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Flashcards in Psych Deck (74):
1

Neuroleptic Malignant Syndrome (slow onset 1-3 days),

D/t

S&S

Tx

Bradykinesia

Lead pipe rigidity

Fever HTN, tachycardia

↑ CPK

2

Cyclothymic disorder

S&S

Tx

mild form of bipolar alternating hypomania and dysthymia (mild depression) for at least 2 yrs (symptom free for 2 mo. max)

 

Tx: Lithium, Quetiapine

3

Hypomania

4 day minimum, no social/occupational impairment, no psychotic features, no hospitalization required

4

Dysthymia, Time frame

 

Tx

depressed for at least 2 yrs (symptom free for 2 mo. max), poor concentration, hopeless, low self esteem, fatigue, insomnia, poor/excessive appetite

 

Tx: Venlafaxine

5

Serotonin Syndrome (fast onset)

d/t

S&S

Tx

d/t when MAOIs are taken with SSRIs/Serotonergic opioids; e.g. Trancypromise + Meperidine/Dextromethorphan/Tramadol

 

hyperkinesia

myoclonic jerks/ clonus

confusion, rhabdo, renal failure, coma

 

Tx: Supportive care then Cyproheptadine (serotonin antagonist)

6

Tourette's keywords

↓ Frontal Lobe mass

impaired DA regulation in caudate

7

Tx. for Extrapyramidal SE of antipsychotics

Benztropine (anticholinergic)

8

How do NSAIDs affect Lithium levels?

NSAIDs ↓ Lithium levels

9

What is Lithium used for? Adverse effects?

Bipolar disorder and Refractory depression

 

AE: metal taste, hypothyroidism, polyuria

10

Factitious disorder

getting sick to assume sick role (1º gain)

11

Histrionic

excessive emotionality, attention seeking

12

Malingering

acting out false/grossly exaggerated signs and symptoms for 2º gain (unemployment benefits, narcotics, money)

13

Extrapyramidal Symptoms (d/t typicals/atypicals i.e. Risperdal or Haldol) Rule of 4's

Rule of After 4's:

4 hrs: acute dystonia

4 days: akathisia (restlessness)

4 wks: bradykinesia

4 mo: tardive dyskinesia

14

Dysthymia (Persistent depressive disorder)

chronic low grade depression at least 2 yrs

15

Avoidant personality disorder, Tx

feels a "void" and wants to be friends, fear intimate relationships/friendships, Tx: SSRIs

16

Cluster A ODD personality disorders "PASS",

Tx: Psychotherapy

PAranoid: mistrust others

Schizoid: no desire for close relationships

Schizotypal: "magical thinking" and distorted cognitions/perceptions

17

Cluster B DRAMATIC personality disorders "BAHN"

Borderline: unstable relationships, mood swings. Tx: Dialectical behavioral (DBT) 

Antisocial: violate rights of others, steals, kills with no guilt. Tx: DBT

Histrionic: attention seeking but functional. Tx: psychotherapy

Narcissistic: grandiose, need for admiration Tx: psychotherapy

18

Cluster C ANXIOUS personality disorders "CADO"

Avoidant: desires companionship. Tx: SSRI

Dependent: afraid of separation. Tx: psychotherapy

OCPD: rigid rules so tight they exclude friendships. Tx: psychotherapy

19

Sublimation

mature way of channeling impulses into socially acceptable behavior

20

When treating a single episode of Major Depression, how long should you continue antidepressants to follow a pt.'s response?

6 mo.

21

What a.a. should you avoid while on MAOIs?

 

Why?

Tyramine (age cheese, anchovies, red wine, cured meats, etc.)

 

Hypertensive crisis

22

Schizoaffective

psychosis + major Depression/Manic S&S lasting 2+ wks

i.e. Schizophrenia + either depression or bipolar disorder. That's why it has two subtypes (depression type, bipolar type)

23

Why can't you abruptly stop benzodiazepines like Xanax?

Seizure risk

24

Hoarding is treated with?

SSRIs

25

Major Depressive Disorder, S&S, d/t?

2+ wks of 5 of 9 CISEGAPS, d/t ↓ 5HT

26

What would you see on PET Scan of MDD?

↓ frontal lobe blood flow

27

Tx MDD

SSRIs, TCAs, MAOIs, ECT if pregnant

28

DIGFAST of Bipolar I

Distracted

Impulsive

Grandiose

Flighty

Activity 

Sleep

Talkative Manic Episodes last 1 wk, may have depressive episodes

29

Tx. Bipolar I

Lithium (mood stabilizer), Carbamazepine or Valproic Acid, Atypicals

30

Bipolar II (Hypomanic)

less severe DIGFAST, more prevalent, 1+ major depressive episode is required

31

Delirium

wax and waning, worse at night, impaired cognition

32

Hypertensive Crisis caused by? Tx.

Taking Tyramine while on MAOIs

S&S: HTN, HA, sweating, N&V

Tx: Phentolamine

33

Lithium toxicity S&S

Li > 1.5

N&V, slurred, ataxia, myoclonus, hyperreflexia

34

DSM IV Axis

I. mental illness + developmental disorders   II. personality disorders + MR 

III. medical condition

IV. psychosocial issues

V. Global Assessment of Functioning

35

Schizophrenia

2+ of the following for at least 1 mo: catatonia, hallucinations, delusions, (-) symptoms d/t excess DA in the Mesolimbic pathway, Tx: Atypical antipsychotics

36

(-) symptoms

blunt affect, anhedonia d/t deficient DA in Prefrontal Cx

37

What would you see on CT in Schizophrenia?

enlarged lateral ventricles and cortical atrophy

38

Atypical antipsychotics: DA and 5HT blockers.

Tx: for (-) symptoms

Old Closets Quietly Risper from A to Z: Olanzapine, Clozapine, Quetiapine, Risperidone, Aripiprazole, Ziprasidone

39

Schizophreniform, Tx.

"Short-term" schizophrenia lasting 1-6 mo.

Tx: 3-6 mo of Atypical antipsychotics

40

Schizoaffective Disorder, Tx

Schizophrenia + Bipolar or Depression

Tx: Atypical antipsychotics, mood stabilizers, antidepressants, ECT

41

MAOIs [Phenelzine] MOA

blocks inactivation of NE, 5HT, DA, Tyramine

42

5 Stages of Grief

1. Denial, 2. Anger, 3. Bargain, 4. Depression, 5. Acceptance

43

Anxiety/Panic Disorder neurotransmitter changes

↑ NE, ↓ GABA and 5HT

Tx: SSRI

44

OCD

d/t?

Tx?

abnormal 5HT regulation

 

Tx: SSRI then TCAs

45

OCPD pt.

ego-syntonic - don't perceive a problem

46

Txs. for Nicotine Dependence, MOA

Varenicline [Chantix]: prevents withdrawal S&S by affecting nicotinic cholinergic receptor

 

Bupropion: partial agonist at nAChR

47

Somatization disorder

multiple physical symptoms, multiple organ systems: 4 Pain, 2 GI, 1 Repro, 1 "Neuro"

48

Anorexia key labs

HypOnatremia, Alkalosis (if vomiting), ↑ Cortisol

49

Sleepwalking occurs during what part of sleep

Stage 3-4 Non-REM (slow wave sleep)

50

Tx. for Sleep Terror

Diazepam

51

Freud Structural model of the psyche

ID: unconscious sexual/aggressive urge

EGO: defense mechanisms, seeks relationships,

SUPEREGO: moral conscious

52

5HT Antagonists [Trazodone, Nefazodone] is used for?

Refractory MDD

53

Carbamazepine MOA

blocks Na+ chan to inhibit action potentials

54

Tx. for Bipolar Depression

Lamictal (levels increase with Depakote administration)

55

Benzodiazepines MOA

potentiates GABA-A by ↑ Cl- conductivity

56

Buspar MOA

5HT-1A partial agonist that is often used in combo with SSRI to Tx Anxiety

57

Narcolepsy S&S

Tx?

short REM latency, cataplexy, hypnagogic hallucinations, sleep paralysis

 

Tx. Sleep hygiene/regular sleep schedule

58

Projection

when a patient projects onto the physician qualities that he cannot tolerate in himself

59

What important side effect of Haloperidol and other antipsychotics like Atypical Antipsychotics should you keep in mind?

Prolonged QT --> Torsades

60

Benzodiazepine and Alcohol OD

"unresponsive pt. with otherwise normal PE"

↓ mentation/obtunded, delirium Dilated pupils (mydriasis)

HypOreflexia, weakness, ataxia, HypOthermia, Mild Resp depression

61

Tylenol OD

Fatal hepatotoxicity

62

B-Blocker OD

Bradycardia

CNS depression

OrthohypoTN

Pulm edema

Seizures

63

Sulfonylurea OD

Hypoglycemia

64

Opioid (e.g. Heroin, Morphine, Meperidine, Demerol) OD?

 

Withdrawal?

CNS depression

Constricted pupils (miosis) - Opioid

Resp depression

Constipation

 

W/D: Piloerection

65

Amphetamines OD

Dilated pupils (mydriasis) - meth heads are always on the lookout for more!

Psychomotor agitation

Tachycardia

Seizures

66

Cocaine OD

Chest pain substernal

Dilated pupils (mydriasis)

Hallucinations and paranoia - Psychomotor agitation 

HTN

ST elevations

 

Tx acute intoxication: Lorazepam or Phentolamine and ASA and O2

67

PCP OD

Assaultiveness/impulsive

HTN

Vertical nystagmus

Hyperthermia

68

LSD OD

Marked anxiety/depression/panic

Delusions, hallucinations

Dilated pupils (mydriasis)

Heightened senses

Flashbacks

69

Marijuana OD

Euphoria Hunger, dry mouth Slowed sense of time

70

Barbiturates OD

Respiratory depression

Low safety margin

71

Sequelae of prolonged IV Lorazepam use? Why?

Lactic acidosis. IV Lorazepam is preserved with propylene glycol. Prolonged propylene glycol intoxication manifests as lactic acidosis.

72

1º Hypersomnia

excessive daytime sleepiness despite more than adequate nighttime sleeping and daytime napping for at least 1 mo.

 

Tx: Amphetamines

73

EKG Hallmark of TCA OD Tx?

Wide QRS >100ms

 

Tx: Sodium bicarb

74

What do you do if a pt. is acutely suicidal?

notify police allow her to leave if she won't stay voluntarily give them hotline/crisis #s