ego defenses?

A
  • transferring avoided ideas and feelings to a neutral person or object
  • different from projection
  • example: mother yells at her child because her husband yelled at her
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15
Q

What is meant by dissociation in the context of ego defenses?

A
  • a temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress
  • dissociative identify disorder would be the extreme of this
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16
Q

What is meant by fixation in the context of ego defenses?

A
  • partially remaining at a more childish level of development
  • different than regression
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17
Q

What is meant by idealization in the context of ego defenses?

A

expressing extremely positive thoughts of self and others while ignoring negative ones

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18
Q

What is meant by identification in the context of ego defenses?

A
  • modeling behavior after another person who is more powerful
  • prime example is an abused child later becoming a child abuser
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19
Q

The idea that victims of child abuse often later become child abusers is an example of what ego defense mechanism?

A

identification (modeling behavior after another person who is more powerful)

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20
Q

What is meant by intellectualization in the context of ego defenses?

A
  • the use of facts and logic to emotionally distance oneself from a stressful situation
  • perfect example is a patient who focuses only on rates of survival after receiving a cancer diagnosis
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21
Q

What is meant by isolation of affect in the context of ego defenses?

A
  • separating feelings from ideas and events

- e.g. a murderer describing in graphic detail what he did without emotional response

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22
Q

What is meant by passive aggression in the context of ego defenses?

A

failing to meet the needs or expectations of others as an indirect show of opposition

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23
Q

What is meant by projection in the context of ego defenses?

A
  • attributing an unacceptable internal impulse to an external source
  • e.g. a man who wants to cheat on his wife accuses her of being unfaithful
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24
Q

What is meant by rationalization in the context of ego defenses?

A

proclaiming logical reasons for actions actually performed for other reasons, most often to avoid self-blame

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25
Q

What is meant by reaction formation in the context of ego defenses?

A
  • replacing a warded-off idea or feeling by an unconsciously derived emphasis on it’s opposite
  • i.e. a patient with libidinous thoughts entering the monastery
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26
Q

What is meant by regression in the context of ego defenses?

A

involuntarily turning back the maturational clock and going back to earlier modes of dealing with the world

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27
Q

What is meant by repression in the context of ego defenses?

A
  • involuntarily withholding an idea or feeling from conscious awareness
  • differs from suppression which is more conscious
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28
Q

What is meant by splitting in the context of ego defenses? In which population is it commonly seen?

A
  • believing that people are either all good or all bad at different times due to intolerance of ambiguity
  • commonly seen in those with borderline personality disorder
  • e.g. a patient says that all the nurses are cold and insensitive but the doctors are warm and friendly
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29
Q

How do repression and suppression differ in the context of ego defenses??

A
  • repression is an unconscious act whereas suppression is more conscious
  • furthermore, repression is an immature defense whereas suppression is a mature one
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30
Q

Ego defenses can be divided into what two categories?

A

immature and mature

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31
Q

Which ego defenses are considered “mature”?

A
  • sublimation
  • altruism
  • suppression
  • humor
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32
Q

What is meant by sublimation in the context of ego defenses?

A
  • a mature defense in which an unacceptable wish is replaced by another course of action that is similar but does not conflict with one’s value system
  • e.g. teenager’s aggression toward his father is redirected to perform well in sports
  • in contrast to the immature response of reaction formation
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33
Q

What is meant by altruism in the context of ego defenses?

A
  • a mature defense in which negative feelings are alleviated via unsolicited generosity
  • e.g. a mafia boss makes a large donation to charity
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34
Q

What is meant by suppression in the context of ego defenses?

A
  • a mature defense that involves intentionally withholding an idea or feeling from conscious awareness
  • differs from repression in that it is conscious and meant to be temporary
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35
Q

What is meant by humor in the context of ego defenses?

A

a mature defense characterized by appreciating the amusing nature of an anxiety-provoking or adverse situation

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36
Q

What is meant by the phrase “infant deprivation effects”? What specific effects are seen?

A
  • changes in infants that arise out of long-term deprivation of affection
  • failure to thrive, poor language/social skills, lack of basic trust, and reactive attachment disorder (withdraws or is unresponsive to comfort)
  • these can be remembered by the 4 W’s: weak, wordless, wanting (socially), and wary
  • the changes are typically irreversible if deprivation lasts more than 6 months and severe deprivation can even result in infant death
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37
Q

What percentage of deaths in children less than one year old can be attributed to physical abuse?

A

40%

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38
Q

Who is most often the perpetrator in instances of physical child abuse? Who is most often the perpetrator of sexual child abuse?

A
  • the biological mother is most often the physical abuser

- a male known to the victim is most often the sexual abuser

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39
Q

At what age does the incidence of child sexual abuse peak?

A

between the ages of 9-12

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40
Q

What kind of fraction is pathognomonic for child abuse?

A

a spiral fracture

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41
Q

Polymicrobial septicemia in children is almost always attributable to what?

A

Munchausen’s by proxy

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42
Q

What is the most common form of child maltreatment?

A

neglect

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43
Q

Vulnerable Child Syndrome

A
  • an instance in which the parents perceive their child as especially susceptible to illness or injury
  • usually follows a serious illness or life-threatening event
  • can result in missed school days or overuse of medical services
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44
Q

ADHD

A
  • an early-onset disorder of limited attention span and poor impulse control that begins before age 12
  • characterized by hyperactivity, impulsivity, and/or inattention in multiple settings
  • normal intelligence but often struggle at school
  • persists into adulthood in nearly half of all cases
  • treat with stimulants like methylphenidate with or without CBT
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45
Q

What is the preferred treatment for ADHD?

A

methylphenidate

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46
Q

Autism Spectrum Disorder

A
  • a disorder of poor social interaction, social communication deficits, restricted interests, and repetitive or ritualized behaviors
  • may be accompanied by intellectually disability and only rarely accompanied by unusual abilities (savants)
  • associated with larger head and brain size
  • must present in early childhood
  • more common in boys
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47
Q

Rett Syndrome

A
  • an X-linked dominant disorder seen almost exclusively in girls because affected males die in utero or shortly after birth
  • presents around age 1-4 with regression, including loss of development, loss of verbal abilities, intellectual disability, ataxia, and stereotyped hand-wringing
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48
Q

Conduct Disorder

A
  • repetitive and pervasive behavior violating the basic rights of others or social norms
  • many patients often meet criteria for antisocial personality disorder after reaching the age of 18
  • treatment is CBT
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49
Q

Those with what childhood disorder often progress to antisocial personality disorder in adulthood?

A

conduct disorder

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50
Q

Oppositional Defiant Disorder

A
  • an enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms
  • treatment is CBT
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51
Q

Separation Anxiety Disoder

A
  • an overwhelming fear of separation from home or loss of attachment figure
  • commonly presents between 7-9 with factitious physical complaints to avoid going to or staying at school
  • treatment involves CBT, play therapy, and family therapy
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52
Q

Tourette Syndrome

A
  • a disorder of sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist longer than one year with an onset before age 18
  • Coprolalia is only seen in 20% of cases
  • associated with OCD and ADHD
  • treatment is psychoeducation and behavioral therapy
  • for intractable and distressing tics, high-potency antipsychotics, tetrabenazine, guanfacine, and clonidine can be used
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53
Q

What is coprolalia?

A

a form of Tourette syndrome characterized by involuntary obscene speech

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54
Q

Schizophrenia is associated with what NT changes?

A

an increase in dopamine

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55
Q

Parkinson disease is associated with what NT changes?

A

a decrease in dopamine and increase in ACh

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56
Q

Huntington disease is associated with what NT changes?

A

a decrease in GABA and ACh and an increase in DA

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57
Q

Depression is associated with what NT changes?

A

a decrease in NE, serotonin, and dopamine

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58
Q

Anxiety disorders are associated with what NT changes?

A

an increase in NE and a decrease in both GABA and serotonin

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59
Q

Alzheimer’s disease is associated with what NT changes?

A

an increase in glutamate and a decrease in ACh

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60
Q

In what order is orientation most often lost?

A
  • first lost is orientation to time
  • second is to place
  • last is to person
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61
Q

What is retrograde amnesia?

A

the inability to remember things that occurred before a CNS insult

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62
Q

What is anterograde amnesia?

A

the inability to form new memories

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63
Q

Korsakoff Syndrome

A
  • anterograde amnesia caused by a vitamin B1 deficiency and associated with destruction of the mammillary bodies
  • patients often compensate with confabulation
  • most often seen in alcoholics as a late neuropsychologist manifestation of Wernicke encephalopathy
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64
Q

What are dissociative amnesia and dissociative fugue?

A
  • the inability to recall important personal information, most often in a period following severe trauma or stress
  • may be accompanied by a dissociative fugue, which is abrupt travel or wandering in the setting of dissociative amnesia
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65
Q

Dissociative Identify Disorder

A
  • also known as multiple personality disorder
  • associated with a history of sexual abuse, PTSD, depression, substance abuse, borderline personality disorder, and somatoform conditions
  • more common in women
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66
Q

What is depersonalization disorder? How does it differ from derealization disorder?

A
  • persistent feelings of detachment or estrangement from one’s own body, thoughts, perceptions, and actions
  • by contrast, derealization is a persistent feeling of detachment from one’s environment
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67
Q

What are the criteria for delirium?

A
  • acute and fluctuating course
  • inattention
  • disorder thinking or altered level of consciousness
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68
Q

What kind of EEG is common in those suffering from delirium?

A

a diffuse, slowing EEG

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69
Q

How is delirium treated?

A
  • focus on treating the underlying condition

- use haloperidol as needed and benzodiazepines for alcohol withdrawal

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70
Q

How does dementia differ from delirium?

A
  • dementia has a more chronic, gradual, progressive course than delirium
  • those with dementia also suffer greater functional deficits (ADLs and IADLs)
  • EEG can be helpful in distinguishing the two because the EEG for a demented patient is usually normal but diffuse slowing EEGs are common for delirious patients
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71
Q

What are five reversible causes of dementia?

A
  • hypothyroidism
  • depression
  • vitamin B12 deficiency
  • normal pressure hydrocephalus
  • neurosyphilis
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72
Q

When assessing patients for dementia, be sure to screen them for what else?

A

pseudodementia, including depression, hypothyroidism, and B12 deficiency

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73
Q

How is psychosis defined?

A

as a distorted perception of reality characterized by delusions, hallucinations, and/or disorganized thinking

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74
Q

What are delusions?

A

unique, false beliefs that persist despite the facts

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75
Q

What is a referential delusion?

A

the belief that a neutral event has a special or personal meaning

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76
Q

What is an erotomanic delusion?

A

one in which the person believes another is in love with him or her

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77
Q

What is a somatic delusion?

A

the belief that one’s bodily functioning, sensation, or appearance is grossly abnormal

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78
Q

What are hallucinations? How does this differ from an illusion?

A
  • hallucinations are perceptions in the absence of any
    external stimuli
  • whereas illusions are misperceptions of real external stimuli
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79
Q

Under what circumstances are visual and auditory hallucinations most common?

A
  • visual are more commonly a feature of a medical illness

- auditory are more commonly a feature of a psychiatric illness

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80
Q

Under what circumstances are olfactory hallucinations most common?

A

as an aura preceding temporal lobe epilepsy or in those with brain tumors

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81
Q

Under what circumstances are tactile hallucinations most common?

A

in the settings of alcohol withdrawal and stimulant use (e.g. delusional parasitosis aka “cocaine crawlies”)

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82
Q

What is a hypnagogic hallucination? What are they most often a feature of?

A

one that occurs while going to sleep, sometimes seen in cases of narcolepsy

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83
Q

What is a hypnopompic hallucination? What are they most often a feature of?

A

one that occurs while waking from sleep, sometimes seen in cases of narcolepsy

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84
Q

Schizophrenia

A
  • diagnosis requires two of the following including one of the first three for more than 6 months: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms
  • associated with increased dopaminergic activity, decreased dendritic branching, and ventriculomegaly
  • lifetime prevalence is 1.5% with no gender or racial differences but presents earlier in men than women (early 20s v. late 20s/early 30s)
  • treat with atypical antipsychotics like risperidone
  • associated with frequent cannabis use in teens and increases risk for suicide
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85
Q

What physical, neurologic changes are seen in those with schizophrenia?

A
  • increased dopaminergic activity
  • decreased dendritic branching
  • ventriculomegaly
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86
Q

What are the criteria for diagnosing schizophrenia?

A

two or more of the following, including one of the first three, for a period lasting longer than six months

  • delusions
  • hallucinations
  • disorganized thought
  • disorganized or catatonic behavior
  • negative symptoms
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87
Q

What is a brief psychotic disorder?

A
  • symptoms of schizophrenia lasting less than one month
  • two of the following including one of the first three for less than 1 month: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms
  • usually stress-related
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88
Q

What is the relationship between schizoaffective disorder, brief psychotic disorder, schizophreniform disorder, and schizophrenia?

A
  • schizoaffective is more than 2 weeks of hallucinations or delusions without a major mood episode plus periods with a major mood episode
  • brief psychotic disorder is schizophrenia for less than one month
  • schizophreniform disorder is schizophrenia for 1-6 months
  • schizophrenia is symptoms lasting more than 6 months
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89
Q

What is schizoaffective disorder?

A
  • more than 2 weeks of hallucinations or delusions without a major mood episode
  • plus periods of schizophrenic symptoms with concurrent major mood episodes
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90
Q

What is delusional disorder?

A

a fixed, persistent, false belief system lasting more than one month without otherwise impaired functioning

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91
Q

What is folie a deux?

A

a delusion shared by individuals in a close relationship

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92
Q

What is mood disorder?

A
  • an abnormal range of moods or internal emotional states and loss of control over them
  • severity of moods causes distress and impaired social and occupational functioning
  • includes major depressive disorder, bipolar disorder, dysthymic disorder, and cyclothymic disorder
  • may have superimposed psychotic features
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93
Q

What is a manic episode? What are the diagnostic requirements?

A
  • a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy lasting at least one week
  • diagnosis requires hospitalization or at least three of the following: distractibility, irresponsibility, grandiosity, flight of ideas, decreased need for sleep, talkativeness or pressured speech, and psychomotor agitation or an increase in goal-directives activity
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94
Q

How is a hypomanic episode defined?

A
  • like a manic episode except the disturbance is not severe enough to caused marked impairment in daily living or necessitate hospitalization
  • lasts at least four consecutive days
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95
Q

What is another name for bipolar disorder?

A

manic depression

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96
Q

How does bipolar I differ from bipolar II?

A
  • I is the presence of at least one manic episode with or without a hypomanic or depressive episode
  • II is the experience of a hypomanic episode and a depressive episode without a manic episode
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97
Q

Bipolar Disorder

A
  • defined by the presence of a manic or hypomanic episode and can involve depressive episodes
  • most often, the patient’s mood and functioning return to normal between episodes
  • patients have a high risk for suicide, but anti-depressants can precipitate mania and should not be used
  • treat with mood stabilizers (lithium, valproic acid, carbamazepine) and atypical antipsychotics
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98
Q

Which class of medications should not be used in those with bipolar disorder? Why?

A

anti-depressants because of their ability to precipitate a manic episode

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99
Q

What is the preferred treatment for bipolar disorder?

A
  • mood stabilizers like lithium, valproic acid, carbamazepine
  • atypical antipsychotics
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100
Q

What is cyclothymic disorder?

A

a milder form of bipolar disorder lasting at least two years over the course of which the patient experiences fluctuations between mild depressive and hypomanic symptoms (i.e. longer, milder cycling course)

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101
Q

What are the diagnostic criteria for major depressive disorder?

A

5 or more of the following for two or more weeks with reported depression or anhedonia being one:

  • depressed mood
  • sleep disturbance
  • loss of interest
  • guilt or feelings of worthlessness
  • fatigue
  • difficulty concentrating
  • appetite or weight changes
  • psychomotor retardation or agitation
  • suicidal ideations
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102
Q

Major Depressive Disorder

A
  • diagnosis requires 5 or more symptoms lasting more than two weeks including either depression or anhedonia
  • often have changes in their sleep patterns including: less slow-wave sleep, less REM latency, increased REM early in sleep cycle, increased total REM, repeated awakenings, and early-morning wakening
  • first line therapy is SSRIs and CBT
  • second line therapy is SNRIs, mirtazapine, and bupropion
  • ECT can be used in select patients, often with good results
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103
Q

What changes in sleep are often seen in those with depression?

A
  • less slow wave sleep
  • less REM latency, more REM early in the night, and more total REM
  • repeated nighttime awakenings and terminal insomnia (early wakening)
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104
Q

What are the first three lines of therapy for depression?

A

1) CBT and an SSRI
2) SNRI, mirtazapine, or bupropion
3) ECT

105
Q

What is persistent depressive disorder?

A
  • aka dysthymia

- is a milder form of depression lasting at least two years

106
Q

What is unique about “depression with atypical features”?

A
  • characterized by the ability to react emotionally to positive events (but only for a brief time), reversed vegetative symptoms (hypersomnia and hyperplasia), leaden paralysis (heavy feeling in arms and legs), and long-standing interpersonal rejection sensitivity
  • it is the most common subtype of depression
  • treatment is largely the same as MDD
107
Q

To be considered postpartum, a mood disturbance must occur when?

A

within 4 weeks of delivery

108
Q

Postpartum “Blues”

A
  • characterized by depressed affect, tearfulness, and fatigue starting 2-3 days after delivery
  • treatment is supportive as it usually resolves in 10 days
  • follow-up for possible postpartum depression
  • 50 to 85% incidence rate
109
Q

Postpartum Depression

A
  • depressed affect, anxiety, and poor concentration arising within 4 weeks of delivery
  • treat with CBT and SSRIs
  • 10-15% incidence
110
Q

Postpartum Psychosis

A
  • mood-congruent delusions, hallucinations, and thoughts of harming the baby or self
  • risk factors include history of bipolar or psychotic disorder, first pregnancy, family history, and recent discontinuation of a psychotropic medication
  • treat with hospitalization and initiation of atypical antipsychotics; ECT if necessary
111
Q

What is the difference between normal and pathologic grief?

A
  • normal is characterized by shock, denial, guilt, sadness, yearning, and somatic symptoms
  • pathologic grief is persistent and causes functional impairment
112
Q

Describe normal grief.

A
  • feelings of shock, denial, guilt, sadness, yearning, and somatic symptoms
  • hallucinations of the deceased are common
  • duration varies but is usually less than 6 months
113
Q

What are the uses of ECT?

A
  • refractory depression
  • depression with psychotic symptoms
  • acutely suicidal patients
  • pregnant patients
114
Q

What are the adverse effects of ECT?

A
  • disorientation
  • temporary headache
  • partial anterograde/retrograde amnesia
115
Q

What are risk factors for suicide completion?

A

SAD PERSONS

  • sex (male)
  • age (young adult and elderly)
  • depression
  • previous attempt
  • ethanol or drug use
  • rational thinking loss (psychosis)
  • sickness (medical illness)
  • organized plan
  • no spots or other social support
  • stated future intent
116
Q

What is the most common method of suicide in the US?

A

firearms

117
Q

What is the preferred treatment for anxiety disorders?

A

CBT, SSRIs, or SNRIs

118
Q

Panic Disorder

A
  • recurrent panic attacks defined as periods of intense fear and discomfort peaking in 10 minutes with at least four of the following: palpitations, paresthesia, depersonalization nor derealization, abdominal distress or nausea, intense fear of dying, intense fear of losing control, light-headedness, chest pain, chills, choking, sweating, shaking, shortness of breath
  • additionally, requires a period of 1 month after the attack in which there is persistent fear of another attack, worry about the consequences of the attack, or behavioral change related to attacks
  • there is a strong genetic component
  • first line therapy is CBT, SSRIs, and venlafaxine; benzodiazepines can be used in an acute setting
119
Q

Specific Phobia

A
  • a severe, persistent fear or anxiety due to presence or anticipation of a specific object or situation that the person realizes is excessive
  • treated with systematic desensitization
120
Q

Social Anxiety Disorder

A
  • exaggerated fear of embarrassment in social situations

- treat with CBT, SSRIs, venlafaxine; or try a benzo or beta blocker for only occasional anxiety-inducing situations

121
Q

Agoraphobia

A
  • the exaggerated fear of open or enclosed places such as public transportation, lines/crowds, or leaving home
  • associated with panic disorder
  • treated with CBT, SSRIs, and MAOIs
122
Q

Generalized Anxiety Disorder

A
  • anxiety lasting more than 6 months unrelated to a specific person, place, or thing characterized by restlessness, irritability, sleep disturbance, fatigue, muscle tension, and/or difficulty concentration
  • treat with CBT, SSRIs, or SNRIs as first line; Buspirone, TCAs, and benzos are second line
123
Q

Adjustment Disorder

A
  • emotional symptoms causing impairment following an identifiable psychosocial stressor and lasting less than 6 months (unless the stressor is also chronic)
  • treat with CBT and SSRIs
124
Q

Obsessive-Compulsive Disoder

A
  • recurring, intrusive thoughts, feelings, or sensations that cause severe distress and are relieved, in part, by the performance of repetitive actions
  • ego-dystonic meaning the behavior is inconsistent with one’s own beliefs and attitudes
  • associated with Tourette’s syndrome
  • treat with CBT, SSRs, and clomipramine
125
Q

Body Dysmorphic Disorder

A
  • a preoccupation with minor or imagined defects in appearance which lead to significant emotional distress or impaired functioning
  • these patients may seek cosmetic treatment often
  • treat with CBT
126
Q

How is PTSD treated?

A

CBT, SSRIs, and venlafaxine

127
Q

What is the difference between PTSD and acute stress disorder?

A
  • PTSD lasts more than one month whereas acute stress disorder last less than one month
  • additionally, PTSD usually requires pharmacological treatment with CBT, but acute stress disorder does not
128
Q

Malingering

A
  • consciously faking, profoundly exaggerating, or claiming to have disorders in order to attain a specific external gain such as avoiding work or obtaining compensation
  • often have poor compliance with treatment or follow-up of diagnostic tests
  • complaints cease after the gain
129
Q

How does malingering differ from factitious disorders?

A

malingerers are seeking an external gain whereas those with a factitious disorder are seeking a primary (internal, unconscious) gain

130
Q

Munchausen Syndrome

A
  • also known as factitious disorder imposed on self
  • chronic, conscious creation of physical and/or psychological symptoms in order to assume the “sick role” and get medical attention for the purposes of a primary gain
  • usually characterized by a history of multiple hospital admissions and willingness to undergo invasive procedures
131
Q

Munchausen by Proxy

A
  • aka factitious disorder imposed on another
  • when an illness in a child or elderly patient is caused or fabricated by the caregiver with the purpose of assuming the sick role by proxy
  • qualifies as a form of child/elder abuse
132
Q

What do somatic symptom disorders have in common?

A
  • physical symptoms causing significant distress and impairment which are unconscious produced
  • differs from Munchausen’s in that both the illness and motivation are unconscious drives and the symptoms are not intentionally produced or feigned
  • more common in women
133
Q

Somatic Symptom Disorder

A
  • characterized by a variety of bodily complaints lasting months to years
  • associated with excessive, persistent thoughts and anxiety about symptoms
  • like other somatic disorders, these symptoms are not intentionally produced or feigned and the drive is unconscious
  • may co-occur with a medical illness
134
Q

Conversion Disorder

A
  • the loss of sensory or motor function, most often following an acute stressor
  • patient is aware of but sometimes indifferent toward the symptoms
  • like other somatic disorders, these symptoms are not intentionally produced or feigned and the drive is unconscious
  • more common in females, adolescents, and young adults
135
Q

Illness Anxiety Disorder

A
  • the excessive preoccupation with acquiring or having a serious illness, often despite medical evaluation and reassurance
  • few somatic symptoms
  • like other somatic disorders, it is unintentionally and unconsciously driven
136
Q

Pseudocyesis

A
  • the false, non delusional belief of being pregnant
  • may have signs and symptoms of pregnancy
  • like other somatic disorders, it is unintentionally and unconsciously driven
137
Q

What is a “personality trait”?

A

an enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself

138
Q

What is a personality disorder?

A
  • an inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning
  • the individual is usually not aware of the problem
  • usually presents by early adulthood
  • divided into three clusters A, B, and C, which are somewhat grouped into “weird, wild, and worried”
139
Q

Cluster A personality disorders are grouped according to what shared quality?

A
  • being odd or eccentric
  • inability to develop meaningful social relationships
  • no psychosis
140
Q

What other disorder are cluster A personality disorders genetically related to?

A

Schizophrenia

141
Q

Paranoid Personality Disorder

A
  • pervasive distrust or suspiciousness

- projection is the major defense mechanism

142
Q

Schizoid Personality Disorder

A
  • voluntary social withdrawal and limited emotional expression
  • content with this social isolation, which is how it is distinguished from avoidant personality disorder
143
Q

Which personality disorders are included in group A?

A
  • paranoid
  • schizoid
  • schizotypal
144
Q

Schizotypal Personality Disorder

A
  • eccentric appearance, odd beliefs, or magical thinking

- experience interpersonal awkwardness

145
Q

What other disorder are cluster B personality disorders genetically related to?

A

mood disorders and substance abuse

146
Q

Antisocial Personality Disorder

A
  • a disregard for and violation of others’ rights, criminality, or impulsivity
  • must be over 18 years old and have a history of conduct disorder before the age of 15
  • considered conduct disorder if less than 18 years old
  • more common in men than women
147
Q

Borderline Personality Disorder

A
  • unstable mood and interpersonal relationships, impulsivity, self-mutilation, suicidality, and sense of emptiness
  • treated with dialectical behavior therapy
  • splitting is a major defense mechanisms in these individuals
  • more common in females than males
148
Q

Histrionic Personality Disorder

A

excessive emotionality and excitability, attention seeking, sexually provocative, and overly concerned with appearance

149
Q

Narcissistic Personality Disorder

A
  • grandiosity, sense of entitlement, lack of empathy, requires excessive admiration
  • often demand the best and react to criticism with rage
150
Q

Give a one or two word summary for each of the personality disorders:

  • paranoid
  • schizoid
  • schizotypal
  • antisocial
  • borderline
  • histrionic
  • narcissistic
  • avoidant
  • obsessive-compulsive
  • dependent
A
  • paranoid: suspicious
  • schizoid: voluntarily withdrawn
  • schizotypal: magical thinking
  • antisocial: violation of other’s rights
  • borderline: unstable mood and relationships
  • histrionic: emotional and attention seeking
  • narcissistic: entitled
  • avoidant: hypersensitive to rejection
  • obsessive-compulsive: ordered and controlling
  • dependent: submissive and clingy
151
Q

Cluster C personality disorders are genetically related to what other group of disorders?

A

anxiety disorders

152
Q

Describe someone with avoidant personality disorder.

A
  • hypersensitive to reject and thus socially inhibited and timid with feelings of inadequacy
  • differs from schizoid in that these individuals desire relationships with others
153
Q

What is ego-syntonic?

A

behaviors that are consistent with one’s own beliefs and attitudes (seen in OCPD but not OCD)

154
Q

Describe someone with dependent personality disorder.

A
  • submissive and clingy with an excessive need to be taken care of, often having low self-confidence
  • these patients are often at risk for getting stuck in abusive relationships
155
Q

Anorexia Nervosa

A
  • excessive dieting, exercise, or binge eating/purging with a BMI less than 18.5 in addition to an intense fear of gaining weight and a distortion or overvaluation of body image
  • associated with diminished bone density, severe weight loss, metatarsal stress fractures, amenorrhea (loss of pulsatile GnRH), lanugo, anemia, and electrolyte disturbances
  • commonly coexists with depression
  • psychotherapy and nutritional rehab are first line but refeeding syndrome can occur in significantly malnourished patients
156
Q

What is refeeding syndrome?

A
  • a complication that may arise when treating very malnourished individuals
  • the rise in insulin leads to hypophosphatemia, which contributes to cardiac complications
157
Q

Bulimia Nervosa

A
  • binge eating with recurrent inappropriate compensatory behaviors occurring weekly for at least three months in addition to overvaluation of body image
  • body weight is often maintained with the normal range but associated with parotitis, enamel erosion, electrolyte disturbances, alkalosis, and dorsal hand calluses (Russell sign)
  • treat with psychotherapy, nutritional rehab as necessary, and antidepressants
158
Q

What is a positive Russell sign?

A

finding calluses on the dorsal hand, typically because the individual is inducing vomiting

159
Q

Binge Eating Disorder

A
  • regular episodes of excessive, uncontrollable eating without inappropriate compensatory behaviors
  • increases the risk for diabetes
  • treat with psychotherapy; add an SSRI if necessary
160
Q

Gender Dysphoria

A
  • a strong, persistent cross-gender identification that leads to persistent discomfort with sex assigned at birth, causing significant distress and/or impairing functioning
  • can also be seen in those who have undergone gender reassignment surgery
161
Q

What is the difference between transsexualism and transvestism?

A
  • transsexualism is the desire to live as the opposite sex, often through surgery or hormone treatment
  • transvestism is not associated with gender dysphoria and is the desire tower the clothes of the opposite sex
162
Q

Sleep Terror Disorder

A
  • periods of terror with screaming in the middle of the night
  • occurs during slow-wave/deep/stage N3 sleep and thus there is no memory of the arousal
  • cause is unknown but it can be triggered by emotional stress, fever, or lack of sleep
  • most often in children
  • usually self-limited
163
Q

Narcolepsy

A
  • disordered regulation of sleep-wake cycles
  • the primary symptom is daytime sleepiness although these patients wake feeling rested
  • caused by low hypocretin (aka orexin) production in the lateral hypothalamus
  • associated with hypnagogic or hypnopompic hallucinations, nocturnal and narcoleptic sleep episodes (which importantly start with REM), and cataplexy
  • has a strong genetic component
  • treat with daytime stimulants and nighttime sodium oxybate
164
Q

What is cataplexy?

A

the loss of all muscle tone following strong emotional stimulus such as laughter

165
Q

What are the criteria for substance use disorder?

A

maladaptive pattern of use defined as two or more of the following in one year

  • tolerance
  • withdrawal
  • substance taken in larger amounts, or over a longer time, than desired
  • persistent desire or unsuccessful attempts to cut down
  • significant energy spent obtaining, using, or recovering from substance
  • important social, occupational, or recreational activities reduced because of use
  • continued use despite knowing it causes physical or psychological problems
  • craving
  • recurrent use in physically dangerous situations
  • failure to fulfill major obligations at work, school, or home due to use
  • social or interpersonal conflicts related to substance use
166
Q

What are the six stages of change?

A

precontemplation, contemplation, preparation, action, maintenance, relapse

167
Q

What is the precontemplation stage of change?

A

not yet acknowledging that there is a problem

168
Q

What is the contemplation stage of change?

A

acknowledging there is a problem, but not yet being ready or willing to make a change

169
Q

What is a sensitive indicator of alcohol use?

A

serum gamma-glutamyltransferase

170
Q

What is the most common cause of drug overdose death?

A

opioids

171
Q

How is opioid overdose treated?

A

naloxone or naltrexone

172
Q

How is barbiturate overdose treated?

A

with symptom management and maintenance of respiration; there is no specific antidote

173
Q

How is benzodiazepine overdose treated?

A

with flumazenil, a benzo receptor antagonist

174
Q

What is flumazenil? What is the major side effect?

A
  • it is a competitive antagonist used in the treatment of benzodiazepine overdose
  • it is rarely used because it can precipitate seizures
175
Q

How do we treat delirium tremors?

A

long-actin benzodiazepines

176
Q

How is opioid withdrawal treated?

A

with long-term support in the form of methadone or buprenorphine

177
Q

What are the symptoms of benzodiazepine withdrawal?

A
  • anxiety
  • tremors
  • seizures
  • insomnia
  • depression
  • rebound anxiety
178
Q

What dangers are associated with amphetamine use?

A

cardiac arrest and seizures

179
Q

How is amphetamine overdose treated?

A

benzodiazepines to control both agitation and seizures

180
Q

How is cocaine overdose treated?

A
  • alpha blockers to limit cardiac effects and benzodiazepines
  • beta-blockers are contraindicated
181
Q

What are the symptoms of caffeine intoxication?

A

restlessness, diuresis, muscle twitching

182
Q

What are the symptoms of caffeine withdrawal?

A
  • headache
  • difficulty concentrating
  • flu-like symptoms
183
Q

What are the symptoms of nicotine withdrawal? How is it treated?

A
  • irritability, anxiety, restlessness, difficulty concentrating
  • treat with nicotine replacement, bupropion (an atypical anti-depressant) or varenicline (a nicotinic agonist)
184
Q

What are the symptoms of phencyclidine use? What is the most common complication? How is use treated?

A
  • symptoms include violence, impulsivity, psychomotor agitation, nystagmus, tachycardia, hypertension, analgesia, psychosis, delirium, and seizures
  • trauma is the most common complication
  • treat with benzodiazepines and a rapid-acting anti-psychotic
185
Q

What is dronabintol?

A

a THC isomer used as an antiemetic and appetite stimulant

186
Q

Marijuana is typically detectable in urine for how long?

A

up to one month

187
Q

What are the symptoms of marijuana withdrawal?

A

irritability, anxiety, depression, insomnia, restlessness, and decreased appetite

188
Q

What are the life-threatening effects of MDMA?

A

hypertension, tachycardia, hyperthermia, hyponatremia, and serotonin syndrome

189
Q

What is methadone?

A

a long-acting oral opiate used for opioid detox and long-term maintenance

190
Q

What is naltrexone?

A

a long-acting opioid antagonist used for relapse prevention once a patient has detoxed from opioids

191
Q

What is the naloxone + buprenorphine combination?

A

an antagonist and partial agonist use to treat opioid overdose

192
Q

What role do methadone, naltrexone, and naloxone play in management of opioid use?

A
  • methadone is to assist with detox and for long-term mainteance
  • naltrexone is used for relapse prevention after detox
  • naloxone is an antagonist used to treat overdose
193
Q

What are the symptoms of alcohol withdrawal?

A

tremor, tachycardia, hypertension, sweating, nausea, malaise, deliriums tremens, aggression

194
Q

What are the common complications of alcoholism?

A
  • alcoholic cirrhosis
  • hepatitis
  • pancreatitis
  • peripheral neuropathy
  • testicular atrophy
195
Q

How is alcoholism treated pharmacologically?

A

disulfiram, acamprosate, naltrexone, and supportive care

196
Q

What is disulfiram?

A

an aldehyde dehydrogenase inhibitor used to condition alcoholics to abstain

197
Q

Delirium Tremens

A
  • a life-threatening syndrome of alcohol withdrawal that peaks 2-4 days after abstinence begins
  • characterized by sympathetic overactivity (tachycardia, tremors, anxiety, seizures
  • treat with long-acting benzodiazepines
198
Q

Alcoholic Hallucinosis

A
  • distinct from delirium tremens
  • characterized by visual hallucinations 12-48 hours after abstinence begins
  • treat with benzodiazepines
199
Q

What is the difference between derlirium tremens and alcoholic hallucinosis?

A
  • DT is a syndrome whereas alcoholic hallucinosis is simply the onset of hallucinations due to withdrawal
  • additionally, alcoholic hallucinosis begins 12-48 hours after the last drink whereas DT begins 2-4 days after abstinence
200
Q

What is the preferred class of drugs for ADHD?

A

stimulants like methylphenidate or amphetamines

201
Q

What is the preferred class of drugs for alcohol withdrawal?

A

benzodiazepines

202
Q

What is the preferred class of drugs for bipolar disorders?

A

lithium, valproic acid, atypical antipsychotics

203
Q

What is the preferred class of drugs for bulimia nervosa?

A

SSRIs

204
Q

What is the preferred class of drugs for depression?

A

SSRIs

205
Q

What is the preferred class of drugs for generalized anxiety disorder?

A

SSRIs and SNRIs

206
Q

What is the preferred class of drugs for obsessive-compulsive disorder?

A

SSRIs, venlafaxine, and clomipramine

207
Q

What is the preferred class of drugs for panic disorder?

A

SSRIs, venlafaxine, benzodiazepines

208
Q

What is the preferred class of drugs for PTSD?

A

SSRIs, venlafaxine

209
Q

What is the preferred class of drugs for schizophrenia?

A

atypical antipsychotics

210
Q

What is the preferred class of drugs for social anxiety disorder?

A

SSRIs, venlafaxine if chronic; beta blockers or benzos if performance-limited

211
Q

What is the preferred class of drugs for Tourette syndrome?

A

antipsychotics, tetrabenazine

212
Q

What is methylphenidate?

A

a CNS stimulant used in the treatment of things like ADHD

213
Q

How do CNS stimulants work? What are their primary uses? List three.

A
  • they increase catecholamines in the synaptic cleft, especially NE and DA
  • they are used for ADHD, narcolpesy, and appetite control
  • they include methylphenidate, dextroamphetamine, and methamphetamine
214
Q

All typical antipsychotics work via what mechanism of action?

A

they block D2 receptors

215
Q

List seven uses for antipsychotics.

A
  • schizophrenia
  • psychosis
  • bipolar disorder
  • delirium
  • Tourette syndrome
  • huntington disease
  • OCD
216
Q

What adverse effects are associated with typical anti-psychotics?

A
  • extrapyramidal side effects (e.g. dyskinesias, parkinsonian features, etc.) - treat with benztropine, diphenhydramine, benzodiazepines
  • endocrine side effects since DA controls prolactin secretion
  • antagonist effects at muscarinic, a1, and histamine receptors (dry mouth, constipation, sedation, and orthostatic hypotension)
  • may cause QT prolongation
  • very lipid soluble, so stored in the fat and removed very slowly from the body
217
Q

What is neuroleptic malignant syndrome?

A
  • a toxicity of typical antipsychotics
  • includes rigidity, myoglobinuria, autonomic instability, and hyperpyrexia (think FEVER: fever, encephalopathy, vitals unstable, enzymes increased, rigidity)
  • treated with dantrolene (muscle relaxant) and D2 agonists like bromocriptine
218
Q

What is tardive dyskinesia?

A

orofacial choreas that result form long-term use of typical antipsychotics

219
Q

What drugs are typical anti-psychotics?

A
  • those ending one “-azines” plus haloperidol

- including trifluoperazine, fluphenazine, thioridazine, etc.

220
Q

Which typical antipsychotics have high potency and which have low potency? What is the clinical effect of this difference?

A
  • trifluoperazine, fluphenazine, and haloperidol have high potency and thus have neurologic side effects (EPS)
  • chlorpromazine and thioridazine have low potency and thus have greater peripheral side effects (anti-cholinergic, anti-histamine, and a1-blocking effects)
221
Q

Chlorpromazine

A
  • a typical antipsychotic, which blocks D2 receptors
  • used for schizophrenia, psychosis, bipolar disorder, delirium, Hungtington disease, OCD, and Tourette’s
  • has low potency so side effects are primarily anticholinergic, anti-histamine, and a1-blocking
  • unique side effect is corneal deposits
222
Q

What unique side effects are associated with chlorpromazine, thioridazine, and haloperidol?

A
  • chlorpromazine: corneal deposits
  • thioridazine: retinal deposits
  • haloperidol: neuroleptic malignant syndrome and tardive dyskinesia
223
Q

Describe the natural history of the extra-pyramidal side effects of typical anti-psychotics.

A
  • in hours to days you’ll see acute dystonia
  • days to months: akathisia (restlessness) and Parkinsonism
  • months to years: tardive dyskinesia
224
Q

Haloperidol

A
  • a typical antipsychotic, which blocks D2 receptors
  • used for schizophrenia, psychosis, bipolar disorder, delirium, Hungtington disease, OCD, and Tourette’s
  • has high potency and thus side effects are largely CNS but hyperprolactinemia, antihistamine, anticholinergic, a1-blockade, and QT prolongation are also possible
  • EPS side effects present with acute dystonia in hours to days, akathisia (restlessness) and parkinsonism in days to months, and tardive dyskinesia in months to years
  • treat EPS side effects with benztropine, diphenhydramine, and benzodiazepines
  • may also cause neuroleptic malignant syndrome of rigidity, myoglobinuria, autonomic instability, and hyperpyrexia, which can be treated with dantrolene (a muscle relaxant) and D2 agonsits
225
Q

What is aripiprazole?

A

an atypical anti-psychotic

226
Q

How are most atypical anti-psychotics named?

A
  • suffix of “-apine” or “-idone”

- also includes aripiprazole

227
Q

What is the mechanism of action for atypical anti-psychotics?

A
  • most are D2 antagonists (aripiprazole is a partial agonist)
  • they have varied effects of 5-HT2, dopamine, a-, and H1 receptors
228
Q

How does the benefit of typical antipsychotics compare to those of atypical anti-psychotics?

A

atypical have a greater impact on the negative symptoms while typical generally only improve the positive symptoms of schizophrenia

229
Q

How are extra-pyramidal side effects treated?

A

benzodiazepines, benztropine, and diphenhydramine

230
Q

Describe the general side effect profile for atypical anti-psychotics.

A
  • prolonged QT intervale
  • fewer EPS and anticholinergic side effects than typical anti-psychotics
  • “-apines” are known to cause metabolic syndrome
  • clozapine causes agranulocytosis so monitor WBC weekly
  • risperidone is known for causing hyperprolactinemia
231
Q

What is unique about clozapine compared to other typical antipsychotics?

A

it causes a profound agranulocytosis and therefore requires weekly monitoring via WBC

232
Q

What is unique about risperidone compared to other typical antipsychotics?

A

it causes a more profound hyperprolactinemia, leading to gynecomastia, amenorrhea, or galactorrhea

233
Q

What is the probable mechanism through which lithium functions?

A

it is believed to be related to inhibition of the phosphoinositol cascade

234
Q

How is lithium used clinically?

A

it is a mood stabilizer for those with bipolar disorder and is meant to prevent relapse and treat acute manic events

235
Q

What are the side effects of lithium?

A

LMNOP

  • lithium
  • movement (tremor)
  • nephrogenic diabetes insipidus
  • hypOthyroidism
  • pregnancy problems (Ebstein anomaly)
236
Q

Lithium toxicity is common in patients taking what drug? Why?

A
  • it is excreted by the kidneys and most reabsorption occurs in the PCT through a Na co-transporter
  • thiazides, then, lower sodium levels in the body and increase reabsorption in the PCT, driving excess lithium reabsorption as well
237
Q

What is the mechanism and clinical use of buspirone? What are it’s advantages over other second line drugs and what are its disadvantages?

A
  • it simulates 5-HT-1A receptors
  • used for generalized anxiety disorder
  • it does not cause sedation, addiction, or tolerance and does not interact with alcohol like benzos or barbiturates
  • does take two weeks to take effect, though
238
Q

Serotonin Syndrome

A
  • a syndrome that can arise from any drug that increases serotonin release
  • this includes MAOIs, SNRIs, TCAs, and SSRIs
  • characterized by the 3 A’s: neuromuscular activity (clonus, hyperreflexia, hypertonia, tremor, seizure), autonomic stimulation, and agitation
  • treat with cyproheptadine, a 5-HT2 receptor antagonsit
239
Q

What is cyproheptadine?

A

a 5-HT2 antagonist used to treat serotonin syndrome

240
Q

Describe the mechanism, clinical uses, and adverse effects of SNRIs. How are they named?

A
  • they inhibit 5-HT and NE reuptake
  • used for depression, GAD, and diabetic neuropathy; venlafaxine in particular is also indicated for social anxiety disorder, panic disorder, PTSD, and OCD
  • the most common adverse effect is hypertension, but stimulant effects, sedation, and nausea are also possible
  • most end in “-lafaxine” or “-nacipran” but duloxetine is also part of the class
241
Q

Venlafaxine

A
  • an SNRI
  • more broadly used than the rest of the class, including for depression, GAD, diabetic neuropathy, social anxiety disorder, panic disorder, PTSD, and OCD
  • most common adverse effect is hypertension but may also cause stimulant effects, sedation, or nausea
242
Q

What are the four primary SSRIs to know?

A
  • fluoxetine
  • paroxetine
  • sertraline
  • citalopram
243
Q

What are the clinical uses for SSRIs?

A
  • depression
  • GAD
  • panic disorder
  • OCD
  • bulimia
  • social anxiety disorder
  • PTSD
  • premature ejaculation
  • premenstrual dysphoric disorder
244
Q

What are the adverse effects of SSRIs?

A
  • GI distress, SIADH, and sexual dysfunction, including lowered libido and anorgasmia
  • better profile than TCAs
245
Q

How long does it take for anti-depressants to usually have an effect?

A

4-8 weeks

246
Q

How are TCAs named? What are the exceptions?

A
  • most end in the suffix “triptyline” or “ipramine”

- doxepin and amoxapine are exceptions to this rule

247
Q

Describe the mechanism of action, clinical uses, and adverse effects associated with TCAs. Give examples of drug names.

A
  • includes those ending in “triptyline” or “ipramine” plus doxepin and amoxapine
  • work by blocking reuptake of NE and serotonin
  • used for major depression, OCD, peripheral neuropathy, chronic pain, and migraine prophylaxis
  • primary side effects a the “Tri C’s”: convulsions, coma, and cardiotoxicity
  • may cause sedation, a1-antagonist effects, and anti-cholinergic effects or can cause prolonged QT (Na blocker)
  • other side effects include respiratory depression, hyperpyrexia, confusion and hallucinations in the elderly
248
Q

Amytriptyline

A
  • a tertiary TCA
  • blocks reuptake of NE and serotonin
  • used for major depression, OCD, peripheral neuropathy, chronic pain, and migraine prophylaxis
  • primarily causes anticholinergic side effects but can also prolong the QT interval
249
Q

How are the cardiotoxic effects of TCAs managed?

A

with sodium bicarb since the effects are due to TCAs actions as sodium-channel blockers

250
Q

Which TCA is preferred in the elderly? Why?

A

nortriptyline is preferred because it is a secondary TCA with fewer anticholinergic effects and thus less risk of confusion or hallucinations

251
Q

Buproprion

A
  • increases NE and DA through an unknown mechanism
  • used for smoking cessation and as an atypical anti-depressant
  • adverse effects include stimulant effects and headaches as well as seizures in anorexics or bulimics
  • there are no sexual side effects, however, like typical anti-depressants
252
Q

Mirtazapine

A
  • has several mechanisms: a2 antagonist which increases NE and serotonin release, 5-HT2 and 5-HT3 antagonist, H1 antagonist
  • used as an atypical anti-depressant
  • may cause sedation, excessive appetite and weight gain, or dry mouth
253
Q

Trazodone

A
  • an atypical anti-depressant
  • works by blocking 5-HT2, a1, and H1 receptors but also weakly inhibits serotonin reuptake
  • used primarily for insomnia since high doses are needed for an anti-depressant effect
  • toxicity: sedation, nausea, priapism, and postural hypotension
254
Q

What is varenicline? What is it used for? What is it’s primary adverse effect?

A

it is a nicotinic agonist used for smoking cessation but which is known for causing sleep disturbance

255
Q

How do MAOIs work?

A

they non-selectively increase levels of NE, serotonin, and DA

256
Q

What are the clinical indications for MAOIs?

A

atypical depression or anxiety

257
Q

Name the important MAOIs.

A
  • tranylcypromine
  • phenelzine
  • isocarboxazid
  • selegiline
258
Q

What adverse effects are linked with MAOIs?

A
  • hypertensive crisis, particularly with the ingestion of tyramine
  • CNS stimulation
259
Q

What are the contraindications for MAOIs?

A
  • SSRIs, TCAs, St. John’s wort, meperidine, dextromethorphan
  • you must wait 2 weeks after topping MAOIs before starting sertoonergic drugs or stopping dietary restrictions
  • to prevent serotonin syndrome

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