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Psych Flashcards

1
Q

SSRI

A

Inhibits serotonin reuptake

Fluoxetine (Prozac)
Sertraline ( Zoloft)
Paroxitine (Paxil)
Citalopram (Celexa)
Escitalopram
Vilazadone
Vorioxtine
Fluovoxamine

Weight gain
Abdominal upset
Sexual side effects

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2
Q

SIGECAPS

A 
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicidal thoughts
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3
Q

Depression criteria

A

5/9 x2 weeks consistently

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4
Q

Transmitters involved in depression

A

Serotonin
NE
Dopamine

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5
Q

Eating disorder, anorexia tx

A

CBT, family therapy
Supervised weight gain programs

Fluoxetine (not effective)
(SSRI)

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6
Q

First choice for anxiety in pregnancy

A

Sertraline

SSRI

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7
Q

SNRI

  • types
  • MOA
  • Caution with
  • SE (3)
A

Venlafaxine
Duloxetine
Desvenlafexine

Inhibit NE, Serotonin, dopamine reuptake

Caution in HTN and heart issues increase NE

Weight gain
Sexual side effects
GI upset

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8
Q

Buproprion

  • type
  • MAO
  • SE
  • Helps with
  • CI
A

NDRI
NE and dopamine reuptake inhibitor

No weight gain or sexual side effects

Smoking cessation

CI: eating disorder and seizure disorder

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9
Q

TCA

  • examples
  • MAO
  • Lethal
  • SE (5)
A 
Nortriptyine
Amitriptyline
Dozepin
Imipramine
Clomipramine
Desipramine

Inhibit NE and serotonin

Lethal in overdose due to arrhythmia

Weight gain, drowsiness, hypotension, anticholinergic (red as a beet, dry as a bone, mad as a hatter)

ORTHOSTATIC HYPOTENSION

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10
Q

Atypical antidepressant

A

mirtazapine (Remeron)

  • alpha 2 antagonist
  • Increase NE and 5HT
  • antagonizing 5HT2/3 serotonin receptors
  • Sedation, WEIGHT GAIN, dry mouth

Trazondone

  • priaprism side effect
  • sleep inducing, anti anxiety
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11
Q

2nd gen antipsychotic

A

Abilify

partial agonist/ antagonist at dopamine receptor

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12
Q

DIGFAST

A 
Distractibility
irresponsibility: maxing out cards
Grandiosity
Flight of ideas
Agitation
Sleepless
Thoughtless
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13
Q

Bipolar tx

A

Depakote (irritable mania)
- bad in prego

Lithium (euphoric mania)

  • mood stabilizer
  • bad in prego
  • reduces suicide risk

Carbamazepine and valproic acid (mood stabilizer)

Lamotrigine (mood stabilizer)

Lamictal: maintenance

2nd gen antipsychotic (mania)

  • Latuda (bipolar depression)
  • risperidone
  • aripiprazole
  • olanzapine

Quetiapine [Seroquel] (bipolar depression)

Olanzapine/ Fluoxetine [Symbyax] (SSRI)

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14
Q

Lithium SE

A 
Ebstein abnormality (1st trimester)
- Tricuspid leaflet displaced inferiorly
- RV hypoplasia
- Tricuspid regurgitation or stenosis
- +/- patent foramen ovale
Sedation and dizziness
Tremors
Hypothyroid
Kidney issues
Acne vulgaris
DM insipidus
Sick sinus syndrome
Heart block
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15
Q

High QTC

A

470 or 480

Dont give antipsychotic

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16
Q

First generation antipsychotics

A

First gen

  • Halodol
  • Fluphenazine
  • Perpherazine (mid potency)
  • Chlorpromazine (low) - HAM, cornea deposit
  • Thioridazine (low) - HAM, retina deposit

High potency
- EPS

Low potency
- HAM
Sedation, anticholinergic, metabolic, hot dry, hypotension

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17
Q

Second Generation antipsychotics

A 
Risperdal (IM) (risperidone)
Invega (paliperadone) (IM)
Seroquel (quetiapine) 
Zyprexa (olanzapine) 
Abilify (aripiprazole) 
Geodon (ziprasidone)
Latuda (lurasidone)
Sappharis (asenapine) 
Fanept (Iloperidone) 
Rexalti (brexpiprazole)
Clozaril (clozapine)
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18
Q

Seroquel (quetiapine)

A

Low dose binds H1
300-600 bipolar
600-1200 schizophrenia

Increases QTC
QTC below 450 before prescribe

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19
Q

Olanzapine (zyprexa)

A

2nd most effect antipsycotic after clozaril

Alot of weight gain

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20
Q

Antipsychotic give if over weight

A

Abilify (aripiprazole)

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21
Q

Least metablic side effect of antipsychotic

A

Geodon ( ziprasidone)

prolongs QTC alot

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22
Q

Best antipsychotic for negative symptoms

Suicidality in schizophrenia

A

Clozapine

agranulocytosis, seizures, myocarditis, elderly standard warning, orthostatic hypotension

Excissive salivation most common

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23
Q

Antipsychotics with least side effect

A

Ability (aripiprazole)
Latuda (Lurasidone)
Geodon (ziprasidone)

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24
Q

Cluster A

A

Paranoid
- irrational suspicions and mistrust

Schizoid
- lack of interest in social relationships

Schizotypal
- odd behavior or thinking

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25
CLuster B
Antisocial - pervasive disregard for the law and rights of others Borderline - instability in relationships, self image, identify or behavior - cut them selves Histrionic - pervasive attention-seeking behavior, shallow or exaggerated emotions - bright colors, flirtatious Narcissistic - pervasive pattern of gradiosity - need for admiration and lack of empathy
26
Cluster C
Avoidant - social inhibition; feelings of inadequacy Dependent - pervasive psychological dependence on others OCD - rigid conformity to rules and moral codes
27
Indicated for depressive phase of bipolar
Quetiapine Olanzapine/ fluoxetine Cariprazine Lurasidone
28
Drug recommend for all phase of bipolar
Quetiapine
29
Timeline schizophrenia
> 6 months
30
Timeline delusional disorder
> 1 month
31
Timeline for brief psychotic disorder
< 1 month
32
TImeline for schizophreniform disorder
1-6 months
33
Bugs crawling on you
Tactile hallucinations ALcohol withdrawal or cocaine intoxication
34
Hallucinations when going to sleep or waking up
Narcolepsy
35
Schizophrenic brain (3)
Smaller Enlarged ventricles Thin cortex
36
Physiology of schizophrenia
Increased DA in mesolimbic Decreased DA in mesocortical
37
Schizophrenia criteria
Psychosis - disorganized thought - disorganized speech - delusions (false beliefs, tv talking to you) - halluciinations - illusions (misinterpret something that is actually there, coat rack is person) Decline in functioning > 6 months
38
Schizoaffective disorder
Psychotic symptoms for >2 weeks in absence of mood disorder Mood disorder later
39
Neuroleptic malignant syndrome - 5 features - due to what NT - due to what medication
** Not this is patient has normal vital signs** Mental status changes (not psychosis) - delirium Muscle rigidity +/- tremor (lead pipe rigidity) Hyperthermia Rhabdomyolysis Autonomic instability - tachycardia, high blood pressure, tachypnea, diaphoresis Due to dopamine Due to antipsychotics (olanzpine)
40
Tx neuroleptic malignant syndrome
Dantrolene Dopaminergic - Bromocriptine - Amantadine
41
Which antipsychotic is most closely associated iwth an increased risk of diabetes
Olanzapine
42
Side effect seen with increasing lithium
Tremor
43
Bipolar I
Manic episodes +/- major depression
44
Bipolar II
Hypomania episode | Episode of major depression
45
Tx postpartum psychosis
atypical antipsychotic
46
Persistent depressive disorder
> 2 years in adults > 1 year in children No more than 2 months w/o symptoms in 2 years
47
Stages of grief
DABGA ``` Denial Anger Bargaining Grieving (depression) Acceptance ```
48
Tx OCD
CBT Antidepressant - SSRI (Fluoxetine, sertraline, paroxetine, citalopram) - SNRI ( venlafaxine, desvenlafaxine, duloxetine) Clomipramine (TCA) (not first line)
49
TX Anxiety
Antidepressant
50
Tx PTSD
Antidepressant
51
SNRI for fibromyalgia
Milnacipran
52
Chronic pain tx
Duloxetine | SNRI
53
Tx generalized anxiety disorder
``` First line - CBT - SSRI - SNRI (venlafaxine) (desvenlafaxine) (duloxetine ``` (Increase BP)
54
Enuresis Tx
Imipramine (TCA)
55
OCD tx
CBT SSRI Clomipramine (TCA)
56
Fibromyalgia tx
MIlnacipran (SNRI) | Amitriptyline (TCA)
57
Tx neuropathic pain
Amitriptyline
58
SE TCA
``` Sedation Hypotension Dizziness Anticholinergic High dose --> QT prolongation ```
59
TCA overdose signs Tx
Cardiotoxicity - Tachycardia, hypotension, conduction abnormalities, arrthymias CNS toxicity - sedated, coma, seizures Anticholinergic - dry mouth, ileus, urinary retention, mydraiasis, blurred vision, hyperpyrexia Tx: Sodium bicarbonate
60
SSRI, TCA, MAOI, NDRI, SNRI, Serotonin modulators ``` Amitriptyline Bupropion Citalopram Clomipramine Doxepin Duloxetine Fluoxetine Imipramine Nefazodone Nortriptyline Paroxetine Phenelzine, Sertraline Tranylcypromine Trazodone Venlafaxine ```
``` Amitriptyline- TCA Bupropion- NDRI Citalopram- SSRI Clomipramine- TCA Doxepin- TCA Duloxetine- SNRI Fluoxetine- SSRI Imipramine- TCA Nefazodone- Serotonin modulators Nortriptyline- TCA Paroxetine- SSRI Phenelzine- MAOI Sertraline- SSRI Tranylcypromine- MAOI Trazodone- Serotonin modulators Venlafaxine- SNRI ```
61
Antidepressant the causes appetite stimulant and weight gain
Mirtrazapine
62
Serotonin syndrome signs
Hyperreflexia and clonus Hyperthermia Autonomic instability - Cardiovascular collapse, mental status changes
63
Priapism
pain persistent penile erection | Trazodone, nefazodone serotonin modulators
64
Patient has calustrophobia drug to give
Benzodiazepine
65
Antidepressant to not use in over weight
Mirtazapine
66
Women with daily anxiety tx Panic attack tx
Daily= generalized anxiety disorder give SSRI Panic attack= benzo
67
Conversion disorder tx
Unexplained loss of sensory or motor function (Tests and PE are negative) Paralysis Blindness Mutism (Following acute stressor) tx education about illness
68
Panic disorder tx
CBT SSRI TCA (amitryptilline Benzo (acute only)
69
Specific phobia tx
Systemic desensitization
70
Social anxiety disorder
``` SSRI Beta blocker (propranolol) ``` BEnzodiazepines (lorazepam)
71
PTSD vs acute stress disorder Tx
PTSD > 1 month ASD < 1 month Psychotherapy SSRI
72
Adjustment disorder Tx
Identifable psychosocial stressor < 6 months after stressor is gone With in 3 months of identifiable stressor but lasting no longer than 6 months once stressor ceases 5/9 SIGECAPS TX: psychotherapy
73
Tx generalized anxiety disorder
> 6 months FIrst line: SSRI SNRI Second line Benzo Buspirone (not many side effects)
74
Somatic symptom disorder tx
Complaints in > or = 1 organ system excessive anxiety and worry > or = 6 months regularly scheduled visits with a single primary care physician, who should minimize unnecessary medical workups and tx
75
Bulimina nervosa labs
Hypokalemic Hypochloremic Metabolic alkalosis Non-anion gap metabolic alkalosis w/ respiratory compensation Metabolic acidosis (laxative abuse) Elevated bicarbonate Incrased BUn Hypernatremia Increased amylase
76
Tx Bulimina nervosa
SSRI (fluoxetine)
77
ADHD medications
1st line - Mehtylphenidate - Dexmethylphenidate - Mix amphetamines - Dextroamphetamine 2nd line - atomoxetine (NE reuptake inhibitor) - clonidine - guanfacine
78
Hair pulling disorder
Trichotillomania Education --> CBT --> Fluoxetine (SSRI) or Clomipramine (TCA)
79
Antisocial vs conduct disorder
Conduct < 18
80
Oppositional defiant disorder
Pattern of disobeying authority and hostile behavior No serious violations of social norms No disregard for rights of others No destruction of property or cruelty to animals
81
Fixation
partially remaining at childish level of development
82
Reaction formation
Taking unacceptable thoughts and attempting to over exaggerate in opposite action
83
Projection
Taking unacceptable thoughts and believing that someone else has those thoughts
84
Displacement
Substitutes new aim/ object for something that is undesirable man yells at family for bad day at work
85
Sublimation
unacceptable impulses or feelings transformed into socially acceptable actions
86
Suppression
Voluntarily choosing to not think about something
87
Medications for alcoholic
Naltrexone Disulfiram (inhibit acetyaldehyde dehyrdogenase --> increase acetylaldehyde) Topiramate A camprosate
88
Reversal agent for benzo
Flumazenil - blockade of GABAergic neurotransmission Can cause seizure
89
Reversal agent for opioids
Naloxone | Naltrexone
90
Opioid withdrawal symptoms
``` Sweating Dilated pupils piloerection yawning Rhinorrhea Flu like ``` Tx: Moderate: Clonidine (autonomic signs) Severe: Methadone, suboxone
91
Amphetamine and cocaine overdose tx
Benzodiazepine (agitation) | Haloperiodol ( paranoid idealations)
92
Tx LSD overdose Tx LSD reverse effects of drug
Overdose: Benzo Reverse effects: Ziprasidone
93
Severe depression, HA, fatigue, insomnia/ hypersomnia, hunger
Cocaine and amphetamine withdrawal
94
Pinpoint pupils N/V Seizures
Opioid overdose
95
Belligerence, impulsivness, nystagmus, homicidal ideation, psychosis
PCP intoxication
96
HA | Anxiety depression
Nicotine or caffeine withdrawal
97
Anxiety, depression, delusion, hallucinations, flashblacks
LSD intoxication
98
Euphoria, social withdrawal, impaired judgement, hallucinations
Marjuana intoxication
99
Rebound anxiety, tremors, seizures, life thratening
WD from alcohol, benzo, or barb
100
Anxiety, piloerection, yawning, fever, rhinorhea, nausea, diarrhea
opioid withdrawal
101
Identification
Acting like the person you have positive thoughts towards (changing where you wear sthetoscope
102
Intellectualization
using logic or fact to emotionally distance onself from stressful situation
103
Schizophrenia tx first line - drug - SE of drug (2)
Risperidone | Hyperprolactinemia Can get EPS Tardive dyskinesia, orofacial chorea
104
Postpartum depression tx
CBT | SSRI
105
Grief lasts
< 6 months --> depression
106
ECT used in
``` Treatment refractory depression Depression with psychotic symptoms Acutely suicidality Catatonic Not eating or drinking ```
107
Agoraphobia tx
CBT | SSRI
108
Body dysmorphic disorder tx
CBT
109
Acute stress disorder tx
3 days to 1 month Tx: CBT
110
Transsexualism
Desire to live as opposite sex Through surgery or hormones
111
Transvestism
``` Paraphilia, not genderr dysphoria Wearing clothing (vest) of the opposite sex (cross dressing) ```
112
Sleep terrors
Self limited
113
Narcolepsy tx
Daytime stimulants - Amphetamines - MOdafinil Nighttime sodium oxybate (GHB) Tx cataplexy: sodium oxybate
114
Narcolepsy criteria
Recurrent lapses into sleep or naps (>= 3 times/ week for 3 months) >= 1 of the following: - Cataplexy : brief loss of muscle tone precipitated by strong emotions - low CSF levels of hypocretin-1 - shortened REM sleep latency Associated features - Hypnagogic or hypnopompic hallucinations - sleep paralysis
115
Stages of addictions (6)
1. Precontemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance 6. Relapse
116
Delirium tremens signs Tx
2-4 days after last drink ``` Tachycardia Tremors Anxiety Seizurs Electrolyte disturbances Respiratory alkalosis ``` Tx: Benzo (chlordiazepoxide, lorazepam, diazepam)
117
Tourette syndrome tx
First line: aripiprazole Antipsychotics (haloperidol, fluphenazine, pimozide) Tetraenazine alpha 2 agonist (guanfacine, clonidine) Atypical antipsychotics
118
EPS - hours to days - days to months - months to years - tx
ADAPT Hours to days: Acute Dystonia (Muscle spasm, stiffness, oculogyric grisis) (prolonged involuntary gaze upward) - Benztropine - Diphenhydramine ``` Days to months: Akathiasia, Parkinsonism (restlessness, bradykinesia) - Beta blockers - Benzodiazepine (lorazepam) - Benztropine --- -Benztropine - Amantadine ``` Months to years: Tardive dyskinesia (orofacial chorea) - Valbenazine - Deutetrabenazine
119
Typical antipsychotics
-azine High potency: Try to Fly High Trifluoperazine, Fluphenazine, Haloperiodol, - EPS Low potency: Cheating Thieves are low Chlorpromazine, Thioridazine - anticholinergic hyperprolactinemia (amenorreha, galactorreha, gynecomastia) Weight gain, dyslipidemia, hyperglycemia
120
Atypical antipsychotics
-apine, -peridone, -idone Aripiprazole, asenapine, clozapine, olanzapine, quetiapine, iloperidone, paliperidone, risperidone, lurasidone, ziprasidone ``` Prolong QT Fewer EPS and anticholinergic "pines"- metabolic syndrome (weight gain, diabetes, hyperlipidemia) Clozapine: agranulocytosis Ripseridone: hyperprolactinemia (amenorreha, galactorreha, gynecomastia) ``` Olanzapine= obesity
121
LiTHIUM
Low Thyroid (hypothyroid) Heart (Epstein anomaly) Insipidus (nephrogenic diabetes insipidus) Unwanted Movements (tremor)
122
SSRI (6)
- xetine, -alopram ``` Fluoxetine Fluvoxamine Paroxetine Sertraline Escitalopram Citalopram ``` Depression, anxiety, panic, OCD, bulimia, PTSD, premature ejacuation, premenstrual dysphoric disorder GI distress, SIADH, sexual dysfunction
123
SNRI (5)
``` Venlafaxine Desvenlafaxine Duloxetine Levomilnacipran Milnacipran ``` Diabetic neuropathy, depression, anxiety, Venlafaxine (social anxiety, panic, PTSD, OCD) Duloxetine (fibromyalgia) SE: Increase BP
124
TCA (7)
``` Amitriptyline Nortriptyline Imipramine Desipramine Clomipramine Doxepin Amoxapine ``` Depression, OCD (clom), peripheral neuropathy, chronic pain, migrane prophylaxis, Noctural enuresis (imipramine) SE: sedation, hypotension, anticholinertic like, prolong QT
125
MAOI
``` MAO Takes Pride In Shanghai Tranylcypromine Phenelzine, Isocarboxazid Selegiline ``` Atypical depression Anxeity Parkinson (selegiline)
126
Clonazepam
Benzo Tx anxiety and panic attacks Avoid w/ renal dysfunction
127
Gender dysphoria
> 6 months doesnt feel like gender from birth
128
Flushed, hyperreflexive, diaphoratic, occasional myoclonus, disorientated, seizure Took pill
Ecstasy
129
Major Depressive disorder TX
SSRI If SSRI doesnt work SNRI or NDRI (Buproprion) Last resort: TCA
130
Patient on risperidone, increased dose now smiles less and slowed down. Mild tremor and doesnt swing arms when walking TX
Continue Risperidone and add benztropine anti-psychotic induced parkinsonism Tx anticholinergic antiparkinism benztropine or amantadine
131
Sudden sustained contraction of neck, mouth, tongue and eye muscles Tx
Acute dystonia Benztropine Diphenhydramine
132
Subjective restlessness, inability to sit still Tx
Akathisia Beta blocker (propranolol) Benzodiazepine (lorazepam) Benztropine
133
Gradual onset tremor, rigidity and bradykinesia Tx
Parkinsonism Benztropine Amantadine
134
Gradual onset after prolonged therapy (> 6 months). Dyskinesia of the mouth, face, trunk and extremities
Tardive dyskinesia Discontinue medication Switch to quetiapine or clozapine Treat with Valbenazine Deutetrabenazine Caused by dopamine receptor D2 upregulation and supersensitivity
135
Zolpidem
non-benzodiazepine sleep medication selective receptor binding to the omega 1 receptor on the GABA-A receptor
136
Disruptive mood dysregulation disorder
Disproportionate verbal or physical outbursts Onset before age 10 Persistent irritability or anger inbetween episoes
137
MDD physiology
Increased serum cortisol concentration Hyperactivity of the hypothalamic pituitary adrenal axis results in rising cortisol levels Hyperactivity of the HPA axis leads to blunted response tot he dexamethasone-suppression test Also adrenal gland hypertrophy A blunted response to infusion of thyrotropin release hormone Elevated levels of thyrotropin releasing hormone in CSF Sense of well-being and increased relaxation when thyrotropin releasing hormone is administed Blunted response to serotonin stimulation of prolactin release Blunted response to sleep induced stimulation of growth hormone release Decreased amounts of somatostatin in the CSF
138
Patient with history of bipolar, leaves arm raised and wont talk
Catatonia Benzodiazepines (lorazepam) ECT
139
Complex motor behaviors that occur during REM sleep
Rapid eye movement behavior disorder (RBD) Degeneration of the brainstem nuclei responsible for inhibiting spinal motor neurons during normal REM sleep
140
Insight orientated psychotherapy
focuses on uncovering unconscious patterns originating in childhood experiences
141
What is helpful in schizophrenia patients besides medication
Family intervention CBT
142
Tx Lithium toxicity
Hemodialysis
143
Benzo overdose tx
Flumazenil
144
CBT treats
``` Depression Anxiety PTSD Panic OCD Eating disorder Negatie thoughts pattern ```
145
Interpersonal psychotherapy treats
Depression Links symptoms to current relationship confilcts and interpersonal skill deficits
146
Highter functioning | Personality disorders use what treatment
Psychodynamic psychotherapy
147
Motivational interviewing for what
Substance use disorders
148
Use what for borderline personality disorders
Dialectical behavioral therapy
149
What what treatment modality for pain disorders
Biofeedback
150
``` Psychological features Depression Fatigue Hypersomnia Increased dreaming Hyperphagia Impaired concentration ```
Cocaine withdrawal
151
``` Anxiety Insomnia Tremors Tachycardia HTN ```
Alcohol withdrawal
152
Dysphoria Myalgia Yawning Abdominal cramping
Opioid withdrawl
153
``` Dieting Hallucinations Abominal pain Constipation Tingling sensation in finger tips ```
Acute intermittent porphyria Elevated urinary porphobilinogen levels ``` Painful abdomen Port wine colored urine Polyneuropathy Psylogical disturbances Precipitated by Drugs, alcohol and starvation ```
154
Alcohol withdrawal symptoms (5)
``` Anxiety Insomnia Tremors Tachycardia HTN ```
155
Opioid withdrawal symptoms (4)
Dysphoria (dissatifcation with life) Myalgia (muscle pain) Yawning Abdominal cramping
156
Bipolar Fatigue Constipation Myalgias What medication
Lithium Lithium induced hypothyroidism
157
TCA side effect
Constipation Drowsiness other anticholinergic
158
Social anxiety disorder main tx
Beta blockers (propranolol) Before benzo
159
Gourmet meal with wine and heavy sauces Headache
Phenelzine (MAOI) HTN crisis Dont eat foods with tyramine
160
Patient with retrograde and antegrade amnesia with intact long-term memory, alcohol use history
Korsakoff syndrome Thiamine deficiency
161
Associated iwth MS
Depression
162
Hoarder treatment
CBT Maybe SSRI
163
Intense anxiety that the penis will reced into the body, possibly leading to death
Koro Southeast Asia (Singapore)
164
Sudden unprovoked outbursts of violence, often followed by suicide
Amok Malaysia
165
Headache, fatigue, eye pain, cognitive difficulties and other somatic disturbances in male students
Brain fag Africa
166
Mood disorders with mixed features
Irritability is predominant mood state Poor response to lithium Anticonvulsants such as valproic acid may be more helpful
167
Substance/ medication- induced depressive disorder (11)
``` EtOH Antihypertensives Barbiturates Corticosteroids Levodopa Sedative-hypnotic Anticonvulsants Antipsychotics Diuretics Sulfonamides Withdrawal from stimulants (cocaine, amphetamines) ```
168
Substance/ medications- induced bipolar disorder (8)
``` Antidepressants Sympathomimetics Dopamine Corticosteroids Levodopa Bronchodilators Cocaine Amphetamines ```
169
Tx MDD with atypical features
SSRI first line | MAOIs (phenelzine)
170
Anhedonia
inability to experience pleasure
171
Physiology in depressed patient
Decrease in CSF levels of 5-hydroxyindolacetic acid (5-HIAA) the main metabolite of serotonin High cortisol due to hyperactivity of HPA axis Abnormal thyroid axis
172
MAOI Side effect
Hypertensive crisis w/ tyramine rich foods Serotonin syndrome when mixed with SSRI Orthostatic hypotension
173
Triad for seasonal affective disorder
Irritability Carbohydrate craving Hypersomnia
174
MDD atypical features (5)
``` Hypersomnia Hyperphagia Reactive mood Leaded paralysis Hypersensitivity to Interpersonal rejection ```
175
Bereavement
Simple grief Reaction to major loss Self limiting Last several months
176
Pregnant patient with manic episode tx
ECT
177
Patient with history of postpartum mania tx
Mood stabilizers prophylaxis | Lamotrigine
178
Persistent depressive disorder
Dysthymia ``` Two of more of: CHASES Poor Concentration or difficulty making decisions Feelings of Hopelessness Poor Appetite or overeating InSomnia or hypersomnia Low Energy or fatigue Low Self-esteem ``` 2 years of depression
179
Premenstrual dysphoric disorder tx
SSRI first line daily or lutela phase tx
180
Delirium tremens use what
Lorazepam Dont use Diazepam or chlordiazpoxide in patient with possible liver damage
181
Fetal alcohol vs downs syndrome
Fetal alcohol - heart murmer - low IQ - Low height and weight - thin upper lip - short palpebral fissures - smooth philtrum - Emotional reactivity Downs syndrome - epicanthal folds - upslanting palpebral fissures - flat nasal bridge - protruding tongue - intellectual disability
182
Seizure with eyes closed, absence of self-injury, incontinence or confusion
Psychogenic nonepileptic seizure - conversion disorder Tx videoelectroencephalogram monitoring
183
Generalized tonic clonic seizures characterized by
Abrupt loss of consciousness followed by stiffening of muscles throughout the body Rhythmic jerking of extremities Eyes are open Postictal confusion upon awakening
184
Insomnia causing significant functional impairment Tx
Short term pharmacotherapy Lorazepam
185
Anorexia criteria for hospitalization
Pulse < 40/min BP < 80/60 hypokalemia hypophosphatemia
186
Hospitalized 12 hrs afterwards psychosis and paranoid
Alcoholic hallucinosis
187
``` Depression Anxiety recent onset diabetes Decreased appetite Smoker ```
Pancreatic cancer CT of abdomen
188
Normal aging
Word-finding aphasia Sleep disturbance Forgetting to take medication
189
ADHA treatment thats non-addictive
Atomoxetine Clonidine and guanfacine tx ADHD in children but not adults
190
Manic episode treatment
Lithium If level of creatinine high then valproate (renal failure)
191
Low blood pressure | 2 mm pupils
constricted pupils (miosis) Opioid intoxication Naloxone
192
Naltrexone
Maintenance treatment for opioid use disorder -blockade of opioid receptors in the endorphin system Slower onset Not for acute opioid intoxication
193
Bipolar tx with rash
Lamotrigine | mood stabilizer
194
Normal pupil size
2-4 mm
195
Specific phobia tx
CBT exposure therapy (first line) Benzo
196
Ziprasidone
Geodon No side effects
197
MDD Sleep traits
Decreased REM sleep latency (the time from sleep onset until the start of the first REM sleep period Decreased slow wave sleep Increased total REM sleep duration
198
Hyperprolactinemia
Risperidone
199
Clozapine causes
agranulocytosis Check for neutropenia
200
Risperidone MOA
Serotonin 2A and dopamine D2 receptor blockade All second gen antipsychotics
201
Dopamine reuptake inhibition and stimulation of dopamine release
Stimulants for ADHD
202
Norepinephrine and dopamine reuptake inhibition
Antidepressant bupropion
203
Serotonin and norepinephrine reuptake inhibition
Venlafaxine SNRI and TCA
204
Neuroleptic malignant syndrome
FEver > 40 (104) Confusion Muscle rigidity (generalized) Autonomic instability (sweating, abnormal vital signs) Elevated creatine kinase Tx Dantrolene, bromocriptine
205
Physiology associated with suicidal behavior
Low levels of 5-hydroxyindoleacetic acid (5-HIAA) in CSF Metabolite of serotonin
206
Hydrocephalus ex vacuo on CT
Neurodegenerative conditions (Alzheimer disease) leads to cortical atrophy
207
How long to take antidepressant
additional 6 months in patients with single episode of depression Maintain at level of remission Then taper If patient at high risk for recurrence (>2 episodes) then maintenance for 3 years
208
Medication that causes seizures after abruptly stopping
Benzo Alprazolam
209
Hepatotoxicity medication
Valproate (mood stabilizer)
210
False positive for Phencyclidine
``` Dextromethorphan (cough suppressant) Diphenhydramine Ketamine Tramadol Venlafaxine ```
211
False positive for Amphetamine
Atenolol Propranolol Bupropion Nasal decongestants
212
Excessive anxiety and preoccupation with >1 unexplained symptoms
Somatic symptom disorder
213
Postpartum psychosis tx
Hospitalization | Anti-psychotic (2nd gen)
214
Delusional disorder
Does not include mood symptoms or they are brief
215
Avoidant personality disorder
Avoidance due to fear of criticism and rejection
216
Patient see repeat images of stabbing her mother Count downs to eliminate images
OCD Tx: SSRI
217
Patient with repeat abdominal pain. Negative abdodminal CT
Somatic symptom disorder Tx: Regular scheduled visits with same provider
218
Alzheimer characteristics
Early short term memory loss Language deficits Later personality changes
219
Vascular dementia characteristics
Stepwise decline Early executive dysfunction Cerebral infarct/ deep white matter changes on neuroimaging
220
Frontotemporal dementia characteristics
Early personality changes Apathy, disinhibition and compulsive behavior Frontotemporal atrophy on imaging
221
Dementia with Lewy bodies characteristics
Visual hallucinations Spontaneous parkinsonism Fluctuating cognition
222
Normal pressure hydrocephalus characteristics
Ataxia early in disease Urinary incontinence Dilated ventricles on neuroimaging
223
Prior disease characteristics
Behavioral changes Rapid progression Myoclonus and or seizures
224
Patients of traumatic events are at risk for
Suicide
225
How to reduce long term misuse of opioids in patient
Query the prescription drug- monitoring database at each visit Random drug urine screen Follow up visit every 3 MONTHS
226
Diabetic neuropathy SSRI
Duloxetine
227
Neuropathic pain SSRI
Bupropion
228
Bipolar plus hypercalcemia medication
Lithium
229
Antipsychotic medication effects | - Antipsychotic efficacy the pathway effected
Decreased Dopamine in mesolimbic
230
Antipsychotic medication effects | - EPS pathways
Decrease in Dopamine in nigrostriatal
231
Antipsychotic medication effects | - Hyperprolactinemia pathway
Decrease Dopamine in tuberoinfundibular
232
Increased dopamine in mesolimbic
Euphoric and psychotic symptoms
233
Rapidly progessive dementia what is seen with labs/ imaging
Creutzfeldt-Jakob disease Periodic sharp wave complexes on EEG Positive 14-3-3 CSF assay Caudate nucleus/putamen MRI findings Spongiform changes Neuronal loss without inflammation
234
Creutzfeldt Jakob disease characteristics Tx
Rapidly progressive dementia >2/4 - Myoclonus (startle-induced arm jerking) - Akinetic mutism - Cerebellar or visual disturbances - Pyramidal/ extrapyramidal dysfunction (hypokinesia) Tx: None
235
Low alpha-synuclein
Parkinson disease | Dementia with Lewy bodies
236
Tx Absence seizures
Ethosuximide
237
Asain with facial flushing
Polymorphisms in acetaldehydre dehydrogenase, commonly found in asian populations
238
Early manifestations of word finding difficulties
Dominant temporal lobe Frontotemporal dementia (FTD)
239
2nd generation antipsyhotic iwth QT prolongation
Ziprasidone
240
Ziprasidone SE
Neutral weight | QT prolongation
241
Quetiapine SE
``` Cataracts Orthostatic hypotension (Beware in elderly) Prolongation of QT ```
242
Olanzapine SE
Weight gain | Metabolic syndrome
243
Thiamine deficiency in alcoholics progression
Confusion, ataxia, ophthalmoplegia --> Amnestic disorder (retrograde and anterograde) Cant learn new information
244
Rationialization
Patient excusing or justifying an attitude or event by developing an alternate explanation or shifting the blame Man speed who crashes into other drive. Other drives fault for not paying attention
245
Antipsychotic not working now smoking cigarettes
Hydrocarbon-induced induction of antipsychotic drug metabolism P450 system Olanzapine Clozapine
246
Dissociative fugue
Abrupt travel or wondering associated with traumatic event
247
Involuntary contraction of small muscles groups like repeated contraction of fingers in one hand
Tardive dyskinesia
248
Increased thirst in bipolar patient
Primary polydipsia Increase thirst Normal serum electrolytes Dilute urine
249
Drugs that induce schizophrenia
Marijuana PCP Ketamine
250
Lamotrigine SE
Mood stabilizer for bipolar Stevens Johnson syndrome (10% of body rash) Toxic epidermal necrosis (30% of body w/ rash) (Rash of mucous membranes) Valproate inhibits metabolism of lamotrigine --> accumulation
251
Channeling uncomfortable thoughts or emotions into more acceptable behavior
Sublimation | Acting out is always a negative reaction
252
Celecoxib
NSAID COX2 selective Doesnt cause GI effects Not for psychiatric and/or neuropathic pain Used for inflammatory pain and osteoarthritis
253
Chronic alcohol use physiology
Enhancement of GABAergic neurotransmission --> downregulation of GABA RECEPTOR activity
254
``` Constipation Dry skin Weight gain Sleepiness Decrease appetite Trouble concentrating ```
Hypothyroidism | Brittle hair*
255
Addison disease characteristics
``` Hypotension* Weight loss Fatigue Anhedonia (inability to feel pressure) GI symptoms Hypoglycemia ```
256
Cushing syndrome characteristics
Depressed mood Weight gain Moon facies Buffalo hump
257
Poor prognosis in schizophrenia
``` Onset before 25 Negative features Family hx of schizophrenia (not mood disorders) Poor social/ family support Male sex Poor functioning before onset ```
258
Opioid withdrawal 2 hrs after oral intake of drug
Buprenorphine - partial opioid agonist - trigger withdrawal (Naloxone injection works 20-30 min)
259
Clonidine
Treat autonomic symptoms of opioid withdrawal No role in precipitating a withdrawal syndrome
260
Methadone
Long acting opioid receptor agonist Opioid maintenance therapy Traditional opioid agonist Doesnt cause withdrawal syndrome Can cause QTC prolongation - get ECG
261
Naloxone
Rapid acting opioid antagonist 20-30 min effect Tx opioid overdose IV or intranasally
262
Naltrexone
Competitive Opioid antagonist Longer half-life than naloxone Oral and IM Precipitates withdrawal if used within 7 days of heroin use
263
Buprenorphine
Partial opioid agonist Sublingual Used in a taper dose to prevent withdrawal symptoms in opioid users If taken after significant opioid dose can precipitate withdrawal by displacing the drug from mu opioid receptors Can precipitate withdrawal if used too soon after full opioid agonists
264
Serotonin syndrome caused by
SSRI and MAOIs St John's wort Meperidine ``` Myoclonus Hyperreflexia Rigidity Termor Seizures Flushing Hyperthermia Dilated pupils Tachycardia HTN ```
265
Night blindness
Thiordazine (retina deposit) More common than cornea deposit in chlorpromaxine
266
Unconscious and repressed drives and emotions from childhood are brought to consciousness
Psychoanalysis 3x per week for 5 years
267
Brief dynamic psychotherapy
High functioning patient with a focal and circumscribed area of conflict Addressed in 10-20 sessions High level of motivation
268
Cognitive therapy
Depression Panic, OCD, somatoform Take maladaptive and faulty views of oneself and world are source of affects and behaviors Identify and modify cognitions
269
Interpersonal psychotherapy
short term tx for MDD Depressive symptoms are interpersonal conflicts Patients problems categorized into four areas: unresolved grief, social role disputes, social role transitions, interpersonal deficits
270
Focus is on the here and now. Focus on patients current dynamic conflicts rather than on childhood conflict.
Psychodynamic psychotherapy
271
Avoiding social situations with panic attacks
General social phobia | Avoidant personality disorder dont have panic attacks
272
Memantine
NMDA antagonist Slowing down disease progression with dementia Antagonist at NDMA receptors with pupose of reducing NMDA-medicated neurotoxicity
273
Donepezil
Cholinesterase inhibitors Rivastigmine Galantamine Reducing destruction of ACh in synaptic cleft Can lead to bradycardia and hypotension
274
Tx Dementia
Donepezil Rivastigmine Galantamine (Cholinesterase inhibitors) Memantine (NMDA antagonists)
275
Alprazolam
Benzo
276
Taper of benzo
Chlordiazepoxide | - long acting benzodiazepine to manage withdrawal
277
``` Irritability Anxiety Depression Mood lability Impair concentration/ cognition ```
Hypercalcemia
278
Hyponatremia is psychiatry
Syndrome of SIADH SE of carbamazepine and rare SSRI
279
Bed wetting normal until age
5
280
Man who like risky behavior becomes stunt man
Sublimation
281
Labile affect and mood Interpersonal difficulties Session focus on life threatening behaviors Therapy interfering and quality of life interfering behaviors Weekly group for skills training in emotional regulation, distress tolerance, interpersonal effectivenss and Zen-like mindfulness 1 year commitment
Dialectical behavior therapy (DBT) Borderline personality disorder
282
Interpersonal difficulties and excessive emotionality or expansive cognitive styles
Histrionic PD or narcissistic PD Tx Psychoanalytic psychotherapy - focus on current conflicts and dynamic patterns
283
Increased seizure activity w/o epileptic stressor is concern for
Psychogenic non-epileptic seizures (PNES) Related to emotional stress Prolactin distinguish between epileptic and psychogenic seizures (Elevated prolactin level found in genuine seizure)
284
Haloperiodol Citalopram Methadone
Prolonged QT Antidepressants - Citalopram - Escitalopram - TCA Antipsychotics - Haloperiodol (highest when IV) - Ziprasidone - Thioridazine Opiates - Methadone
285
Anticholinergic intoxication drugs
TCA Paroxetine Sleep aids ``` Vasodilation Anhidrosis (dry) Hyperthermia (hot) Mydriasis (blind) Delirium ```
286
Increased cytochrome P450 mediated metabolism drug
Carbamazepine
287
Neuroleptic malignant syndrome drugs
Haloperidol Metoclopramide Rigidity Fever autonomic instability delirium
288
Serotonin syndrome drugs
``` Dextromethorphan Tramadol Meperidine Amphetamines linezolid SSRI ```
289
Sleep techniques (10)
Avoid bed unless sleep and sex Go to bed quickly upon experiencing sleepiness Only go to bed when sleepy Cant sleep in 20 min, lead bed and do relaxing activity Avoid daytime nap Eat at regular intervals throughout day NO caffeine after lunch Exercise Wind down by reading book Wake up same time every day
290
Drug for nightmares w/ SSRI
Prazosin
291
Nicotine withdrawal symptoms
Constipation Irritable Headache Fatigue
292
Depression cant use SSRI, SNRI, Bupropion
Trazodone | - insomnia
293
First line for hypersomnia
Modafinil
294
Hallucinogens work on what system
Serotonin
295
Cocaine work on what system
Dopamine receptors
296
PCP works on what system
NMDA receptors Glutamate
297
Amphetamines work on what system
Dopamine receptors
298
Ketamine works on what system
NMDA receptors
299
Capgras syndrome
delusional syndrome characterized by belief that a familar person is replaced by imposter Schizophrenia
300
belief that the patient is entirely dead or putrefying or that parts of them (Blood, organs ) are missing or dying Believes nothing exists
Cotard syndrome/ delusion
301
Shared psychotic disorder/ delusion.
Folie a deux
302
delusional syndrome characterized by belief that a familar person is replaced by imposter
Capgras syndrome
303
Belief that several different people/ strangers are actually one person Usually familiar individual or persecutor who is in disguise or can change his/her appearance
Fregoli syndrome
304
Cotard syndrome/ delusion
belief that the patient is entirely dead or putrefying or that parts of them (Blood, organs ) are missing or dying Believes nothing exists
305
Folie a deux
Shared delusion
306
Fregoli syndrome
Belief that several different people/ strangers are actually one person Usually familiar individual or persecutor who is in disguise or can change his/her appearance
307
Refeeding syndrome
Food intake insulin Ž hypophosphatemia, hypokalemia, hypomagnesemia Ž cardiac complications, rhabdomyolysis, seizures. Look for fluid retention and decreased levels - phosphorus - magnesium - calcium
308
Buspirone
Generalized anxiety disorder Anxiolytic Partial agonism of serotonin receptors Doesnt caused sedation, addiction or tolerance Doesnt not interact w/ alcohol
309
ADHD neurotransmitters
Dopamine | Norepinephrine
310
Tetrabenazine
Huntington disease Inhibit vesicular monoamine transporter (VMAT) Decrease dopamine vesicle packaging and release
311
Riluzole
ALS Decrease glutamate excitotoxicity
312
Blockade of postsynaptic dopamine receptors
Antipsychotics
313
Global impairment of serotonergic neurotransmission
Pathophysiology of MDD
314
Localized loss of neurons in the caudate nucleus
Movement symptoms in Huntington's disease
315
Localized loss of neurons in substantia nigra
Decrease in dopaminergic neurotransmission that causes movement symptoms of Parkinson's disease
316
Drug of choice for supervised heroin withdrawal inpatient
Buprenorphine
317
Drug of choice for supervised opioid withdrawal taken at home
Buprenorphine/ naloxone Nloxone component prevents abuse of buprenorphine
318
Heroin withdrawal acute setting
Methadone
319
Heroin withdrawal med in prison
Clonidine (alpha 2 adrenergic agonist) Lofexidine
320
Chlordiazepoxide
Reduce anxiety and agitation due to sedative GABAergic effects Alcohol withdrawal
321
Chlorpromazine
Dopamine antagonist Originally antipsychotic no longer used dues to EPS Reduce vomiting and diarrhea ``` Orthostatic hypotension Blue gray skin discoloration Corneal and lens deposits Photosensitivity Intractable hiccups ```
322
Diphenhydramine in withdrawal
Antihistamine used to manage pruritus in opioid withdrawal Causes sedation
323
Ketorolac
Pain management Potent NSAID
324
First line tx for tics in Tourette syndrome
Aripiprazole (partial agonist at D2 dopamine receptors) FDA approved: Haloperidol and pimozide Pimozide is often correct answer on test Habit reversal training [Guanfacine first choice according to book?]
325
Patient with bipolar on lithium that wants to get pregnant
Continue medication at current dose
326
Labs seen with chronic alcohol abuse
Macrocytic anemia Due to dietary folate deficiency and alcoholic effect on gastric synthesis of intrinsic factor causing deficiency in Vit B 12
327
Alcoholic liver enzymes
AST x2 to ALT
328
Diffuse cerebral atrophy
Alzheimers dementia Lewy body dementia Some cases of vascular dementia
329
Delusions of reference
Type of delusion in which the patient believes that he/she is receiving special coded message via the media Mania Psychotic depression Primary psychosis
330
Panic disorder with agoraphobia
Avoid places from which it would be difficult to escape in the event of panic attack
331
MAOI
Isocarboxazid Tranylcypromine Phenelzine Selegiline (selective MAO-B inhibitor)
332
Isocarboxazid
MAOI
333
HTN crisis Tx
MAOI Pseudoephedrine (sympathomimetics) Tyramine Tx: Phentolamine Sympathomimetics - albuterol - terbutaline - dobutamine - dopamine - epinephrine - midodrine - amphetamine - cocaine - ephedrine
334
SSRI discontinuation syndrome
Seen most commonly in antidepressants with shorter half lives Fluvoxamine Paroxetine Venlafaxine "Electric shocks" Fluoxetine - half life 4-6 days - tx of choice
335
Delusion disorder
Delusions in absence of other psychiatric symptoms or functional impairment No history of mental illness
336
Grandiose delusion
"grand role" Special abilities Mania Schizophrenia
337
Belief that the patient is the subject of malice perpetrated by others
Persecutory delusions Schizophrenia Primary psychotic disorders
338
Alprazolam | Diazepam
Oral outpatient tx Alprazolam: acute anxiety Diazepam: alcohol withdrawal
339
Midazolam
Fastest acting benzo Reduce anxiety prior to anesthesia Emergency setting as a rapid abortive tx for status epilepticus
340
Temazepam
Slower onset and long duration of action Intermittent insomnia
341
Tx individual episodes of panic attacks
Alprazolam
342
Depression NT - Other feature
Decreased amount of Serotonin Decreased Norepinephrine Decrease Dopamine Hypothalamic dysfunction
343
Mania NT
Increased Dopamine
344
Schizophrenia NT
Increased Dopamine in prefrontal cortex
345
OCD NT
Low Serotonin
346
Anxiety disorder NT
Low Serotonin | Low GABA
347
Benzodiazepines target
GABA
348
Benztropine
Improve tremor
349
St. Johns wort
Antidepressatn due to SSRI like effect
350
Bipolar I w/ rapid cycling
1 episode of mania in addition to three other mood disturbances within 1 year Mania Hypomania Major depression Mixed episode
351
Mania
DIGFAST ``` Distractibility Impulsive behavior Grandiosity Flight of ideas Activity/ agitation Sleep disturbance Talkativeness (pressured speech) ``` 3 symptoms for 1 week or any duration if hospitalized
352
Bulimia labs
Decreased potassium Elevated BUN Normal creatinine Increased amylase (parotid gland stimulation) Low albumin
353
Dementia vs MDD
MDD - recognize deficit Dementia - Poor insight
354
Defense mechanism which you consciously choose to not think about anxiety provoking thought
Suppression
355
Delusion vs illusion
Delusion - sensory perception correct - knew it was smoke - belief of demons Illusion - subconscious misinterpretation of sensory perception
356
Delirum tremens characteristics
Disorientation Memory deficits Perceptual and language disturbances Rapidly fluctuating symptoms Disturbance of consciousness (No dreams)
357
Muscle aches part of what withdrawal
Opioids
358
Vivid of unpleasent dreams part of what withdrawal
Cocaine
359
Cognitive triad of depression
1) Negative views about oneself 2) Negative views about the world 3) Expectation of future failure
360
Gambling disorder
Impulse control disorder Tx Group psychotherapy or CBT
361
Inhibition of monoamine reuptake
SNRI | Bupropion
362
What release to feel no pain after severe injury
Endorphins
363
Substance P
NT that is associated w/ pain
364
Endocannabinoids
Provide sense of euphoria in certain situations
365
Tourette tx
Only tx if causing distress to child of decline in academic funcitoning
366
Alzheimers in brain
Neurofibrillary tangles
367
Alpha synuclein inclusions in neurons
Lewy dementia | Parkinson
368
Neurofibrillary tangles
Alzheimers
369
SSRI most likely to cause SSRI discontinuation syndrome
Paroxetine
370
Signs of schizophrenia
Delusions of thought insertion Thought withdrawal Thought broadcasting Voices in discussion Voice commentary Audible thoughts -hallucination in which patients thoughts are relayed back as audible voices
371
Schizophrenia voices
Clearly audible voices Attempt to resist command hallucinations
372
Lab to check neuroleptic malignant syndrome
High levels of creatinine phosphokinase
373
Anticholinergic symptoms - blurry vision - agitation - fever - constipation - urinary retention What type of medication
TCA | - amitriptyline
374
Antihypertensive that can cause depression
Clonidine Propranolol Methyldopa Reserpine
375
Antipsychotic which doesnt cause hyperprolactinemia in preexisting hyperprolactinemia
Clozapine
376
``` Slurred speech Unsteady gait Nystagmus Memory impairment Stupor Seizures ```
Ethanol withdrawal | Ethanol intoxication w/o seizure
377
Dementia Pupillary changes (anisocoria different sized pupils) Ataxia Urinary incontinence Impaired peripheral vibratory and proprioceptive sensation
Neurosyphilis
378
Patient w/ psychosis that recovers quickly in hospital
Delirium
379
Acute alcohol intoxication features
Lack of coordination Impairment of cognition NYSTAGMUS
380
Risperidone causes orthostatic hypotension by
Cross reactivity as an alpha 1 adrenergic antagonist impairing binding of norepinephrine to alpha 1 receptor
381
Schizophrenia brain changes
Deterioration of Hippocampus
382
Nefazodone
Antidepressant SE: hepatotoxicity
383
MDD w/ sexual side effects and generalized anxiety
Dont use Bupropion Nefazodone
384
MDD that develops psychotic features such as auditory hallucinations Tx
Risperidone (due to high potency)
385
Auditory hallucination are from what part of the brain
Temporal lobe
386
Generalized anxiety disorder lab level
Elevated cortisol
387
OCD due to what part of brain
Cerebral cortex or basal ganglia
388
clonus=
serotonin syndrome
389
Lorazepam vs other benzo
Lorazepam is not metabolized by liver
390
Patient abruptly stops talking
Thought blocking Person stealing thoughts
391
Wandering off topic during regular conversations
Derailment
392
Wandering off topic during an explanation or while responding to a question
Tangentiality
393
Rapid cycling between different ideas without direct relationship with one another
Flight of ideas
394
Losing track of the intended purpose of a sentence
Loss of a goal
395
Decreased speech, but complete sentences present
Poverty of speech
396
Adequate amount of speech with very little actual content
Poverty of thought
397
Illness anxiety disorder
Focus on obtaining a diagnosis for mild complaints that are genuine not pathological Preoccupation with having or acquiring a serious illness persists 6 months tx: regular visits with one primary care physician
398
Delirium tx
Haloperidol
399
NT responsible for patients sexual dysfunction on clozapine
Anticholinergic activity | Parasympathetic
400
Several unrelated physical symptoms in several different systems
Somatic symptom disorder
401
Other features of PTSD
Sense of foreshortened future
402
Breathing techniques target what NT
Norepinephrine
403
Girl 1-4 y.o Wringing hands Delay in intellectual development
Rett syndrome
404
Alcohol changes on sleep
Decreased REM sleep Decreased sleep latency (shorter time to fall asleep) Increased sleep fragmentation (increased nighttime awakenings)
405
Pain relief tx in heroin use disorder
Ketorolac - NSAID - Potent
406
Hear colors | See tastes
Synesthesia
407
Visual hallucinations in those that are blind
Charles Bonnet syndrome
408
Neutropenia in patient
Clozapine | Carbamazepine
409
Carbamazepine SE
Agraulocytosis Stevens-Johnson syndrome Teratogenic in pregnancy Cytochrome P450 induction Hyponatremia Hepatotoxicity
410
Drugs that induce mania or psychosis is patients with previous history of disease (6)
Corticosteriods ``` Thyroxine Dopaminergic anti-parkinsonian drugs Amphetamines Cocaine PCP ```
411
Drugs that induce depression in already depressed patient (8)
``` Corticosteriods Lidocaine Procainamide Beta blockers Reserpine Antimalarials - chloroquine - mefloquine Levetiracetam ```
412
Anticonvulsant that can exacerbate depression and anxiety
Levetiracetam
413
Topiramate - what is it - SE (2) - Used in (2)
Mood stabilizer Significant cognitive suppression and sedation Useful in migraine prophylaxis and weight loss
414
Valproic acid - what is it - use in (2) - SE (5)
Mood stablizer Use for seizure disorder, migraine prophylaxis Sedation, hepatotoxicity, teratogenesis, weight gain and hair loss
415
Epilepsy associated with psychosis
Temporal lobe epilepsy (TLE)
416
Major NTs in anxiety
NE Serotonin 5HT GABA
417
Most common form of psychopathology
Anxiety
418
If patient has a comorbid depressive disorder dont use what medications
Benzodiazepines, as they will worsen depression
419
Anxiety with comorbid substance abuse consider using
non-addictive anxiolytic alternatives prn such as diphenhyramine, hydroxyzine, and gagapentin
420
Busprione MOA
NOn-benzodiazepine anxiolytic which has partial agonist activity at serotonin receptor
421
Panic disorder tx
Combination of CBT and pharmacotherapy most effective First line: SSRI
422
Agoraphobia duration and tx
> 6 months CBT and SSRI
423
Specific phobias duration and tx
> 6 months CBT
424
Selective mutism Tx
Rare Failure to speak in specific situations for a least 1 month Consistent failure to speak in select social situations (school) despite speech ability in other scenarios Tx: CBT, family therapy SSRI
425
Separation anxiety disorders - duration - tx
Excessive and developmentally inappropriate fear/anxiety regarding separation from attachment figures >4 weeks in children/ adolescents >6 months in adults TX: CBT, family therapy
426
Characteristics of generalized anxiety disorder (6)
associated >=3 symptoms: ``` Restlessness Fatigue Impaired concentration Irritability Muscle tension Insomnia ```
427
OCD tx
CBT - exposure and response prevention - SSRI Second line: - SNRI - TCA - Clomipramine
428
Hoarding tx
CBT for hoarding | SSRI can be used
429
Hair pulling disorder tx
SSRI Second gen antipsychotics Lithium N-acetylcysteine Specialized CBT - Habit reversal training
430
Medication to stop nightmares
Prazosin
431
Medication to avoid in PTSD
Benzo
432
Tx PTSD
SSRI Prazosin (alpha 1 antagonist) CBT - exposure therpy - cognitive processing therapy
433
Adjustment disorder - is what - timeline - tx
Non lifethreatening, stressful life event Symptoms resolve within 6 months after stressor has terminated Tx: Supportive psychotherapy Group therapy
434
Group therapy should be avoid in what personality disorder
Paranoid personality disorder
435
Pharmacotherapy and tx that is useful in borderline personality disorder
Dialectical behavior therapy - cognitive behavioral therapy - mindful skills - group therapy Mood stabilizers Antipsychotics Antidepressants
436
Alcohol intoxication tx
Thiamine before glucose
437
Alcohol withdrawal what predisoses to seizures
Hypomagnesemia
438
Confabulation is part of what
Inventing stories Korsakoff's psychosis Patients unaware they are making things up
439
Alcoholic ketoacidosis - tx
Ketosis without hyperglycemia and a negative alcohol level High anion gap metabolic acidosis, ketonemia, and low level of potassium, magnesium and phosphorus Tx: Hydration with D5N5 and replacing electrolytes
440
Tx alcohol use disorder
First line: Naltrexone - Opioid receptor antagonist - Reduces desire/ craving and the "high" associated with alcohol - will precipitate withdrawal in patient with physical opioid dependence Acamprosate - modulate glutamate transmission - used for relapse prevention in patients who have stopped drinking (post-detoxification) - advantage is liver disease - CI if renal disease Second line: Disulfiram -blocks aldehyde dehydrogenase in liver Topiramate - anticonvulsant that potentiates GABA and inhibits glutamate receptors - reduces cravings for alcohol and decreases alcohol use
441
Naltrexone
- Opioid receptor antagonist - Reduces desire/ craving and the "high" associated with alcohol - will precipitate withdrawal in patient with physical opioid dependence
442
Acamprosate
- modulate glutamate transmission - used for relapse prevention in patients who have stopped drinking (post-detoxification) - advantage is liver disease - CI if renal disease
443
Topiramate
- anticonvulsant that potentiates GABA and inhibits glutamate receptors - reduces cravings for alcohol and decreases alcohol use
444
Alcohol can cause what changes in labs
increased LFTs | Macrocytosis (increased in MCV)
445
Cocaine MOA
blocks the reuptake of dopamine, epinephrine and norepinephrine
446
What labs to check in PCP and amphetamine
Elevated creatine kinase. Rhabdomyolysis
447
Amphetamines MOA
Release dopamine, NE and serotonin from nerve endings
448
Synesthesia seen with what drug
One sensory stimulation evokes another hearing a sound causes one to see a color PCP
449
Tx barbiturates overdose
Alkalinize urine with sodium bicarbonate to promote renal excretion
450
Tx benzodiazpine overdose
Flumazenil
451
Marijuana MOA
Cannabinoid receptors in brain inhibit adenylate cyclase
452
Marijuana withdrawal
``` Irritability Anxiety Restlessness Aggression STRANGE DREAMS Depression HA Sweating Chills ```
453
Dronabinol
FDA approved form of THC
454
Caffeine MOA
Increasing in cyclic adenosine monophosphate (cAMP) and stimulating the release of excitatory NT
455
Nicoteine dependce tx
Varenicline - alpha4beta2 nicotinic cholinergic receptor partial agonist - mimics action of nicotine - reduces rewarding aspects and prevents withdrawal Bupropion - antidepressant inhibits reuptake of dopamine and NE helps reduce cravings and withdrawal symptoms
456
Common causes of medication induced delirium
``` TCA Anticholinergics Benzo Nonbenzo hypnotics Corticosteriods H2 blockers Opioids (esp meperidine) ```
457
Opioid that doesnt cause miosis
Meperidine
458
Delirium on EEG
Diffuse background slowing Delirium tremens opposite: fast EEG activity
459
Tool for assessing delirium
Confusion assessment method (CAM)
460
Medication to avoid in delirium
Benzo Worsen delirium by causing paradoxical disinhibition or oversedation
461
Alzheimers disease in brain - accumulation - genes
Accumulation of extraneuronal beta- amyloid plaques and intraneuronal tau protein tangles assocaited iwth progressive brain atrophy ``` Mutation - Amyloid precursor protein - Presenilin 1 - Presenilin 2 (early onset) ``` Epsilon-4 variant of the apolipoprotein gene is a risk factor for developoing early onset AD
462
Alzheimers tx
No cure ``` Cholinesterase inhibitors - donepezil - rivastigmine - galantamine (may slow clinical deterioration by 6-12 months) ``` NMDA receptor antagonist - memantine Antipsychotics for agitation and aggression - low doses
463
Increased difficulty in planning and decision making
Complex attention and executive functioning Vascular disease
464
Lewy body disease - brain - features (3) - suggesive features (3) - biomarkers (3)
brain - lewy bodies (alpha synuclein) and lewy neurites in the brain, primarily basal ganglia Progressive cognitive delcine WAXING AND WANING Visual hallucinations Rapid eye movement sleep behavior disorder (REM) Suggestive features - antipsychotic sensitivity (EPS) - postural instability and recurrent falls - diminished sense of smell Biomarkers - REM sleep without atonia - decreased 123iodine-MIBG uptake on myocardial scintigraphy - Reuced dopamine receptor uptake in basal ganglia vis PET or SPECT
465
Lewy body tx
Cholinesterase inhibitors Quetiapine or clozapine for psychotic symptoms Levodopa carbidopa for parkinsonism Melatonin or clonazepam for REM sleep disorder
466
Tx Huntingtons
Symtoms directed tx Tetrabenazine Atypical (second gen) antipsychotic
467
Rapidly progressive cognitive decline with myoclonus
Creutzfeldt jakob disease
468
Features of creutzfeldt jakob disease
Ataxia Nystagmus Hypokinesia
469
Features of creutzfeldt jakob disease labs
Periodic sharp wave complexes of EEG CSF positive for 14-3-3 protins Lesions in the putamen or caudate nucleus on MRI
470
Normal aging of brain
Decreased brain weight/ enlarged ventricles and sulci
471
Pseudodementia tx
SSRI If have to use TCA use nortriptyine less anticholinergic side effects Mirtazapine can increase appetite and is also sedating (dose at bed time)
472
Restless leg movements due to
Dopamine imbalance
473
Sleep changes in elderly
Decreased REM latency Decreased total REM Increased amount stage 1 and 2 Decreased stage 3 and 4 Decrease sleep efficiency (frequent nocturnal awakenings) Decreased total sleep amount
474
If elderly need sedative hypnotics then use
Trazodone
475
K-ABC
Kaufman assessment battery for children Intelligence test comparing intellectual capacity with acquired knowledge of patients between 2-12
476
WISC-R
Wechsler intelligence scale for children revised Assesses verbal, performance and full scale IQ of patients between 6-16 years old
477
Difficulty acquiring and using language Reduced vocab Limited sentence structure
Language disorder
478
Difficulty producing articulate intelligible speech
Speech sound disorder
479
Stuttering
Childhood onset fluency disorder
480
ADHD - onset - duration - associated with - tx
>6 months Prior to age 12 Comorbid - oppositional defiant disorder - conduct disorder - specific learning disorder Methylphenidate, amphetamines Second line: Atomoxetine (NE reuptake inhibitor) Alpha 2 agonist (clonidine, guanfacine)
481
Coprolalia
Utterance of obscene, taboo words in abrupt sharp bark or grunt
482
Enuresis
Recurrent bed wetting At least 5 years old 3 months Spontaneous remission Psychoeducation Limit fluid intake and caffeine at night Urine alarm Desmopressin (DDAVP) antidiuretic Imipramine (TCA)
483
Encopresis
Recurrent defecation 3 months 4 years old
484
Depersonalization tx
out of body experience cbt
485
Derealization | tx
experiencing world around them in a dream or movie Tx CBT
486
Medication to reduce self mutilation
Naltrexone
487
Intermittent explosive disorder - criteria - lab finding - tx
outbursts twice weekly for 3 months CSF shows low 5-hydroxyindoleacetic acid (5-HIAA) concentration SSRI (fluoxetine) Anticonvulsants lithium
488
What is associated with aggressive and impulsiveness lab
Low levels of serotonin in CSF
489
Kleptomania comorbid with
Bulimia nervosa
490
Kleptomania tx
CBT - systematic desensitization and aversive conditioning SSRI Naltrexone maybe
491
Anorexia nervousa comorbid with
OCD
492
Physical findings in Anorexia nervousa
``` Bradycardia Orthostatic hypotension Arrhythmias QTC prlongation ST-T wave changes Anemia (normocytic normochromic) Leukopenia ``` Enlarged ventricles and neuropathy Muscle wasting Amenorrhea and loss of libido Parotid enlargement Increased amylase levels Hypokalemia Elevated BUN Increase GH Increased CORTISOL Lanugo (fine soft hair on body) Hypochloremic hypokalemic alkalosis (if vomiting)
493
REM sleep is characterized by
Increase in - blood pressure - heart rate - respiratory rate
494
Insomnia disorder - criteria - tx
3 days a week for at least 3 months Sleep hygiene measures CBT (first line) Chronotherapy (bright light therapy) Benzo (redue sleep latencya nd nocturnal awakening)
495
Insomnia medication with increased risk of falls in elderly
zolpidem (ambien) Also causes cognitive impairment
496
Tx Sleep related hypoventilation
CPAP Medications to stimulate/ promote breathing - bronchodilators - theophylline
497
Nightmare disorder
Recurrent frightening dreams Vivid recall No confusion or disorientation upon awakening Tx: Densensitization/ imagery rehearsal therapy (IRT)
498
REM sleep behavior disorder tx
Clonazepam
499
Dopamine and serotonin effect on sex
Dopamine enhances libido Serotonin inhibits sexual function
500
Tx premature ejactulation
SSRI | TCA
501
Frotteuristic disorder
Sexual arousal from touching or rubbing against a nonconsenting person
502
Voyeuristic disorder
Sexual arousal from observing an unsuspecting nude, or disrobing individual (binoculars)
503
Exhibitionistic disorder
Sexual arousal from exposure of one's genitals to an unsuspecting person
504
Sexual masochism disorder
Sexual arousal from the act of being humiliated beaten bound or made to suffer
505
Sexual sadism disorder
Sexual arousal from the physical or psychological suffering of another person
506
Isolation of affect
Unconsciously limiting the experience of feelings or emotions associated with stressful life event in order to avoid anxiety
507
Undoing
Attempting to reverse a situation by adopting a new behavior Man had fantasy of killing wift by sabotaging her car takes the car for complete check up
508
Homework assignments between therapy session Set agenda Review homework challenge cognitive distortions 6 weeks to 6 months
CBT Current symptoms
509
Dialectical behavioral therapy
once weekly individual and group tx Reduce urges to engage in self harm behavior
510
Duty of warn
Tarasoff duty
511
Dont require consent (3)
Life saving medical emergency Prevention of suicide or homicidal behavior Unemancipated minor (require consent from parent)
512
Emanciapted minor (4)
Self supporting In the military Married Have children or pregnant
513
Capacity vs competence
Capacity - clinical term by physician Competence - legal term by judge
514
Parens patriae
Protecting citizens who cant care for themselves
515
Sixth amendment
right to counsel, a speedy trial and to confront witnesses
516
Fourteenth amendment
right to due process by law
517
M'Naghten insanity defense
Person did not understand what he/she was doing was wrong
518
Durham insanity defense
Criminal act resulted from mental illness
519
OTC drugs that can cause serotonin syndrome
St. John's wort | dextromethorphan
520
CYP 450 inducers
Tobacco Carbamazepine Barbiturates St. John's wort
521
CYP450 inhibitors
``` Fluvoxamine Fluoxetine Paroxetine Duloxetine Sertraline ```
522
SSRI most associated with weight gain
Paroxetine
523
SSRI and MAOI
SSRI should not be used for at least 2 weeks before or after use of an MAOI
524
Fluvoxamine
SSRI | only for OCD
525
Citalopram | Escitalopram
SSRI | Dose dependent QTC prolongation
526
Trazodone | Nefazodone
Serotonin receptor antagonists Tx - MDD - MDD w/ anxiety - Insomnia SE - orthostatic hypotension - arrhythmias - sedation - priapism Nefazodone - black box warning for liver failure
527
Mirtazapine
Alpha 2 adrenergic receptor antagonists Tx MDD Patients with weight loss and or insomnia SE weight gain sedation
528
TCA
Tertiary amines - Amitriptyline: chronic pain, migraines, insomnia - Imipramine: enuresis and panic disorder - Clomipramine: OCD - Doxepin: Chronic pain Secondary amines - Nortriptyline: least likely to cause orthostatic hypotension Desipramine
529
TCA overdose
Sodium bicarbonate
530
Factors that increase Li levels
NSAIDS Aspirin Thiazide diuretics
531
Carbamazepine
Especially useful in treating mania with mixed features and rapid-cycling bipolar disorder Acts by blocking sodium channels and inhibiting action potentials
532
Valproic acid
acute mania acute mania with mixed features rapid cycling Blocks sodium channels and increases GABA concentration in the brain
533
Lamotrigine
Bipolar depression Steven johnson syndrome
534
Anxiety inducing
Sympathomimetics | Antiasthmatics
535
Miosis pupil size Mydrasis pupil size
Miosis less than 2 mm Mydrasis larger than 4 mm
536
What inhibits lamotrigine
Valproic acid

Third Year Shelf (7 decks)

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