psychiatry Flashcards
operant conditioning
an action is elicited because it produces a reward
negative reinforcement (a type of operant conditioning)
target behavior is followed by removal of aversive stimulus
temporary but drastic change in personality, behavior, memory, consciousness to avoid emotional stress
dissociation
-extreme forms = multiple personality disorder
mother yells at children bc husband yelled at her
displacement: a transfer of emotions
projection
unacceptable internal impulse is attributed to external source
i want to cheat on wife, but I blame her for cheating on me
isolation (of affect)
seperate feeling from ideas/events
Don’t show emotion when describing trauma
conduct disorder
repetitive/pervasive violation of basic rights of others. After 18 -> antisocial personality disorder
oppositional defiant disorder
enduring hostile behavior toward authority figures
-no serious violation of social norms or disregard or basic rights of others
Tourette’s
onset before 18, often resolves by adulthood
persistant tic/stereotyped behavior >1yr
**assoc with OCD
tx; antipscychotics (antidopamine)
dvlpment 3months 6months 9months 12months 2yr 3yr
3mo social smile
6mo roll
9mo stranger anxiety
12mo: walk, separation anxiety, 1 word phrases, no babinsky, stack 3 blocks
2yr; 200words, 2 word phrases, 6 blocks
3yr; tricycle, pee at 3 (toilet training)
1 dimensional perception until about 7
severe language and poor social abilities
repetitive behaviors. focus on objects
usually below normal intelligence
Autistic disorder occasional savants (unusual abilities)
milder autism without verbal/cognitive deficits
all absorbing interests, repetitive behavior, problem with social relationships
Asberger’s disorder
stereotyped hand wringing in girls with regression of development
Rett’s disorder (x linked). boys die in utero
ADHD must start before when?
<12y/o
trichotillomania
hair pulling disorder to relieve anxiety
antisocial personality disorder
conduct disorder at age 18 and older (disregard for rights of everything)
binge eating vs bulimia disorder
binge eaters feel guilty but don’t purge or complensate (tend to become obese)
electrolyte distrubance of vomiting
hypokalemic hypochloremic metabolic alkalosis
vomit = HCL
exchange intracellular H+ for extracellulur K+ => hypokalemic
hypnogogic
hallucination while GOing to sleep
hypnoPOMPic
hallucination while awakening from sleep
sublimation
replace unacceptable wish with action similar but without conflict of your morals
“sex with wife when wanted sex with office worker”
or im anxious so I’m going to go run to get it out
fixation
partially remaining at childhood lvl of development (men and sports games)
hallucination vs illusion
hallucination is seeing what’s not there
illusion is interpreting erroneously something that is there (tree branch is an arm!!!)
visual vs auditory hallucinations in psychosis associated with disease
visual more common with medical illness
auditory more common with psychiatric (schiz)
formications
sensation of ants crawling on you
formic = ant. formic acid is in ant bites
schizophrenia vs schizoaffective vs brief psychotic disorder vs schizophreniform
schizophrenia: at least 1 + and 1 + or - symptoms for >6months AND a coinciding social/occupational dysfunction
brief psychotic disorder: 6mo
Schizaffective: 2 wks without mood disorder (depression/bipolar) concurrently
schizoid
schiZOID aVOID; go live in cabin
voluntary withdrawal
NOT PART OF SCHIZOPHRENIA progression
schizotypal
may avoid, but also with strange behavior/thinking. may be a palm reader bc believes self is clarvoyant
NOT PART OF SCHIZOPHRENIA progression
delusional disorder
> 1month but functioning otherwise NOT impaired
Folie a deux if shared: “madness shared by 2”
paranoia but doesn’t inhibit functioning
positive symptoms
negative symptoms
1 is required
- hallucinations
- delusions
- disorganized speech
grossly disorganized or catatonic behavior (immobile/unresponsive behavior)
NEG = diminished emotional expression or avolition
flat affect, social withdrawal, lack of motivation, lack in speech/thought, alogia (poverty of speech= lack of unprompted speech), avolition
mania
symptoms >1 week
impairment of social/occupational abilities
3+/7 symptoms DIGFAST
distractibility
irresponsible activities with high potential for consequence
grandiosity or inflated self esteem
flight of ideas or subjectively thoughts racing
activity increased/agitation, goal or nongoal oriented
sleep (need less)
talkative and or pressured speech
hypomania (>4 days); less severe
-not total loss in social/occupational ability
bipolar I
bipolar II
cyclothymic disorder
bipolar I: at least 1 manic episode, depressive and hypomania not required
bipolar II: hypomanic episode and a depressive episode required, there is NO MANIC episode
In all reality, eventually everyone has a depressive disorder in bipolar
Cyclothymic: hypomania, dysthmia >2 years: more mild.
-normal mood
SSIGECAPS
5/9 >2wks major depression *sadness Sleep disturbance *Interest loss (anhedonia) guilt energy decrease concentration decrease appetite change psychomotor changes (slowing agintation) SI
- one is required
obsession and compulsion in OCD
obsession is an intrusive thought that cannot be controlled
compulsion is the act of fulfilling the obsession in order to relieve it
PTSD
must last >1 month, can begin whenever nightmare, hypervigilence, ect. -hyperarousal -intrusion recolection of trauma -efforts to avoid recollection
if
generalized anxiety disorder
must last >6 months
3+ symptoms
vs adjustment disorder: <6mo, following identifiable psychosocial stressor (divorce)
personality trait vs disorder
disorder is a problem, trait is intrinsic pattern
they don’t recognize disorder
cluster A personality
paranoid: often projection
schizoid: avoid/distant
schizotypical: eccentric, magical belief,
but no psychosis
cluster B (in B movies)
DRama
antisocial -> >18y/o conduct disorder (sociopath)
borderline: unusual moods, manipulative, trouble with relationships (splitting)
histrionic: excessive emotion, attention seeking, provacative/sexual, overly interested with appearance
narcissistic: grandiosity, sense of entitlement, without empathy. is the “best”, and doesn’t like criticism
Cluster C (c’s)
avoidant: coward, desire of relationships with others, but don’t, and feel lonely (like ppl)
obsessive-compulsive: unaware of disorder, as opposed to legit OCD. compulsive
dependent: clingy
***NOT AWARE OF THE DISORDERS
undoing
a form of ego defense = confession
fine motor
2, 3,4,5 y/o
line, circle, square, triangle
language 1,2,3,4,5 years
1,2,3,4,5 word sentances
transference
patient projects feelings from another important person onto physician. ie. psychiatrist is seen as parent
“if parent wasn’t there for the person as a child, then if the psychiatrist has to cancer the patient will be like… you’re never here for me.”
atypical depression
a subtype of major depression
mood reactivity (can improve mood with positive events, vs major depression is no change)
hypersomnia and weight gain
leaden paralysis (heavy arms and legs)
Tx; unique bc use MAOi’s with SSRI’s
Paranoid
pervasive distrust
delusion unrealistic but possible
FBI is following me, vs FBI has transmitters in my teeth
Avoidant
Desire social interaction but hypersensitive to rejection, and is timid; feelings of inadequacy
Schizotypal
truly believes in their magical beliefs
palm readers, tarot card readers
Identification
Abused child abuses children
loved by mother, becomes loving mother
identify with persons from youth
Rationalization
claiming a logical reasons for something when its actually the result of something else
Getting fired, didn’t like job anyway
Reaction formation
You do the opposite of what you want to do
You are angry so you act super nice
Repression vs Suppression
Repression is involuntary avoidance of feelings, Suppression is voluntary withholding of bad feelings.
chlorpromazine
thioridazine
-zine = traditional low potency neuroleptics
low potency antipsychotics (neuroleptics)
-high anticholinergic SE
-antidopaminergic (D2) in mesolimbic area
-antiadrenergic
USE: Schizo
- *every other traditional neuroleptic is high potency with fewer anticholinergic SE, but increased extrapyramidal effects/tardive dyskinesia
- *SE neuroleptic malignant syndrome
“Cheating Thieves are LOW”
High potency traditional neuroleptics (3)
“Try Fly High”
trifluoperazine
fluphenazine
haldol (Frequent EPS)
MOA: anti D2 receptor
antipsychotics, mostly of positive symptom control
SE: Extrapyramidal rxn, neuroleptic malignant syndrome
extrapyramidal side effects antipsychotics
MORE in TYPICALS
hrs: acute dystonia (muscle spasm, stiffness, oculogyric crisis(upward deviation of eyes)
days: akathisia (restless) 20-75% prevalence, tx with B-blocker
wks: bradykinesia (parkinsonism), resting tremor
months: tardive dyskinesia )smack lips, stereotyped facial movements
clozapine
MOA: complicated; anti dop, antiadren, antiserotonin
USE: schizo(helps + and - symptoms), bipolar, ocd, works to decrease/suppress tardive dyskenesia
SE: *agranulocytosis (1% incidence, weekly WBC monitoring), seizures (10% incidence), weight gain, dyslipidemia, DM II, hypotension; less EPS and anticholinergic than traditionals but still quite anticholinergic
olanzapine is another atypical that treats + and - symptoms
**Clozapine is the gold standard for TREATMENT RESISTANT schizophrenia, must fail 2 antipsychotics prior to use
risperidone- Risperdal
atypical antipsychotic
USE: less sedation than other neuroleptics
SE: less extrapyramidal and anticholinergic, weight gain, dyslipidemia, DM II
**Orthostasis, maybe more EPS than other atypicals
olanzapine- Zyprexa
atypical antipsychotic
Treats + and - symptoms (only one other than cloazapine)
SE: less extrapyramidal and anticholinergic,weight gain, dyslipidemia, DM II
**Weight Gain, prolactin increase
quetiapine- Seroquel
atypical antipsychotic
SE: less extrapyramidal and anticholinergic, weight gain, dyslipidemia, DM II
**Weight Gain, Sedation, Anxiety
aripiprazole- Abilify
3rd generation atypical antipsychotic
SE: less extrapyramidal and anticholinergic, weight gain, dyslipidemia, DM II
**Nausea, Anxiety, Insomnia
ziprasidone - Geodon
atypical antipsychotic
SE: less extrapyramidal and anticholinergic, little weight gain, dyslipidemia, DM II
paliperidone - Invega
atypical antipsychotic
SE: less extrapyramidal and anticholinergic, weight gain, dyslipidemia, DM II
neuroleptic malignant syndrome
from traditional antipsychotics
rigidity, myoglobinuria, autonomic instability(tachycardia), hyperpyrexia, rhabdomyolisis
tx; dantrolene or d2 agonist
What SE profile do you need to monitor for atypical antipsychotics?
weight gain, dyslipidemia (lipid profile), DM II (BGL)
Lithium
Mood Stabilizer, only med proven to acutely decrease suicide rates
USE: Bipolar disorder (>12y/o, if children decreased GFR can raise lithium to toxic lvls (Ibuprofen/ARB/ACEi)
delusional disorder
symptoms of persistent delusion >1month without other psychotic symptoms
Tx; antipsychotics (not that helpful with delusional disorder) and psychosocial
Schizoaffective disorder
Schizoaffective disorder is essentially schizophrenia with manic episodes or a significant depressive component.
●The difference between mood disorders with psychosis and schizoaffective disorder is the timing of symptoms. In schizoaffective disorder, psychosis can and does occur in the absence of a mood episode (2wks minimum); in psychotic mood disorders the psychosis is only observed in the presence of a mood episode
Clonazepam (klonipine)
MOA: unknown, GABA-like action
USE: seizures, panic attacks
Carbamazepine
MOA: unknown Use: Epilepsy: partial/generalized/mixed Trigeminal neuralgia Bipolar disorder I, acute mania
SE: sjs, aplastic anemia, neural tube defects
Bupropion
MOA: NDRI (norepi dopamine reuptake inhibitor)
USE: antidepressant, smoking cessation
SE: seizures, NO SEXUAL Dysfunction, stimulant
Do tricyclic SE include sexual dysfunction?
yep.
tricyclic antidepressant
MOA: block NE/serotinin
USE: major depression, bedwetting, ocd (clomipramine esp in drug abuse d/o), fibromyalgia
3C’s
- cardiotoxicity (tachy, hypotension
- cns (obtundended, coma, seizure)
- antiCholinergic (mydriasis, pyrexia, anhidrosis)
- hyperpyrexia
- respiratory depression
tx overdose with benzo and bicarb
*imipramine, desipramine (10% caucasians poor metabolizers), amitriptyline, nortriptyline (10% caucasians poor metabolizers)
What two antipsychotics ameliorate negative symptoms of schizophrenia on top of the normal + symptom control.
Clozapine and Olanzepine
Trazodone
MOA: SSRI, and blocks H-1 and Alpha-1 Receptors
USE: Major Depression D/o, Insomnia
SE: priapism (1:10,000 -> discontinue),
TCA overdose
1) severe toxicity
2) death
TCA severe toxicity by 1gram (as little as 700mg)
Death usually 2-3grams
Serotonin syndrome (overdose SSRI)
S/s
hyperthermia, hyperreflexia, myoclonas, diarrhea, flushing, autonomic instability (tachycardia)
1) Benzos + supportive care
2) Cyproheptadine (serotonin antagonist), not used that much
Cyproheptadine
MOA: Serotonin Antagonist
USE: Seroronine syndrome, reverse negative effects of SSRI’s
Chance of relapse depression if you’ve had one episode?
> 50%
Valproic Acid
Divalproex
BLocks NA channels (prevent depolarization and increase refractory period
USE: Generalized seizures, 2nd for absence seizure, mania
SE: hepatotoxic, spina bifida/neural tube defects
Best way to check for tricyclic overdose
QRS prolongation
Venlafaxine
MOA: SNRI
USE: Generalized anxiety, Major depressive disorder, panic disorder, social phobia
SE
What psych meds inhibit P450 system and can affect INR with coumadin admin
SSRI’s: esp sertraline (zoloft), paroxetine, fluvoxamine
Clonidine
MOA: Alpha 2 agonist
USE: Essential htn
-off label; ADHD (esp hyperactivity), tics
What meds reduce REM sleep and can be used for cataplexy?
Brainstem circuits that generate REM sleep are strongly inhibited by norepinephrine and serotonin. Thus, drugs that increase noradrenergic and serotonergic signaling suppress REM sleep and reduce cataplexy
Antidepressants: SSRI’s, MAOi’s, TCA’s
