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USMLE Step 1 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is the diagnostic criteria for major depressive disorders?

A

Any 5 of the 9 following, 1 of the 5 which must include either depressed mood of anhedonia (loss of interest), for at least 2 weeks or more:

SIG E CAPS:

  1. Sleep disturbances: hypersomnia or insomnia
  2. Loss of interest: anhedonia
  3. Guilt/Feeling of worthlessness
  4. Energy loss and fatigue
  5. Concentration loss/problems
  6. Appetite changes/Weight changes
  7. Psychomotor retardation/agitation
  8. Suicidal ideation
  9. Depressed mood
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2
Q

What are the risks of suicide?

A

SAD PERSONS

  • S: Sex (Male)
  • A: Age (45y)
  • D: Depression
  • P: Previous attempts
  • E: Ethanol/Drug abuse
  • R: Loss of Rational Thinking
  • S: Sicknesses (chronic medical illnesses)
  • O: Organized plan
  • N: No social support
  • S: Stated future intent
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3
Q

What is dysthymia?

A

Milder form of depression lasting at least 2 years

= Persistent depressive disorder

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4
Q

What are the indications for electroconvulsive therapy?

A
  • Major depressive disorder refractory to other treatment
  • Pregnant women with major depressive disorder
  • Acute suicidality when immediate response is needed
  • Depression with psychotic features
  • Catatonia
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5
Q

What are the side effects of electroconvulsive therapy?

A
  • Disorientation
  • Partial anterograde/retrograde amnesia
  • Headache

> > Usually resolves fully in 6 months

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6
Q

What is the physiology of electroconvulsive therapy?

A

Induction of a relatively controlled seizure in a patient under GENERAL anaestheia

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7
Q

How long does postpartum blues usually last?

A

Usually resolves within 10 days of onset

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8
Q

When is the typical onset of postpartum mood disturbances?

A

Within 4 weeks of delivery

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9
Q

What characterizes postpartum psychosis?

A
  • Hallucinations
  • Delusions
  • Confusion
  • Unusual behaviour
  • Homicidal/Suicidal ideations/attempts

Usually lasts from days to 4-6 weeks
» May need inpatient care
» Assessment for child safety

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10
Q

Which class of drug is fluoxetine?

A

SSRI: Selective serotonin reuptake inhibitors

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11
Q

Which class of drug is paroxetine?

A

SSRI: selective serotonin reuptake inhibitor

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12
Q

Which class of drug is sertraline?

A

SSRI: selective serotonin reuptake inhibitor

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13
Q

Which class of drug is citalopram?

A

SSRI: selective serotonin reuptake inhibitor

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14
Q

Which class of drug is duloxetine?

A

SNRI: serotonin-norepinephrine reuptake inhibitor

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15
Q

Which class of drug is venlafaxine?

A

SNRI: serotonin-norepinephrine reuptake inhibitor

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16
Q

Which class of drug is milnacipran?

A

SNRI: serotonin-norepinephrine reuptake inhibitor

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17
Q

Which class of drug is amitriptyline?

A

TCA: tricyclic anti-depressant

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18
Q

Which class of drug is nortriptyline?

A

TCA: tricyclic anti-depressant

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19
Q

Which class of drug is imipramine?

A

TCA: tricyclic anti-depressant

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20
Q

Which class of drug is desipramine?

A

TCA: tricyclic anti-depressant

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21
Q

Which class of drug is doxepin?

A

TCA: tricyclic anti-depressant

22
Q

Which class of drug is amoxapine?

A

TCA: tricyclic anti-depressant

23
Q

Which class of drug is selegiline?

A

MAOI: monoamine oxidase inhibitor

24
Q

Which class of drug is tranylcypromine?

A

MAOI: monoamine oxidase inhibitor

25
Which class of drug is isocarboxazid?
MAOI: monoamine oxidase inhibitor
26
Which class of drug is phenelzine?
MAOI: monoamine oxidase inhibitor
27
Name 4 examples of SSRIs.
- Fluoxetine - Paroxetine - Sertraline - Citalopram
28
Name 3 examples of SNRIs.
- Venlafaxine - Duloxetine - Milnacipran
29
Name 6 examples of TCAs.
- Amitriptyline - Nortriptyline - Imipramine - Desipramine - Clomipramine - Doxepin - Amoxapine
30
Name 4 examples of MAOIs.
- Tranylcypromine - Phenelzine - Isocarboxazid - Selegiline
31
Which class of drug is clomipramine?
SNRI: serotonin-noradrenaline reuptake inhibitor
32
Name 3 atypical antidepressants.
- Bupropion - Mirtazapine - Trazodone
33
What are the indications for SSRIs?
- Depression - Generalized anxiety disorder - Panic disorder - OCD - Bulimia - Social phobia - PTSD
34
What are the side effects of SSRIs?
Sexual dysfunction ``` Serotonin syndrome - Mental status changes: delirium, disorientation, anxiety - Autonomic instability >> Hyperthermia >> Cardiovascular collapse >> Flushing >> Diarrhea - Neuromuscular changes >> Hyperreflexia >> Myoclonus ```
35
What are the drugs associated with serotonin syndrome?
- SSRIs - SNRIs - MAOIs - Cocaine - Amphetamines - Tryptophan - St. John's Wort - Kava Kava
36
What are the indications for SNRIs?
- Depression - Generalized anxiety disorder - Panic disorder - Diabetic peripheral neuropathy (duloxetine) - Fibromyalgia (milnacipran)
37
What are the presenting features of TCA toxicity?
THREE Cs: - Convulsion - Coma - Cardiotoxicity (Arrhythmias) + Respiratory depression + Hyperpyrexia + Confusion and hallucinations
38
How do we treat TCA toxicity?
NaHCO3 for urine ion trapping effect ONLY IF the patient is suffering from cardiotoxicity
39
How do we treat TCA toxicity?
NaHCO3 for urine ion trapping effect ONLY IF the patient is suffering from cardiotoxicity
40
What are the indications for MAOIs?
- ATYPICAL depression - Anxiety - Hypochondriasis
41
What are the side effects of MAOIs?
- Hypertensive crisis (with ingestion of tyramine) - Tachycardia - CNS stimulation
42
What are some drugs that are contraindicated in a patient taking MAOIs?
- SSRIs - SNRIs - TCAs - Tryptophan - Cocaine - Amphetamine - St. John's Worst - Mepiridine - Dextromethorphan >> To prevent precipitating serotonin syndrome (mental status changes, autonomic instability and neuromuscular abnormalities)
43
What are some drugs that are contraindicated in a patient taking MAOIs?
- SSRIs - SNRIs - TCAs - Tryptophan - Cocaine - Amphetamine - St. John's Worst - Mepiridine - Dextromethorphan >> To prevent precipitating serotonin syndrome (mental status changes, autonomic instability and neuromuscular abnormalities)
44
What is the mechanism of action of bupropion?
Inhibits reuptake of: - Norepinephrine - Dopamine
45
What are the indications for bupropion?
- Depression | - Smoking cessation
46
What are the side effects of bupropion?
- Stimulant effects - Headaches - Seizures NO SEXUAL SIDE EFFECTS (VS. SSRIs)
47
What is the mechanism of action of mirtazapine?
- a2-antagonist: increases NE and 5-HT release | - 5HT2 and 5HT3 receptor antagonist
48
What are the side effects of mirtazapine?
- Sedation - Increased appetite - Weight gain - Dry mouth >> Anti-histaminergic effects
49
What is the mechanism of action of trazodone?
Antagonist of 5-HT2 and a1-adrenergic receptors
50
What are the indications for trazodone?
- INSOMNIA | - Depression: requires a large dose
51
What are the side effects of trazodone?
- Sedation - Priapism - Sedation - Postural hypotension

USMLE Step 1 (14 decks)

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