mature defense mechs
SASH sublimation altruism suppression humor
anaclitic depression
results from depriving severe infant deprivation
child becomes withdrawn and unresponsive
many of the children dx w/ conduct disorder will qualify for what dx after age 18?
antisocial personality disorder
coprolalia
involuntary obscene speech. observed in 10-20% of tourette’s syndrome
Rett’s disorder
x linked disorder almost exclusively in females (males die in utero or shortly post partum)
regression, loss of development / verbal abilities, mental retardation, ataxia, stereotyped hand wringing
NT changes in anxiety and depression
anxiety - inc NE, dec GABA and 5 HT
depression - dec NE, 5HT, DA
order of loss of orientation
time > place > person
Korsakoff’s amnesia
anterograde w/ some retrograde. caused by thiamine def > destruction of mamillary bodies
MC presentation of AMS in inpatient setting
delirium
tx of delirium
id and address underlying cause
optimize brain condition (O2, hydration, pain etc)
antipsychotics (haloperidol)
3 signs of psychosis
hallucinations
delusions
disorganized speech
which type of hallucination is more likely caused by psychiatric illness rather than medical - visual or auditory?
auditory > psych
visual > med
hypnagogic vs hypnapompic hallucinations
gogic - GOing to sleep
pompic - upon waking
3 signs of psychosis
hallucinations
delusions
disorganized speech
which type of hallucination is more likely caused by psychiatric illness rather than medical - visual or auditory?
auditory > psych
visual > med
schizoaffective disorder def
at least 2 wks of stable mood w/ psychotic sx plus major depressive, manic, or mixed episode
5 subtypes of schizophrenia
paranoid, disorganized, catatonic, undifferentiated, residual
criteria to dx schizophrenia
2 of the following: delusions hallucinations disorganized speech disorganized/catatonic behavior negative sx (flat affect, social withdrawal, amotivation, lack of speech or thought)
schizoaffective disorder def
at least 2 wks of stable mood w/ psychotic sx plus major depressive, manic, or mixed episode
5 subtypes of schizophrenia
paranoid, disorganized, catatonic, undifferentiated, residual
time req for manic episode
at least 1 wk
difference btwn postpartum blues and depression
blues - depressed affect, tearfulness, fatigue from 2-3 d postpartum resolving in 10-14 d
depression - depressed affect, anxiety, poor concentration w/in 4 wks of delivery lasting 2 wks to a year+
diagnostic criteria for major depressive disorder
depressive episodes for 6-12 mo. episodes must have at least 5 sx and last at least 2 wks. must include patient reported depressed mood or anhedonia possible sx (need >=5): sleep disturbance anhedonia guilt/worthlessness loss of energy loss of concentration appetite/wt changes psychomotor retardation/agitation suicidal ideations depressed mood
def of dysthymia
milder form of depression lasting at least 2 yrs
difference btwn postpartum blues and depression
blues - depressed affect, tearfulness, fatigue from 2-3 d postpartum resolving in 10-14 d
depression - depressed affect, anxiety, poor concentration w/in 4 wks of delivery lasting 2 wks to a year+
time req for PTSD, and what is the other disorder for if you have sx for less than that
> 1 mo
acute stress disorder is 2d-1mo
generalized anxiety disorder time req
6 mo
tx of DTs in alcohol withdrawal
benzos
clusters of personality disorders
a - odd/eccentric, trouble forming meaningful relationships. paranoid, schizoid, schizotypal
b - dramatic, emotional, erratic. antisocial, borderline, histrionic, narcissistic
c - anxious, fearful. avoidant, OCPD, dependant
serum indications of alcohol abuse
serum GGT is very sensitive
AST > 2xALT
tx of DTs in alcohol withdrawal
benzos
when does delirium tremens happen?
peaks 2-5 d after last drink
olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone - class/mech, tox
atypical antipsychotics - mech not completely understood
fewer EPS and anticholinergic SEs.
olanzapine/clozapine: wt gain / metabolic synd
clozapine - agraunlocytosis (weekly monitoring) and seizures
ziprasidone - prolong QT interval
“typical” antipsychotics - names, mech, tox
haloperidol + "-azines" block D2 receptors extrapyramidal SEs (dyskinesia, etc), hyperprolactinemia, antimuscarinic, anti-alpha1, anti-histamine effects
neuroleptic malignant syndrome
FEVER- fever encephalopathy vitals unstable elevated enzymes rigidity of muscles
tx w/ dantroline and D2 agonists (bromocriptine)
olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone - class/mech, tox
atypical antipsychotics - mech not completely understood
fewer EPS and anticholinergic SEs.
olanzapine/clozapine: wt gain / metabolic synd
clozapine - agraunlocytosis (weekly monitoring) and seizures
ziprasidone - prolong QT interval
lithium tox
LMNOP: lithium tox: mvmt (tremor) nephrogenic DI hypOthyroid pregnancy problems
serotonin syndrome
can occur w/ any drug that inc serotonin
hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures
tx w/ cyproheptadine (5HT2 antagonist)
busprione - mech, use
stim 5HT1a receptors
GAD - no addiction, sedation, or tolerance and can be taken w/ alcohol
list 4 SSRIs
fluoxetine, paroxetine, sertraline, citalopram
serotonin syndrome
can occur w/ any drug that inc serotonin
hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures
tx w/ cyproheptadine (5HT2 antagonist)
list 2 SNRIs
venlafaxine, duloxetine
buproprion - mech, use, tox
inc NE and DA via unknown mech (atypical antidepressant)
depression, smoking cessation
tox - stimulant effects (tachy, insomnia), HA, seizure in bulimic patients. NO sexual side effects
tox of TCAs
sedation, postural hypotension, atropine like anticholinergic effects
convulsions, coma, cardiotox (arrhythmias), resp depression, hyperpyrexia, confusion/hallucinations
tranylcypromine, phenelzine, isocarboxazid, selegiline - class
MAOi
buproprion - mech, use, tox
inc NE and DA via unknown mech (atypical antidepressant)
depression, smoking cessation
tox - stimulant effects (tachy, insomnia), HA, seizure in bulimic patients. NO sexual side effects
mirtazapine - mech, use, tox
atypical antidepressant - alpha 2 antagonist, potent 5HT2 and 3 receptor antagonist
depression, esp w/ inpatients who can’t sleep or eat
sedation, inc appetite/wt gain, dry mouth
maprotiline - mech, tox
atypical antidepressant - blocks NE reuptake
sedation, orthostatic hypoTN
trazodone - mech, use, tox
atypical antidepressant - inhibits serotonin reuptake
used primarily for insomnia
sedation, nausea, priapism**, postural hypoTN