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FA Psychiatry
First Aid Psychiatry
| Question | Answer |
|---|---|
| DOC to treat EPS produced by neuroleptics | Benztropine |
| TCA & low-potency antipsychotic sfx | HAM: anti-Histamine (sedation, weight gain), anti-Adrenergic (hypotension), anti-Muscarinic (dry mouth, blurred vision, urinary retention) |
| Initial: lethargy, restless, confusion, flushing, diaphoresis, tremor, myoclonic jerks; Progression: hyperthermia, hypertonicity, rhabdomyolysis, renal failure, convulsions, coma, death | Serotonin syndrome, often d/t SSRI + MAOI |
| Hypertensive crisis | Buildup of stored catecholamines, usu d/t MAOI + tyramine or sympathomimetics |
| Grimacing, tongue protrusion; choreoathetoid muscle movements (mouth, tongue) | Tardive dyskinesia; occurs YEARS after high-potency typical neuroleptics (>6mo); can be irreversible; usu older women; 50% spontaneously remit; d/c neuroleptic tx & change to med w/ less risk of TD |
| Twisting, abnormal postures, sustained painful contraction of muscles of neck (torticollis), tongue, eyes (oculogyric crisis), diaphragm (life-threatening) | Acute dystonia (EPS) |
| Inability to sit still, restlessness & agitation, subjective anxiety, objective fidgeting | Akathisia (EPS) |
| Decreased/slow body movement | Bradykinesia |
| Bradykinesia, masklike face, cogwheel rigidity, pill-rolling tremor | Parkinsonism (EPS) |
| Extrapyramidal side effects | High-potency traditional antipsychotics; reversible; occur w/in DAYS of starting medications; can be life-threatening (ex. dystonia of diaphragm-->asphyxiation) |
| Hyperprolactinemia sfx of... | High-potency typical antipsychotics & risperidone |
| Fever, Autonomic instability (tachycardia, labile hypertension, diaphoresis), Leukocytosis, Tremor, Elevated creatine phosphokinase, Rigidity (lead pipe), Excessive sweating, Delirium | Neuroleptic Malignant Syndrome; d/t any antipsychotic after short or long time (esp high-potency traditionals); 20% mortality; young male; tx: d/c meds & admin cooling; pt CAN re-start med later |
| Smoking induces CYP... | A12 |
| Carbamazepine induces CYP... | A12, 2C9, 3A4 |
| Barbiturates induce CYP... | 2C9 |
| St. John's Wort induces CYP... | 2C19, 3A4 |
| Fluvoxamine inhibits CYP... | 1A2, 2D6, 3A4 |
| Fluoxetine inhibits CYP... | 2C19, 2C9, 2D6 |
| Paroxetine inhibits CYP... | 2D6 |
| Duloxetine inhibits CYP... | 2D6 |
| Sertraline inhibits CYP... | 2C19 |
| Alzheimer's can be exacerbated by... | Anticholinergic drugs |
| SSRI mechanism of action | Inhibit presynaptic serotonin pumps that take up serotonin-->increased serotonin availability in synaptic clefts |
| Fluoxetine (Prozac) | SSRI, longest t1/2 w/ active metabolites & no need to taper; safe in pregnancy & kids; more common sleep changes & anxiety; can INCREASE levels of neuroleptics-->sfx |
| Sertraline (Zoloft) | SSRI; highest risk of GI disturbance; more common sleep changes |
| Paroxetine (Paxil) | SSRI; highly protein bound--> many drug intrxns; more anticholinergic sfx (sedation, constipation, wt gain); short t1/2-->w/drawal phenomena |
| Fluvoxamine (Luvox) | SSRI; approved only for OCD tx; N/V common; many drug intrxns |
| Citalopram (Celexa) | SSRI; fewest drug intrxns; poss fewer sexual sfx |
| Escitalopram (Lexapro) | SSRI; similar efficacy, fewer sfx than Celexa; expensive |
| Tx'ing sexual sfx of SSRI | Augment regimen w/ buproprion (DA part restores sexual fxn), change to non-SSRI, or add sildenafil (for men) |
| Black Box warning for all SSRIs | Increased suicidal thinking & behavior; most documented in children & adolescents |
| SSRI sfx | Sexual dysfxn (25-30%), GI disturbance (N/V/D), insomnia, vivid dreams, HA, anorexia, restlessness (esp at initiation & termination), seizures (.2%); can INCREASE WARFARIN LVLS |
| Velnafaxine (Effexor) | SNRI; Tx: depression, anxiety, ADHD; low drug intrxn; sfx similar to SSRI; can incr BP |
| Desvenlafaxine (Pristiq) | SNRI, active metabolite of venlafaxine |
| Duloxetine (Cymbalta) | SNRI; Tx: depression & neuropathic pain, fibromyalgia; sfx similar to SSRI + dry mouth & constipation (NEpi fx); incr liver sfx in pts w/ hepatic dz or EtOH abuse |
| Bupropion (Wellbutrin) | NE, DA, 5-HT RI; Tx: depression (esp atypical--decr appetite & sleep) ADHD, smoking cessation; exacerbates anxiety; less sexual sfx than SSRIs; incr seizures & psychosis at high dose; contraindicated in pts w/ seizures, eating disorders, taking MAOIs |
| Trazodone (Desyrel) | Serotonin Receptor Antagonist & Agonist; Tx: refractory major depression, major depression w/ anxiety, insomnia (2/2 sedation); no sexual sfx, do not affect REM; sfx: nausea, dizziness, orthostatic hypoTN, arrhythmias, sedation, priapism |
| Nefazodone (Serzone) | Serotonin Receptor Antagonist & Agonist; similar to trazodone in sfx & tx; Black Box Warning--rare but serious liver failure |
| Mirtazapine (Remeron) | a2-Adrenergic Receptor Antagonist; Tx: refractory major depression, esp in pts who need to gain weight; sfx: sedation, wt gain, dizziness, somnolence, tremor, dry mouth, constipation, rare agranulocytosis |
| Heterocyclic Antidepressants--mechanism of action | Inhibit reuptake of NEpi & 5-HT, incr availability of monoamines in synapse; can be lethal in OD |
| Tertiary Amine TCAs | Highly anticholinergic (block M1R), sedating (block H1R), lethality in OD (cardiotoxic), orthostatic hypotension (block a1-Rs); Amitriptyline, Imipramine, Clomipramine, Doxepin |
| Amitriptyline (Elavil) | Tertiary TCA: tx chronic pain, migraines, insomnia, peripheral neuropathy |
| Imipramine (Tofranil) | Tertiary TCA: tx enuresis, panic disorder; has IM form |
| Clomipramine (Anafranil) | Tertiary TCA: tx OCD, most serotonin-specific |
| Doxepin (Sinequan) | Tertiary TCA: tx chronic pain; sleep aid low doses |
| Secondary Amine TCAs | Metabolites of tertiaries, less anticholinergic, less sedating; Types: Nortriptyline, Desipramine |
| Nortriptyline (Pamelor, Aventyl) | Secondary Amine TCA: least likely to cause orthostatic hypotn; can check therapeutic blood levels; Tx: chronic pain |
| Desipramine (Norpramin) | Secondary Amine TCA; more activating, less sedating; least anticholinergic |
| Tx of TCA OD | IV Sodium Bicarbonate |
| Amoxapine (Asendin) | Tetracyclic Antidepressant: metabolite of antipsychotic Loxaine; may cause EPS; similar sfx to typical antipsychotics |
| Maprotiline (Ludiomil) | Tetracyclic Antidepressant; higher rate of seizure, arrhythmia, & fatality on OD |
| TCA interxn w/ other meds (general) | Highly protein bound & lipid soluble & can interact w/ other meds w/ high protein-binding |
| TCA anti-histaminergic sfx | Sedation |
| TCA anti-adrenergic sfx | Cardiovascular--orthostatic hypotension, dizziness, reflex tachycardia, arrhythmias, EKG changes (widening QRS, QT, PR intervals); avoid in pts w/ pre-existing conduction abnormalities or recent MI |
| TCA antimuscarinic (anticholinergic) sfx | Dry mouth, constipation, urinary retention, blurry vision, tachycardia, exacerbation of narrow-angle glaucoma |
| Signs of TCA OD | Agitation, tremors, ataxia, delirium, hypoventilation from CNS depression, myoclonus, hyperreflexia, seizures, coma |
| TCAs & seizures | .3% of pts have seizures; more common at higher plasma levels & w/ clomipramine & tetracyclics |
| TCA serotonergic sfx | Erectile/ejaculatory dysfxn in males; anorgasmia in females |
| MAO-I mechanism of action | Prevent inactivation of biogenic amines (NEpi, 5-HT, DA, tyramine); irreversibly inhibit MAO-A & MAO-B incr NTs in synapses |
| MAO-A specific mechanism | Preferentially deactivates 5-HT; also acts on DA & tyramine |
| MAO-B specific mechanism | Preferentially deactivates NEpi/Epi; also acts on DA & tyramine |
| MAO-I use | Effective for certain types of refractory depression & refractory panic/anxiety disorder; not first line for depression d/t sfx |
| Phenelzine (Nardil); Tranylcypromine (Parnate); Isocarboxazid (Marplan) | MAO-I's |
| MAO-I side effects | Serotonin syndrome; hypertensive crisis; orthostatic hypotn, drowsiness, wt gain, sexual dysfxn, dry mouth, sleep dysfxn, parasthesias w/ concurrent pyridoxine deficiency (tx w/ B6), liver tox, seizure, edema |
| Tyramine + MAOI | Buildup catecholamines-->elevated BP, HA, sweating, N/V, photophobia, autonomic instability, chest pain, arrhythmias, death |
| Major sfx of clozapine | Agranulocytosis--check WBC weekly for 6 months after initiation |
| Labs to monitor in lithium therapy | Lithium levels, creatinine, thyroid hormone |
| Antidepressant tx of OCD | SSRIs (high dose), clomipramine (TCA) |
| Antidepressant tx of panic disorder | SSRIs, imipramine (TCA), MAO-I |
| Antidepressant tx of eating disorder | SSRI (high dose), TCA, MAO-I |
| Antidepressant tx of dysthymia | SSRI |
| Antidepressant tx of social phobia | SSRI, TCA, MAO-I |
| Antidepressant tx of GAD | SSRI, venlafaxine (SNRI), TCA |
| Antidepressant tx of PTSD | SSRI |
| Antidepressant tx of IBS | SSRI, TCA |
| Antidepressant tx of enuresis | Imipramine (TCA) |
| Antidepressant tx of neuropathic pain | Amitryptiline, nortriptyline (TCAs), Duloxetine (SNRI) |
| Antidepressant tx of chronic pain | SSRIs, TCAs |
| Antidepressant tx of fibromyalgia | SSRIs |
| Antidepressant tx of migraines | Amitryptiline (TCA), SSRI |
| Antidepressant use for smoking cessation | Buproprion (NDRI) |
| Antidepressant tx of premenstrual dysphoric disorder | SSRI |
| Antidepresant tx of depressive phase of bipolar | SSRI |
| Antidepressant tx of insomnia | Mirtazapine (a2R antagonist), Amitryptiline (TCA) |
| Atypical antipsychotics used to tx dementia & delirium in elderly--> | Increased risk of all-cause mortality & stroke |
| Typical antipsychotic method of action | Block D2 receptors |
| Atypical/2nd generation antipsychotics method of action | Block D2R and serotonin 2A receptors |
| Typical vs atypical antipsychotic efficacy in tx'ing presence of positive psychotic sx (hallucinations, delusions) | EQUAL efficacy |
| Typical vs atypical antipsychotic efficacy in tx'ing presence of negative psychotic sx (flattened affect, social withdrawal) | Atypicals more efficacious |
| Low potency typical antipsychotics | Chlorpromazine, Thioridazine; lower affinity for D2Rs; higher incidence of anticholinergic & antihistaminergic sfx; lower incidence of EPS & NMS; more lethality d/t QTc prolongation, potential for heart block, & ventricular tachycardia; higher risk of sz |
| Chlorpromazine (Thorazine) | Low-potency typical antipsychotic; can cause orthostatic hypotension, blue skin discoloration, photosensitivity, corneal & lens deposits; also used to tx N/V & hiccups |
| Thioridazine (Mellaril) | Low-potency typical antipsychotic; sfx include retinitis pigmentosa |
| Mid-potency typical antipsychotics | Loxapine, Thiothixene, Trifluoperazine, Perphenazine |
| Loxapine (Loxitane) | Mid-potency typical antipsychotic; higher risk of seizure; metabolite is an antidepressant |
| Thiothixene (Navane) | Mid-potency typical antipsychotic; can cause ocular pigment changes |
| Trifluoperazine (Stelazine) | Mid-potency typical antipsychotic; can reduce anxiety |
| High potency typical antipsychotics | Haloperidol, Fluphenazine, Pimozide; greater affinity for D2Rs, cause less sedation, orthohypotn, & anticholinergic fx; greater risk for EPS & tardive dyskinesia; can be given IM to tx acute psychosis & agitation |
| Haloperidol (Haldol) | High-potency typical antipsychotic; injectable form available |
| Fluphenazine (Prolixin) | High-potency typical antipsychotic; injectable form available |
| Pimozide (Orap) | High-potency typical antipsychotic; assoc w/ heart block, ventricular tachycardia, & other cardiac fx |
| Positive sx of schizophrenia thought to be treated by actions of medications on... | Mesolimbic dopamine pathway (nucleus accumbens, fornix, amygdala, hippocampus) |
| Negative sx of schizophrenia thought to be treated by actions of medications on... | DA action in mesocortical pathway |
| Extrapyramidal sfx of typical neuroleptics are thought to be d/to | DA pathways in nigrostriatum |
| Increased prolactin levels d/t typical neuroleptics are related to... | DA action in tuberoinfundibular area |
| Anti-dopaminergic fx of typical neuroleptics | EPS, Hyperprolactinemia |
| Extrapyramidal symptoms | Parkinsonism, Akathisia, Dystonia |
| Hyperprolactinemia can lead to | Decreased libido, galactorrhea, gynecomastia, impotence, amehorrhea, osteoporosis |
| Anti-HAM effects of typical neuroleptics | Histaminic (sedation, wt gain), Adrenergic a1 (orthostatic hypotension, cardiac abnormalities, sexual dysfxn), Muscarinic (anticholinergic fx--dry mouth, tachycardia, urinary retention, blurred vision, constipation, precipitation of narrow-angle glaucoma) |
| Onset of neuroleptic side effects | Acute dystonia: hrs/days; EPS/Akathisia: days/months; Tardive Dyskinesia: months/years |
| Clozapine (Clozaril) | Atypical antipsych; MORE efficacy vs typicals; tachycardia hypersaliva, most anticholinergic sfx; myocarditis; 1-2% agranulocytosis, 2-5% sz; stop if neutros drop <1500microL; DECR suicide risk; less TD; 30% of tx-resistant psychosis WILL respond |
| Risperidone (Risperdal) | Atypical antipsych; incr prolactin, orthohtn, reflex tachy; long-acting injectable form |
| Quetiapine (Seroquel) | Atypical antipsych; sedation, orthohtn |
| Olanzapine (Zyprexa) | Atypical antipsych; wt gain sfx |
| Ziprasidone (Geodon) | Atypical antipsych; LESS wt gain than others |
| Aripiprazole (Abilify) | Atypical antipsych; unique mechanism--D2 partial agonist; more activating (akathisia), less sedating; less wt gain |
| Paliperidone (Invega) | Atypical antipsych (newer); metabolite or risperidone; long-acting injectable |
| Atypical antipsychotics to tx mania | Quetiapine, olanzapine, aripiprazole, risperidone, ziprasidone |
| General sfx of atypical antipsychotics | Metabolic syndrome; anti-HAM; wt gain; HLD; hyperglycemia, DM ketoacidosis; liver fxn; QTc prolonged |
| Mood stabilizer use | Tx acute mania, prevent mania relapse(in BPD & schizoaffective), potentiate anti-d's in pts w/ MDD refractory to monotx; potentiate antipsychotics in pts w/ schizophrenia; enhance abstinence from EtOH; tx aggression & impulsivity (dementia, EtOH, MR, PDs) |
| Mood stabilizer types | Lithium; Anticonvulsants (valproate, lamotrigine, carbamazepine) |
| Blood levels are useful for... | Lithium, valproate, carbamazapine, clozapine |
| Things that affect lithium levels | Decr: NSAIDs; Incr: dehydration, salt deprivation, sweating, impaired renal fxn; ASA, thiazides |
| Lithium used to tx... | Acute mania; manic & depressive episodes of BPD & schizoaffective prophylaxis; cyclothymia; unipolar depression |
| Lithium is metabolized... | In the kidney--dosage adjust for renal dysfxn |
| Before initiating lithium, pt must have... | EKG, basic chemistries, thyroid function tests, CBC, pregnancy test |
| Onset of lithium action | 5-7 days |
| Lithium blood levels, therapeutic range | Blood levels correlate w/ clinical efficacy; check after 5d & then Q2-3d until therapeutic; therapeutic index: 0.6-1.2; toxic >1.5, lethal >2.0 |
| Sfx of Lithium | Toxic levels; AMS, coarse tremors, convulsions, death; fine tremor; nephrogenic diabetes insipidus; GI disturbance; wt gain; sedation; thyroid enlargement, hypothyroid; EKG change; benign leukocytosis; Ebstein's anomaly (babies) |
| Drug-->elevated prolactin d/t D2 receptor blockade | Risperidone |
| Drug-->cataracts, no muscarinic fx | Quetiapine |
| Drug-->retinitis pigmentosa | Thioridazine |
| Drug-->eosinophilia, decreases tardive dyskinesias, no movement disorder risk, 1% agranulocytosis risk | Clozapine |
| Drug-->weight gain, glucose issues (DMII), increased lipids | Olanzapine (Zyprexa) |
| Drug-->cholestatic jaundice, photosensitivity | Chlorpromazine |
| Drug-->prolonged QTc | Ziprasidone (Geodon) |
| Drug that is a DA receptor agonist, postsynaptic D2R partial agonist | Aripiprazole (Abilify) |
| Amantidine has no... | anticohlinergic side effects |
| Buproprion (Welbutrin) works on... | NE & DA |
| Drug-->increased appetite, sedation; a2 adrenergic antagonist | Mirtazapine (Remeron) |
| Give fluoxetine (Prozac) in... | AM (activating) |
| Give paroxetine (Paxil) in... | PM (sedating); heavy discontinuation syndrome |
| Drug-->SJS, renal AND hepatic excretion | Lamictal |
| Anti-depressant also good for pain | Duloxetine (Cymbalta) |
| Drug-->hypothyroidism, increased by NSAIDs & ACE-Is, decreases suicidality, leukocytosis, T wave flattened/inverted, Epstein's anomaly | Lithium |
| Drug for pts who don't respond to lithium; induces own metabolism (drug levels decline in 3-8 weeks); can-->aplastic anemia, agranulocytosis, elevated serum ammonia | Carbamazepine (Tegretol) |
| Drug-->thrombocytopenia, alopecia; lowest toxicity of all mood stabilizers | Depakote |
| Gabapentin (neurontin) is excreted by the... | Kidney |
| Blockade of ______ receptors-->weight gain | 5HT-2C, histamine |
| Blockade of ________ receptors-->sedation | H1 receptors |
| Blockade of _______ receptors-->orthostatic hypotension | Alpha1 adrenergic receptors |
| Treatment of neuroleptic malignant syndrome side effect | Bromocriptine + Dantrolene |
| Treatment of acute dystonia side effect | Benztropine |
| Treatment of drug-induced Parkinsonism | Benztropine (Cogentin) |
| Treatment of akathisia side effect | Propranolol |
| Lab values in NMS | Incr WBCs, CPK, LFTs |
| Pupils in people on cocaine | Mydriasis (dilated) |
| Pupils in people on opioids | Miosis (constricted) |
| Drug-->nystagmus, decreased pain sensation | PCP |
| Bereavement sx last less than _______ | 2 months |
| Acute dystonia onset is _________ after starting antipsychotics | 3-5 days |
| ECT is good for ________ patients & should be given with ______ | pregnant; succinylcholine & methohexital |
| Drug type contraindicated in narrow-angle glaucoma | anticholinergics |
| Drugs that can cause AV nodal block | Tricyclic antidepressants |
| Axis I | All psych disorders except MR & Personality Disorders |
| Axis II | MR & personality disorders |
| Axis III | Medical/physical disorders |
| Axis IV | Environmental & psychosocial problems of clinical significance |
| Axis V | GAF=clinician judgment of individual's overall level of functioning |
| Defense mechanism: attempt to return to an earlier developmental phase to avoid tension & conflict at present level of development | Regression |
| Defense mechanism: idea/feeling is expelled or withheld from consciousness | Repression |
| Defense mechanism: unconscious wish/impulse expressed through action to avoid an accompanying affect | Acting out |
| Defense mechanism: awareness of painful aspect of reality is avoided by negating sensory data | Denial |
| Defense mechanism: thought, impulse, or effect is transiently inhibited, causing tension or distress | Blocking |
| Process of adopting other people's characteristics; important w/ a parent in personality formation | Identification |
| Defense mechanism: unacceptable impulse transformed into its opposite | Reaction formation |
| Defense mechanism: emotions are shifted from one idea/object to another that resembles the original but evokes less distress | Displacement |
| Defense mechanism: explanations are offered in attempt to justify unacceptable attitudes, beliefs, or behaviors | Rationalization |
| Defense mechanism: person's character or sense of identity is temporarily but drastically modified in order to avoid emotional distress | Dissociation |
| Consistent failure to speak in a specific social situation despite speaking in other situations | Selective mutism |
| Only personality disorder requiring previous diagnosis of something | Antisocial personality disorder--requires evidence of conduct disorder before age 15 |
| Personality disorder showing reduced capacity for close relationships, eccentric behavior | Schizotypal personality disorder |
| Recurrent suicidal behavior, identity disturbance, rapid mood swings, efforts to avoid abandonment, chronic feelings of emptiness, intense anger outbursts, impulsivity, fluctuations b/t idealization & devaluation, splitting, primary defense mechanisms | Borderline PD; best tx: psychotherapy, steady social support |
| Excessive attention-seeking behavior in PD | Histrionic |
| Abnormalities in anorexia | amenorrhea, hypercholesterolemia, normocytic normochromic anemia, leukopenia, incr CRH, hypoglycemia, hypothyroidism, decr estrogen, incr BUN (catabolic state), incr cortisol (stress), nml TSH response, incr GH; lanugo hair, hypOtn, bradycardia |
| Physiological abnormalities in bulimia | 1-3% adolescent girls; hypokalemia, hypochloremia, metabolic alkalosis, hyponatremia |
| Inability to read | Alexia |
| Specific inability to name objects even though object is recognizable & can be described | Anomia |
| Global abnormality in either expression or comprehension of language | Aphasia |
| Inability to recognize objects but object can be perceived by the patient's intact senses | Agnosia |
| Inability to perform learned motor skills despite normal strength & coordination | Apraxia |
| Toxocara canis or cati infection, visceral larva migrans in a kid | Pica-->soil, feces ingestion |
| 6yo boy w/ rectal bleeding & anemia | Stereotypic movement disorder-->self-inflicted bodily injury severe enough to require medical attention |
| Nml development 1st 5 months; 5-48mo deceleration head growth, hand skills loss, stereotyped hand mvmt, loss social interxn, uncoordinated gait/trunk mvmts, impaired expressive & receptive lang, psychomotor retardation | Rett disorder; only in girls |
| Age onset of trichotillomania | 5-8, 13 |
| Most common initial sx in Tourette's | Eye tics: blinking, eye rolling |
| Pervasive developmental disorder w/ impaired social interaction & development of stereotyped or repetitive patterns of behavior w/o significant delay in language skills or cognitive function | Asperger's; more common in males |
| Conduct disorder criteria | Aggression toward people & animals; Destruction of property; Deceitfulness; Serious violation of rules |
| Oppositional defiant disorder criteria | 6mo of negativistic, hostile, & defiant behavior directed mostly at authority figures |
| Mild MR IQ | 55-70 |
| Moderate MR IQ | 40-54 |
| Severe MR IQ | 25-39 |
| Profound MR IQ | <25 |
| Prevalence & monozygotic concordance of schizophrenia | 1%, 50% |
| Psychotic/delusional theme seen potentially in multiple psychotic illnesses, often have nihilistic delusion content | Cotard syndrome |
| Belief that people have been replaced by imposters | Capgras syndrome |
| Shared delusion aroused in one person by the influence of another | Folie a deux |
| Delusional disorder is characterized by | Nonbizarre delusions (involving situations that are logically possible) for at least 1 month |
| Simple schizophrenia | All negative (no positive) sx |
| Postpartum psychotic episode w/ depression, mood lability, delusions, hallucinations | Bipolar disorder usually the cause; less frequently d/t MDD |
| Prodrome of schizophrenia | Progressive social withdrawal |
| Schizophrenic symptoms lasting b/t 1 & 6 months | Schizophreniform disorder |
| Intellectualization & undoing are considered to be _______ defenses | Neurotic |
| Altruism & sublimation are considered to be _______ defenses | Mature |
| Bleuler's description of schizophrenia | 4 A's: association, affect, autism, ambivalence |
| Negativism, hypomotorism, echolalia, echopraxia | Classic catatonic features of schizophrenia |
| Universally accepted criteria for ECT in major depression | Depression severity, history of poor response to many medications, need for quick antidepressant action |
| Early morning awakening can be a sign of | Depression |
| Levels of cortisol, catecholamines, sex hormones, immune fxn in depression | Increased cortisol; Decreased catecholamines, sex hormones, immune fxn |
| Strongest genetic link of all psychiatric illness | Bipolar I disorder |
| Episodes of hypomania & dysthymia | Cyclothymia; tx same as BPD |
| 1st degree relatives of pts w/ BPD have a X% risk of any mood disorder | 25% |
| Manifestation of porphyria | Psychiatric (manic/psychotic), abdominal pain |
| Nonauditory hallucinations suggest... | Delirium |
| Docility, lack of fear response, anterograde amnesia, hyperphagia, hypersexuality | Kluver-Bucy syndrome; assoc w/ severely damaged or disconnected amygdala bilaterally |
| Frontal & temporal lobe atrophy-->dementia | Pick disease (often indistinguishable from Alzheimer's) |
| Hydrocephalus & cerebellar anatomic abnormalities & functional abnormalities | Arnold-Chiari syndrome |
| Acquired movement disorder assoc w/ traumatic damage to substantia nigra | Punchdrunk syndrome |
| Congenital absence of facial nerves & nuclei-->bilateral facial paralysis | Mobius syndrome |
| 3 or more missed periods not d/t physiological issues automatically diagnoses w/... | Anorexia (even if binging/purging) |
| DOC tx panic disorder w/ or w/o agoraphobia | Fluoxetine (SSRI) |
| Pts w/ MDD: cortisol response to dexamethasone challenge | 50% of all pts w/ MDD do NOT have normal blunted cortisol level response to dexamethasone; indicates abnormal feedback control in HPA-axis; pts w/ psychotic depression even more likely to have poor dexamethasone suppression |
| TRH administration/TSH response in patients w/ depression | 30% of all pts w/ MDD do NOT show an increase of TSH w/ administration of TRH |
| Reclusive, aloof, isolated, don't mind lack of social interaction, indifferent to praise or criticism; able to recognize reality (no bizarre cognition or psychosis) | Schizoid personality disorder |
| Fear of panic in public | Agoraphobia |
| Shy, fearful of social rejection, lack of socializing is distressing | Avoidant personality disorder |
| Eccentric behavior, reduced capacity for close relationships, magical thinking, bizarre fantasies, belief in clairvoyance, sixth sense, etc. | Schizotypal personality disorder |
| Minimum dose of methadone to sufficiently decrease craving for heroin during initial detox | 60mg/day; will NOT decr libido, bone mass |
| Side fx of imipramine (TCA) | Anticholinergic & antiadrenergic blocking fx-->dry mouth, dizziness (assoc w/ hypotension), urinary hesitancy |
| Side fx of fluoxetine (SSRI) | GI upset, sexual dysfxn, agitation |
| Sidefx of phenelzine (MAOI) | Hypotension; less likely to have anticholinergic fx |
| Side fx of lithium | Polyuria, polydipsia, tremor, mental confusion |
| Side fx of divalproex Na | GI upset, sedation, tremor |
| Confusion, gait ataxia, incontinence | Normopressure hydrocephalus; normal opening pressure |
| Oculomotor difficulties can indicate | Wernicke-Korsakoff syndrome |
| Frontal release signs, perseveration=nonspecific findings common in... | demented patients |
| NPH CT findings | Dilated ventricles 2º/2 incr pressure waves impinging on ventricular system |
| Underlying cerebral atrophy-->dementia shows _____ on CT | Frontal sulcal widening |
| Lacunar stroke seen on CT | Hypodensities in subcortical areas |
| Cerebellar atrophy on CT often seen in | Congenital disorders, alcoholism |
| Labs in alcoholics | Incr GGT, ALT, AST, AST:ALT ratio, uric acid, serum triglycerides; macrocytic anemia |
| Length of sx differentiating acute stress disorder vs. PTSD | 4 weeks |
| Lifetime incidence of suicide in general population vs. schizophrenics | 1% vs 10% |
| Occurs when one assigns emotions to another person in an attempt to psychologically cover up the presence of those emotions within oneself (ex. doc says pt attracted to him when in reality, he is attracted to pt) | Projection |
| ECT in catatonia vs. depression vs. psychosis/mania | Catatonia: 2-4 sessions; Depression: 6-12 sessions; Psychosis/Mania: 20+ sessions; Memory impairment at 20-40 |
| Recurrent, distressing thoughts conceived as a product of patient's mind can indicate... | OCD |
| Recurrent thoughts perceived as "implanted messages" can indicate... | Schizophrenia |
| Best tx for OCD | SSRIs--antiobsessional fx, antidepressant fx, antianxiety fx |
| Antidepressants: placebo vs. tx effects | 30% placebo, 70% drug |
| Histopathology of Alzheimer's brain, current tx | Selective loss of cholinergic neurons; tx: reversible AChE-inhibitors (donepezil, rivastigmine, galantamine, tacrine) |
| 6 hrs after last drink--> | Mild withdrawal (can still lead to DTs): anxiety, tremors, sweating, palpitations |
| 12-48 hrs after last drink--> | Withdrawal seizure (can still progress to DTs): single or multiple seizures in short period of time |
| 12-24 hrs after last drink--> | Alcoholic hallucinosis: auditory, visual, tactile hallucinations w/ normal vital signs & intact sensorium |
| 48-96 hrs after last drink--> | DTs (5% mortality); fever, hypertension, tachycardia, diaphoresis, hallucinations, disorientation |
| Treatment of alcohol withdrawal | Long-acting benzo (diazepam, lorazepam, chlordiazepoxide): stimulate the GABA receptor-->sedation |
| Treatment of benzodiazepine toxicity | Flumazenil |
| Normal development of at least 2 years-->loss of previously acquired skills in at least 2 of: expressive or receptive language, social skills, bowel/bladder control, play or motor skills; then develop autistic sx | Childhood disintegrative disorder; more common in boys (pervasive developmental disorder) |
| Onset of sx before 3yo; qualitative impairments in communication & social interaction; repetitive, stereotyped behavior + strange preoccupations | Autism (PDD), more common in boys |
| Initial normal development (up to 6mo old)-->loss of hand coordination, development of stereotyped hand movements; decelerated head growth, poor coordination, seizures, ataxia, MR, diminished social interaction | Rhett disorder (PDD), more common in girls |
| Qualitative impairment in social interaction & restricted repetitive & sterotyped patterns of behavior; normal cognitive & language development | Asperger's |
| Child w/ pattern of defiant, hostile behavior; disobedient, irritable, spiteful, argumentative; blame others for their feelings | Oppositional defiant disorder |
| Presents prior to 7yo; inattention, impulsivity, overactivity, forgetfulness, poor organization, poor attention span | ADHD |
| Increased DA activity--> | Psychosis |
| Treatment of psychosis | DA-2R blockers (ex. risperidone) |
| Added ________ receptor binding of atypical antipsychotics reduces likelihood of EPS | Serotonin (5-HT 2A R's) |
| Treatment of NMS | Dantrolene (direct muscle relaxant), Amantadine, Bromocriptine (DA agonist) |
| NMS can lead to--> | Hyperthermia, autonomic instability, muscular rigidity, altered sensorium, elevated CPK, rhabdomyolysis & myoglobinuria-->ARF |
| Treatment of toxic CNS fx caused by anticholinergic drugs | Physostigmine |
| Treatment of akathisia 2º/2 neuroleptics | Propranolol |
| Difficulty falling or staying asleep for at least 1 month | Primary insomnia |
| Disregard for & violation of rights of others; illegal activities; hx of diagnosis in adolescence | Antisocial PD |
| Delusions, hallucinations, disorganized speech, or grossly disorganized behavior lasting >1 day & <1 month, completely resolve | Brief psychotic disorder |
| Systolic HTN, tachycardia, staring, muscle weakness, hyperactivity, anxiety, increased perspiration, heat intolerance, tremor, palpitations, weight loss, oligomenorrhea | Thyrotoxicosis |
| Dx of mania | 3+ of DIGFAST for ≥1 week: Distractibility, Insomnia, Grandiosity, Flight of ideas, Activity increase (goal-oriented), Speech (pressured), Thoughtlessness (high-risk behavior) |
| Decreased DA in tuberoinfundibular pathway--> | Hyperprolactinemia: sexual dysfxn, gynecomastia; tuberoinfundibular path neurons usually secrete DA-->inhibit PRL release from anterior pituitary-->incr PRL |
| Increased DA activity in nigrostriatal (substantia nigra to basal ganglia) pathway--> | Movement disorders (chorea, tics) |
| Increased DA activity in mesolimbic (ventral tegmentum to limbic) pathway--> | Euphoria assoc w/ drug use; Delusions, hallucinations in pts w/ schizophrenia |
| Decreased DA in nigrostriatal pathway--> | EPS assoc w/ neuroleptics; s/sx of Parkinson's |
| Hypersensitivity to criticism, social inhibition, feelings of inadequacy; want friendships but fear ridicule; view self as inferior; reluctant to engage in new activities | Avoidant personality disorder |
| Hallucinations, delusions, disorganized speech, disorganized or catatonic behavior, or negative sx (flattened affect) for >1mo & <6mo | Schizophreniform disorder |
| Pharmacological tx of specific phobia | Benzos, esp short-acting |
| Excessive anxiety/concern re: multiple events/activities for ≥6 mo + ≥3 of: sleep impairment, easily fatigued, restless, muscle tension, poor concentration, irritability | Generalized anxiety disorder; tx/ w buspar, benzos, or anti-D's |
| Buproprion used to tx | Depression, smoking cessation, SAD, dysthymia, PTSD, chronic fatigue syndrome, ADHD, narcolepsy, neuropathic pain, periodic limb movement disorder |
| Stepwise deterioration & neurological signs | Multiinfarct dementia |
| Progressive cognitive decline, memory impairment; apraxia, aphasia, agnosia, disturbed executive fxn | Alzheimer's |
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