Psych/behavior & Substance Abuse Flashcards
Alpha ketogluarate dehydrogenase requires thiamine as a cofactor to convert alpha ketoglutarate to what
Succinyl co A
What ratio of metabolic biproducts is increased during alohol consumption
NADH to NAD +
NAD+ is used up
The tuberoinfundibular pathway connects the hypothalamus to the ____
Pituitary gland
The uberoinfundibular pathway is responsible for the tonic inhiition of _______
Prolactin secretion
How may antipsychotics cause a patient to have amenorrhea and galactorrhea
Blockade of dopamine 2 receptors –> inhibiting tuberoinfundibular pathway –> loss of prolactin secretion inhibition
Haloperidol MOA
First generation antipsychotic
Function of the orbitofrontal cortex
Modulatory connections to the limbic system (emotions)
Involved in behavioral and emotional regulation
Function of the lateral prefrontal cortex
Executive functioning (includes motivation, organization, planning, and purposeful action)
What is an impulse disorder that is specific to repetitive outbursts of impulsive aggression that is grossly disproportionate to the situation
Intermittent explosive disorder
Treatment for anorexia nervosa
Cognititve behavioral therapy
Nutritional rehabilitation
Olazapine if no response to other 2 treatments
Bulimia nervosa treatment
Cognititve behavorial therapy
Nutritional rehabitlitation
SSRI (fluoxetine) (often in combo with above)
Binge eating disorder treatment
Cognitive behavioral therapy
Behavioral weight loss therapy
SSRI
Lisdexamfetamine
Anorexia nervosa is defined as a BMI < ____
18.5 kg/m^2
Bulimia nervosa clinical features
Recurrent episodes of bings eating
Binge eating and inappropriate compensatory behavior to prevent weight gain
Excess worrying about body shape/weight
Binge eating disorder clinical features
Recurrent episodes of binge ating
Lack of control during eating
(No inappropriate compensatory behaviors as seen in bulimia)
What are the common side effects seen in high potency (haloperidol) first generation antipsychotics
Extrapyramidal symptoms (acute dystonia, akathisia, parkinsonism) Tardive dyskinesia
What are the common side effects seen in low potency (chlorpromazine) first generation antipsychotics
Sedation
Cholinergic blockade
Orthostatic hypotension
Weight gain
What are the common side effects seen in second generation antipsychotics
Metabolic syndrome
Weight gain
Extrapyramidal symptoms (less common than first generation antipsychotics though)
As a class, first generation antipsychotics are assciated with a high risk of extrapyramidal symptoms due to their potent ____ antagonism
D2
Define akathisia
Inner restlessness and inability to sit still
Tricyclic antidepresants’ inhibitory affects on ___ receptors can cause tachycardia, delirium, dilated pupils, flushing, decreased sweating, hyperthermia, ileus, and urinary retention
Muscarinic acetylcholine
Tricyclic antidepressants’ inhibition of ____ receptorscan lead to peripheral vasodilation (orthostatic hypotension)
Alpha 1 adrenergic
Tricyclic antidepressants’ inhibition of ____ can lead to conduction defects and arrhythmias
Cardiac fast sodium channels
Tricyclic antidepressants’ inhibition of presynaptic NE and serotonin reuptake can cause what adverse effects
Seizures
Tremors
Tricyclic antidepressants’ inhibition of ____ receptors can lead to desation and increased appetite
Histamine (H1)
Most deaths from tricyclic antidepressant overdose is due to ____ and ____
Cardiac arrhythmias
Refractory hypotension
TCA overdose is treated with ____ which increases serum pH and promotes TCA dissociation from sodium channels
Sodium bicarbonate (NaHCO3)
Indications for lithium in bipolar disorder
Manic and depressive features
Indications for valproate in bipolar disorder
Manic features
Indication for carbamazepine in bipolar disorder
Manic features
Indication for lamotrigine in bipolar disorder
Depressive features
Duration of symptoms in brief psychotic disorder
> 1 day, < 1 month
Duration of symptoms in schizophreniform disorder
> 1 month <6 months
Duration of symptoms in schizophrenia
> 6 months
A patient found to be lethargic, ataxic, disoriented and have slurred speech followed by rapid improvement and a parioral and perinasal rash indicates what type of substance use
Inhalants
Inhalation/misuse of nitrous oxide is associated with ____ deficiency and resultant symptoms of polyneuropathy (symmetric numbness, gait abnormalities)
B12
frontotemporal dementia microscopic features includes initial neuronal loss in the frontotemporal lobes with ___ and ___ inclusions
Tau protein (neurofibrillary tangles, pick bodies) TDP-43 protein
____ protein is involved in DNA repair and transcription and it becomes abnormally ubiquinted in frontotemporal dementia
TDP-43
Pathologically ubiquitinated TDP-43 is seen in what two diseases
Frontotemporal dementia
Amyotrophi lateral sclerosis
What abnormal labrotory findings are seen in bulimia nervosa
Hypokalemia
Metabolic alkalosis
Treatment for social anxiety disorder (social phobia)
SSRI/SNRI
Cognitive behavioral therapy
Beta blocker or benzo for performance-only subtype
Duration of symptoms in post traumatic stress disorder
> 1 month
First line treatment PTSD
SSRI/SNRI
Phenelzine MOA
MAO inhibitor
If antipsychotic medication cannot be reduced or discontinued, drug induced parkinsonism is best treated with _____
Centrally acting anticholinergic agent (benztropine)
Why should levadopa not be used for treating drug induced parkinsonism in a patient being treated with antipsychotics
Levadopa can exacerbate or even precepitate psychosis (use anticholinergic instead)
_____ disorder is characterized by a pattern of behaviors that violate major societal norms or rights of others. Behaviors seen in this disorder include byllying, frequent fights, using weapons, torturing animals, breaking into houses, and sexual coercion. It generally presents in middle childhood to adolescence and is more common in boys
Conduct
What are the first line drug treeatments for school-age children with ADHD
Stimulant drugs including methylphenidate and amphetamines
Which cluter A personality disorder is described as a person who prefers to be a loner and is detatched and unemotional
Schizoid
What cluster C personality disorder is described as avdance due to fears of criticism and rejection
Avoidant
A patient with normal development through age 10 months followed by regression and development of hand wringing likely has what diagnosis (other features include seizures, intellectual disability, autistic features, breathing abnormalities, and deceleration of head growth)
Rett Syndrome
Rett syndrome is caused by a de novo mutation in the X-linked _____ gene
MECP2
Treatment for akathisia, an extrapyramidal side effect of antipsycotic medication
Reduction of antipsychotic dose, if possible, or the addition of beta blocker or a benzodiazepine
Decreased renal perfusion due to what medications can cause decreased lithium clearance and therefore toxicity
Thiazide diuretics
NSAIDs
ACE inhibitors
Positive psychotic symptoms are thought to be caused by an excess of dopamine in the ____ pathway
Mesolimbic
____ is the compulsive consumption of nonstaple food or non nutritive substance for > 1 month
Pica
Pica is most commonly seen in what 2 populations
Pregnant women
Schoolchildren
What is the term for involuntary movements after chronic use of antipsychotics which typically involves lip smacking or choreoathetoid movements
Tardive dyskinesia
Lacrimation and yawning are specific findings for what drug withdrawal
Opiod
What is the term for the mature defense mechanism inwhich someone puts unwanted feeligns aside to cope with reality
Supression
What is the mature defense mechanism in which someone chanels impulses into socially acceptable behaviors
Sublimation
What is the best approach when treating a patient with somatic symptom disorder
Schedule regular visits with their primary care provider who can monitor them and avoid unnecessary diagnostic testing and specialist referals
What are the signs and symptoms of neuroleptic malignant syndrome
Fever
Altered mental status
Generalized muscle rigidity (lead pipe rigidity)
Autonomic instability
Neuroleptic malignant syndrome is thought to be primarily ue to dysregulation of ______
Dopamine
During alcohol withdrawal, symtpoms are due to increased activity of what receptors
NMDA glutamate
Chronic alcohol exposure leads to the downregulation of what receptors
GABA A
How is methadone metabolized
P450 system, specifically the CYP3A4
Fluconazole, voriconazole, ketoconazole, ciprofloxacin, clarithromycin, cimetidine,, and fluvoxamine all inhibit_____ which prrolongs the effects of methadone
P450 3A4
Clozapine drug class
Atypical antipsychotic (used in treatment resistant schizophrenia)
Adverse effects of clozapine
Agranulocytosis
Seizures
Myocarditis
Metbolic syndrome
What is the diagnosis of someone who has mood episoides with concurrent active phase symptoms of schizophrenia with more than 2 weeks of delusions or hallucinations inthe absence of prominent mood symptoms
Schizoaffective disorder
Which first generation antipsychotics are more likely to precipitate extrapyramidal symptoms such as acute dystonia, akathisia, and parkinsonism
High potency (haloperidol, fluphenazine)
What personality disorder may lead to maladaptive pattern of behavior characterized by social inhibition, feelings of inadequacy, andfear of embarrassment and rejection
Avoidant
Moa buspirone
Partial agonist f 5HT1a receptor
Does buspirone carry a risk of dependence
No (slow onset of action, lacks muscle relaxnt or anticonvulsant properties)
What asepct of an ADHD diagnosis may require a teacher’s evaluation
The symptoms aer present in 2 or more settings (home and school for example)
Phenelzine MOA
Monoamine oxidase inhibitor
Monoamine oxidase inhibitors work by inhibitig oxidtive deamination, thereby increasing the presynaptic availibility of _____, _____, and _____
Serotonin
Norepinephrine
Dopamine
MAOIs are supperior to other antidepressants in treating what type of depression
Major depressive disorder with atypical features
Major depressive disorder with atypical feactures is characteriezed by ______ (mood improve in response to positive events), ______ (patients arms and legs feel extremely heavy), ______ (overly sensitive to slight criticism) and the reversed vegatiative signs of incerased sleep and appetite
Mood reactivity
Leaden paralysis
Rejection sensitivity
At age 2, a child should have a vocabulary of __-___ words and be able to use 2 word phrases
50-200
What is the most commonly delayed milestone and an isolatd delay in this milestone with usually catch up in preschool
Language
What disease may present in an adolescent patient as postural tremor on extension of the arms, broad based gait, slurred speech, sad mood, distractibility, and elevated serum transaminases
Wilsons disease
Wilsons disease is an autosomal recessive mutation in what gene
ATP7B
Wilsons disease is an autosomal recessive mutation of ATP7B that causes a hepatic accumulation of ____
Copper
Mehanism of action: citalopram
SSRI
What disorder presents with repeated nocturnal episodes of violent motor behaviors reflecting dream enactment
REM sleep behavior disorder
What are the primary mecahnisms of action for second generation antipsychotics
Dopamine D2 receptor antagonism
Serotonin 2A receptor antagonism
Drug class: quetiapine
Second generation antipsychotiv
______ is an immature defense mechanism where the patient will attribute their own feelings to others
Projection
_____ is an immature defense mechanism where a patient transfers their feelings to less threatening object/person
Displacement
______ disorder is characterized by 1 or more delusions for 1 or more months in the abence of other psychotic symptoms
Delusional
____ is a full mu-opiod receptor agonist used for withdrawal and maintenance treatment for opiod use disorders. Its long half life allows it to effectively supress cravings and withdrawal symptoms
Methadone
____ is an immature defense mechanism in which a patient will experience a person or situation as all positive or all negative
Splitting
Splitting is commonly seen in people with ____ disorder which contributes to unstable relationships and mood instability that exemplify this disorder
Borderline personality
The most common adverse affects of methylphenidate are what?
Decreases appetite
Weight loss
Insomnia
_____ disorder is defined as 1 or more unexplained symtpomswth excessive thoughts, anxiety, and behaviors in response to symptoms
Somatic symptom disorder
_____ disorder hasminimal to no symptoms and preocupation with the idea of having a serious illness
Illness anxiety disorder
______ disorder presents with neurologic symptoms incompatible with anatomy or pathophysiology
Conversion disorder (functional neurologic symptom disorder)
_______ disorder is falsification of symptoms/inducing inury in the absence of obvious external rewards
Factitious disorder
_____ is falsification of illness for obvious external rewards
Malingering
The stages of change include precontemplation, contemplation, ______, action, maintenance
Preparation
How might lithium use cause weight gain, hair loss, and bradycardia
Lithium induced hypothyroidism
What differentiates adjustment disorder fom normal sadness
Impaired social and/or occupational functioning
How is opiod overdose treated
Naloxone
How does naloxone treat opiod overdose (MOA)
Antagonizes opiod receptors (competes with opiod medications and displaces them)
Adverse affects of clozapine treatment (4)
Agranulocytosis
Seizures
Myocarditis
Metabolic syndrome
Why might a patient on resperidone present with amenorrhea and breast tenderness
Hyperprolactinemia due to ihibition of D2 receptors which normally inhibit prolactin release
First line treatment for specific phobia
Cognitive behavioral therapy
What is the first line pharmacotherapy for moderate to severe alcohol use disorder
Opiod antagonist naltrexone
What is the second line pharmacotherapy for alcohol use disorder
Aldehyde dehydrogenase inhibitor
Clinical features of tourette syndrome include ____ and ____ with an onset of <18 (usually 6-15)
Motor tics
Vocal tics
Treatment for a patient with panic disorder presenting with acute distress
Benzodiazepine
SSRI/SNRI and or CBT are first line but would not produce relief of symptoms acutely
Substance induced psycotic disorder may present similarly to schizophrenia but with an acute onset corilating to stimulant use as well as physical signs such as tachycardia, diaphoresis, hypertension and what other finding in the eyes
Mydriasis
When individuals with conduct disorder continue to display a pattern of violating th rights of others into adulthood, they are diagnosed with ______
Antisocial personality disorder
Define conjunctival injection
Red eyes
The most characteristic physiological signs of _____ intoxication are conjunctival injection, tachycardia, increased appetite, and dry mouth
Marijuana
BMI < _____ is consistant with anorexia nervosa diagnosis
18.5
Describe the restricting subtype of anorexia nervosa
Patients fast and exercise excessively but do not purge
Describe the binge eating/purging subtype of anorexia nervosa
Patients engage in vomiting and/or use substances (laxative, enemas, or diuretics) to avoid weight gain
How do opiods cause central sensitization (3)
Opiod receptor down regulation Recetor decoupling (from second messengers) Upregulation of excitatory NMDA receptors
What is a partial opioid receptor agonist that binds with high affinity but has has low intrinsic activity which may precipitate withdrawal in long term opiod users
Buprenorphine
First line treatment for OCD
SSRI
REM sleep behavior disorder is strongly associated with neurodegeneration due to accumulation of _____
Alpha-synuclein
What is the unconscious shifting of emotions or desires associated wth a person from the past to another person in the present
Transference
What immature defense mechanism is transforming unacceptable feelings/impulses into the extreme opposite
Reaction formation
Of the risk factors for suicide what is the strongest single factor thatis most predictive of completed suicide
Past suicde attempt
Why might lorazepam, oxazepam, clonazepam be better choices for sleep aid than diazepam, chordiazepoxide, or flurazepam
Lorazepam has an intermediate duration of action so has less of a chance to precipitate adverse ideeffects of sedation and fatigue when the patient wakes up as the medications with long durations of action
What drug class is first line therapy for psychomotor agitation associated with alcohol withdrawal and to prevent progression to seizures and delirium
Benzodiazepines
Chlorodiazepoxide MOA
Benzodiazepine
Mecanism of action of antipsychotics
Antagonism of postsynaptic dopamine D2 receptors
Withdrawal from what drug is characterized by anxiety, tremor, insomnia, and sympathetic hyperactivity and can also be accompanied by psychosis, seizures, or death
Benzodiazepines
What immature defense mechanism is transferring feelingsto less threatening object/person
Displacement
A patient using what substance may present with violent behavior, dissociation, hallucinations, amnesia, nystagmus, and/or ataxia
PCP (phencyclidine)
PCP (phencyclidine) is a hallucinogen that works primaritly as a _____ receptor antagonist as well as a monoamine reuptake inhibitor
NMDA
A patient that deliberately induces an infection in the absence of obvious external rewards is consistent with ____ disorder
Factitious
side effects frome what medication can include the following: confusion, constipation, acute urinary retention, hypotension, and sedation
Tricyclic antidepressants
Describe schizotypal personality disorder
Unusual thoughts, perceptions, and behaviors
Postpartum blues is a normal, self-limiting condition that occurswihtin a few days postpartum, the symtpoms typically peak at 5 days and resolve within __ days
14
Postpartum depression typically presents within 4-6 ___folowing delivery
Weeks
Discribe a learning disorder
Difficulties with key academic skills (reading, writing, or mathematics)
Patient presening with anxiety, weight loss without trying, tachycardia, warm moist skin, tremor, frightened stare and restlessness are consistent with what diagnosis
Hyperthyroidism
____ disorderis characterized by excessive concern about having a serious, undiagnosed disease, despite few or no symptoms and negative medical workup
Illness anxiety disorder
In acute distress disorder, syptoms usually develop directly following the trauma and last from 3 days to _______. When symptoms persist long, the diagnosis is changed to post-traumatic stress disoder
1 mont
How does transference differ from countertransference
Transference: patient’s reactions towards a provider
Contertransference: provider’s reaction to a patient
Bipolar II characteristics
Hypomanic episodes
1 or more depressive episodes
Bipolar I characteristics
Manic episodes
Depressive episodes common but not required for diagnosis
Dx of persistent depressive disorder requires depressed mood more days than not for more than _____ and at least 2 other depressive symptoms
2 years
Pure dysthymic syndrome is a subset of persistent depressive disorder with what characteristics
Someone who has never met the criteria fo a major depressive episode
Attention deficit hyperactivity disorder should not be diagnosed until what age
4-5
In cognitive testing, what does reciting months of the year backwards test for
Concentration
Name an antidepressant that does not cause sexual dysfunction
Buprpion
What isbthe process of a previously neutral stimulus eliciting a response after association with a natural, unlearned stimulus
Classical conditioning
What is the process of a behavior becoming associated with an environmental consequence
Operant conditioning
What diagnosis is described by angry/irritable mood, argumentative/defiant behavior, or vendictiveness for 6 months oor more
Oppositional defiant disorder
