Test 4 - Psychiatry, Behavioral Science Flashcards
What is it called when a person is lip-smacking or constantly swallowing during a seizure? In what types of seizures is this seen in?
Automatism
seen in complex (awareness-impaired) seizures
Seizures that involve the _________ lobe are often preceded by an olfactory aura because…?
temporal lobe because the primary olfactory cortex is located in the uncus of the temporal lobe
Antiepileptic pharmacotherapy is indicated if a clinician determines that a patient’s risk of having another seizure is ____% or greater.
60%
Describe the steps for treating a patient presenting w/ status epilepticus.
1st: ABCs (airway/breathing, circulatory), body temp., O2 sats, blood glucose
2nd: get IV placed and give thiamine + glucose + Lorazepam
3rd: start Phenytoin
What anti-epileptic drug is most commonly used in the pediatric population?
Phenobarbital
(see jackhammer cats)
Name 4 drugs that can be used to treat both focal and generalized seizures.
Topiramate, valproate, lamotrigine, levatiracetam
Name four side effects of valproate.
- Hepatotoxicity (can be fatal - seen in children more often)
- Teratogenic (neural tube defects)
- Acute pancreatitis
- Tremor
What are the main indications for phenytoin use? What are the side effects?
Focal seizures, status epilepticus
Side effects:
Nystagmus and diplopia
Ataxia
Decreased bone density
Stevens-Johnson Syndrome (esp. in HLA-B1502 Asians)
DRESS syndrome
Teratogenic (cleft palate)
Folate deficiency -> megaloblastic anemia
Drug-induced lupus
Gingival hyperplasia
What are the main indications for carbamazepine use? What are the side effects?
Focal seizures (partial epilepsy)
Side effects:
SIADH -> hyponatremia
Teratogenic -> neural tube defects
Agranulocytosis
DRESS syndrome
Ataxia
Diplopia
SJS esp. in HLA-B1502
What are the side effects of Lamotrigine?
SJS, diplopia, interactions with CYP450 inducers like valproate
What is the best drug for generalized absence seizures? What are its side effects?
Ethosuximide
Side effects: lethargy/fatigue, GI distress
Which dopamine pathway is involved in the manifestation of the positive symptoms of schizophrenia?
Mesolimbic dopamine system (increased dopamine causes the positive symptoms)
Which dopamine pathway is involved in the manifestation of the negative symptoms of schizophrenia?
Mesocortical (less dopamine in psychosis)
How is the niagrostriatal pathway affected in schizophrenia? How do antipsychotics affect this pathway?
Niagrostriatal pathway is involved in motor function (direct, indirect pathways) and is not affected in schizophrenia.
Antipsychotics block the D2 pathway, which turns on the sub-thalamic nucleus –> inhibition of cortical activity.
How is the tuberoinfundibular pathway affected in schizophrenia? How do antipsychotics affect this pathway?
Tuberoinfundibular pathway regulates prolactin secretion (via dopamine), antipsychotics block dopamine –> increased prolactin
What symptoms are catatonia characterized by? In what psychiatric conditions is it seen in? How is it treated?
Catalepsy (muscle rigidity; waxy flexibility)
Mutism
Echolalia (mimics what people say)
Negativism (resistance to do shit)
Echopraxia (mimics what people do)
Seen in schizophrenia (most commonly) and MDD
Tx: benzodiazepines like lorazepam and electroconvulsive therapy (ECT)
Does clonidine treat Tourette’s/tics?
Yeah (puppet at the bottom)
What is the adult version of conduct disorder?
Antisocial disorder
antisocial = sociopath
Which two drugs/drug types can treat PTSD?
SNRIs/SSRIs and Prazosin (alpha-1 antagonist)
Dude on stage w/ dog tags
What drugs treat acute panic disorder and chronic panic disorder, respectively?
Benzodiazepines for acute panics
SSRIs/SNRIs for chronic panic disorder
Name three drugs that can treat trichotillomania.
Olanzapine, n-acetylcysteine, and naltrexone (all off label)
Which benzo has a quick onset and short duration?
Alprazolam
What non-pharmacologic treatment is used for specific phobia?
Flooding
What non-pharmacologic treatment is used for PTSD?
Prolonged exposure
What non-pharmacologic treatment is used for OCD?
Exposure and response prevention
What non-pharmacologic treatment is used for panic disorder?
CBT
Compare and contrast facticious disorder from malingering.
Facticious disorder is when someone falsifies disease for primary gain (likes being cared for/being a patient)
Malingering is when someone fakes an illness for the purposes of external gain
Bruxism is most commonly seen in ________ intoxication.
Ecstasy (MDMA)
Which benzos are best for treating alcohol withdrawals in a patient with normal liver function? Why?
Chlordiazepoxide and Diazepam cuz they have long half-lives
Name three drugs and their MOAs that can be used for prevention of alcohol abuse relapse.
Disulfiram (aldehyde DH inhibitor)
Acamproasate (GABA agonist)
Naltrexone (mu antagonist that decreases cravings/reward)
Name the cluster A personality disorders
Paranoid
Schizoid
Schizotypal
Name the cluster B personality disorders
Narcissistic
Borderline
Antisocial
Histrionic
Name the cluster C personality disorders
Avoidant
Dependent
Obsessive-compulsive
Name the personality disorder:
Suspicious/mistrusting of others
Frequent hostility
Paranoid PD
Name the personality disorder:
Detachment from social relationships
Restrictive affective range (blunted emotions)
Schizoid PD
Name the personality disorder:
Odd, eccentric beliefs and behaviors
Magical thinking
Schizotypal PD
Name the personality disorder:
Grandiosity, inflated self-importance
Entitled, needs admiration
Narcissistic PD
Name the personality disorder and how is it treated:
Unstable mood and relationships
Self-mutilation
Suicidality
Borderline personality disorder
Treat with dialectical behavioral therapy (DBT)
Name the personality disorder:
Disregard for/violation of others’ rights w/ no remorse
Charming and manipulative
Antisocial PD
Name the personality disorder:
Excessive but superficial emotions
Attention seeking
Seductive/provocative
Histrionic PD
Name the personality disorder:
Extreme fear of rejection
No friendships despite a strong desire for them
Avoidant PD
Name the personality disorder:
Excessive need to be cared for
Passivity
Intense self-doubt; difficulty with decision making on their own
Dependent PD
Name the personality disorder:
Overly preoccupied with rules and organization
Likes the shit out of lists
Obsessive-compulsive PD
Name three treatments for neurocognitive disorders and the MOAs.
Donepezil - acetylcholinesterase inhibitor
Tacrine - acetylcholinesterase inhibitor
Memantine - NMDA antagonist
What are the treatments for binge-eating disorder?
SSRIs, CBT, lisdexamfetamine
What is the treatment for bulimia nervosa?
Fluoxetine (SSRI), CBT
What is the treatment for anorexia nervosa?
Weight restoration and family therapy
Fill it in
After treatment with a 1st gen antipsychotic, someone becomes rigid, febrile, confused, and has unstable vitals. U check CK and its high. What is the Dx? What is the treatment?
NMS
Treat with bromocriptine (D2 agonist) or dantrolene (ryanodine receptor antagonist decreases muscle contraction)
Name the atypical antipsychotics that have the fewest metabolic side effects.
Risperidone, ziprasidone, aripiprazole
Which atypical antipsychotic has the fewest extrapyramidal side effects?
Aripiprazole
