Psychiatry Flashcards
Positive vs Negative Reinforcement:
Positive: desired reward produces action (ie mouse presses button to get food)
Negative: removal of aversive stimulus elicits behavior (ie mouse presses button to avoid shock)
Transference:
patient projects feelings about an important person in life onto physician (like saying that the psychiatrist = parent)
Counter-transference:
physician projects feelings about important people in life onto patient
Acting out:
- immature defense
- ->like tantrums; unacceptable feelings and thoughts are expressed through actions
Dissociation:
–>seen in Multiple Personality Disorder (Dissociative Identity Disorder)
–>In order to avoid emotional distress, have rapid, temporary, drastic changes in personality, memory, consciousness, behavior…
Displacement:
avoided ideas and feelings are transferred to a neutral person or object
–> like a mother placing blame on child, when really she is angry at her husband
Projection:
unacceptable personal internal impulse is attributed to an external souce
–>like a man who wants another woman thinks his wife is cheating on him
Fixation:
Partially remaining at more childish level of development
–>like a man who fixates on sports games; or maybe a man who fixates on comic books and superhero movies…
Identification:
modeling behavior after another person who is more powerful (not necessarily an admired person though)
–>like an abused child identifying as an abuser (abusing others…)
Isolation of effect:
separation of feelings from ideas and events
–>like describing murder in detail without an emotional response; or maybe war veterans having no emotions when talking about war
Rationalization:
finding logical reasons for actions that were actually performed for other reasons, to avoid self-blame
–>like after getting fired from a job, person claims that job was not important anyway
Reaction formation:
–>process where a warded-off idea or feeling is unconsciously replaced by an emphasis on its opposite
–>like a person with lots of sexual drive entering a monastery
Regression:
–>turning back maturational clock and dealing with world immaturely
–>like a child bedwetting after previously being toilet-trained, when under stress (like if ill, hospitalized, punished, birth of new sibling…)
Repression:
–>involuntary withholding idea/feeling from conscious awareness
–>like not remembering a traumatic/conflictual experience; push bad thoughts in unconscious
Splitting:
- ->seen in Borderline Personality Disorder
- belief that people are either all-good or all-bad at different times
Which immature defense is seen in dissociative identity/multiple personality disorder?
–>Dissociation
Which immature defense is seen in Borderline pts?
–>Splitting
List the 4 mature defenses:
“a Mature woman wears a SASH”
- Sublimation
- Altruism
- Suppression
- Humor
Sublimation:
- ->mature ego defense
- replacing an unacceptable wish with actions that are similar to the wish, but don’t conflict with values
–>like a person’s feelings of aggression redirected to perform well in sports
Altruism:
–>a mature ego defense
-guilty feelings alleviated by unsolicited generosity towards others
–>ie mafia boss making large donation to charity; or former alcoholic who got in an accident while drunk-driving going around talking to teens about risks of drinking and driving…
Humor:
- ->mature ego defense
- finding amusement in anxiety-provoking situations
- ->med students joking about the boards
Suppression:
- ->mature ego defense
- voluntary withholding idea/feeling from conscious awareness (vs repression, which is unconscious)
–>ie choosing not to think about USMLE scores after the exam, b/c nothing you can do about it :)
Effects of infant deprivation:
- Weak (decreased muscle tone)
- poor language and socialization skills
- lack of trust
- Anaclitic depression (from separation from caregiver)
- weight loss
- physical illness
Consequences of of prolonged infant deprivation:
- Deprivation > 6months –> can be irreversible
* Severe deprivation can result in infant death
Who is usually the abuser in:
- physical abuse?
- sexual abuse?
- ->physical abuse: abuser is usually female and primary care giver
- ->sexual abuse: abuser is usually male and known to victim
methylphenidate
=Ritalin
–>treatment of ADHD
Atomoxetine
- ->non-stimulant SNRI
- ->can be used to treat ADHD
Treatment options for ADHD:
- methylphenidate (Ritalin)
- amphetamines (ie Dexedrine)
- Atomoxetine (non-stimulant SNRI)
Age of onset of ADHD?
onset before age 7
Oppositional Defiant Disorder:
-childhood disorder:
–>hostile, defiant behavior towards authority figures, but don’t really violate social norms (like disregard authority, but not the rights of others… unlike conduct disorder)
Tourette’s syndrome:
- Dx criteria (timing)?
- associated with what other condition?
- treatment?
- onset before age 18, lasts >1 year
- Coprolalia = obscene speech –> only in about 20% of pts
- associated with OCD
- treat with Haloperidol (anti-pyschotics)
Typical age of Separation Anxiety Disorder:
- ->common onset = 7-9 years old
- ->may lead to factitious physical complaints to avoid going to school
Intelligence in Autism disorder:
below normal intelligence; but may rarely be accompanied by unusual abilities
girl, a few years old, regresses in development, and constant hand-wringing?
Rett’s disoder
- ->autosomal dominant X-linked disorder (boys die in utero or shortly after birth)
- -> symptoms usually start between 1-4 years old; pt regresses from how was: loss of development, loss of verbal abilities, develops mental retardation, ataxia, and stereotyped hand-wringing
Boy, 3-4 years old, after at least 2 years of normal development begins regressing in development/skills:
Childhood Disintegrative Disorder
- ->more common in boys; onset 3-4 years old
- ->Loss of expressive or receptive language skills, social skills, adaptive behavior, bowel or bladder control, play, motor skills
Neurotransmitter changes seen in Anxiety:
- Increased NE
- Decreased GABA
- Decreased Serotonin
Neurotransmitter changes seen in Depression:
- Decreased NE
- Decreased Serotonin
- Decreased Dopamine
Neurotransmitter changes seen in Alzheimer’s?
-Decreased ACh
Neurotransmitter changes seen in Huntington’s?
- Decreased ACh
- Decreased GABA
- Increased Dopamine
Neurotransmitter changes seen in Schizophrenia?
-Increased Dopamine
Neurotransmitter changes seen in Parkinson’s?
- Decreased Dopamine
- Increased ACh
- Increased Serotonin
In terms of a person’s orientation to person, time, and place - what is the order of loss (what orientation factors are lost first, if lose orientation)?
First –> lose time
Then –> lose place (where one is)
Last –> lose person (knowing who self is)
Korsakoff’s amnesia:
- ->from Thiamine deficiency and the destruction of mammillary bodies
- ->anterograde amnesia (can’t form new memories); sometimes may have some retrograde amnesia too (also, associated with personality change and confabulations)
Dissociative amnesia:
–>can’t remember important personal details; usually after trauma or stress
Delirium vs Dementia:
- Onset?
- Consciousness?
- Course?
- Prognosis?
- Type of memory Impairment?
- EEG?
- Common causes?
- Delirium:
- Acute onset
- Impaired consciousness
- Fluctuating symptoms
- Reversible
- Global memory impairment
- Abnormal EEG
- usually secondary to other illnesses (ie UTIs, etc) or Drugs (ie anti-cholinergic side effects)
- Dementia:
- Gradual onset
- Intact consciousness
- Progressive decline in symptoms
- Irreversible
- Remote memory spared (remember certain things)
- Normal EEG
- Common causes: Alzheimer’s, cerebral infarcts, HIV, Pick’s disease, CJD…
Pseudodementia:
–>Elderly pts; depression may present like dementia (pt is aware of memory loss, losing stuff, etc though; whereas in real dementia, pt is unaware of these things)
A reversible cause of dementia in elderly (and why it’s so important to do a head CT in cases of dementia):
Normal pressure hydrocephalus: “wet, wobbly, and wacky” (incontinence + ataxia + dementia)
–>expansion of ventricles; but, NOT an increase in subarachnoid space
Causes of visual Hallucinations:
- ->usually associated with medical illnesses (not psychiatric), like d/t drug intoxication
- ->see in Lewy Body dementia
Cause of auditory hallucinations?
–>usually feature of psychiatric illness, ie schizophrenia
Cause of olfactory hallucinations?
- ->may be part of aura before seizure
- ->brain tumors
Causes of tactile hallucinations (feeling something on skin)?
- Alcohol withdrawal–> formication = sensation of insects crawling on skin
- Cocaine abusers (“cocaine bugs”)
What drug use in teens is a risk factor schizophrenia?
Marijuana
Timing of:
- Schizophrenia
- Schizophreniform disorder
- Brief psychotic disorder
- Schizophrenia: > 6 months
- Schizophreniform: 1-6 months
- Brief psychotic disorder: < 1 month (usually stress related)
Dx criteria of schizophrenia:
> 6 months
- at least 2 of following:
1) Delusions
2) hallucinations (usually auditory)
3) Disorganized speech (loose associations)
4) Disorganized or catatonic behavior (catatonia = either extreme loss of motor skills, like holding a position for a while, or maybe constant hyperactive motor activity)
5) Negative symptoms: - flat affect (no emotional expression)
- social withdrawal
- lack of motivation
- lack of speech or thought
***Note: increased risk for suicide in schizophrenic pts.
5 subtypes of schizophrenia:
1) Paranoid (delusions)
2) Disorganized (speech, behavior, affect)
3) Catatonic (automatisms)
4) Undifferentiated (elements of all types)
5) Residual (positive symptoms present, but at low intensity)
Schizoaffective Disorder:
at least 2 weeks of a stable mood (not elevated or depressed), but have psychotic symptoms during those 2 weeks; and,also periods of mood disorder (depressive, manic, or both/mixed) with psychosis (can either be bipolar or depressive = 2 subtypes)
How long must a person have delusions in delusional disorder?
at least 1 month
–>pt has strange belief/delusion (ie a woman who thinks she’s married to a celebrity, but is not); but, can otherwise function normally
Dissociative Identity Disorder: What past history may be common to pts?
This is multiple personality disorder (former name)
–>associated with history of sexual abuse
*pts have at least 2 distinct identities/personality states
Dissociative fugue:
Abrupt change in geographic location + inability to remember past, confused about personal identity, assume new identity
–>associated w/traumatic experiences (like war, natural disasters, etc)
Dx of a manic episode:
*lasts at least 1 week (note, mood may be elevated, expansive, or irritable)
- at least 3 of following: “DIG FAST”
1) Distractibility
2) Irresponsibility (seeks pleasure, disregard of consequences)
3) Grandiosity (inflated self esteem)
4) Flight of ideas (racing thoughts)
5) increased Activity and Agitation
6) Talkativeness
Bipolar disorder:
- Dx criteria?
- Trtmnt?
*at least 1 manic or hypomanic episode and eventually depressive mood; with normal mood in between episodes
- Treatment:
- NOT antidepressants (b/c can lead to increased mania)
- Mood stabilizers (lithium, valproic acid, carbamazepine)
- Atypical antipsychotics
***note: increased risk of suicide in bipolar pts
Cyclothymic disorder:
–>milder form of bipolar disorder that lasts at least 2 years
(dysthymia (=mild depression) + hypomania (= mild manic episode))
Major Depressive Disorder:
-Dx criteria?
*lasts at least 2 weeks
- Must include patient reported depressed mood or Anhedonia (loss of interest) + at least 5 of following 9 symptoms: “SIG E CAPS”
1) Sleep disturbances
2) loss of Interest in things that used to be pleasurable (anhedonia)
3) Guilt, or feelings of worthlessness
4) loss of Energy
5) loss of Concentration
6) Appetite/weight changes
7) Psychomotor retardation or agitation
8) Suicidal ideations
9) Depressed mood
Dysthymia:
–> milder form of depression (like at least 2 of depression criteria); lasts at least 2 years
Atypical Depression:
- hypersomnia (sleep lots)
- overeating (weight gain)
- mood reactivity (pt can experience improved mood in response to certain positive events)
Pospartum: “blues” vs depression vs psychosis:
- “blues” –> resolve within 10 days (follow up with pt though, to make sure it’s not depression); no trtmnt, just supportive
- depression –> lasts at least 2 weeks; treat with anti-depressants, therapy
- psychosis –> rare; lasts days to 4-6 weeks; treat with antipsychotics, antidepressants, possible hospitalization
Risk factors for committing suicide (suicide completion):
“SAD PERSONS”
- Sex (male)
- Age (teenagers or elderly)
- Depression
- Previous attempts
- Ethanol or drug use
- loss of Rational thinking
- Sickness (medical illness; multiple prescription meds)
- Organized plan how to commit suicide
- No spouse (divorced, widowed, single, childless)
- Social support lacking
***Men commit suicide more often, though women try more.
Treatment of social phobia (ie public speaking, using public restrooms…):
SSRIs
Agoraphobia:
Anxiety in an environment where person thinks it will be difficult or embarrassing to escape
–>it’s a subset of panic disorder
Treatment options for Panic Disorder:
- CBT
- SSRIs
- TCAs
- Benzos
Treatment for specific phobias?
–>systemic desensitization
What other psych disorder is OCD associated with?
–>Tourrettes
Treatment for OCD?
- SSRIs
- Clomipramine (TCA)
Timing of Acute Stress Disorder vs PTSD?
- Acute Stress Disorder: 2 days to 1 month
* PTSD: lasts at least 1 month; onset of symptoms may begin any time after event
Dx criteria of Generalized Anxiety Disorder:
- At least 6 months
* Anxiety is unrelated to specific person, situation or event
Adjustment Disorder: Dx criteria?
- ->anxiety, depression causing impairment after an identifiable stressor (ie divorce, illness)
- ->lasts LESS than 6 months (or more than 6 months if the stressor is chronic)
Malingering:
- ->pt CONSCIOUSLY fakes or claims to have a disorder in order to get a specific secondary gain (ie skip work, get meds)
- ->don’t comply with trtment, follow-up with dr, etc
- ->complaints stop after get gain
Factitious Disorder:
–>Pt CONSCIOUSLY creates physical/psych symptoms in order to be “sick” and get medical attention (motivation is unconscious though)
***unlike Malingering, in Factitious complaints continue even after getting the gain…
***Munchausen’s and Munchausen’s by proxy are both Factitious disorders
Munchausen’s syndrome and Munchausen’s syndrome by proxy:
–>Both are Factitious Disorders:
- Munchausen’s: Chronic factitious disorder; hx of lots of hospital admissions, procedures…
- Munchausen’s by proxy: caregiver makes child sick; form of child abuse
Somatoform disorders, generally:
physical symptoms but no identifiable physical cause
–> pt UNCONSCIOUSLY produces symptoms and with UNCONSCIOUS motivation
- Includes:
- Somatization disorder
- Conversion
- Hypochondriasis
- Body dysmorphic disorder
- Pain disorder
Somatization disorder:
- ->type of somatoform disorder
- over several years, pt presents with multiple organ system complaints, but no identifiable physical cause (at least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic symptoms)
Conversion disorder:
- ->sudden loss of sensory or motor function (like sudden blindness) after an acute stressor
- ->pt is aware, but indifferent to symptoms (la belle indifference)
Cluster A Personality Disorders:
–> Weird, odd, eccentric:
- Paranoid
- Schizoid
- Schizotypal
Schizoid Personality Disorder:
- ->VOLUNTARY social withdrawal; content with social isolation
- a type A PD
Cluster B Personality Disorders:
- -> Wild, Dramatic, Emotional, Erratic
- -> genetic associations with mood disorders and substance abuse
- Antisocial
- Borderline
- Histrionic
- Narcissistic
Cluster C Personality Disorders:
- ->Worried, anxious, fearful
- -> genetic association with anxiety disorders
- Avoidant
- Obsessive-Compulsive
- Dependent
Avoidant PD:
–>WANTS relationships with others (as opposed to schizoid PD); but, hypersensitive to rejection, timid, feel inadequate, etc
-a cluster C PD
Russel’s sign:
seen in Bulemic pts; dorsal hand calluses from inducing vomiting
List drugs that are depressants:
- general symptoms of intoxication?
- general withdrawal symptoms?
- Alcohol
- Opiods (morphine, heroin, methadone…)
- Barbiturates
- Benzodiazepines
- Nonspecific intoxication symptoms: elevated mood, decreased anxiety, sedation, behavior disinhibition, respi depression
- Nonspecific withdrawal: anxiety, tremors, seizures, insomnia
List drugs that are stimulants:
- nonspecific intoxication symptoms:
- nonspecific withdrawal symptoms:
- Amphetamines
- Cocaine
- Caffeine
- Nicotine
- nonspecific intoxication: elevated mood, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety
- nonspecific withdrawal: post-use “crash” with depression, lethargy, weight gain, headache
List drugs that are hallucinogens:
- PCP = Phenylcyclidine
- LSD
- Marijauna
Constipation, pupillary constriction (pinpoint pupils), seizures, CNS depression, nausea, vomiting:
–>Opioid intoxication (morphine, heroin, methadone, etc…)
***overdose can be fatal (treat OD with Naloxone, Naltrexone)
Flumazenil
–>Treatment for Benzo overdose (competitive GABA antagonist –> blocks GABA!)
Pupillary dilation, tactile hallucinations (or other hallucinations), paranoid thoughts, angina, sudden cardiac death
Cocaine intoxication
–>treat cocaine OD with Benzos
Pupillary dilation, prolonged wakefullness and attention, delusions, hallucinations, fever:
Amphetamine intoxication
Belligerence (violent!!), impulsiveness, vertical and horizontal nystagmus, delirium, psychosis, homicidality, tachycardia:
PCP (Phenylcyclidine) intoxication
–>PCP inhibits the NMDA receptor (glutamate receptor)
Pupillary dilation, flashbacks (perhaps long after drug use), visual hallucinations, anxiety or depression:
LSD intoxication
Conjunctival injection, rapid HR, dry mouth, increased appetite, paranoia
Marijuana intoxication
Treatment for Cocaine OD?
–>Benzos
Treatment for Benzo OD?
Flumazenil
Treatment for Opioid (ie heroin) OD?
–>Naloxone or Naltrexone
Dilated pupils, sweating, piloerection (if quit “cold turkey”), rhinorrhea, flu-like symptoms: d/t withdrawal from which drug?
–>Opioids withdrawal (ie heroin, methadone, morphine; can also get these symptoms from chronic prescription narcotics, like in cancer pts)
Methadone:
->long-acting oral opiate; used for heroin detox and long-term maintenance; but, can have opioid withdrawal symptoms.
Intoxication with which drugs will cause pupillary dilation?
- Amphetamines
- Cocaine
- LSD
–> Also: anti-cholinergics (ie Atropine) causes midriasis
Intoxication with which drugs will causes pupillary constriction?
-Opioids (ie heroin)
–> Also: cholinergic-agonists (ie organophosphates) cause miosis!
Intoxication with which drug may cause violence/belligerence?
–>PCP (phenylcyclidine)
Sublaxone:
= Naloxone + Buprenorphine (partial opioid agonist) –> can be used to treat heroin addiction; long-acting and fewer withdrawal symptoms than Methadone (b/c Naloxone is not active when taken orally, so only get withdrawal symptoms if it’s injected; so has a lower abuse potential)
Treatment of Wernicke-Korsakoff syndrome:
IV vitamin B1 (Thiamine)
Treatment of Alcoholism:
- Disulfiram (so pt feels sick when drinks alcohol)
- supportive care, AA, etc
Alcohol withdrawal symptoms?
–>treatment?
- Delirium Tremens –> get it 2-5 days after last drink:
- tachycardia, tremors, anxiety, seizures
- hallucinations, delusions
- confusion
*note: alcohol withdrawal can be fatal!
***Treat with Benzos!
Treatment for Bulimia?
SSRIs
Treatment for Atypical depression:
- MAO inhibitors
- SSRIs
Treatment for Depression:
- SSRIs, SNRIs
- TCAs
Treatment for Depression with Insomnia?
Mirtazapine
–>alpha-2-blocker (increases release of NE and serotonin) and serotonin receptor-blocker
Clomipramine
TCA used to treat OCD (along with SSRIs)
Treatment for Panic Disorder:
- SSRIs
- TCAs
- Benzos
Treatment for PTSD:
-SSRIs
Treatment for Tourette’s:
-antipsychotics (haloperidol, respiridone)
Treatment for scoial phobias:
-SSRIs
Methylphenidate and amphetamines:
- clinical uses?
- mechanism?
- ->used to treat Narcolepsy, ADHD…
- ->increase catecholamines (esp NE and Dopamine) at synaptic cleft
Mechanism of typical antipsychotics:
–>block D2 receptors (get increased cAMP)
List the typical antipsychotics:
- Haloperidol + drugs ending in “-azine”
- Trifluoperazine
- Fluphenazine
- Thioridazine
- Chlorpromazine
Which typical antipsychotics cause neurological/extrapyramidal side effects?
- ->High potency antipyschotics: “Try to Fly High”
- Trifluoperazine
- Fluphenazine
- Haloperidol
Which typical antipsychotics cause not neurological, but anti-cholinergic, anti-histamine, and anti-alpha side effects? What are these side effects?
- Low potency antipsychotics: “Cheating Thieves are low”
- Chlorpromazine
- Thioridazine
*blurred vision, constipation, hypotension, sedation
Which antipsychotic may cause corneal deposits? Retinal deposits?
Corneal deposits–> Chlorpromazine
ReTinal deposits –> Thioridazine
–>both of these are low-potency atypical antipsychotics; have anti-cholinergic, anti-histamine, and alpha-blockade side effects (dry mouth, constipation, hypotension, sedation)
Neuroleptic Malignant Syndrome:
- cause?
- presentation?
- treatment?
- toxicity of typical antipsychotic meds; starts a few days after begin meds
- presentation = excess muscle contraction:
- rigidity
- myoglobinuria
- hyperpyrexia (very high temp)
- treatment:
- Dantrolene (prevents Ca release from sarcoplasmic reticulum)
- Bromocriptine (D2-receptor-blocker; used in Parkinson’s)
Tardive dyskinesia:
- cause?
- presentation?
- ->result of lont-term typical antipsychotic use
- ->stereotypical facial movements
- ->often irreversible
Atypical antipsychotics: list them!
“it’s Atypical for Old Closets to Quietly Risper from A to Z”
- Olanzapine
- Clozapine
- Quetiapine
- Risperidone
- Apiprazole
- Ziprasidone
Mechanism of atypical antispychotics:
–>not fully understood; effects on serotonin, dopamine, alpha, and histamine receptors
Olanzapine:
atypical antipsychotic that can be used to treat OCD, anxiety, depression, mania, Tourrette’s
Which class of anti-psychotic meds can treat both positive and negative symptoms of schizophrenia?
–>Atypical antipsychotics (typical primarily just treats positive symptoms)
Which antipsychotic may cause agranulocytosis?
–>Clozapine (atypical antipsychotic); must monitor WBC weekly in these pts
Which antipsychotics may cause significant weight gain?
- ->Olanzapine and Clozapine (both are atypical antipsychotics)
- so increased risk of developing DM
Which antipsychotic may prolong the QT interval?
(like Class IA and III antiarrhythmics!)
–>Ziprasidone
Apiprazole:
Atypical antipsychotic
Why may antipsychotics cause galactorrhea?
–>b/c block dopamine –> so less inhibition of prolactin by dopamine –> increased prolactin –> galactorrhea and amenorrhea (amenorrhea b/c prolactin inhibits GnRH, so get decreased LH and FSH –> decreased spermatogenesis and ovulation)
Risperidone:
atypical antipsychotic
Affect of lithium in bipolar disorder?
–>blocks relapse and acute manic attacks; stabilizes mood (so, acts on the mania, not the depression)
Lithium Toxicity:
“LMNOP”
- Lithium
- Movement (tremor)
- Nephrogenic DI (it’s an ADH-blocker, so causes polyuria; so, can be used to treat SIADH!)
- hypOthyroidism
- Pregnancy problems (teratogenic–> Ebstein anomaly and malformation of great vessels)
***Narrow Therapeutic Index, so must monitor pts closely!
Buspirone:
- mechanism?
- clinical use?
- ->stimulates serotonin receptors
- ->used to treat GAD (no addiction, sedation, tolerance)
TCA:
- Mechanism?
- Toxicity?
- Mechanism: block reuptake of NE and Serotonin
- Toxicity = Tri-C’s:
- Convulsions
- Coma
- Cardiotoxicity (arrhythmias)
- ->Also:
- anticholinergic side effects; can lead to confusion and hallucinations in elderly
- Sedation
Treatment for CV toxicity from TCAs?
–>NaHCO3
Which TCA should be used in elderly pts?
–>Nortryptiline (has fewer anti-cholinergic side effects, so better in elderly)
Imipramine:
–>TCA that is used to treat bedwetting
Clomipramine:
TCA used to treat OCD
Doxepin
TCA (that doesn’t end in -typtyline or -ipramine!
Amoxapine
TCA (that doesn’t end in -typtyline or -ipramine!
SSRI that can be used to treat premature ejaculation?
Paroxetine
List the SSRIs:
- Fluoxetines
- Paroxetine
- Sertraline
- Citalopram
Toxicity of SSRIs:
- sexual dysfunction –> anorgasmia (although Paroxetine can be used to treat premature ejaculation)
- GI distress
- Serotonin syndrome (hyperthermia, myoclonus, CV collapse, flushing, diarrhea, seizures)
Serotonin syndrome:
- cause?
- presenation?
- treatment?
- ->When have too much serotonin; like if combine an SSRI and an MAO, so get lots of serotonin!
- Presentation (think: lots of serotonin):
- diarrhea
- flushing
- seizures
- hyperthermia
- myoclonus
- CV collapse
*Treat with Cyproheptadine (an anti-histamine that is also a serotonin receptor blocker)
Venlafaxine
SNRI
–>can be used to treat depression, GAD
Duloxetine
SNRI
= “cimbalta”
–>treatment of depression, also can be used to treat diabetic peripheral neuropathy
Tanylcypromaine
MAO inhibitor
Phenelzine
MAO inhibitor
Mechanism of MAO inhibitors:
–>increased levels of NE, Serotonin, Dopamine
Selegiline
MAO inhibitor that is NOT used for depression; used to treat Parkinson’s
Isocarboxazid
MAO inhibitor
MAO inhibitors are contraindicated with:
- foods with high tyramine content (wine, cheese, etc) –> b/c can get hypertensive crisis (b/c tyramine can act as a catecholamine, so get a whole ton of catecholamine release –> INCREASED BP!!!!)
- Beta-agonists (can also lead to hypertensive crisis, b/c increased catecholamine action)
- SSRIs (can lead to serotonin syndrome)
- Meperidine (Opioid; can lead to serotonin syndrome)
Buproprion:
- atypical antidepressant
- no sexual side effects
- lowers seizure threshold (especially in bulemics, anorexics)
- unknown mechanism, but leads to increased NE and dopamine
- can be used for depression and also for smoking cessation
Mirtazapine:
- atypical antidepressant; good for depression with insomnia (b/c sedation = toxicity)
- alpha -2-antagonist (so increases release of NE and serotonin) and serotonin-receptor antagonist
Maprotiline:
- atypical antidepressant
- ->blocks NE reuptake
- ->may cause orthostatic hypotension
Trazodone:
- atypical antidepressant
- ->inhibits serotonin reuptake
- ->used for insomnia (not really for depression, b/c need high doses for depression treatment)
- toxicities:
- postural hypotension
- sedation (so can use for insomnia)
- priapism –> “trazaBONE!”
Buproprion:
- atypical antidepressant
- no sexual side effects
- lowers seizure threshold (especially in bulemics, anorexics)
- unknown mechanism, but leads to increased NE and dopamine
- can be used for depression and also for smoking cessation
Mirtazapine:
- atypical antidepressant; good for depression with insomnia (b/c sedation = toxicity)
- alpha -2-antagonist (so increases release of NE and serotonin) and serotonin-receptor antagonist
Maprotiline:
- atypical antidepressant
- ->blocks NE reuptake
- ->may cause orthostatic hypotension
Trazodone:
- atypical antidepressant
- ->inhibits serotonin reuptake
- ->used for insomnia (not really for depression, b/c need high doses for depression treatment)
- toxicities:
- postural hypotension
- sedation (so can use for insomnia)
- priapism –> “trazaBONE!”
