Psychiatry Flashcards
What is acting out?
Immature ego defense in which a patient expresses unacceptable thoughts/feelings through action
Ex: Tantrum
What are the mature ego defenses?
SASH
Suppression
Altruism
Sublimation
Humor
What is Dissociation?
Immature ego defense in which a patient temporarily drastically changes personality, memory, or behavior to avoid emotional stress.
Extreme form is dissociative identity disorder (split personalities).
What is denial?
Immature ego defense in which the patient avoids the awareness of some painful reality.
Ex: AIDS and cancer patients commonly react this way
What is Displacement?
Immature ego defense in which the takes emotions toward one thing and directs them toward another.
Ex: My boss yells at me, I’m mad at my boss, I yell at my wife.
What is Projection?
Attributing an unacceptable INTERNAL impulse to an external source.
Ex: Patient wants another women, accuses his wife of cheating.
What is Fixation?
Immature ego defense in which a patient remains partially at a more childish level of development.
What is Identification?
Immature ego defense in which a person will model behavior after another person who is more powerful (even if not admired).
Ex: Abused child identifies with an abuser
What is Isolation?
Isolation of affect is an immature ego defense in which a person separates feelings from ideas & events.
Ex: Describes a murder in gory detail without an emotional response.
What is Rationalization?
Proclaiming logical reasons for actions performed for other reasons. Usually to avoid self-blame.
Ex: After getting fired, claiming that you didn’t want the job anyway.
What is Reaction Formation?
Immature ego defense in which a person replaces a feeling with an emphasis on its opposite.
Ex: A very sexual person joins a monastery.
What is Regression?
Immature ego defense in which a person reverses their maturation to go back to an earlier mode of dealing with the world. Seen in children under new stressors (birth of a sibling, hospitalization).
What is Repression?
Immature ego defense in which a person INVOLUNTARILY withholds a feeling/idea from conscious thought.
Ex: Not remembering that a traumatic experience happened.
What is Splitting?
Immature ego defense in which patients believe that people are either all good or all bad at different times. Commonly seen in borderline personality disorder.
What is Altruism?
A mature ego defense in which people alleviate guilty feelings by generosity toward others.
What is Humor?
A mature ego defense in which a person can laugh about an adverse or anxious situation.
What is Sublimation?
A mature ego defense in which a person replaces an unacceptable wish with an action that is similar but acceptable.
Ex: A teen’s aggression toward his father is channeled into sports
What is Suppression?
A mature ego defense in which a person intentionally withholds an idea/feeling from conscious awareness.
What is the treatment for separation anxiety disorder?
SSRI’s & behavioral interventions
When must ADHD present to be diagnosable?
Before age 12
What is seen with autism spectrum disorder?
Poor social interactions
Communication deficits
Repetitive behaviors
Restricted interests
Seen more in boys
What is seen with Rett disorder?
X-linked seen only in females (males die in utero)
Symptoms at age 1-4 Regression/loss of development Loss of speech Ataxia Stereotyped hand wringing
What NT changes are seen in Huntinton’s disease?
Decreased GABA & ACh
Increased Dopamine
What NT changes are seen in Parkinson’s disease?
Decreased Dopamine
Increased 5-HT & ACh
What NT changes are seen in schizophrenia?
Increased Dopamine
What is lost first with regard to orientation in a confused patient?
1) Time
2) Place
3) Person
What is the treatment for delirium?
Identify & address underlying cause
Optimize brain function (O2, etc.)
Haloperidol
What is pseudodementia?
Depression in the elderly may present like dementia
What type of hallucinations are usually medical in etiology & what type are psychiatric?
Auditory –> psychiatric
Visual –> medical
What are the time cutoffs on the spectrum of schizophrenic disorders?
Brief psychotic disorder (stress)
1-6 months –> Schizophreniform disorder
> 6 months –> Schizophrenia
What is seen in schizoaffective disorder?
1) At least 2 weeks of psychotic symptoms with stable mood
2) At least 1 episode of major depression or mania or mixed
When does schizophrenia present?
~20 in males
~30 in females
What is seen in delusional disorder?
Fixed untrue belief for > 1 month
Functioning is otherwise not impaired
What is seen during a manic episode?
Lasts > 1 wk. Hospitalization or 3+ of the following (DIG FAST):
Distractibility Irresponsibility (hedonistic) Grandiosity Flight of ideas Agitation/Activity Sleep (decreased need) Talkativeness (pressured speech)
What constitutes bipolar disorder?
Bipolar I:
1+ manic episode with or without depression
Bipolar II:
1+ hypomanic & 1+ depressive episode
What is seen with cyclothymic disorder?
Dysthymia & hypomania. Milder form of bipolar disorder lasting at least 2 years.
What are the criteria for Major depressive disorder?
Depressed mood & 5 of the 9 symptoms for 2+ weeks
(SIG E CAPS)
Sleep Disturbance Interest (loss of) Guilt or feelings of worthlessness Energy loss & fatigue Concentration problems Appetite & weight changes Psychomotor retardation or agitation Suicidal ideation
What is the criteria for persistent depressive disorder?
aka Dysthymia
Depression, often mild, lasting at least 2 years
What is seen in atypical depression?
Mood reactivity (mood improvement in response to positive events) Hypersomnia Weight gain Leaden paralysis Sensitivity to interpersonal rejection
How long do postpartum blues last?
Postpartum depression?
Postpartum psychosis?
Blues: begin 2-3 weeks postpartum; last <10 days
Depression: Begin within 1 month; lasts 2 weeks to over a year
Psychosis: Lasts a few days to 4-6 weeks
What is electroconvulsive therapy used for?
Refractory major depression
Major depression in a pregnant patient
Depression with psychotic features
Catatonia
What are the risk factors for completion of suicide?
SAD PERSONS
Sex (male) Age (teens or elderly) Depression Previous attempt EtOH or drug use Rational thinking (loss of) Sickness (medical illness; 3+ meds) Organized plan No spouse Social support lacking
What is seen with agoraphobia?
Exaggerated fear of open or enclosed places, public transportation, lines or crowds, or leaving home alone.
What is the minimum cutoff in time for generalized anxiety disorder?
> 6 months
Must be unrelated to a specific person, situation, or event.
What is seen in adjustment disorder?
Emotional symptoms causing impairment that follow an identifiable stressor for <6 months.
What is the time cutoff for PTSD?
> 1 month –> PTSD
< 1 month –> Acute stress disorder
What is malingering?
Factitious disorders?
Somatoform disorders?
Malingering –> Pt consciously lies to get an external (secondary) gain
Factitious –> Pt consciously lies to get psychological (primary) gain
Somatiform –> Illness production is unconscious drive
What are the somatoform disorders?
Somatic symptom disorder:
Many complaints in multiple organ systems
Conversion disorder:
Sudden loss of sensory or motor function following acute stressor
Illness anxiety disorder (hypochondriasis)
What are the Cluster A personality disorders?
Describe them
Paranoid - distrust
Schizoid - voluntary social withdrawal, content with isolation
Schizotypal - eccentric, odd beliefs, awkwardness
What are the cluster B personality disorders?
Antisocial
Borderline
Histrionic
Narcissistic
What is seen in antisocial PD?
Disregard for rights of others
Criminality
Males > Females
Must be >18 & have Hx of conduct disorder before 15
What are the Cluster C personality disorders?
Describe them
Avoidant - Sensitive to rejection, desires relationships w/ others
Obsessive-Compulsive - needs order, perfectionist
Dependent - submissive & clingy, low sel-confidence
What is seen with anorexia nervosa?
Excessive dieting +/- purging
Body image distortion
Osteoporosis
Amenorrhea
What is seen with bulimia nervosa?
Binge eating +/- purging Normal body weight Parotitis Dorsal hand calluses Enamel erosions Mallory-Weiss tears
What is the treatment for narcolepsy?
Daytime stimulants
Nighttime sodium oxybate
What are the stages of change in overcoming substance addiction?
1) Precontemplation
2) Contemplation
3) Planning
4) Action
5) Maintenance
6) Relapse
What is seen with opioid withdrawal?
Sweating Dilated pupils Rhinorrhea Yawning Stomach cramps Diarrhea
What is the treatment for cocaine intoxication?
Benzodiazepines
Do NOT use beta blockers (unopposed alpha –> malignant HTN)
What is seen with delirium tremens?
1) Autonomic hyperactivity (tachycardia, tremors, anxiety)
2) Seizures
3) Psychotic symptoms
4) Confusion
What is the treatment for Tourette syndrome?
Antipsychotics
What are the high potency neuroleptics?
What toxicities are seen?
Neuroleptics = 1st generation antipsychotics
“Try Flying High”
Trifluoperazine
Fluphenazine
Haloperidol
Toxicities:
EPS
Galactorrhea
Neuroleptic malignant syndrome
What is the evolution of extrapyramidal side effects of the neuroleptics?
4 hour dystonia (stiffness, spasm)
4 day akithisia (restlessness)
4 week bradykinesia (parkinsonism)
4 month tardive dyskinesia (oral-facial movements; can be permanent)
What is seen with neuroleptic malignant syndrome?
FEVER: Fever Encephalopathy Vitals unstable Enzymes^ (CPK) Rigidity
What are the low potency neuroleptics?
“LOWlife Cheating Thieves”
Chlorpromazine
Thioridazine
What side effects are seen with low-potency neuroleptics?
All: Dry mouth (M) Constipation (M) Hypotension (alpha-1) Sedation (Histamine)
Chlorpromazine - Corneal deposits
Thioridazine - reTinal deposits
What is the mechanism of neuroleptics?
Block D2 dopamine receptors in the mesolimbic pathway
What are the atypical antipsychotics?
“atypical for Old Closets to Quietly Risper from A to Z”
Olanzapine Clozapine Quetiapine Risperidone Aripiprazole Ziprasidone
What toxicities are seen with Clozapine?
Agranulocytosis (weekly WBC counts)
Weight gain
Seizure
What toxicities are seen with Risperidone?
^Prolactin
Can cause irregular menstruation ^ fertility issues
What toxicities are seen with Ziprasidone?
Atypical antipsychotic
QT prolongation
What are the uses for Lithium?
What toxicities are seen?
Mood stabilizer for bipolar disorder
SIADH
Toxicities (STENT): Sedation Thyroid dysfunction Ebstein anomaly Nephrogenic diabetes insipidus Tremor
What is the mechanism of Buspirone?
Stimulates 5-HT(1a) receptors
Used for GAD
What side effects are seen with SSRI’s?
GI upset
Sexual dysfunction
Serotonin syndrome w/ other drugs that ^5-HT
Suicide during 4-8 wk lag time
What is seen in serotonin syndrome?
What is the treatment?
Hyperthermia Confusion Diarrhea Flushing CV collapse
Tx: Cyproheptadine (5-HT2 antagonist)
What are the SNRI’s?
What are their uses?
Venlafaxine - Depression & GAD
Duloxetine - Depression & diabetic neuropathy
What toxicities are seen with TCA’s?
Sedation
Anti-adrenergic –> postural hypotension
Anticholinergic –> dry mouth, tachycardia, urinary retention
What are the MAOI’s?
“MAO Takes Pride In Shanghai”
Tranylcupromine
Phenelzine
Isocarboxazid
Selegiline (MAO-B only)
What are the uses of MAOI’s?
What toxicities are seen?
Used for: Atypical depression, Anxiety, Hypochondriasis
Toxicities: Hypertensive crisis (tyramine found in wine & cheese) Many drug interactions (SSRI's, TCA's, St. John's wart, meperidine, dextromethorphan)
What is bupropion used for?
What side effects are seen?
Atypical antidepressant; Smoking cessation
Toxicities:
Stimulant effects
Seizure in bulemic pts
No sexual side effects
What is the mechanism of Trazadone?
What toxicities are seen?
Blocks 5-HT2 & alpha-1 adrenergic receptors
Toxicities:
Priapism
Postural hypotension
Sedation
What drugs are used in the treatment of bipolar disorder?
Mood stabilizers: Lithium, Valproic acid, Carbamazepine
Atypical antipsychotics
What is seen with serum sickness?
5-10 days after a drug exposure Fever Urticaria Proteinuria LAD Vasculitis - fibrinoid necrosis w/ PMN infiltration
It is a Type III hypersensitivity reaction
How is acyclovir activated?
Viral thymidine kinase
Only present in HSV & VZV
What is seen with systemic mastocytosis?
Mast cells in the bone marrow & other organs --> ^^Histamine Gastric acid secretion --> diarrhea Syncope Flushing Hypotension Bronchospasm Urticaria
Can Turner syndrome patients become pregnant?
Yes, usually only with in vitro fertilization & hormone supplementation.
Where in the bone does hematogenous osteomyelitis commonly occur?
The metaphysis of long bones
The hematogenous route is seen primarily in children
What are the pharmacologic methods of preventing sickle cell crisis?
1) Hydroxyurea –> ^HbF
2) Ca2+-dependent K+ channel blockers –> prevent RBC dehydration
What is a germinoma?
What is seen?
It is a pineal gland germ-cell tumor.
Symptoms: Precocious puberty (hCG secretion) Obstructive hydrocephalus Parinaud syndrome (impaired upward gaze)
What antipsychotics can affect the eyes?
Chlorpromazine - Corneal deposits
Thioridazine - Retinal deposits (“Thioretazine”)
What stain can be used to stain the liver for A1AT deficiency?
PAS stain
It shows the A1AT deposits in the liver.
What drugs cause gallstones?
Bile acid-binding resins (loss of bile acids)
Fibrates (inhibit 7-alpha-hydroxylase)
Octreotide
Ceftriaxone
What anti-MTB drug should be used if a patient is on protease inhibitors?
Rifabutin
