SAS/Review Flashcards
Which opioids affect serotonin levels?
Why is this important?
Tramadol, fentanyl
Patients on serotoninergic agents should not take!
Can lead to serotonin syndrome
What kind of defense mechanism:
A person is angry at their phsysician for cancelling their appointment. They end up cleaning their entire department to avoid thinking about being angry
Sublimation
Channeling anger, discomfort, unpleasant thoughts at productive activities
Which side effect of first-generation antipsychotics is likely to present after decades of use?
Tardive dyskinesia
Due to long term dopamine blockade
Describe the general timeline of symptoms onset during alcohol withdrawal
- 6-48h: ANS hyperactivity
- 12-48h: Seizures
- 12-24h: Hallucinations
- 3-5+ days: Delirium Tremens
What are the risks associated with MAO inhibitors?
- Serotonin Syndrome
- Hypertensive crisis
- Must avoid tyramine-rich foods
- Severe interaction with meperidine
Which drugs increase serum Lithium levels?
- NSAIDs
-
Diuretics
- Thiazides, spironalactone, triamterene
- ACE inhibitors
- Ca2+ channel blockers
- Metronidazole
- Tetracycline
What factors might precipitate delerium?
I-WATCH-DEATH
The slides specifically highlight factors in bold
- Infection - pneumonia
- Withdrawal
- Acute metabolic
- Trauma
- CNS pathology
- Hypoxia/hypercarbia - hypoxia
- Deficiencies
- Endocrine
- Acute vascular
- Toxins - diphenhydramine
- Heavy metal
What is the difference between schizoaffective disorder and schizophrenia?
-
Schizoaffective disorder:
- Mood symptoms regardless of whether psychotic symptoms are present or absent
-
Schizophrenia:
- Mood symptoms only present when psychotic symptoms are present
(Thank you @Nathan Shlobin!)
Abnormal eye movements (nystagmus) are characteristic of which drug intoxication?
Phencyclidine (PCP)
Which antidepressants are contraindicated in patients with current or history of anorexia nervosa or bulimia nervosa?
Bupropion
Is this neurotransmitter associated with wakefullness or sleep?
Where is it secreted?
Serotonin
Wakefullness
Raphe nuclei (pons)
Which antipsychotics are most likely to have side effects of involuntary facial movements, restlessness, and dystonia?
High-potency first-generation antipsychotics
- Haloperidol
- Fluphenazine
- Trifluoperazine
Hoover’s sign provides evidence for which disorder?
Functional Neurological Disorder (aka conversion disorder)
Is this neurotransmitter associated with wakefullness or sleep?
Where is it secreted?
Orexin
Wakefulness
Lateral hypothalamus
Is this neurotransmitter associated with wakefullness or sleep?
Where is it secreted?
Histamine
Wakefulness
Tuberomamillary nucleus (hypothalamus)
What differentiates Bipolar I from Bipolar II?
- Bipolar I
- At least 1 manic episode lasting 1+ weeks
- Bioplar II
- Hypomania
- Different from mania b/c does not cause marked impairment in social/occupational functioning, does not require hospitalization
- No manic episodes
- Hypomania
E - All of the above
- Bupropion = atypical antidepressant (NE and DA reuptake inhibitor)
- Clonidine, guanfacine = alpha-2 blockers
- Atomoxetine = selective NE reuptake inhibitor
Rapid withdrawal of what hormone can trigger migraine?
Estrogen
- Rapid withdrawal occurs during the following times:
- Perimenopause
- Post-partum
- Perimenstruation
What is the most consistent but non-specific neuroimaging finding in schizophrenia?
Enlarged ventricles
- Almost always found in patients with schizophrenia
- Not specific for schizophrenia
Which seizure medications are prefered in women of childbearing age?
Lamotrigine, levetiracetam
Sometimes carbamazepine
Avoid valproate!!
What is the most effective treatment for insomnia?
Cognitive behavioral therapy
Focuses on:
- Sleep hygeine
- Sleep restriction
- Bed is for sleeping and sex only!
- Wake up at the same time every day
- Stimulus control
- Don’t sleep until you’re tired
- If you can’t fall asleep in 20 min, get out of bed and read
- Avoid screens
What is the difference between schizotypal and schizoid personality disorders?
- Schizoid
- Socially withdrawn
- Desire to be left alone
- Limited emotional expression
- Schizotypal
- Also socially withdrawn
- Interpersonal awkwardness
- Magical thinking, eccentricity
A set of sidely scattered but orchestrated crerebral areas that are activated by a specific task observed on neuroimaging is a…
- State network
- Attention network
- Channel network
- Default mode network
c. Channel network
Schizophrenia is a [developmental/degenerative] disorder
What is the brain pathology?
Schizophrenia is a developmental disorder
Results from abnormal neuronal migration during development
What are the classic features of MDD, melancholic subtype?
- Anhedonia and/or lack of reactivity
- Early morning awakening
- Significant anorexia or weight loss
- Excessive or inappropriate guilt
A - Methylphenidate
- Bupropion can also be used for ADHD, but not first line
- Guanfacine is an alpha-2 agonist that is 2nd line or ad-junct to the stimulants
- Tranylcypromine is a MAO inibitor - not indicated for ADHD
Which antipsychotic may cause neutropenia?
Clozapine
- Atypical anti-psychotic
- Blocks serotonin and norepinephrine
- Used as a 3rd line agent
- But must register in database
- Track any neutropenia resulting so it is not prescribed in the future
What time period constitutes persistent depressive disorder?
2+ years of depressed mood for most of the day, more days than not
Which antipsychotics are likely to cause abnormal lactation?
- Low-potency first-generation
- Chlorpromazine
- Thioridazine
- Second-generation - lower risk than FGA, but can still happen
- Quetiapine
- Olanzapine
- Risperidone
- Aripiprazole
- Ziprasodone
- Clozapine
What kind of medication is cyclobenzaprine?
Muscle relaxant
What kind of defense mechanism:
A person is angry at their psysician for cancelling their appointment. Next time they see their physician, they compliment the physician on their shirt
Reaction formation
(Doing the opposite of what you feel)
Which class of antidepressants is most likely to have cardiac effects?
What are the effects?
TCAs
Long QT -> Torsades (potentially fatal arrhythmia)
- Amitriptyline
- Nortriptilyine
- Desipraime
- Amoxapine
- Imipramine
- Clomipramine
- Doxepin
Citalopram (SSRI) also can cause long QT
How is lithium metabolized?
Excreted unchanged by the kidney
(No hepatic metabolism)
What are the indications for haloperidol in a patient with delerium?
- Psychosis
- Hallucinations
- Agitation
But remember, the focus of the treatment should always be the underlying cause!!
What further testing is indicated when a child presents with signs and symptoms of autism spectrum disorder?
- Genetic testing
- Lead levels (if reasonable environmental risk)
- EEG
- Hearing and vision
- Wood’s lamp (for Tuberous Sclerosis)
According to Robins and Guze (1970), what 5 steps can help achieve diagnostic validity for psychiatric disorders?
- Clinical description
- Delimitation from other disorders
- Follow-up study (including treatment response)
- Family study
- Laboratory studies
What are the classic features of MDD, atypical subtype?
- Mood reactivity
- Significant weight gain
- Hypersomnia
- Leaden paralysis
Is this neurotransmitter associated with wakefullness or sleep?
Where is it secreted?
Norepinephrine
Wakefulness
Locus ceruleus (pons)
Which medication can be used to augment the effects of SSRIs and is known for reducing the risk of suicide?
Lithium
Is this neurotransmitter associated with wakefullness or sleep?
Where is it secreted?
GABA
Sleep
Ventrolateral peroptic nucleus (VLPO)
