Psychiatry & Behavioral Science Flashcards
Neuroleptic malignant syndrome
Reaction to antipsychotic medications
- Fever (>40 C common)
- Confusion
- Muscle rigidity (generalized)
- Autonomic instability (abnormal vital signs, sweating)
Wernicke encephalopathy
Caused by Vitamin-B1 (Thiamine) deficiency in alcoholics
Confusion, Ophthalmoplegia/Nystagmus, Ataxia (add confabulation/memory loss for Korsakoff syndrome)
Damage to Mamilliary bodies.
Serotonin Syndrome
– Neuromuscluar hyperactivity (clonus,hypereflexia, hypertonia, tremors, siezures)
– Autonomic stimulation
(hyperthermia, diaphoresis, diarrhea)
– Agitation
Treatment:
Benzodiazipine (to calm the patient)
Cyproheptadine (serotonin recptor antagonist)
Note: Differentiation point b/w serotonin syndrome and NMS is that only serotonin syndrome has Clonus & Hyperreflexia, NMS has Hyporeflexia and no clonus
Neuroleptic Malignant Syndrome
- Feared side effect of typical antipsychotics
- Progression to EPS
- Muscle rigidity, Myoglobinuria
- Fever
- Encephalopathy
- Unstable vitals
- Elevated Liver enzymes
Metabolic Syndrome
Wt.gain , Diabetes , Hyperlipidemia
Atypical antipsychotics have highest risk of causing metabolic syndrome (i.e clozapine, olanzipine, quetiapine)
Tourrette syndrome
Motor and vocal tics that presist for > 1 year.
Tx: Fluphenazine, Resperidone
Alcohol Intoxication
- Slurred speech, Mood changes, Horizontal Nystagmus, Lack of coordinated movement.
- Delerium tremens: life threatnening alcohol withdrawal symptoms peak 2-4 days after last drink, characterized by autonomic hyperactivity (Tremors, Anxiety, Siezures, Electrolyte disturbances, Respiratory alkalosis)
- Drugs for withdrawal: benzodiazipines (lorazipam, diazepam)
Tx for alcoholism:
Disulfram (to condition the patient to abstain from alcohol use)
Acamprosate, Naltrexone (reduce cravings)
Support group.
Opiod Intoxication
Sx of OD:
- Euphoria,
- Respiratory/CNS depression,
- Pupillary constriction (pinpoint pupils)
Tx: Naloxone (Opiod recptor anatgonist)
Sx of Withdrawal:
- Flu-like symptoms Sweating
- Dilated pupils
- Piloerection
- Fever, Rhinorhea, Lacrimation
- Nauseas, Stomach cramps, Diarrhea
Tx: Naltrexone
Cocaine Intoxication
- Cocaine blocks Dopamine, Serotonin, NorEpi reuptake.
Sx of intoxication:
- Pupillary dilation
- Hallucinations (including tactile i.e feeling bugs all over the body aka cocaine crawlies)
- Paranoid ideations
- Angina, SCD
- Perforation of nasal septum
Tx: Alpha blockers (Phenoxybenzamine, Phentolamine) , Benzodiazipines, B-blockers C/I.
MDMA intoxication
Aka Ecstacy
- Club drug
- For social closeness
- Distorted sensory and time preception
- Teeth clenching
- Life threatening effects include:
Tachycardia, HTN, Hyperthermia, Hyponatremia, Serotonin syndrome
Marijuana/ Cannaboid intoxication
Euphoria , Anxiety , Paranoid delusions , Preception of slowed time , Impaired judgement , Social withdrawal , Increase Appetite , Dry mouth , conjunctival injection , Hallucination
Phenycyclidine / PCP intoxication
Violence , Impulsivity , Psychomotor agitation , Nystagmus , Tachycardia , HTN , Analgesia , Psychosis , Delerium , Siezures
LSD intoxication
- Action at serotonin receptor
- Visual hallucinations
- Synesthesia ( seeing sounds as colours )
- Pupillary dilation
- Paranoia
- Psychosis
- Possible Flashbacks
TCA Overdose
- New On-set Seizures
- Anticholinergic toxicity (i.e., dilated pupils, hyperthermia, tachycardia, decreased bowel sounds, urinary retention)
- Cardiac toxicity (i.e. QRS widening, Ventricular arrythmias)
- Hypotension
- Sedation
Inhalant Abuse
- Young adult, Teenager
- Rapid onset of Bilegerence , Assaultiveness
- Apathy , Impaired judgement , Blurred vision , Coma.
- Resolution can be just as rapid
Acute Benzodiazepine Overdose
- Benzodiazepines (eg, alprazolam, lorazepam) cause sedation and central respiratory depression with hypoventilation
- The hypoventilation leads to CO2 retention and acute respiratory acidosis
- It also decreases the PAO2, leading directly to hypoxemia (PaO2 <75 mm Hg)
- The efficiency of gas transfer between the lungs and the circulation is intact; therefore, a normal alveolar-arterial O2 gradient (eg, <15 mm Hg) is expected.
Rett Syndrome
Only in girls
Decreased head growth
Hand wringing
Lose motor skills (Normal until 5 months of age)
Autism
Poor eye contact , Repetitive movements, lack verbal skills and bonding, symptoms since birth
Major depressive disorder
( M D D )
Need 5 of 8 SIGECAPS for over 2 weeks
“ S I G E C A P S “
S = Sleep disturbances
I = Interest/ Lipido loss
G = Gulit
E = Energy loss
C = Concentration loss
A = Appitite loss
P = Psychomotor agitation
S = Suicidal Ideation (hopelessness)
Malignant Hyperthermia
Widespread muscle rigidity after administration of inhalation anesthetics and/or succinylcholine to genetically susceptible individuals.
Genetic mutation in Rayanodine receptors
Unregulated sarcoplasmic Ca+2 release —> sustained muscle contraction
Symptoms:
- Masseter muscle spasm
- Widespread muscle rigidity
- Hypercarbia
- Rhabdomyolysis —> Hyperkalemia & ARF.
- Hyperthermia (late manifestation)
Dantrolene is used for treatment it directly inhibits intracellular Ca+2 release from abnormal ryanodine receptors (RYR1).
Brief psychotic disorder
Brief psychotic disorder is characterized by the sudden onset of psychotic symptoms lasting ≥1 day but <1 month.
Delirium
Delirium is a reversible, acute-onset confusional state characterized by a fluctuating level of consciousness with deficits in attention, memory, and executive function
Frontotemporal dementia
Frontotemporal dementia presents with early behavior change (eg, disinhibition, apathy), followed later by memory impairments
Paranoid Personality Disorder
Pervasive pattern of distrust & suspiciousness beginning in early adulthood & occurring in a variety of settings (no clear delusions)
- Believes being exploited & deceived by others
- Interprets benign comments & events as threats; reacts angrily
- Bears grudges
- Questions loyalty of partner without justification
Schizophrenia
→ Positive symptoms:
- Delusions - Hallucinations - Disorganization
→ Negative symptoms:
- Flat Effect - Social Withdrawal - Lack of Motivation - Catatonia (Rare)
No or less negative symptoms, Lack of Stressors, early intervention can lead to better prognosis
Schizotypal personality disorder
Characterized by magical beliefs, social anxiety, eccentric behavior, and odd perceptual experiences.
- Eccentric behavior & thinking
- Unusual perceptual experiences
Narcissistic personality disorder
- Consists of a pervasive pattern of grandiosity, need for admiration, sense of entitlement, and lack of empathy.
- Behaviors and interactions are often motivated by a need for attention and praise
Anorexia nervosa
- BMI <18.5 kg/m2
- Intense fear of weight gain
- Distorted views of body weight & shape
Treatment:
- Cognitive-behavioral therapy
- Nutritional rehabilitation
- Olanzapine if no response to first-line treatments
Bulimia Nervosa
- Recurrent episodes of binge eating
- Inappropriate compensatory behavior to prevent weight gain
- Excessive worrying about body shape & weight
Treatment:
- Cognitive-behavioral therapy
- Nutritional rehabilitation
- SSRI (fluoxetine), often in combination with first-line treatments
Binge Eating Disorder
- Recurrent episodes of binge eating
- No inappropriate compensatory behaviors
- Lack of control during eating
Treatment:
- Cognitive-behavioral therapy
- Behavioral weight loss therapy
- SSRI Lisdexamfetamine, topiramate
Body dysmorphic disorder
- Characterized by intense preoccupation with a perceived defect in physical appearance leading to significant functional impairment.
- It is not diagnosed when weight gain is the preoccupation of an individual who meets the criteria for an eating disorder.
Cluster-A Disorders
Odd/eccentric
- Paranoid: suspicious, distrustful, hypervigilant
- Schizoid: prefers to be a loner, detached, unemotional
- Schizotypal: unusual thoughts, perceptions & behavior
Cluster-B Disorders
Dramatic/erratic
- Antisocial: disregard & violation of the rights of others
- Borderline: chaotic relationships, abandonment fears, labile mood, impulsivity, inner emptiness, self-harm
- Histrionic: superficial, theatrical, attention-seeking
- Narcissistic: grandiosity, lack of empathy
Cluster-C Disorders
Anxious/fearful
- Avoidant: avoidance due to fears of criticism & rejection
- Dependent: submissive, clingy, needs to be taken care of
- Obsessive-compulsive: rigid, controlling, perfectionistic
Alcohol Withdrawal
Alcohol withdrawal symptoms typically start within 8-12 hours after the last drink and include:
- Insomnia
- Tremulousness
- Anxiety
- Autonomic hyperactivity (variable blood pressure, diaphoresis, and tachycardia).
Alcohol withdrawal seizures can occur within 12-48 hours.
Delirium tremens (disorientation, severe agitation, fever) typically begins within 48-96 hours.
Benzodiazepines (eg, lorazepam, diazepam, chlordiazepoxide) are used as first-line therapy
Delirium Tremens
Alcohol withdrawal complication, typically begins within 48-96 hours of withdrawal, usually seen in the setting of hospitalized patients.
- Disorientation
- Severe agitation
- Fever
Stages of change model
- Precontemplation:
- Not ready to change:
- Patient does not acknowledge negative consequences
- Contemplation:
- Thinking of changing:
- Patient acknowledges consequences but is ambivalent
- Preparation:
- Ready to change: patient decides to change - Action:
- Making change: patient makes specific, overt changes - Maintenance:
- Changes integrated into patient’s life
- Focus on relapse prevention - Identification:
- Behavior is automatic: changes incorporated into sense of self
Manic episode
- ≥1 week of elevated or irritable mood & increased energy/activity
- ≥3 of the following symptoms (4 if mood is irritable only)
(DIGFAST mnemonic):
- Distractibility
- Impulsivity/indiscretion, risky behavior
- Grandiosity
- Flight of ideas/racing thoughts
- Increased activity/psychomotor agitation
- Decreased need for sleep
- Talkativeness/pressured speech
Severe cases may have:
- Impaired psychosocial function
- May have psychotic features (hallucinations, delusions)
- May require hospitalization
Major depressive disorder
- ≥2 weeks
- ≥5 of 9 symptoms: depressed mood & SIGECAPS
- Significant functional impairment
- No lifetime history of mania
SIGECAPS = Sleep disturbance, loss of Interest, excessive Guilt, low Energy, impaired Concentration, Appetite disturbance, Psychomotor agitation/retardation, and Suicidal ideation.
Persistent depressive disorder (dysthymia)
- Chronic depressed mood ≥2 years
- ≥2 of the following:
- appetite disturbance,
- sleep disturbance,
- low energy,
- low self-esteem,
- poor concentration,
- hopelessness
Adjustment disorder with depressed mood
- Onset within 3 months of identifiable stressor
- Marked distress &/or functional impairment
- Does not meet criteria for another DSM-5-TRdisorder
First-generation antipsychotics (FGAs) Side effects
High-potency (eg, haloperidol):
- Extrapyramidal symptoms (acute dystonia, akathisia, parkinsonism), tardive dyskinesia
Low-potency (eg, chlorpromazine):
- Sedation, cholinergic blockade, orthostatic hypotension, weight gain
Second-generation antipsychotics (SGAs) Side effects
- Metabolic syndrome, weight gain
- Extrapyramidal symptoms (less common than FGAs)
Manic
- Symptoms more severe
- 1 week unless hospitalized
- Marked impairment in social or occupational functioning or hospitalization necessary
- May have psychotic features; makes episode manic by definition
Hypomanic
- Symptoms less severe
- ≥4 consecutive days
- Unequivocal, observable change in functioning from baseline
- Symptoms not severe enough to cause marked impairment or necessitate hospitalization
- No psychotic features
Bipolar I
- Manic episodes
- Depressive episodes common but not required for diagnosis
Bipolar II
- Hypomanic episode(s)
- ≥1 major depressive episodes
Cyclothymic disorder
≥2 years of fluctuating, mild hypomanic & depressive symptoms that do not meet criteria for hypomanic or major depressive episodes
Gender dysphoria
- Gender dysphoria is characterized by a strong and persistent desire to live and be treated as another gender, which causes distress or impairment.
- It is often accompanied by a desire to change one’s primary or secondary sexual characteristics.
Bisexuality
- Bisexuality is a form of sexual orientation defined as being attracted (sexually, romantically, and/or emotionally) to more than one gender.
- Gender identity and expression (eg, behavior, clothing, hairstyle, makeup) are independent of an individual’s sexual orientation.
Transvestic disorder
- Transvestic disorder involves sexual arousal from cross-dressing. - - - Unlike in GD, individuals with transvestic disorder do not typically report a desire to be another gender.
Immature defense mechanisms
- Acting out: expressing unacceptable feelings through actions
- Denial: behaving as if an aspect of reality does not exist
- Displacement: transferring feelings to less threatening object/person
- Intellectualization: focusing on non-emotional aspects to avoid distressing feelings
- Passive aggression: avoiding conflict by expressing hostility covertly
- Projection: attributing one’s own feelings to others
- Rationalization: justifying behavior to avoid difficult truths
- Reaction formation: transforming unacceptable feelings/impulses into the opposite
- Regression: reverting to earlier developmental stage
- Splitting: experiencing a person/situation as either all positive or all negative
Mature defense mechanisms
- Sublimation: channeling impulses into socially acceptable behaviors
- Suppression: putting unwanted feelings aside to cope with reality
