PSYCH Flashcards by Dana Gross

What are the first three warning signs for suicide?

threatening to hurt or kill self
looking for ways/seeking means
talking/writing about death, dying, suicide

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When is it particularly important to ask about OTC use?

pt on lithium - NSAIDs decrease excretion which increases concentration in the body

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What are different possible qualities of affect?

flat, blunted, constricted, full (avg, intense (more than normal)

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What are neologisms?

made up words

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What are clang associations?

word connections due to phonetics rather than actual meaning

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What are the different axis of a diagnosis scheme?

I: clinical disorders (MI)
II: dev (ID) and personality disorders
III: physical disorders (gen med conditions)
IV: severity of psychosocial factors
V: global assessment

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What is the GAF value for hospitalization?

< or = to 30

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What are some medical conditions that can case psychosis?

CNS dz
endocrinopathies
nutritional/vitamin deficiency states

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What are the three phases of schizophrenia?

prodromal
psychotic
residual: negative symptoms

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What is the most severe consequence of seretonine syndrome?

renal failure

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What are some important p450 inducers?

smoking
carbamazepine
barbiturates
st. john’s wort

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What are some important p450 inhibitors?

fluvoxamine
fluoxetine
paroxetine
duloxetine
sertraline

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Which SSRI is safe in pregnancy?

fluoxetine

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Which SSRI has a long half life? Short?

fluoxetine - don’t need to taper

paroxetine

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Which SSRI has the highest risk for GI disturbances?

sertraline

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Which SSRI is only approved for use in OCD?

fluvoxamine

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Which SSRI has the fewest drug-drug interactions?

citalopram

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What are some important interactions of SSRIs?

shouldn’t be used for 2 wks before or after MAOI

can increase levels of warfarin

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What are the SNRIs?

venlafaxine - can increase BP!

duloxetine - depression and neuropathic pain, fibromyalgia

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What are the norepinephrine-dopamine reuptake inhibitors?

bupropion - can lower seizure threshold, caution in epilepsy and eating disorders

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What are the seretonin receptor antagonists and agonists?

trazodone and nefazodone (liver failure)

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What are the alpha2 adrenergic receptor antagonists?

mirtazapine - good for sedation and weight gain too

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What are the major complications of TCAs?

cardiotoxicity, convulsions, coma

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What condition can MAOIs be particularly effective for?

atypical depression

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Which MAOI does not require dietary restrictions?

selegiline patch

What is the difference between MAO-A and MAO-B?

A deactivates seretonin B deactivates NE/epi both act on dopamine and tyramine

What are the subtypes of schizophrenia?

paranoid - delusions and AH disorganized type - behavior and speech, flat affect catatonic type - may have echolalia, echopraxia residual type - negative symptoms undifferentiated

What are the dopamine pathways affected in schizophrenia?

prefrontal cortical - inadequate dopamine causes negative symptoms mesolimbic - excessive dopamine causes positive symptoms

What dopamine pathways are also affected by neuroleptics?

tuberinfundibular --> blockade causes hyperprolactinemia | nigrostriatal --> blockade causes EPS

What are some high potency neuroleptics? low potency?

haloperidol and trifluoperazine - more EPS | chlorpromazine and thioridazine - more anticholinergic SEs

How can you tell the difference between schizoaffective d/o and mood d/o with psychotic features?

delusions or hallucinations for 2 wks in absence of mood d/o symptoms

What is the criteria for delusional disorder?

nonbizarre fixed delusions for at least 1 month don't meet criteria for schizophrenia fxning in life not impaired

What are some differences between bereavement and depression?

lasts less than 2 months, no SI

What is the triad for seasonal affective disorder?

irritability carb craving hypersomnia

What are some of the criteria for adjustment disorders?

symptoms begin w/i 3 months of event and end w/i 6 months distress in excess of expected stressful event not life threatening

What defense mechanism do people with HPD usually use?

regression (also seen in DPD)

What can be used to treat aggression in patients with delirium?

antipsychotics (low dose haldol - IM, IV, or PO) | also maybe benzos - if benzo or alcohol withdrawal

tremor, EPS, frontal dizziness, sluggish pupillary reflexes

tertiary syph

What are three typical findings in delirium?

short attention span visual hallucinations impairment in recent memory

What is the workup for reversible causes of dementia?

CBC, electrolytes, TFTs (hypothyroidism), VDRL/RPR, B12 and folate, Brain CT or MRI

What are some possible pharmacologic treatments for Alzheimers?

``` cholinesterase inhibitors (donepezil, rivastigmine, galantamine) NMDA antagonists ```

What are core features of lewy body dementia?

``` waxing and waning parkinsonism visual hallucinations sensitivity to neuroleptics can have REM sleep behavior disorder ```

How can you tell the difference between lewy body dementia and parkinsons w dementia?

onset of dementia more than 12 months after parkinsons = parkinsons w/i 12 months = lewy body

What is the treatment for FTD?

anticholinergics and antidepressants improve behavior but not cognition

What is the pathology of Huntingtons?

expanded CAG on ch 4, caudate atrophy

What lab values suggest excessive alcohol use.

AST:ALT greater than 2:1, elevated GGT

For which drugs is immediate cessation after heavy use note life threatening?

Cocaine (stimulants in general), withdrawal from sedatives is life threatening

What is rotatory nystagmus a pathognomonic finding of?

PCP intoxication

What is the treatment for barbiturate overdose? Benzos?

Sodium bicarbonate | Flumazenil

What is the classic triad of opioid overdose?

Resp dep, AMS, miosis

Which eating disorders do SSRIs have some indication fr?

bulimia | not effective in anorexia because not adequate intake of tryptophan, precursor to seretonin

What medication should be AVOIDED in patients with eating disorders?

bupropion - lowers seizure threshold

dyssomnias: parasomnias:

insufficient, excessive, or altered timing of sleep | unusual sleep related behaviors

What is the drug of choice for cataplexy (associated w narcolepsy)?

sodium oxybate

What is Kleine-Levin syndrome?

recurrent hypersomnia with episodes of daytime sleepiness with hyperphagia, hypersexuality, aggression

What part of the brain coordinates 24 hour or circadian rhythmicity?

suprachiasmatic nucleus in hypothalamus

Who is psychotherapy not indicated for?

people who have problems with reality testing (psychosis) or people with severe cluster A and B disorders

What are the types of mature defenses?

altruism, humor, sublimation, suppression (conscious)

What are the types of neurotic defenses?

``` controlling displacement intellectualization isolation of affect rationalization reaction formation repression (unconscious) ```

What are the types of immature defenses?

acting out, denial, regression, projection

How long does it take for the onset of each of the following side effects to occur after neuroleptic use? acute dystonia: EPS/akathisia: TD:

hours to days days to months months to yrs

When MUST you stop clozapine?

when ANC drops below 1500

``` What are unique features of: risperidone: quetiapine: olanzapine: aripiprazole: ```

can cause increased prolactin sedation and orthostatic hypotension weight gain!!! partial D2 agonism*, more activating (akathisia) and less sedating

What are factors that affect lithium levels?

NSAIDs decrease | sweating, salt deprivation, dehydration, impaired renal fxn increase

What are the lithium levels to remember?

therapuetic: 0.6-1.2 toxic: >1.5 lethal: >2.0

What are features of anticonvulsants as treatments of psychiatric disorders? (carbamazepine, valproic acid, lamotrigine, gabapentin)

treats mixed episodes and rapid cycling bipolar better treats trigeminal neuralgia monitor CBC and LFTs neural tube defects in pregnancy

What order does the cognitive impairment of dementia progress in?

amnesia, aphasia, apraxia, agnosia

What is sundowning?

patients w dementia often get more confused later in day and at night

What is a serious side effect of lithium toxicity?

renal failure - avoid in pts w decreased renal fxn

PSYCH Flashcards

(69 cards)