PSYCH 513 - 516 Flashcards by Daniel Zheng

What is the primary characteristic in narcolepsy?

Excessive daytime sleepiness

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What psychiatric diagnosis involves disordered regulation of sleep-wake cycles?

Narcolepsy

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What hormone change drives narcolepsy?

Decreased orexin production in lateral hypothalamus

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What are some associations with narcolepsy?

Hallucinations - either hypnagogic or hypnopompic
Nocturnal and narcoleptic sleep episodes that start off with REM sleep
Cataplexy - loss of all muscle tone following a strong emotional stimulus, such as laughter

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Is there a genetic component in narcolepsy?

STRONG genetic component

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How do we treat narcolepsy?

Daytime stimulants (e.g. amphetamines, modafinil) and nighttime sodium oxybate (GHB)

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Substance use disorder is defined as the maladaptive pattern of substance use marked by 2 or more of what signs within a year?

Mnemonic: SUBSTANCE

Social or interpersonal conflicts
Unsuccessful attempts to cut down
Broke (significant energy spent obtaining, using, or recovering from substance)
Still using despite knowing its problems, still using despite physically dangerous situations
Tolerance - need more to achieve same effect
Addicted - withdrawal symptoms
Nothing else (important social, occupational, or recreational activities reduced because of substance use; unable to fulfill major obligations
)
Craving
Excessive amounts

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What are the 6 stages of change in overcoming substance addiction?

Precontemplation
Contemplation
Preparation/determination
Action/willpower
Maintenance
Relapse

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What is the difference between precontemplation vs. contemplation?

Precontemplation - not yet acknowledging there is a problem

Contemplation - acknowledging there is a problem but not yet ready or willing to make a change

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What is getting ready to change behavior called?

Preparation/determination

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What is the stage of changing behaviors in overcoming substance addiction?

Action/willpower

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What is maintenance?

Maintaining the behavior change

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What is relapse?

Returning to old behaviors and abandoning new changes

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Give 4 examples of classes of depressant psychoactive drugs.

Alcohol
Opioids
Barbiturates
Benzodiazepines

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What are the nonspecific symptoms of depressant intoxification?

Elevated: Mood
Depressed: Anxiety, behavioral inhibition, respiratory, agitation (depressants cause sedation)

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What are the general withdrawal symptoms of depressants?

Anxiety, tremor, seizures, insomnia

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What are the intoxification symptoms seen with alcohol?

Mnemonic: ALCOholS
Ataxia
Lability (emotional)
Coma
Out (blackout)
HOL
Slurred speech

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What can severe alcohol withdrawal cause?

Autonomic hyperactivity and delirium tremens

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How do we treat delirium tremens?

Benzodiazepines

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What are intoxification effects of opioids?

Depression of respiratory and CNS
Euphoria
Decreased gag reflex
Pupillary constriction
Seizures

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How do we treat an opioid overdose?

Naloxone, naltrexone

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What are withdrawal symptoms for opioids?

3 HEENT:

Dilated pupils
Rhinorrhea
Yawning

3 Systemic:

Fever
Sweating
Piloerection (goosebumps)

3 Stomach:

Cramps
Nausea
Diarrhea

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What do we use to treat opioid withdrawal?

Long-term support, methadone, buprenorphine

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Compare and contrast toxicity of benzodiazepine vs. barbiturate intoxification.

Barbiturates - respiratory depression

Benzos - minor respiratory depression, ataxia

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What are withdrawal symptoms for barbiturates?

Delirium, life-threatening cardiovascular collapse

Do barbiturates or benzodiazepines have a greater safety margin?

Benzodiazepines

What are symptoms of benzodiazepine withdrawal?

Sleep disturbance, depression, rebound anxiety, seizure

Give 4 examples of stimulant psychoactive drugs.

1. Amphetamines 2. Cocaine 3. Caffeine 4. Nicotine

What are the nonspecific intoxification effects for stimulant drugs?

Elevated: Mood, psychomotor agitation, cardiac arrythmias, heart rate (tachycardia), anxiety Depressed: Sleep (insomnia)

What are the nonspecific symptoms of stimulant withdrawal?

Post-use "crash" - depression, lethargy, weight gain, headache

What are the intoxification symptoms for amphetamines?

Mnemonic - AMPHETAMINE ``` Attention increase Magnified self view (grandiosity) Pupillary dilation Hypertension Euphoria Tachycardia Awake (prolonged wakefulness) MI (cardiac arrest) Increased temperature (fever) Nervous (paranoia) Eating less (anorexia ```

What are the withdrawal symptoms for amphetamines?

Anhedonia, increased appetite, hypersomnolence, existential crisis

What are the intoxification symptoms for cocaine?

Mnemonic: COCAINE ``` Cardiac death (sudden) treat with benzOs Creating things that aren't there (hallucinations) Angina Impaired judgment Nervous (paranoia) Eyes - pupillary dilation ```

What are the withdrawal symptoms for cocaine?

Hypersomnolence, malaise, severe psychological craving, depression/suicidality

What are the intoxification effects for caffeine?

Restlessness, increased diuresis, muscle twitching

Patient drinks 3 cups of coffee every day and suddenly stops one day. What is he or she likely to experience?

Lack of concentration, headache

What is the number on intoxification effect of nicotine?

Restlessness

What are some symptoms that people who quit cigarettes might experience?

Nicotine withdrawal - irritability, anxiety, craving

What are some possible treatments for someone trying to quit cigarettes (deal with nicotine withdrawal)?

Nicotine patches, gum, or lozenges Bupropion/varenicline

Give three examples of hallucinogens.

PCP, LSD, marijuana

Of the three hallucinogens, which one is not associated with withdrawal symptoms?

LSD

What are the intoxification symptoms of PCP?

Mnemonic: ANGEL DUST ``` Agitation (psychomotor) Nystagmus analGesia Elevated temperature (fever) Loud (belligerent) ``` Delirium Unstable (homicidality, psychosis, impulsiveness) Seizures Tachycardia

What are the withdrawal symptoms of PCP?

Depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep

What are the intoxification symptoms for marijuana?

Mnemonic: MARIJUANA ``` Mouth dry Appetite increased Red eyes (conjunctival injection) Intense feelings of joy (euphoria) Judgment impaired Unstable (paranoid delusions, hallucinations) Anxiety No hurry (perception of slowed time) Alone (social withdrawal) ```

What are the withdrawal symptoms of marijuana?

Irritability, depression, insomnia, nausea, anorexia

What is the prescription form of marijuana?

Dronabinol (tetrahydrocannabinol isomer)

How do you treat ADHD?

Methylphenidate

How do you treat alcohol withdrawal?

Benzodiazepines

How do you treat anxiety?

SSRI's, SNRI's, buspirone

How do you treat bipolar disorder?

Mood stabilizers (lithium, valproic acid, carbamazepine), atypical antipsychotics

How do you treat bulimia?

SSRI's

How do you treat depression?

SSRI's, SNRI's, TCA's, bupropion, mirtazapine (especially with insomnia)

How do you treat OCD?

SSRI's, clomipramine

How do you treat panic disorder?

SSRI's, venlafaxine (think hyperVENtilation), benzodiazepines

How do you treat PTSD?

SSRI's

How do you treat schizophrenia?

Antipsychotics

How do you treat social phobias?

SSRI's, beta blockers

How do you treat Tourette syndrome?

Antipsychotics (e.g. haloperidol, risperidone)

What is a sensitive indicator of alcohol intoxification?

Serum gamma-glutamyltransferase (GGT)

What do AST/ALT values look like when someone is alcohol-intoxicated?

AST twice the ALT

What are CNS stimulants used to treat?

ADHD, narcolepsy, appetite control

What is the mechanism of CNS stimulants?

Increase catecholamines at the synaptic cleft, especially norepinephrine and dopamine

How do you treat intoxification of PCP?

Benzodiazepines, rapid-acting antipsychotic

How do you treat benzodiazepine intoxification?

Flumazenil

How do you treat cocaine intoxification?

Benzodiazepine

Name 2 uses of dronabinol.

1. Antiemetic (chemotherapy) | 2. Appetite stimulant (AIDS)

When do most withdrawal symptoms for marijuana peak?

48 hours, but last for 5-7 days

How can marijuana use be detected?

Urine - for 4 to 10 days

What are heroin users at increased risk for?

``` Hepatitis Enflamed anus (hemorrhoids) Right-sided endocarditis Overdose Immunocompromise (AIDS) Neutrophil-filled abscess ```

What is a life-threatening alcohol withdrawal syndrome and when does it occur?

Delirium tremens - peaks 2 to 5 days after last drink

How do we treat delirium tremens?

Benzodiazepines

What are the symptoms in order of appearance of delirium tremens?

Autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures) Psychotic symptoms (hallucinations, delusions) Confusion

What are 3 treatments for heroin addiction?

1. Methadone 2. Naloxone + buprenorphine 3. Naltrexone

What is methadone?

Long-acting oral opiate used for heroin detoxification or long-term maintenance

PSYCH 513 - 516 Flashcards

(74 cards)