Psychiatry Flashcards
Sexual masochism vs sadism
Sexual masochism occurs when patients receive sexual arousal or pleasure from being humiliated, demeaned, or abused and sexual sadism individuals experience sexual arousal or pleasure from humiliating or demeaning others
Olanzapine and clozapine main side effect
Metabolic: weight gain, and metabolic syndrome.
Atypical features in depression
Heavy limbs or psychomotor retardation, a high degree of mood volatility and hypersensitivity to rejection, hyperphagia, and hypersomnolence.
Monoamine oxidase inhibitors and depression.
Are effective treatments for treatment-refractory depression with atypical features.
After a patient has failed multiple (2 or more) agents and doses.
Monoamine oxidase inhibitors. phenelzine, isocarboxazid, and tranylcypromine).
In patients who require long-term treatment of depression with SSRIs, TCAs, or monoamine oxidase inhibitors, the sexual side effects could be a problem, which are the options?
Bupropion is a norepinephrine and dopamine re-uptake inhibitor, which improves sexual functioning in those taking SSRIs. Other anti-depressants that have minimal sexual side effects or may improve SSRI induced sexual dysfunction include: buspirone, vilazodone and mirtazapine.
Haloperidol
nonselective D2 receptor antagonist in postsynaptic neurons.
First-line mood-stabilizing agents
Lithium, quetiapine, olanzapine, lamotrigine, and carbamazepine.
Olanzapine side effects
is associated with weight gain and increases the risk of developing metabolic syndrome.
Lithium and Thiazides
Lithium is excreted by the kidneys and is absorbed primarily by the proximal convoluted tubule as well as the collecting duct. The use of thiazide diuretics inhibits the reabsorption of sodium in the distal convoluted tubule, which can lead to a compensatory increase in sodium and lithium reabsorption in the proximal tubule and collecting duct——– lead to supratherapeutic levels of lithium.
Tremors, ataxia and hypothyroidism.
Which is the better anxiolytic for the elderly?
Buspirone, partial agonist at 5HT1A receptors, antagonist at dopamine D2 receptors.
low side effect profile.
Bipolar type I
Cycles between depression and mania. Evidence of depression is not necessary for a diagnosis.
Is ego syntonic and patients rarely understand that there is anything wrong with them.
A person who is having a manic spell has symptoms for a period of 1 week or more.
They could have hallucinations and delusions.
Disrupt normal social functioning.
Cyclothymic disorder
Hypomania and dysthymia. Symptoms must occur over a minimum of 2 years.
The symptoms must not meet the criteria for a true manic episode.
Projection
When an unacceptable internal state is attributed to another individual. An example would be a patient who has a substance use disorder who accuses another individual of using drugs.
Factitious disorder
A patient falsifies a medical condition in order to obtain medical attention. This disorder is motivated by primary gain, meaning the unconscious desire to receive medical care and assume the sick role.
Unlike malingering, the patient does not seek a tangible benefit such as money
Treatment involves setting clear boundaries with patients and consolidating care to a minimal number of providers. Outpatient behavioral therapy is also appropriate.
Antipsychotics and nipple discharge
Psychosis is typically treated with medications that block D2 receptors in the mesolimbic pathway.
A side-effect of these medications is D2 blockade in the tuberoinfundibular pathway. Dopamine inhibits prolactin release; when these receptors are blocked, prolactin is released in increased amounts: bilateral milky nipple discharge and amenorrhea
Acute dystonia appropriate treatment?
Diphenhydramine.
