Psychiatry Flashcards
1
Q
Classical conditioning?
A
Natural response (salivation) elicited by conditioned or learnt stimulus (bell)
Because previously presented in conjunction with unconditioned stimulus (food)
2
Q
Operent conditioning and the stages?
A
Learning in wich a particular action produces a punishment/reward (usually a voluntary response)
reinforcement: target behavior is followed by reward OR removal of aversive stimulus
Punishment: repeated application of aversive stimulus (postivie punishment) to extinguish unwanted behavior
Extinction: discontinuation of reinforcement (positive or negative) willeventually eliminate the behavior
3
Q
Tranference?
A
Patient projects feelings about formative or other important persons onto physician
4
Q
Countertransference?
A
doctor projects feelings about formative or other important persons onto the patient (ex patient reminds physician of their younger sibling)
5
Q
Ego defense?
A
Mental process (unconscious or conscious) used to resolve conflict and prevent undesirable feelings (anxiety or depression)
6
Q
Immature defense: acting out?
A
Expressing unacceptable feelings and thoughts through actions (example: tantrums)
7
Q
Immature defense: denial?
A
Avoiding the awareness of painful reality (common reaction in newly diagnosed HIV)
8
Q
Displacement?
A
Transferring avoided ideas and feelings to a neutral person or object (vs projection) mother yelled at her child because husband yelled at her
9
Q
Dissociation?
A
Temporary, drastic change in personality (memory, consciousness, or motor behavior to avoid emoitonal stress)
Extreme forms can result in dissociative identitiy disorder
10
Q
Fixation?
A
Partially remainging at more childish level of developpement (vs regression)
11
Q
Idealization?
A
Expressing extremely positive thoughts of self anf others while ignoring negative thoughs
A patient boasts about his physician and accomplishments while ignoring flaws
12
Q
Identification?
A
Modeling behavior after another person who is more powerful (though not necessarily admired)
Abused child becomes abuser
13
Q
Intellectualization?
A
Using facts and logic to emotionally distance oneself from a stressful situation
In therapy, patient diagnosed with cancer focuses only on rates of survival
14
Q
Isolation?
A
Seperating feelings from ideas and events
Describing murder in graphic details with no emotional response
15
Q
Passive aggression?
A
Failing to meet the needs and expectations of others as an indirect show of support or opposition
Employee repeatedly showing up late for work because disgruntled.
16
Q
Projection?
A
Attributing inacceptable internal impulse to external source
Man wants to cheat, accuses wife of doing so
17
Q
Rationalization?
A
Giving logical reasons for actions to avoid self blame
18
Q
Reaction formation
A
Replacing a warded off idea or feeling by an unconscious emphasis on the opposite
19
Q
Regression?
A
Involuntarily withholding an idea or feeling from conscious awareness or suppression
20
Q
Splitting?
A
Believing that all people are either good or bad
Intolerant to ambiguity
21
Q
Mature defense: sublimation?
A
Replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one’s value system
22
Q
Mature defense: altruism?
A
Alleviating negative feelings with unsolicitated generosity
23
Q
Mature defense: Suppression?
A
Intentionally withholding an idea or feeling of conscious awareness vs repression
24
Q
Mature defense: humor?
A
Appreciating the amusing nature of an anxiety provoking adverse situation
25
Psychiatric genetics?
Both genetic and environmental factors are involved in the developpement of most pyschiatric discordance
26
Effects of infant depreivation?
Failure to thrive
Poor language and socialization skills
lack of basic trust
Reactive attachement disorder (withdrawn, unresponsive to comfort)
27
what are the 4W's of deprivation?
Weak
Wordless
Wanting
Wary
28
What is the evidence of child abuse?
Fractures (ribs, lone bone, spiral, multiple at different stages of healing)
Bruises: trunk, ear, neck
Cigarette burns
Subdural hematoma, retinal hemorraghes
Child avoids eye contact during the exam
Results in 4o% deaths in children less then 1 year old
29
Signs of child neglect?
Failure to provide child with adequate food, shelter, supervision, education or affection
Evidence: poor hygiene, malnutiriton, withdrawl, failure of emotional developpement
As with child abuse, needs to be reported.
30
Vulnerable child syndrome?
Parent thinks child is especially susceptible to illness of injury
May follow illness or life threatening event
Can lead to overuse of medical services
31
Attention deficit disorder?
Onset before 12 years old
Limited attention span and poor impulse
Charactersized by hyperactivity and impulsivity
(multiple settings)
Normal intelligence with difficulty in learning
50% of individuals have symptoms as adults
Treatement: stimulants (methyphenidate + cognitive behavior therapy)
Alternatives: atomoxetine, guanfacine, clonidine
32
Autism specturum disorder?
```
Poor social communication
repetitive behaviors
restricted interests
presents in early childhood
Intellectual diability
More common in bous
Increase head and brain size
```
33
Rhett syndrome?
X linked dominenet (seen in girls) males die
symtpms at ages 1-4 with regrression and loss of developpement of verbal abilities ataxia and sterotyped handwritting
34
Conduct disorder?
Repetitive and pervasive behavior violating the basic rights of others (theft, destruction)
After age 18 will meet criteria for anti-social
Treatment is psychotherapy such as CBT
35
Oppositional defiant disorder?
Pattern of hostile and defiant behavior toward authority figures in violation of social norms (psychotherapy and CBT)
36
Seperation anxiety disorder?
Common from 7-9 years
Overwhelming fear of seperation from home or loss of attachement.
May have false complaints to avoid school
CBT, play therapy, and family therapy
37
Tourette syndrome?
Onset before 18 years of agr
Sudden, rapid, non rythmic,sterotype motor and vocal tics that persist after 1 year
Corprolalia: involuntary, obscene speech in 10-20%
Associated with OCD and ADHD
Treatment with CBT, play therapy, family therapy
For intractable and distressing tics, high grade anti-psychotics (fluphenazine, pimozide) tetrabenazaine, guanfacine, clonidine
38
Neurotransmitter: alzheimer's disease?
Decrease AcH
| Increase glutamate
39
Neurotransmitter depression?
Decrease norrephinephrine
| Decrease 5-HT, decrease dopamine
40
Huntingtons' neurotransmittor?
Decrease GABA, decrease Ach
| Increase dopamine
41
Parkinson's disease?
Decrease dopamine
| Increase Ach
42
Schizophrenia neurotransmiter
Increase dopamine
43
Componenets of orientation?
Ability of a person to know where he is
Loss of time, then place, and then person
44
Common causes of loss of orientation?
```
ETOH
Drugs
Electrolyte imbalance
Head trauma
Hypoglycemia
infection
nutritional deficiency
```
45
Retrograde amnesia?
Can not remember things before the CNS insult
46
Antegrade amnesia?
Cant remember things that occurred after the CNS insult
47
Korsakoff sydrome?
Amnesia (antegrade more then retrograde)
Caused by vitamin B deficiency
Associated with destruction of mamillary bodies
Seen in ETOH as late manifestaion of Wernicke
Often have confabulation
48
Dissocaitive amnesia?
Inability to recall personal info
Usually due to severe trauma or stress
Can have dissociative fugue (abrupt travel or wandering during period of dissociative amneisa)
Can be associated with traumatic circumstances
49
Dissociative identity disorder?
```
Formerly multiple personality disorder
Two or more personality states
More common in women
Associated with sexual abuse
PTSD
Depression
Substance abuse
Borderline personality
Somatoform disorders
```
50
Depersonalization/derealization disorder?
Persistant feeling of detachement or estrangement from one's own body
Thoughts, perceptions and actions
51
Characteristics of Delirium?
Waxing and weaning of level of consciousness
Decrease in attention span and level of arousal
Disorganized thinking, hallucinations and illusions
Usually secondary to other illness (CNS, disease, infection, trauma, substance, metabolic, hemorrage, urinary, fecal retention)
Most common presentation of altered mental status within inpatient setting
Will have diffuse EEG slowing
Treatment is identifying the underlying condition
Haldol may be needed
Benzodiazepines for ETOH withdrawl
TADA approach: tolerate, anticipate, don't agitate are helpful for management
52
Characteristics of Dementia?
Decrease intellectual function without affecting level of consciousness
Aphasia, apraxia, agnosia and loss of abstract thought
Behavioral problems, impaired judgement
Patient can have delirium ontop of the the dementia
53
Irreversible causes of dementia?
```
Alzheimers
Lewy body
Huntington
Pick disease
Cerebral infarct
Cresutfeldt-jakob
Chronic substance abuse
```
54
what are reversible causes of the dementia?
```
Hypothyroidism
Depression
Vitamin B defieincy
Normal pressure hydrocephalus
Neurosyphilis
Increase incidence with age
```
55
What screens to do for dementia?
Depression
Hypothyroidism
TSH
B12 levels
56
What is psychosis?
Distorted perception caused by delusions, hallucinations, disorganized thinking (can be due to medical illness, psychiatric illness or both
57
What are delusions?
Unique, false beliefs despite the facts
| Can be persecutory, referential, gradoise, erotomanic, somatic
58
What are disorganized thought?
Speech may be incoherent
Tangential
Or derailed
59
What are the different types of hallucinations?
Visual: more common in medical illness then psychiatric
Auditory: more common in pyshciatric illness
Olfactory: occur as aura of temporal lobe epilepsy
Gustatoty: rare but seen in epilepsy
Tactile: common in ETOH and withdrawl of stimulant use (cocaine and ampehtamines)
Hypnagogic: occurs while going to sleep (can be seen in narcolepsy)
Hypnopompic: occurs while waking from sleep (sometimes seen with narcolepsu)
60
Prevalence of schizophrenia?
1.5 % prevalence
Males =females = african americans= caucasians
Men present in late teens to early 20s
Women late 20's to early 30's
61
Criteria of diagnosis?
Need two of the criteria, lasting more then 6 months for diagnosis
1. Delusions
2. Hallucinations (often auditory)
3. Disorganzied speech
4. Disorganized or catatonic behavior
5. Negative symptoms (affective flattening, avolition, anhedonia, asociality, alogia)
62
Schizophrenia brain imaging?
Shows ventriculomegaly
63
Brief psychotic disorder?
Lasting less then 1 month and usually stress related
64
Schizophreniform disorder?
LAsting 1 to 6 months
65
Schizoaffective disorder?
More then 2 weeks of hallucinations and delusions without major mood episode(depression or mania)
Plus periods of major mood episode with schizophrenic symptoms
66
Delusional disorder?
Fixed, persistant false belief lasting more then 1 month
Functioning is not impaired
Can be shared by two called folie a deux
67
Mood disorder?
Abnormal range of moods or emotional states with loss of control
Severity can cause social and occupational functioning decrease
68
What is a maniac episode?
| Critieria for diagnosis?
Distinct period of abnormally and persistantly elevated, expansive, or irritable mood
Lasts about 1 week
```
Criteria for diagnosis:
distractability
irresponsibility (seeks pleasure)
grandiosity: inflated self esteem
Flight of ideas
Increase in goal directed activity, agitation
Decrease the need for sleep
Talkative or pressured speech
```
69
Maternal post partum blues?
```
50-85%
Depressed affect
Tearfulness
Fatigue (2-3 weeks after delivery)
Resolved within 10 days
```
70
Postpartum depression?
10-15% incidence (depressed affect, anxiety and poor concentration)
Treatment CBT and SSRI
71
Post partum psychosis?
0.1 to 0.2 incidence: mood congruent delusions, hallucinations and thoughts of harming the baby or self
Risk factors if have bipolar or psychotic delusions
First pregnancy, family history, recent discontiuation of psychotropic medication
Treatment: hospitalization and initiation of atypical antipsychotics (if not sufficient use ECT)
72
Definition of Grief?
Shock, denial, guilt, sadness, anxiety, yearning
Hallucinations of the dead person are common
Duration varies, but usually less then 6 months
Pathological grief is persistant and causes functional impairment (can meet the criteria for major depressive episode)
73
Electroconvulsive therapy?
For treatment refractory depression
Depression with psychotic symptoms
Acutely suicidal patients
Produces grand mal seizure in anesthetized patient
Adverse effects include: disorientation, temporary headache, antegrade or retrograde amnesia usually resolving in months (safe for pregnancy)
74
What are risk factors for suicide?
```
Sex
Male
Depression
Previous attemt
Ethanol or drug use
Rational thinking loss
Sickeness
Organized plan
No spouse or social support
Stated future intent
```
Most common method in the US is with firearms
75
Anxiety disorder?
Inappropriate experience of fear and worry and its physical manifestations
Symptoms interfere with daily functioning : panic disorders, phobias, generalized anxiety disorder, selective mutism
Treatment: SSRI, SNRI
76
What are the symptoms of panic disorder?
| What is the criteria needed for diagnosis of panic attack?
```
Palpitations
Paresthesia
De personalization
Derelaization
Abdominal distress
Nausea
Intense fear of dying
Intense fear of losing control or going crazy
```
1) Persistent concern for additional panic attacks
2) Worrying about the consequences of the attack
3) Behavioral changes related to the attacks
77
Specific phobia?
Fear or anticipation of a specific object or situation
Person recognizes that the fear is excessive
Can be treated with systemic desensitization
78
Social anxiety disorder?
Exaggerated fear of embarassement in social situations
Treatment CBT, SSRI, venlafaxine
If have occasional anxiety producing situations:
Benzodiazepines or B-blocker
79
Agoraphobia?
Exaggerated fear of open or enclosed places
For example, public transportation, in line or crowds
Leaving home alone
Associated with panic disorder
Treatment CBT, SSRI, MAO inhibitors
80
What is generalized anxiety disorder?
Anxiety lasting more then 6 months unrelated to specific person, situation or event
Associated with restlessnes, irritablity, and sleep distrubances, fatigue, muscle tension, difficulty concentrating
Treatment: CBT, SSI,SNRI, buspirone,TCA, benzo are second line
81
Adjustement disorder?
emotional symptoms (anxiety and depression) causing impairment following psychosocial stressor (illness or divorce) lasting less then 6 months.
Can be more then 6 months if chronic stressor
Treat with CBT and SSi
82
Obsessive compulsive disorder?
Recurring intrusive thoughts, feelings or sensations that cause severe distress
Relieved by repetitive functions
Treatment with CBT, SSRI
83
What is ego-dystonic behavior?
behavior is inconsistant with one's belief and attitudes
| (vs, obsessive personality disorder and associated Tourette's syndrome
84
What is body dysmorphic disorder?
Preoccupation with minor or imagined defect in appearence
will frequently seek out cosmetic surgery
Treatement with CBT
85
What is post-traumatic stress disorder?
Exposure to prior trauma (withnessing death, injury or rape)
Intrusive reexperiencing of the event (nightmare, flashbacks) avoidence of the associated stimuli (changes with cognition or mood)
Persistantly elevated state of arousal
Disturbances last more then 1 month
Treatment with CBT, SSRI, and venalfaxine
86
What is acute stress disorder?
Lasts between 3 dyas and 1 month
| Treatment: CBT, pharmcotherapy usually not indicated
87
Malignering?
False illness for external gain
Poor compliance for follow-up necklace
Complaints cease after gain
88
Facititious disorder?
Physical and psychological symptoms to assume sick role
89
Facitious disorder imposed on self?
Chronic facititious disoder, multiple hospital admission, and will undergo tests
90
Facititious disorder imposed on another?
Illness in child or elderly parent is fabricated by care caregiver
91
Somatic symptom disorder?
Bodily complains (pain and fatigue) that last for years. excessive, persistent thoughts about symptoms
92
Conversion disorder?
Loss of sensory or motor function following a stressor.
| The patient is indifferent about the symptoms
93
Illness anxiety disorder?
Excessive preoccupation with having a serious illness, often despite reassurance or minimal symptoms
94
Pseudosyseis?
False, non delusional belief of being pregnen
| May have signs of pregnancy
95
Personality trait?
endurine, repeitive patter of precieving, relating to and thinking about the environment, or one's self
96
Personality disorder?
Inflexble, maladpative and rigidly pervasive pattern of behavior causing distress
Patient is not aware of the problem
97
Cluster A personality disorder?
| What do they consist of?
Odd and eccentric (inability to develope meaningful social interactions
No psyhcosis
Genetic association with schizophrenia
Paranoid: Pervasive distrust and sucpisciousness
Schizoid: Voluntary social withdrawl, limited emotional expression, content with social isolation
Schizotypal: eccentric appearnace, odd beliefs, magical thinking, interpersonal awkwardness
98
Cluster B personality disorders?
Dramatic, emotional, erratic, genetic association with mood disorders and substance abuse
Antisocial: disregard for and violation of rights of others (criminality, impulsivity, males more then females)
Must be more then 18 years old and have a history of conduct disorder before the age of 15
Borderline: unstable mood andinterpersonal relationships (impulsive, self mutilation)
feeling of emptiness
Histrionic: excessive emotionality and excitability
Attention seeking, sexually provocative splitting is a major defense mechanism
Narcissistic: grandiosity
Sense of entitlement
Lack of empathy
Est
99
Cluster C personality?
Anxious or fearful (genetic association with anxiety disorders)
Avoidant: hypersenstive ro rejection (socially inhibited) feeling of inadequacy, desires relationship with others
Compulsive-Obsessive: Preoccupation with order, perfection, control, OCD
Dependent: submissive and clingy
Excessive need to be taken care of
Low self-confidence
100
Anorexia nervosa?
```
Excessive dieting and eating with BMI less then 18.5
Distortion of body immage
Decrease in bone densitt
metatarsal stress fractures
Amenorrhea
loss of GnRH secreation
Luango
Anemia
Electrolyte imbalance
Coexists with depression
Increase in insulin with hypophophatemia
Cardiac complications
```
101
Bullimia nervosa?
Binge eating in inappropriate compensatory behavior (vomiting, laxatives, diuretics)
Occuring for 3 months
Normal body Mass index
Assocaited with parotitis, enamel erosision, electorlyte disturbances, alkalosis, dorsal hand calluses from induced vomiting
102
Binge eating disorder?
Regular episodes of excessive, uncontrollable eating without inappropriate compensatory behaviors, increase risk of diabetes
103
Gender dysphoria?
Strong, persistant cross gender identification that leads to persistant discomfort with sex assigned at birth, causing significant distress
104
Transesual?
Desire to live as the opposite sex
| Often through surgery or hormone treatment
105
Transvestitre?
Paraphelia, not gender dysphoria (wearing clothes of the opposite sex)
106
Sexual dysfunction?
Hypoactive sexual desire or sexual aversion
Sexual arousal disorderds
Orgasmic disorder (anorgasmia, premature ejaculation, sexual pain)
Differential diagnosis: Drugs (anti-ypertensives, neuroleptics, SSRI, ethanol)
Diseases: (depression, diabetes, STI)
Psychological (performance anxiety
107
Sleep terror disroder?
Period of screaming in the middle of the night
During the slow-wave/deep N3 sleep
Most common in children
Occurs during NON REM sleep (no memory of arousal)
Triggers
108
Narcolepsy?
Disodered regulation of sleep-wake cycle
Excessive day-time sleepiness (awaken feeling rested(
Caused by decrease hypocrtein production in the lateral hypothalamus
109
What are symptoms associated with narcolepsy?
Hypnagogic: just before sleep pr hypnopomic (just after awakaing) hallucinations
Nocturnal or narcoleptic sleep episodes that start with REM sleep
Cataplexy: loss of all muscle tone following strong emotional stimulus such as laughter in some patients
There is strong genetic component
Treatement with daytime stimulants (apmphetamines, modainil, and nighttime sodium oxybate (GHB)
110
What are signs of substance abuse?
Maladaptive pattern of substance use as defined as 2 or more of the following signs within 1 year
Tolerance
Withdrawl
Substance taken in larger amounts or over longer period of time then desired
Persistent desire, or unsuccessful to cut down
Significant energy spent obtaining, using, or recovering from substance
Important social, occupational, or recreational activities are reduced because of substance abuse
Continued use despite knowing there are physical and pyschological problems
Craving
Failure to fulfill major obligation at work, school or home
Social or interpersonal conflicts related to substance abuse
111
Stages of change in overcoming substance addiction?
Precontemplation: not even acknowledging that there is a problem
Contemplation: acknowlegde there is a problem but not ready or willing to make a change
Action/willpower: changing behavior
Maintenecce: maintaining behavior changes
Relaspse: returning to old behaviors
Abandoning new changes
112
ETOH intoxication and withdrawl?
```
emotional liability
Slurred speecj
ataxia
Coma
Blackout
Serum glutamyltransferease GGT
AST value is twice of ALT
```
Severe wihdrawl:
Autonoic hyperactivity
DT in 5-15% mortality
Treat with benzo
113
Opiod intoxication and withdrawl?
```
Euphoria
Respiratory and CNS depression
Pinpoint pupils
Pupillary constriction
Pinpoint pupils
Seizures
Most common cause of drug overdose is death
```
Treatment naloxone and naltexone
```
Withdrawl:
Sweating
Dilated pupils
piloerection
fever
rhinorrhea
yawning
nausea
stomach cramps
dirreha
```
Treatment: long term support, methadone, buprenophine
114
Barbituates intoxication/withdrawl?
Low margin of safety
Marked respiratory depression
Treatment: symptom management (assist respiration and increase BP)
withdrawl: Delirium (life threatening cardiovascular collaspse)
115
Benzodiazepines?
Greater safety margin
Ataxia, minor respiratory depression
Treatment wih flumazenil
Withdrawl: sleep disturbances, depression, rebound anxiety seizure
116
Amphetamine intoxication and withdrawl?
```
Euphoria: mood elevation, psychomotor agitation
Insomnia
Cardiac arrythmias
Tachycardia
Anxiety
```
117
Cocaine intoxication?
Impaired judgement
Pupillary dilatation
Prolonged wakfulness
Angina and sudden death
Treatment:
Alpha blockers
Benzodiazepines
B blockers are NOT recommended
118
Caffeine?
Restlessness
Increase diuresus
Muscle twitching
Withdrawl: headache (difficulty concentrating)
Flu like symptoms
119
Nicotine?
```
Intoxication: restlessness
Withdrawl: irritability
anxiety
Restlessness
difficulty concentrating
treatment with: nicotine patch, gum, lozenges, bupropion/varenicline
```
120
What are the classes of hallucinations?
Phencyclidine
Lysergic acid
Marijauna
MDMA (esctacy)
121
Phencyclidine?
```
Intoxification:
violence
impulsivity
Pyschomotor agitation
Nystagmus
Tachycardia
HTN
analgesia
Psychosis
Delirium
Seizures
Trauma is most common comlication
```
Treatment: benzodiazepine
122
Lysergic acid?
```
Perceptual distortion (visual, auditory)
Depersonalizarion
Anxiety
Paranoia
Psychosis
Possible flashback
```
123
Marijuana?
```
Euphoria
Anxiety
Paranoid delusions
Perception of slowed time
Impaired judgement
Social withdrawl
Increase appetite
Dry mouth
Conjunctival injection
```
Pharmaceutic form: dronabinol
(used for antimetic when on chemotherapy
Can also be used to stimulate the appetite in AIDS
```
Withdrawl:
Irritability
Anxiety
Depression
Insomnia
Restlessness
Decrease appetite
Difficulty concentrating
Anxiety
Detectable in urine for up to one month
```
124
MDMA (ecstasy)?
```
Hallucinogenic stimulant
euphoria
Disinhibition
Hyperactivity
Life threatening effects include hypertension
Tachycardia
Hyperthermia
hyponatremia
serotonin syndrome
```
125
Heroine addication?
Users have increase risk of HIV
Abcesses
Bacteremia
Right heart endocarditis
126
What are treatment options for heroine addiction?
Methadon: long acting oral opiate used for heroin detoxification or long term maintenece
Nalxone: antagonist and partial agonist
NOT oral bioavialabe
Withdrawl only occurs if injected (lower abuse potential)
Naltrexone: long acting opiod anatgonist used for relapse preventiononce detoxified
127
Alcholism?
Physiologic tolerance and dependence with symptoms of withdrawl
Tremor, tachycardia, HTN, malaise, nausea, DT when intake is interrupted
Complications: cirrhosis, hepatitis, pancreatitis, periphereal neuropathy, testicular atrophu
Treatment: disulfiram (to condition the patient to abstain from ETOH)
naltresxone
supportive care
Groups such as Alcoholic annonymous
Helpful in sustaining abstinence and supporting patient family
128
Wernicke-Korsakoff syndrome?
Vitamin B1 deficiency
Triad: confusion, opthamlmoplegia, ataxia
Can go to irreveresible memory losss, confabulation, personality change (Kosakoff syndrome)
Associated with periventricular hemorraghe /necrosis of mamillary bodies
Treatment is IV vitamin B
129
What is Mallory-Weiss syndome?
partial thickness tear in gastroesophageal junction caused by excessive/forcful vomiting
Often presents with hematemesis
Misdiagnosed as ruptured esophageal varices
130
Delirium Tremens?
Life threatening ETOH withdrawl
Peaks 2-5 days after the last drink
Characterized by autoimmune hyperactivity (tachycarida, tremens, seizures(
Usually within a hospital setting
Treatment with benzodiazepines
There is also a phenomen known as ETOH hallucinations (12-48 hours after the last drink)
Treatment with benzodiazepines (chlordiazepoxide, lorazepam, diazepam)
131
Medication for ADHD?
Stimulants (methyphenidate, amphetamine)
132
Medication for ETOH withdrawl?
Benzodiazepine
Chlordiazepoxide
Lorazepam
Diazepam
133
Medication for bipolar disorder
Lithium
Valporic acid
Atypical antipsychotics
134
Bulimia Nervosa?
SSRI
135
Depression?
SSRI
136
Generalized anxiety disordeer?
SSRI, SNRI
137
Obssesive compulsive disorder?
SSRI, venlafaxine, clomipramine
138
Panic disorder?
SSRI, venlafaxine, benzodiazepine
139
PTSD?
SSRI, venlafaxine
140
Schizophrenia?
atypical antipsychotic
141
Social anxiety disorder?
SSRI, venalfaxine
| Performance only:B blocker, benzodiazepine
142
Tourette's syndrome?
Antipsychotic (fluphenazine, pimozide tetrabenazine
143
Medications considered CNS stimulants?
methylphenidate, dextroamphetamine, methamphentamine
Mechanism: increase catecholamines in synaptic cleft
(especially norephinenprine and dopamine)
Use in: ADHAD,narcolepsy. and appetite control
144
How does Lithium work?
Not established (might be linked to inhibition of the phosphoinoside cascade
Clincial use: mood stabilizer for bipolar events
Blocks relaspse and acute maniac events
Adverse effects:
Tremor
Hypothyroidism
Polyuria (caused by nephrogenic diabetes insipidus)
Can cause Ebstein anomaly (in newborn if taken by mother)
Narrow therapeutic window
Requires close monitoring of serum levels
Almost exclusively excreted by the kidneys
If used with Thiazide can be implicated in lithium toxicity
145
What are the side-effects of lithium?
Movement (tremor)
Nephrogenic diabetes insipidus
Hypothyroidism
Pregnancy problems
146
Mechanism and use of Buspirone?
Stimulates 5-HT receptors
Clinical use in generalized anxiety disorder
Does not cause sedation, addiction, or tolerance
Takes 1-2 weeks to take effect
Does not interact with ETOH
147
SSRI mechanism, use and side-effects?
examples: fluoxetine, proxetine, sertaline, citalopram
mechanism: 5-HT specific reuptake inhibitors
Clinical: depression, anxiety, panic disorder, OCD, bulemia, social anxiety disorder, PTSD, premature ejaculation, premenstral dysphoric disorder
```
Adverse effects:
Increase in BP is the most common
Stimulant effects
Sedation
Nausea
```
148
What is serotonin syndrome?
Can occur with any drug that increases 5-HT (MAO inhibitors, SNRI, and TCA)
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Characterized by:
Neuromuscular activity (clonus, hyperreflexia, hypertonia, tremor and seizure)
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Autonomic stimulation (hyperthermia, diaphoresis, diarrhea)
Treatment: cryproheptaine
149
Tri-cyclic anti-depressents: mechanism, clinical use, adverse effects?
Examples: amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, anoxapine
Mechanism: Blocks reuptake of norepinephrine and 5 HT
Clinical use: Major depression, OCD, peripherial neuropathy, chronic pain, migraine prophylaxis
Adverse effects: Sedation
Alpha-blocking (postural hypotension)
Atropine like effects (tachycardia, urinary retention, dry mouth)
NOTE: 3rd generation TCA have more anticholinergic effects then 2TCA
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3rd can prolong the QT interval
Cardiotoxicity
Respiratory depression
Hyperpyrexia
Confusion
Hallucinations
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150
Monamine oxidase inhibitors (mechanism, clinical use, adverse effects)
Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline
Mechanism: Non selective MAO inhibition with increase levels of amine neurotransmittos (noreepinephrine, 5-HT, dopamine)
Clinical use: Atypical depression, anxiety
Adverse effects: HTN crisis (especially when eated with tyramine, found in foods such as aged cheese)
CNS stimulation
Contraindicated with SSRI, TCA, St-John's Wort, meperidine, destromethophan (or may cause serotonin sydrome)
Wait 2 weeks after stopping MAO before starting serotonergic drugs or stopping dietary restrictions
151
what are the atypical anti-depressents? And their mechanism?
Bupropion( increase in norepinephrine and dopamine via unknown mechanism )
Used for smoking cessation
Toxicity: tachycardia, insomnia, headache, anorexia (no sexual side effect)
Mirtazapine (alpha antagonist) increase release of NE, potent 5 HT2 and 5-HT3 receptor antagonist and H3 antagonist
Toxicity; Sedation, increase appetite, weight gain and dry mouth (weight gain might be good in elderly)
Trazadone; bocks 5HT 2, alpha adrenergic and Hi receptors
Used primarily for insomnia
High dose needed for anti-depresent effect
Toxicity: sedation, nausea, priapism, postural hypotension
Vernicline: Nicotinic AcH receptor, partial agonist
Used for Smoking cessation
Toxicity: Sleep disturbances
