PSYCH COMAT Flashcards
SSRI Drugs Tx …AR …
“City Parrots Flu South”CitalopramParoxetineFluoxetineSertalineTx: First-Line for Antidepressants AR: Dec libido, delayed ejaculation, GI dysfxn, Insomnia, Seretonin Syndrome
SNRI Drugs
“SN … Venla Dulo”VenlafaxineDuloxetineCleaner but more expensive than SSRI
TCA Drugs
-“tryptiline”ImipramineDespiramineDoxepin
Bipolar Tx
Lithium or Valproate»_space; Add 2 gen Anti-psych»_space; d/c previous, use Lamotrigine (anticonvulsant)
Bupropion Class/Use/Adverse Reaction
Class: 2nd Gen AntipsychTx: Smoking cessation/DepressionAR: Dec seizure thresholdDO NOT GIVE TO ANOREXIC/BULIMIC PTS!
Smoker w/ Depression, Tx w/ …
Bupropion
Depression w/ weight loss/under weight, Tx w/ …
Mirtazapine
Depression w/ Insomnia, Tx w/ …
TrazadoneAR: Priapism
Atypical Anti-Psyche with low metabolic effects
Aripiprazole and Lurasidone
Atypical Anti-Psyche MOA and Rx
D2 Antagonist and Seretonin AntagonistQuiet CARBOLIC ZAPQuetipineCariprazineAriprazoleRisperadoneBupropionOlanzapinelurasidoneIloperidoneClozapine ZiprazidoneAsenapinePaliperadone
How to abort a panic attack
Tx w/ Benzo
Munchausen by proxy is suspected, next step …
call CPS
Polycyclic Aromatic Hydro carbons found in … bind to … and causes … in antipsychotic meds, most notably …
NicotineAHRInduction of the P450 1A2 metabolismOlanzapine
MDD w/ cc of memory impairment and cognitive impairment
Pseudodementia
Dx criteria of MDD
SIGECAPSAt least 4 of the following for 2 weeks + Low moodSleepInterestGuiltEnergyConcentrationAppetite PsychomotorSuicide
NMS presents with…
FeverRigidMydriasisCreatine KinaseD/T Anti-dopamine Med
Seretonin Syndrome presents w/ …
Hyperreflex/ClonusMydriasis+/- Elevated CKD/T Seretonin Drugs
Pt lives vicariously by helping others
Altruism Mature Defense
Pt jokes with his Palliative care doctor about the disease
Humor Mature Defense
Pt shifts the blame and justifies his actions for the disease
RationalizationNeurotic Defense
Pt seems emotionless about his condition and reasons out the cause
Intellectualization Neurotic Defense
The Pt is adamant that they are in excellent health despite an A1c of 12
DenialImmature Defense
Pt is angry with his nurse and reports to the doctor that he is being treated poorly d/t the anger the nurses have for him
ProjectingImmature Defense
Pt w/ OCD is given an SSRI. Little effect occurs. In addition to CBT, the Pt should be perscribed …
Clomipramine (TCA)
Tx for PTSD related nightmares
Prazosin
Motor immobility w/ mutism. Vitals Normal. Hx of schizophrenia. Dx?
Catatonia
First line Tx for PTSD
SSRI
First line Tx for Tourette
Aripiprazole
Specific phobia w/ highest FamHx
Injections/needles
Alpha-synuclein inclusions are found in
Lewy BodiesParkinson’s
Pt has trisomy 21 and neurofibrillary tangles. Dx?
Early onset Alzheimers
Volume loss in Caudate Nucleus and choreoathetoid movements. Dx?
Huntington
Most common metabolic abnormality w/ bulimic pt.
Non Gap Metabolic Alkalosis w/ resp compensation +hypokalemia +Increased Amylase
To interact w/ this personality disorder, you must monitor your emotions to avoid countertransference
Borderline
Unstable, suicidal, promiscuous, rapid mood change “empty”
Borderline
Dopamine pathway that controls function and movement
Nigrostriatal
Dopamine pathway that controls pleasure, delusions and hallucinations
Mesolimbic
Dopamine pathway that controls prolactin secretion
Tuberfundibular
Dopamine pathway that controls Cognitive and Affective Sx
Mesocortical
Cognitive Sx arise from this area of the brain, be specific
Dorsal Lateral Prefrontal Cortex
Affective Sx arise from this area of the brain, be specific
Ventromedial Prefrontal Cortex
Loss of the caudate nucleus results in …
Huntington Disease
Loss in the frontal and temporal lobes results in …
Frontaltemporal Dementia
Loss of the Substantia Nigra leads to
Parkison’s and Lewey Body Dementia
Diffuse cerebral atrophy leads to
Alzheimers
Diffuse spongiform lesions in the brain
Creutzfeldtz Jakob
Pt is increasingly irritable, decreased concentration, and has constipation, what electrolyte is out of balance
Hypercalcemia
Pt on a three month binge presents w/ two months of low mood and Pos SIGECAPS, Dx ?
Substance induced mood disorder
What anticonvulsant is safe in pregnancy
Lamotrigine
Tx for Impulse Control Disorders
Psychotherapy
Inappropriate sexual behavior in children may be d/t …
Sexual abuse
Schneideran First Rank Symptoms (7)
Thought Insertion, Thought W/DThought BroadcastingDelusional PerceptionVoice CommentaryVoice DiscussionAudible Thoughts
EtoH w/d is life threatening d/t this feedback mechanism
Down regulation of GABA receptors
Pt loves blood, so he becomes a phleb.
SublimationMature Defense
Pt, who is a lawyer, gets yelled at by the judge. Later, the pt yells at his wife.
DisplacementNeurotic Defense
Man w/ a sexual addiction becomes a priest
Reaction FormationNeurotic Defense
MDD second to substance abuse, no SIHI. Next step?
Rehabilitation program
Why are pts hospitalized for psych issues
Danger to self or others
Pt believes a famous person is in love w/ them
Erotomania (Erotomanic Delusion)
Pt describes secret messages from Washington in songs on the radio.
Delusion of Reference
What is Amylase increased in bulemic pts
Parotid glands are over active d/t repeat emesis
Major difference b/t acute stress disorder and adjustment disorder
Acute stress involves a traumatic stressor
Pt is on haloperidol, citalopram, methadone. Long term affect?
QT prolongation through potassium channel inhibition
Type of therapy where repressed childhood feelings are uncovered
Psychoanalysis
Therapy based on the learning theory
Behavioral
Therapy to treat maladaptive beliefs
Cognitive
A chronic schizophrenic brain will have volume loss of the …
hippocampus and medial temporal lobe
A chronic schizophrenic brain will have volume increase of the …
hypothalamus
Ralphe nuclei are associated w/ …
Serotonin re-uptake inhibition
Pt hear colors or sees tastes
Synesthesia
Process of the brain “filling in” a perception following a traumatic stressor
Pseudohallucination
Elderly pt taking an SSRI for MDD is not improving. Next step?
ECT
GAD and OCD are treated w/
SSRI
Buspirone is indicated to Tx ONLY
GAD
Most common physical manifestation of GAD is
Insomnia
Visual Hallucinations ParkinsonismFluctuating CognitionAdverse effects to Neuroleptics
Lewey Body Dementia
Knife like frontal temporal atrophy<65 yo
Pick Disease
Focal Neuro DeficitsStep-wise Decline
Vascular Dementia
Lewey Body Tx
Cholinesterase inhibitor (Donepezil)
Akathsia
Continuous movement when attempting to sit still
Most concerning side effect of Lamotigine
TENS/SJS
Pt has orthostatic hypotension and schizophrenia. What neuroleptic should he be on
Haloperidol
Wandering off topic during regular conversation
Derailment
Rapid cycling through ideas w/ no connection
Flighty
Lose track of intended purpose of a sentence
Loss of Goal
Decreased speech, but complete sentences
Poverty of Speech
Adequate speech, but lack of content
Poverty of Thought
Wandering off topic during an explanation or responding to a question
Tangentiality
Thoughts go blank mid sentence
Thought blocking
Wandering off topic but returns to it
Circumstantiality
Pt afraid of:Public peeingPublic Speaking
Social Phobia
Pt is having trouble in school but not at home
Learning Disorder
Tics that last less then 12 months
Provisional Tic Disorder
Monoclonic jerks, typically in the morning and UE along w/ absence seizures
Juvenile Monoclonic Epilepsy
Chronic alcoholism will cause this on a CBC
MCV > 100 d/t B12 deficiency
ECT is indicated for
Mood and Psych Disorders, NOT Anxiety Disorders
Rapid acting opioid antagonist, used for Opiate overdose
Naloxone
Long acting opioid antagonist in the endorphin system.Only active if given IM. Often paired w/ Buprenorphine in tablet formAlso used to Tx alcoholism
Naltrexone
Used to Tx the autonomic Sx of Opioid w/d
Clonidine
Partial opioid agonistCan cause w/d if taken after heroinTaken orally
Buprenorphine
Causes adverse effects if alcohol is drank
Disulfiram
Intrusive idea that is hard for the Pt to dismiss
Obsession
Delusional type thinking, but the Pt is able to see it might be inaccurate
Overvalued Idea
This lab can differentiate b/t psychogenic and epileptic seizures
Prolactin
This personality disorder is categorized by:Maladaptive coping strategyImmature Defense Childhood trauma
Boderline
Long acting bento to Tx w/d from alcoholism or tapering from short acting benzos
Chlordiazepoxide
HTN med that can cause MDD Sx (4)
ClonidineReserpineMethyldopaPropranolol
Tx for akathisia
Propranolol
Tx for acute dystonia and parkinsonism
BenztropineDiphenhydramine
Pramipexole treats
Restless Leg
Tx for Fibromyalgia
TCA
Difference b/t Fibromyalgia and Polymyalgia Rheumatica
FM has normal labs
Echolalia
Pt mimics speech
Echopraxia
Pt mimics movement
Pt interacts w/ hallucinations that he knows are not real. What substance did they ingest?
Psilocybin (Mushrooms)
Pt being Tx w/ Buprenorphine takes this med and the result is Resp Depression, Miosis, Wheezes, Somnolance
Alprazolam (Benzo)
Triad of MDD
Neg about selfNeg about worldNeg about future
Tx for narcolepsy
Modafinil
MDD w/ Psychotic features, Tx w/ …
Risperadone
Anticonvulsant that can depresses cognitive ability that does not improve w/ time
Topiramate
Tetrabenazine may cause a depressive mood by
depleting dopamine in the synaptic cleft
OCD Pt will have this change on a brain MRI
Basal Ganglia (Vol increase in Caudate Nucleus)
Med to reduce Alcohol Craving
Acamprosate
Med to cause adverse effects if Alcohol is ingested
Disulfiram
Med to reduce the pleasure acquired from drinking
Naltrexone
Panic disorder is defined by
Non specific stimuliFear of having another
Epstein Abnormally disassociated w/ this mood stabilizer
Lithium
Pt is on Lithium and becomes preggo, next step is
Switch med to haloperidol
Nephro DI d/t Lithium has a urine osmo that is …
normal
Inability to measure distance/field depth
Dysmetria
Impaired ability to perform rapid, alternating movements
Dysdiadochokinesia
Mental illness in which the affected person holds the delusional belief that they are already dead, do not exist, are putrefying, or have lost their blood or internal organs.
Cotards Syn
Delief that different people are in fact a single person who changes appearance or is in disguise – Delusion of Doubles
Fregoli Syn
Delusion that a friend, spouse, parent, or other close family member (or pet) has been replaced by an identical impostor
Capgras Syn
Elderly pt has delirium d/t UTI and is hospitalized. She is quite agitated, so you prescribe …
Haloperidol (or another High potency Antipsych)High potency: Halo Tries Flying High H = Haloperidol T = Trifluoperazine F = Fluphenazine
How to determine the difference b/t the combined mood and psychotic.
What is present at baseline is the basis
Background of schizophrenia that develops MDD, Dx…
Schizoaffective
major difference b/t schizophrenia/phreniform and MDD w/ psychosis?
schizophrenia/phreniform do not have depressive features
mental condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation.
Conversion
Obsession with the idea of having a serious but undiagnosed medical condition.
Illness anxiety disorder
occurs when a person feels extreme anxiety about physical symptoms such as pain or fatigue. The person has intense thoughts, feelings, and behaviors related to the symptoms that interfere with daily life, no medical cause found
Somatic Symptom Disorder
sleep disorder characterized by persistent episodic hypersomnia and cognitive or mood changes. Many patients also experience hyperphagia, hypersexuality and other symptoms.
Kleine–Levin syndrome “Sleeping Beauty Syndrome”
Acute Stress Disorder vs PTSD
PTSD = ASD>1 Month
Dementia plus non-dilating pupils and anisocoria
Tert Syphilis
Unequal pupils
anisocoria
Pt has FM and takes Benadryl to relieve allergies. She starts to have cholinergic sx d/t this FM medication
TCA
syndrome in which symptoms of a delusional belief and sometimes hallucinations are transmitted from one individual to another.
Folie à deux
NMDA Antagonist to Tx Alzheimers Sx
Memantamine
Cholinesterase inhibitors to slow the progress of Alzheimers
DonezepilGalantamineRivastigmine
Tx for tourettes
Anti-psych
Feelings a physician has for a pt
Countertransference
Key features of alcohol use disorder include …
ToleranceW/D
Time Dx Criteria for tourettesTx?
> 1 Year<18 yoTx: Impairment – pharm Non- Impair – Reassure/reasses
Hormone that blocks pain in trauma
Endorphin
First line med for sedation in the ER
Lorazepam +/- Haloperidol