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Pance Re-Up > Psychology #1 > Flashcards

Psychology #1 Flashcards

1
Q

Risk factors for Major Depressive Disorder

A

Female, 20’s, poor socioeconomic status, family history

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2
Q

Pathophysiology of Major Depressive Disorder

A

Alteration of neurotransmitters (serotonin, epinephrine, norepinephrine, histamaine, dopamine, and acetylcholine)

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3
Q

What screening methods are used for MDD

A

PHQ-2 and then, if positive, PHQ-9

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4
Q

What are the diagnostic criteria for MDD?

A

5 or more symptoms for most days for 2 or more weeks. Must include anhedonia or depressive mood
-fatigue, insomnia, sleep changes, weight change, concentration issues, guilt, suicidal thoughts, worthlessness feelings (SIGEMCAPS)

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5
Q

What must be true about the symptoms in MDD to diagnose it as MDD?

A

It MUST cause significant distress and must not be related to substance use

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6
Q

When should you consider treatment for a patient with MDD?

A

If PHQ-9 score is 10 or more

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7
Q

Treatment for MDD

A

1) Psychotherapy: CBT, interpersonal, or supportive therapy)
2) SSRI’s are first line
3) SNRI, TCA, Bupropion
4) Electroconvulsive therapy if no response to medication

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8
Q

What is seasonal affective disorder?

A

Presence of depressive symptoms at the same time each year

-Treamtent with SSRI’s, light therapy, Bupropion

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9
Q

What is atypical depression?

A

Normal depressive symptoms, but improved mood with positive events

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10
Q

Name the SSRI’s and how long do they take to reach maximum efficacy?

A

Sertraline, Fluoxetine, Paroxetine, Citalopram, Escitalopram

4-6 weeks for maximum efficacy

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11
Q

Which SSRI has a longer half life?

A

Fluoxetine

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12
Q

Adverse effects of SSRI’s include…

A

-GI, sexual dysfunction, insomnia, increased suicidality

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13
Q

What is one thing to be remembered when prescribing Citalopram (who is it contraindicated in?)

A

Those with long QT syndrome

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14
Q

SNRI’s inhibit the uptake of ______, ____, and ______. These drugs are….

A

Serotonin, norepinephrine, dopamine

Duloxetine, Venlafaxine, Desvenlafaxine

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15
Q

Which SNRI is given if the patient has severe fatigue or neuropathy pain syndromes?

A

Duloxetine

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16
Q

What is one advantage of Bupropion?

A

Less GI, sexual side effects than SSRI and SNRI

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17
Q

Bupropion also aids in _______, but has some adverse effects including…

A

Smoking cessation

Seizures (lowers threshold). Therefore, avoid abrupt withdrawal!

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18
Q

Another atypical antidepressant, Mirtazapine, inhibits which two neurotransmitters. It also has a benefit of

A

Inhibits serotonin and norepinephrine

-Fewer sexual side effects

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19
Q

Although Mirtazapine works quicker than SSRI’s (it takes 2-3 weeks), it has some adverse effects that include…

A

Weight gain, constipation, dry mouth, sedation

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20
Q

Name 4 TCA’s and what is the MC side effect of them?

A

Doxepin, Amitriptyline, Nortriptyline, Imipramine

Anticholinergic (MC)

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21
Q

What are the three signs of TCA overdose and what can be given for the first symptom?

A

-Cardiotoxicity (wide complex tachycardia)
-Coma
-Convulsions (Seizures)

-Give sodium bicarbonate for cardiotoxicity

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22
Q

Which TCA should be given for treatment of enuresis in kids?

A

Imipramine

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23
Q

The most serotonin specific TCA and what can it also be used as treatment for.

A

Clomipramine

OCD

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24
Q

MAO’s are drugs such as Phenelzine, Isocarboxazid and Tranylcypromine. Name two adverse effects or cautionary things to remember with these drugs.

A

-Orthostatic hypotension (MC)
-Hypertensive crisis (after eating foods high in tyramine such as aged cheese, red wine, beer, meats, chocolate)

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25
Q

Serotonin Receptor Antagonists and Agonists include two common drugs such as

A

Trazodone and Nefazodone

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26
Q

Serotonin Receptor Antagonists and Agonists are useful for _______, but some common side effects are ____ and _____

A

Insomnia

Sedation and Priapism

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27
Q

When does serotonin syndrome occur?

A

MC occurs after 24 hours after initiating or change in serotonergic drug dose

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28
Q

Symptoms of serotonin syndrome

A

-Cognitive: agitation, AMS, confusion
-Autonomic instability: hyperthermia, diaphoresis, tachycardia, BP changes
-Nausea, vomiting, diarrhea
-Clonus, hypertonia, tremor, akithisia
-Mydriasis, dry mouth, flushed skin

29
Q

Treatment for serotonin syndrome (mild)

A

Prompt discontinuation of offending drug(s)

Supportive, IVF, oxygen, Benzos

30
Q

Treatment for serotonin syndrome (moderate)

A

As above + Cyproheptadine

31
Q

What is persistent depressive disorder?

A

Depressed mood for most days for 2 years or more (in adults) and at least 1 year in kids/adolescents

32
Q

Treatment for persistent depressive disorder

A

Pharmacotherapy (SSRI) + Psychotherapy most effective

33
Q

What is cyclothymic disorder?

A

At least 2 years of prolonged, milder elevations and milder depressions (do not meet criteria of hypomanic or depression)

34
Q

Treatment for cyclothymic disorder

A

Lithium, Valproic Acid
-Alternatives: 2nd generation antipsychotics (Risperidone, Olanzapine, Quetiapine, Ziprasidone)

35
Q

What is adjustment disorder and how long does it usually take to resolve?

A

Emotional or behavioral symptoms in response to stressor within 3 months of stressor onset

Resolves within 6 months usually

36
Q

Treatment for adjustment disorder

A

Psychotherapy

37
Q

What are the 5 stages of grief

A

-Denial, anger, bargaining, depression, acceptance

38
Q

What are signs of abnormal grief?

A

If it lasts longer than 1 year or if she has suicidal ideation

39
Q

What are some differences between grief and MDD?

A

Grief: intermittent
MDD: Consistent symptoms

Grief: self esteem preserved
MDD: Feeling of worthlessness

40
Q

What are the criteria for Bipolar 1 Disorder?

A

At least 1 manic episode
-Abnormal, elevated, expansive, irritated mood for at least 1 week impairs function
-thinking: flight of ideas, grandiose, racing
-behavior: hyperactivity, pressured speech, no sleep, hypersexuality

41
Q

Treatment for Bipolar I Disorder

A

Lithium (first line)
-Alternatives: Valproic acid, 2nd gen antipsychotics
-Psychotherapy

42
Q

What is one benefit of Lithium as treatment?

A

It reduces suicide risk as well

43
Q

What are the criteria for Bipolar II Disorder?

A

History of 1 major depressive episode + 1 hypomanic episode

-Patient has never had a manic episode!

44
Q

What is hypomania?

A

Abnormal elevated mood < 1 week, doesn’t need hospitalization and doesn’t impair function at all

45
Q

Treatment for Bipolar II Disorder

A

Lithium or 2nd gen antipsychotics
-Psychotherapy as well

46
Q

Lithium alters neuronal sodium transport. What are some adverse effects of this medication.

A

Hypothyroidism
Hyperparathyroidism
Hypercalcemia
Hypermagnesemia

47
Q

Prior to starting Lithium, what are some labs that should be obtained?

A

ECG, Beta-HCG, TSH, CBC

Monitor every 4-8 weeks

48
Q

Contraindications and cautions to using Lithium

A

Do not use in pregnancy - associated with Ebstein’s Anomaly

Do not use in severe renal disease

Do not use with NSAIDs. Can raise Lithium levels in the blood too high.

49
Q

Generalized anxiety disorder is anxiety or worry for at least _______ and the anxiety is out of proportion to the event. What should you screen with?

A

At least 6 months

GAD-7 (score of 10 or more is positive)

50
Q

Treatment for GAD (acute and long-term)

A

Benzos for short-term (risk of dependence)

SSRI (first-line) but takes 4-6 weeks to reach efficacy

CBT, Psychotherapy

51
Q

What are two positives about Buspirone?

A

Does not cause sedation and does not have abuse potential

52
Q

What is the diagnostic criteria for panic disorder?

A

Recurrent, unexpected panic attacks (2 or more) that are often followed by concern about future attacks, persistent worry about attacks, and maladaptive behavior related to attacks

53
Q

Treatment for panic disorder

A

SSRI + CBT

54
Q

What is the usual time frame for a panic attack?

A

Peaks within 10 minutes and never lasts longer than 1 hour

55
Q

Pathophysiology of a panic attack

A

Sympathetic system overdrive

56
Q

Treatment for an acute panic attack

A

Benzos

57
Q

What should you do BEFORE diagnosing a panic attack or treating it as a panic attack?

A

Rule out life threatening conditions such as a heart attack or thyrotoxicosis

58
Q

What is agoraphobia?

A

Intense fear of being in places where escape is difficult (crowds, public transportation, out of the home)

59
Q

Diagnostic criteria for agoraphobia

A

Symptoms last longer than 6 months and cause social or occupational impairment

60
Q

Treatment for agoraphobia

A

SSRI + CBT

61
Q

Treatment for a specific phobia

A

Exposure + desensitization

Short-term Benzos can be used in some patients

62
Q

MC type of phobia

A

Social phobia (public speaking)

63
Q

Treatment for social phobia

A

Psychotherapy (initially)
SSRIs
Situational: Propanolol 30-60 min prior to event

64
Q

What is the difference between obsessions and compulsions?

A

Obsessions: recurrent or persistent thoughts

Compulsions: repetitive behaviors that cause distress, impairment, or are time-consuming

65
Q

OCD is ego-dystonic/ego-syntonic?

A

Ego-dystonic (inconsistent with personal beliefs)

66
Q

Which neurotransmitter is generally involved with OCD?

A

Serotonin

67
Q

What are the four patterns in OCD?

A

1) Contamination
2) Pathologic Doubt
3) Symmetry/Precision
4) Intrusive obsessive thoughts with compulsion

68
Q

Treatment for OCD

A

CBT + Pharmacotherapy
–SSRI (first line)
–TCA’s (Clomipramine)

69
Q

Which TCA can be used for OCD and why?

A

Clomipramine because it is the most serotonin specific

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