Psych Flashcards
schizophreniform disorder
schizophrenia sxs < 6 months
schizoaffective disorder
schizophrenia + mood disturbance (mania or depression)
schizophrenia symptoms
positive - hallucinations, delusions, disorganized speech & thinkings, abnormal behavior
negative - flat affect, avolition, social withdrawal, poor eye contact
schizophrenia treatment
1st line - 2nd gen antipsychotics (risperidone, olanzapine, quetiapine); dopamine and serotonin antagonists
2nd line - 1st gen antipsychotics (haloperidol, chlorpromazine)
“typical” 1st gen antipsychotics (names, MOA, s/e)
haloperidol, droperidol, fluphenazine, perphenazine, chlorpromazine, thioridazine
MOA - dopamine antagonists
S/E - extrapyramidal symptoms (rigidity, bradykinesia, tremor, akathisia; dystonic reactions (dyskinesia), tardive dyskinesia, parkinsonism)
“atypical” 2nd gen antipsychotics (names, MOA, s/e)
clozapine, quetiapine, olanzapine, loxapine
MOA - dopamine and serotonin antagonists
S/E - clozapine = agranulocytosis; lower incidence of EPS than 1st gen because their bind to dopamine receptors is weaker
risperidone (class, MOA, s/e)
class - benzisoxazoles
MOA - partial dopamine and serotonin receptor antagonist
s/e - EPS, increased prolactin
lithium (MOA, s/e)
MOA - increases NE and serotonin receptor sensitivity
s/e - hypothyroidism, hyperparathyroidism, increased urination and thirst, arrhythmias
**narrow therapeutic index; monitor level q 4-8wks
major depressive disorder
depressed mood or anhedonia w/ >= 5 associated symptoms almost every day for most of the days for at least 2 weeks with the symptoms causing clinical distress or impairment
tx - psychotherapy, meds (SSRIs 1st line - continue 3-6 wks to determine efficacy; SNRIs, bupropion)
seasonal affective disorder
presence of depressive symptoms at the same time each year
atypical depression
typical symptoms of major depression but patients experience mood reactivity (improved mood in response to positive events)
tx - MAOI
SSRIs (names, MOA, s/e)
names - citalopram (celexa), escitalopram (lexapro), paroxetine (paxil), fluoxetine (prozac), sertraline (zoloft), fluvoxamine (zyvox)
MOA - serotonin reuptake inhibitor
s/e - GI upset, sexual dysfunction, headache, serotonin syndrome
serotonin syndrome symptoms
neuro sxs - acute AMS seizure, coma, death
autonomic - restlessness, diaphoresis, tremor, hyperthermia, nausea, vomiting, abdominal pain, mydriasis, tachycardia
SNRIs (names, MOA, s/e)
names - venlafaxine (effexor), desvenlafaxine (pristiq), duloxetine (cymbalta)
MOA - serotonin, NE, and dopamine reuptake inhibitors
s/e - similar to SSRI, HTN
**useful in patients w/ significant fatigue or pain syndromes in association with depression
TCAs (names, MOA, s/e)
names - amitriptyline (elavil), clomipramine (anafranil), desipramine (norpramin), doxepin (sinequan), imipramine (tofranil), nortriptyline (pamelor)
MOA - serotonin and NE reuptake inhibitors
s/e - anticholinergic effects, severe toxicity w/ overdose, prolonged QT interval
bupropion (Wellbutrin) MOA, s/e
MOA - inhibits neuronal uptake of dopamine and NE
s/e - weight loss, agitation
MAOIs (names, MOA, s/e)
nonselective (MAO A & B) - phenelzine (nardil), tranylcypromine (parnate), isocarboxazid (marplan)
selective (MAO B) - selegiline (eldepryl); less chance of HTN crisis
MOA - inhibits monoamine oxidase, blocking the breakdown of neurotransmitters (serotonin, dopamine, EPI, and NE)
s/e - HTN crisis (must avoid tyramine-containing foods), serotonin syndrome
bipolar I disorder
> = 1 manic or mixed episode, often cycling with occasional depressive episodes
mania - abnormal and persistently elevated, expansive, or irritable mood at least 1 week (or requiring hospitalization) WITH MARKED IMPAIRMENT of social/occupational function (mood, thinking, behavior)
management - mood stabilizers (lithium 1st line; 2nd gen antipsychotics, 1st gen antipsychotics, benzos)
**antidepressants may precipitate mania
bipolar II disorder
> = 1 hypomanic episode + >= 1 major depressive episode
hypomania - period of elevated, expansive, or irritably mood at least 4 days which DOES NOT cause marked impairment, no psychotic features, and does not require hospitalization usually
management - antipsychotics, mood stabilizers (lithium), and benzos
persistent depressive disorder
chronic depressed mood > 2 years in adults (1 yr in children) that is usually milder than major depression (patients usually able to function); patient not symptom free for > 2 months at a time)
mgmt - psychotherapy, SSRIs
cyclothymic disorder
recurrent episodes of hypomanic symptoms cycling with relatively mild depressive episodes for at least a 2-year period in adults (1 yr in children); similar to bipolar II but less severe
mgmt - mood stabilizers and neuroleptics (similar to bipolar I)
panic attacks
not a disorder in and of itself but a feature of many different anxiety disorders
episode of intense fear or discomfort that develops abruptly, usually peaks w/in 10 minutes, and usually lasts < 60 minutes
mgmt - benzos
panic disorder
recurrent, unexpected panic attacks (>=2) with at least one of the following occurring for at least one month: attack followed by concern about future attacks, worry about the implication of attacks (losing control), or significant change in behavior related to the attacks
mgmt - SSRI, CBT, benzos for acute attacks
generalized anxiety disorder
GAD - excessive anxiety or worry a majority of days >6 month period about various aspects of life
mgmt - SSRIs, psychotherapy
social anxiety disorder
persistent (>6 mo) intense fear of social or performance situations in which the person is exposed to scrutiny of others for fear of embarrassment
mgmt - SSRI, BB for performance anxiety, psychotherapy
specific phobias
persistent (>6mo), intense fear/anxiety of a specific situation, object, or place in which the phobic object or situation is actively avoided or endured with intense fear or anxiety so as to impair everyday activities with distress or avoidance
mgmt - exposure/desensitization therapy
PTSD
> =1 (lasting >1mo) re-experiencing event (>1mo as repetitive recollections and dissociative reactions), avoidance of stimuli associate w/ the traumatic event, negative alterations in cognitions and mood, arousal & reactivity
mgmt - SSRIs, CBT
acute stress disorder
similar to PTSD but sxs lasting <1mo
mgmt - couseling/psychotherapy; treat as PTSD if persistent
adjustment disorder
emotional or behavioral reaction to an identifiable stressor (job loss, physical illness, leaving home, divorce, etc.); marked distress out of proportion to the severity of stressor and/or significant impairment in areas of functioning
mgmt - psychotherapy; meds not preferred
dissociative identity disorder
presence of >= 2 distinct identities or states of personalities
mgmt - psychotherapy
depersonalization/derealization disorder
persistent feelings of detachment or estrangement from oneself and/or surrounding environment
reality testing is intact and symptoms cause distress
mgmt - psychotherapy
dissociative amnesia
inability to recall personal/autobiographical information; causes significant impairment in functioning
mgmt - psychotherapy
obsessive compulsive disorder
combination of thoughts (obsessions) that are inappropriate, intrusive, and unwanted and behaviors (compulsions) that often interfere with patient’s lifestyle and are time consuming
major patterns - contamination, pathologic doubt, symmetry/precision, intrusive obsessive thoughts
mgmt - SSRIs, CBT
body dysmorphic disorder
excessive preoccupation that >1 body part is deformed or an over-exaggerations of a minor flaw, often causing patient to have functional impairment
mgmt - SSRI, psychotherapy
somatic symptom disorder
(formerly somatization disorder)
one or more vague somatic symptoms that are distressing or result in significant disruption of daily life, with symptoms not explained by a physical or medical cause
mgmt - regularly scheduled visits to a healthcare provider
illness anxiety disorder
(formerly hypochondriasis)
preoccupation with the fear or belief one has or will contract a serious, undiagnosed disease; somatic symptoms not usually present
mgmt - regularly scheduled visits to healthcare provider
functional neurological symptom disorder
(conversion disorder)
neurological dysfunction (motor or sensory) suggestive of a physical disorder that cannot be explained clinically; symptoms cause significant distress or impairment and tend to be episodic, recurring during times of stress
mgmt - psychotherapy
factitious disorder
intentional falsification or exaggeration of signs and symptoms of medical or psychiatric illness for primary gain (assuming the sick role to get SYMPATHY)
mgmt - nonspecific treatment
malingering
intentional falsification or exaggeration of s/s of medical or psychiatric illness for secondary gain (financial, food, shelter, avoidance of prison/school/work, to obtain drugs, etc.)
obesity
BMI >30kg/m2 or body weight >=20% over ideal weight
mgmt - behavior modification, meds (orlistat, lorcaserin)
anorexia nervosa
refusal to maintain a minimally normal body weight (patient is UNDERWEIGHT; BMI <17.5) and has a morbid fear of fatness or gaining weight; restrictive type or purging type
mgmt - medical stabilization, psychotherapy, pharmacotherapy if depressed
**refeeding syndrome - watch for hypophosphatemia which occurs if refed too quickly (phos driven into cells)
bulimia nervosa
binge eating (at least weekly x 3mo) with compensatory behavior (purging or non-purging); patients have NORMAL weight or are overweight
mgmt - psychotherapy, pharmacotherapy (fluoxetine has been shown to reduce binge-purge cycle)
schizoid personality disorder
voluntary social withdraw, anhedonic introversion, hermit-like behavior, inability to form relationships, prefers to be alone
mgmt - psychotherapy
schizotypal personality disorder
odd, eccentric behavior and peculiar thought patterns (magical thinking but without psychosis (delusions)); pervasive discomfort with close relationships
mgmt - psychotherapy
paranoid personality disorder
pervasive pattern of distrust and suspiciousness of others; preoccupation with doubt regarding the loyalty of others
mgmt - psychotherapy
antisocial personality disorder
inability to conform to social norms with disregard and violation of the right of others; pattern of criminal behavior
may begin in childhood as conduct disorders but must be >=18 to diagnose
mgmt - psychotherapy
borderline personality disorder
unstable, unpredictable mood and affect; extreme pattern of instability in relationships, fear of abandonment, black and white thinking, impulsivity in self-damaging behaviors
mgmt - psychotherapy
histrionic personality disorder
overly emotional, dramatic, seductive, attention-seeking; need to be the center of attention; often inappropriate, sexually provocative, seductive
mgmt - psychotherapy
narcissistic personality disorder
grandiose, often excessive sense of self-importance but needs praise and admiration (fragile self-esteem)
mgmt - psychotherapy
avoidant personality disorder
desires relationships but avoids them due to inferiority complex (timid, shy, lacks confidence)
mgmt - psychotherapy
dependent personality disorder
dependent, submissive behavior; constantly needs to be reassured, relies on others, will not initiate things
mgmt - psychotherapy
obsessive-compulsive personality disorder
perfectionists who require a great deal of order and control, preoccupied with minute details
mgmt - psychotherapy
autism spectrum disorder
social interaction difficulties, impaired communication, and restricted/repetitive/stereotyped behaviors
oppositional defiant disorder
persistent pattern of negative, hostile, and defiant behavior towards adults
at least 6 months of angry/irritable mood, argumentative/defiant behavior, and vindictiveness
mgmt - psychotherapy
conduct disorder
persistent pattern of behaviors that deviate sharply from the age-appropriate norms and violate the rights of others; social and academic difficult
4 main areas - serious violations of laws, aggressive/cruel to animals, deceitfulness, and destruction of property
**40% develop antisocial personality disorder
ADD and ADHD
hyperactivity, impulsivity, and/or inattentiveness leading to impairment; must have onset before 12 y/o, be present for at least 6 months, and symptoms must occur in at least two settings
mgmt - behavior modification, sympathomimetic meds (stimulants; ritalin, adderall), non-stimulants (atomoxetine)
sympathomimetic medications (names, MOA, s/e)
methylphenidate (ritalin), amphetamine/dextroamphetamine (adderall)
block NE and dopamine reuptake, increase release of NE and dopamine in extraneuronal space
s/e - anxiety, HTN, tachycardia, weight loss, addiction
alcohol dependence (CAGE questions, treatment)
CAGE - cutdown, annoyed, guilt, eye opener
tx - psychotherapy, disulfiram (antabuse; produces uncomfortable symptoms when couples with alcohol intake)
strongest predictive factor of suicide
previous attempt or threat
population with highest suicide rate in US
elderly white men
normal grief reaction
DABDA - denial, anger, bargaining, depression, acceptance
resolves w/in 1 year
patient may have illusions/hallucinations but perceives these as not being real
abnormal grief
severe symptoms, continued symptoms after 1 year, positive suicide ideation
illusions/hallucinations that patient perceives as being real
