Psych Flashcards
5 stages of substance abuse
1) pre contemplative - denial
2) contemplative - acceptance
3) preparation - committed steps
4) action - actual behavioral change
5) maintenance - sustained behavioral change
populations more susceptible for alcoholism (MC abused substance)
native americans
alaska natives
they have increased for suicide
Wernickes
reversible cerebellum
tx - thiamine + folate –> D50
korsakoffs
irreversible confuabulation
alcoholic found down and out you give what in what order
thiamine followed by d50 after otherwise you worsen the hypoglycemia
acute alcohol intoxication symptoms and tx
disinhibtion amnesia ataxia
nausea vomiting and death
slurred speech
tx - IVF, time
EtOH withdrawal symptom order
HTN (diastolic) + tachy tremors, diaphoresis, seizures agitation, confusion DTs then death
mechanism and pathway for etoh withdrawal seizures
etoh –> increases GABA which blocks brain activity
chronic etoh –> downregulated gaba receptors since they are always blocked by GABAa–> so with etoh stop (no more inhibitor on activity) there leads to overactivity in the muscles (tremors) and the brain (seizures)
treatment of alcohol withdrawal or benzo withdrawal (same thing)
long acting benzos + short acting benzos
as they improve you take away short acting
what are long acting benzos
chlordiazepoxide
diazepam
what are short acting benzos
loreazepam (IV)
alprazolam (PO)
benzo intoxication symtoms
delrium in the elderly
resp depression
coma with increased dose
amnesia
benzo withdrawal symptoms
tachy tremor HTN seizures psycosis
antidote for benzos
flumazenil
opiate intoxication symptoms
euphoria
pupil constriction
resp depression
tract marks
opiate withdrawal symptoms
pain yawning lacrimation NVD sweating
treatment of opiate abuse/ withdrawal
naloxone methadone (long term)
cocaine intoxication symptoms
psychomotor agitation HTN tachy dilated pupils psychosis - hallucinations and paranoia angina/ HTN crisis
cocaine withdrawal symptoms
depression
suicidality
cocaine bugs
crash
treatment of cocaine abuse
supp care or benzos
alpha – > then beta blockade
never give beta blockers early on will lead to unopposed alpha action
MDMA intoxication symptoms
overheat (fever, tachy)
water intoxication
pupillary dilation
psychosis
PCP intoxication symptoms
vertical and horizontal nystagmus
aggressive psychosis
impossible strength
blunted senses
pcp withdrawal symptoms
severe random violence
tx of pcp abuse
haloperidol to subdue
acidify urine to enhance its excretion
LSD intoxication symptoms
hallucinations
flashbacks
heightened senses
Marijuana intoxications symptoms
tired slowed reflexes conjuctivitis munchies overdose brings paranoia
nicotine overdose
patient goes in to V tach
treatment of nicotine abuse
bupropion chantix ( varenicline) - adr = suicide
amphetamine intoxication symptoms
tachy
HTN
pressured speech
flight of ideas
generalized anxiety disorder
females 20s
constant state of worry about most things that leads to impairment of daily life >6months/years at least 3: -irritability -somatic pain -weight change -sleep change -concentration
treatment of GAD
psychotherapy
SSRIS and buspirone
never benzos
panic disorders
acute
without provocation
sob trembling unsteadiness depersonalization excessive heart rate numbness tingling sweating
palpitations abdominal distrss nausea intense ear of losing control/dying chest pain
treatment of panic disorder
acute attacks - benzos
chronic - SSRIs
agoraphobia
fear of going outside, public areas, public transportation , crowds
treatment for public speaking phobia
nonselective beta blocker (propanolol, atenolol, nadolol)
treatment of phobias 2 types
systemic desensitization - better overalls - slower
flooding - better for quick needs (actor - cave scene)
benzos are metabolized via
liver - so in patient’s with hepatic impairments short acting are preferred
MOA of benzos
increased frequency of Cl- channel opens
GABAa antagonist - same as etoh
benzos as anesthesia
dose dependent anterograde amnesia
paranoid personality disorder
distrustful, suspicious,
ppl are out to get them
short lived delusions
schizoid personality disorder
loners but enjoy being alone
schizotypal
weird
bizarre
borderline personality disorder
unstable, impulsive, rapid changes in mood
promiscuous
suicidal gestures
spitting behavioral will be seen
F>M
hx of childhood abuse/ trauma
histrionic personality disorder
theatrical
use of physical appearance
dramatic
F>M
narcissistic personality disorder
inflated sense of worth
men > women
anti-social personality disorder
preceded by conduct disorder
criminal
lacks any remorse
avoidant personality disorder
fears rejection and criticism
wants friends and relationships
passes on promotions
dependent personality disorder
unable to assume responsibility
clingy/attached
fears being alone
abusive husband relationship example
Obsessive compulsive
orderliness at the expense of efficiency
rewriting notes 100 times
SSRIs + MOA
blocsk reuptake of serotonin at the presynaptic nerve terminal
citalopram , fluoxetine, paroxetine
sertraline , escotalopram
SSRIs - side effects
decreased libido
delayed ejaculation
GI upset, HA, flushing
hypernatremia in elderly
SnRIs
venlafaxine
duloxetine
cleaner and more expensive
bupropion MOA
atypical antidepressant - increased dopamine activity
bupropion
smoking cessation
no weight gain
no sexual dysfunction
C/I - bulimi - lowers seizure threshold
TCAs
tryptilines
imipramine
desipramine
doxepin
TCAs uses
used for enuresis
1st line for neuropathic pain
Mirtazapine
MOA - Serotonin modulator, alpha 2 adrenergic antagonist,
increases NE and fSerotoinin due to dec neg feedback
ADR - weight gain, somnolence
trazadone
serotonin modulator
sleep aid
ADR - priaprism
MAO-Is
phenelzine
tranylcypromine
selegiline
MAO-Is - ADR
HTN crisis when mixed with tyramine (red wine, cheese)
antidepressant tx rules
> 6wk trial
6month treatment
3 week washout period
Major Depressive Disorder
at least 5 of SIGECAPS: S- sleep I - interest G - guilt E - energy C - concentration A - appetite/weight P - pyschomotor retardation S - suicidal ideation
MUST HAVE: depressed mood or ahedonia > 2wks
Tx of MDD
SSRIs + psychotherapy
ECT (best but used for refractory MDD or catatonia)
Dysthymia (persistent depressive disorder)
at least 2 years but without symptoms for > 2months at a time
functioning but will have depressed mood
tx = SSRIs after you r/o - hypothyroidism and SI
Bipolar I
function is impaired - needs hospitalization at least (7) days
DIGFASTER - (3) + "E" D - distractibility I - insomnia G- grandiosity F- flight of ideas A- agitation S- sexual exploits T-talkative E- elevated mood R- racing thoughts
bipolar II
hypomania and major depression at least (4) days functional
tx of bipolar I
1) ER - benzo
2) life long - lithium or valproate
3) comorbid = carbamazepine or lamotrigine
another drug = quetiapine (seroquel)
do you give SSRIs to patients with bipolar I or bipolar II
NO - they will induce mania
cyclothymia
roller coaster up and down but failure to meet any of the criteria for bipolar II
normal grief
< 12 months still functional waxes and wanes praying at them glimpses of deceased talking to them wishing they traded places
not to be treated
persistent complicated bereavement disorder
> 12 months
mostly depression - persistent depressed mood
hopelessness
hallucinations
tx = SSRI or SnRIs
post partum depression
> # 1 babydoesnt care about baby/ may hurt baby
within 1 month onset and duration ongoing
tx = antidepressants
baby blues
1st baby
cares about baby
onset and duration within 2 weeks
no tx needed
post partum psychosis
> # 1 babyfears the baby/ likely to kill it
onset within 1 month and duration ongoing
tx = mood stabilizers or antipsychotics
schizophrenia criteria
1 bizarre delusions 2 hallucinations 3 disorganized speech 4 disorganized or catatonic behavior 5 flat affect, cognitive defects, poverty of speech, anhedonia
must have any (2) as long as (1) = 1-3
schizophrenia other facts
young male in 20s
> 6 months
overload of dopamine
schizophreniform
> 1 month but less than 6 months
schizoaffective disorder
schizophrenia + mood at least (2) wks of psychosis without the mood
brief psychotic disorder
> 1day and <1 .month
delusional disorder
logical thought process
functional
ex: man believes wife is cheating on him and has someone follow her everyday even tho there is no evidence
typical antipyschotics
haloperidol
thiazide
chlorpromazine
good for (+) symptoms
atypical antipsychotics
risperidone quetiapine olanzapine ziprasidone apriprazole clozapine
good for (-) symptoms
ADR of Clozapine
agranulocytosis - check ANC >1500 - neutropenia
weekly CBCs
last line drug to use for refractory schizophrenia
DOC for bipolar/mania
lithium
ADR of lithium
narrow therapeutic index
nephrotoxicity
nephrogenic DI
ataxia/ tremor/fasciculations
N/V/D
confusion/ agitation
If Lithium cant be used DOC for bipolar =
Valproate
valproate ADR
teratogen (spina bifida) elevated LFTs -> hepatic failure thrombocytopenia agranulocytosis pancreatitis
ADR of quetiapine (2nd line bipolar tx)
weight gain
QTc prolongation
ADR of lamotrigine (2nd line bipolar tx)
blurred vision
SJS
ADR of Carbamazepine (3rd line bipolar tx, trigeminal neuralgia, absence seizures)
teratogen (cleft palate)
rash, SJS
AV block
MOA of Typical antipyschotics
D2 receptor antagonism
ADR of typical antipsychotics
EPS side effects
increased prolactin leading to gynecomastia
MOA of atypical antipyschotics
D2 and 5HT antagonism
ADR of atypical antipyschotics
QTc prolongation
less EPS risk
gynecomastia
sedation
DM and weight gain (olanzapine and clozapine)
drug with the most potent EPS side effects
haloperidol (typical)
antipyschotic for combative ED patient
Haloperidol depot (sedating)
Extrapyramidal side effects
akathisia
acute dystonia
dyskinesia
tardive dysinesia
akathisia
restlessness
tx - decreased dose of antipyschotic + beta blockers
tx = benztropine
acute dystonia
involuntary muscle contractions
hand ringing
torticollis
oculogyric crisis
dyskinesia
parkinsonism
tx - benztropine
tardive dyskinesia
irreversible
hypersensitization of dopamin R
oral facial movements
tx - stop drug
Fluoxetine ADR
decreased libido
paroxetine ADR
serotonin syndrome = fever, myoclonus, AMS
Citalopram - ADR
GI
Insomnia
Bupropion ADR
minimal sex issues
increased risk of seizures (lowers threshold)
Mirtazapine ADR
weight gain
Trazodone ADR
priapism
sedation
ADR of MAO-I
HTN crisis when mixed together with tyramine (wine, cheese)
ADR of benzos
addiction
withdrawal seizures - must taper off
Intermittent explosive disorder
action is violent and out of proportion to the initial stressor
2/week for 3 months without harm = mild
3/ever for 12 months with harm = severe
tx - SSRIs or group therpy
pyromania
deliberate fire setting on >1 occasion
decreases their anxiety
sexual arousal
pleasure
vs arson - for monetary gain
kleptomania
decreases anxiety
unable to resist
item has NO value
remorse and guilt after event
F>M
OCD
persistent, intrusive, unwanted thoughts - obsessions that provoke anxiety
obsessions - contamination, symmetry safety
compulsion - cleaning, order/counting, checking
tx - CBT and SSRIs
body dysmorphic disorder
perceived defects in physical appearance
appearance checking
excessive unneeded cosmetic surgeries
F>M
muscle dysmoprhia
M>F
preoccupation with muscle size
anabolic steroids
excessive exercise
rhabdo
roid rage
copper - small testicles
trichotillomania
pulling out there hair to reduce anxiety
greater on dominant hand side
hair in different lengths
small bowel obstruction - from hair ball (trichobezoar)
acute stress disorder
timeline <1 month
PTSD
> 1 month
exposure to some extreme emotional event
group therapy
SSRIs
benzos - only for panic attacks
reactive attachment disorder
<5 years old
stressor is neglect or abuse during infancy and chilhood
kid fails to attach to anyone
disinhibited socia engagement disorder
<5 years old
kid is way too friendly with strangers
adjustment disorder
start within 3 months of the stressor and duration should be less than 6 months after event
binge purge emesis
dorsal hand scars dental erosion metabolic alkalosis low - K low - Mg
binge purge laxative
metabolic acidosis
diarrhea
anorexia
F>M 10:1, BMI < 15 fears she is going to be fat lacks recognition of a problem malnourished may require hosptialization
tx - group therapy and SSRIs
bulimia nervosa
binge, feeling ashamed
nml weight
hypokalemia
hypochloremia
metabolic alkalosis
Tx - SSRI (fluoxetine) CBT
binge eating disorder
its bulimia but without the purge
patients are overweight
dissociative identity disorder
> 2 distinct identity states
most severe and prolonged trauma
memory gaps paradoxical behaviors (doing things you wouldnt normally do) appearance changes
tx - pyschotherapy and hypnosis
dissociative amnesia
stressors induce memory loss
memory loss of event -> regular everyday routine –> complete idea of self
dissociative amnesia with fugue
= dissociative amnesia + travel
depersonalization derealization disorder
adolescent with non severe trauma
feels like a dream
feels detached from own thoughts
Catatonia
3 of the following: stupor catalepsy waxy flexibility mutism negativsm stereotypy agitation or grimacing echolalia echopraxia
stupor
decreased alertness and decrease response to stimuli
catalepsy
patient can be put in any position
waxy flexibility
slight to no resistance to positioning and will hold new position
mutsim
no verbal response when there once was
negativism
motiveless resistance to instructions
stereotypy
repetitive non goal directed movements
echolalia
mimicking speech
echopraxia
mimicking movements
tx of catatonia
lorazepam
ECT
Retarded catatonia
mutism
posturing
negativism
staring
excited catatonia
hyperkinesis
frenzy
combativeness
restless
malignant catatonia
rigidity autonomic instability high HTN high HR high Temp
caused by NO MEDS
neuroleptic malignant syndorme
rigidity - lead pipe
autonomic instability
increased CK
patient is ON antipsychotic meds
serotonin syndrome
myoclonus hyperreflexia lead pipe rigidity increased Temp increased CK
patient is ON SSRIs
malignant hyperthermia
halothane anesthesia rxn
rigidity
autonomic instability
increased CK
tic disorders
associated with OCD and ADHD
tx - dopamine antagonists
MOA of benzos
increased frequency of Cl- channel opening
GABAa
ADR of benzos
dose dependent anterograde amnesia - especially in the elderly
quetiapine is effective in the
depressed phase of bipolar
acute dystonia tx
benadryl
tx of tardive dyskinesia
valbenzine
naltrexone
1st line tx for alcohol use disorder that decreases cravings and heavy drinking
somatic symptoms disorder
> 1somatic symptom causing distress and functional impairment
excessive thoughts or behavior related to somatic symptoms
6 months in duration
tx - regularly scheduled visits
inhalant disorder
14-17 y/o boys
common houselhold products
perioral skin changes = glue sniffers rash
rapid onset and relatively short duration
tx of specific phobias
tx exposure CT therapy
buspirone
tx of anxiety disorders
neuroleptic malignant disorder
F > 104 confusion sweating muscle rigidity abnormal vital signs
tx of neurolpetic malignant disorder
stop medications –> bromocriptine or dantrolene if necessary
tx of serotonin syndrome
cyproheptadine
tx of bulimia nervosa
CBT and fluoxetine
tx of anorexia nervosa
CBT and olanzapine if refractory
complications of anorexia nervosa
myocardial atrophy, bradycardia, low BP, arrthymias
dry skin, lanugo, dehydration, seizures
cognitive impairment, amenorrhea, infertility
ostepenia, cytopenia, constipation
hypercholesteremia, hypercarotenemia
factitious disorder
intentional falsification or inducement of symptoms with goal to assume sick role
malingering
falsification or exaggeration of symptoms to obtain external incentives
conversion disorder
neurological symptom incompatible with any known neurological disease
acute onset associated with stress
illness anxiety disorder
fear of having serious illness despite few or no symptoms and consistently negative evaluations
antidepressant discontinuation syndrome
abrupt discontinuation or rapid taper of short half life serotonergic antidepressants
tx - restart meds and slow slow taper
MOA of 2nd gen antipsychotic
serotonin 2A and dopamine D2 antagonists
Bupropion MOA
NE and dopamine re-uptake inhibitor
neuro-imaging finding associated with schizophrenia
enlargement of the lateral cerebral ventricles
medication induced psychotic disorder
acute onset of delusions and/or hallucinations that are temporarily associated with use of a new med
(common = high dose glucocorticoids)
sleep latency
time from going to bed to falling asleep
its elevated in insomnia
decreased in sleep deprivation
REM latency
time from falling asleep to REM
avg 40 min
shortened by depression or narcolepsy
REM Rebound
occurs when the body has been deprived of REM
its easier to get REM AND you get more of it
Nightmares
during REM
remember everything
night terrors
during N3
doesnt remember anything
in a child - parents will complain
some causes of REM deprivation
etoh abuse
sleep apnea
obstructive sleep apnea
obese
snores
daytime somnolence
dx - polysomnography - 15 obstructive apneas/ hr or 5 per hour with snoring
tx - lose weight and/or CPAP
central sleep apnea
tx - with bipap
lost their intrinsic drive to breathe
cheynes strokes breathing - no chest rise
narcolepsy
rapidly plunged into REM sleep
3x/week for 3 months
cataplexy - is the loss of muscle tone while conscious
hypnagogic and hypnopompic hallucinations
tx - schedule naps and stimulants (modafinil, provigil)
insomnia
difficulty falling asleep
3x/week for 3 months
sleep hygiene
sleep medication
benadryl - dont give to elderly
quetiapine - off label - prolonged QTc
trazadone - strong - erections, nasal congestion
zolpidem - strong - benzo derivative not as addicting
enuresis
> 2/wk for 3 months
5 years up to 7 = nml
avoid negative reinforcement
nighttime fluid restriction
water alarm blankets
desmopressin
oxybutynin
watch out for regression = child abuse or new stressor
conduct disorder
criminal harms animals harms friends lies steals and cheats defiant towards authority
oppositional defiant disorder
defiant towards authority
does not break the law
does NOT hurt friends
paranoid
MC delusion
delusion of grandeur and persecution
infertility due to what psych meds
antipsychotics due to dopamine antagonism –> hyperprolactinemia –> galactorrhea, amenorrhea, infertility
esp in 2nd gen = risperidone
ADR of carbamazepine
aplastic anemia
transient global amnesia
anterograde amnesia
resolves within 24 hrs
acting out
expressing unacceptable feelings through actions
denial
behaving as if an aspect of reality does not exist
displacement
transferring feelings to less threatening object or person
intellectualization
focusing on nonemotional aspects to avoid distressing feelings
projection
attributing ones own feelings to others
rationalization
justifying behavior to avoid difficult truths
rxn formation
transferring unacceptable feelings/impulse into the opposite
regression
reverting to earlier developmental stage
splitting
experiencing a pressure/situation as either all positive or all negative
sublimation
channeling impulses into socially acceptable behavior
suppression
putting unwanted feelings aside to cope with reality
acute mania with non compliant patient tx =
olanzapine since it can be given IM
hallucinations in kids can be caused by
over the counter cold medications
HIV associated dementia
early sign = subcortical symptoms
management of PCP agitation and aggression
benzos
DOC for ADHD
always stimulants unless parents dont want stimulants
First line tx for bipolar disorder
lithium
valproate
quetiapine
lamotrigine
doc for social anxiety disorder
SSRIs/SNRIs
such as sertraline
REM sleep behavior disorder
dream enactment that occurs during REM sleep if muscle atonia is absent - more common in the elderly
drug that is associated with dose dependent HTN
venlafaxine - SNRI
drugs that are associated with hypotension
MAO-Is
TCA
bipolar pts not adequately controlled with monotherapy should be treated with what med
lithium or valproate
+
2nd gen antipsychotic
unexplained abd pain
new onset neuropsych symptoms (anxiety, mood changes psychosis)
dx =
AIP
overdose patient - seizures - mental changes tachy hypotension cardiac conduction delay anticholinergic (dilated pupils, flushed, dry skin)
TCA overdose
first line tx for major depressive disorder with psychotic features
ECT
pathology behind tardive dyskinesia
dopamine receptor hypersentivity
which 2nd gen antipsychotic has less metabolic risk
ziprasidone has the least vs olanzapine
2nd gen has less EPS risk then 1st gen
tx of choice for adjustment disorder
psychotherapy
After SSRIs what are the next tx options for depression
(1) SNRIs then (2) buproprion mitrazapine serotonin modulators then (3)TCAs
baseline studies needed before intiating lithium
BMP calcium thyroid UA ECG
what drug has a high frequency of prolactin elevation
respiridone
tx of acute dystonia
benadryl
diphenhydramine
what sign is associated with dementia and not normal aging
getting lost in familiar territory
sexual assault increases risk for
suicidal ideation and attempts
caffeine intoxication
sympathetic hyperactivity
- anxiety, jitteriness,
insomnia
palpitations
nightmare disorder
child remembers the disorder and can be consoled
alzheimer basics
early insidious short term memory loss
later personality changes
vascular dementia basics
stepwise decline
cerebral infarctions and/o deep white matter changes on neuroimaging.
frontotemporal dementia basics
early personality changes
apathy
disinhibition
compulsive behavior
frontaltemporal atrophy on neuroimaging
dementia with lewy bodies bascis
visual hallucinations
spontaneous parkinonism
fluctuating cognition
normal pressure hydrocephalus
wet wobbly weird
dilated ventricles on neuroimaging
prior disease
behavioral changes
rapid progression myoclonus and/or seizures
side effects of ECT and safety in pregnancy
anterograde and retrograde amnesia
safe during all terms of pregnancy
tx of choice for borderline personality disorder
dialectical behavioral therapy
example of reaction formation
you hate someone but when you see them you act super nice to them
presentation of acute dystonia
sudden sustained contraction of the neck, mouth, tongue and eye muscles
tx - benadryl and/or benztropine
increased serum cortisol is associated with what disorder
MDD
depression and sleep
decreased REM latency and increased overall REM
decreased concentration of 5-hydroxyindoleacetic acid in CSF analysis is associated with
depression
5-HIAA metabolite of serotonin (5-HT)
increased sensitivity to lactate infusion is associated with
panic disorder
serology positive for HLA-DR2 is associated with
narcolepsy
oxalate crystals are associated with
ethylene glycol toxicity
somatization disorder timeline
> 6months and they dont blame themselves
nucleus accumbens associated with
cannaboids - increased food intake
mamillary bodies are associated with
wernickes and krosakoff syndromes in alcoholics
area of the brain associated with drug induced parksonism
substantia niagra
locus cereulus is associated with
increased NE = anxiety
decreased NE = depression
cerebellar vermis associated with
truncal ataxia
tx of tyramine hypertensive crisis
nitroprusside or phentolamine
dx test for kids with seizures
EEG
tramadol when combined with an SSRI can lead to what
serotonin syndrome
beta blockers can induce what type of moods
depressed moods that mimic MDD
smelling rubber -
temporal lobe seizure - focal spikes on EEG
only TCA approved for OCD
clomipramine
caudate atrophy =
huntingtons dz
ADR of metoclompramide or prochlorperazine
akithesia - tx beta blockers
EPS
Contraindication for beta blockers
asthma
marker of malnutrition
albumin - low in anorexia
part of the brain of affected by alzheimers
nucleus basalis of meynert
ADR of IV methylprednisolone therapy
corticosteroid psychotic disorder
closed fracture in kid
abuse
drug for anxiety that is safe during pregnancy
buspirone
tx of tourette syndrome
antipyschotics 2nd gen Respiridone is an option
illness anxiety disorder vs somatic disorder
illness anxiety disorder - more concerned with being sick rather then about their actual symptoms like somatic syndrome which are concurrent
serotonin syndrome is typically caused by
drug drug interaction between SSRIs and MAO Is
signs of pyschomotor retardation
quiet
rocking back and forth
dx of narcolepsy
plysomnography
tx of choice for OCD if no SSRI
TCA such as clomipramine
OCD affect on brain
increased size of caudate nucleus and increased frontal lobe metabolism
PET scan shows hypoactivity in the frontal lobs and hyperactivity in the basal ganglia - disorder = ?
schizophrenia
positive symptoms - neuro trans and receptor
negative symptoms - neuro trans and receptor
pos = dopamine receptors
neg = muscarinic receptors
bipolar is associated with increased levels of
NE and serotonin
MDD is associated with
decreased NE, serotonin dopamin and REM latency
increased REM
ADHD is associated with lower levels of
dopamine
first symptom to disappear after treatment of ADHD is
hyperactivity
tx of nightmares
prazosin
inhalants effect on the brain
white matter changes
diffuse brain atrophy
alcoholic withdrawal delusions tend to be more
visual than auditory
tx of essential tremor secondary to lithium
propanolol
increased amylase is found in what type of patient
purging vomiting patient
alcoholic with pancreatitis
benztropine MOA
anticholinergic effect - restores ACh/Dopamine balance
used for EPS tx
hydroxyzine
MOA - antihistamine - tx of anxiety and pruritus
use for buprenorphine
tx of opioid dependence
acetylcholinesterase inhibitors
donepezil and rivastigmine
tx of mild to mod dementia
Memantine
NMDA antagonist - reduces glutamate
tx of mod to severe dementia
conditons that mimic depression
anemia b12/folate def hypothyroidism hypoglycemia hypercalcemia/hypocalcemia cushings/addisons parkinons alzheimers
before starting an SSRI what labs do you need to check
platelets - since SSRIs decrease platelet adhesion
Na - since SSRIs can decrease Na
SSRIs with shortest half life
paroxtine
fluvoxamine
longest half life SSRI
Fluoxetine
which SSRI has the least drug drug interaction
citalopram
ADR of venlafaxine
risk of increased BP - C/I in patients with untreated HTN
tx of lewy body dementia
quetiapine
atypical antipsychotics least associated with metabolic syndrome
ziprasidone
aripriprazole
dielectival behavioral therapy is indicated for the tx of
borderline personality disorder to prevent splitting
tourette syndrome brain involvement
basal ganglia involvment
impaired regualtion of dopamine in caudate
loss of hypocretin
narcolepsy
insomnia has a decrease in what receptor
GABA
lithium drug drug interactions
thiazides nsaids ace inh tetracyclines metronidazole
why are TCAs C/I in elderly
confusion
halucinations
irritability
in a TCA overdose what determines the severity of the outcome
QRS prolongation length
primary cause of NMS
dsyregulation of dopamine
what type of psychotherapy is for PTSD pts
prolonged exposure
eye movement desensitization and reprocessing
pancreatitis is an ADR to what drug
depakote
DOC for atypical depression
MAO-Is
DOC for melacholic depression
TCAs
defense mechanism most commonly used by paranoid ppl
projection
defense mechanism most commonly used by OCD ppl
undoing
C/I to 4 pt restraints
pregnant women
most common type of anxiety disorder
phobias
most common comorbid condition with depression
anxiety
GAD req in kids vs adults
kids - 1/6
adults 3/6
first SSRI created
fluxoetine
cotard syndrome
belief that one has lost their soul or is dead
capgreass syndrome
family or ppl they know have been replaced by imposters
fregoli syndrome
shapeshifter belief someone keeps changing into different ppl
koro
south and east asia syndrome - anxiety that their penis will recede into the body leading to death
what is the only relative C/I to ECT
recent acute MI
mesocortical pathway
cognition
reward
meslombic pathway
+ symptoms of schizophrenia
nigostriatal pathway
EPS
parkinson symptoms
tuberoinfundibular
sexual side effects
amenorrhea issues
typical antipsychotic with the ADR of photosynesitivity
chlorpromazine
typical antipsychotic with ADR of pigment retinopathy
thioridazine
what are the only 2 drugs that reduce suicide
clozapine and lithium
ADR of Ziprasidone
prolonged QT interval
Lurisidone
atypical antipsychotic >13 y/o schizophrenia
adr - renal dsyfunction
clonidine moa
alpha 2 antagonist
RETT syndrome
deceleration of head growth and small hands and feet
seizures
normal function up to 5 months than regression begins
uses for clonidine
ADHD
tourrette
opiod withdrawal
risk factors for suicide
white old man jew divorced/single
atrophy of cingulate gyrus seen in
schizophrenia
bupropion MOA
NE and dopamine reuptake inhibitor
major tool of tx for psychoanalysis
interpretation of transferrence
TCA - MOA
blok 5-ht and NE
alpha adrenergic blockade
antihistaminic
anticholinergic
SSRI –> MSO-I washout period
2wks unless fluoxtine washout takes 5-6 weeks
washout period from MAO-I to SSRI
2 weeks
uses for duloxetine
diabetic neuropathy
fibromyalgia
nefazodone
blackboxed
liver toxicity
MC - ADR of buproprion
nervousness
HA
Insomnia
normal lithium levels
0.8 -1.2
how many days until you measure lithium levels or depakote levels
3 - for lithium
5- for depakote
stroke patients are at highest risk for developing what mood disroder
depression along with pancreatic cancer patients
what drugs are C/I in breast feeding
antidepressants
lithium
defense mechanism that histrionic patients use
regression
methadone
long acting opioid receptor agonist
ADR - prolonged QT
most common finding in derlium aptients
impairment with recent memory
visual hallucinations and short attention spans are 2 other very common symptoms
lithium reversible vs irreversible damage
thyroid damage = reversible
renal damage = irreversible
stage I sleep EEG
theta waves
absent alpha waves
stage 2 sleep EEG
k complexes
sleep spindles
stage 3 sleep EEG
delta waves
increased ACH associated with what sleep function
increased dreams
increased serotonin = what sleep effect
increased sleep
increased dopamine = what sleep effect
increased awakeness
increased NE = what sleep effect
increased arousal
increased GABA =
decreased sleep latency
decreased NREM 3
zolpidems increase what
sleep walking
over oxygenation of COPD patients can lead to
central sleep apnea
OSA tx vs CSA tx
OSA tx = cpap
CSA tx = bipap
abnormal labs seen in refeeding syndrome
fluid retention
decreased phosphorus Mg Ca
complications of refeeding syndrome
arrhythmias
resp failure
delirium
seizures
cortisol in anorexia nervosa
increased like depression
dopamine does what to sexual function
increases libido
serotonin does what to libido
inhibits sexual function
tx of TCA overdose
sodium bicarbonate
complications involved with catatonia
malnutrition - check albumin
DVT - tx with low molecular weight heparin
rhabdo - check cpk
busprione is for
buproprion is for
buspirone is for –> anxiety
buproprion is for –> depression add on
criteria for hospitlization for anorexia nervosa
BMI < 15
vital sign abnormalities
first line tx of anorexia nervosa that doesnt require hosptilization
CBT
tx for social anxiety disorder
SSRI/SNRI
