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Step 1 Subjects > Psych > Flashcards

Psych Flashcards

1
Q

Countertransference

A

Doctor projects feelings about formative/other important persons onto patient (vs transference= patient onto doctor)

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2
Q

Displacement

A

Immature ego defense:
- Avoided ideas/feeling transferred onto neutral person/object

Ex: Dad yells at mom, so mom yells at child

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3
Q

Fixation

A

Immature ego defense:

- Partially remaining at more childish level of development (vs regression to prior developmental stages)

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4
Q

Identification

A

Immature defense
Modeling behavior after person who is more powerful

Ex: abused child identifies with an abuser

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5
Q

Projection

A

Immature defense
Unacceptable internal impulse attributed to external source

Ex: man wants another woman; thinks his wife is cheating on him

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6
Q

Reaction formation

A

Immature defense
Warded-off idea or feeling replaced by UNCONCIOUS emphasis on opposite

Ex: pervert joins monastery

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7
Q

Repression

A

Immature defense
Involuntary withholding of an idea/feeling from conscious awareness (vs suppression= voluntary)

Ex: not remembering conflict/traumatic experience

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8
Q

Splitting

A

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

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9
Q

Altruism

A

Mature defense
Guilty feelings alleviated by unsolicited generosity

  • Criminal donates to charity
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10
Q

Sublimation

A

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)

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11
Q

Suppression

A

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

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12
Q

Child disintegrative disorder

A

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

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13
Q

Hallucinations

A

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

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14
Q

Schizophreniform disorder

A

1-6 months of psychosis, disturbed behavoir and thought (brief if < 6 months, schizophrenia of > 6 months)

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15
Q

Schizoaffective disorder

A

2+ weeks of stable mood WITH psychotic symptoms
PLUS major depressive, manic, mixed episodes
- Types= bipolar, depressive

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16
Q

Schizophrenia subtypes

A 
Paranoid (delusions)
Disorganized (with regard to speech, behavior, affect)
Catatonic (automatisms)
Undifferentiated (all types)
Residual
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17
Q

Delusional disorder

A

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

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18
Q

Hypomania

A

Like mania (DIGFAST) with no marked impairment in social/work funcitons (no hospitalization)

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19
Q

Bipolar disorder

A

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

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20
Q

Atypical depression

A
  • 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
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21
Q

Postpartum mood disturbance

A

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

22
Q

Electroconvulsive therapy

A

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

23
Q

Post-traumatic stress disorder

A

Persistant arousal due to reexperiences of previous trauma
- Disturbance > 1 month (can start anytime after event)

Acute stress disorder= 2 days-1 month

24
Q

Generalized anxiety disorder

A

Uncontrollable anxiety for > 6 months

  • Unrelated to specific person, situation, event
  • Sleepdisturbance, fatigue, GI disturbance, difficulty concentrating

Tx: SSRIs, SNRIs

25
Q

Adjustment disorder

A

Emotional symptoms causing impairment due to identifiable psychosocial stressor

  • Lasts < 6 months
  • Chronic stressor: > 6 months
26
Q

Somatization disorder

A

Develops before age 30

- Complaints in multiple organ systems

27
Q

Conversion

A

Loss of sensory, motor function in response to acute stressor

  • Patient may be indifferent
  • Females, adolescents/young adults
28
Q

Cluster A personality disorders

A

Weird: Accusatory, aloof, awkward

  • Paranoid
  • Schizoid (content with isolation)
  • Schizotypal (odd beliefs/magical thinking, interpersonal awkwardness)
29
Q

Cluster B personality disorders

A

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
30
Q

Cluster C personality disorders

A

Worried

  • Avoidant: hypersensitive to rejection, desires relationships
  • Obsessive compulsive: LIKES being obsessive (vs. OCD)
  • Dependent: Submissive and clinging
31
Q

Stages in overcoming substance abuse

A
  1. Precontemplation: not yet acknowledging problem
  2. Contemplation: acknowledging problem, not ready to make change
  3. Preparation/determination: getting ready to make change
  4. Action/willpower: changing behavior
  5. Maintenance: maintaining behavior change
  6. Relapse: returning to old behaviors, abandoning new changes
32
Q

PCP intoxication

A

Hallucinogen:

  • Belligerence, impulsiveness, agitation, homocidal, psychotic
  • Fever, tachycardia, delirium, seizures, tonic jerking

withdrawal:
- Anxiety, irritability, restlessness, nystagmus, ataxia

33
Q

Methylphenidate
Dextroamphetamine
Methamphetamine

A

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

34
Q

Haloperidol
Trifluoperazine
Fluphenazine

A

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)
35
Q

Chlorpromazine

Thioridazine

A

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
36
Q

Neuroleptic malignant syndrome

A

Due to typical antipsychotic use:

  • Rigidity
  • Myoglobinuria
  • Autonomic instability
  • Hyperpyrexia

Tx: Dantrolene, D2 agonists (bromocriptine)

37
Q

Tardive dyskinesia

A

Sterotypic oral-buccal movements (lip smacking, chewing) due to long-term antipsychotic use
- Often irreversible

38
Q

Extrapyramidal symptoms

A

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

39
Q 
Olanzapine
Clozapine
Quetiapine
Risperidone
Aripiprazole
Ziprasidone
A

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
40
Q

Lithium

A

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
41
Q

Buspirone

A

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

42
Q

Fluoxetine
Paroxetine
Sertraline
Citalopram

A

SSRIs
MOA: serotonin-specific reuptake inhibitor

Tox:

  • GI distress, sexual dysfunction
  • Serotonin syndrome with MAO-I, SNRI, TCAs

**Takes 4-8 weeks for effectiveness

43
Q

Serotonin syndrome

A

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)

44
Q

Venlafaxine

Duloxetine

A

SNRIs:
MOA: inhibit serotonin and NE reuptake

Use: Depression

  • Venlafaxine= GAD, panic d/o
  • Duloxetine= diabetic peripheral neuropathy

Tox: increased BP

  • Stimulant
  • Sedation, Nausea
45
Q 
Amitriptyline
Nortriptyline
Imipramine
Desipramine
Clomipramine
Doxepin
Amoxapine
A

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

46
Q

Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline (selective)

A

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
47
Q

Bupropion

A

MOA: increase NE, DA

Use: depression, smoking cessation

Tox:

  • Stimulant (tachycardia, insomnia)
  • Headache
  • Seizure in bulimic patients
  • NO sexual side-effects
48
Q

Mirtazapine

A

MOA: alpha-2 antagonist

  • Increase NE, serotonin release
  • 5-HT2, 5-HT3 receptor antagonist

Use: depression

Tox: sedation, increased appetite, weight gain
- Dry mouth

49
Q

Maprotiline

A

MOA: blocks NE reuptake

Use: depression

Tox: sedation, orthostatic hypotension

50
Q

Trazodone

A

MOA: inhibits serotonin reuptake

Use: insomnia (high doses for antidepressant)

Tox:

  • sedation, nausea,
  • Priapism (trazobone)
  • Postural hypotension

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