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psych 1 Flashcards

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1
Q

3 dopamine tracts

A
  1. Nigrostriatal pathway- parkinson symptoms
  2. mesolimbic-mesocortical pathway- psychosis (involved in mediating antipsychotic effects of antipsychotic drugs)
  3. tuberoinfundibular tract-galactorhea (dopamine inhibits prolactin so if use dopamine antagonist prolactin increases causing galactorhea)
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2
Q

when can you start using adhd meds

A

6 yrs old

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3
Q

workup before prescribing adhd meds

A

ekg, bp, tsh, lipids, cbc, cmp, seizure free (good h/o and physical exam for base line…get height and weight to make sure still growing-decrease weight is a side effect)

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4
Q

meds for adhd

A

methylphenidate (ritaline) (inhibit reuptake of dopamine and Norepi)
dextroamphetamine (adderal)
non stimulant- atomoxetine (strattera) (black box warning- increase risk of suicide)

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5
Q

scale for adhd

A

vanderbilt scale

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6
Q

signs of death

A

palor mortis- paleness 15-20 min after death
livor mortis- edema in dependent part of body
algo mortis- decline in body temp
rigor mortis- stiffening of limbs

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7
Q

signs that suggest active dying

A 
no intake of food/water
dramatic skin color changes
respiratory mandibular movement
sunken cheeks, relaxation of facial muscles
rattels in chest
cheynes-stokes respirations
feeble pulse
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8
Q

stages of grief

A
  1. shock and denial
  2. anger
  3. bargaining
  4. depression
  5. acceptance
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9
Q

depression vs grief

A 
mood disturbance (depression- no fluctuations in mood; grief-fluctuations common-ups and downs)
shame and guilt- (depression- belief that one is shameful and worthless; grief-regret not doing more for deceased)
suicidal ideation- ( depression- threaten suicide more often; grief- claim life is unbearable but don't really want to die)
greif lasts usually 6 months to 1 year (some signs can last longer)
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10
Q

risk factors for abnormal grief

A

Those who suffer a loss suddenly or through horrific circumstances
Those who are socially isolated
Those who believe they are responsible (whether real or imagined)
Those with a history of traumatic losses
Those with an intensely dependent relationship with the deceased
Those who have suffered the death of a child
Those who have suffered from depression

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11
Q

medical conditions that can cause depression

A 
sleep apnea
chronic pain
hypothyroidism
stroke
heart disease 
there are others (ms, cancer, diabetes, copd, dementia, etc) but these are the main ones
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12
Q

meds can cause depression

A 
beta blockers
corticosteroids
benzodiazepines
chantix (varenicline)
interferon
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13
Q

depression scales

A

beck depression scale

quick inventory of depressive symptomatology

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14
Q

bipolar scale

A

mood disorder questionaire

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15
Q

anxiety scale

A

hamilton anxiety rating scale

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16
Q

risk factors for suicide

A 
sad persons
Sex (male)
Age (elderly adolescent)
Depression
Previous attempts
Ethanol abuse
Rational thinking loss (psychosis)
Social support lacking
Organized plan to commit suicide
No spouse (divorced, single, widowed)
Sickness (physical illness)
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17
Q

tx of disorders

A

mild depression-psychothearpy
moderate or severe- psychotherapy plus meds (sari)
bipolar- mood stabilizer +/- antidepressant
psychotic- antipsychotic plus antidepressant

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18
Q

diagnosis of depression

A

5 symptoms in 2 week time
at least one symptom has to be depressed mood most of the day everyday or anhodonia (don’t find pleasure in things anymore)

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19
Q

what goes in each axis

A

I- psychiatry conditions
II- personality disorders and mental retardation
III- medical conditions
IV- psychological or environmental issues contributing to mental problem
V- GAF

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20
Q

what is go to med for anxiety disorders

A

Paxil

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21
Q

first line agent for 8 and up depression

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A

prozac (start at 10 mg and taper to 20 mg)

22
Q

first line agent for 12 and up depression

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A

lexapro (start at 5 mg and taper to 10-20mg)

23
Q

key to diagnosing hypochondrias

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A

at least 6 months of illness despite medical eval

24
Q

keys to look for in malingering

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A

Memory loss following head injury is unusual without LOC, and typically the amnesia would involve the accident and events surrounding the accident
Long-term memories are LEAST likely to be affected by mild traumatic injury
Loss of orientation to person without other memory deficits seldom occurs

25
treatment for somatization
cognitive based therapy | ssri for body dysmorphic
26
what drug has active metabolite
fluoxetine
27
what ssri are contraindicated for breast cancer (tamoxifen)
fluoxetine and paroxetine
28
what ssri carries risk of qt prolongation
citalopram
29
what ssri can be dosed weely
fluoxetine
30
if get side effects w/ snri what can you do
take w/ food
31
main side effects w/ snri
diaphoresis dizziness nausea
32
what snri causes weight gain
cymbalta (duloxetine)
33
what is perfect patient for wellbutrin
The perfect patient for this is mild depression, very sleepy, can’t concentrate at job (cause it is stimulating)
34
hunters criteria for serotonin syndrome
Has taken a serotonergic agent PLUS (1) Spontaneous clonus Inducible clonus AND agitation or diaphoresis Ocular clonus AND agitation or diaphoresis Tremor and hyperreflexia Hypertonia AND temp > 38C AND ocular clonus or inducible clonus
35
personality disorders
``` A- weird (eccentric and odd behavior) paranoid, schizoid, schizotypal B- wild antisocial, borderline, histonic, narcissistic C- wimpy avoidant, ocd, dependent ```
36
mneumonic for paranoid
``` suspect S: spouse fidelity suspected U: unforgiving (bears grudges) S: suspicious of others P: perceives attacks (and reacts quickly) E: œenemy of friend? (suspects associates, friends) C: confiding in others feared T: threats perceived in benign events ```
37
pneumonic for schizoid
``` D: Detached (or flattened) affect I: Indifferent to criticism and praise S: Sexual experiences of little interest T: Tasks (activities) done solitarily A: Absence of close friends N: Neither desires nor enjoys close relations T: Takes pleasure in few activities ```
38
mneumonic for schizotypal
M: Magical thinking or odd beliefs E: Experiences unusual perceptions ``` P: Paranoid ideation E: Eccentric behavior or appearance C: Constricted (or inappropriate) affect U: Unusual (odd) thinking and speech L: Lacks close friends I: Ideas of reference A: Anxiety in social situations R: Rule out psychotic disorders and pervasive developmental disorder ```
39
mnemonic for antisocial
C: Conformity to law lacking 0: Obligations ignored R: Reckless disregard for safety of self or others R: Remorse lacking U: Underhanded (deceitful, lies, cons others) P: Planning insufficient (impulsive) T: Temper (irritable and aggressive)
40
mneumonic for borderline
``` P-Paranoid R-relationship instability A-anger outburts I-Impulsive S-suicidal E-Emptiness feeling ```
41
mneumonic for histrionic
P: Provocative (or sexually seductive) behavior R: Relationships (considered more intimate than they are) A: Attention (uncomfortable when not the center of attention) I: Influenced easily S: Style of speech (impressionistic, lacks detail) E: Emotions (rapidly shifting and shallow) M: Made up (physical appearance used to draw attention to self) E: Emotions exaggerated (theatrical)
42
mneumonic for narcisitic
S: Special (believes he or she is special and unique) P: Preoccupied with fantasies (of unlimited success, power, brilliance, beauty, or ideal love) E: Entitlement C: Conceited (grandiose sense of self-importance) I: Interpersonal exploitation A: Arrogant (haughty) L: Lacks empathy
43
mneumonic for avoidant
C: Certainty (of being liked required before willing to get involved with others) R: Rejection (or criticism) preoccupies one's thoughts in social situations I: Intimate relationships (restraint in intimate relationships due to fear of being samed) N: New interpersonal relationships (is inhibited in) G: Gets around occupational activity (involing significant interpersonal contact) E Embarrassment (potential) prevents new activity or taking personal risks S: Self viewed as unappealing, inept, or inferior
44
mneumnoic for dependant
R: Reassurance required tor decisions E: Expressing disagreement difficult (due to fear of loss of support or approval) L: Life responsibilites (needs to have these assumed by others) I: Initiating projects difficult (due to lack of self-confidence) A: Alone (feels helpless and discomfort when alone) N: Nurturance (goes to excessive lengths to obtain nurturance and support) C: Companionship (another relationship) sought urgently when close relationship ends E: Exaggerated fears of being left to care for self
45
mneumnoic for ocd
L: Loses point of activity (due to preoccupation with detail) A: Ability to complete tasks (compromised by perfectionism) W: Worthless objects (unable to discard) F: Friendships (and leisure activities) excluded (due to a preoccupation with work) I: Inflexible, scrupulous, overconscientious (on ethics, values, or morality, not accounted for by religion or culture) R: Reluctant to delegate (unless others submit to exact guidelines) M: Miserly (toward self and others) S: Stubbornness (and rigidity)
46
stages of normal grief
``` dabda Denial Anger Bargaining Depression Acceptance ```
47
tx of paranoid
ssri
48
tx of schizoid and schizotypal
low dose antipsychotics or antidepressant
49
tx of borderline personality
dialectical behavior therapy- tx of choice | cognitive behavioral thearpy
50
tx of histrionic
cognitive behaioral thearpy
51
postpartum blues
begins w/in 48hrs of delivery peaks in 3-5 days lasts about 2 weeks (if lasts more then 2 weeks consider post partum depression)

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