Psychiatry Flashcards
What are the mature defense mechanisms?
Altruism, humor, sublimation (channeling impulses into socially acceptable behaviors), suppression
Reaction formation?
Doing opposite of what they truly feel or desire (excessive opposite)
Tx of narcolepsy
Stimulants; 1st - modafinil (non-amphetamine stimulant); 2nd - amphetamines (SE’s of HTN, arrhythmia, psychosis and risk for dependency)
Projection vs. displacement
Attributing own feelings for someone else vs. redirect emotions toward a more acceptable but still inappropriate person or object. “I think that SHE/HE thinks…”
Pica is associated with what lab finding?
Iron-deficiency anemia
Buspirone?
Selective agonist of 5HT1a receptor for GAD. Not muscle relaxant, or anticonvulsant. Few side-effects. But takes 1-2 weeks.
Passive-aggressive vs acting out
P-A: expression of hostile feelings in non-confrontational manner. Acting out is confrontational (temper tantrum. Expressing unconscious wishes or impulses through actions)
Serotonin syndrome vs. Neuroleptic malignant syndrome
Serotonin syndrome 2/2 to inc. serotonin (e.g. SSRIs + MAOIs) leading to MYOclonus, hyperreflexia, autonomic stimulation, AMS. NMS has rigidity and NO myoclonus, hyperthermia, AMS, autonomic instability. NMS 2/2 to antagonism of D2 receptor (e.g. haloperidol)
Suppression vs. repression
Suppression is the INTENTIONAL withholding of distressing unconscious material. Repression is the unconscious removal.
Schizoid vs. Schizotypical
Schizotypical is more schizophrenia-type. Paranoid. Strange superstitions. Schizoid - self-absorbed, isolated loners, restricted range of emotion. Avoidant-types desire relationship but feel inadequate, timid, and fear rejection
Classical vs. operant conditioning
Classical - involuntary responses. Operant - voluntary responses (punishment or reward)
Extinction
Discontinuation of reinforcement (whether positive or negative) eventually eliminates behavior (both classical and operant)
Transferance vs. countertransferance
What patient feels about physician vs. what physician feels about patient
Dissociation vs. Displacement?
Temporary drastic change in personality, memory, consciousness, or motor behavior vs. transferring avoided ideas and feelings to some neutral person/object
Infant deprivation effects
4 W’s = Weak, Wordless, Wanting, Wary. Deprivation for >6 mo can lead to irreversible changes
Evidence of physical abuse?
Healed fractures on X-ray, burns, subdural hematomas, pattern marks, rib fractures, retinal hemorrhage or detachment. Usu. biological mother and in kids <3 y/o
Conduct disorder vs. oppositional defiant disorder?
Oppositional defiant are hostile, defiant behavior to authority figures w/o serious violations. Conduct disorder = violating BASIC rights —-> antisocial personality disorder
Tourette syndrome
Usu. onset before age 18. Sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics > ONE YEAR. Coprolalia (inv. obscene speech in 10-20%). Tx = antipsychotics and behavioral
Treatment for separation anxiety disorder?
SSRIs and relaxation techniques/behavior interventions
Rett disorder
X-linked disorder seen almost exclusively in girls (b/c boys die in utero). Ages 1-4 –> Regression w/ loss of dvpt, loss of verbal, ID, ataxia, and stereotyped hand-wringing
Neurotransmitter changes in Anxiety vs. Depression
Depression is decreased NE, 5-HT, DA. Anxiety is INCREASED NE, decreased GABA and 5-HT.
HD vs. Parkinsons’ neurotransmitter change
HD is INC DA, low GABA and ACh. Parkinsons is LOW DA and increased 5-HT and ACh. Think how do you “Parkinsonize” people?
Alzheimer’s neurotransmitter change?
Decreased ACh.
Order of loss of orientation
Time, place, person
Korsakoff amnesia
Thiamine deficiency and associated destruction of MAMMILLARY bodies. Classically anterograde, tho some retrograde. Confabulations
Dissociative amnesia
Inability to recall important personal information usu. subsequent to severe trauma or stress. Dissociative fugue (abrupt travel during period)
Etios of delirium
CNS disease, infection, trauma, substance abuse/withdrawal, metabolic/electrolyte disturbances, hemorrhage, urinary/fecal retention
Reversible causes of dementia
NPH, vitamin B12 deficiency, hypothyroidism, neurosyphilis, HIV (partially).
Delrium vs. dementia
Waxing and waning consciousness with abnormal EEG and often reversible VS gradual decreased cognition w/o effect on level of consciousness, EEG normal, and often irreversible
Hypnagogic vs. hypnopompic?
Gogic is going to sleep. Pompic is upon awakening.
Diagnostic criteria for schizophrenia?
> SIX MONTHS, 2/5: Delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms (flat affect, social withdrawal, lack of motivation, lack of speech or thought.”
Brief pyschotic vs. schizophreniform vs. schizoaffective disorder?
< 1 mo vs. 1-6 mo vs. at least 2 weeks of sable mood WITH psych + MDD, Manic, or mixed
Delusional disorder
Fixed, persistent, untrue belief system lasting > 1 MONTH
Dissociative identity disorder vs. Depersonalization/derealization disorder
Dissociative = presence of 2 or more distinct identities/personality states. Most common in women - sexual abuse, PTSD, depression, substance, borderline, somatoform. Depersonalization = persistent feelings of detachment or estrangement from one’s own body, thoughts, perceptions, actions, or environment
Manic episode criteria
> 1 week. At least three of DIG FAST = Distractibility, irresponsibility, grandiosity, flight of ideas, Activities and agitation, Sleep down, talkativenes/pressured speech
Hypomanic criteria
No marked impairment in functioning. At least 4 consc. days. No psychosis.
Bipolar I vs. II
II is hypomanic + depressive.
Cyclothymic
Dysthymia and hypomania. At least TWO YEARS.
Major depressive disorder criteria
At least 5/9 for TWO WEEKS. SIG E CAPS - Sleep disturbance, loss of Interest, Guilt/feelings of worthlessness, Energy loss/fatigue, Concentration problems, Appetite/wt changes, Pyschomotor retardation or agitation, Suicidal ideations.
Depression –> what sleep changes?
Decreased slow-wave, decreased REM latency, increased REM early in sleep, increased overall REM, repeated nighttime awakenings, EARLY-MORNING wakening
Dysthymia
TWO YEARS
Atypical depression
Mood reactivity, reversed vegetative symptoms (hypersomnia and weight gain), leaden paralysis, long-standing interpersonal rejection sensitivity
Three types of postpartum mood
Within 4 weeks of delivery. “Blues” (50-85% incidence) characterized by depressed affect, tearfulness, fatigue starting 2-3 days after. Usually resolves in TEN DAYS. Tx = supportive. Postpartum depression (10-15% inc.), depressed, anxiety, poor concentration lasting TWO WEEKS to a YEAR. Pyschosis usually lasting 4-6 weeks..
Pathologic grief
Longer than SIX-TWELVE months. Normal grief - shock, denial, guilt, somatic, simple hallucinations.
Adverse effects of ECT?
Disorientation, temporary HA, partial anterograde /retrograde amnesia usu. fully resolving in 6 months
Panic disorder
Intense fear and discomfort peaking in 10 minutes w/ at least four: Palps, Parasthesias, And distress, Nausea, Intense fear of dying/loss of control, light headedness, CP, Chills, Choking, disconnectedness, Sweating, Shaking, SOB. Tx = CBT, SSRI, venlafaxine, Benzos. Dx requires an attack AND FEAR of attack for 1 month
GAD criteria
At least SIX MONTHS. Associated with sleep disturbance, fatigue, GI, difficulty concentration. Tx = SSRIs, SNRIs, buspirone, CBT
Adjustment disorder
LESS than SIX months.
OCD vs. OCPD
OCD is “Ego-dystonic” meaning that obsessions are INCONSISTENT with beliefs. Whereas OCPD are ego-tonic. Tx OCD with SSRIs and clomipramine
PTSD
Persistent re-experiencing > ONE MONTH. Tx = psych, SSRIs. Acute stress disorder is 3 days to 1 month.
Unexplained symptoms or complaints with a conscious attempt to deceive
If for SECONDARY gain = malingering. If chief goal is psychological (PRIMARY) = factitious disorder (where complaints continue even after gain)
Munchausen syndrome
CHRONIC factitious disorder w/ predominantly physical signs and symptoms. Multiple admission, willingness to undergo procedures.
Somatic symptom disorder vs. conversion disorder
Somatic symptom - varied complaints lasting months to years usu. associated with excessive thought and anxiety. Conversion - SUDDEN loss of sensory or motor function often following stress; pt aware but indifferent (la belle indifference)
Personality disorder vs. trait
Disorder is inflexible, maladaptive, rigid pattern of behavior causing distress and impaired f(x). Pt usually NOT aware.
Avoidant vs. dependent vs schizoid personality disorder
Avoidants are sensitive to rejection, desire relationships, feel inadequate. Dependents are submissive, CLINGY, need to be taken care of. Schizoids are VOLUNTARY social withdrawal and content with isolation.
Histrionic vs narcissitic personality disorder
Histrionic - excessive emotionality and excitability, attention seeking, sexually provocative, appearance. Narcissitic = sense of ENTITLEMENT, lacks empathy, demands “the best.”
Anorexia nervosa vs. Bulimia nervosa
Anorexia - Excessive dieting +/- purging, intense fear of gaining weight, body image distortion, and increase exercise (BMI < 18.5). Dec. bone density - metatarsal stress fx, amenorrhea, lanugo, anemia, electrolyte disturbances. Bulimia has BINGE eating +/- purging. Parotitis, enamel erosion, electrolyte distruabcnes, alkalosis, dorsal hand calluses (Russel)
Sleep terror
Terror w/ screaming at night. non-REM (so no memory of arousal). slow-wave sleep
Narcolepsy cause
Caused by decrease OREXIN production in lateral hypothalamus.
Substance use disorder criteria
Two or more in ONE year: tolerance, withdrawal, larger amounts than desired, persistent dire to cut down, sig energy, important f(x) down, continued use, craving, recurrent use in physically dangerous situations, failure to fulfill obligations, conflicts
Six stages of overcoming addiction
Pre-contemplation, contemplation, preparation/determination, action/willpower, maintenance, relapse
Opioid intoxication vs. withdrawal
Intox - Pinpoint pupils, CNS depression, dec. gag, sz (Tx = naloxone or naltrexone). Withdrawal - sweating, dilation, piloerection, fever, thinorrhea, yawning, nausea, stomach cramps, diarrhea (Tx = support, methadone, buprenorphine)
Amphetamine withdrawal vs. cocaine withdrawal
Amph - anhedonia, increased appetite, hyper-somnolence, existential crisis. Cocaine - hyper somnolence, malaise, severe craving, depression/suicidality
Cocaine intox
Impaired judgment, pupils BIG, hallucinations, paranoid, angina, SCD. Tx = benzos
PCP tx
Benzos and rapid-acting anti-psychotic
Marijuana intoxication
Euphoria, anxiety, paranoid, perception of slowed time, impaired judgment, social withdrawal, inc. appetite, dry mouth, conjuctival inn, hallucinations
Treatments for heroin addiction
Methadone - long-acting oral opiate. Naloxone + buprenorphine - partial agonist. Naltrexone is a long-acting opioid antagonist used for relapse prevention once detox’d
DT’s time
2-5 days after last drink. Autonomic -> psychotic -> confusion. Tx = benzos
Neuroleptic malignant syndrome
Rigidity, myoglobinuria, autonomic instability, hyperpyrexia. Tx = dantrolene (binds ryanodine receptor to decrease intracellular Ca2+ = muscle relaxant), bromocriptine (DA agonist)
Chlorpromazine side effects?
Corneal deposits
Thioridazine side effects?
reTINAL deposits
Clozapine
May cause agranulocytosis (weekly WBC) and seizures
Risperidone side effects
Increased prolactin -> decreased GnRH, LH, and FSH (lactation, gynecomastia, irregular menstruation, fertility)
Ziprasidone side effects
Prolonged QT
Lithium side effects
Tremor, nephrogenic DI, hypothyroidism, pregnancy problems (Ebstein). Most is reabsorbed at PCT of kidney
Serotonin syndrome
Hyperthermia, confusion, MYOCLONUS, CV collapse, flushing, diarrhea, sz. Tx = cyproheptadine (5-HT2 receptor antagonist)
SNRIs
Venlafaxine and duloxetine. Inhibit 5-HT and NE reuptake. Venla used also for GAD and panic while duloxetine for diabetic peripheral neuropathy. Tox = HTN, stimulant, sedation nausea
TCA toxicities
Alpha-1 blocking (hypotension), antichol (tachy, urinary retntion, dry mouth, seen more in amitriptyline over nortriptyline). Cardiotoxicity (Tx = NaHCO3)
MAOi names
Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B)
MAOi
Increase NE, 5-HT, and DA. Tox = HTN, CNS stim, serotonin syndrome. Thought to be more useful for atypical depression (phenelzine and tranylcypromine; leaden, mood reactivity, rejection sensitivity, inc. sleep + appetite)
Bupropion
Antidepressant also used for smoking cessation. Increases NE and DA by unknown. SE - SEIZURE, stimulant, HA. No sexual side effects
Mirtazapine
alpha-2 antagonist (increased release of NE and 5-HT) and 5-HT2/3 antagonist. Tox = sedation, increased appetite and weight gain, dry mouth
Trazodone
Blocks 5-HT2 and alpha-1 adrenergic. Tox - priapism, sedation, nausea, postural hypotension
Globus pharyngis/hysteriucs
Feeling of lump in one’s throat. 45% of pop. gets at one point. Commonly triggered by emotions/stress.
