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
