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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
Adjustment disorder
Emotional symptoms causing impairment due to identifiable psychosocial stressor - Lasts < 6 months - Chronic stressor: > 6 months
26
Somatization disorder
Develops before age 30 | - Complaints in multiple organ systems
27
Conversion
Loss of sensory, motor function in response to acute stressor - Patient may be indifferent - Females, adolescents/young adults
28
Cluster A personality disorders
Weird: Accusatory, aloof, awkward - Paranoid - Schizoid (content with isolation) - Schizotypal (odd beliefs/magical thinking, interpersonal awkwardness)
29
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
30
Cluster C personality disorders
Worried - Avoidant: hypersensitive to rejection, desires relationships - Obsessive compulsive: LIKES being obsessive (vs. OCD) - Dependent: Submissive and clinging
31
Stages in overcoming substance abuse
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
PCP intoxication
Hallucinogen: - Belligerence, impulsiveness, agitation, homocidal, psychotic - Fever, tachycardia, delirium, seizures, tonic jerking withdrawal: - Anxiety, irritability, restlessness, nystagmus, ataxia
33
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
34
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)
35
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
36
Neuroleptic malignant syndrome
Due to typical antipsychotic use: - Rigidity - Myoglobinuria - Autonomic instability - Hyperpyrexia Tx: Dantrolene, D2 agonists (bromocriptine)
37
Tardive dyskinesia
Sterotypic oral-buccal movements (lip smacking, chewing) due to long-term antipsychotic use - Often irreversible
38
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
39
``` 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
40
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
41
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
42
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
43
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)
44
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
45
``` 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**
46
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
47
Bupropion
MOA: increase NE, DA Use: depression, smoking cessation Tox: - Stimulant (tachycardia, insomnia) - Headache - Seizure in bulimic patients - NO sexual side-effects
48
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
49
Maprotiline
MOA: blocks NE reuptake Use: depression Tox: sedation, orthostatic hypotension
50
Trazodone
MOA: inhibits serotonin reuptake Use: insomnia (high doses for antidepressant) Tox: - sedation, nausea, - Priapism (trazobone) - Postural hypotension

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