Westchester Flashcards
What is the center for the subcortical primary affects (Panksepp’s basic feelings), particularly the NEGATIVE ones like fear, rage and grief?
Periacqueductal gray
In Borderline Personality Disorder, the amygdala is (larger/smaller) volume than normal and has exaggerated reactivity.
smaller
What is the word for “requires increasing dosages to get an effect”?
tachyphylaxis
What are black box warnings associated with clozapine?
Which is the only one that is dose dependent?
1) agranulocytosis
2) myocarditis
3) seizure (the only one that is dose dependent; >900 mg)
4) cardiovascular collapse (esp. when used with a benzo)
5) hypersalivation/aspiration pneumonia
What are the Frontal Lobe Functions?
SOAP
sequencing, organizing, abstracting, planning
For which pathologies is ECT a treatment?
1) depression (postpartum, persistence of suicidality in the light of treatment resistance)
2) mania
3) schizophrenia (but not as good for that)
What are side effects of ECT? What are absolute contraindications?
Rare: headache, some memory loss.
There are no absolute contraindications (pregnancy, anorexia, etc. ok). But use a LOW dose of antiseizure meds and use it AFTER the ECT, not before. Also: space-occupying lesions; MI within 3 months
Which antipsychotics should be used in Parkinson’s patients?
Those that are less dopamine-blocking, like:
1) quetiapine
2) clozapine
Which atypical antipsychotic is most associated with weight neutrality?
ziprasidone
Compare typical and atypical antipsychotics.
Typical antipsychotics are:
1) associated with more EPS
2) more galactorrhea (with the exception of risperidone)
3) more tardive dyskinesia
4) more NMS
5) more D2 blockade as mechanism
Typical antipsychotics are more associated with galactorrhea than atypical antipsychotics, with the exception of
risperidone
Clozapine
atypical antipsychotic: weekly CBCs (risk of agranulocytosis) anticholinergic (as much as antitryptiline) orthostatic hypotension myoclonic jerking seizures at doses >900 mg myocarditis significant weight gain NO stiffness of EPS treatment-refractory patients
olanzapine (Zyprexa)
SIGNIFICANT weight gain
metabolic syndrome –> diabetes (must test fasting glucose/lipid level, BMI, waist circumference)
quetiapine (Seroquel)
LEAST likely to cause EPS (less dopamine blockade; use in Parkinson’s)
used in bipolar depression and bipolar mania
sedative
aripiprazole (Abilify)
dopamine partial agonist/antagonist (as a low dose it is an agonist and used in depression)
VERY long half life (75-150h)
ziprasidone
most weight neutral
metabolized by cytochrome P450 3a4
prolongation of QT = risk for Torsades
SHORT half life (BID drug)
How do you treat akisthisa?
propanolol (or other beta blockers)
benzos
What are suicide risk factors?
prior attempts (BIGGEST risk factor) FH 60 high/drunk psychiatric disease stressors Native Americans hoplessness anxiety akisthisia command hallucinations
How do you treat a dystonic reaction and why does it work?
INTRAMUSCULAR cogentin (benztropine) or benadryl These are ACh blockers. Dystonic reactions are caused by a relative increase in NE over DA
How do you treat tardive dyskinesia?
1) stop the medications
2) vitamin E?
NOTE: tardive dyskinesia may be permanent
Postpartum psychosis is associated with which psychiatric disorder?
Bipolar
What are the psychiatric symptoms associated with suicide?
1) hopelessness
2) impulsivity/aggression
3) anxiety/akasthisia
4) command hallucinations
What are the only 2 medications that provide protection against suicide?
1) lithium
2) clozapine
Name 3 drugs that can augment antidepressants
1) aripiprazole
2) quetiapine
3) lithium
Antidepressants can increase suicidality in people up to age __
24
