Psychscene Miscellaneous Flashcards
Structural classes of antipsychotics?
- Phenothiazines 2. Butyrophenones 3. Thioxanthines 4. Substituted Benzamides Dibenzazepine 5. Dibenzodiazepine 6. Thienobenzadiazepine 7. Dibenzothiazepine 8. Benzisoxazole
Phenothiazines?
ChlorPromazine FluPhenazine
Butyrophenones?
Haloperidol - D2 blockade
ThioXanthines?
FlupenthiXol
Dibenzodiazepine?
Clozapine
Thienobenzodiazepine?
Olanzapine
Dibenzothiazepine?
Quetiapine
Benzisoxazole
Risperidone
Piperazine
Trifluoperazine
Piperidine
Thioridazine
Benzamide?
Sulpride
Mechanism of Haloperidol?
D2 blockade
Mechanism of Sulpride?
D3 presynaptic antagonist at low doses, D2 post synaptic antagonist at high doses
Why is Sulpride different from the others?
It does not follow the pharmacokinetic principles of the other antipsychotics so it is… -water soluble/poorly fat soluble -poorly absorbed -doesn’t cross the BBB as well as the others
D2D - What do SSRIs do to Cytochrome P450?
Inhibit it. So it can raise plasma levels of Haloperidol
D2D - What does smoking do to enzymes?
Enzyme induction. Therefore it lowers plasma concentrations of antipsychotics.
Safe antipsychotics in pregnancy?
Haloperidol (no good reason) Atypicals
Mechanism of Risperidone?
5HT2:D2 antagonist A1 blockade leads to FIRST DOSE HYPOTENSION.
Mechanism of Olanzapine?
5HT2:D2 antagonist H1 blockade causes SEDATION
Mechanism of Quetiapine?
5HT2:D2 antagonist H1 blockade causes SEDATION
Mechanism of Clozapine?
D4 & D1 antagonist. Highest affinity for 5HT2 than other antipsychotics. D2 receptor occupancy of 50-60% at therapeutic levels.
Mechanism of Aripiprazole?
D2 Partial agonist, 5HT1 partial agonist 5HT2a antagonist
What causes EPSEs?
High (>80%) central D2 receptor occupancy.
How can you treat EPSEs?
Anticholinergics or dose reduction
What is dystonia?
Muscle spasms - occur when starting antipsychotics. Can be treated with IV/IM anticholinergics Can be prevented by co-administering anticholinergics for 4-7 days of initiation.
What is akathisia?
Motor restlessness/inability to sit still.
What causes akathisia?
Decreased D2 activity in the basal ganglia. Rating scale - BAS - Barnes Akathisia Scale.
How do you treat akathisia?
B blockers Benzos
MacArthur Violence Risk Assessment Study
ETOH and drug use accounted for increased incidence of violence, for 20 weeks post discharge.
If they didn’t use drugs or ETOH, acute inpatients were NO MORE LIKELY THAN CONTROLS TO COMMIT VIOLENCE.
VIOLENCE RATING SCALES
V’s and S’s
VRAG
HCR-20-historical clinical risk
VRS
Static 99-sexual recidivism
SORAG-sex offender risk appraisal
Mens Rea
Actus Rea
To be convicted prosecution needs to prove :
guilty mind,
guilty action
Sane Automatism
Vs
Insane Automatism
Sane Automatism - person reacting to external factor (consussion, spasm, killing someone while SNEEZING)
Insane Automatism - person reacting to internal factor (disease of the mind)
Provocation
- when a person commits a crime due to a preceding act
- PARTIAL DEFENCE - only reduces murder charges to manslaughter
- crime caused by provocation, committed in the heat of passion under an irresistable urge, without being determined by reason
Malice Afterthought
Vs
Furor Brevis
Malice Afterthought - under the sway of reason
Furor Brevis - deaf to the voice of reason even though the act was intentional
Catatonia
Karl Kahlbaum
Vaillants Defense Mechanisms
I - PATHOLOGICAL
II - IMMATURE
III - NEUROTIC
IV - MATURE
Sublimation
MATURE
- transform unhelpful emotions into constructive behaviour
- play sport to deal with aggression
Displacement
- NEUROTIC DEFENCE
- shift impulse onto something or someone else (less threatening target)
- redirecting emotion from the real object to a different one
Doing and Undoing
- NEUROTIC
- after doing something regretable, trying to undo it
Externilization
- projecting your own internal characteristics onto others
- perceiving others as argumentative when YOU are the argumentative one
Isolation
-seperating ones thoughts from their feelings
Projection
- IMMATURE
- primitive form of paranoia
- attributing your own unwanted thoughts or desires onto another
- hypervigilant, injustice collecting
Raven’s Progressive Matrices
Non Verbal Intelligence
Ray Osterrieth Test
VISUAL MEMORY
WORKING MEMORY
EXECUTIVE FAMILY
WISCONSIN CARD SORTING TEST
EXECUTIVE FUNCTIONING
abstraction, set shifting, attention
EEG in CJD
PSWC - periodic sharp wave complexes
diffuse slowing and…
FIRDA - fronal rhythmic delta activity
EEG in HSE
UNILATERAL/BILATERAL PERIODIC SHARP WAVES
FOCAL/LATERALIZED SEIZURE + ENCEPHALITIS
EEG IN HUNTINGTONS
Slow, gradual EEG slowing
EEG in Metabolic/Hepatic Encephalopathy
TRIPHASIC WAVES
EEG IN MYOCLONIC EPILEPSY
3-6 Hz, POLYSPIKE AND WAVE
CYP enzymes?
CYP 1A2
CYP 2D6
CYP 3A4
CYP 2C9
CYP 2C19
Sodium Valproate interactions
- highly protein bound (poor volume of distribution).
- displaces other drugs that are protein bound (and so, there will be more free drug in the blood stream)
- other protein bound drugs include :
CARBAMAZEPINE
WARFARIN
PHENYTOIN
TOPIRAMATE
Therefore if you give valproate with any of these, their drug levels will go up.
Intraversion/Extroversion
JUNG
introversion - orientation in life through subjective psychosis content
extraversion - concentration of interest on external object
Models of Personality
Big 5
Eysenck’s 3
Cattell’s 16 PF
MMPI
Myers Briggs
Jungian Analytical Psychology
Analytical Psychology (Jungian)
Anima and Animus
feminine side of a man, masculine side of the woman (unconcious)
Archetypes (the mother, the child, the trickster)
Collective Unconcious
“To have a complex”
Myer Briggs Type Indicator
self report
INFJ/ENFP
based on jungian analysis
16PF
CATTELL
clinical instrument used by professionals
Working Memory
- hold info temporarily
- used for reasoning and decision making
Sensory Memory
-recall great detail about a complex stimulus immediately following the presentation but for like a second.
no manipulation of memory
-immediately transferred to working memory
Working Memory
BADDELEY AND HITCH
Working memory has…
- phonological loop - way of remembering auditory information (like phone numbers) and consists of a short term pholological loop (rapid decay) and an articulatory loop that can revive the memory trace
- visuospatial scratchpad - information about position and properties of objects are stored.
- central executive to disperse attention between them and also links working memory to the long term memory
Long term memory
final stage
semi permanent
infinite capacity
divided into IMPLICIT and EXPLICIT
Explicit Memory
- semantic or episodic
- semantic are abstract and fact based
- episodic are event based
Implicit Memory
-procedural memory for motor tasks
BIOPSYCHOSOCIAL MODEL
ENGEL
D
DIATHESIS-STRESS MODEL OF PSYCHOPATHOLOGY
AARON BECK
GENETIC DETERMINISM
AUGUST WEISMANN, 1890
PATIENT CENTERED CARE
BROWN AND STEWART
Remember “Stuart Brown* is very patient centered
