Psych Flashcards
(43 cards)
What class of drug do you use while you’re waiting for SSRI to take effect in the management of GAD?
Benzodiazepine
What property of methadone justifies its substitution w/ heroine?
Long HL
Diff between altruism, reaction formation, and sublimation?
Altruism: guilty feelings alleviated by unsolicited generosity towards others -> mature defense
Reaction formation: excessive and opposite behavior (pt w/ libidinous thought enters monastery) -> immature defense
Sublimation: replacing unacceptable wish to something similar to it but doesn’t conflict w/ value system (teen w/ aggression channels his anger to do well in sports) -> emphasis on channeling emotion rather than benefiting others -> mature defense
Man believes his neighbor is trying to poison him and kept ordering soil toxicity tests. Functioning normal otherwise. What’s the disorder?
Delusional disorder
NOT paranoid personality disorder b/c not pervasive enough, and paranoid PD doesn’t include clear delusion (no fixed, false belief)
NOT schizophrenia b/c no psychotic sx
Give 3 sx of serotonin syndrome
Neuromuscular excitation (HYPERREFLEXIA, clonus, myoclonus, rigidity, tremor) Autonomic stimulation (hyperthermia, diaphoresis, tachycardia, vomiting/diarrhea) Altered mental status
Taking SSRI w/ what 5 groups of drugs increase the chance of serotonin syndrome?
Antidepressants: MAOi, SNRIs, TCAs Analgesics: tramadol Anti-emetics: ondansetron (serotonin antagonist) Antibiotics: linezolid Neuropsychiatric: triptans
2 things that can be used to treat serotonin syndrome
Cytoheptadine (anti-serotonin and anti-histamine)
Benzodiazepine
Signs of chronic lithium toxicity? How do you acutely fix this?
Ataxia, coarse tremor, fascicular twitching
Delirium, agitation
Neuromuscular excitability
Fix: hemodialysis
What factors increase blood lithium conc and predispose to toxicity?
Li exclusively excreted in kidney so anything that messes kidney up & any drug that increases Na+ reabsorption in PCT will have an effect. Examples are
Thiazide diuretics: b/c it impairs Na+ resorption in DCT -> kidney compensates by increasing reabsorption of Na+ in PCT and reabsorbing more Li (b/c it works the same way as Na+)
ACEi
NSAIDs
Nonhydropyridine CCBs (verapamil, diltiazam)
Other volume depletion conditions: GI loss, decompensated CHF, cirrhosis
Alcohol withdrawal sx? Tx?
8-12 hrs after the last drink: agitated, tremulous, autonomic hyperactivity, headache
3rd day: delirium tremens (fluctuant arousal level, sever sympa hyperactivity, hallucinations)
Tx: long-acting benzodiazepines in most pts, short-acting in pts w/ advanced liver disease -> if still persist after benzo, try propanolol
Length of psychotic episode and dx for each?
Less than 1 mo & w/ clear precipitating factor: brief psychosis disorder
1-6 mo: schizophreniform disorder
More than 6 mo: schizophrenia
HTN crisis after food intake in depressed pts. What drug should you think about? And what food specifically?
MAOi (selegiline, tranylcypromine, phenelzine, isocarboxazid)
Tyramine-containing food: cheese, wine, sausage
Differences bet. conversion disorder vs. somatization disorder?
Conversion disorder: neurologic in nature (can’t be limited to pain or sexual dysfx) -> 75% have spontaneous recovery
Somatization disorder: prior to 30 yo -> 4 pain sx + 2 GI sx + 1 sexual sx + 1 pseudoneurologic sx
What happens to BP in panic attack?
Isolated rise in systolic BP (rather than combined systolic and diastolic)
What 2 recreational drugs are assc. w/ violent behavior? How do you distinguish bet. the two?
PCP -> NYSTAGMUS, acute brain syndrome, loss of coordination -> trauma is the potentially lethal sequelae
Methamphetamine -> no nystagmus, and intoxication lasts longer (up to 20 hrs)
What complication is amphetamine overdose most assc. w/?
Intracranial hemorrhage (from sympathomimetic effect) -> cocaine can cause this too (in addition to ischemic stroke and MI)
Mainstay drugs for acute mania?
Mood-stabilizing agent (lithium, carbamazepine, or valproic acid) + atypical antipsychotic (olanzapine)
What does MMSE (mini-mental state exam) NOT test for?
Executive fx -> test this by asking pt to draw a clock oriented to the time requested
Why do high potency typical antipsychotics create extrapyramidal effects? And how do you alleviate these?
They’re anti-D2 meant to affect mainly mesocortical-mesolimbic, but they also cross over to nigrostriatal -> so mess w/ cholinergic-dopaminergic balance and get extrapyramidal things
Fix w/ benztropine and diphenhydramine (M3 receptor antagonists) to tip the balance back
Define facilitation, support, and reflection as interview techniques
Facilitation: “and then what happened?”
Support: acknowledging that what the pt is going thru must have been difficult “Yes, he really hurt you. A lot of abused children have the same rxn.”
Reflection: repeating back/summarizing what pt just said to you
Projection vs. displacement?
Projection: transplantation of one’s unacceptable impulses to another person (wife thinking about cheating accuses her husband of cheating
Displacement: transfer impulses to safer and less distressful object (husband yelling at his dog after an argument w/ wife)
Major depression vs. dysthymic?
Major depression: at least 2 weeks, at least 5 of SIGECAPS w/ 2 being depressed mood or anhedonia (Sleep disorder, Interest deficit aka anhedonia, Guilt, Energy deficit, Concentration deficit, Appetite disorder, Psychomotor retardation/agitation, Suicidality)
Dysthymic: not meeting the criteria but present at least 2 years
Timeline for adjustment disorder?
W/in 3 months after onset of identifiable stressor
Assc. condition in infants when mother is on lithium?
Ebstein’s anomaly = apical displacement of tricuspid leaflets, decreased vol of RV, and atrialization of right ventricle
