Psychology Flashcards
Rx:
Social anxiety DO (SAD)
*Self-med with alcohol prior to social event
SSRI
CBT
B-blocker or Benzo = performance-only subtype SAD
*Benzo: 2nd line (avoid in self-med with alc)
Meds that incr methadone (mu-R agonist) effect?
ABx: \+ -nazole (antifungal - cryptococcal meningitis) \+ ciprofloxacin, clarithromycin \+ cimetidine \+ Fluvoxamine
- Pinpoint pupils, sluggish rxn, bradypnea, QTc prolongation (torsade de pointes)
- meta by CYP450, CYP3A4
Diagnosis:
Episodic Psych sx + abd pain + peripheral neuropathy
*onset: midlife
acute intermittent porphyria (AIP)
Diagnosis:
Personality changes, social withdrawal *prior to onset of overt psychosis.
Prodromal schizophrenia
Diagnosis:
1+ unexplained sx, excessive thoughts, anxiety & behaviors in response to sx.
Somatic sx DO
Diagnosis:
Minimal to no sx, preoccupation with idea of having a serious illness
illness anxiety DO
Diagnosis:
Neurologic sx incompatible with anatomy or pathophysiology
Conversion DO (functional neurologic sx DO)
Diagnosis:
Falsification of sx/ inducing inj in the absence of obvious external rewards
Factitious DO
Diagnosis:
Falsification of illness for obvious external rewards
Malingering
Rx:
Anticonvulsant and mood stabilizer for bipolar
- Voltage-gated Na channel blocker
- enhance vail of GABA
Valproate (Valproic acid)
*reduce GABA catabolism
Rx:
Anticonvulsant and mood stabilizer for bipolar
*CYP450 inducer
Carbamazepine
Rx:
Anticonvulsant and mood stabilizer for bipolar
*SE: skin rash, rare Stevens-Johnson syndrome
Lamotrigine
*Stevens Johnson syndrome: life threatening mucocutaneous rxn.
Rx: 2nd Gen antipsychotic
antipsychotic + mood DO
Aripiprazole
RX: SSRI
- Avoided in bipolar DO
- risk of inducing mania
Citalopram
Rx:
Anticonvulsants + epilepsy tx
Levetiracetam
Phenytoin
RX
Mood stabilizer, bipolar DO
*2nd messenger signal transduction (AC»_space; PIP)»_space; decr excitatory neurotransmission.
Lithium
*Toxicity: n/v/d, neuromuscular signs dev later
Rx:
1st line tx of active seizures, acute anxiety, alc withdrawal
*Benzo, enhance affinity of GABA»_space; incr inh potential.
Lorazepam
RX:
generalized anxiety DO (GAD)
- nonbenzo anxiolytic
- no risk of dependence
Buspirone
- partial 5HT_1A R agonist
- no m relaxant, no anticonvulsant (in constrast of GABA-A)
RX:
short acting opioids only for break through pain
hydrocodone, oxycodone
Diagnosis:
+Disinhibition: socially inappropriate behavior
+Apathy
+Hyperorality: change sin diets, sweets, binge eating, consume inedible objects
+Compulsive behavior: simple repetitive speech/motions, complex hoarding/ following new religion
Frontotemporal dementia
*early 50-60s
- tau protein inclusions, TDP-43 protein inclusions
- AD (20-40% of cases)
- initial neuronal loss in frontotemporal lobes
Diagnosis:
- 60-70s
- prominent memory impairment
- Chr 21 (APP gene)
Alzheimer dz
- mild to moderate generalized brain atrophy
- initial neuro loss in parietal and temporal lobs
- tau protein, amyloid plaques
- chr 21, Apolipoprotein E4
Presenilin (component of gamma-secretase complex)
Alzheimer’s disease
involve in cleavage of APP
First line RX for panic DO
SSRI/SNRI
CBT
Acute distress: benzo
Psychotic sx <1mo
Brief psychotic DO
Which personality DO?
Frantic efforts to avoid abandonment
Borderline PD
Tx and Rx:
BMI <18.5 kg/m2
intense fear of weight gain
distorted views of body weight/shape
Anorexia nervosa
Tx: CBT, nutritional rehab
Rx: Olanzapine
Tx and Rx:
BMI <18.5 kg/m2
intense fear of weight gain
distorted views of body weight/shape
Anorexia nervosa
Tx: CBT, nutritional rehab
Rx: Olanzapine (assoc with WG) if tx dont work
Tx and Rx:
Recurrent ep of binge eating
+inappropriate compensatory behavior to prevent WG
+Excess worrying about body shape/weight
Bulimia nervosa
Tx: CBT, nutritional rehab
Rx: SSRI (fluoxetine) + tx
Contraindicate: Bupropion (antidepressant - NE/D reuptake Inh) = risk of seizures
Tx and Rx:
recurrent ep of binge eating
no inappropriate compensatory behaviors
lack of ct during eating
Binge-eating DO
Tx: CBT, behavioral weight loss therapy
Rx: SSRI, Lisdexamfetamine
Withdrawal syndromes from which substance?
tremors, agitation, anxiety, delirium*, psychosis
Alcohol
PE: seizures, tachC, palpitations
Withdrawal syndromes from which substance?
Tremors, anxiety, perceptual* disturbances, psychosis, insomnia.
Benzodiazepines
PE: seizures, tachC, palpitations
Withdrawal syndromes from which substance?
N/v, abd cramping, diarrhea, m aches
opioids
PE: dilated pupils, yawning, piloerection, lacrimation, hyperactive bowel sounds
Withdrawal syndromes from which substance?
incr appetite, hypersomnia, intense psychomotor retardation, severe depression (crash)
stimulants (cocaine, amphetamines)
Withdrawal syndromes from which substance?
Dysphoria*, irritability, anxiety, incr appetite
Nicotine
Withdrawal syndromes from which substance?
Irritability, anxiety, depressed mood, insomnia, decr* appetite
Cannabis
Diagnosis:
manic ep
+/- depressive ep
Bipolar I
Manic ep: severe, 1week (unless hosp)
Diagnosis:
hypomanic ep
+ 1 or more major depressive ep
Bipolar II
Diagnosis:
2+ years of fluctuating, mild hypomanic, depressive sx
do not meet criteria for hypomanic or major depressive ep.
Cyclothymic DO
Diagnosis:
Recurrent major depressive disorder
Unipolar major depressive DO
Major depressive/manic ep concurrent with sx of schizophrenia
Life time hx of delusions/hallucinations for 2 or more weeks (ABSENCE of Major depressive/ manic ep) - psychotic sx w/o mood sx in between hospitalization
Schizoaffective DO
- in contrast to bipolar/ major depression with psychotic (psychotic sx occur exclusively DURING manic/depressive ep)
- contrast to schizophrenia: no prominent mood sx that meet manic/depressive ep.
Most imp screening before dx/tx of major depressive DO?
hx of mania
*Prevent use of antidepressant monotherapy as they carry risk of inducing mania
Which medication?
(NMS) Neuroleptic malignant syndrome (hyperthermia, severe muscular rigidity, altered mental status, autonomic dysfx)
*fever, confusion, abn VS, difficulty moving 5 days later
FGAs - Haloperadol - Dopamine antagonists
*D/t dysregulation of dopamine
*D2 antagonism in nigrostiatal pathway - lead pipe rigidity
Reversal: Dantrolene
serotonin syndrome
neuromuscular irritability, hyperreflexia (clonus)
- rather than generalized muscle rigidity (in neuroleptic malignant syndrome in D antagonists)
onset: <1 day
+ Altered mental status, symp hyperactivity (hyperthermia, HTN, tachC, diaphoresis)
what syndrome?
*Diffuse rigidity (lead pipe), hyporeflexia
onset: 1-3days
Altered mental status, symp hyperactivity (hyperthermia, HTN, tachyC, diaphoresis)
Neuroleptic malignant syndrome
D/t dysreg of dopamine antagonist
Precipitant?
Acute dystonic rxn
Antipsychotic D2 dopamine R antagonism (in nigrostiatal pathway)
*distressing contractions of neck, mouth, tongue
Diagnosis:
psychotic do 1day-1mo
Brief psychotic DO
Diagnosis:
increased D activity in the mesolimbic pathway
Schizophrenia
tx: Dopamine antagonist antipsychotic
antidepression with no sexual dysfx SE
Bupropion
Mirtazapine
Rx:
Major depressive DO with atypical features
+ Mood reactivity (mood improves in response to pos events)
+laden paralysis (arms/legs feel extremely heavy)
+rejection sensitivity (overly sensitive to slight criticism)
+vegetative signs: incr sleep & appetite
MAOi (phenelzine, tranylpromine)
Dx:
Physician’s conscious and unconscious rxn toward a patient that is based on past personal relationships
countertransference
Dx:
patient redirect emotion from a significant person in the past to physician (immediate sense of comfort/familiarity with a physician who resembles her daughter)
transference
Tx with rapid response
for psychotic depression (+ suicidal ideation)
ECT (electroconvulsive therapy)
*or antipsychotic + antidepressant
Adjustment DO vs generalized anxiety DO
adjustment = less than 3mo
GAD: 6+ mo
acute distress DO vs PTSD
acute: 3days - 1mo
PTSD: >6mo
Dx of personality DO:
suspicious, distrustful, hypervigilant
*avoid relationships/ socialization
paranoid
cluster A: odd/eccentric
Dx of personality DO:
prefers to be a loner, detached, unemotional
schizoid
cluster A: odd/eccentric
Dx of personality DO:
unusual thoughts, perceptions/ behavior
schizotypal
cluster A: odd/eccentric
Dx of personality DO:
disregard/ violation of rights of others
antisocial
cluster B: dramatic/ erratic
Dx of personality DO:
chaotic relationships, abandonment fears, labile mood, impulsivity, inner emptiness, self-harm
borderline
cluster B: dramatic/ erratic
Dx of personality DO:
superficial, theatrical, attention-seeking
histrionic
cluster B: dramatic/ erratic
Dx of personality DO:
grandiosity, lack of empathy
narcissistic
cluster B: dramatic/erratic
Dx of personality DO:
avoidance d/t fears of criticism/ rejection
avoidant
cluster C: anxious/fearful
Dx of personality DO:
submissive, clingy, needs to be taken care of
dependent
cluster C: anxious/fearful
Dx of personality DO:
rigid, controlling, perfectionistic
obsessive compulsive
cluster C: anxious/fearful
What age:
children dev understanding of concept of gener
3-4 yo
What age:
sense of permanence of gender
around 5-6yo
Dx:
intense feeling of a person’s gender does not match one’s assigned birth sex»_space; cont into puberty
*assoc with significant distress
gender dysphoria
*assoc depression, anxiety
Intoxication of which drug?
violent behavior, dissociation, hallucinations, amnesia
*nystagmus (horiz/vertical)
ataxia
PCP (phencyclidine)
Hallucinogen
*N-methyl-D-aspartate glutamate R antagonist + monoamine reuptake inh
Intoxication of which drug?
*visual ahllucinations
euphoria, dysphoria/panic, tachyC/HTN
LSD Hallucinogen
Intoxication of which drug?
Euphoria, agitation/psychosis
*chest pain, *seizures, *mydriasis
TachyC/HTN, MI, stroke, severe vasoconstriction
*last less than 1hr
Cocaine
*stimulant
- high dose: paranoid delusions (like schizophrenia)
- auditory, visual, tactile hallucination (insect crawling under skin)
- grandiosity, euphoria, hyperactivity, agitation
Intoxication of which drug?
violent behavior, psychosis, diaphoresis, tachyC/HTN
Choreiform movement
*tooth decay
Methamphetamine
stimulant
Intoxication of which drug?
incr appetite, euphoria, dysphoria/panic, slow reflexes, impaired time perception, dry mouth
*conjunctival injection
Marijuana (THC, cannabis)
Cannabinoid
Intoxication of which drug?
Euphoria
*depressed mental status, miosis, resp depression
constipation, decr bowel sound
heroin
opioid
Intoxication of which drug?
mild amnesia, sedation, slurred speech, resp depression
HypoTN, bradyC
benzodiazepine (diazepam) CNS depressant (mild euphoria/ relaxation)
D-D interaction with lithium:
thiazide diuretics (>> dehydration >> incr lithium/Na reabs) NSAIDs & ACEi (impaired lithium clearance)
- chronic tox: decr renal perfusion/ dehydration; lethargy/confusion/agitation, ataxia/tremor/fasciculations/ seizure
tx: IV hydration, hemodialysis (severe cases)
potassium sparing diuretics effect on serum lithium lv
decrase
*amiloride
Adequate antidepressant trial time
4-6 weeks
Dx:
cortical hyperexpansion in toddlers
- regression of speech, stereotypical movement (flapping, clapping)
- no motor milestone dysfx/regression
autism spectrum DO (ASD)
Dx:
neonate sx
neuro: irrtability, hypertonia, jittery movement, seizures (rare)
GI: d/v/ feeding intolerance
autonomic: sweating, sneezing, pupillary dilation
*high pitched cry
neonatal abstinence syndrome
*heroin, methadone in mother
- withdrawal from transplacental opiates d/t maternal drug use
- tx: opioid (morphine, methadone)
prenatal exposure to which substance:
jitteriness, excessive sucking, hyperactive moro reflex
cocaine
- neonate withdrawal = not as severe as opiates
- effects of long term behavior, attention lv, intelligence
prenatal exposure to which substance:
neural tube defects
cardiac anomalies
dysmorphic facies: cleft lip, narrow bifrontal diameter, midface hypoplasia, broad/ depressed nasal bridge, long philtrum
valproic acid
What syndrome:
mental status changes, autonomic instability, neuromuscular hyperactivity
serotonin syndrome
Withdrawal of which anxiolytic:
rebound anxiety, tremor insomnia, symp hyperactivity (diaphoresis, palpitation) – psychotic (hallucination, delusions), seizures*, death.
benzo (-zepam)
- highest risk of withdrawal = short acting agents, prolonged use, higher dose
- alprazolam (intermediate)
*rebound hyperactivity d/t incr GABAa Rs during drug use
sx of anticholinergic toxicity
dry skin, mucous membranes
urinary retention, decr bowel sounds, hyperthermia
*decr parasym effect
