Psych Shelf Flashcards
What is the difference between acute stress disorder and PTSD?
Acute stress disorder, sx 1mos
What are the 4 symptoms of PTSD?
- Anhedonia
- Hypervigilence
- Avoidance
- Flashbacks
How to you control symptoms in PTSD?
Psychotherapy!!! numero uno!
- also SSRIs
and if panic attacks: BZDs
In what instances is clozapine (and other atypicals) more effective than the typical antipsychotics?
For the treatment of refractory psychotic disorders
What symptoms are the atypical antipsychotics better at treating?
The negative symptoms
Other than tx psychotic disorders, what else can antipsychotics be used for?
- Bipolar disorder
- Delirium
- Tourette’s
- PTSD
- Transient psychotic symptoms in personality disorders
Antipsychotic potency correlates with what?
Potency of dopaminergic receptor blockade
How is risperidone similar to typical antipsychotics?
very potent blocker of D2 receptor with relatively less serotonin activity
What are the first line agents for acute psychosis?
oral preparations of the atypical antipsychotics
which medication is used in patients who have failed other antipsychotics?
clozapine
What medications are used for acute agitation in schizophrenia?
- Aripiprazole
- Olanzapine
- Ziprasidone
(IM)
Which drugs are approved for the treatment of the manic phase of bipolar disorder?
- Aripiprazole
- Chlorpromazine
- Olanzapine
- Quetiapine
- Risperidone
- Ziprasidone
Which drugs are approved for the treatment of the depressive phase of bipolar disorder?
- Combination of olanzapine-fluoxetine
2. Quetiapine
Generally speaking, what are the differences in SE profiles of the typical versus atypical antipsychotics?
typicals = movement disorders atypicals = sedation and metabolic effects
which antipsychotic has the greatest anticholinergic side effects?
- low potency, typical antipsychotics (chlorpromazine)
which antipsychotics lower the seizure threshold?
low potency, typical antipsychotics and clozapine
What antipsychotic causes hypotension and how does it do so?
Risperidone: via alpha receptor blockade
Which antipsychotic is associated with agranulocytosis?
Clozapine! most efficacious but last line drug bc of side effects
Which antipsychotics can cause QT prolongation?
- Ziprasidone
- Low potentcy typical antipsychotics: thioridazine and mesoridazine
- Risperidone
what antipsychotic causes myocarditis and when does it occur?
Clozapine- early in treatment
which antipsychotics are associated with metabolic effects (weight gain, dyslipidemia, and adult onset diabetes)
Olanzapine and closapine
Which antipsychotic can cause pigmentary retinopathy?
Thioridazine
Which antipsychotic can increase the risk of developing cataracts?
Quetiapine
What are the atypical antipsychotics? (7)
"Oh, Crap! QZ" Olanzapine Clozapine Risperidone Aripiprazole Paliperidone Quetiapine Ziprasidone
What is the difference w hallucinations between schizophrenia and psychosis 2ndary to a general medical condition?
Schizophrenia = mostly auditory hallucinations
2ndary to GMC = prominent hallucinations and delusions, sx only occur during episodes of delirium
Difference between delusion, illusion, and hallucination
Delusion: fixed false belief
Illusion: misinterpretation of an external stimulus
Hallucination: perception in the absence of an external stimulus
What endocrinopathies can cause psychosis?
- Addison/Cushing disease
- Hyper/hypothyroidism
- Hyper/hypocalcemia
- Hypopituitarism
Medications that could cause psychosis?? (9 classes)
1 Corticosteroids
- Antiparkinsonian agents
- Anticonvulsants
- Antihistamines
- Anticholinergics
- Some antihypertensives: beta blockers
- Digitalis
- Methylphenidate
- Fluoroquinolones
What are the 3 phases of schizophrenia?
- Prodromal: decline in functioning that precedes first psychotic episode
- Psychotic
- Residual: occurs between episodes of psychosis, flat affect, social withdrawal, odd thinking, can continue to have hallucinations
Only one other sx (rather than 2) is required in what 3 conditions?
- If delusions are bizarre
- Hallucinations consist of a voice keeping up a running commentary of a persons behavior
- Two or more voices conversing with one another
What are the 5 A’s of schizophrenia (negative sx)
- Anhedonia
- Affect (flat)
- Alogia (poverty of speech)
- Avolition (apathy)
5 Attention (poor)
How do you diagnose catatonic type schizophrenia?
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
What are the five subtypes of schizophrenia?
- Paranoid type
- Disorganized type
- Catatonic type
- Undifferntiated type
- Residual type
What is postpsychotic depression?
- the phenomenon of schizophrenic patients developing a MDE after resolution of their psychotic symptoms
What are the theorized DA pathways affected in Schizophrenia?
- Prefrontal cortical: inadequate DA activity = negative symptoms
- Mesolimbic: excessive DA activity = positive sx
What other pathways do the neuroleptics affect in schizophrenia besides prefrontal cortical and mesolimbic?
- Tuberoinfundibular: causes hyperprolactinemia
2. Nigrostriatal: causes EPSEs
What is a predisposing factor to paranois psychosis?
Deafness!
EPSEs are seen specifically with? tx?
high potency traditional antipsychotics
tx: antiparkinosnian agents (benztropine, diphenhydramine,etc), BZDs, beta blockers (for akasthisia)
Anticholinergic side effects are seen in which antipsychotics?
low potency traditional antipsychotics and atypical antipsychotics
What is metabolic syndrome and what medications cause it?
- Incrased BP
- Increased insulin levels
- Excess body fat around the waist
- Abnormal cholesteral levels
- drugs = atypical antipsychotics
Which second generation antipsychotics are considered weight neutral?
Aripiprazole or ziprasidone
tx of tardive dyskinesia?
discontinue offending agent
BZDs, beta blockers, and cholinomimetics may be used short term
what are the sx of NMS?
- change in metnal status
- autonomic changes (high fever, elevated BP, tachycardia)
- lead pipe rigidity
- sweating
- Elevated CPK, leukocytosis
- metabolic acidosis
NMS is assoc with what dose and administration of antipsychotics?
- initiation of treatment
- higher IV/IM dosing of high potency neuroleptics
what is the tx of schizophreniform?
hospitalization, 3-6 mos antipsychotics, supportive psychotherapy
How do you diagnose schizoaffective disorder?
- Meet criteria for either MDE, manic episode or mixed
- Have had delusions or hallucinations for 2 wks in the absence of mood disorder symptoms
- Have mood symptoms present for substantial portion of psychotic illness
tx of schizoaffective disorder?
- hospitalization and supportive psychotherapy
- antipsychotics and mood stabilizers
- antidepressants or ECT may be indicated for tx of mood symptoms
What is a brief psychotic disorder?
- psychotic sx of schizophrenia lasting 1day-1mos
- 50-80% recovery rate
What 3 populations does delusional disorder most often occur in?
- Older (>40yrs)
- Immigrants
- Hearing impaired
Tx of delusional disorder?
- psychotherapy
- antipsychotics are often ineffective but should try a course: high potency traditional or a newer atypical
Symptoms of major depression
SIG E CAPS Sleep Interest Guilt Energy Concentration Appetite Psychomotor activity Suicidal Ideation
What are the sx of a mania?
DIG FAST Distractability Irritability/insomnia Grandiosity Flight of ideas/racing thoughts Activity/agitation Speech (pressured) Thoughtlessness
What are the differences between mania and hypomania?
Mania:
- last at least 7 days
- severe social or occupational impairment
- may necessitate hospitalization
- may have psychotic features
Hypomania:
- Last at least 4 days
- No marked impairment in social or occupational functioning
- Does not require hospitalization
- No psychotic features
what feelings seen in a mood disorder CANNOT be caused by a medical illness?
guilt and worthlessness
which medications can cause substance induced mania?
- Antidepressants
- Sympathomimetics
- Dopamine
- Corticosteroids
- Levodopa
- Bronchodialators
What drugs are FDA approved first line tx for OCD?
- Clomipramine
- Fluoxetine
- Fluvoxamine
- Paroxetine
- Sertraline
When can antipsychotics be used in OCD?
as augmentation if a pt fails to respond to initial SSRI treatment
The diagnosis of conduct disorder requires:
At least 3 Sx of the following categories:
- Aggression towards people or animals
- Destruction of property
- Deceitfulness or theft
- A serious violation of rules
What is the first line tx for social phobia?
CBT!!!!
then Beta blockers and SSRIs if meds are needed
What is a complication of NMS?
rhabdomyolysis followed by myoglobinuria that can cause acute renal failure
What medication is used in NMS?
dantrolene sodium (mm relaxant)
What drug can be used to treat akathisia?
Propanolol
Which drug is used to treat narcolepsy?
Modafinil
What are the long acting BZDs?
- diazepam
- Lorazepam
- Chlordiazepoxide
What is the treatment for Anorexia nervosa?
- CBT
- Nutritional rehab
- Olanzapine if no response above
What is the treatment for Bulimia?
- CBT
- Nutritional rehab
- SSRI antidepressants
How do you diagnose enuresis?
- recurrent involuntary voiding of urine into clothing or bed linens after age 5yrs
Tx for enuresis?
- Behavioral therapy: enuresis alarms
- Desmopressing (ADH analogue)
- TCAs like imipramine 2nd line pharmacotherapy
Immature Defense mechanism: distortion
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
Neurotic defense mechanism: displacement
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
Immature defense mechanism: acting out
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
Immature defense mechanism: introjection
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
Mature defense mechanism: suppression
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
Immature defense mechanism: denial
failure to accept a disturbing aspect of external reality
ex) pt refuses to accept that he will die soon
Neurotic defense mechanism: dissociation
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
How is lithium excreted?
kidneys!!!! be careful in pts with an elevated Cr
How does amphetamine intoxication differ from cocaine intoxication?
theyre similar though amphetamine has more prominent psychotic features
What is the triad seen in heroin intoxication?
- Altered consciousness
- Respiratory depression
- Pinpoint pupils
What is the most common side effect in olanzapine?
weight gain!!
When does acute dystonia occur?tx?
between four hours and four days after starting an antipsychotic medication
- tx = antihistamines (diphenhydramine) or anticholinergics (benztropine or trihexyphenidyl)
What are the diagnostic criteria for GAD?
- 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
What comorbid disorders are linked with tourettes?
Obsessive compulsive disorder (3-6yrs after tics appear) & ADHD
What lab levels should be checked 3 months after starting Olanzapine?
Fasting glucose and lipids levels
Neurotic defense mechanism: reaction formation
address their anxiety by substituting behavior or feelings that are the exact opposite of their own unacceptable feelings
what is the Social and genetic background of bipolar disorder?
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%
What are the symptoms of avoidant personality disorder?
- socially isolated
- hypersensitive to criticism
- lacks self-esteem
- is unhappy and wants relationships but doesnt for fear of being humiliated or rejected
What are the characteristics of schizoid personality disorder?
- 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
What are the characteristics of dependent personality disorder?
- 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
What are the characteristics of schizotypal personality disorder?
- eccentric behavior
- reduced capacity for close relationships
- exhibit magical thinking
- bizarre fantasies or believe in telepathy, clairvoyance, or the concept of a sixth sense
What are the characteristics of autism spectrum disorder?
- impairments in communication and social interaction
- repetitive stereotyped behavior
- abnormal reactivity to sensory input
Epicanthal folds + palpebral fissures + maxillary hypoplasia + micrognathia
Fetal Alcohol syndrome
Fetal Alcholol syndrome increases the incidence of whay disorer?
ADHD
Tx of choice for Acute stress disorder?
Short term BZDs for severe distress (<2 weeks only)
Tx of choice for Generalized anxiety disorder?
SSRI or SNRI
Tx of choice for panic disorder?
Short term BZDs for severe distress (<2 wks)
Tx of choice for PTSD?
CBT or SSRI/SNRI or both
Tx of choice for OCD?
CBT or SSRI/SNRI or both
Which antipsychotics can be delivered intramuscularly?!
- Haloperidol decanoate (once every 2 wks to once a month)
- Fluphenazine decanoate (2x a month)
- Risperidone depot (2x month)
- Paliperidone depot (once a month)
tx of uncontrolled severe tourettes?
traditional antipsychotics such as haloperidol or pimozide
Mature defense mechanism: Altruism
individuals dedicate themselves to helping others in order to deal with an emotional conflict, internal stressor
Mature defense: sublimation
allows unacceptable or negative impulses to be channeled into more acceptable or positive activities
ex) angry man channels anger into athletic pursuits
What neurotransmitter is involved in OCD?
serotonin!!
