Steve Prefontaine's Psychiatry Run-Through Flashcards
Classical conditioning
Learning in which a natural response (salivation) is elicited by a conditioned or learned, stimulus that previously was present in conjunction with an unconditioned stimulus;
usually deals with involuntary response
Operant conditioning
Learning in which a particular action is elicited because it produces a punishment or reward;
usually deals with voluntary response
Operant conditioning: Positive reinforcement
Desired reward produces action (mouse presses button to get food)
Operant conditioning: Negative reinforcement
Target behavior (Response) is followed by removal of aversive stimulus (mouse presses button to turn off continuous loud noise)
Operant conditioning: punishment
Repeated application of aversive stimulus extinguishes unwanted behavior
Operant conditioning: extinction
discontinuation of reinforcement (+ or -) eventually eliminates behavior;
can occur in operant or classical conditioning
Transference
Patient projects feelings about formative or other important persons onto physician (e.g. psychiatrist is seen as parent)
Countertransference
Doctor projects feeling about formative or other important persons onto patient (e.g. patient reminds physician of younger sibling)
Dissociation
Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress;
Example would be multiple personality disorder
Displacement
Transferring avoided ideas and feelings to some neutral person or object (vs. projection);
e.g. Mother yells at child because husband yelled at her
Fixation
Partially remaining at a more childish level of development;
Identification
Modeling behavior after another person who is more powerful;
e.g. abused child identifies with an abuser
Isolation
Separating feelings from ideas and events;
e.g. describing murder in graphic detail without emotional response
Projection
Attributing an unacceptable internal impulse to an external source;
e.g. a man who wants another woman thinks his wife is cheating on him
Reaction formation
Replacing a warded off idea or feeling by an (unconsciously derived) emphasis on its opposite (vs. sublimation);
A patient with libidinous thoughts enters a monastery
Repression
Involuntary withholding an idea or feeling from conscious awareness
Splitting
Believing that people are either all good or all bad at different times due to intolerance of ambiguity;
commonly seen in borderline personality disorder
Sublimation
Replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one’s value system
Suppression
Intentional withholding of an idea or feeling from conscious awareness
Evidence of child abuse
Healed fractures on x-ray (spiral fractures are highly suggestive), burns, subdural hematomas, retinal hemorrhage or detachement;
usually biological mother
Attention-deficit hyperactivity disorder
onset before 12;
limited attention span and poor impulse control;
continues into adulthood in 50% of cases;
decreased frontal lobe volume/metabolism;
treat with methylphenidate, amphetamines, atomoxetine, and behavioral interventions
Conduct disorder
Repetitive and pervasive behavior violating the basic rights of others;
after age 18 many meet criteria of antisocial personality disorder
Oppositional defiant disorder
Enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms;
Tourette syndrome
Onset before age 18;
sudden, rapid, recurrent, non-rhythmic, stereotyped motor and vocal tics that persist for more than 1 year;
Coprolalia (obscene speech) in 10-20% of patients;
treat with antipsychotics
Separation disorder
Common onset at 7-9;
overwhelming fear of separation from home or loss of attachment figure;
May lead to factitious physical complaints to avoid going to or staying at school;
Treat with SSRIs and relaxation techniques
Rett disorder
X-linked disorder seen almost exclusively in girls (males die in utero or after birth);
onset of 1 to 4 y/o;
includes regression characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, and stereotyped hand-wringing;
Neurotransmitter changes in: alzheimer disease
decreased ACh
Neurotransmitter changes in: Anxiety
increased NE;
decreased GABA and 5-HT;
Neurotransmitter changes in: Huntington disease
Decreased GABA, ACh;
increased Dopamine
Neurotransmitter changes in: Parkinson disease
decreased dopamine;
increased 5-HT, and ACh
Neurotransmitter changes in: Schizophrenia
increased Dopamine
retrograde amnesia
inability to remember things that occurred before a CNS insult
Anterograde amnesia
Inability to remember things that occur after a CNS injury (no new memory)
Korsakoff amnesia
Classic anterograde amnesia caused by thiamine deficiency and the associated destruction of mammillary bodies;
may also include some retrograde amnesia;
seen in alcoholics, and associated with confabulations
Dissociative amnesia
Inability to recall important personal information, usually subsequent to severe trauma or stress;
may be accompanies by dissociative fugue (wandering around during a period of dissociative amnesia)
Delirium
acute onset waxing and waning level of consciousness;
rapid decrease in attention span and level of arousal;
characterized by disorganized thinking, hallucinations (often visual), illusions, misperceptions, disturbances in sleep wake cycle, cognitive dysfunction;
Treatment: get rid of cause, optimize brain condition (O2, decrease pain, hydration), haloperidol
Dementia
gradual decline in intellectual ability or cognition without affecting level of consciousness;
memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, impaired judgement;
patient with dementia can get delirium (e.g. alz patient gets pneumonia which increases risk for delirium)
Psychosis
a distorted perception of reality characterized by delusions, hallucinations, and/or disorganized thinking;
Psychosis can occur in patients with medical illness, psychiatric illness or both
Hallucinations
Perception in the absence of external stimuli (e.g. seeing a light that is not actually there)
Delusions
Unique, false beliefs about oneself or others that persist despite the facts (thinking aliens are communicating with you)
Disorganized speech with psychosis
Words and ideas are strung together based on sounds, puns, or loose associations
Visual hallucinations
More commonly a feature of a medical illness (drug intoxication) than a psychiatric illness
Auditory hallucinations
More commonly a feature of psychiatric illness (schizophrenia) than medical illness
Olfactory hallucinations
Often occur as an aura of psychomotor epilepsy and in brain tumors;
Hypnagogic
occurs when GOing to sleep
Hypnopompic
occurs while waking from sleep (POMPous when awakening)
Schizophrenia
Chronic mental disorder with periods of psychosis, disturbed behavior and thought, and decline in functioning that lasts > 6 months;
associated with increased dopamine activity, decreased dendritic branching;
Diagnoses need 2 of these- delusions, hallucinations (usually auditory), disorganized speech, disorganized or catatonic behavior, negative symptoms (flat affect, social withdrawal, lack of motivation, lack of speech or thought
Brief psychotic disorder
Schizophrenia for less than 1 month;
usually due to stress
Schizophreniform disorder
Schizophrenia for 1-6 months
Schizoaffective disorder
type of schizophrenia; for at least 2 weeks of stable mood with psychotic symptoms, plus a major depressive, manic, or mixed (both) episodes; 2 subtyes (bipolar or depressive)
Delusional disorder
Fixed, persistent, untrue belief system lasting > 1 month;
functioning otherwise not impaired;
e.g. woman who genuinely believes she is married to a celebrity when she is not
Dissociative identity disorder
AKA multiple personality disorder;
presence of 2 or more distinct identities or personality states;
more common in women;
associated with history of sexual abuse, PTSD, depression, substance abuse, borderline personality, and somatoform conditions
Depersonalization/derealization disorder
Persistent feeling of detachment or estrangement from one’s own body, thoughts, perceptions, and actions (depersonalization) or one’s environment (derealization)
mood disorder
Characterized by an abnormal range of moods or internal emotional states and loss of control over them;
includes major depressive disorder, bipolar, dysthymic disorder, cyclothymic disorder;
psychotic features may be present such as delusions or hallucinations
Manic episode
distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy lasting at least 1 week;
See Distractibility, Irresponsibility, Grandiosity, Flight of ideas, increased goal direct activity, decreased need for sleep, talkativeness or pressured speech
Hypomanic episode
Like manic; Lasts 4 consecutive days; no hospitalization required; no psychotic features; Not severe enough to caused marked impairment in social and/or occupation functioning
Bipolar disorder I
defined by the presence of at least 1 manic episode with or without hypomanic or depressive episode;
Bipolar disorder II
presence of a hypomanic and depressive state
Bipolar in general
patient’s mood and functioning usually return to normal between episodes;
use of antidepressants can lead to increased mania;
high suicide rate;
treat with mood stabilizers (lithium, valproic acid, carbamazepine, atypical antipsychotics
Cyclothymic disorder
Dysthymia and hypomania;
milder form of bipolar disorder lasting at least 2 years
Major depressive disorder
Episodes lasting 6-12 months;
at least 5 symptoms for 2 or more weeks- loss of sleep, loss of interest (anhedonia), guilt or feelings of worthlessness, energy loss and fatigue, Concentration problems, appetite/weight loss, psychomotor retardation, suicidal ideations, depressed mood;
Patients get to REM sleep quicker and stay there longer, but repeatedly wake up, early morning awakening
Persistant depressive disorder (dysthymia)
depression, often milder, lasting at least 2 years
Seasonal affective disorder
Symptoms in winter season;
improves with full spectrum bright light exposure
Maternal postpartum blues
50-85% incidence rate;
depressed affect, tearfulness, and fatigue starting 2-3 days after delivery;
Usually resolves within 10 days;
treatment is supportive;
Postpartum depression
10-15% incidence;
depressed affect, anxiety, and poor concentration starting within 4 weeks after delivery;
last 2 weeks to a year or more;
treat: antidepressants, psychotherapy
Postpartum psychosis
.1 to .2 % incidence;
Delusions, hallucinations, confusion, unusual behavior, and possible homicidal/suicidal ideations or attempts;
usually lasts days to 4-6 weeks;
treatment: antipsychotics, antidepressants, possible inpatients hospitalizations, assessment of child safety
Pathologic grief
normal bereavement characterized by shock, denial, guilt and somatic symptoms;
can last 6-12 months;
may experience depressive symptoms, delusions, and hallucinations
Electroconvulsive therapy
Treatment option for major depressive disorder refractory to other methods and pregnant women;
also used when immediate response is needed (suicidality, psychotic features, catatonia);
causes small seizure, may have retro/anterograde amnesia that resolves in 6 months
Panic disorder
Presence or recurrent panic attacks (periods of intense fear and discomfort peaking in 10 minutes with at least 4 of the following)- palpitations, paresthesias, ab distress, nausea, intense fear of dying, light headedness, chest pain, chills, choking, disconnectedness, sweating, shaking, SOB;
treat with cognitive therapy, SSRIs, venlafazine, benzodiazapines (risk of tolerance, dependence);
Diagnosis requires attack followed by 1 month or more of 1 or more of the following- worrying about more attacks or consequences of the attack, or behavioral change related to atack
Social anxiety disorder
Exaggerated fear of embarrassment in social situations;
Treat with SSRIs
Agoraphobia
Exaggerated fear of open or enclosed places, using public transportation, being in line or in crowds, or leaving home alone
Generalized anxiety disorder
Pattern of uncontrolled anxiety for at least 6 months that in unrelated to a specific person, situation, or event;
get sleep disturbances, fatigue, GI disturbances, and difficulty concentrating;
treat with SSRIs, SNRIs, buspirone, cognitive therapy
Adjustment disorder
Emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (divorce, illness) and lasting 6 months in presence of chronic stressor)
Obsessive compulsive
Recurring intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress;
relieve in part by doing compulsions;
ego-dystonic if it is against persons own beliefs or attitudes;
treat with SSRIs, clomipramine
Body dysmorphic disorder
Preoccupation with minor or imagined defect in appearance, leading to significant emotional distress or impaired functioning;
patients often repeatedly seek cosmetic surgery
PTSD
Persistent re-experiencing of a previous traumatic event;
lasts longer that 1 month;
treat with psychotherapy, SSRIs
Acute distress disorder
PTSD lasting between 3 days and one month
Malingering
Patient consciously fakes, profoundly exaggerates, or claims to have a disorder in order to attain a specific secondary gain (wants to get out of work)
Factitious disorders
patient consciously creates physical and/or psychological symptoms in order to assume “sick role” and to get medical attention (primary gain)
Munchausen syndrome
Factitious disorder;
Chronic;
predominantly physical signs and symptoms;
Characterized by a history of multiple hospital admissions and willingness to receive invasive procedures
Munchausen syndrome by proxy
Factitious disorder;
when illness in child or elderly is caused by caregiver;
motivation is to assume a sick role by proxy;
form of abuse
Somatic symptom and related disorders
Symptoms not intentionally produced or feigned;
Physical symptoms with no identifiable physical cause;
both illness production and motivation are unconscious drives
Somatic symptom disorder
Variety of complaints in one or more organ system lasting for months to years;
associated with excessive, persistent thoughts and anxiety about symptoms;
may co-occur with medical illness
Conversion disorder
Sudden loss of sensory or motor function (paralysis, blindness), often following an acute stressor;
patient is aware of but sometimes indifferent toward symptoms
Illness anxiety disorder
AKA hypochondriasis;
preoccupation with and fear of a serious illness despite medical evaluation and reassurance
Personality disorder
Inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning;
person is usually not aware of the problem;
usually presents by early adult hood;
Three categories (A, B, and C clusters)
Cluster A Personality Disorders
Paranoid, Schizoid, Schizotypal;
Weird category (Accusatory, Aloof, Awkward);
Odd or eccentric;
inability to develop meaningful social relationships;
no psychosis;
genetic association with schizophrenia
Paranoid Personality Disorder
Cluster A Personality Disorder;
Pervasive distrust and suspiciousness;
projection is the major defense mechanism
Schizoid Personality Disorder
Cluster A Personality Disorder;
Voluntary social withdrawal, limited emotional expression, content with social isolation (vs. avoidance);
schizoiD=Distant
Schizotypal Personality Disorder
Cluster A Personality Disorder;
Eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness;
schizoTypal=magical Thinking
Cluster B Personality Disorders
Antisocial, Borderline, Histrionic, Narcissistic;
Wild category;
dramatic, emotional, or erratic;
genetic association with mood disorders and substance abuse;
Antisocial Personality Disorder
Cluster B Personality Disorder;
Disregard for and violation of rights of others;
criminality, impulsivity, males>females;
must be >18 years old and have a history of conduct disorder before age 15;
Called conduct disorder if under 18 years old;
antiSOCial=SOCiopath
Borderline Personality Disorder
Cluster B Personality Disorder;
Unstable mood and interpersonal relationships, impulsiveness, self-mutilation, boredom, sense of emptiness;
females > males;
splitting is a major defense mechanism
Histrionic Personality Disorder
Cluster B Personality Disorder;
Excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance
Narcissistic Personality Disorder
Cluster B Personality Disorder;
Grandiosity, sense of entitlement;
lacks empathy and requires excessive admiration;
often demands the “best” and reacts to criticism with rage
Cluster C Personality Disorder
Anxious or fearful;
genetic association with anxiety disorders;
Worried cluster
Avoidant Personality Disorder
Cluster C Personality Disorder;
Hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others (vs. schizoid)
Obsessive-compulsive Personality Disorder
Cluster C Personality Disorder;
Preoccupation with order, perfectionism, and control;
ego-syntonic- behavior consistent with one’s own beliefs and attitudes (vs. OCD)
Dependent Personality Disorder
Cluster C Personality Disorder;
submissive and clinging, excessive need to be taken care of, low self-confidence
Name the different schizo- diseases and how to differentiate them
Schizoid (voluntary social withdrawal, low emotion expression, happy with isolation)
Anorexia nervosa
excessive dieting +/- purging;
intense fear of gaining weight, body image distortion, and increased exercise, leading to a BMI usually less than 17;
associated with decreased bone density;
Can get metatarsal stress fractures, amenorrhea, lanugo (fine body hair), anemia, and electrolyte disturbances;
osteoporosis caused in part by decreased estrogen over time;
usually coexists with depression
Bulimia nervosa
binge eating +/- purging;
often followed by self-induced vomiting or use of laxatives, diuretics, or emetics;
body weight usually normal;
associated with parotitis, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand calluses from induced vomiting (Russel sign)
Gender dysphoria
Strong persistent cross-gender identification;
characterized by persistent discomfort with one’s sex assigned at birth, causing significant distress and/or impaired functioning;
affected individuals are often referred to as transgender
Transsexualism
Desire to live as the opposite sex, often through surgery or hormone replacement;
Transvestism
paraphilia, not gender dysphoria;
wearing clothes (vest) of the opposite sex;
cross-dressing
Sexual dysfunction
includes sexual desire disorders (hypoactive sexual desire or sexual aversion), sexual arousal disorder (erectile dysfunction), orgasmic disorder (anorgasmia and premature ejaculation), and sexual pain disorders (dyspareunia and vaginismus);
DDX includes- drugs (anithypertensives, neuroleptics, SSRIs, ethanol), Diseases (depression, diabetes, STDs), and Psychological (performance anxiety)
Sleep terror disorder
Periods of terror with screaming in the middle of the night;
occurs during slow-wave sleep;
most common in children;
occurs during non-REM sleep (no memory of arousal) as opposed to nightmares that occur during REM sleep (memory of a scary dream);
cause unknown, but triggers may include emotional stress, fever, or lack of sleep;
usually self limited
Narcolepsy
Disordered regulation of sleep-wake cycles;
primary characteristic is excessive daytime sleepiness;
caused by decreased orexin production in lateral hypothalamus;
also associated with- Hypnagogic (just before sleep, go-going) or hypnopompic (just before awakening, po-post sleep) hallucinations, Nocturnal and narcoleptic sleep episodes that start off with REM sleep, Cataplexy (loss of all muscle tone following a strong emotional stimulus, such as laughter) in some patients;
Strong genetic component;
Treat with daytime stimulants (amphetamines, modafinil) and nighttime sodium oxybate (GHB)
Substance use disorder
Maladaptive pattern of substance abuse defined as 2 or more of the following signs in 1 year;
Tolerance, withdrawal, substance taken in large amounts or over longer time than desired, persistent desire or unsuccessful attempts to cut down, significant energy spent obtaining using or recovering from substance, social/occupational problems, continuing but you know not to, craving
Stages of change in overcoming substance addiction
1) Precontemplation- not yet acknowledging there is a problem;
2) contemplation- acknowledging that there is a problem, but not yet ready or willing to make a change;
3) Preparation/determination-getting ready to change behavior;
4) Action/willpower- changing behavior;
5) Maintenance- maintaining the behavior change;
6) relapse-return to old behaviors and abandoning new changes
Alcohol
Depressant, ataxia, slurred speech, blackouts;
serum gamma-glutamyltransferase (GGT) indicator of alcohol use;
Lab AST twice ALT value;
Severe withdrawal leads to autonomic hyperactivity and DTs (can kill you);
treat DTs with benzodiazepines;
opioids
Depressant, Respiratory and CNS depression, decrease gag reflex, pupillary constriction, seizures;
treat with naloxone, Naltrexone;
Withdrawal- sweating, dilated pupils, piloerection, fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea (flu like Sx);
treat withdrawal with methadone, buprenorphine
Barbiturates
Depressant, Low safety margin, marked respiratory depression, treat with symptom management (assist respiration and increase their BP);
Withdrawal can cause delirium and life threatening cardiovascular collapse
Amphetamines
Stimulant, Cause euphoria, pupillary dilation, prolonged wakefulness and attention, HTN, tachycardia, anorexia, paranoia, fever, cardiac arrest and seizure;
Withdrawal- anhedonia, increased appetite, hypersomnolence, existential crisis
Cocaine
Stimulant, impaired judgement, pupillary dilation, hallucinations, paranoid ideations, angina, sudden cardiac death;
treat with benzodiazepines;
withdrawal causes hypersomnolence, malaise, severe psychological craving, depression/suicidality
Nicotine
Stimulant, causes restlessness;
withdrawal causes irritability, anxiety, craving;
treat with nicotine replacement, bupropion or varenicline
PCP
Hallucinogen, causes belligerence, impulsiveness, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium, seizures;
treatment is benzodiazepines, rapid acting antipsychotic;
Withdrawal-depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep
LSD
Hallucinogen, causes perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks
Marijuana
Hallucinogen, causes euphoria, anxiety, paranoid delusions, perceptions of slowed time, impaired judgement, social withdrawal, increased appetite, dry mouth, conjunctival injection;
prescription form is dronabinol- used as antiemetic (chemo) and appetite stimulant (cancer and AIDS);
can detect in urine for 4-10 days
Heroin addiction are increased risk for
Hepatitis, abcesses, overdose, hemorrhoids, AIDS, and right sided endocarditis;
look for track marks;
Heroin treatment
Methadone- long-acting oral opiate, used for heroin detox or long term maintenance;
Naloxone + buprenorphine- partial agonist, long acting with fewer withdrawal symptoms than methadone, nalaxone is not active when taken orally, so withdrawal symptoms occur only if injected (lower abuse potential);
Naltrexone- long acting opioid antagonist used for relapse prevention once detoxified
Signs and treatment of alcoholism
tremor, tachycardia, HTN, malaise, nausea, DTs on withdrawal;
Treat- disulfiram (to condition the patient to abstain from alcohol use), naltrexone, supportive care, AA for help
Wernicke-Korsakoff syndrome
B1/thiamine deficiency;
triad of confusion, ophthalmoplegia, ataxia (wernicke encephalopathy);
may progress to irreversible memory loss, confabulation, personality change (Korsakoff psychosis);
associated with periventricular hemorrhage/necrosis of mammillary bodies;
treat with IV B1/Thiamine
Mallory-Weiss
longitudinal partial thickness tear at the GE junction caused by excessive vomiting;
often presents with hematemesis;
associated with pain (esophageal varices are usually painless)
Delirium Tremors (DTs)
Life threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink;
Symptoms in order of appearance- Autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures), psychotic symptoms (hallucinations, delusions), confusion;
treat with benzodiazepines
Treatment for: ADHD
methylphenidate
Treatment for: Alcohol withdrawal
benzodiazepines (-zepam)
Treatment for: anxiety
SSRIs, SNRIs, buspirone
Treatment for: bipolar
mood stabilizers (lithium, valproic acid, carbamazepine), atypical antipsychotics
Treatment for: Bulimia
SSRIs
Treatment for: Depression
SSRIs, SNRIs, TCAs, bupropion, mirtazapine (especially with insomnia)
Treatment for: Obsessive-compulsive disorder
SSRIs, clomipramine
Treatment for: Panic disorder
SSRIs, venlafaxine, benzodiazepines
Treatment for: PTSD
SSRIs
Treatment for: Schizophrenia
Antipsychotics
Treatment for: Social phobias
SSRIs, beta-blockers
Treatment for: Tourette syndrome
Antipsychotics (eg. haloperidol, risperidone)
CNS stimulants: names, mechanism, use
names: methylphenidate, dextroamphetamine, methamphetamine, phetermine;
Mechanism: increase catecholamines at synaptic cleft, especially NE and dopamine;
Use: ADHD, narcolepsy, appetite control
Antipsychotics (neuroleptics): name them
Haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine, (haloperidol + azines)
Antipsychotics (neuroleptics): Uses
Schizophrenia (primary positive symptoms);
psychosis, acute mania, tourette syndrome
Antipsychotics (neuroleptics): Toxicity
Highly lipid soluble and stored in body fat, so very slow to be removed from body;
Extrapyramidal side effects (dyskinesias)-treat with benztropine or diphenhydramine;
Endocrine side effects (e.g. dopamine receptor antagonism leads to hyperprolactinemia leading to galactorrhea);
side effects arising from blocking muscarinic (dry mouth, constipation), Alpha 1 (hypotension), and histamine (sedation) receptors
Antipsychotics (neuroleptics): Neuroleptic malignant syndrome
Side effect;
Rigidity, myoglobinuria, autonomic instability, hyperpyrexia;
treat: dantrolene, D2 agonists (bromocriptine);
Think FEVER: Fever, Encephalopathy, Vitals unstable, Enzymes increased, Rigidity of muscles
Antipsychotics (neuroleptics): Tardive dyskinesia
Side effect;
Stereotypical oral-facial movements as a result of long-term antipsychotic use;
potentially irreversible
Antipsychotics (neuroleptics): Potency of meds
High potency: Try to Fly High, Trifluoperazine, Fluphenazine, Haloperidol;
Low potency: Cheating Thieves are Low, Chlorpromazine, Thioridazine;
Antipsychotics (neuroleptics): Chlorpromazine side effect
Corneal deposits;
Antipsychotics (neuroleptics): Thioridazine side effect
reTinal deposits
Atypical Antipsychotics: names
Olanzapine, Clozapine, quetiapine, risperidone, aripiprazole, ziprasidone;
its’s ATYPCIAL for OLd, CLOSets to QUIETly, RISPER from A to Z
Atypical Antipsychotics: mechanism
not understood;
varied effect on 5-HT2, Dopamine, and alpha and H1 receptors;
Atypical Antipsychotics: Use
Schizophrenia- both positive and negative symptoms;
also used for bipolar disorder, OCD, anxiety, depression, mania, Tourette syndrome
Atypical Antipsychotics: Toxicity
Fewer extrapyramidal and anticholinergic side effects than traditional antipsychotics;
Olanzapine/clozapine may cause significant weight gain;
clozapine may cause agranulocytosis (do weekly WBC counts) and seizure;
Risperidone can increase prolactin (causing lactation and gynecomastia leading to decreased GnRH, LH, and FSH (causing irregular menstruation and fertility issues);
Ziprasidone may prolong the QT interval
Lithium
mechanism: possibly related to inhibition of phosphoinositol cascade (decreased PIP2 recycling);
Uses: mood stabilizer for bipolar, blocks relapse and acute manic episodes, also SIADH;
Side effects: LMNOP- Lithium side effects, Movement (tremor), Nephrogenic diabetes insipidus (ADH antagonist causing nephrogenic DI), hypOthyroidism, Pregnancy problems
Buspirone
Stimulates 5-HT1A receptors;
used in generalized anxiety disorder, does not cause sedation, addiction, or tolerance, takes 1-2 weeks to take affect, does not interact with alcohol (vs. barbs and benz);
I am anxious if the BUS will be ON time, so I take BUSpirONe
SSRIs: Names
Fluoxetine, paroxetine, sertraline, citalopram;
SSRIs: Mechanism and uses
mechanism: 5-HT specific reuptake inhibitor, takes 4-8 weeks to work;
Uses: depression, generalized anxiety, panic disorder, OCD, bulimia, social phobias, PTSD;
SSRIs: Toxicity
Fewer than TCAs;
GI distress, sexual dysfunction;
Serotonin syndrome with any drug that increased 5-HT: hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures, treat with cryproheptadine (5-HT2 receptor antagonist)
SNRIs
Venlafaxine, duloxetine;
Mechanism: inhibit 5-HT and NE reuptake;
Used for depression, Venlafaxine used in generalized anxiety and panic disorder, duloxetine used for diabetic peripheral neuropathy;
Toxicity: increased BP, also stimulant effect, sedation, nausea, and serotonin syndrome
Tricyclic antidepressants: names
Amitryptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine (all TCAs end in -iptyline or -ipramine except doxepin and amoxapine)
Tricyclic antidepressants: Mechanism
block NE and 5-HT reuptake
Tricyclic antidepressants: Uses
major depression, OCD (clomipramine), fibromyalgia
Tricyclic antidepressants: Toxicity
sedation, alpha 1 blocking causes postural hypotension, anticholinergic side effects (increased HR, urinary retention, dry mouth), Amitriptyline has more anticholinergic effects than nortiptyline have;
desipramine is less sedating but increased seizures;
Tri-Cs: Convulsions, Coma, Cardiotoxicity (treat with NaHCO3);
confusion and hallucinations in the elderly due to anticholinergic side effects
Monoamine oxidase inhibitors: names
Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor);
MAO Takes Pride In Shanghai
Monoamine oxidase inhibitors: Mechanism
Non selective MAO inhibition increases levels of amine neurotransmitters (NE, 5-HT, Dopamine)
Monoamine oxidase inhibitors: Uses
Atypical depression, anxiety, Hypochondriasis
Monoamine oxidase inhibitors: Toxicity
HTN crisis (eat tyramine get increased HTN);
CNS stimulation;
Contraindicated with SSRIs, TCAs, St. John’s wort, meperidine, and dextromethorphane (to prevent serotonin syndrome)
Bupropion
Atypical Antidepressant;
Also used for smoking cessation;
increased NE and dopamine via reuptake inhibition;
toxicity is stimulant effects (insomnia, tachycardia), headache, seizure in bulimic patients;
no sexual side effects
Mirtazapine
Atypical Antidepressant;
alpha2-antagonist (increased release of NE and 5-HT) and potent 5-HT2 and 5-HT3 receptor antagonist;
toxicity is sedation (may be wanted), increased appetite, weight gain (which may be wanted in elderly or anorexic patients), dry mouth
Trazodone
Atypical Antidepressant;
Primarily blocks 5-HT2 and alpha 1 adrenergic receptor;
used primarily for insomnia, as high doses are needed for antidepressant effects;
toxicity: sedation, nausea, priapism, postural hypotensionl
trazoBONE due to male-specific side effects
