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Psychiatry Flashcards

1
Q

Negative reinforcement vs Positive punishment

Note - Used in operant conditioning (voluntary responses)

A

Negative reinforcement - Removal of aversive stimuli with target behavior

Positive punishment - Application of aversive stimulus

Negative punishment - Removal of a desired reward

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2
Q

Displacement vs Projection

A

Displacement - Transferring avoided ideas and feelings to a neural person or object (e.g. doing to others what someone did to you)

Projection - Attributing an unacceptable internal impulse to an external source (e.g. accusing someone of your impulse)

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3
Q

Regression vs Fixation

A

Fixation - Partially remaining at a childish level of development

Regression - Involuntarily turning back maturational clock to deal with the world

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4
Q

Sublimation vs Reaction formation

A

Reaction formation - Replacing warded-off feeling with unconsciously derived emphasis on opposite

Sublimation (mature) - Replacing an unacceptable wish with a similar wish that does not conflict with value system

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5
Q

Supression vs Repression

A

Repression - Involuntary

Suppression (mature) - Voluntary and temporary

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6
Q

Infant withdrawn or unresponsive to comfort

A

Reactive attachment disorder

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7
Q

Girl toddler with…
Developmental regression
Ataxia
Stereotyped-hand wringing

A

RETT SYNDROME

X-linked dominant

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8
Q

Treatment of ADHD

Note - Must be diagnosed before age 12 and involve more than one setting

A

Methylphenidate
Atomoxetine
Guanfacine
Clonidine

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9
Q

Treatment of Tourette’s

Note - Must be diagnosed before age 18 and persist for >1 year

A 
Fluphenazine
Pimozide
Tetrabenazine
Guanfacine 
Clonidine
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10
Q 
Neurotransmitters affected in...
Alzheimers
Anxiety
Depression
Huntington's
Parkinson's
Schizophrenia
A

Decreased Ach
Increased Glutamate

Increased NE
Decreased GABA, Serotonin

Decreased NE, Serotonin, Dopamine

Decreased Ach, GABA
Increased Dopamine

Decreased Dopamine
Increased Ach

Increased Dopamine

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11
Q

Diffuse slowing on EEG

A

Delerium

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12
Q

Reversible causes of dementia

A 
Hypothyroidism
Depression (pseudodementia)
Vitamin B12 deficiency
NPH
Neurosyphilis
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13
Q

Hypnagogic vs Hypnopompic

A

Hypnagogic - Going to sleep

Hypnopompic - Waking from sleep

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14
Q

Timeframe for…
Brief psychotic disorder
Schizophreniform disorder
Schizophrenia

Note - Ventriculomegaly on MRI

A

< 1 month
1 - 6 months
> 6 months

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15
Q

Criteria for schizoaffective disorder

A

2 weeks of hallucinations or delusions without mood disorder

Also periods of concurrent mood disorder with symptoms of schizophrenia

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16
Q

Folie a deux

A

Shared delusion - Must not impair functioning and last > 1 month

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17
Q

Criteria for manic episode - must last > 1 week

A

At least 3 of…

Distractibility
Impulsivity
Grandiosity
Flight of ideas
Agitation
Sleep decreased
Talkativeness or pressured speech

Note - If lasts > 4 days but does not impair functioning, require hospitalization, or come with psychosis then hypomania instead

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18
Q

Cyclothymic disorder

A

At least 2 years of hypomania and mild depression

Note - Bipolar II requires MDD instead

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19
Q

Sleep pattern changes in MDD…

Slow-wave sleep
REM latency
REM timing
Total REM

Note - Requires 5 out of 9 criteria for > 2 weeks

A

Decreased
Decreased
Earlier
Increased

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20
Q 
Mood reactivity to positive event
Hypersomnia
Hyperphagia
Leaden paralysis
Rejection sensitivity
A

Atypical depression

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21
Q

Presentation of…
Postpartum blues
Postpartum depression
Postpartum psychosis

Note - Must present within a month of delivery

A

Depressed affect, tearfulness, and fatigue resolving usually within 10 days

Depressed affect, anxiety, and poor concentration

Mood-congruent delusions

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22
Q

Criteria for GAD

A

Lasting > 6 months unrelated to specific person, situation, or event

Note - Treat with SSRI or SNRI (Buspirone is second line)

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23
Q

Timeline for adjustment disorder

A

Lasting < 6 months after stressor is removed

24
Q

Timeline for PTSD

A

Lasting > 1 month

Note - 3 days - 1 month is acute stress disorder

25
Cluster A personality disorders
Paranoid - Pervasive distrust and projection Schizoid - Voluntary social withdrawal Schizotypal - Eccentric, odd, magical thinking, awkward
26
Cluster C personality disorders
Avoidant - Hypersensitive but desires relationships Obsessive-Compulsive - Ego-syntonic perfectionism Dependent - Submissive and clingy
27
Mechanism of re-feeding syndrome
Increased insulin Hyperphosphatemia Arrhythmias
28
Timeline for bulimia Note - Binge eating disorder does not have inappropriate compensatory behavior
Occurring weekly for > 3 months Note - Response to Fluoxetine unlike Anorexia
29
Transsexualism vs Transvestism
Transexualism - Desire to live as opposite sex Transvestism - Desire to wear paraphilia of opposite se (not gender dysphoria)
30
Difference between sleep terror and nightmare
Sleep terror - Non-REM sleep (slow-wave/deep) so no recollection Nightmare - REM sleep so recollection
31
Mechanism and treatment of narcolepsy Note - Narcoleptic episodes start with REM sleep
Decreased Hypocretin (Orexin) production in lateral hypothalamus Treat with... Day - Amphetamines, Modafinil Night - Sodium oxybate (GHB)
32
Stages (6) of overcoming substance addiction
Precontemplation - there is no problem Contemplation - there is a problem Preparation/Determination - ready to change behavior Action/willpower - changing behavior Maintenance - maintaining changed behavior Relapse - return to old behavior and abandoning new changes
33
Sensitive serum marker indicative of alcohol use
y-glutamyltransferase (GGT)
34
Symptoms of barbiturate vs benzodiazepine withdrawal
Barbiturates - Delirium, CV collapse Benzodiazepines - Sleep disturbance, depression, rebound anxiety, seizure
35
Mechanism of Naloxone + Buprenorphine
Buprenorphine is a partial agonist Naloxone is not orally bioavailable so withdrawl symptoms only develop with IV use Note - Naltrexone is long-acting opioid antagonist used for relapse prevention once detoxified
36
Treatment of alcoholism
Naltrexone - Prevent cravings Disulfiram - Condition abstinence Acamprosate (modulates Glutamate at NDMA) - Prevent relapse
37
Treatment of OCD
SSRI Venlafaxine Clomipramine
38
Treatment of panic disorder
SSRI Venlafaxine Benzodiazepines
39
Treatment of PTSD
SSRI | Venalfaxine
40
Treatment of social anxiety disorder
SSRI Venlafaxine Note - If performance only then b-blockers or Benzodiazepines
41
High and low potency typical antipsychotics, and their side effects Note - All block dopamine D2 receptors increasing cAMP
High potency: Trifluoperazine, Fluphenazine, Haloperidol May cause EPS symptoms, hyperprolactinemia, prolonged QT Low potency: Chlorpromazine, Thioridazine May cause HAM side effects, corneal deposits (Chlorpromazine), or retinal deposits (Thioridazine) Note - Treat EPS with Benztropine/Diphenhydramine
42
Mechanism and side effects of atypical antipsychotics ``` Includes... Aripiprazole Clozapine Olanzapine Quetiapine Risperidone ZIprasidone Lurasidone Paliperidone Iloperidone ``` Note - Can treat positive and negative symptoms of schizophrenia
5HT2 Antagonists Weaker D2 Antagonist ``` HAM side effects (less EPS) QT prolongation Weight gain ("-pines") Hyperprolactinemia (Risperidone) ```
43
Side effects of Lithium
``` Tremor Ataxia Hypothyroidism Nephrogenic DI Teratogen ``` Almost exclusively excreted by kidneys and most is resorbed at PCT - Anything increasing Na resorption (e.g. Thiazides, ACEi, NSAIDs) also increases Li resorption Note - Acutely mostly GI distress
44
Mechanism of Buspirone
Stimulates 5-HT1A receptors
45
Mechanism of SSRIs ``` Includes... Fluoxetine Paroxetine Sertraline Citalopram ```
5-HT specific reuptake inhibitors May cause... GI distress SIADH Sexual dysfunction
46
Mechanism of SNRIs ``` Includes... Venlafaxine Desvenlafaxine Duloxetine Levomilnacipran Milnacipran ```
5-HT and NE reuptake inhibitors ``` May cause... Hypertension Stimulation Sedation Nausea ``` Note - can also be used for diabetic neuropathy
47
Treatment of serotonin syndrome
Cyproheptadine
48
Mechanism of TCAs ``` Includes... Amitriptyline Nortriptyline Imipramine Desipramine Clomipramine Doxepin Amoxapine ```
5-HT and NE reuptake inhibitors ``` Major depression OCD (Clomipramine) Peripheral neuropathy Chronic pain Migraine prophylaxis ``` ``` May cause... Sedation Orthostatic hypotension (a1-blocking) Anticholinergic (tertiary; Amitriptyline) Prolonged QT Delerium (use Nortriptyline in elderly) Hyperpyrexia Convulsions, Coma, Arrhythmia ```
49
Mechanism of MAOi ``` Includes... Tranylcypromine Phenelzine Isocarboxazid Selegiline (MAO-B selective) ```
Non-selective MAO inhibition increases 5-HT, NE, and Dopamine Refractory atypical depression Anxiety May cause... Hypertensive crisis CNS stimulation Serotonin syndrome if taken with SSRIs, TCAs, St. John's wort, Meperidine, Dextromethorphan Note - Wait 2 weeks after stopping drug to take other serotonergic drug or stop dietary (Tyramine) restrictions
50
Mechanism of Buproprion
Increased NE and Dopamine Depression Smoking cessation May cause... Simulation/Anxiety Headache Seizures in anorexia/bulimia Note - No sexual side effects
51
Mechanism of Mirtazipine
a2-antagonist increases NE and 5-HT 5-HT2, 5-HT3 antagonist H1 antagonist Depression Insomnia ``` May cause... Sedation Increased appetite Weight gain Dry mouth ``` Note - No sexual side effects
52
Mechanism of Trazodone Note - Not used in depression as high doses are needed
5-HT2 antagonist a1 antagonist H1 antagonist Insomnia ``` May cause... Sedation Nausea Orthostatic hypotension Priapism ```
53
Mechanism of Varenicline
Nicotinic ACh receptor partial agonist Smoking cessation May cause... Sleep disturbance
54
Presence of multiple motor or multiple vocal tics but not both
CHRONIC TIC DISORDER Note - Tourettes requires multiple motor and at least 1 vocal tic >1 year
55
Mechanism of Dantrolene
Stops Ca release from SR (RYR antagonist) - Prevents consumption of excess ATP (generates heat) to move Ca back into SR Note - Also used in malignant hyperthermia

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