Psychiatry- First Aid Flashcards
Acting Out
Expressing unacceptable feelings and thoughts through actions, eg tantrums
Dissociation
Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress
Displacement
Transferring avoided ideas and feelings to some neutral person or object, eg mom yells at child because husband yelled at her
Identification
Modeling behavior after another person who is more powerful, eg abused child identifies with an abuser
Isolation
Separating feelings from ideas and events, eg describing murder in graphic detail with no emotional response
Projection
attributing an unacceptable internal impulse to an external source, eg a man who wants another woman thinks that his wife is cheating on him
Reaction formation
replacing a warded-off idea or feeling by an emphasis on its opposite, eg a libidinous patient walks into a monastery
Repression vs Suppression
Involuntary vs intentional withholding of an idea or feeling from conscious awareness
Splitting
Believing that people are either all good or all bad
Sublimation
replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with personal ideals, eg teenager’s aggression against father is directed to performing well in sports
Neurotransmitter Changes in
1) Alzheimer’s
2) Anxiety
3) Depression
4) Huntington’s
5) Parkinson’s
6) Schizophrenia
1) decreased ACh
2) increased NE, decreased GABA, 5-HT
3) decreased NE, GABA, 5-HT
4) decreased GABA, ACh, increased Dopa
5) decreased Dopa, increased Ach, 5-HT
6) increased Dopa
Predisposing factors to delirium (WATCH DEATH)
Withdrawal, Acute metabolic, Trauma, CNS pathology, Hypoxia, Deficiencies, Endocrine, Acute Vascular, Toxins, Heavy metals
SIGECAPS (for Major depressive disorder)
Sleep disturbance, Loss of interest, guilt/feelings of worthlessness, energy loss, concentration problems, appetite/weight changes, psychomotor retardation, suicidal ideations
Paranoid (Cluster A)
pervasive distrust and suspiciousness, projection is major defense mech.
Schizoid (Cluster A)
voluntary social withdrawal, limited emotional expression, content with social isolation
Schizotypal (Cluster B)
eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness
Antisocial (Cluster B)
disregard for and violation of rights of others, criminality, impulsivity, called conduct disorder for agefemales
Borderline (Cluster B)
unstable mood and interpersonal relationships, impulsiveness, self-mutilation, splitting is major defense mech, females>males
Histrionic (Cluster B)
excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance
Narcissistic (Cluster B)
grandiosity, sense of entitlement, lacks empathy and requires excessive admiration, often demand sand reacts negatively to criticism
Avoidant (Cluster C)
hypersensitive to rejection, socially inhibited, desires relationships with others
Dependent (Cluster C)
submissive and clinging, excessive need to be taken care of, low self-confidence
OCD vs OCPD
OCD- obsessions that are relieved by compulsions, ego dystonic
OCPD- preoccupation with order, prefectionism, control, ego-syntonic
Neuroleptic Malignant Syndrome (FEVER)
Fever, Encephalopathy, Vitals Unstable (autonomic instability), Enzymes (myoglobinuria), Ridigity of muscles
Side Effects of 1st Generation Anti-Psychotics
Extrapyramidal side effects (dystonia, akathisia, bradykinesia, tardive dyskinesa)
Endocrine side effects (hyperprolactinemia)
Alpha-1 blockade (hypotension)
Muscarinic block (dry mouth, constipation)
Histamine blockade (sedation, weight gain)
Side Effects of 2nd Generation Anti-Psychotics
Fewer extrapyramidal and cognitive (negative) side effects because of serotonin blockade
Olanzapine/clozpine- significant weight gain
Clozapine- most efficacious for positive sx, agranulocytosis
Risperidone- increase prolactin
Ziprasidone- prolong QT interval
Adverse Events of Lithium Use
Renal (nephrogenic DI, renal insufficiency)
CNS (sedation, impaired cognition, tremor)
CV (sinus bradycardia, SA/AV blockade, Ebstein anomaly in fetus)
GI (increased appetite and weight, n+v, upset stomach)
Note: LI is reabsorbed in proximal tubule with sodium, LI serum levels will increase with low Na intake
Renally excreted
Serotonin Syndrome
Occurs with SSRI’s, TCAs, SNRI’s, MAO inhibitors
Hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures
Side Effects of TCA’s
Sedation
Alpha-1 Blockade (postural hypotension)
Anti-cholinergic (tachycardia, urinary retention, dry mouth)
Convulsions, Coma, Cardiotoxicity
