Day 4.1 Psych Flashcards
(185 cards)
1
Q
Voluntarily choosing not to think of bad news
A
Suppression
Mature, bc it’s voluntary
2
Q
Using comedy to express discomfort
A
Humor
Mature
3
Q
Arsonist donates money to fire dept
A
altruism
mature
4
Q
Using your aggression to succeed in business ventures
A
sublimation
mature
5
Q
realistically planning for future discomfort
A
anticipation
mature
6
Q
consciously postponing inner conflict until after big project is complete
A
suppression
mature
7
Q
Redirecting impulses toward socially favorable object
A
sublimation
eg hitting pillow when angry
mature
8
Q
Not acknowledging bad news as if it weren’t said
A
denial
9
Q
Involuntary withholding of a feeling from conscientious awareness
A
repression
immature bc it’s involuntary
10
Q
Veteran that can describe horrific war details without any emotion
A
isolation
11
Q
child abuser who was abused as a child
A
identification
12
Q
Man yells at family when had bad day at work
A
Displacement
this is immature bc it’s redirecting impulses to a socially unfavorable thing (vs sublimation to a favorable thing eg punching bag)
13
Q
Closet homosexual hates homosexuals for the way the “make” him feel
A
projection
14
Q
using intellectual processes to avoid affective expression
A
intellectualization
15
Q
belief that ppl are either all good or all bad
A
splitting
borderline personality disorder pts do this
16
Q
expressing anger thru passivity, masochism, and turning against self
A
passive-aggressive
17
Q
believing external source is responsible for unacceptable inner impulse
A
projection
18
Q
changing one’s character/personal identity to avoid emotional distress
A
dissociation
19
Q
returning to earlier level of maturation to avoid conflict at current maturational level
eg stressed kids wet bed
A
regression
20
Q
offering an explanation for an unacceptable attitude/belief/bhvr
A
rationalization
21
Q
a thought that is avoided is replaced by an unconscious emphasis on the opposite
A
rxn formation
22
Q
converting mental conflicts into bodily symptoms
A
somatization
23
Q
temporarily inhibiting thinking but continuing to build more tension
A
blocking
schizophrenic pts do this
24
Q
avoiding interpersonal intimacy to resolve conflict and obtain gratification
A
schizoid fantasy
25
extreme forms of this can result in multiple personalities
dissociation
26
chronically giving into impulse to avoid tension from an unexpressed unconscious wish; tantrums
acting out
27
Electrolyte chgs in pts who vomit a lot (eg bulemics)
hypokalemic, hypochloremic metabolic alkalosis
28
NT chgs in depression
decreased NE, serotonin, dopamine
| opp is mania
29
NT chgs in anxiety
Increased NE
| Decreased GABA and serotonin
30
NT chgs in Huntington's
Decreased GABA and ACh
31
NT chgs in Alzheimers
Decreased ACh
32
NT chgs in schizophrenia
Increased dopamine
33
NT chgs in Parkinson's
Decreased dopamine
| Increased ACh
34
IQ
Stanford-Binet: IQ = mental age/chronological age x 100
WAIS III uses 14 subtests- can quantify intellectual decline
WISC is for kids 6-16yo
Mean IQ = 100, st dev = 15
35
IQ dx for MR
IQ <20 profound
36
Habituation, Sensitization
```
Habituation = repeated stimulus leads to decreased response
Senitization = repeated stimulation leads to increased response
```
37
Classical conditioning
```
Pavlov
Natural response (salivation) is elicited by a condition/learned stimulus (bell) that was presented together with an unconditioned stimulus (food).
```
38
Operant conditioning
Action is elicited bc it produces reward.
Positive reinforcement- desired reward produces action (press button, get food)
Negative reinforcement- do an action to remove a bad thing/avoid something bad (press button to avoid shock)
Punishment- adverse stimulus extinguished unwanted bhvr
Extinction- discontinuation of reinforcement eliminates bhvr
39
Reinforcement schedule
Pattern of reinforcement determines how quickly a bhvr is learned or extinguished.
Continuous- reward after every response. rapidly extinguished (vending machine)
Variable ratio- reward received after a random number of responses. slowly extinguished (slot machine)
40
Transference
| Countertransference
Transference: pt projects feelings abt formative or other imp person onto doc (eg psychiatrist = parent)
Countertransference: doc projects onto pt
41
Goal of Freudian psychoanalysis
Mk pt aware of what is hidden in their unconscious
42
Id
Primal urges, food, sex, aggression.
Id drives Instinct
Entirely subconscious
"I want it"
43
Ego
Mediator bt primal urges and bhvr accepted in reality.
| "Take it and you will get in trouble"
44
Superego
Moral values, conscience
Can lead to self-blame and attacks on ego
"You know you can't take it, taking it is wrong"
45
Erikson's stgs of psychosocial development
8 stgs of normal devt, each posing a new crisis. unsuccessful completion of a stage can manifest as psychosocial maladaption later in life.
Oral sensory stg 0 to 12-18mo (crisis = trust vs mistrust)
Adlescence stg 12-20 yrs (crisis - identity vs role confusion)
46
Ego defenses
unconscious mental processes of the ego used to resolve conflict and prevent anx and deprsn. can be immature or mature
47
Acting out
unacceptable thoughts/feelings expressed through actions.
| tantrums
48
Dissociation
Temporary, drastic chgs in personality, memory, consciousness, motor bhvr, to avoid stress
Extreme forms = dissociative id disorder (mult personality)
49
Denial
Avoidance of awareness of a painful reality
| Common newly-dx'd in cancer and AIDS pts
50
Displacement
Avoided ideas/feelings are txfrd to a neutral person or object (vs projection)
Mom blames kids bc she's angry at husband
51
Fixation
Partially remaining at a more childish level of devt (vs regression)
Men fixating on sports games
52
Identification
Modeling behavior after another person who is more powerful (tho not nec admired)
Abused child is an abuser
53
Isolation of affect
Separation of feelings from ideas/events
| Describing murder in graphic detail w no emotional response
54
Projection
Unacceptable internal impulse is attributed to an external source
Man who wants another woman think his wife is cheating
55
Rationalization
Proclaiming logical reasons for actions actually performed for other reasons, usu to avoid self-blame
After getting fired, saying job wasn't imp anyway.
56
Reaction formation
Warded-off idea/feeling is replaced by an unconsciously derived emphasis on its opposite
pt w high libido enters monastery
57
Repression
Involuntary withholding of idea/feeling from conscious awareness
Not remembering conflictual/traumatic experience, pressing bad thoughts into unconscious
58
Regression
Turning back maturational clock and going back to earlier modes of dealing w the world
kids under stress (bedwetting)
pts on dialysis (crying)
59
Splitting
belief that ppl are all gd or bad at different times due to intolerance of ambiguity.
Seen in borderline personality disorder
Pt says all nurses are insensitive but all docs are friendly
60
Altruism
Guilty feelings alleviated by unsolicited generosity toward others
Mafia boss mks donation toward charity
Mature
61
Humor
Appreciating the amusing nature of an anx-provoking/ adverse situation
Nervous med student jokes abt boards
Mature
62
Sublimation
Replacing unacceptable wish w course of action that is similar to the wish but does not conflict w one's value system
Actress using experience of abuse to enhance her acting.
mature
63
Suppression
Voluntary withholding of an idea or feeling from conscious awareness (vs repression, which is involuntary)
Choosing not to think abt USMLE until week of exam
Mature
64
Mature ego defenses (4)
```
Mature women wear a SASH:
Sublimation
Altruism
Suppression
Humor
```
65
Infant deprivation effects
```
Long-term deprivation results in:
1. decrsd musc tone
2. poor lang skills
3. poor socialization skills
4. lack of basic trust
5. anaclitic deprsn
6. weight loss
7. physical illness
Severe deprivation can result in infant death.
4 W's weak, wordless, wanting, wary
If deprivation >6 mo, irrev chgs
```
66
Child abuse signs
```
healed fractures on x-ray
cigarette burns
subdural hematoma
mult bruises
retinal hemorrhage/detachment
sexual: genital/anal trauma, STDs, UTIs
```
67
Child abuse epi
abuser usu female and primary caregiver
3000 deaths/yr in USA
if sexual:
abuser usu male and known to victim
peak incidence 9-12 yo (prepuberty)
68
Child neglect
failure to provide adequate food, shelter, supervision, education, affection
most common form of childhood mistreatment.
evidence: poor hygiene, malnutrition, withdrawal, impaired social/emotional devt, FTT
Must be reported to authorities
More common than overt abuse
69
Anaclitic deprsn (hosptialism)
Deprsn in infant d/t continued separation from caregiver. Infant withdrawn, unresponsive.
Reversible, but prolonged separation can result in FTT or devt disturbances - delayed speech.
70
Regression in children
Regression to younger bhvr patterns under condition of stress- physical illness, punishment, new sibling, fatigue.
eg bedwetting
71
ADHD
limited attn span, poor impulse control.
onset <7yo
hyperactivity, motor impairment, emotional lability
normal intelligence but difficulties in school
cont to adulthood in 50%
assoc w decreased frontal lobe volume
72
Rx for ADHD
methylphenidate (ritalin)
amphetamines (dexedrine)
atomoxetine (non-stimulant SNRI)
73
Conduct disorder
repetitive, pervasive bhvr violating social norms- physical aggression, destruction of property, theft.
After 18yo is antisocial personality disorder
Disregard for rights of others
Cruelty to animals
74
Oppositional defiant disorder
pattern of hostile, defiant bhvr toward authority
but, not serious violation of social norms
don't disregard rights of others
75
Tourette's synd
```
sudden rapid reccurent non-rhythmic sterotyped motor mvmts or vocalizations- tics.
persist for >1year
Lifetime prev .1-1% of general pop
Coprolalia (obscene speech) found in 20%
assocd w OCD
onset <18yo
```
76
Rx for Tourette's
```
antipsychotics
old (in FA): haloperidol
now (in DIT): anti-dopamine agents- fluphenazine, pimozide, tetrabenazine
```
77
Separation Anx Disorder
overwhelming fear of separation from home or loss of attachment figure. may lead to faking illness to stay home from school
age 7-9 onset
78
Autistic disorder
MR
severe lang impairment, poor social interactions, greater focus on obj than ppl.
repetitive bhvr
savants rarely
M>F
Rx: bhvrl therapy and supportive therapy to improve communication and social skills
79
Asperger's disorder
Normal intelligence
milder autism. all-absorbing interests, repetitive bhvr, problems w social relationships
no verbal or cognitive deficits, no lang impairment
80
Rett's disorder
X-linked dominant, so affects girls only (boys die in-utero/after birth)
Normal to age 4, the regression- loss of devt, MR, loss of verbal abilities, ataxia, stereotyped midline handwringing.
81
Childhood disintegrative disorder
Marked regression in multiple areas of fn'g after at least 2 years of apparently normal devt. Loss of expressive or receptive lang skills, social skills, adaptive bhvr, bowel/bladder control, play, motor skills.
Common onset 3-4 yo
M>F
82
Orientation
order of loss:
first lose time, then place, then person.
(can also lose circumstances- don't know why they're in the hospital. lose this last)
Common causes of loss of orientation:
alch/drugs, fluid/electrolyte imbalance, head trauma, hypoglycemia, nutritional deficit
83
Retrograde amnesia
can't remember what occurred before CNS insult
84
Anterograde amnesia
no new memory- can't remember what occur after CNS insult
85
Korsakoff's amnesia
anterograde amnesia (no new memory) caused by thiamine deficiency.
leads to bilateral destruction of mammillary bodies.
can also lead to retrograde amnesia
seen in alcoholics, assocd w confabulations
86
Dissociative amnesia
inability to recall imp personal info, usu subsequent to severe trauma or stress
87
Delirium
Waxing/waning lvl of consciousness
Acute onset (hrs/days)
Rapid decrease in attn span and lvl of arousal
Acute chg in mental status, disorg'd thinking, hallucinations (often visual), illusions, misperceptions, disturbance in sleep-wake cycle, cogntv dysfn
Often reversible
Most common psych illness in hospital
Abn EEG
88
2 most common causes of delirium:
Drugs (esp those w anti-ACh side effects)
| UTIs
89
Dementia
Gradual decline in cognition (wks/mo/yrs)
NO chg in lvl of consciousness
Mem deficits, aphasia, apraxia, agnosia, loss of abstract thought, bhvr/personality chgs, impaired judgement
Pt is alert.
Increased incidence w age
Normal EEG
Irreversible
90
Pseudodementia
In elderly pts, depression presenting like dementia.
If you are depressed you have memory loss and you know you have memory loss
Pts w actual dementia don't know they have memory loss.
So if pt himself complains of mem loss, it's not dementia, may be deprsn.
91
Cause of Dementia
```
Alz dz
Vascular thrombosis/hemorrhage (esp multi-infarct thrombosis)- can have acute or subacute onset
HIV
Pick's dz
Substance abuse (esp alch)
CJD
```
92
Drugs used in ADHD
Methylphenidate (ritalin) and dextroamphetamine (adderall) are amphetamines- they increase pre-synaptic NE rls
Atomoxetine is a NE reuptake inhibitor
93
Uses of stimulants (NE releasers, NE uptake inhibitors)
ADHD
Narcolepsy (modafinil)
Obstructive sleep apnea (excessive daytime sleepiness)
Mjr depressive disorder- bridge until other drugs start working
94
Most common genetic causes of MR
Downs
Fragile X
Rett synd
95
Non-genetic prenatal causes of MR
Congenital hypothyroidism
FAS (most common)
Prenatal toxin exposure (lead, merc, valproate- anticonvulsant, mood stabilizer)
96
Non-genetic postnatal causes of MR
```
trauma/abuse
CNS hemorrhage
hypoxia (near drowning)
toxins
psychosocial deprivation
malnutrition
intracranial infection
CNS malignancy
```
97
Trichotillomania
```
Compulsive nervous hair-pulling
young girls
wire-brush feel, pattern of broken hair
Rx: education, CBT
only if those don't work: fluoxetine or clomipramine
```
98
Hallucination
see something that's not there (absence of external stimuli)
schizophrenic- auditory
alch withdrawal- tactile
dementia- visual
99
Illusion
See things that are there but misinterpret them
100
Delusion
false belief not shared w others of culture.
| maintained in spite of proof to contrary
101
Loose associations
disorders in form of thought/way ideas are tied together.
102
Gender identity disorder
cross-gender identification. persistent discomfort/anx w one's sex
transsexual- chg body w surgery to relieve the anx
not transvestite
103
Anorexia nervosa
excessive dieting
can be with or w/o purging
commonly coexists w depression
rx CBT
104
Bulemia nervosa
binge eating
can be w or w/o purging
use laxitives
assoc w parotitis bc increased salivary amylase (systemically)
russell's sign- hand callus from inducing vom
electrolyte disturbances, alkalosis
rx SSRIs
105
What electrical disturbances happen when you vom a lot?
Vomit = get rid of HCl, so you have hypochloremia and metabolic alkalosis
Also get hypokalemia: cells have H+/K+ countertransporter. To counteract the alkalosis, cells put acid into serum, which means they pull the K+ out of serum and into cells.
Hypochloremic, hypokalemic metabolic alkalosis.
106
Why do Down Syndrome pts have an increased risk of Alz?
familial form early-onset Alz is assoc'd with APP gene, which is on chromosome 21. Down syndrome pts have 3 copies of chr 21.
APP = amyloid precursor protein
107
Genes assoc'd with Alz
Familial form (10% of Alz) is assoc'd with:
Early-onset: APP on Chr 21
Presenilin-1 on Chr 14
Presenilin-2 on Chr 1
Late-onset: ApoE4 on Chr 19 (Apo E4 is a chaperone protein that helps induce B-sheet formation)
Protective gene:
ApoE2 on Chr 19
108
Histological findings in Alz
Diffuse widespread cortical atrophy
Decreased ACh
Senile plaques (extracellular B-amyloid core)- can cause amyloid angiopathy, leading to intracranial hemorrhage (AB-amyloid is synth'd by cleaving amyloid)
Neurofibrillary tangles
109
What are neurofibrillary tangles?
Intracellular, abnormally phosphorylated tau protein, making insoluble cytoskeletal elements.
Tangles correlate with degree of dementia
110
High potency neuroleptic (antipsychotic)
Haloperidol
Fluphenazine
Thiothixene
Trifluoperazine (can also be considered moderate potency)
High potency means more EPS side effects, less anti-ACh side eff
111
Moderate potency neuroleptic (antipsychotic)
Molindone
Loxapine
Trifluoperazine (can also be considered high potency)
112
Low potency neuorleptic (antipsychotic)
Chlorpromazide
Theoridazine
Low potency means less EPS side effects, but more anti-ACh side effects (hot as a hare, dry as a bone, etc)
113
Atypical antipsychotics
```
Olazapine
Risperidone
Quetiapine
Clozapine
Aripiprazole
```
114
Halperidol
High potency neuroleptic
115
Molindone
Moderate potency neuroleptic
116
Loxapine
Moderate potency neuroleptic
117
Fluphenazine
High potency neuroleptic
118
Risperidone
Atypical antipsychotic
119
Clozapine
Atypical antipsychotic
120
Thiothixene
High potency neuroleptic
121
Theoridazine
Low potency neuroleptic
122
Olanzapine
Atypical antipsychotic
123
Trifluoperozine
High/moderate potency neuroleptic
124
Chlorpromazine
Low potency neuroleptic
125
Quetiapine
Atypical antipsychotic
126
Apiprazole
Atypical antipsychotic
127
Alz dz epi
More common in elderly, down synd pts have increased risk.
| 10% familial
128
Pick's dz
Frontotemporal dementia.
Change in personality, behavior (1st), then dementia, aphasia, parkinsonian sympt
Spares parietal lob and posterior 2/3 of superior temporal gyrus, but pt has frontotemporal atrophy.
Pick bodies
129
What are Pick Bodies?
intracellular (inside of neurons), aggregated tau protein
Stain with silver
seen in Pick's dz (frontotemporal dementia)
130
In which dz's are Lewy bodies seen?
Lewy body dementia
Alzheimer's (the diffuse lewy body type of Alz)
Parkinson's
131
Lewy Body Dementia
Parkinsonism plus dementia and visual hallucinations, with repeated falls and syncopal episodes.
alpha-synuclein defect
see lewy bodies
132
CJD
Prion dz- infections proteins chg alpha helix to beta sheet, which are resistant to proteases and heat
Rapidly progressive dementia (wks-months) with myoclonus
Causes spongiform cortex
133
Causes of dementia
```
Alz, Pick's, Lewy body, CJD
Multi-infarct (2nd most common in elderly)
syphilis
HIV
B12 deficiency
Wilson's dz (copper accumulations)
```
134
Drugs for Alz
Memantine
Donepezil
Galantamine
Rivastigmine
135
Donepezil
Anti-AChE
| for Alz
136
Memantine
NMDA receptor antagonist
| for Alz
137
Galantamine
AChE inhibitor
| for alz
138
Rivastigmine
```
AChE inhibitor (indirect muscarinic agonist)
for alz
```
139
Haloperidol
dopamine receptor antagonist
neuroleptic
for Huntington's
140
Memantine- mech, toxicity
Used for Alz
NMDA (glutamate) receptor antagonist
helps prevent excitotoxicity (mediated by Ca2+)
Toxicity: dizziness, confusion, hallucinations
141
Donepezil, Galatamine, Rivastigmine
Used for Alz
ACh-E inhibitors
Toxicity: nausea (start low, go slow!)
also dizziness, insomnia
142
Sumitriptan
Serotonin 1b/1d agonist
| use for acute migrane, cluster headaches
143
Schizophrenia pos sympt
```
Adding something:
Delusions
Hallucinations (esp auditory)
Disorganizes speech (loose assoc)
Disorganized/catatonic bhvr
```
144
Schizophrenia neg sympt
```
Takes something good away:
flat affect
social withdrawal
lack of motivation
lack of thought, speech (alogia)
thought blocking (abruptly halt train of thought)
poor grooming
```
145
Dx of schizophrenia
req's 2 of 5 things (the 4 pos sympt + negative symptoms counts as 1)
146
Brief psychotic disorder
<1month
| usu stress related
147
Schizophreniform disorder
1-6months
| 6mo = schizophrenic
148
Schizoaffective disorder
at least 2 wks of STABLE mood w psychotic sympt
plus a mjr depressive, manic, or mixed (depressive+manic) episode
2 subtypes:
bipolar
depressive
149
Schizophrenia
Periods of psychosis and disturbed bhvr with a decline in functioning
>6mo
Associated with increased dopaminergic activity (too much dopamine) and decreased dendritic branching
Mj use is a risk factor in teens
150
5 subtypes of schizophrenia
```
paranoid (delusions)
disorganized (wrt bhvr, speech, affect)
catatonic (automatisms)
undifferentiated (elements of all types)
residual
```
151
Which is more imp for schizophrenia, genes or env?
Genes
152
Schizophrenia epi
```
Lifetime prev 1.5% (!!)
M = F
Black = white
Presents earlier in men (late teens- early 20s)
than women (late 20s/early 30s)
Pts are at increased risk for suicide
```
153
List the neuroleptics/antipsychotics (typical)
```
Haloperidol
Trifluoperazine
Fluphenazine
Thioridazine
Chlorpromazine
(haloperidol + -azine)
```
154
How do neuroleptics work?
They block D2 dopamine receptors, thereby increasing cAMP.
Schizophrenia is increased dopamine, so it's good to block the receptors.
D2 = Gi, which decreases cAMP. Block the inhibitor to increase cAMP.
155
Use of neuroleptics
```
Schizophrenia (mainly pos sympt)
psychosis
acute mania
Tourette's synd
to decrease agitation in delerium, dementia
```
156
Toxicity of neuroleptics
1. slowly removed from body (bc highly lipid soluble so stored in body fat)
2. EPS side effects
3. endocrine side effects (D2 receptor antagonism means dopamine no longer suppresses prolactin, so hyperprolactinemia, so galactorrhea)
4. side eff from blocking muscarinic receptors (dry mouth, constipation), alpha receptors (hypotension), and histamine receptors (sedation)
5. NMS, Tardive dyskinesia
157
What is Neuroleptic malignant syndrome (NMS)?
```
Rigidity, myoglobinuriam autonomic instability, hyperpyrexia
Caused by neuroleptics.
Breakdown of muscle --> myoglobinura -->kidneys clog (rhabdomyolysis) --> renal failure
For NMS think FEVER:
Fever
Encephalopathy
Vitals unstable
Elevated enz
Rigidity of muscles
```
158
Rx for NMS
```
Dantrolene
Dopamine agonists (bromocriptine)
```
159
What is tardive dyskinesia?
Stereotypical oral-facial mvmts d/t long-term anti pscyhotic use.
Often irrev
160
Low potency neuroleptic side effects
low potency = less EPS side effects but more anti-ACh side effects
Chlorpromazine- Corneal deposits
Thioridazine- reTinal deposits
161
EPS extra pyrimidal symptoms
4hrs- acute dystonia (muscle spasm, stiffness, oculogyric crisis-rotating eyeballs, torticollis-neck twisting
4days- akinesia (parkinsonian sympt)
4wks- akathisia (restlessness, can't stop mvmt)
4mo-tardive dyskinesia
162
List the atypical antipsychotics
OLanzapine, CLOzapine, QUETIapine, RISPERidone, Aripiprazole, Ziprasidone
It's atypical for OLd CLOsets to QUIETly RISPER from A to Z
163
How do the atypical antipsychotics work?
They block serotonin, alpha, H1, and dopamine receptors.
| Have less side effects bc they block both dopamine and serotonin, but do get alpha and H1 side effects
164
Schizophrenia sympt for <1mo
brief psychotic disorder, usu stress related
165
Schizophrenia sympt for 1-6mo
Schizophreniform disorder
166
Schizoid
Avoidant
167
Schizotypal
Odd thinking
168
Schizophrenic sympt >6mo + bipolar or depressive mood disorder
Schizoaffective
169
Schizophrenic sympt >6mo
Schizophrenia
170
visual hallucinations
delerium
171
auditory hallucinations
schizophrenia
172
olfactory hallucinations
aura of psychomotor epilepsy
| esp burning rubber smell
173
tactile hallucinations
alch withdrawal
formication-ants crawling in skin
also seen in cocaine abuse - cocaine bugs
174
hypnagogic hallicinations
when going to sleep
175
hypnopompic hallucinations
while waking up from sleep
176
delusional disorder
>1mo fixed persistent NON-bizarre belief system
functioning not impaired
often self limited
strange thoughts, but not outside scope of reality
177
shared psychotic disorder
folie a deux
devt of delusions in a person in a close relationship w someone else w delusional disorder.
often resolves upon separation
178
dissociative identity disorder
mult personality disorder
presence of 2 or more distinct identities or personality states
F>M, assoc w hx of sexual abuse
179
depersonalization disorder
persistent feelings of detachment or estrangement from oneself
180
dissociative fugue
abrupt chg in geographic location w inability to recall past, confusion abt personal identity, or assumption of new identity
assocd w traumatic circumstances (natural disaster, wartime, trauma)
leads to significant distress/impairment
not the result of substance abuse or medical condition
181
Clinical use for atypical antipsychotics
Schizophrenia (both pos and neg sympt)
Olazapine is used for OCD, anx disorder, depression, mania, bipolar, Tourette's, depression
Quetine can treat psychosis d/t parkinson's
182
Toxicity of atypical antipsychotics
Fewer EPS and anti-ACh side effects than traditional antipsychotics (haloperidol and the -azines), but olanzapine, clozapine, quetine can cause signficant weight gain (and DM bc of it).
Clozapine can cause agranulocytosis and req's weekly monitoring of WBCs
Since they block alpha receptors, there can be some HTN, sedation, dizziness
The H1 blockage is responsible for the weight gain, and also sedation.
Rx for side effects: Amantidine (Parkinson's med)
183
Dantrolene
Drug used for malignant hyperthermia and NMS- neuroleptic malignant syndrome.
Prevents rls of Ca2+ from Sarcoplasmic Reticulum of skel musc, therefore stopping muscle contraction.
184
Malignant hyperthermia
Uncontrolled increase in skeletal muscle oxidative metabolism- causing high temp, incrsd HR and respi rate, increased O2 consumption with increased CO2 production, acidosis, rigid muscles (contraction), rhabdomyolysis.
Caused by concomitant use of inhalation anesthetics (the -anes, except N2O) and succinylcholine (NMJ blocker).
185
Genes involved in malignant hyperthermia
Autodom gene mutation in RYR1 gene, which makes the skeletal muscle's ryanodine Ca2+ receptor
