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Psych Clerkship > Psych Review Notes 2 > Flashcards

Psych Review Notes 2 Flashcards

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1
Q

Name the 2 SNRI’s & 2 Mixed-Actions

A

SNRI: Venlafaxine (Effexor), Duloxetine (Cymbalta)

Mixed action: Bupropion (Wellbutrin), Mirtazapine (Remeron)

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2
Q

What are the SE of Effexor (Venlafaxine)?

A

May give NEW diastolic HTN (not for pts w/ HTN)

Also gives sexual SE

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3
Q

What are 2 SE of Cymbalta (Duloxetine)?

A

Elevates liver enzymes (check LFT’s!)

Also sexual SE

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4
Q

What are 2 SE of Bupropion (Wellbutrin)?

A

May lower SEIZURE threshold (not for EtOH or BN/AN)

May WORSEN pts with ANXIETY d/o

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5
Q

What are the SE of Remeron (Mirtazapine)?

A

Highly sedating - take at bedtime

Inc appetite.

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6
Q

Name the 6 tricyclic antidepressants

A

Tertiary: Amitriptyline, Imipramine
Secondary: Nortriptyline, Desipramine
Other: Clomipramine, Doxepin

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7
Q

Name two antidepressants without sexual side effects

A

Mirtazapine (Remeron) ; Bupropion (Wellbutrin)

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8
Q

Which one of the SSRIS is worst for discontinuation syndrome? 2nd?

A

Paroxetine (Paxil), then Luvox (b/c of shortest t ½)

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9
Q

Which one of the SSRIS may cause weight gain?

A

Paroxetine (Paxil)

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10
Q

Irritability, unstable gait, rebound anxiety and shock-like or electric-like shocks are all symptoms of what syndrome?
What should you use to avoid this?

A

SSRI discontinuation syndrome

Avoided best with fluoxetine (Prozac) & Citalopram (Celexa)

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11
Q

What are the “three C’s” of TCA overdose?

A

Coma, Convulsions and Cardiotoxicity

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12
Q

What is a side-effect to Trazodone?

A

“Trazodone raises the bone” (Priapism)

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13
Q

What can happen with MAOI + Tyramine excess?

A

HTN crisis (increased catecholaminergic activity)➔stroke, aneurysm

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14
Q

Which MAOI binds reversibly?

Irreversibly?

A

Reversible: Moclobemide
Irreversible: Phenelzine, Tranylcypromine, Selegiline

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15
Q

What are the 6 signs of Neuroleptic Malignant Syndrome?

A 
FALTER from antipsychotics:
F=Fever (usually over 40C)
A=autonomic instability				
L=leukocytosis
T=tremor
E=elevated CPK
R=rigid mm
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16
Q

What HTN med can be given for nightmares in PTSD?

A

Prazosin (alpha-blocker)

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17
Q

What is a non-stimulant option for treatment of ADHD?

A

Strattera (Atomoxetine)+

  • has slower onset, but less abuse potential
  • is also used for narcolepsy
18
Q

At what age can you give amphetamines for ADHD?

A

No Amphetamines until 3 years old

19
Q

At what age can you give methylphenidate for ADHD?

A

No MPH (Ritalin) until 6 years old

20
Q

Why can’t stimulants be given to ADHD children if they have hx of:
HTN?
Psychosis?
Seizures?

think mechanism of action

A

Release of NE (catecholamines)=worsened HTN
Release of DA (dopamine)=worsened psychosis
Increased activity and excitation=worsened seizures
-finally cardiac problems are an issue (no stimulants!)

21
Q

What is included in the Criteria A signs and symptoms for schizo?

A 
Hallucinations (auditory most common)
Delusions
Disorganized Thinking
Disorganized Behavior
Negative Symptoms
22
Q

What are Negative Symptoms of schizo?

A 
5A’s:
Anhedonia
Affect (flat)
Alogia (don’t speak)
Avolition (apathy/indifference)
Attention (poor)
23
Q

how many “A” symptoms do patients need to meet criteria? for how long?

A

2 out of the 5 for at least 1 month

24
Q

how long do symptoms need to last for diagnosis?

A

Total duration of illness (including prodrome, residual sx) needs to be at least 6 months
1-6 months=schizophreniform
<1 mo=brief psychotic reaction or psychosis NOS

25
Q

What is Criteria “B” for schizophrenia?

What’s downward drift hypothesis?

A

Social-Occupational Dysfunction
-Work, interpersonal relationships, self-care

-downward drift hypothesis-persons with schizophrenia gradually lose their resources due to dysfunction and end up in low socioeconomic status group as a result

26
Q

What developmental disorders could present w/ psychosis?

A

Asperger’s, Rett’s disorder, Autism

-AUTISM is 10x more common than schizo in kids!

27
Q

What personality disorders could explain odd behavior?

A

Cluster A-paranoid, schizoid, schizotypal

28
Q

What medications (rx) could cause psychosis?

A

STEROIDS in particular but pretty much anything

29
Q

Do more men or more women get schizophrenia?

A

Males=Females but males w/more severe illness

-lifetime prevalence is about 1%

30
Q

At what age is the onset of schizophrenia?

A

Men sooner than women, 90% before age 30

  • males age 15, then 18-25 years
  • women age 25-35, up to 40 years (3/4 after age 30)
31
Q

When is the most common time schizophrenics may attempt suicide?

A

During remission of illness just following a relapse
Note: younger males who are DOING WELL with good insight into illness are at highest risk for attempt and often complete suicide.

32
Q

What are the cognitive deficits of schizophrenia?

A 
Difficulty paying attention. Think “SMART”
S-Speed of thinking
M-Memory
A-Attention
R-Reasoning
T-Tact (Social cognition)

-defects in the above impact disorganized behavior & speech

33
Q

What is the general lifespan for someone with schizophrenia?

Why?

A

Shortened to about 50 (comparison: 78 general pop)
Substance abuse (smoking, EtOH)
-Higher completion rates of suicide (8-10% complete)
-Increased CV Risks (smoking, antipsychotics, obesity)

34
Q 
What is dopamine’s effect on the following tracts of the brain?
     Nigrostriatal
     Tuberoinfundibular
     Mesolimbic
     Mesocortical
A

Nigrostriatal=EPS (dystonia, parkinsonism, akathisia, tardive dyskinesia)

Tuberoinfundibular=endocrine changes like prolactin, gynecomastia, menstrual changes

Mesolimbic=target system-psychosis (inc by inc DA)
May be responsible for negative signs/symptoms

35
Q

What is the general treatment algorithm for schizophrenia?

A 
Stage 1: SGA
Stage 2: Different SGA or try FGA
Stage 3: Consider Clozapine (3rd line)
Stage 4: Clozapine +SGA or FGA
Stage 5: Modify SGA or FGA in Stage 4
Stage 6 (last line): Give 2 FGA’s, 2 SGA’s or one of each
36
Q

How long is an adequate antipsychotic trial?

A

About 4 weeks of therapeutic dose

*patients should have SOME response in first 2 weeks.

37
Q

Mirtazapine vs Bupropion

A

Both have NO SEXUAL s/e

Mirtazapine is OK in anxiety (vs Bupropion)

38
Q

Withdrawal sxs seen with missing how many doses of Effexor (Venlafaxine)?

A

Withdrawal sxs w/ as little as 1-3 missed doses

39
Q

Cymbalta is good for ____

A

Neuropathy

40
Q

What are 2 benefits of Bupropion (Wellbutrin)?

A

NO sexual SE

May cause weight loss

41
Q

Mirtazapine is used for _____

A

Used frequently in anxiety d/o in OEF/OIF Veterans

Psych Clerkship (6 decks)

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