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Shelf Exam Study Materials > Psychiatry: PreTest > Flashcards

Psychiatry: PreTest Flashcards

1
Q

CYP450 medications interactions

A

-drugs metabolized by CYP450 (e.g. antiretrovirals) can increase levels of psych drugs: -buproprion -meperidine -benzos -SSRIs

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2
Q

Clomipramine: drug category, use

A

-TCAs -OCD

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3
Q

Leukopenia management with clozapine use

A

-mild (WBC=3-3.5) +/- sx ==> twice weekly CBCs w/diff -serious (WBC=2-3) ==> daily CBCs and stop clozapine; can restart after CBCs normalize -agranulocytosis ==> stop cloz, isolate, bone marrow sample, cannot restart cloz

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4
Q

Ramelteon =

A

melatonin agonist

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5
Q

Labs in carbamazepine initiation/monitoring

A

-@ initiation: CBC, retic count, electrolyes, LFTs, UPT -qmonth x 2, then q3mo.: LFTs

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6
Q

Weight gain with antidepressants

A

-high: amitriptyline -intermediate: doxepin, nortriptyline, phenelIne -low: sertraline

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7
Q

Use of St. John’s wort

A

-antidepressant, sedative, anxiolytic

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8
Q

Psych drugs preg. categories

A

C = ASA, haloperidol, chlorpromazine(antipsych) D = Li, tetracycline, ethanol X = valproic acid, thalidomide

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9
Q

Tx of tardive dyskinesia

A
  1. reduce dose or d/c antipsychotic 2. if not possible ==> clozapine
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10
Q

Tx of akithesia

A
  1. B-blocker 2. benzo or anticholinergic
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11
Q

Induction agent used in ECT

A

Methohexital = barbituate w/quick onset/offset

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12
Q

Seizure after flumazenil?

A

Likely in setting of seizure d/o

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13
Q

TCA side effects

A

-anticholinergic = urinary retention, blurred vision, constipation, dry mouth -amitryptiline = most anticholinergic

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14
Q

Ritalin SE

A

-can lead to insomnia

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15
Q

Tx of tourette syndrome

A
  1. haloperidol
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16
Q

Anti-depressant choice in elderly

A

SSRIs > TCAs b/c no anticholinergic or cardiotoxic effects and no orthostatic hypotension

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17
Q

Disulfiram: MOA

A

inhibits acetaldehyde dehydrogenase

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18
Q

Psychotic sx in parkinsons tx

A

clozapine = anticholinergic & sparing of nigrostriatial sparing

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19
Q

Non-psych med used to treat depression

A

levothyroxine

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20
Q

Tx of hyperarousal sx in PTSD

A

-B-blockers -Clonidine (alpha-agonist)

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21
Q

Characteristics of serotonin discontinuation

A

-w/abrupt d/c of SSRIs -dizziness, nausea, flu-like, sensory/sleep disturbance -crying spells or irritability -usually 1-3 days after last dose -most common w/paroxetine and sertraline

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22
Q

Tx of cataplexy

A

Anti-depressants (SSRIs, TCAs, MAOIs) suppress REM sleep and tx cataplexy

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23
Q

Tx of NMS

A
  1. d/c antipsychotics 2. correct fluid imbalance, manage pressure, tx fever 3. DA agents: bromocriptene, dantrolene, amantadine
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24
Q

Meds for improving cognitive fxn in Alzheimers

A

-anti-cholinesterases: -tacrine -donepezil -metrifonate -galantamine

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25
Q

Medication for nocturnal enuresis

A

-imipramine

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26
Q

Therapeutic Li level

A

1-1.5

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27
Q

TCA effect on heart

A

==> slowed cardiac conduction ==> fatal heart block

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28
Q

Normal bereavement vs. Adjustment d/o

A
  1. bereavement is less than 2 mo.
  2. adj. d/o = > 2mo. + some dysfxn
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29
Q

MDD in post-stroke patients (incidence)

A
  • 30-50%
  • left > right lobe
  • frontal > more posterior
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30
Q

PPD incidence

A

10-15%

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31
Q

Possible lifestyle trigger of manic episode + tx

A
  • sleep deprivation
  • tx = increase sleep
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32
Q

Lifetime risk of suicide in mood d/o

A

10-15%

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33
Q

Kohut theory =

A
  • poor psych/childhood development ==> psychopathology
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34
Q

Mood stabilizers are most effective at ______?

Tx of bipolar depression

A
  • Li/mood stabilizers treat mania > depression
  • Bipolar depression
    • supplement w/antidepressant
    • taper as soon as sx resolve 2/2 high rate of induced mania (up to 30%)
    • buproprion = slightly lower risk of mania
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35
Q

Common psych SE of OCPs

A

depression

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36
Q

Frued =

Beck =

Bowlby =

Sullivan =

A
  1. Freud: Depression = anger turned towards self
  2. Beck: Depression = cognitive patterns are negative
  3. Bowlby: poor attachment predisposes to psychopathalogy
  4. Sullivan: interpersonal relationships are important
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37
Q

ECT characteristics/use

A
  1. ECT effect >= anti-dperessants
  2. Uses
    1. MDD not responding to meds
    2. highly suicidal
    3. severe psychotic sx
    4. medically ill who cannot tolerate anti-dep meds
    5. Parkinson’s dz w/MDD (also decreases extrapyramidal sx)
  3. Safe, relatively few contraindications
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38
Q

Augmentation of depression therapy

A
  1. Lithium
  2. Thyroid hormones
  3. Stimulants
  4. Estrogens
  5. Light therapy
39
Q

MDD in children

A
  • Major depression is not a rare occurrence in children
  • presentation of juvenile depression often differs from adult
    • irritable, aggressive, withdrawn, or clingy instead of sad
    • In school-age children, the main manifestation = loss of interest in friends and school
  • psychotic sx = common
  • Up to one-third of the children dx with MDD ==> dx of bipolar disorder later
  • medications may be used but response is different from adults
40
Q

Neuroimaging in MDD

A

PET ==> decreased blood flow/metabolism @ frontal lobe

41
Q

Length of sx for dx of hypochondriasis

A

6 mo.

42
Q

Characteristics of buspirone

A
  • Buspirone and benzodiazepines have different chemical structures
  • buspirone’s potency is equivalent to the potency of diazepam
  • takes one to two weeks for the antianxiety effects to appear ==> not useful for anxiety conditions that require acute intervention.
  • Buspirone is less sedating than benzodiazepines and appears to have less potential for abuse.
43
Q

Tx of social phobia/fear of public speaking

A
  • Three major cognitive behavioral techniques, usually used in combination: exposure, cognitive restructuring, and social skills training.
  • Several classes of medications have also been proven effective in the treatment of social phobia, including MAO inhibitors, SSRIs, benzodiazepines, and beta blockers.
  • Buspirone can be useful when social phobia and generalized anxiety disorder are comorbid
44
Q

Panic d/o pharma options

A

SSRIs (sertraline), tricyclic antidepressants (imipramine), and benzodiazepines (lorazepam)

45
Q

Locus ceruleus fxn/pathology

A
  • locus ceruleus = @ floor of the fourth ventricle in the anterior pons.
  • main noradrenergic nucleus of the brain ==> regulates arousal, attention, and autonomic tone
  • connection with the amygdala ==> stimulated by exposure to threats
  • hyperactivated in PTSD
46
Q

Nucleus basalis fxn/pathology

A
  • nucleus basalis of Meynert is connected to cognitive functions and memory
  • This nucleus degenerates in Alzheimer’s dementia.
47
Q

Raphe nuclei fxn

A
  • The raphe nuclei are the main source of serotonin in the central nervous system
  • connected with the regulation of mood, pain, and aggression
48
Q

Events associated w/REM sleep

A
  • Dreaming
  • Increase in blood pressure and heart rate
  • penile tumescence
49
Q

Hurler syndrome characteristics

A
  • Hurler’s syndrome = accumulation of mucopolysaccharidoses.
  • Hurler’s syndrome starts during the first year of life and causes death before age 10.
50
Q

Rett’s d/o characteristics

A
  • Rett’s syndrome, a pervasive developmental disorder, is characterized by a devastating progressive deterioration of cognitive, social, and motor functions that starts between age 5 months and 18 months, after an initial period of normal development
51
Q

Broca’s area location

A

L. frontal lobe

52
Q

Characteristics of complex partial seizures

A
  • Partial complex seizures usually (90% of the time) originate from the temporal lobe.
  • Auras that consist of unpleasant odors often originate from the tip of the temporal lobe, the uncus, an area involved in processing olfactory sensations.
53
Q

Night terrors occur during…

A

Non-rem sleep

54
Q

Excitatory neurotransmitters

A

Glutamic and aspartic acids have excitatory properties.

55
Q

Biogenic amines =

A

The biogenic amines include the catecholamines such as dopamine, norepinephrine, epinephrine, histamine, and the indolamine serotonin.

56
Q

Neuropeptides =

A

Neuropeptides include beta-endorphin, somatostatin, and vasopressin.

57
Q

Hypothalamic nuclei:

anterior ==>

ventromedial ==>

lateral ==>

posterior ==>

supraoptic ==>

A

The anterior nucleus facilitates sexual interest and specific sexual behaviors.

The ventromedial nucleus acts as a satiety center and stimulation of this area reduces appetite. This nucleus acts by inhibiting the lateral nucleus, which stimulates appetite.

The posterior nucleus, along with the contiguous reticular activating system, controls levels of arousal. Lesions in these areas cause lethargy and somnolence.

The supraoptic and paraventricular nuclei produce vasopressin and oxytocin.

58
Q

hypothalamic controls:

  1. appetite
  2. sexual behavior
  3. produces hormones
  4. arousal
A
  1. ventromedial = suppress; lateral = stimulate
  2. anterior
  3. supraoptic
  4. posterior
59
Q

Freud’s stages of development

(why are we still learning this???)

A
  • Oral: 0-1yo
  • Anal: 1-3yo ==> ~potty-training experience impacts development; harsh => anal-retentive
  • Phallic: 3-5/6yo
  • Latency: 5/6 - puberty ==> sexual impulses are repressed and sublimated (re: defense mechanisms) towards school work, hobbies and friendships. Tendency toward orderliness, attention to de- tails, and collecting things. Under stress, these traits may become exagger- ated
60
Q

Margaret Mahler theory

A
  • Theory of early infantile development on the basis of observations of normal and pathological mother-child interactions
    1. autistic phase (0-2mo.): sleeping; no interest in interpersonal relationships
    1. symbiosis (2-6mo.): psychological fusion or lack of differentiation between mother and child.
    1. separation-individuation (6-36mo.): child develops a concept of him- or herself as different and separated from the mother.
      * a. differentiation (6-10mo.): initial awareness that mother is different from self
      * b. practicing (10-16mo.): enthusiastic exploration of environment
      * c. rapprochement (16-24mo.): need to know where mother is/checking in 2/2 awareness that indepence = vulnerability
      * d. object constancy (24-36mo.): integration of good/bad aspects of mother and self
  • object constancy must develop to allow for mature and stable relationship formation
61
Q

“depressive position” =

A
  • Melanie Klein’s theory of infantile psy- chological development
  • during which the infant realizes that the “bad mother” who frustrates the child’s wishes and the “good mother” who nurtures him or her are the same person
  • child worries that rage at the “bad mother” may also destroy the good
62
Q

Piaget’s theory of development

A
  • theory of cognitive development based on way children relate to world
  • ensorimotor (18–24 months)
  • pre-operational (2 to 5–7 years)
    • egocentrism
  • concrete operational (6–11 years)
  • formal operational (11 years to adulthood)
63
Q

Winnicott’s theories

A
  • early mother-child relationship
  • child is able to develop a separate and stable identity only if the child’s needs are met by his or her mother’s empathic anticipation
  • “holding environment” = positive environment created by the mother
  • “transitional object” = toy/blanket that represent comforting substitue for primary caregiver
64
Q

Erik Erikson’s theory of psychosocial development

A
  • 8 stages of ego development during the life cycle
  • stages = turning points: physical, cognitive, social, and emotional changes ==> internal crisis; resolution leads to psych growth or regression
  1. trust vs. mistrust (0-18mo.): if needs are met, the world seems good
  2. autonomy vs. shame (18mo.-3yrs): nurtured/encouraged ==> self-esteem and autonomy
  3. initiative vs. guilt (3-5yo): expands horizons, fantasies of power but sense of guilt w/broken rules
  4. industry vs. inferiority (5-13yo): psych health depends on opportunities for new skills and pride with accomplishments
  5. identity vs. role confusion (13-21)
  6. Intimacy vs. isolation
  7. Generativity vs. stagnation
  8. Integrity vs. despair
65
Q

temperament definition

A
  • Temperament = inherited set of traits present at birth; stable during first years of life to be modified by interpersonal experiences
  • variations in several categories: rhythmicity, adaptability, intesity of rxn, quality of mood, attention span, etc.
66
Q

“shadow” definition

A
  • component of Jung theory
  • part of the unconscious personality that contains all the traits and qualities that are unacceptable to an individual
67
Q

“archetypes” definition

A
  • part of Jungian psychology
  • universal, symbolic images that recur in dreams and are part of the “collective uncon- scious.”
68
Q

Animus/Anima definition

A
  • part of Jung theory
  • animus = masculine elements of woman’s personality
  • anima = female traits of male personality
69
Q

“naricissitic injury” definition

A
  • Kohut’s theory
  • individuals who require other people’s constant validation to maintain a marginal self-esteem have suffered a “narcissistic injury” during childhood due to parental neglect or lack of empathy
70
Q

Freud’s structural theory of the mind

(why????)

A
  • id = contains the instinctual drives
  • ego = whose function is to find an equilibrium between gratification of the instinctual drives and the rules of society (and the demands of the superego)
  • superego = the agency that contains the internalized parental and societal rules and dictates to the ego what is not to be done
    • ego ideal = component of superego; internal standard of what one should be to be approved
  • ego and superego have unconscious and conscious components
71
Q

Shame/guilt per Freud

A
  • shame = consequence of not liv- ing up to one’s ego ideal
  • guilt = consequence of transgressing the superego’s prohibitions
72
Q

Failure to thrive w/out organic cause + non-nurturing environment ==> dx?

A
  • per Spitz: “analytic depression”
  • children who are emotionally deprived do not grow well even when an adequate amount of food is available
  • lack of adequate nurturing, they become apathetic, withdrawn, and less interested in feeding, which in turn causes failure to thrive
73
Q

sublimation =

A

sublimation = satisfaction of an objectionable impulse is obtained by using socially acceptable mean

74
Q

Primary gain vs. secondary gain

A
  • Primary gain refers to the relief of tension and conflict produced by the development of symptoms.
  • In addition to the internal reduction of distress, the symptoms may gratify wishes or impulses (secondary gain).
    • e.g. increased attention/sympathy, relief from obligations, monetary compensation
75
Q
  • “wish fulfillment”
  • “dream work”
  • “condensation”
  • “secondary revision”
A
  • All Freud’s theory of dreams/meaning
  • wish fulfillment = one of the goals of dreams
  • dream work = process through which the latent content of the dream is transformed into the more acceptable manifest content
  • Condensation, displacement, and symbolic representation = primary processes and can make the manifest content of the dream quite bizarre
  • Secondary revision = a process guided by the ego, intervenes at the end of the dream work to make the manifest content more rational and acceptable to the dreamer
76
Q

Medication effective for depression & ADHD

A

buproprion

77
Q

Antipsychotics that improve negative sx

A
  • olanzapine
  • clozapine
78
Q

Major side effect w/trazadone

A
  • Priapism, an abnormally prolonged erection, is estimated to happen in 1 in every 10,000 patients treated with trazodone.
  • The risk for this side effect is higher during the first month of treatment and at low doses.
79
Q

Dose needed for overdose on TCA

A

2-3g

80
Q

Medications used to reverse negative effects of SSRIs on sexual fxn

A
  • cryopetadine (antihistamine)
  • yohimbine
  • bethanecol
  • amantadine
  • buproprion
81
Q

Drugs that can interact w/lithium

A
  • nonsteroidal anti- inflammatory drugs
    • ibuprofen
    • naproxen
    • diclofenac
    • indomethacin
  • ==> increase plasma lithium levels and have been associated with toxicity
  • mechanism of action: inhibition of renal tubular prostaglandin synthesis.
82
Q
  • high potency antipsychotics
  • intermediate potency antipsychotics
  • low potency antipsychotics
A
  • high
    • haloperidol
    • fluphenazine
  • intermediate
    • molindone
    • perphenazine
  • low
    • chlorpromazine
    • thioridazine
83
Q

Meds assoc. NTDs

A
  • valproic acid
  • carbamazepine
84
Q

Li ==> ?congenital anomalies

A

cardiac (Ebstein’s)

85
Q

Tx of Tourettes/ADHD w/tics on stimulants

A
  • alpha-2 agonists
    • clonidine
    • guanfacine
86
Q

How long before noticeable effects w/Li?

A

1-2 weeks

87
Q

Lowest & Highest anticholingeric SE in antipsychotics

A
  • low anticholinergic = high potency antipsychotics
    • haloperidol
    • fluphenazine
  • high antichoinergic
    • low potency antipsychotics
      • chlorpromazine
      • thioridazine
    • clozapine
88
Q

Antipsychotic of choice in elderly patients

A
  • high-potency 2/2 less anticholinergic activity
    • haloperidol
    • fluphenazine
89
Q

Catatonic schizophrenia

A
  • marked psychomotor disturbances
  • prolonged immobility, posturing, extreme negativism (the patient actively resists any attempts made to change his or her position) or waxy flexibility (the patient maintains the position in which he or she is placed)
  • mutism, echolalia (repetition of words said by another person), and echopraxia (repetition of movements made by another person)
  • Periods of immobility and mutism can alternate with periods of extreme agitation (catatonic excitement).
90
Q

Formal thought disorder vs. disturbances of thought content

A
  • formal thought d/o: disturbance of flow of ideation including thought blocking, poverty of speech, flight of ideas
    • examples: circumstanstiality, tangentiality, clanging, loose associations etc.
  • Delusions, ideas of reference, hallucinations = disturbances of thought content
91
Q

Major SE of clozapine

A
  1. agranulocytosis
  2. risk for seizures
92
Q

Antipsychotics that ==> photosensitivity

A
  • low-potency neuroleptics, in particular, chlorpromazine
  • photosensitization effect ==> sun- burn, patchy discoloration of the skin, and rashes when the patients expose themselves to the sun without adequate protection
93
Q
  1. Amok =
  2. Koro =
  3. Dhat =
  4. Sangue dormido =
  5. Ghost sickness =
A
  1. amok = dissociative episode characterized by violent agitation and aggressive and homicidal behavior precipitated by insult or brooding (Malaysia)
  2. koro = characterized by a sudden and intense anxiety connected to the belief that the penis is receding into the body and that death will follow when it has totally disappeared (South/East Asia)
  3. Dhat = characterized by anxiety, hypochondriac concern about semen discharge, and fatigue (India)
  4. Sangue dormido = numbness, tremor, paralysis, convulsions, strokes, and heart attacks (Portugese Cape Verdians)
  5. Ghost sickness = preocuppation w/death and dead people (Native American)

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