Psychiatry Flashcards
Transference
Patient projects feelings about formative or other important persons onto physician
Countertransference
Doctor projects feelings about formative or other important persons onto patient
Acting out
Immature
Subconsciously coping with stressor or emotional conflict using actions rather than reflections or feelings
Denial
Immature
Avoiding the awareness of some painful reality
Displacement
Immature
Redirection of emotions or impulses to a neutral person or object
Dissociation
Immature
Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress. Patient has incomplete or no memory of traumatic event.
Fixation
Partially remaining at a more childish level of development
Idealization
Expressing extremely positive thoughts of self and others while ignoring negative thoughts
Identification
Largely unconscious assumption of the characteristics, qualities or traits of another person or group
Intellectualization
Using facts and logic to emotionally distance oneself from a stressful situation
Isolation of affect
Separating feelings from ideas and events
Passive aggressive
Demonstrating hostile feelings in a nonconfrontational manners; indirect opposition
Projection
Attributing an unacceptable internal impulse to an external source
Rationalization
Asserting plausible explanations for events that actually occurred for other reasons, avoid self blame
Reaction Formation
replacing a warded off idea or feeling with an emphasis on its opposite
Regression
involuntarily turning back the maturational clock to behaviors previously demonstrated under stress
Repression
Involuntarily withholding an idea or feeling from conscious awareness
Splitting
Believing that people are either all good or all bad at different times due to intolerance of ambiguity. Borderline Personality Disorder
Sublimation
Replacing an unacceptable wish with a course of action that is similar to the wish but socially acceptable
Mature
Altruism
Alleviating negative feelings via unsolicited generosity, which provides gratification
Suppression
Intentionally withholding an idea or feeling from conscious awareness temporarily
Humor
Lightheartedly expressing uncomfortable feelings to shift the internal focus away from distress
Infant deprivation effects
failure to thrive
poor language/socialization
lack of basic trust
Reactive attachment disorder
Disinhibited social engagement (attached to strangers)
Deprivation for >6 months –> irreversible changes
Child Physical Abuse
Fracture, bruises, burns
Different stages of healing
Caregivers may delay seeking medical attention
Child Sexual Abuse
STI, UTI, genital, anal or oral trauma
May be no physical trauma
9-12 years
Child Emotional abuse
lack a bond with caregiver but overly affectionate with other adults
Aggressive toward children and animals
Child Neglect
Failure to provide with adequate food, shelter, supervision, education, affection
Poor hygiene, malnutrition, withdrawal, impaired social development, failure to thrive
Report to CPS
Vulnerable Child Syndrome
Parents perceive the child as susceptible to illness or injury.
Attention deficit Hyperactivity Disorder
<12 years
>6 months of limited attention span or poor impulse control
Hyperactivity, impulsivity, inattention in >2 settings
Normal intelligence but difficulty in school
T(x): stimulants, behavioral therapy
Autism Spectrum Disorder
Repetitive, pervasive behavior violating social norms.
After age 18 –> Antisocial Personality Disorder
T(x) CBT
Disruptive Mood Dysregulation Disorder
Before 10 years
Severe, recurrent temper outbursts
Child is constantly angry and irritable
T(x): CBT, stimulants, antipsychotics
Intellectual Disability
Global cognitive deficits that affect reasoning, memory, abstract thinking, judgement, language, learning.
Difficulty with education, employment, communication, socialization
T(x): psychotherapy, occupational therapy, special ed
Oppositional Defiant disorder
Enduring pattern of anger and irritability with argumentative, vindictive and defiant behavior toward authority figures
T(x): CBT
Selective mutism
Onset <5 years
Anxiety disorder lasting >1 month involving refraining from speech in certain situations despite speaking in other, usually more comfortable situation.
Development not typically impaired
Coexists with social anxiety disorder
T(x): behavioral, family, play therapy, SSRIs
Separation anxiety Disorder
Overwhelming fear of separation from home or attachment figure lasting >4 weeks. Can be normal behavior up to 3-4 years. May lead to factitious physical complaints to avoid school
T(x): CBT, play therapy, family therapy
Specific Learning Disorder
Onset during school age years.
Inability to acquire or use information form a specific subject near age expected proficiency for > 6 months despite focused intervention.
General functioning and intelligence are normal
T(x): academic support, counseling, extracurricular activities
Tourette Syndrome
Onset before age 18
sudden, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for >1 year.
Coprolalia found in some
Associated with OCD and ADHD
T(x): psychoeducation, Behavioral therapy, haloperidol, fluphenazine, tetrabenazine, a2 agonists
Orientation
Patients’ ability to know the date and time, where they are, and who they are
Loss of orientation- alcohol, drugs, fluid, imbalance, head trauma, hypoglycemia, infection, nutrition, hypoxia
Retrograde Amnesia
Inability to remember things that occurred before a CNS insult
Anterograde Amnesia
Inability to remember things that occurred after a CNS insult
Korsakoff Syndrome
Amnesia (anterograde > retrograde) and disorientation caused by vitamin B1 deficiency.
Associated with disruption and destruction of the limbic system (mammillary bodies and anterior thalamus)
Confabulations
Depersonalization/ derealization Disorder
Persistent feelings of detachment or estrangement from one’s own body, thoughts, perceptions and actions (depersonalization) or one’s environment (derealization)
Intact reality testing
Dissociative Amnesia
Inability to recall important personal information, usually following severe trauma or stress.
May be accompanied by dissociative fugue
Dissociative Identity Disorder
Presence of >2 distinct identities or personalities
Women
Associated with Hx of sexual abuse, PTSD, depression, substance abuse, borderline personality, somatic symptom disorder
Delirium
Waxing and waning levels of consciousness with acute onset, decrease attention span, decrease level of arousal.
Disorganized thinking, hallucinations, misperceptions
Secondary to identifiable illness
T(x): underlying cause, decrease sleep disturbance, increase cognitive stimulation, antipsychotics
Delusions
False, fixed, idiosyncratic beliefs that persist despite evidence to the contrary and are not typical of a patient’s culture or religion
Disorganized though
Speech may be incoherent, tangential, derailed
Hallucinations
Perception in the absence of external stimuli Auditory- in schizophrenic pt Visual- drugs, delirium Tactile- alcohol withdrawal and stimulant use Olfactory- epilepsy, brain tumors Gustatory- epilepsy Hypnagogic- going to sleep, narcolepsy Hypnopompic- when waking up, narcolepsy
Schizophrenia
Profound functional impairment
(+) hallucinations, delusions, unusual thought processes, disorganized speech, bizarre behavior
(-) flat, blunted affect, apathy, anhedonia, alogia, social withdrawal
Cognitive- reduced ability to understand or make plans, diminished working memory, inattention
Schizophrenia D(x)
>2 symptoms Delusion Hallucinations (auditory) Disorganized speech Disorganized or catatonic behavior Negative symptoms >1 month of active symptoms over the past 6 months
Schizophrenia path
associated with altered dopaminergic activity, increased 5HT activity and decreased dendritic branching.
Men
Associated with heavy cannabis use in adolescence
T(x) atypical antipsychotics
Brief psychotic Disorder
> 1 positive symptom lasting <1 month, stress related
Schizophreniform Disorder
> 2 symptoms lasting 1-6 months
Schizoaffective Disorder
shares symptoms with both schizophrenia and mood disorders
> 2 weeks of psychotic symptoms without manic or depressive episode
Delusional Disorder
> 1 delusion lasting >1 month without mood disorder or other psychotic symptoms. Daily functions may be impacted. Can be shared by individuals in close relationship
Schizotypal Personality Disorder
Cluster A
brief psychotic episodes that are less frequent and severe than schizophrenia
Social Anxiety
eccentric appearance, odd beliefs, or magical thinking, interpersonal awkwardness
Manic Episode
Distinct period of abnormally and persistently elevated expansive or irritable mood and increased activity or energy >1 week. D(x)= >3 Distractibility Impulsivity Grandiosity Flight of ideas Increased activity decrease sleep Talkative
Hypomanic episode
Mood disturbance is not severe enough to cause marked impairment in social or occupational functioning or necessitate hospitalization. >4 consecutive days
Bipolar 1
> 1 manic episode +/- hypomanic or depressive episode
Bipolar 2
hypomanic and a depressive episode. Patient’s mood and functioning usually normal between episodes.
Cyclothymic disorder
mild form of bipolar disorder fluctuating between mild depressive and hypomanic symptoms
>2 years with symptoms present at least half of the time with remission lasting <2 months
Major Depressive Disorder
Recurrent episodes lasting >2 weeks characterized by >5 symptoms Depressed mood decreased interest guilt/worthlessness sleep disturbances suicidal ideation psychomotor retardation Appetite changes decreased concentration decreased energy T(x): CBT and SSRIs
Major Depressive Disorder with psychotic features
MDD + hallucinations or delusions. Psychotic features are typically mood congruent and occur only in the context of major depressive episode
T(x): antidepressant with atypical antipsychotic, ECT
Persistent Depressive Disorder
milder than MDD, >2 depressive symptoms lasting >2 years with any remission lasting <2 months
MDD with seasonal pattern
Major depressive episodes occurring only during particular season in >2 consecutive years. Atypical symptoms common
Depression with atypical features
mood reactivity, hypersomnia, hyperphagia, leaden paralysis, long standing interpersonal rejection sensitivity.
T(x) CBT, SSRIs, then MAOi
Peripartum mood disturbances
onset during or shortly after pregnancy or within 4 weeks of delivery. increased risk with Hx of mood disorders
Maternal postpartum blues
depressed affect, tearfulness, fatigue 2-3 days after delivery
resolves within 2 weeks
T(x): supportive and follow up to assess for MDD
MDD with peripartum onset
Meet MDD criteria with onset no later than 1 year after delivery
T(X): CBT and SSRIs
Postpartum psychosis
mood congruent delusions, hallucinations and thoughts of harming the baby or self
Risk factors include first pregnancy, FMHx, bipolar, psychotic, recent drug med change.
T(x) hospitalization and initiation of atypical antipsychotic
Grief
Denial, anger, bargaining, depression, acceptance
Hallucinations of deceased person is common.
Resolves 6-12 months
Electroconvulsive Therapy
Treat refractory depression, depression with psychotic symptoms, catatonia and acute suicidality
Induce tonic-clonic seizures under anesthesia and neuromuscular blockade.
Adverse: disorientation, HA, partial anterograde/retrograde amnesia (resolve in 6 months)
Risk factors for Suicide completion
Sex (male Age (adult/elderly) Depression Previous attempt Ethanol Rational thinking loss Sickness Organized plan No spouse/support Stated future intent
Anxiety Disorders
inappropriate experiences of fear/worry and their physical manifestations incongruent with the magnitude of the stressors
Symptoms are not attributable to another psychiatric disorder, medical condition or substance abuse.
Panic Disorder
Recurrent panic attacks involving intense fear and discomfort
Peach in 10 minutes with >4 (palpitations, paresthesias, depersonalization or derealization, ab pain, nausea, intense fear of dying/losing control, lightheadedness, chest pain, chills, choking, sweating, shaking, SOB
increased risk of suicide
Panic Disorder D(x)
Attack followed by >1 month of >1 persistent concern of additional attacks Worrying about consequences of attack Behavioral change related to attacks T(x): CBT SSRIs venlafaxine Benzo in acute setting
Phobias
Severe, persistent (> 6 months) fear or anxiety due to presence or anticipation of a specific object or situation.
T(x) CBT with exposure therapy)
Social Anxiety Disorder
Exaggerated fear of embarrassment in social situations
T(x): CBT SSRIs venlafaxine
Agoraphobia
irrational fear while facing or anticipating >2 specific situations
Associated with panic disorder
T(x): CBT SSRIs
Generalized Anxiety Disorder
Excessive anxiety and worry about different aspects of daily life for most days of >6 months
>3 symptoms- restlessness, irritability, sleep disturbance, fatigue, muscle tension, difficulty concentrating
T(x): CBT, SSRIs, SNRIs
OCD
obsession that cause severe distress, relieved in part by compulsions
Ego-dystonic behavior inconsistent with one’s beliefs and attitudes
Associated with Tourette syndrome
T(x) CBT SSRI chlomipramine vanlafaxine
Body Dysmorphic Disorder
preoccupation with mirror or imagined defects in appearances
Causes significant emotional distress and repetitive appearance related behaviors
Common in eating disorders
T(x): CBT
Trichotillomania
Compulsively pulling out one’s hair
Causes significant distress and persists despite attempts to stop
Presents with areas of thinning hair or balness
T(x) psychotherapy
Adjustment Disorder
emotional or behavioral symtpoms that occur within 3 months of an psychosocial stressor lasting <6 months once the stressor has ended
T(x) CBT
PTSD
experiencing or discovering that a loved one has experiences, a life threatening situation
Hyperarousal, avoidance, re-experiencing, distress
>1 month
T(x) CBT, SSRIs venlafaxine
Acute stress Disorder
lasts between 3 days and 1 month
T(x) CBT
Cluster A
odd/eccentric
inability to develop meaningful social relationships
No psychosis
genetic association with schizophrenia
Paranoid
Cluster A
pervasive distrust, suspiciousness, hypervigilance, cynical view of world
Schizoid
Cluster A
voluntary social withdrawal, limited emotional expression, content with social isolation
Cluster B
Dramatic, emotional, erratic
genetic association with mood disorders and substance abuse
Antisocial
Cluster B
disregard for the rights of others with lack of remorse.
Criminality, impulsivity, hostility, manipulation
Males
>18 years with onset before 15
Borderline
Cluster B
Unstable mood and interpersonal relationships, fear of abandonment, impulsivity, self mutilation, suicidality, emotional emptiness
Females
Splitting
Histronic
Cluster B
Attention seeking, dramatic speech, and emotional expression, shallow, labile emotions, sexually provocative
Narcissistic
Cluster B
Grandiose, sense of entitlement, lacks empathy, and requires excessive admiration
Fragile self esteem
Con artists
Cluster C
anxious or fearful
genetic association with anxiety disorders
Avoidant
Cluster C
Hypersensitive to rejection and criticism, socially inhibited, timid, feelings of inadequacy, desires relationship with others
Obsessive Compulsive
Cluster C
preoccupation with order, perfectionism and control.
Dependent
Cluster C
Excessive need for support, low self confidence,
Abusive relationships
Malingering
symptoms are intentional, motivation is intentional
Patient consciously fakes a disorder in order to attain a secondary gain.
Poor compliance with treatment or follow up of diagnostic tests
complaints cease after gain
Factitious Disorder
Symptoms are intentional, motivation is unconscious. Patient consciously creates physical and or psychological symptoms in order to assume sick role and to get medical attention and sympathy
Factitious Disorder imposed on self
Chronic factitious disorder with predominantly physical signs and symptoms
Hx of multiple hospital admissions and willingness to undergo invasive procedures
Women and healthcare workers
Factitious Disorder imposed on another
Illness in a child or elderly patient is caused or fabricated by the caregiver. Motivation is to assume a sick role by proxy
Child/elder abuse
Somatic Symptom and related disorders
Symptoms are unconscious, motivation is unconscious
Physical symptoms causing significant distress and impairment
Somatic Symptom Disorder
> 1 bodily complaints lasting months to years
Excessive persistent thoughts and anxiety about symptoms
T(x):regular office visits with the same physician + psychotherapy
Conversion Disorder
Loss of sensory or motor function following stressor
Patient may be aware but indifferent toward symptoms
Female adolescents and young adults
Illness anxiety Disorder
preoccupation with acquiring or having a serious illness despite medical evaluation
Anorexia Nervosa
Intense fear of weight gain, overevaluation of thinness and body image. Calorie restriction and severe weight loss resulting in low body weight
t(x) psychotherapy, nutritional rehab, SSRIs
Anorexia Nervosa Binge-eating/purging type
recurring purging behavior or binge eating over the last 3 months
Anorexia Nervosa Restricting Type
diet, fast, over exercise
no recurring purging behaviors or binge eating over the last 3 months
Anorexia Nervosa Refeeding Syndrome
occurs in significantly malnourished patients with sudden increase in calorie intake –> increase insulin –> decrease phosphate, K+ Mg + –> cardiac complications, rhabdomyolysis, seizures
Bulimia Nervosa
Recurring episodes of binge eating with compensatory purging at least weekly over the last 3 months. BMI normal or slightly overweight
Associated with parotid gland hypertrophy, enamel erosion, Mallory Weiss syndrome, electrolyte disturbance, met alk dorsal hand calluses
T(x): psychotherapy, nutritional rehab, SSRI. NO BUPROPRION (seizures)
Binge Eating Disorder
Recurring episodes of binge eating without purging at least weekly for 3 months
Increase risk diabetes
T(x): psychotherapy, SSRI, lisdexmfetamine
Pica
recurring episodes of eating non food substances over >1 month that are not culturally or developmentally recognized as normal.
Temporary emotional relief
Associated with malnutrition, Fe deficiency anemia, developmental disabilities, emotional trauma
T(x): psychotherapy, nutritional rehab, SSRIs
Gender dysphoria
incongruence between one’s experienced gender and the gender assigned at birth >6 months –> persistent distress
Transgender
desiring and often making lifestyle changes to live as a different gender. Medical interventions may be utilized
Transvestism
deriving pleasure from wearing clothes of opposite sex
Transvestic Disorder
transvestism that causes significant distress. Paraphilia
Sexual Dysfunction
Psychological Endocrine Neurogenic Insufficient blood flow Substances
Sleep Terror Disorder
period of inconsolable terror with screaming in the middle of the night
Children
During N3 with no memory of arousal episode
Trigger: emotional stress, fever, lack of sleep
self limited
Enuresis
Nighttime urinary incontinence >2 times/wk for >3 months in person >5 years old
T(x): behavioral modifications and positive reinforcement
Narcolepsy
Excessive day time sleepiness with recurrent episodes of rapid onset overwhelming sleepiness >3 times/wk for 3 months
Decreased Orexin production in lateral hypothalamus
Associated with hypnagogic or hypnopompic hallucinations, nocturnal and narcoleptic sleep episodes that start with REM, cataplexy
T(x): good sleep hygiene, daytime stimulants, GHB
Precontemplation
1
deny problem
Contemplation
2
acknowledge problem but unwilling to change
Preparation
3
preparing for behavioral changes
Action
4
change behavior
Maintenance
5
Maintain changes
Relapse
6
Return to old behaviors and abandon change
5HT syndrome
caused by any drug that increase 5HT
Increase activity, autonomic instability, AMS
T(x): cyproheptadine
Hypertensive Crisis
via antipsychotics
Myoglobinuria, fever, encephalopathy, vitals unstable, increase CK, muscle rigidity
T(x): dantrolene, DA agonist
Delirium Tremens
via alcohol withdrawal (2-4 days after last drink)
AMS, hallucinations, autonomic hyperactivity, anxiety, seizures, tremors, psychomotor agitation, insomnia, nausea
T(x): benzo
Acute dystonia
via typical antipsychotic, anticonvulsants
sudden onset of muscle spasms, stiffness, oculogyric crisis
T(x): benzotropine
Li toxicity
via increase lithium dosage, decrease renal elimination, meds affecting clearance
Nausea, vomiting, slurred speech, hyperreflexia, seizures, ataxia, DI
T(x) DC Li, hydrate with isotonic NaCl
Tricyclic Antidepressant Toxicity
via TCA overdose
Respiratory depressrion, hyperpyrexia, prolonged QT
T(x): supportive, NaHCO3, charcoal
Alcohol intoxication/withdrawal
Intoxication- emotional liability, slurred speech, ataxia, coma, blackouts
T(x): benzo
Withdrawal: seizures, tremors, insomnia, diaphoresis, delirium tremens
Barbiturates intoxication/withdrawal
Intoxication:Low safety margin, marked respiratory depression
T(x): symptoms
wIthdrawal: delirium, life threatening CV collapse
Benzo intoxication/withdrawal
Intoxication: ataxia, minor respiratory depression
T(x): flumazenil
Withdrawal: sleep disturbance, depression
Opioid intoxication/withdrawal
Intoxication: euphoria, respiratory and CNS depression, decrease gag reflex, pupillary constriction, seizures
T(x): naloxone
Withdrawal: sweat, dilated pupils, piloerection, rhinorrhea, lacrimation, yawning, nausea, stomach cramps, diarrhea
T(x): symptoms, methadone, buprenorphine
inhalant intoxication/withdrawal
intoxication: disinhibition, euphoria, slurred speech, disturbed gait, disorientation
Withdrawal: irritability, dysphoria, sleep disturbance, HA
Amphetamine intoxication/withdrawal
intoxication: euphoria, grandiose, pupillary dilation, prolonged wakefulness, hyperalert, HTN, paranoia, fever, fractured teeth.
T(x): benzo
Caffeine intoxication/withdrawal
intox: palpitations, agitation, tremor, insomnia
Withdrawal: HA, difficulty concentrating, flu like
Cocaine intoxication/withdrawal
intoxication: impaired judgement, pupillary dilation, hallucinations, paranoia, angina, sudden cardiac death
T(x) benzos
Nicotine intoxication/withdrawal
Intoxication: restlessness
Withdrawal: irritability, anxiety, restlessness, decreased concentration, increase appetite
T(x): nicotine patch, gum, lozange
Lysergic Acid Diethylamide intoxication/withdrawal
intox: perceptual distortion, depersonalization, anxiety, paranoia, psychosis, flashbacks
Marijuana intoxication/withdrawal
intoxication: euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, social withdrawal, increased appetite, dry mouth, hallucinations
Withdrawal: irritability, anxiety, depression, insomnia, restlessness, decreased appetite
MDMA intoxication/withdrawal
Intoxication: hallucinations, euphoria, disinhibition, hyperactivity, increased thirst, bruxism, distorted sensory and time perception
Withdrawal: depression, fatigue, change in appetite, difficulty concentrating, anxiety
Phencyclidine intoxication/withdrawal
intoxication: violence, impulsivity, pychomotor agitation, nystagmus, tachy, HTN, analgesia, psychosis, delirium, seizures
Alcohol abuse T(x)
naltrexone, acamprosate, disulfiram, AA
Behavioral Therapy
Teach patient how to identify and change maladaptive behavior.
Cognitive Behavioral therapy
Teaches patient to recognize distortions in their thought processes, develop coping skills and decrease maladaptive behavior –> greater emotional control and tolerance of distress
Dialectical behavioral therapy
For Borderline personality disorder
Interpersonal therapy
improve interpersonal relationships and communication skills
Supportive therapy
utilize empathy to help individuals during times of hardship to maintain optimism
CNS stimulants
methylphenidate, dextroamphetamine, methamphetamine, lisdexamfetamine
increase catecholamines in the synaptic cleft (NE and DA)
use for ADHD, narcolepsy, binge eating
adverse: nervousness, agitation, anxiety, insomnia, anorexia, tachy, HTN, weight loss, tics, bruxism
Typical antipsychotics
Haloperidol, pimizide, -azine
Block D2
Use for schizophrenia, psychosis, bipolar disorder, delirium, tourette, huntington, OCD
Adverse: stored in fat, hyperlacteinemia, dyslipidemia, dry mouth, sedation, orthostatic hypotension, QT prolongation
Atypical antipsychotics
- apine, -peridone, -idone
5HT2 and D2 antagonists
used for schizophrenia, bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette
Adverse: prolonged QT
Lithium
mood stabilizer for bipolar, acute manic episodes and prevents relapse
Adverse: tremors, thyroid issues, polyuria, teratogenesis
Buspirone
stimulate 5HT1A receptor
used for generalized anxiety disorder
SSRI
Fluoxetine, flucoxamine, paroxetine, sertraline, escitalopram, citalopram
inhibit 5HT reuptake
used for depression, D=GAD, panic disorder, OCD, binge eating, social anxiety, PTSD
Adverse: 5HT syndrome, GI distress, SIADH, sexual dysfunction
SNRI
venlafaxine, desvenlafaxine, duloxetine, levomilnacipran, milnacipran
inhibit 5HT and NE reuptake
used for depression, GAD, diabetic neuropathy
Adverse: increased BP, stimulant effects, sedation, nausea
TCA
Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine
inhibit 5HT and NE reuptake
used for MDD, peripheral neuropathy, chronic neuropathic pain, migraine, OCD, nocturnal enuresis
Adverse: convulsions, coma, cardiotox
T(x): NaHCO3
MAOi
Selegiline, Tranylcypromine, phenelzine, isocarboxazid
Increase NE, 5HT, DA
use for atypical depression, anxiety, parkinson disease
Adverse: hypertensive crisis
contra with SSRIs, TCAs (2 wk washout)
Buproprion
Atypical antidepressant
inhibit NE and DA reuptake
used for smoking cessation
tox: stimulant, HA, seizures
Mirtazapine
Atypical antidepressant
a2 antagonist, 5HT receptor antagonist, H1 antagonist
tox: sedation, increased appetite, weight gain, dry mouth
Trazadone
Atypical antidepressant
block 5HT2, a1 and H1
used for insomnia
tox: sedation, nausea, priapism, postural hypotension
Varenicline
Atypical antidepressant
nAChR partial agonist
smoking cessation
tox: sleep disturbance, depressed mood, suicide
Vilazodone
Atypical antidepressant
inhibit 5HT reuptake, 5HT partial agonist
MDD
tox: HA, diarrhea, nausea, anticholinergic, 5HT syndrome
Vortioxetine
inhibit 5HT reuptake, 5HT receptor agonist/antagonist
MDD
tox: nausea, sexual dysfunction, sleep distrubances, anticholinergic, 5HT syndrome
Methadone
Opioid detox and relapse prevention
long acting oral
for heroin detox or maintenance
Buprenorphine
Opioid detox and relapse prevention
sublingual to prevent relapse
Naloxone
Opioid detox and relapse prevention
short acting opioid antagonist via IM, IV or nasal
treat overdose
Naltrexone
Opioid detox and relapse prevention
long lasting oral opioid antagonist after detox to prevent relapse
