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psychiatry Flashcards

1
Q

how long does a major depression have to last to be called major depressive episode?

A

at least 2 weeks.

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2
Q

what are criteria for major depressive disorder?

A

two or more major depressive episodes at least 2 months apart.

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3
Q

what brain area is hypometabolic in depression?

A

dorsolateral prefrontal cortex.

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4
Q

what brain areas are hypermetabolic in depression?

A

orbitofrontal cortex and subcallosal cingulate gyrus

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5
Q

what brain area is the target for ECT in depression?

A

subcallosal cingulate gyrus.

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6
Q

how long do manic symptoms have to last to be called an “acute manic episode?”

A

one week

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7
Q

what is a mixed episode?

A

both depression and manic criteria are met over a 7 day period.

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8
Q

what is the difference between mania and hypomania?

A

in a hypomanic episodes elevated mood is present for at least 4 days, but patient has insight without functional impairment.

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9
Q

what is the difference between Bipolar I and Bipolar II.

A

Bipolar I is at least one episode of acute mania, bipolar II is at least one episode of hypomania.

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10
Q

what is cyclothymic disorder?

A

attenuated form of bipolar disorder lasting several years. periods of hypomania with depressive sx between.

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11
Q

what duration defines an acute psychotic episode?

A

> 1 day

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12
Q

what is schizophreniform disorder?

A

symptoms of schizophrenia lasting more than one month but less than 6 months.

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13
Q

what class of medications is safest in older adults for depression?

A

SSRIs

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14
Q

what is the difference between conduct disorder and ODD?

A

conduct disorder is more severe and includes aggression towards people and animals.

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15
Q

What is the difference between conduct disorder and anti-social personality disorder?

A

anti-social personality disorder can’t be given to people under age 18. Ppl with conduct disorder often go on to meet criteria for anti-social personality disorder.

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16
Q

what is the difference between chronic depressive disorder and dysthymic disorder?

A

in chronic depressive disorder there are clear cut major depressive episodes with residual depression between. In dysthymic disorder people describe always being depressed without major episodes.

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17
Q

what enzyme catalyzes the first step of serotonin synthesis?

A

tryptophan hydroxylase.

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18
Q

what enzyme catalyzed the 2nd step of serotonin synthesis?

A

L-amino acid decarboxylase

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19
Q

what class of MAO enzyme catalyzes serotonin metabolism?

A

MAO-A

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20
Q

where is the principal site of seratonergic neuron cell bodies?

A

raphe nucleus

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21
Q

what is the difference between suicide rates in caucasions vs african americans?

A

in caucasians the suicide risk increases with increasing age, in african americans the rate decreases after the 4th decade.

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22
Q

what ethnicity has the highest suicide rate?

A

Native americans.

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23
Q

which personality disorder has the highest risk of suicide?

A

borderline.

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24
Q

which SSRIs have the least drug-drug interactions?

A

citalopram and escitalopram

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25
Q

how or SSRIs metabolized?

A

p450 system

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26
Q

which dopiminergic receptors are implicated in schizophrenia?

A

D2

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27
Q

which dopaminergic pathways are implicated in schizophrenia?

A

mesolimbic and mesocortical pathways.

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28
Q

what are the 3 cluster A personality disorders?

A
  1. paranoid
  2. schizoid
  3. schyzotypal
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29
Q

what is the difference between factitious disorder and malingering?

A

in factitious disorder the secondary gain is assuming the role of the patient, in malingering there is other secondary gain, such as money.

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30
Q

what are the 3 cluster C personality disorders?

A
  1. avoidant- excessive fear of criticism and rejection
  2. dependent
  3. obsessive compulsive
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31
Q

which TCA antidepressant is used to treat overactive bladder? Due to activity at which receptor?

A

Imipramine. Muscarinic.

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32
Q

which TCA has the most alpha adrenergic and muscarinic activity?

A

Amitriptyline

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33
Q

which TCA has the least alpha adrenergic activity and so is least likely to cause postural hypotension?

A

Nortriptyline

34
Q

Which TCA is the most sedating? Due to what action?

A

Doxepin. Anti-histimine activity.

35
Q

which SSRI has the highest anti-cholinergic side effects?

A

Paroxetine

36
Q

which anti-psychotics have the most side effects?

A

Chlorpromazine and thioradazine.

37
Q

what is the treatment of acute dystonia in anti-psychotic use?

A

Benztropine

38
Q

What is adjustment disorder?

A

response to stressor that is greater than expected and occurs within 3 months of the stressor. Does not persist beyond 6 months of the stressor.

39
Q

which SSRIs are more likely to cause hyponatremia?

A

Fluoxetine and paroxetine

40
Q

what is the mechanism of action of Benzodiazepines?

A

agonist at GABAa receptors.

41
Q

What are the 4 cluster B personality disorders?

A

narcissistic, antisocial, borderline, histrionic

42
Q

what class of medication are Venlafaxine and duloxetine?

A

SNRIs

43
Q

what is the main difference between mechanism of action of SNRIs and TCAs?

A

SNRIs selectively inhibit serotonin and norepinepherine reuptake, TCAs also have muscarinic, histaminergic and alpha-adrenergic action.

44
Q

what is mechanism of action of buproprion?

A

inhibits reuptake and increases pre-synaptic release of norepinephrine and dopamine. Does not have serotonergic affects.

45
Q

what class of drug are Trazodone and nefazodone?

A

Antagonism at 5-HT2 receptors.

46
Q

what is one major adverse affect of Trazodone?

A

priapism

47
Q

what is schizoaffective disorder?

A

psychotic disorder with a concomitant mood disorder. there must be at least a 2 week period during which psychotic symptoms are present without prominent mood symptoms.

48
Q

what are the risks of using atypical antipsychotics in people with dementia?

A

increased risk of mortality and thromboemoblic events.

49
Q

what is the length of trial needed before determining if an anti-depressant is ineffective? What percentage of people respond to their first anti-depressant?

A

6 weeks, 50%

50
Q

which aspects of schizophrenia are atypical anti-psychotics better at treating?

A

negative symptoms

51
Q

Which atypical antipsychotics are most likely to cause weight gain?

A

Clozapine and olanzapine.

52
Q

which atypical antipsychotics are least likely to cause weight gain?

A

ziprasidone and apripiprazole

53
Q

Which atypical antipsychotic is least likely to cause QT prolongation?

A

Aripiprazole

54
Q

which atypical antipsychotic can cause myocarditis?

A

clozapine

55
Q

which atypical antipsychotic can cause agranulocytosis?

A

clozapine

56
Q

which atypical antipsychotic has the most muscarinic action and co can lead to dry mouth, urinary retention, confusion and constipation?

A

Olanzipine

57
Q

Which atypical antipsychotic has the most anti-histamine affects and so is the most sedating?

A

Quetiapine

58
Q

Which atypical antispychotic is the least likely to cause EPS?

A

Clozapine

59
Q

which atypical antipsychotic has a dose dependent increased risk of seizures?

A

clozapine

60
Q

what is the mechanism of action of memantine?

A

NMDA antagonist

61
Q

which mood stabilizing drug is contraindicated in sick sinus syndrome?

A

Lamotrigine

62
Q

Personality disorder with reasonable but frequent paranoid thoughts.

A

Paranoid

63
Q

personality disorder with blunted emotions and affect, dislike of relationships and social activities, preference for solitude.

A

Schizoid

64
Q

Personality disorder with discomfort with social interactions, social anxiety, bizarre and eccentric beliefs and behaviors.

A

schizotypal

65
Q

what is the demographic most likely to complete suicide?

A

men 75-85

66
Q

what is the risk of relapse after 1 major depressive episode?

A

50%

67
Q

what allele increases risk of impulsive, compulsive, and addictive disorders?

A

D2A1

68
Q

what substance is decreased in those attempting suicide?

A

5-HIAA

69
Q

in which anti-psychotic is there the highest risk of akisthesia/EPS?

A

Haldol

70
Q

which anti-psychotic is most likely to cause QT prolongation?

A

Thioridazine

71
Q

which antipsychotic can cause thyroid dysfunction?

A

Quitiepine

72
Q

which antipsychotic is most likely to cause orthostatic hypotension and dizziness?

A

Risperidol

73
Q

which antipsychotic is most likely to cause hepatic dysfunction?

A

Olanzipine

74
Q

in what lithium serum level range does delirium, abnormal EEG and renal toxicity occur?

A

2.0-2.5 mEq/L

75
Q

what are early symptoms of lithium toxicity?

A

diarrhea, vomiting, drowsiness, muscle weakness, incoordination

76
Q

which antidepressant is most likely to cause hypertension?

A

Venalfaxine

77
Q

which antipsychotics are least likely to cause weight gain?

A

Milnidone and loxapine

78
Q

injection of what substance can confirm panic disorder by precipitating a panic attack?

A

Sodium lactate

79
Q

at what phase of pregnancy should lithium be discontinued due to large shifts in serum level?

A

delivery

80
Q

what is the main affect of EtOH on sleep architecture?

A

decreased REM

81
Q

which SSRI has the highest chance of causing adverse drug-drug interactions?

A

fluvoxamine

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