psych randoms from firecracker and first aid Flashcards
Name the neurotransmitter implicated in Schizophrenia. Where is it increased and where is it decreased?
Schizophrenia: ↑ dopamine in the mesolimbic pathway (positive symptoms) and ↓ dopamine in the mesocortical pathway (negative symptoms)
Causes of delirium (AEIOU TIPS):
Alcohol
Electrolytes
Iatrogenic (anticholinergics, anticonvulsants, antihypertensives, anti-Parkinson drugs, antibiotics, benzodiazepines, disulfiram, H2 receptor blockers, hypoglycemics, insulin, narcotics, NSAIDs, steroids)
Oxygen hypoxia (bleeding, pulmonary disease, carbon monoxide poisoning)
Uremia and hepatic encephalopathy
Trauma
Infection
Poisons
Seizures (post-ictal)
Parkinson’s disease:
↓ dopamine, ↑ serotonin, ↑ acetylcholine
hypnaGOgic halluciations
occurs while Going to sleep
hypnoPOMPic
occurs while waking from sleep POMPous upon awakening
Name 8 features of a manic episode.
During the mood disturbance, three or more of the following are present. Use the DIG FAST mnemonic:
Distractibility
Irresponsible and erratic behavior
Grandiosity (inflated self-esteem)
Flight of ideas (racing thoughts)
Activity is increased and goal directed
Sleep (decreased need)
Talkativeness or pressured speech
Degrees of Schizo
Schizoaffective > schizophrenia > schizotypal personality disorder > schizoid personality disorder
6 months: schizophrenia
duration of a brief psychotic disorder?
<1 month
duration of schizopherniform disorder?
1-6months
When can you diagnose schizophrenia?
> 6months
2 of the 4 positive symptoms/negative symptoms
Lifetime prevalence: 1.5% (males=females, whites=blacks)
schizotypal
schizoid + odd thinking
bizarre behavior and odd thought patterns without psychosis. Thoughts are usually magical.
Schizoaffective
schizophrenic psychotic symptoms + bipolar or depressive mood disorder has to be at least two weeks
Major Depressive Disorder
Characterized by at least 5 of the following for 2 weeks with either depressed mood or anhedonia required for diagnosis with no history of a manic or hypomanic episode:
Remembered by the mnemonic SIG E CAPS Sleep disturbance Interest loss (anhedonia) Guilt or feelings of worthlessness Energy loss Concentration or Cognitive deficits Appetite loss Psychomotor retardation or agitation Suicidal ideations
Lifetime prevalence of major depressive episode is 5-12% for males and 10-25% for females
Schizoid personality disorder
: social withdrawal without psychosis. People often have very few friends and they are content with this.
Schizophrenia negative symptoms
Negative symptoms include:
- flattening of affect
- thought blocking (sudden halt in train of thought)
- deficiencies in speech content
- cognitive disturbances
- poor grooming
- lack of motivation
- social withdrawal
If you dont treat bipolar how long do the manic episodes last?
If untreated, a manic episode lasts approximately 3 months
mania
A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least one week During the mood disturbance, three or more of the following are present. Use the DIG FAST mnemonic: Distractibility Irresponsible and erratic behavior Grandiosity (inflated self-esteem) Flight of ideas (racing thoughts) Activity is increased and goal directed Sleep (decreased need) Talkativeness or pressured speech
Cyclothymic disorder
mild form of bipolar disorder with depressive symptoms lasting at least 2 years. Intermittent hypomanic episodes occur. Many affected patients have relatives with bipolar disorder
Electroconvulsive Therapy (ECT)
electrically induced painless seizure under anesthesia, used to treat mania, catatonia, and major depressive disorder refractory to pharmacotherapy
Approximately 8 treatments are administered over a 2-3 week period, but major improvements are seen after the 1st treatment
Safe to use in patients who may not tolerate the side effects of antidepressant medications, including the elderly and pregnant women
Major adverse effects: disorientation, anterograde amnesia, and retrograde amnesia usually resolving in 6 months
suicide completions
Risk factors for suicide completion can be remembered with the mnemonic: “SAD PERSONS”:
Sex (male)
Age (elderly >65 and teenagers 15-24)
Depression
Previous attempt
Ethanol or drug use
Rational thinking lost
Sickness (medical illness, 3 or more prescription meds)
Organized plan
No spouse (divorced, widowed, or single, especially if childless)
Social support lacking
What is the treatment of anorexia nervosa?
Treatment for this life-threatening condition initially involves hospitalization to restore a good nutritional status. Antidepressants (especially Mirtazipine because of weight gain side effects) and family therapy are also useful
Somatization Disorder
- 4 Pain sxs: e.g. abdominal, joint, head, chest
- 2 GI sxs: nausea, vomiting, diarrhea
- 1 Sexual sx: irregular menses, erectile dysfunction
- 1 Pseudoneurological sx: isolated paralysis, ataxia, etc
Elevation of what enzyme is a sensitive indicator of alcohol intoxication?
Serum gamma glutamyltransferase (GGT) is a sensitive indicator of alcohol use
The effects of ethanol ingestion include the following:
increased NADH/NAD ratio which leads to increased conversion of pyruvate to lactate. This inhibits gluconeogenesis, fatty acid oxidation and glycerophosphate dehydrogenase leading to elevated glycerophosphate
Describe the signs and symptoms of PCP-phencyclidine intoxication.
Phencyclidine (PCP)
Mechanism: Works by inhibiting activation of NMDA receptors
Intoxication:
- belligerence, impulsiveness, homicidal tendencies
- vertical and horizontal nystagmus, tachycardia, ataxia, fever
- psychomotor agitation, psychosis, delirium
Withdrawal: recurrence of intoxication symptoms due to gastrointestinal reabsorption, sudden onset of severe, random homicidal violence.
Name 5 symptoms of Lysergic acid diethylamide (LSD) intoxication.
Lysergic acid diethylamide (LSD)
Intoxication:
- pupillary dilatation
- marked anxiety or depression
- delusions
- visual hallucinations
- flashbacks
Name some typical antipsychotics?
What do we use them for?
Haloperidol + “azines”
- trifluoroperazine
- fluphenazine
- thioridazine
- chlorpromazine
Block DA D2 receptors (increase cAMP)
Treat Schizophrenia (it has increase DA recall), psychosis, acute mania and tourette syndrome
note they are highly lipid soluble and thus slow to be removed from the body
How to treat extrapyrimidal system side effects?
Benztropine or diphenhydramine
Benzatropine is a centrally acting anticholinergic/antihistamine agent resulting from the combination of the tropine portion of the atropine molecule and the benzohydryl portion of diphenhydramine.
What are some endocrine side effects of using DA antagonists?
antagonism –> hyperprolactinemia –> galctorrhea
The antipsychotics DA blockers are not completely specific what are some other side effects from blocking other receptors?
- blocking muscarinic–> dry mouth, constipation (recally muscarinic agonists would increase motility)
- blocking a1 –> hypotension
- blocking histamine receptors –> sedation
What is the evolution of EPS side effects?
4hr acute dystonia (muscle spasm, stiffness, oculogyric crisis)
4 day akathisia (restlessness)
4 week bradykinesia (parkinosonism)
4 month tardive dyskinesia
antipsychotics can cause neuroeleptic malignant syndrom NMS
acronym FEVER
Fever encephalopoathy vitals unstable enzymes up rigidity in muscles
- rigidity, myoglobinuria, autonomic instability, hyperexia
treat: dantrolene (prevents the release of Ca from the SR used also for malignant hyperthermia), or a D2 agonist like bromocriptine
antipsychotics can also cause tardive dyskninesia
- Stereotypical oral facial movements as a result of long term antipsychotic use
- potentially irreversible
What are high potency anytipsychotis?
TRy to Fly High
trifluoroperazine
fluphenazine
Haloperidol
EPS side effects
What are low potency antipsychotis?
Cheating THieves are Low
Chloropromazine
Thioridazine
non-neurologic side effects (anticholinergic, antihistamine and a1 blockade effects
Name some ATYPICAL antipsychotics
its atypical for Old CLOZets to QUIEtly RISPER from A to Z
- olanazapine
- clozapine
- quietiapine
- risperidone
- aripiprazole
- zisprasidone
ATYPICAL antipsychotics
mechanism: varied effects on 5-HT2, DA, A and H1 receptors
used: Schizophrenia both POSITIVE and NEGATIVE symptoms, Bipolar disorder, OCD, anxiety disorder, depression, mania, tourette
ATYPICAL antipsychotics
side effects:
less EPS and anticholinergic side effects but stil HAMS
olanzapine/clozapine - wtgain
Clozapine - agranulocytosis and seizure
risperidone - may increase prolactin
zisperadone may prolong QT interval
Lithium
- possibly inhibits the phosphoinositol cascade
- mood stabilizer
side effects:
- tremor, sedation, edema, heart block, hypothyroidism
- nephrogenic diabetes insipidus
- fetal cardiac defects (ebsteins anomaly and malformation of the great vessels )
- narrow therapeutic window
- excreted in kidney, but most reabsorbed in PT tubule following Na reabsorption
Buspirone
stimulates 5-HT1A receptors
-used for generalized anxiety disorders
does not cause sedation, addiction or tolerance =D
- takes 1-2 weeks to take effect
- does not interact with alcohol
Bupropion
- increases NE and DA release via an unknown mechanism
- use for smoking cessation
- toxicity stimulant effects (tach, insomnia) , headache, seizure in bulimic patients. NO sexual side effects
Mirtazapine
a2 antagonist –> increase the release of NE and 5-HT
-potent 5-Ht2 and 5-HT3 receptor antagonist.
toxicity: sedation (which may be desirable in insomnia), increased appetite and weight gain (which may be desirable in elderly and anorexic patients), dry mouth
trazedone
-blocks 5-HT2 and a1 receptors
-insomnia, high does can be for antidepressents
side effects: sedation, nausea, priapism, postural hypotension (a1 block)
trazaboneee
Name some SSRIS?
Flashbacks paralyze senior citizens fluoxetine paroxetine sertraline citalopram
Serotonin syndrome?
anything that could increase seretonin is at reisk
- hyperthermia
- confusion
- myoclonus
- cardiovascular collapse
- flushing
- diarrhea
- seizures
Treat: cyproheptadine (5-HT2 receptor antagonist)
Cyproheptadine
5-HT2 receptor antagonist
treats serotonin syndrome
SSRIs
fluoxetine paroxetine sertraline citalopram -5HT reuptake inhibitors -takes 4-8 weeks to start working -used for depression, GAD, panic, OCD, bulimia, social phobias and PTSD
side effects: gi distress, sexual dysfunction
watch out for seretonin syndrome
Name the two SNRIs
Venlafaxine, duloxetine
SNRIs
inhibit 5ht and NE reuptake
- used for depression, venlafaxine is also used in GAD, panic disorders
- duloxetine is also used in diabetic peripheral neuropathy
side effects:
stimulant (NE), increase BP, sedation (5HT), nausea
What is used in diabetic peripheral neuropathy?
duloxetine
inhibit 5ht and NE reuptake
SNRI
Name some tricylic antidepressants
amitryptiline nortiptyline imipramine desipramine clomipramine doxepin amoxapine
tricylic antidepressants
amitryptiline nortiptyline imipramine desipramine clomipramine doxepin amoxapine
1) Presynaptic NE and 5HT reuptake
2) Muscarinic cholinergic receptors
3) α1 adrenergic receptors
4) H1 histamine receptors
used: major depression, OCD (clomipramine) and fibromyalgia
toxicity: a1 blocking effects including postural hypotension, and atropine like (anticholinergic side effects)
tertiary amine amytriptylene has more anticholinergic effect than nortrypityline
despyramine is less sedating but has higher seizure side effects
Monoamine oxidases inhibitors name?
tranylcypromine
phenelzine
isocarboxazid
selegiline (selective MAO-B inhibitor, used in parkinsons remember!)
Monoamine oxidases inhibitors
tranylcypromine
phenelzine
isocarboxazid
selegiline (selective MAO-B inhibitor, used in parkinsons remember!)
-nonselective MAO inhibition increases levels of amine neurotransmitters (NE, 5HT,DA)
used: atypical depression, anxiety, hypochondriasis
tox: HTNcrisis most notably with ingestion of tyramine (wine cheese), CNS stimulation.
Contraindicated with SSRI, TCA, St johns wort, mepreridine and dextromethorphan — to avoid seretonin syndrome as these could increase 5HT
oh no hypertensive crisis you are on a drug and ate some cheese and wine
MAO inhibitor!
not tyramine oh noooooes
Name the major side effects of tricyclic antidepressants (TCAs).
Side effects:
- Antihistaminic (sedation and weight gain)
- Antiadrenergic (orthostatic hypotension and arrhythmias)
- Anticholinergic (dry mouth, tachycardia, confusion, constipation, and urinary retention)
- Lethal in overdose: must assess suicide risk before prescribing TCAs because a 1-week supply can be lethal in overdose
Treatment for TCA overdose
Treatment for TCA overdose: administration of IV sodium bicarbonate has been shown to be effective for treating metabolic acidosis and cardiovascular complications
Name two medications used to treat depression.
1st line – SSRIs and SNRIs. Alternative – TCA’s or MAOIs for atypical depression. (Note: ECT can be used for medication-nonresponsive patients)
How to treat ADHD
methylphenidate
How to treat alcohol withdrawal
benzos, sometimes barbs
how to treat anxiety?
SSRI, SNRI buspirone
i get anxiety on the bus
how to treat bipolar?
-lithium, valproic acid, carbamezepine, atypical antipsychotics like risperidone
remember dont give antidepressants it can induce mania!
how to treat bulimia
SSRI
how to treat OCD
SSRI, clomipramine (TCA)
How to treat panic disorder?
SSRI, venlafaxine (SNRI), benzos)
how to treat PTSD
SSRI
How to treat schozophrenia
typical anytipsychotics - positive symptoms
atypical - positive and negative symptoms
how to treat social phobias?
SSRI, b blocker
how to treat tourette?
haloperidol - typical
risperidone - atypical antipsychotics
how do you treat akathisia from typical antipsychotics? (restlessness)
propanolol
Which two atypical antipsychotics cause the most weight gain? Which one may cause cataracts? Which elevates prolactin the most? Which prolongs the QT interval?
- Olanzapine and Clozapine: hyperlipidemia, glucose intolerance, and weight gain
- Clozapine: agranulocytosis and seizures but has fewest EPS
- Quetiapine: cataracts → periodic slit lamp examination recommended
- Risperidone: elevates prolactin → gynecomastia, galactorrhea, and amenorrhea
- Aripiprazole: low incidence of weight gain and no effect on glucose, lipids, or QT interval
- Ziprasidone: prolongs QT interval
Name 5 effects secondary to toxicity of TCAs (tricyclic antidepressants).
Toxicity:
3 C’s – Convulsions, Coma, Cardiotoxicity (due to inhibition of fast Na+ channels → slowed cardiac conduction → prolonged QRS)
- Respiratory depression
- Hyperpyrexia
- Mydriasis & Flushing: due to anticholinergic effects
What are three drugs that can cause lithium toxicity?
Lithium toxicity is increased by: thiazide diuretics (leads to increased proximal tubule absorption of sodium) NSAIDs, ACE inhibitors, dehydration, salt deprivation, and impaired renal function
What medication is used to treat Tourette’s syndrome? What medication can be used if there are co-occuring ADHD symptoms?
Tourette’s disorder: Haloperidol, pimozide, and risperidone (if EPS symptoms develop)
High Yield: Clonidine and guanfacine can be used to treat tics with co-occurring ADHD symptoms
