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Flashcards in Psych Deck (227):
1

Difference btw schizophrenia, schizophreniform, and brief psychotic disorder

brief psychosis < 1 month
Schizophreniform 1-6 months
Schizophrenia > 6 months

2

Adjustment disorder time frame

Occurs within three months of a stressor and lasts no more than six months with anxiety/depression/disturbed behavior

3

Features of narcolepsy

Sudden naps 3x/week for 3 months
At least one of the following:
1. cataplexy
2. los CSF hypocretin-1
3. shortened REM latency

Associated with hallucinations right before or after sleep and sleep paralysis

4

Diff btw narcolepsy and hypersomnolence

persistent daytime sleepiness that are not refreshed with napping

5

Difference between classical and operant conditioning

Operant conditioning produces a particular action. Classical conditioning elicits a natural response (like salivation

6

Transference

projection of feelings towards other persons onto physician (i.e. treating physician like parent)

7

Dissociation

ego defense: temporary change in personality, memory, consciousness, or motor behavior

8

Displacement

feelings (anger) transferred to another person (vs transference, where you are treating one person as if they are someone else)

9

Fixation

Staying at a childish level

10

Identification

Modeling behavior after another more powerful person

11

Infant deprivation effects

Weak wordless, wanting (socially), and wary

12

how long infant deprived for irreversible effects?

6 months

13

Peak incidence of child abuse

9-12 years

14

common signs of child abuse

retinal hemorrhage
detachment
coup-countercoup head trauma

15

What is the most common form of child maltreatment?

neglect

16

ADHD onset before age

7

17

brain in ADHD

decreased frontal lobe volume

18

Tx: ADHD

methylphenidate, amphetamine, atomoxetine

19

Oppositional defiant disorder

hostile, defiant toward authority, without violating serious social norms (conduct disorder)

20

How long to have sx to be diagnosed with tourette's

Over 1 year

21

Coprolalia

Involuntary obscene speech

22

Tourettes associ'd with

OCD

23

Tx: tourette's

antipsychotics/behavioral therapy

24

Tourette's onset

Before age 18

25

Age group for separation anxiety disorder

7-9 years

26

Presentation: separation anxiety disorder

fear of separation from home or loss of parent. May make up excuses to stay at home

27

Tx: separation anxiety disorder:

SSRI/behavior

28

Narcolepsy caused by

loss of hypocretin-1/2

29

pointing

social development 1 year

30

Lots of imitation

social development 2 year

31

Parallel play

social development 3 year

32

cooperative play

4 yr

33

pincer development

1 yr

34

walking

1 year

35

says mom or dad

1 year

36

page turn

2 yr

37

draw shapes

3 yr

38

dress self

4 yr

39

jump

2 yr

40

tricycle

3 yr

41

run

4 yr

42

simple sentence

3yr

43

complex sentence

4 yr

44

2 words

2 yr

45

Tx: autism

behavioral/supportive

46

Signs autism

language impairment, poor social skills, focus on objects, repetitive behavior

-->usually below normal intelligence

47

Asperger's

normal intelligence, no verbal deficits
--problems socially, repetitive behavior and all-absorbing interests

48

Inheritance of rett's

X-linked

49

Rett's

regression age 1-4
loss of development, verbal skills, and retardation
STEREOTYPED HAND WRINGING
ataxia

50

Childhood disintegrative disorder

2 years of normal development
-Loss of language skills, social skills, bowel/bladder control, play/motor skills

51

which childhood development disorder is more common in boys

Childhood disintegrative disorder and autism

52

Anxiety neurotransmitters

Increased NE
Decreased GABA
Decreased Serotonin

53

Alzheimer's neurotransmitters

decreased Ach

54

Huntington's neurotransmitters

Decreased Gaba
Decreased Ach
Increased dopamine

55

Parkinson's neurotransmitters

Increased serotonin, increased Ach, decreased dopamine

56

Korsakoff's amnesia

ANTEROGRADE amnesia with confabulations

57

Dissociative amnesia

Forget important personal information after trauma/stress (i.e. borne identity)

58

Delirium vs dementia

Delirium has decreased arousal. Also, more likely reversible and 2ndary cause.

Will see hallucinations, in dementia usually not the case

59

EEG in delirium

Abnormal

60

Which drugs likely for delirium

anticholinergic drugs (atropine, benztropine)

61

Pseudodementia

In elderly pts, depression can present as dementia

62

EEG in dementia

normal

63

Olfactory hallucination associated with:

epilepsy/brain tumor

64

Tactile hallucinations

alcohol withdrawal
Cocaine abusers

65

Schizophrenic brain

decreased dendritic branching

66

schizophrenia associated with

frequent cannabis use

67

Positive sx in schizo

Delusions
hallucinations
disorganized speech
disorganized/catatonic behavior

68

Negative sx in schizo

flat affect
social withdrawal
lack of motivation
lack of speech/thought

69

Five subtypes of schizo

paranoid
disorganized
catatonic (automatism)
Undifferentiated
Residual

70

Delusional disorder

Fixed false belief lasting > 1 month

71

Dissociative identity disorder

Tamu.
At least 2 personalities

72

Dissociative identity disorder associ'd with

sexual abuse

73

Persistent feelings of detachment/estrangement from body, social situation, environment

depersonalization disorder

74

Abrupt change in geographic location with inability to recall past, may assume new identity with SIGNIFICANT DISTRESS

dissociative fugue

75

dissociative fugue associated with:

natural disaster, wartime, trauma

76

Manic sx:

DIG FAST
distractible
irresponsible
grandiosity
flight of ideas
agitation/activity
sleep (less needed)
talkative

77

Criteria for manic episode

At least 1 week
-3/7 sx
-OR if hospitalized

78

Hypomanic episode

Same as manic, but less than a week or not enough disturbance to impair/hospitalize

79

Bipolar disorder always requires

depressive sx

80

What can precipitate a manic episode

antidepressants

81

What r u most worried about in manic episode

suicide risk

82

Tx for bipolar disorder

lithium, valproid acid, carbamazepine
atypical antipsychotics

83

Bipolar I vs bipolar II

Bipolar I: 1 manic episode
Bipolar 2: 1 hypomanic episode

84

cyclothymic disorder

mild bipolar, lasting 2 YEARS
-alternating mild depression and hypomania

85

MDD sx

SIG E CAPS
sleep disturbed
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor agitation/retardation
Suicidal ideation
Oh, and FEELING DEPRESSED

86

Criteria for MDD:

5/9 Sx for at least 2 weeks
Episodes usually last 6-12 months

87

Dysthymia

mild depression lasting at least 2 years

88

Atypical depression

Hypersomnia/weight gain instead of lack of sleep/weight loss
-leaden paralysis
-sensitivity to interpersonal rejection
-reactive mood

89

Incidence of baby blues

50-85%

90

Incidence of postpartum depression

10-15%

91

Sx of baby blues

depressed affect, tearfulness, and fatigue 2-3 days after delivery. MUST RESOLVE in 2 weeks.

92

Tx of baby blues

support and follow up

93

Pospartum depression

depressed affect, anxiety, and concentration 4 weeks after delivery. Lasts at least 2 weeks-1 year

94

Postpartum psychosis

delusions/hallucination. May have homicidal ideation. Lasts days to 4-6 weeks

95

Tx: postpartum psychosis

antipsychotics, antidepressants, inpatient hospitalization

96

A post-partum mother says she feels depressed. How do you know if it is regular MDD or postpartum depression?

If < 4 weeks after delivery, then postpartum.

97

When would you consider giving ECT?

Refractory MDD
Pregnant women with MDD
Catatonic, psychotic
Or acutely suicidal

98

What are the major adverse effects of ECT?

amnesia and disorientation, but goes away after 6 months

99

Risk factors for suicide completion

SAD PERSONS
Sex
Age (teen/elderly)
Depression
Previous attempt
Ethanol/drug use
Rational thinking loss
Sickness
Organized plan
No spouse
Social support lacking

100

Prevalence of anxiety disorders

30% in women, 19% in men

101

Sx of panic disorders

Palpitations
Paresthesias
Abdominal dispress
Nausea
Intense fear of dying
Lightheadedness
Chest pain
Chills
Choking
Sweating
Shaking
Shortness of breath

PPANICCCSSS

102

Treatment of panic disorder

CBT
SSRI
Venlafaxine
Benzo

103

Criteria for panic disorder

Discomfort peaking in 10 minutes with at least 4 sx

104

Tx of phobia

SSRI

105

OCD associated with

tourettes

106

Treatment of OCD

SSRIs, clomipramine

107

Acute stress disorder

PTSD: lasts between 2 days and 1 month

108

Sx of PTSD

flashbacks, fear, helplessness, horror
-Avoidance of stimuli associated with trauma

109

Criteria for PTSD

Disturbance for at least 1 month with significant distress.

110

Treatment for PTSD

psychotherapy and SSRIs

111

Generalized anxiety disorder

anxiety for at least 6 months

112

Tx for generalized anxiety

SSRI/SNRI

113

Adjustment disorder

emotional anxiety/depression after a distinct stressor lasting LESS than 6 months

114

Somatization disorder

multiple organ system (4 pain, 2 GI, 1 sexual, 1 pseudoneuro like sz or loss of feeling)
-Must occur before the age of 30

115

Conversion disorder

Sudden loss of sensory or motor function after an acute stressor. More common in females and adolescents.

116

la belle indifference

seen in conversion disorder.

117

How old does pt have to be to dx a personality disorder

18

118

Cluster A personalities

paranoid, schizoid, schizotypal

119

Cluster B disorders

antisocial, borderline, histrionic, narcissistic

120

Cluster C personality disorders

Avoidant
Obsessive compulsive
dependent

121

cluster A disorders associated with

schizophrenia

122

cluster B disorders associated with

mood disorder and substance abuse

123

cluster C disorders associated with

anxiety disorders

124

avoidant personality

wants relationship with others, but inhibited/timid

125

Egosyntonic/egodystonic example

OCPD is egosyntonic
OCD is egodystonic

126

Anorexia nervosa associated with

depression

127

Bulimia nervosa side efects

parotitis, enamel erosion, electrolyte disturbances, alkalosis

128

russell's sign

dorsal hand caluses from induced vomiting

129

signs of substance dependence

tolerance
withdrawal
more taken than desired
persistent desire or attempt to cut down
significant energy spent on getting substance
reduced social/occupational activities reduced
Continued use despite problems
--3+ needed!

130

Substance abuse

failure to fulfill major obligations at home/work
use in physically hazardous situations
legal problems
persistent problems, yet continued use

131

sensitive test for alcohol use

gamma-glutamyltransferse (GGT)

132

Signs of alcohol withdrawal

anxiety, insomnia, tremor.

Severe=autonomic hyperactivity and delirium tremens

133

opoid signs

respiratory/CNS depression
Decreased gag reflex
Pupil constriction
Seizures

134

Tx for opioid overdose

naloxone/naltrexone

135

Opioid withdrawal

dilated pupils, piloerection, fever sweating, rhinorrhea, diarrhea, GI, (flu like sx) YAWNING

136

why would you use benzos before barbiturates?

greater safety margin

137

Sign of barbiturate tox

Marked respiratory depression

138

barbiturate withdrawal

delirium, CV collapse

139

benzo intox:

ataxia, mild respiratory depression

140

tx: benzo overdose

flumenazil

141

benzo withdrawal

anxiety, seizure, sleep disturbance, depression

142

euphoria, grandiosity, pupillary dilation, wakefullness and attention, hypertension, tachycardia, paranoia, fever

amphetamines

143

pupillary dilation, hallucinations (tactile), paranoid ideation, sudden cardiac death

cocaine

144

tx for cocaine o/d

benzos

145

anhedonia, increased appetite, hypersomnolence

amphetamine withdrawal

146

nictotine withdrawal

irritability, anxiety, craving

147

drugs for nicotine withdrawal

buproprion/varenicline

148

hypersomnolence, malaise, severe craving, depression/suicidality

cocaine withdrawal

149

belligerence, impulsiveness, vertical + horizontal nystagmus, homicidality, psychosis, seizures

PCP

150

tx for PCP

benzo or antipsychotic

151

depression, anxiety, irritability, restless, anergia, disturbed thoughts/sleep

PCP withdrawal

152

anxiety, paranoia, visual auditory distortion, depersonalization

LSD

153

how long is MJ detected in urine

4-10 days

154

how long do MJ sx last

5-7 days but peak in 48 hours

155

dronabinol

prescription MJ, for chemo or appetite stimulant in AIDS

156

Heroin users are at risk for

hepatitis, abscess, hemorrhoids

157

Methadone

long acting opiate

158

naloxone plus buprenorphine

partial agonist do decrease withdrawal. naloxone blocks the opioid receptor and becomes active if injected to prevent buprenorphine from being abused

159

wernicke's encaphalopathy

confusion
opthalmoplegia
ataxia

160

korsakoff's psychosis

loss of memory making capabilities

161

When does DT occur?

2-5 days after last drink

162

sx of DT

tachy, tremor, anxiety, seizures
THEN
psychotic symptoms and confusion

163

bulimia tx

SSRI

164

tx: panic disorder

SSRI, venlafaxine, benzodiazepine

165

Tx: tourette's

haloperidol, resperidone, other antipsychotics

166

mechanism methylphenidate, destroamphetamine, methamphetamine

Increase NE and dopamine at synaptic cleft

167

name the antipsychotics

haloperidol, trigluoperazine, fluphenazine, thioridazine, chlorpromazine (haloperidol + azines)

168

Mechanism antipsych

block D2 dopamine receptors
-->increased cAMP

169

High potency antipsych

Trifluoperazine, fluphenazine, haloperidol

170

Low potency antipsych

Chlorpromazine, thioridazine

171

side effects of high potency antipsychotics

extrapyramidal sx:
dystonia (4 hr)
akathisia (4 day)
bradykinesia (4 wks)
tardive dyskinesia (4 mos)

172

chlorpromazine side effect

corneal deposits

173

thioridazine side effects

reTinal deposits

174

haloperidol side effects

tardive dyskinesia and neuroleptic malignant syndrome

175

antipsychotic side effects:

endocrine (galactorrhea from dopamine block)
dry mouth, constipation,
hypotension
sedation (histamine receptor block)

176

Neuroleptic malignant syndrome signs

rigidity
myoglobinuria
autonomic instability
fever

177

Tx of neuroleptic malignant syndrome

dantrolene or
bromocriptine (D2 agonist)

178

Is tardive dyskinesia reversible?

no

179

Atypical antipsychotics

Olanzapine
Clozapine
quetiapine
risperidone
aripiprazole
ziprasidone

180

Atypical antipsychotic uses

bipolar, OCD, anxiety, depression, tourettes

181

olanzapine side effect

weight gain

182

clozapine side effect

agranulocytosis
seizure
weight gain

183

ziprasidone side effect

prolongation of QT interval

184

Lithium side effects

LMNOP

Movement
Nephrogenic diabetes insipidus
Hypothyroid
pregnancy problems

185

Clinical use of lithium

bipolar
SIADH

186

lithium birth defect

ebstein anomaly
malformation of vessels

187

What do you need to monitor with lithium

Check serum levels frequently cause narrow therapeutic window. Excreted by kidneys

188

Buspirone: mechanism

stimulates serotonin1A receptors

189

buspirone clinical use

generalized anxiety disorder

190

benefits of buspirone

no addiction/sedation/tolerance. BUT takes 1-2 weeks to work

191

Name the SSRIs

fluoxetine
paroxetine
sertraline
citalopram

192

How long does it take for antidepressants to have an effect

4-8 weeks

193

tox: SSRI

GI distress
serotonin syndrome
sexual dysfunction

194

serotonin syndrome

clonus
hyperthermia
tremor
flushing, diarrhea
CV collapse

195

tx: serotonin syndrome

cyproheptadine, a serotonin antagonist

196

SNRIs

venlafaxine, duloxetine

197

venlafaxine indications

depression, anxiety, panic disorder

198

duloxetine indications

diabetic peripheral neuropathy.

199

tox of SNRI

increased BP, stimulant effect

200

TCAs

-tryptyline
-imipramine
doxepin
amoxapine

201

Mechanism of TCA

block reuptake of NE and serotonin

202

clinical use of imipramine

depression, bed wetting

203

clinical use clomipramine

OCD/depression

204

clinical use TCA

fibromyalgia/depression

205

Side effect of TCA

convulsions, coma, cardiotoxicity
-postural hypotension
-atropine like effects

206

which TCA to give to elderly

nortriptyline
-fewer anticholinergic side effects causing confusion and hallucinations

207

desipramine effect

less sedating higher seizure threshold

208

MAO inhibitors

tranylcypromine
phenelzine
isocarboxazid
selegiline

MAO takes pride in shanghai

209

MAO uses

atypical depression
anxiety
hypochondriasis

210

MAO side effect

hypertensive crisis with tyramine
Contraindicated with SSRI, TCA, st. John's Wort, meperidine, and dextromethorphan to prevent serotonin syndrome

211

Atypical antidepressants

bupropion
mirtazapine
maprotiline
trazodone

212

Mechanism of bupropion

Increase Ne and dopamine

213

Bupropion tox

tachycardia, insomnia, but NO SEX SIDE EFFECTS

214

who is bupropion contraindicated in?

bulimic pts--seizure risk

215

mirtazapine

alpha-2 and 5-HT antagonist (increases release of NE and serotonin)

216

tox: mirtazapine

sedation
appetite
weight gain
dry mouth

217

maprotiline mech

blocks NE reuptake

218

maprotiline tox:

sedation, hypotension

219

trazodone mech

inhibits serotonin reuptake

220

trazodone use

insomnia

221

tox: trazodone

sedation, nausea, PRIAPISM, hypotension

222

What is Epstein's abnormality

Apical displacement of tricuspid valve with a SMALLER right ventricle. Also atrialization of the right ventricle.

223

Fetal alcohol syndrome

1. facial anomalies
2. Growth retardation
3. Mental retardation

224

Schizoaffective disorder

at least 2 weeks of stable mood with ONLY psychotic symptoms PLUS a major depressive, manic, or mixed episode.

Differentiate from bipolar disorder/MDD with psychotic features--psychotic features only occur DURING an episode

225

Risperidone side effect

Hyperprolactinemia, with breast soreness and amenorrhea.

low dopamine in the brain causes high prolactin. Inhibits GnRH

226

What does carbidopa not reduce in the side effects of levodopa?

anxiety and agitation

227

Undoing defense mechanism

confession or atonement to nullify unacceptable thought