psychiatry Flashcards
how long does a major depression have to last to be called major depressive episode?
at least 2 weeks.
what are criteria for major depressive disorder?
two or more major depressive episodes at least 2 months apart.
what brain area is hypometabolic in depression?
dorsolateral prefrontal cortex.
what brain areas are hypermetabolic in depression?
orbitofrontal cortex and subcallosal cingulate gyrus
what brain area is the target for ECT in depression?
subcallosal cingulate gyrus.
how long do manic symptoms have to last to be called an “acute manic episode?”
one week
what is a mixed episode?
both depression and manic criteria are met over a 7 day period.
what is the difference between mania and hypomania?
in a hypomanic episodes elevated mood is present for at least 4 days, but patient has insight without functional impairment.
what is the difference between Bipolar I and Bipolar II.
Bipolar I is at least one episode of acute mania, bipolar II is at least one episode of hypomania.
what is cyclothymic disorder?
attenuated form of bipolar disorder lasting several years. periods of hypomania with depressive sx between.
what duration defines an acute psychotic episode?
> 1 day
what is schizophreniform disorder?
symptoms of schizophrenia lasting more than one month but less than 6 months.
what class of medications is safest in older adults for depression?
SSRIs
what is the difference between conduct disorder and ODD?
conduct disorder is more severe and includes aggression towards people and animals.
What is the difference between conduct disorder and anti-social personality disorder?
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.
what is the difference between chronic depressive disorder and dysthymic disorder?
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.
what enzyme catalyzes the first step of serotonin synthesis?
tryptophan hydroxylase.
what enzyme catalyzed the 2nd step of serotonin synthesis?
L-amino acid decarboxylase
what class of MAO enzyme catalyzes serotonin metabolism?
MAO-A
where is the principal site of seratonergic neuron cell bodies?
raphe nucleus
what is the difference between suicide rates in caucasions vs african americans?
in caucasians the suicide risk increases with increasing age, in african americans the rate decreases after the 4th decade.
what ethnicity has the highest suicide rate?
Native americans.
which personality disorder has the highest risk of suicide?
borderline.
which SSRIs have the least drug-drug interactions?
citalopram and escitalopram
how or SSRIs metabolized?
p450 system
which dopiminergic receptors are implicated in schizophrenia?
D2
which dopaminergic pathways are implicated in schizophrenia?
mesolimbic and mesocortical pathways.
what are the 3 cluster A personality disorders?
- paranoid
- schizoid
- schyzotypal
what is the difference between factitious disorder and malingering?
in factitious disorder the secondary gain is assuming the role of the patient, in malingering there is other secondary gain, such as money.
what are the 3 cluster C personality disorders?
- avoidant- excessive fear of criticism and rejection
- dependent
- obsessive compulsive
which TCA antidepressant is used to treat overactive bladder? Due to activity at which receptor?
Imipramine. Muscarinic.
which TCA has the most alpha adrenergic and muscarinic activity?
Amitriptyline
which TCA has the least alpha adrenergic activity and so is least likely to cause postural hypotension?
Nortriptyline
Which TCA is the most sedating? Due to what action?
Doxepin. Anti-histimine activity.
which SSRI has the highest anti-cholinergic side effects?
Paroxetine
which anti-psychotics have the most side effects?
Chlorpromazine and thioradazine.
what is the treatment of acute dystonia in anti-psychotic use?
Benztropine
What is adjustment disorder?
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.
which SSRIs are more likely to cause hyponatremia?
Fluoxetine and paroxetine
what is the mechanism of action of Benzodiazepines?
agonist at GABAa receptors.
What are the 4 cluster B personality disorders?
narcissistic, antisocial, borderline, histrionic
what class of medication are Venlafaxine and duloxetine?
SNRIs
what is the main difference between mechanism of action of SNRIs and TCAs?
SNRIs selectively inhibit serotonin and norepinepherine reuptake, TCAs also have muscarinic, histaminergic and alpha-adrenergic action.
what is mechanism of action of buproprion?
inhibits reuptake and increases pre-synaptic release of norepinephrine and dopamine. Does not have serotonergic affects.
what class of drug are Trazodone and nefazodone?
Antagonism at 5-HT2 receptors.
what is one major adverse affect of Trazodone?
priapism
what is schizoaffective disorder?
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.
what are the risks of using atypical antipsychotics in people with dementia?
increased risk of mortality and thromboemoblic events.
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?
6 weeks, 50%
which aspects of schizophrenia are atypical anti-psychotics better at treating?
negative symptoms
Which atypical antipsychotics are most likely to cause weight gain?
Clozapine and olanzapine.
which atypical antipsychotics are least likely to cause weight gain?
ziprasidone and apripiprazole
Which atypical antipsychotic is least likely to cause QT prolongation?
Aripiprazole
which atypical antipsychotic can cause myocarditis?
clozapine
which atypical antipsychotic can cause agranulocytosis?
clozapine
which atypical antipsychotic has the most muscarinic action and co can lead to dry mouth, urinary retention, confusion and constipation?
Olanzipine
Which atypical antipsychotic has the most anti-histamine affects and so is the most sedating?
Quetiapine
Which atypical antispychotic is the least likely to cause EPS?
Clozapine
which atypical antipsychotic has a dose dependent increased risk of seizures?
clozapine
what is the mechanism of action of memantine?
NMDA antagonist
which mood stabilizing drug is contraindicated in sick sinus syndrome?
Lamotrigine
Personality disorder with reasonable but frequent paranoid thoughts.
Paranoid
personality disorder with blunted emotions and affect, dislike of relationships and social activities, preference for solitude.
Schizoid
Personality disorder with discomfort with social interactions, social anxiety, bizarre and eccentric beliefs and behaviors.
schizotypal
what is the demographic most likely to complete suicide?
men 75-85
what is the risk of relapse after 1 major depressive episode?
50%
what allele increases risk of impulsive, compulsive, and addictive disorders?
D2A1
what substance is decreased in those attempting suicide?
5-HIAA
in which anti-psychotic is there the highest risk of akisthesia/EPS?
Haldol
which anti-psychotic is most likely to cause QT prolongation?
Thioridazine
which antipsychotic can cause thyroid dysfunction?
Quitiepine
which antipsychotic is most likely to cause orthostatic hypotension and dizziness?
Risperidol
which antipsychotic is most likely to cause hepatic dysfunction?
Olanzipine
in what lithium serum level range does delirium, abnormal EEG and renal toxicity occur?
2.0-2.5 mEq/L
what are early symptoms of lithium toxicity?
diarrhea, vomiting, drowsiness, muscle weakness, incoordination
which antidepressant is most likely to cause hypertension?
Venalfaxine
which antipsychotics are least likely to cause weight gain?
Milnidone and loxapine
injection of what substance can confirm panic disorder by precipitating a panic attack?
Sodium lactate
at what phase of pregnancy should lithium be discontinued due to large shifts in serum level?
delivery
what is the main affect of EtOH on sleep architecture?
decreased REM
which SSRI has the highest chance of causing adverse drug-drug interactions?
fluvoxamine
