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*First Aid in Brainscape* > Steve Prefontaine's Psychiatry Run-Through > Flashcards

Steve Prefontaine's Psychiatry Run-Through Flashcards

1
Q

Classical conditioning

A

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

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2
Q

Operant conditioning

A

Learning in which a particular action is elicited because it produces a punishment or reward;
usually deals with voluntary response

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3
Q

Operant conditioning: Positive reinforcement

A

Desired reward produces action (mouse presses button to get food)

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4
Q

Operant conditioning: Negative reinforcement

A

Target behavior (Response) is followed by removal of aversive stimulus (mouse presses button to turn off continuous loud noise)

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5
Q

Operant conditioning: punishment

A

Repeated application of aversive stimulus extinguishes unwanted behavior

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6
Q

Operant conditioning: extinction

A

discontinuation of reinforcement (+ or -) eventually eliminates behavior;
can occur in operant or classical conditioning

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7
Q

Transference

A

Patient projects feelings about formative or other important persons onto physician (e.g. psychiatrist is seen as parent)

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8
Q

Countertransference

A

Doctor projects feeling about formative or other important persons onto patient (e.g. patient reminds physician of younger sibling)

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9
Q

Dissociation

A

Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress;
Example would be multiple personality disorder

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10
Q

Displacement

A

Transferring avoided ideas and feelings to some neutral person or object (vs. projection);
e.g. Mother yells at child because husband yelled at her

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11
Q

Fixation

A

Partially remaining at a more childish level of development;

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12
Q

Identification

A

Modeling behavior after another person who is more powerful;

e.g. abused child identifies with an abuser

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13
Q

Isolation

A

Separating feelings from ideas and events;

e.g. describing murder in graphic detail without emotional response

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14
Q

Projection

A

Attributing an unacceptable internal impulse to an external source;
e.g. a man who wants another woman thinks his wife is cheating on him

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15
Q

Reaction formation

A

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

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16
Q

Repression

A

Involuntary withholding an idea or feeling from conscious awareness

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17
Q

Splitting

A

Believing that people are either all good or all bad at different times due to intolerance of ambiguity;
commonly seen in borderline personality disorder

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18
Q

Sublimation

A

Replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one’s value system

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19
Q

Suppression

A

Intentional withholding of an idea or feeling from conscious awareness

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20
Q

Evidence of child abuse

A

Healed fractures on x-ray (spiral fractures are highly suggestive), burns, subdural hematomas, retinal hemorrhage or detachement;
usually biological mother

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21
Q

Attention-deficit hyperactivity disorder

A

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

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22
Q

Conduct disorder

A

Repetitive and pervasive behavior violating the basic rights of others;
after age 18 many meet criteria of antisocial personality disorder

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23
Q

Oppositional defiant disorder

A

Enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms;

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24
Q

Tourette syndrome

A

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

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25
Q

Separation disorder

A

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

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26
Q

Rett disorder

A

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;

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27
Q

Neurotransmitter changes in: alzheimer disease

A

decreased ACh

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28
Q

Neurotransmitter changes in: Anxiety

A

increased NE;

decreased GABA and 5-HT;

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29
Q

Neurotransmitter changes in: Huntington disease

A

Decreased GABA, ACh;

increased Dopamine

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30
Q

Neurotransmitter changes in: Parkinson disease

A

decreased dopamine;

increased 5-HT, and ACh

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31
Q

Neurotransmitter changes in: Schizophrenia

A

increased Dopamine

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32
Q

retrograde amnesia

A

inability to remember things that occurred before a CNS insult

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33
Q

Anterograde amnesia

A

Inability to remember things that occur after a CNS injury (no new memory)

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34
Q

Korsakoff amnesia

A

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

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35
Q

Dissociative amnesia

A

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)

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36
Q

Delirium

A

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

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37
Q

Dementia

A

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)

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38
Q

Psychosis

A

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

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39
Q

Hallucinations

A

Perception in the absence of external stimuli (e.g. seeing a light that is not actually there)

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40
Q

Delusions

A

Unique, false beliefs about oneself or others that persist despite the facts (thinking aliens are communicating with you)

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41
Q

Disorganized speech with psychosis

A

Words and ideas are strung together based on sounds, puns, or loose associations

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42
Q

Visual hallucinations

A

More commonly a feature of a medical illness (drug intoxication) than a psychiatric illness

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43
Q

Auditory hallucinations

A

More commonly a feature of psychiatric illness (schizophrenia) than medical illness

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44
Q

Olfactory hallucinations

A

Often occur as an aura of psychomotor epilepsy and in brain tumors;

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45
Q

Hypnagogic

A

occurs when GOing to sleep

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46
Q

Hypnopompic

A

occurs while waking from sleep (POMPous when awakening)

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47
Q

Schizophrenia

A

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

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48
Q

Brief psychotic disorder

A

Schizophrenia for less than 1 month;

usually due to stress

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49
Q

Schizophreniform disorder

A

Schizophrenia for 1-6 months

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50
Q

Schizoaffective disorder

A 
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)
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51
Q

Delusional disorder

A

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

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52
Q

Dissociative identity disorder

A

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

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53
Q

Depersonalization/derealization disorder

A

Persistent feeling of detachment or estrangement from one’s own body, thoughts, perceptions, and actions (depersonalization) or one’s environment (derealization)

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54
Q

mood disorder

A

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

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55
Q

Manic episode

A

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

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56
Q

Hypomanic episode

A 
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
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57
Q

Bipolar disorder I

A

defined by the presence of at least 1 manic episode with or without hypomanic or depressive episode;

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58
Q

Bipolar disorder II

A

presence of a hypomanic and depressive state

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59
Q

Bipolar in general

A

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

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60
Q

Cyclothymic disorder

A

Dysthymia and hypomania;

milder form of bipolar disorder lasting at least 2 years

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61
Q

Major depressive disorder

A

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

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62
Q

Persistant depressive disorder (dysthymia)

A

depression, often milder, lasting at least 2 years

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63
Q

Seasonal affective disorder

A

Symptoms in winter season;

improves with full spectrum bright light exposure

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64
Q

Maternal postpartum blues

A

50-85% incidence rate;
depressed affect, tearfulness, and fatigue starting 2-3 days after delivery;
Usually resolves within 10 days;
treatment is supportive;

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65
Q

Postpartum depression

A

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

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66
Q

Postpartum psychosis

A

.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

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67
Q

Pathologic grief

A

normal bereavement characterized by shock, denial, guilt and somatic symptoms;
can last 6-12 months;
may experience depressive symptoms, delusions, and hallucinations

68
Q

Electroconvulsive therapy

A

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

69
Q

Panic disorder

A

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

70
Q

Social anxiety disorder

A

Exaggerated fear of embarrassment in social situations;

Treat with SSRIs

71
Q

Agoraphobia

A

Exaggerated fear of open or enclosed places, using public transportation, being in line or in crowds, or leaving home alone

72
Q

Generalized anxiety disorder

A

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

73
Q

Adjustment disorder

A

Emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (divorce, illness) and lasting 6 months in presence of chronic stressor)

74
Q

Obsessive compulsive

A

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

75
Q

Body dysmorphic disorder

A

Preoccupation with minor or imagined defect in appearance, leading to significant emotional distress or impaired functioning;
patients often repeatedly seek cosmetic surgery

76
Q

PTSD

A

Persistent re-experiencing of a previous traumatic event;
lasts longer that 1 month;
treat with psychotherapy, SSRIs

77
Q

Acute distress disorder

A

PTSD lasting between 3 days and one month

78
Q

Malingering

A

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)

79
Q

Factitious disorders

A

patient consciously creates physical and/or psychological symptoms in order to assume “sick role” and to get medical attention (primary gain)

80
Q

Munchausen syndrome

A

Factitious disorder;
Chronic;
predominantly physical signs and symptoms;
Characterized by a history of multiple hospital admissions and willingness to receive invasive procedures

81
Q

Munchausen syndrome by proxy

A

Factitious disorder;
when illness in child or elderly is caused by caregiver;
motivation is to assume a sick role by proxy;
form of abuse

82
Q

Somatic symptom and related disorders

A

Symptoms not intentionally produced or feigned;
Physical symptoms with no identifiable physical cause;
both illness production and motivation are unconscious drives

83
Q

Somatic symptom disorder

A

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

84
Q

Conversion disorder

A

Sudden loss of sensory or motor function (paralysis, blindness), often following an acute stressor;
patient is aware of but sometimes indifferent toward symptoms

85
Q

Illness anxiety disorder

A

AKA hypochondriasis;

preoccupation with and fear of a serious illness despite medical evaluation and reassurance

86
Q

Personality disorder

A

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)

87
Q

Cluster A Personality Disorders

A

Paranoid, Schizoid, Schizotypal;
Weird category (Accusatory, Aloof, Awkward);
Odd or eccentric;
inability to develop meaningful social relationships;
no psychosis;
genetic association with schizophrenia

88
Q

Paranoid Personality Disorder

A

Cluster A Personality Disorder;
Pervasive distrust and suspiciousness;
projection is the major defense mechanism

89
Q

Schizoid Personality Disorder

A

Cluster A Personality Disorder;
Voluntary social withdrawal, limited emotional expression, content with social isolation (vs. avoidance);
schizoiD=Distant

90
Q

Schizotypal Personality Disorder

A

Cluster A Personality Disorder;
Eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness;
schizoTypal=magical Thinking

91
Q

Cluster B Personality Disorders

A

Antisocial, Borderline, Histrionic, Narcissistic;
Wild category;
dramatic, emotional, or erratic;
genetic association with mood disorders and substance abuse;

92
Q

Antisocial Personality Disorder

A

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

93
Q

Borderline Personality Disorder

A

Cluster B Personality Disorder;
Unstable mood and interpersonal relationships, impulsiveness, self-mutilation, boredom, sense of emptiness;
females > males;
splitting is a major defense mechanism

94
Q

Histrionic Personality Disorder

A

Cluster B Personality Disorder;

Excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned with appearance

95
Q

Narcissistic Personality Disorder

A

Cluster B Personality Disorder;
Grandiosity, sense of entitlement;
lacks empathy and requires excessive admiration;
often demands the “best” and reacts to criticism with rage

96
Q

Cluster C Personality Disorder

A

Anxious or fearful;
genetic association with anxiety disorders;
Worried cluster

97
Q

Avoidant Personality Disorder

A

Cluster C Personality Disorder;
Hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others (vs. schizoid)

98
Q

Obsessive-compulsive Personality Disorder

A

Cluster C Personality Disorder;
Preoccupation with order, perfectionism, and control;
ego-syntonic- behavior consistent with one’s own beliefs and attitudes (vs. OCD)

99
Q

Dependent Personality Disorder

A

Cluster C Personality Disorder;

submissive and clinging, excessive need to be taken care of, low self-confidence

100
Q

Name the different schizo- diseases and how to differentiate them

A

Schizoid (voluntary social withdrawal, low emotion expression, happy with isolation)

101
Q

Anorexia nervosa

A

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

102
Q

Bulimia nervosa

A

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)

103
Q

Gender dysphoria

A

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

104
Q

Transsexualism

A

Desire to live as the opposite sex, often through surgery or hormone replacement;

105
Q

Transvestism

A

paraphilia, not gender dysphoria;
wearing clothes (vest) of the opposite sex;
cross-dressing

106
Q

Sexual dysfunction

A

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)

107
Q

Sleep terror disorder

A

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

108
Q

Narcolepsy

A

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)

109
Q

Substance use disorder

A

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

110
Q

Stages of change in overcoming substance addiction

A

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

111
Q

Alcohol

A

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;

112
Q

opioids

A

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

113
Q

Barbiturates

A

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

114
Q

Amphetamines

A

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

115
Q

Cocaine

A

Stimulant, impaired judgement, pupillary dilation, hallucinations, paranoid ideations, angina, sudden cardiac death;
treat with benzodiazepines;
withdrawal causes hypersomnolence, malaise, severe psychological craving, depression/suicidality

116
Q

Nicotine

A

Stimulant, causes restlessness;
withdrawal causes irritability, anxiety, craving;
treat with nicotine replacement, bupropion or varenicline

117
Q

PCP

A

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

118
Q

LSD

A

Hallucinogen, causes perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks

119
Q

Marijuana

A

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

120
Q

Heroin addiction are increased risk for

A

Hepatitis, abcesses, overdose, hemorrhoids, AIDS, and right sided endocarditis;
look for track marks;

121
Q

Heroin treatment

A

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

122
Q

Signs and treatment of alcoholism

A

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

123
Q

Wernicke-Korsakoff syndrome

A

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

124
Q

Mallory-Weiss

A

longitudinal partial thickness tear at the GE junction caused by excessive vomiting;
often presents with hematemesis;
associated with pain (esophageal varices are usually painless)

125
Q

Delirium Tremors (DTs)

A

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

126
Q

Treatment for: ADHD

A

methylphenidate

127
Q

Treatment for: Alcohol withdrawal

A

benzodiazepines (-zepam)

128
Q

Treatment for: anxiety

A

SSRIs, SNRIs, buspirone

129
Q

Treatment for: bipolar

A

mood stabilizers (lithium, valproic acid, carbamazepine), atypical antipsychotics

130
Q

Treatment for: Bulimia

A

SSRIs

131
Q

Treatment for: Depression

A

SSRIs, SNRIs, TCAs, bupropion, mirtazapine (especially with insomnia)

132
Q

Treatment for: Obsessive-compulsive disorder

A

SSRIs, clomipramine

133
Q

Treatment for: Panic disorder

A

SSRIs, venlafaxine, benzodiazepines

134
Q

Treatment for: PTSD

A

SSRIs

135
Q

Treatment for: Schizophrenia

A

Antipsychotics

136
Q

Treatment for: Social phobias

A

SSRIs, beta-blockers

137
Q

Treatment for: Tourette syndrome

A

Antipsychotics (eg. haloperidol, risperidone)

138
Q

CNS stimulants: names, mechanism, use

A

names: methylphenidate, dextroamphetamine, methamphetamine, phetermine;
Mechanism: increase catecholamines at synaptic cleft, especially NE and dopamine;
Use: ADHD, narcolepsy, appetite control

139
Q

Antipsychotics (neuroleptics): name them

A

Haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine, (haloperidol + azines)

140
Q

Antipsychotics (neuroleptics): Uses

A

Schizophrenia (primary positive symptoms);

psychosis, acute mania, tourette syndrome

141
Q

Antipsychotics (neuroleptics): Toxicity

A

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

142
Q

Antipsychotics (neuroleptics): Neuroleptic malignant syndrome

A

Side effect;
Rigidity, myoglobinuria, autonomic instability, hyperpyrexia;
treat: dantrolene, D2 agonists (bromocriptine);
Think FEVER: Fever, Encephalopathy, Vitals unstable, Enzymes increased, Rigidity of muscles

143
Q

Antipsychotics (neuroleptics): Tardive dyskinesia

A

Side effect;
Stereotypical oral-facial movements as a result of long-term antipsychotic use;
potentially irreversible

144
Q

Antipsychotics (neuroleptics): Potency of meds

A

High potency: Try to Fly High, Trifluoperazine, Fluphenazine, Haloperidol;
Low potency: Cheating Thieves are Low, Chlorpromazine, Thioridazine;

145
Q

Antipsychotics (neuroleptics): Chlorpromazine side effect

A

Corneal deposits;

146
Q

Antipsychotics (neuroleptics): Thioridazine side effect

A

reTinal deposits

147
Q

Atypical Antipsychotics: names

A

Olanzapine, Clozapine, quetiapine, risperidone, aripiprazole, ziprasidone;
its’s ATYPCIAL for OLd, CLOSets to QUIETly, RISPER from A to Z

148
Q

Atypical Antipsychotics: mechanism

A

not understood;

varied effect on 5-HT2, Dopamine, and alpha and H1 receptors;

149
Q

Atypical Antipsychotics: Use

A

Schizophrenia- both positive and negative symptoms;

also used for bipolar disorder, OCD, anxiety, depression, mania, Tourette syndrome

150
Q

Atypical Antipsychotics: Toxicity

A

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

151
Q

Lithium

A

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

152
Q

Buspirone

A

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

153
Q

SSRIs: Names

A

Fluoxetine, paroxetine, sertraline, citalopram;

154
Q

SSRIs: Mechanism and uses

A

mechanism: 5-HT specific reuptake inhibitor, takes 4-8 weeks to work;
Uses: depression, generalized anxiety, panic disorder, OCD, bulimia, social phobias, PTSD;

155
Q

SSRIs: Toxicity

A

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)

156
Q

SNRIs

A

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

157
Q

Tricyclic antidepressants: names

A

Amitryptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine (all TCAs end in -iptyline or -ipramine except doxepin and amoxapine)

158
Q

Tricyclic antidepressants: Mechanism

A

block NE and 5-HT reuptake

159
Q

Tricyclic antidepressants: Uses

A

major depression, OCD (clomipramine), fibromyalgia

160
Q

Tricyclic antidepressants: Toxicity

A

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

161
Q

Monoamine oxidase inhibitors: names

A

Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor);
MAO Takes Pride In Shanghai

162
Q

Monoamine oxidase inhibitors: Mechanism

A

Non selective MAO inhibition increases levels of amine neurotransmitters (NE, 5-HT, Dopamine)

163
Q

Monoamine oxidase inhibitors: Uses

A

Atypical depression, anxiety, Hypochondriasis

164
Q

Monoamine oxidase inhibitors: Toxicity

A

HTN crisis (eat tyramine get increased HTN);
CNS stimulation;
Contraindicated with SSRIs, TCAs, St. John’s wort, meperidine, and dextromethorphane (to prevent serotonin syndrome)

165
Q

Bupropion

A

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

166
Q

Mirtazapine

A

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

167
Q

Trazodone

A

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

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