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Psych Shelf Flashcards

1
Q

What is the difference between acute stress disorder and PTSD?

A

Acute stress disorder, sx 1mos

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2
Q

What are the 4 symptoms of PTSD?

A
  1. Anhedonia
  2. Hypervigilence
  3. Avoidance
  4. Flashbacks
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3
Q

How to you control symptoms in PTSD?

A

Psychotherapy!!! numero uno!
- also SSRIs
and if panic attacks: BZDs

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4
Q

In what instances is clozapine (and other atypicals) more effective than the typical antipsychotics?

A

For the treatment of refractory psychotic disorders

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5
Q

What symptoms are the atypical antipsychotics better at treating?

A

The negative symptoms

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6
Q

Other than tx psychotic disorders, what else can antipsychotics be used for?

A
  1. Bipolar disorder
  2. Delirium
  3. Tourette’s
  4. PTSD
  5. Transient psychotic symptoms in personality disorders
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7
Q

Antipsychotic potency correlates with what?

A

Potency of dopaminergic receptor blockade

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8
Q

How is risperidone similar to typical antipsychotics?

A

very potent blocker of D2 receptor with relatively less serotonin activity

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9
Q

What are the first line agents for acute psychosis?

A

oral preparations of the atypical antipsychotics

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10
Q

which medication is used in patients who have failed other antipsychotics?

A

clozapine

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11
Q

What medications are used for acute agitation in schizophrenia?

A
  1. Aripiprazole
  2. Olanzapine
  3. Ziprasidone
    (IM)
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12
Q

Which drugs are approved for the treatment of the manic phase of bipolar disorder?

A
  1. Aripiprazole
  2. Chlorpromazine
  3. Olanzapine
  4. Quetiapine
  5. Risperidone
  6. Ziprasidone
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13
Q

Which drugs are approved for the treatment of the depressive phase of bipolar disorder?

A
  1. Combination of olanzapine-fluoxetine

2. Quetiapine

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14
Q

Generally speaking, what are the differences in SE profiles of the typical versus atypical antipsychotics?

A 
typicals = movement disorders 
atypicals = sedation and metabolic effects
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15
Q

which antipsychotic has the greatest anticholinergic side effects?

A
  • low potency, typical antipsychotics (chlorpromazine)
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16
Q

which antipsychotics lower the seizure threshold?

A

low potency, typical antipsychotics and clozapine

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17
Q

What antipsychotic causes hypotension and how does it do so?

A

Risperidone: via alpha receptor blockade

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18
Q

Which antipsychotic is associated with agranulocytosis?

A

Clozapine! most efficacious but last line drug bc of side effects

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19
Q

Which antipsychotics can cause QT prolongation?

A
  1. Ziprasidone
  2. Low potentcy typical antipsychotics: thioridazine and mesoridazine
  3. Risperidone
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20
Q

what antipsychotic causes myocarditis and when does it occur?

A

Clozapine- early in treatment

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21
Q

which antipsychotics are associated with metabolic effects (weight gain, dyslipidemia, and adult onset diabetes)

A

Olanzapine and closapine

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22
Q

Which antipsychotic can cause pigmentary retinopathy?

A

Thioridazine

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23
Q

Which antipsychotic can increase the risk of developing cataracts?

A

Quetiapine

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24
Q

What are the atypical antipsychotics? (7)

A 
"Oh, Crap! QZ"
Olanzapine
Clozapine
Risperidone
Aripiprazole
Paliperidone
Quetiapine
Ziprasidone
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25
Q

What is the difference w hallucinations between schizophrenia and psychosis 2ndary to a general medical condition?

A

Schizophrenia = mostly auditory hallucinations

2ndary to GMC = prominent hallucinations and delusions, sx only occur during episodes of delirium

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26
Q

Difference between delusion, illusion, and hallucination

A

Delusion: fixed false belief
Illusion: misinterpretation of an external stimulus
Hallucination: perception in the absence of an external stimulus

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27
Q

What endocrinopathies can cause psychosis?

A
  1. Addison/Cushing disease
  2. Hyper/hypothyroidism
  3. Hyper/hypocalcemia
  4. Hypopituitarism
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28
Q

Medications that could cause psychosis?? (9 classes)

A

1 Corticosteroids

  1. Antiparkinsonian agents
  2. Anticonvulsants
  3. Antihistamines
  4. Anticholinergics
  5. Some antihypertensives: beta blockers
  6. Digitalis
  7. Methylphenidate
  8. Fluoroquinolones
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29
Q

What are the 3 phases of schizophrenia?

A
  1. Prodromal: decline in functioning that precedes first psychotic episode
  2. Psychotic
  3. Residual: occurs between episodes of psychosis, flat affect, social withdrawal, odd thinking, can continue to have hallucinations
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30
Q

Only one other sx (rather than 2) is required in what 3 conditions?

A
  1. If delusions are bizarre
  2. Hallucinations consist of a voice keeping up a running commentary of a persons behavior
  3. Two or more voices conversing with one another
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31
Q

What are the 5 A’s of schizophrenia (negative sx)

A
  1. Anhedonia
  2. Affect (flat)
  3. Alogia (poverty of speech)
  4. Avolition (apathy)
    5 Attention (poor)
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32
Q

How do you diagnose catatonic type schizophrenia?

A

Must have at least 2 of the following criteria::

  • motor immobility
  • excessive purposeless motor activity
  • extreme negativism/mutism
  • peculiar voluntary movements or posturing
  • echolalia or echopraxia
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33
Q

What are the five subtypes of schizophrenia?

A
  1. Paranoid type
  2. Disorganized type
  3. Catatonic type
  4. Undifferntiated type
  5. Residual type
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34
Q

What is postpsychotic depression?

A
  • the phenomenon of schizophrenic patients developing a MDE after resolution of their psychotic symptoms
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35
Q

What are the theorized DA pathways affected in Schizophrenia?

A
  1. Prefrontal cortical: inadequate DA activity = negative symptoms
  2. Mesolimbic: excessive DA activity = positive sx
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36
Q

What other pathways do the neuroleptics affect in schizophrenia besides prefrontal cortical and mesolimbic?

A
  1. Tuberoinfundibular: causes hyperprolactinemia

2. Nigrostriatal: causes EPSEs

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37
Q

What is a predisposing factor to paranois psychosis?

A

Deafness!

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38
Q

EPSEs are seen specifically with? tx?

A

high potency traditional antipsychotics

tx: antiparkinosnian agents (benztropine, diphenhydramine,etc), BZDs, beta blockers (for akasthisia)

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39
Q

Anticholinergic side effects are seen in which antipsychotics?

A

low potency traditional antipsychotics and atypical antipsychotics

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40
Q

What is metabolic syndrome and what medications cause it?

A
  1. Incrased BP
  2. Increased insulin levels
  3. Excess body fat around the waist
  4. Abnormal cholesteral levels
    - drugs = atypical antipsychotics
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41
Q

Which second generation antipsychotics are considered weight neutral?

A

Aripiprazole or ziprasidone

42
Q

tx of tardive dyskinesia?

A

discontinue offending agent

BZDs, beta blockers, and cholinomimetics may be used short term

43
Q

what are the sx of NMS?

A
  • change in metnal status
  • autonomic changes (high fever, elevated BP, tachycardia)
  • lead pipe rigidity
  • sweating
  • Elevated CPK, leukocytosis
  • metabolic acidosis
44
Q

NMS is assoc with what dose and administration of antipsychotics?

A
  • initiation of treatment

- higher IV/IM dosing of high potency neuroleptics

45
Q

what is the tx of schizophreniform?

A

hospitalization, 3-6 mos antipsychotics, supportive psychotherapy

46
Q

How do you diagnose schizoaffective disorder?

A
  1. Meet criteria for either MDE, manic episode or mixed
  2. Have had delusions or hallucinations for 2 wks in the absence of mood disorder symptoms
  3. Have mood symptoms present for substantial portion of psychotic illness
47
Q

tx of schizoaffective disorder?

A
  • hospitalization and supportive psychotherapy
  • antipsychotics and mood stabilizers
  • antidepressants or ECT may be indicated for tx of mood symptoms
48
Q

What is a brief psychotic disorder?

A
  • psychotic sx of schizophrenia lasting 1day-1mos

- 50-80% recovery rate

49
Q

What 3 populations does delusional disorder most often occur in?

A
  1. Older (>40yrs)
  2. Immigrants
  3. Hearing impaired
50
Q

Tx of delusional disorder?

A
  • psychotherapy

- antipsychotics are often ineffective but should try a course: high potency traditional or a newer atypical

51
Q

Symptoms of major depression

A 
SIG E CAPS
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor activity
Suicidal Ideation
52
Q

What are the sx of a mania?

A 
DIG FAST
Distractability
Irritability/insomnia
Grandiosity
Flight of ideas/racing thoughts
Activity/agitation
Speech (pressured)
Thoughtlessness
53
Q

What are the differences between mania and hypomania?

A

Mania:

  1. last at least 7 days
  2. severe social or occupational impairment
  3. may necessitate hospitalization
  4. may have psychotic features

Hypomania:

  1. Last at least 4 days
  2. No marked impairment in social or occupational functioning
  3. Does not require hospitalization
  4. No psychotic features
54
Q

what feelings seen in a mood disorder CANNOT be caused by a medical illness?

A

guilt and worthlessness

55
Q

which medications can cause substance induced mania?

A
  1. Antidepressants
  2. Sympathomimetics
  3. Dopamine
  4. Corticosteroids
  5. Levodopa
  6. Bronchodialators
56
Q

What drugs are FDA approved first line tx for OCD?

A
  1. Clomipramine
  2. Fluoxetine
  3. Fluvoxamine
  4. Paroxetine
  5. Sertraline
57
Q

When can antipsychotics be used in OCD?

A

as augmentation if a pt fails to respond to initial SSRI treatment

58
Q

The diagnosis of conduct disorder requires:

A

At least 3 Sx of the following categories:

  1. Aggression towards people or animals
  2. Destruction of property
  3. Deceitfulness or theft
  4. A serious violation of rules
59
Q

What is the first line tx for social phobia?

A

CBT!!!!

then Beta blockers and SSRIs if meds are needed

60
Q

What is a complication of NMS?

A

rhabdomyolysis followed by myoglobinuria that can cause acute renal failure

61
Q

What medication is used in NMS?

A

dantrolene sodium (mm relaxant)

62
Q

What drug can be used to treat akathisia?

A

Propanolol

63
Q

Which drug is used to treat narcolepsy?

A

Modafinil

64
Q

What are the long acting BZDs?

A
  • diazepam
  • Lorazepam
  • Chlordiazepoxide
65
Q

What is the treatment for Anorexia nervosa?

A
  1. CBT
  2. Nutritional rehab
  3. Olanzapine if no response above
66
Q

What is the treatment for Bulimia?

A
  1. CBT
  2. Nutritional rehab
  3. SSRI antidepressants
67
Q

How do you diagnose enuresis?

A
  • recurrent involuntary voiding of urine into clothing or bed linens after age 5yrs
68
Q

Tx for enuresis?

A
  1. Behavioral therapy: enuresis alarms
  2. Desmopressing (ADH analogue)
  3. TCAs like imipramine 2nd line pharmacotherapy
69
Q

Immature Defense mechanism: distortion

A

altered perception of disturbing aspects of external reality in an effort to make it more aceptable
ex) IV drug user gets hep C and says its bc of inadequate control of hep C within the community

70
Q

Neurotic defense mechanism: displacement

A

shifting of emotions associated with an upsetting object or person to a safer alternate object or person
ex) woman is angry with husband so she throws his bball collection not hurting him

71
Q

Immature defense mechanism: acting out

A

directly expressing an unconscious wish or imulse to avoid addressing the accompanying emotion
ex) child who has a temper tantrum bc disappointed with his mom

72
Q

Immature defense mechanism: introjection

A

the assimilating of another person’s attitude into one’s own perspective
ex) a battered woman who believes her husband is right when he says she is worthless

73
Q

Mature defense mechanism: suppression

A

intentionally postponing the exploration of anxiety provoking thoughts by substituting other thoughts
ex_ woman who focuses on her children’s needs instead of thinking about her father’s cancer diagnosis

74
Q

Immature defense mechanism: denial

A

failure to accept a disturbing aspect of external reality

ex) pt refuses to accept that he will die soon

75
Q

Neurotic defense mechanism: dissociation

A

completely blocking off disturbing thoughts or feelings from consciousness in an atempt to avoid emotional upset
ex) pt was rescued from a burning building and now denies memory of the event

76
Q

How is lithium excreted?

A

kidneys!!!! be careful in pts with an elevated Cr

77
Q

How does amphetamine intoxication differ from cocaine intoxication?

A

theyre similar though amphetamine has more prominent psychotic features

78
Q

What is the triad seen in heroin intoxication?

A
  1. Altered consciousness
  2. Respiratory depression
  3. Pinpoint pupils
79
Q

What is the most common side effect in olanzapine?

A

weight gain!!

80
Q

When does acute dystonia occur?tx?

A

between four hours and four days after starting an antipsychotic medication
- tx = antihistamines (diphenhydramine) or anticholinergics (benztropine or trihexyphenidyl)

81
Q

What are the diagnostic criteria for GAD?

A
  • excessive anxiety about multiple events and
  • 3 or more of the following for at least 6 months:
    1. Impaired sleep
    2. Poor concentration
    3. Easy fatigability
    4. Irritability
    5. Muscle tension
    6. Restlessness
82
Q

What comorbid disorders are linked with tourettes?

A

Obsessive compulsive disorder (3-6yrs after tics appear) & ADHD

83
Q

What lab levels should be checked 3 months after starting Olanzapine?

A

Fasting glucose and lipids levels

84
Q

Neurotic defense mechanism: reaction formation

A

address their anxiety by substituting behavior or feelings that are the exact opposite of their own unacceptable feelings

85
Q

what is the Social and genetic background of bipolar disorder?

A 
more common in: 
- single or divorced individuals
- higher SES
- 5-10% of children w bipolar parents have it
child of two parents w bipolar = 60%
monozygotic twins = 70%
86
Q

What are the symptoms of avoidant personality disorder?

A
  • socially isolated
  • hypersensitive to criticism
  • lacks self-esteem
  • is unhappy and wants relationships but doesnt for fear of being humiliated or rejected
87
Q

What are the characteristics of schizoid personality disorder?

A
  • social detachment and a restricted range of expressed emotion
  • do not enjoy close relationships with others and prefer to be isolated
  • appear indifferent to praise or criticism
88
Q

What are the characteristics of dependent personality disorder?

A
  • excessive need to be cared for, tend to be clingy and submissive with loved ones
  • indecisive and avoid taking the initiative bc of feelings of inadequacy
89
Q

What are the characteristics of schizotypal personality disorder?

A
  • eccentric behavior
  • reduced capacity for close relationships
  • exhibit magical thinking
  • bizarre fantasies or believe in telepathy, clairvoyance, or the concept of a sixth sense
90
Q

What are the characteristics of autism spectrum disorder?

A
  • impairments in communication and social interaction
  • repetitive stereotyped behavior
  • abnormal reactivity to sensory input
91
Q

Epicanthal folds + palpebral fissures + maxillary hypoplasia + micrognathia

A

Fetal Alcohol syndrome

92
Q

Fetal Alcholol syndrome increases the incidence of whay disorer?

A

ADHD

93
Q

Tx of choice for Acute stress disorder?

A

Short term BZDs for severe distress (<2 weeks only)

94
Q

Tx of choice for Generalized anxiety disorder?

A

SSRI or SNRI

95
Q

Tx of choice for panic disorder?

A

Short term BZDs for severe distress (<2 wks)

96
Q

Tx of choice for PTSD?

A

CBT or SSRI/SNRI or both

97
Q

Tx of choice for OCD?

A

CBT or SSRI/SNRI or both

98
Q

Which antipsychotics can be delivered intramuscularly?!

A
  1. Haloperidol decanoate (once every 2 wks to once a month)
  2. Fluphenazine decanoate (2x a month)
  3. Risperidone depot (2x month)
  4. Paliperidone depot (once a month)
99
Q

tx of uncontrolled severe tourettes?

A

traditional antipsychotics such as haloperidol or pimozide

100
Q

Mature defense mechanism: Altruism

A

individuals dedicate themselves to helping others in order to deal with an emotional conflict, internal stressor

101
Q

Mature defense: sublimation

A

allows unacceptable or negative impulses to be channeled into more acceptable or positive activities
ex) angry man channels anger into athletic pursuits

102
Q

What neurotransmitter is involved in OCD?

A

serotonin!!

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