Psych Flashcards
Countertransference
Doctor projects feelings about formative/other important persons onto patient (vs transference= patient onto doctor)
Displacement
Immature ego defense:
- Avoided ideas/feeling transferred onto neutral person/object
Ex: Dad yells at mom, so mom yells at child
Fixation
Immature ego defense:
- Partially remaining at more childish level of development (vs regression to prior developmental stages)
Identification
Immature defense
Modeling behavior after person who is more powerful
Ex: abused child identifies with an abuser
Projection
Immature defense
Unacceptable internal impulse attributed to external source
Ex: man wants another woman; thinks his wife is cheating on him
Reaction formation
Immature defense
Warded-off idea or feeling replaced by UNCONCIOUS emphasis on opposite
Ex: pervert joins monastery
Repression
Immature defense
Involuntary withholding of an idea/feeling from conscious awareness (vs suppression= voluntary)
Ex: not remembering conflict/traumatic experience
Splitting
Immature defense
Belief that people are either all good or all bad (seen in borderline personality disorder)
Ex: All nurses are amazing, all the doctors are awful people
Altruism
Mature defense
Guilty feelings alleviated by unsolicited generosity
- Criminal donates to charity
Sublimation
Mature defense
Replace unacceptable desire with course of action similar to desire but in line with one’s value system (vs reaction formation= unconcious about changing focus of desire)
Ex: Man recognizes desire to cut people open, becomes a surgeon (vs serial killer)
Suppression
VOLUNTARYILY withholding of idea/feeling from conscious awareness (vs involuntary in repression where it is forgotten)
Ex: choosing not to think of USMLE until it is close
Child disintegrative disorder
3-4 years of age; more common in boys
Regression in multiple areas of functioning after 2+ years of normal development
Loss of expressive, receptive language skills, social skills, adaptive behaviors, bowel/bladder control, motor skills
Hallucinations
Visual: more common in medical illness
Auditory: more common in psychiatric illness
Olfactory: aura of epilepsy, brain tumors
Tactile: alcohol withdrawal, cocaine abusers (cocaine crawlies)
Hypnagogic= while going to sleep
Hypnopompic= while waking from sleep
Schizophreniform disorder
1-6 months of psychosis, disturbed behavoir and thought (brief if < 6 months, schizophrenia of > 6 months)
Schizoaffective disorder
2+ weeks of stable mood WITH psychotic symptoms
PLUS major depressive, manic, mixed episodes
- Types= bipolar, depressive
Schizophrenia subtypes
Paranoid (delusions) Disorganized (with regard to speech, behavior, affect) Catatonic (automatisms) Undifferentiated (all types) Residual
Delusional disorder
Fixed, persistent, nonbizarre belief lasting > 1 month
- No other functional impairments
Shared psychotic disorder (folie a deux): development of delusions in person in close relationship with someone with delusional disorder
- Resolves upon separation
Hypomania
Like mania (DIGFAST) with no marked impairment in social/work funcitons (no hospitalization)
Bipolar disorder
Type 1= 1+ manic episodes with depression
Type II= 1+ hypomanic episode with depression
Cyclothymic= dysthymia (depressed mood for 2+ years with no remission for > 2 months) + hypomanic episode
Atypical depression
- Mood reactivity (improved mood in response to positive events)
- Reversed vegetative symptoms: hypersomnia, weight gain
- Leaden paralysis (heavy feeling in arms, legs)
- Long-standing interpersonal rejection sensitivity
Postpartum mood disturbance
Maternal blues= change in mood 2-3 days postpartum; resolves in 10-14 days
Postpartum depression= depressed affect, anxiety within 4 weeks postpartum; lasts 2+ weeks to a year+
- Tx: antidepressants, therapy
Postpartum psychosis= delusions, hallucination, homicidal/suicidal ideations; lasts days to 4-6 weeks
- Tx: antipsychotics, antidepressants, inpatient hospitalization
Electroconvulsive therapy
Painless seizure in anesthetized patient
Major depressive disorder refractory to other treatment
- Pregnant women with MDD
- Acute suicidality
- Depression with psychotic features
- Catatonia
AEs: disorientation, temporary antero/retrograde amnesia, usually resolving by 6 months
Post-traumatic stress disorder
Persistant arousal due to reexperiences of previous trauma
- Disturbance > 1 month (can start anytime after event)
Acute stress disorder= 2 days-1 month
Generalized anxiety disorder
Uncontrollable anxiety for > 6 months
- Unrelated to specific person, situation, event
- Sleepdisturbance, fatigue, GI disturbance, difficulty concentrating
Tx: SSRIs, SNRIs
Adjustment disorder
Emotional symptoms causing impairment due to identifiable psychosocial stressor
- Lasts < 6 months
- Chronic stressor: > 6 months
Somatization disorder
Develops before age 30
- Complaints in multiple organ systems
Conversion
Loss of sensory, motor function in response to acute stressor
- Patient may be indifferent
- Females, adolescents/young adults
Cluster A personality disorders
Weird: Accusatory, aloof, awkward
- Paranoid
- Schizoid (content with isolation)
- Schizotypal (odd beliefs/magical thinking, interpersonal awkwardness)
Cluster B personality disorders
Wild
- Antisocial: disregard for/violation of rights of others (conduct disorder < 18 years)
- Borderline: unstable mood and interpersonal relationships; splitting as major defense mechanism
- Histrionic: excessive emotionality, excitability, attention seeking
- Narcissistic: grandiosity, sense of entitlement; lacking empathy, requiring admiration
Cluster C personality disorders
Worried
- Avoidant: hypersensitive to rejection, desires relationships
- Obsessive compulsive: LIKES being obsessive (vs. OCD)
- Dependent: Submissive and clinging
Stages in overcoming substance abuse
- Precontemplation: not yet acknowledging problem
- Contemplation: acknowledging problem, not ready to make change
- Preparation/determination: getting ready to make change
- Action/willpower: changing behavior
- Maintenance: maintaining behavior change
- Relapse: returning to old behaviors, abandoning new changes
PCP intoxication
Hallucinogen:
- Belligerence, impulsiveness, agitation, homocidal, psychotic
- Fever, tachycardia, delirium, seizures, tonic jerking
withdrawal:
- Anxiety, irritability, restlessness, nystagmus, ataxia
Methylphenidate
Dextroamphetamine
Methamphetamine
CNS stimulants
MOA: Increase catecholamines at synaptic cleft (NE, DA): enhance release and block reuptake
Use: ADHD, narcolepsy, appetite control
Tox:
- Confusion, dry mucous membranes, mydriasis
Haloperidol
Trifluoperazine
Fluphenazine
High potency typical antipsychotics
MOA: block D2 receptors
Tox:
- Highly lipid soluble (Stored in fat, slow to remove)
- EPS (worse with high potency than low potency)
- Endocrine side effects: DA antagonist–> hyperprolactinemia–> galactorrhea, amenorrhea
- Muscarinic, alpha-1, histamine blockade (worse with low potency typical antipsychotics)
- Neuroleptic malignant syndrome (NMS), Tardive dyskinesia (TD) (esp. Haloperidol)
Chlorpromazine
Thioridazine
Low potency typical antipsychotics
MOA: block D2 receptors
Tox:
- Highly lipid soluble (Stored in fat, slow to remove)
- EPS (worse with high potency than low potency)
- Endocrine side effects: DA antagonist–> hyperprolactinemia–> galactorrhea, amenorrhea
- Muscarinic, alpha-1, histamine blockade (worse with low potency typical antipsychotics)
- Neuroleptic malignant syndrome (NMS), Tardive dyskinesia (TD)
- Chlorpromazine= corneal deposits
- Thioridazine= retinal deposits
Neuroleptic malignant syndrome
Due to typical antipsychotic use:
- Rigidity
- Myoglobinuria
- Autonomic instability
- Hyperpyrexia
Tx: Dantrolene, D2 agonists (bromocriptine)
Tardive dyskinesia
Sterotypic oral-buccal movements (lip smacking, chewing) due to long-term antipsychotic use
- Often irreversible
Extrapyramidal symptoms
Due to dopamine blockade (D2 blockade)
4 hr: dystonia (muscle spasm, stiffness, oculogyric crisis)
4 days: akathisia (restlessness)
4 weeks: bradykinesia (parkinsonism)
4 months: Tardive dyskinesia
Treatment: trihexphenidyl, benzotropine, (anticholinergics)
- avoid in BPH, acute-angle closure glaucoma
Olanzapine Clozapine Quetiapine Risperidone Aripiprazole Ziprasidone
MOA: Serotonin (5-HT2), DA (D3, D4), alpha-, H1 receptor effects
Use:
- Schizophrenia
- bipolar, OCD, anxiety disorder, depression, mania, Tourette’s syndrome
ToxL
- Fewer EPS, anticholinergic effects
- Olanzapine/clozapine: weight gain
- Clozapine= agranulocytosis (weekly RBC monitoring), seizure
- Ziprasidone: prolong QT interval
Lithium
PPI cascade
Use: Mood stabilizer
- Also SIADH (ADH antagonism)
Tox:
- Tremor, sedation, edema
- Heart block
- Hypothyroidism
- Polyuria (ADH antagonist–> nephrogenic DI)
- Teratogen: Ebstein anomaly, malformation of great vessels
- ** Monitor serum levels!!
- Excreted by kidneys: most reabsorbed at PCT following Na+, therefore levels increased with:
- Thiazide diuretics (block Na+ reabsorption in DCT–> kidney increases Na+ reabsorption in PCT, lithium follows)
- ACE-I, Verapamil, Diltiazem, NSAIDs
- Loop diurectics do not cause this problem
Buspirone
MOA: stimulate 5-HT1A receptors
Use: Generalized anxiety disorder
Tox: does NOT cause sedation, addiction, tolerance; does not interact with alcohol
- Takes 1-2 weeks to take effect
Fluoxetine
Paroxetine
Sertraline
Citalopram
SSRIs
MOA: serotonin-specific reuptake inhibitor
Tox:
- GI distress, sexual dysfunction
- Serotonin syndrome with MAO-I, SNRI, TCAs
**Takes 4-8 weeks for effectiveness
Serotonin syndrome
Interaction between antidepressants with effects on serotonin (SSRI, SNRI, MAO-I, TCAs)
- Hyperthermia
- Confusion
- Myoclonus
- CV collapse
- Flushing
- Diarrhea
- Seizures
Tx: Cyproheptadine (5-HT2 receptor antagonist)
Venlafaxine
Duloxetine
SNRIs:
MOA: inhibit serotonin and NE reuptake
Use: Depression
- Venlafaxine= GAD, panic d/o
- Duloxetine= diabetic peripheral neuropathy
Tox: increased BP
- Stimulant
- Sedation, Nausea
Amitriptyline Nortriptyline Imipramine Desipramine Clomipramine Doxepin Amoxapine
Tricyclic antidepressants
MOA: block reuptake of NE and serotonin
Use: Major depression
- Imipramine= bedwetting
- Clomipramine= OCD
- Fibromyalgia
Tox:
- Sedation
- Alpha-1 blockade: postural hypotension
- Anticholinergic (atropine-like) effects (more with amitriptyline than nortriptyline)
- Desspiramine= less sedating, lower seizure threshold
- Convulsions, Coma, Cardiotoxicity
- Cardiotox:
1. inhibits fast Na+ channel conduction–> prolonged phase 0 depolarization
2. cardiogenic shock d/t alpha-1 antagonism–> vasodilation, decreased cardiac contractility - Confusion, hallucinations d/t anticholinergic (use nortriptyline)
Treat overdose with sodium bicarb
Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline (selective)
MAO-I
MOA: Monoamine oxidase inhibition–> increased NE, 5-HT, DA)
Use: atypical depression, anxiety, hypochondriasis
Tox:
- Hypertensive crisis (esp. after eating tyramine-containing foods)
- CNS stimulation
- Serotonin syndrome with SSRI, TCA, St. John’s wort, meperidine, dextromethorphan, linezolid
Bupropion
MOA: increase NE, DA
Use: depression, smoking cessation
Tox:
- Stimulant (tachycardia, insomnia)
- Headache
- Seizure in bulimic patients
- NO sexual side-effects
Mirtazapine
MOA: alpha-2 antagonist
- Increase NE, serotonin release
- 5-HT2, 5-HT3 receptor antagonist
Use: depression
Tox: sedation, increased appetite, weight gain
- Dry mouth
Maprotiline
MOA: blocks NE reuptake
Use: depression
Tox: sedation, orthostatic hypotension
Trazodone
MOA: inhibits serotonin reuptake
Use: insomnia (high doses for antidepressant)
Tox:
- sedation, nausea,
- Priapism (trazobone)
- Postural hypotension
