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Psychiatry > Week 3 > Flashcards

Week 3 Flashcards

1
Q

______ is a condition in which the patient seems to be out of touch with reality. Schizophrenia is a type of ______.

A

Psychosis, Psychosis

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2
Q

To be diagnosed with Schizophrenia an individual must have at least on of: {3 Things}

A
  • Delusions
  • Hallucinations
  • Disorganized Speech {Incoherent or Derailed}
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3
Q

A lesion of the ______ lobe may present with contralateral neglect, and if in the dominant hemisphere ______.

A

Parietal, Aphasia

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4
Q

______ Disorders present with ≥ 1 ______ for ≥ 1 month.If hallucinations are present in this disorder they are not the dominant symptom.

A

Delusional, Delusion

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5
Q

Brief Psychotic Disorder presents with ______, ______, OR ______ for between 1 day and 1 month.

A

Delusions, Hallucinations, Disorganized Speech

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6
Q

Countertransference is:

A

A doctors emotional reaction to a patients contribution.

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7
Q

Splitting is:

A
  • A divide of emotions and relationships into the extremes of “all good” or “all bad”.
  • Divisions between healthcare team members caused by a patient.
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8
Q

A Personality Disorder cannot be diagnosed when there is:

A

An Acute Psychiatric Pathology {like MDE or Anxiety}.

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9
Q

Histrionic Personality Disorder often co-occurs with?

A

Somatization Disorder

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10
Q

What Personality Disorder is associated with a restricted range of emotions in an interpersonal setting and detachment from relationships?

A

Schizoid Personality Disorder

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11
Q

What Personality Disorder is associated with a disregard for the rights of others since before the age of 15?

A

Antisocial Personality Disorder

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12
Q

What Personality Disorder is associated with excessive attention seeking and emotion?

A

Histrionic Personality Disorder

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13
Q

What Personality Disorder is associated with social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation?

A

Avoidant Personality Disorder

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14
Q

What Personality Disorder is associated with social and interpersonal deficits marked by an acute discomfort with, and reduced capacity for, close relationships?

A

Schizotypal Personality Disorder

Also presents with cognitive or perceptual distortions and eccentricities of behaviour.

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15
Q

What Personality Disorder is associated with an increased risk of developing Schizophrenia?

A

Schizotypal Personality Disorder

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16
Q

Personality Disorders are classified into ___ clusters. These groups put together disorders which are ______, ______, and _____.

A

3

A = Mad, B = Bad, C = Sad

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17
Q

What Personality Disorder is associated with a persistent distrust of others which may be interpreted as malevolent?

A

Paranoid Personality Disorder

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18
Q

What Personality Disorder is associated with grandiosity, a need for admiration, and a lack of empathy?

A

Narcissistic Personality Disorder

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19
Q

What Personality Disorder is associated with unstable interpersonal relationships, self image, and affect in addition to impulsivity?

A

Borderline Personality Disorder

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20
Q

What Personality Disorder is associated with an excessive need to be taken care of?

A

Dependant Personality Disorder

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21
Q

What Personality Disorder is associated with a preoccupation with order, perfectionism, and control?

A

Obsessive Compulsive Personality Disorder

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22
Q

Which typical criteria of the DSM V is not necessary for diagnosing Schizophreniform Disorder?

A

A condition causing social / occupational impaired function.

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23
Q

What is needed to diagnose Schizophreniform disorder?

A

Schizophrenia Criterion A for 1 - 6 months.

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24
Q

What is Criterion A for Schizophrenia?

A

≥2 of 5 with at least 1 { } for most of a month.

  • {Delusions}
  • {Hallucinations}
  • {Disorganized Speech}
  • Negative Symptoms
  • Grossly Disorganized / Catatonic
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25
Q

Schizoaffective Disorder is diagnosed by Schizophrenia Criterion A with?

A

A MDE {depressed mood} OR Manic Episode.

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26
Q

How do you diagnose Metabolic Syndrome?

A

≥ 3 of 5:

  • ↑ Blood Pressure
  • ↑ Serum Glucose
  • ↑ Triglycerides
  • ↓ HDL
  • Central Obesity
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27
Q

With Hallucinations & Delusions, which usually stems from the other?

A

Delusions usually stem from the Hallucinations which are occurring. {Schneiderian}

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28
Q

Name and Define a Significant Negative Symptom of Schizophrenia.

A

Avolition is a lack of desire to pursue meaningful goals, these patients will find joy in doing an activity but are unable to anticipate enjoyment from doing anything.

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29
Q

What is the suicide rate for Schizophrenia?

A

5 - 15% {Similar to Bipolar}

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30
Q

What other conditions are often present with Schizophrenia?

A

Depression & Metabolic Syndrome

31
Q

What are some of the factors associated with suicide in schizophrenics?

A
  • High SES / IQ
  • Early Onset
  • Deteriorating Condition
  • Good Insight
32
Q

The Dopamine Hypothesis posits that the ______ Pathway is {hyper/hypo} active in Schizophrenia causing the ______ symptoms.

A

Mesolimbic, Hyperactive, Positive
OR
Mesocortical, Hypoactive, Negative

33
Q

A major action of antipsychotic drugs is the blocking of?

A

Dopamine Receptors {D2}

34
Q

The Revised Dopamine Hypothesis posits that ______ ______ in the ______ Pathway and hypo/hyper stimulation of dopamine rectors in the ______ Cortex is responsible for the ______ symptoms in Schizophrenia.

A

Dopamine Deficiency, Mesocortical, Hypostimulation Prefrontal, Negative

35
Q

The Glutamate Hypothesis posits that we should target the ______ Receptor.

A

NMDA

36
Q

The potency of antipsychotics is based on their?

A

Affinity for the Dopamine {D2} Receptor.

37
Q

Highly potent antipsychotic drugs are associated with ______ side effects and ______.

A

Extrapyramidal, Akathisia

38
Q

Lower potency antipsychotics have worse ______ and ______ effects.

A

Histaminergic, Sedating

39
Q

“Typical” Antipsychotics like Haloperidol cause more ______ and fewer ______ than Atypical and vice-versa.

A

Extrapyramidal, Metabolic

40
Q

This atypical antipsychotic is the only drug to reduce suicide in Schizophrenia – but also may develop ______ in as little as a week.

A

Clozapine, T2DM

41
Q

Many atypical antipsychotics have ______ effects which may cause ______ which can be fatal!

A

Anticholinergic, Constipation

42
Q

If a Schizophrenic patients weight increases by ≥ ___%, or glucose / lipid levels get worse you should consider changing to one of these two AAP.

A

5, Aripiprazole {Abilify} or Loxapine {Super Cheap!}

43
Q

What drug is fantastic for treating Bipolar Disorder and has the added benefit of decreasing suicide?

A

Lithium

44
Q

How do you treat Catatonia in Schizophrenia?

A

High dose Benzodiazepines or Electroconvulsive Therapy.

45
Q

Schizophrenics often feel depressed, and often smoke. What drug could you consider giving them?

A

Bupropion

46
Q

What substance has evidence to show that is can prevent progression to Schizophrenia?

A

Omega-3 Fatty Acids

47
Q

Briefly, what are the four primary Extrapyramidal Side Effects?

A
  • Tardive Dyskinesia
  • Akathisia
  • Acute Dystonia
  • Parkinsonism
48
Q

How does Neuroleptic Malignant Syndrome Present? What causes it?

A
  • Muscle Rigidity & Fever + …
  • Autonomic Symptoms
  • Neurological Symptoms
  • ↑CK
  • Caused by Antipsychotics
  • 25% MORTALITY
49
Q

What are the “6 S” of Mania?

A
  • Sleepless
  • Sex
  • Speeding {Reckless}
  • Special Projects
  • Spending
  • Socializing
50
Q

Mania Screening: DIG FAST

A 
≥ 3 OR ≥ 4 if Irritable
D: Distractible 
I:  Increased Activity / Psychomotor Agitation
G: Grandiosity / ↑Self Esteem
F: Flight of Ideas
A: Activities Pleasurable; Painful Consequences  
S: Sleeplessness
T: Talkative
51
Q

______ can improve social recovery outcomes in Schizophrenics by up to 80% while ______ reduces both hospitalization and symptoms.

A

Vocational Intervention, Assertive Community Treatment {ACT}

52
Q

What is Vocational Intervention?

A

Vocational rehabilitation is a process which enables persons with functional, psychological, developmental, cognitive and emotional impairments or health conditions to overcome barriers to accessing, maintaining or returning to employment or other useful occupation.

53
Q

A hypomanic episode, by definition, CANNOT have?

A
  • Any psychotic features.
  • It does not cause a marked impairment to function.
  • It IS noticeable to others.
  • It lasts ≥ 4 days.
54
Q

Define what a Manic Episode is?

A

A Manic Episode is a distinct period of abnormally & persistently elevated, expansive, or irritable mood AND abnormally & persistently increased activity or energy lasting at least 1 week and present most of the time.

55
Q

Bipolar I must have ______ episodes.

A

Manic Episodes.

Though there are often episodes of hypomania and major depression they are not required.

56
Q

Bipolar II does not have ______ episodes.

A

Manic Episodes

57
Q

Cyclothymic Disorder presents with?

A

Hypomanic symptoms + Depressive symptoms for ≥ 2 years.

58
Q

What conditions commonly co-occur with Bipolar Disorders?

A
  • Anxiety {3/4}

- Substance Use Disorder {1/2}

59
Q

Name some First Line drugs for Bipolar Acute Mania.

A

LITHIUM, Divalproex {Valproic Acid}, Olanzapine, Aripiprazole.

60
Q

Name some First Line drugs for Bipolar Depression

A

LITHIUM.

  • Consider adding an SSRI or Bupropion, or Switching to Lamotrigine or Quetiapine if Lithium isn’t working.
61
Q

When should Electroconvulsive Therapy be seriously considered?

A

If there are psychotic features, high suicide risk, patient preference, pregnancy, or medical complications.

  • ECT can be done on patients taking anticonvulsants, they will just need more of it.
62
Q

What do you need to watch when someone is taking Lithium?

A

Monitor Creatinine and TSH to monitor your Kidney’s and Thyroid.

63
Q

Which drugs will increase plasma concentrations of Lithium?

A

CANT Drugs

  • CCBs
  • ACEi
  • NSAIDs
  • Thiazide Diuretics
64
Q

What drugs may be used for maintenance therapy of Bipolar Disorder?

A

Lithium, Olanzapine, or Aripiprazole.

65
Q

What congenital anomaly does Lithium increase the risk of? What should we do about this?

A

Increases the risk of Ebstein’s Anomaly – a heart malformation – but it is still pretty rare.

Lithium is still a good option in pregnancy so don’t consider this a contraindication.

66
Q

Divalproex {Valproic Acid, Valproate} should not be used in _______.

A

In pregnant women!!!

Causes major malformation in > 10% of babies.

67
Q

What should you worry about moms developing in the first two weeks post partum?

A

Bipolar Type I. This is a PSYCHIATRIC EMERGENCY as there is a 4% risk of infanticide.

68
Q

______ leads to recovery from Bipolar Disorder ___ days sooner.

A

Any Psychotherapy, 110

69
Q

What percentage of patients with Bipolar Disorder will relapse if medication is ceased?

A

> 90%

70
Q

What Atypical Antipsychotic has very few side effects?

A

Aripiprazole

71
Q

What is Naltrexone used for?

A

{Oral or Depot} can be used while someone is still drinking. It blocks the mu-opioid receptor and modifies the HPA axis to suppress alcohol consumption. Naltrexone reduced the risk of heavy drinking by 83% and drinking days by 4%. Naltrexone works particularly well in those with genetic susceptibility to alcoholism. Side effects include nausea, headache, and dizziness. Monitor Liver Enzymes.

72
Q

What is Acamprosate used for?

A

It cannot be used with alcohol and functions by affecting a glutamate receptor. Increased abstinence in both length and rate of success. Dose is 666mg 3 times daily. Generally well tolerated. May cause diarrhea, nervousness, and fatigue.

73
Q

What is Disulfiram used for?

A

It does not influence motivation to drink but discourages drinking by causing an unpleasant reaction with drinking. It acts by inhibiting aldehyde dehydrogenase which causes acetaldehyde to build up when alcohol is consumed. This causes sweating, headaches, dyspnea, lowered blood pressure, flushing, sympathetic overactivity, palpitations, nausea, and vomiting. Dermatitis, psychosis and hepatitis are the notable side effects. DOES NOT seem to be that much better than a placebo is preventing relapse. Some evidence that it reduces quantity of alcohol drank.

Psychiatry (4 decks)

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