Flashcards in Psych Deck (43):
What class of drug do you use while you're waiting for SSRI to take effect in the management of GAD?
What property of methadone justifies its substitution w/ heroine?
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?
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
Anti-emetics: ondansetron (serotonin antagonist)
2 things that can be used to treat serotonin syndrome
Cytoheptadine (anti-serotonin and anti-histamine)
Signs of chronic lithium toxicity? How do you acutely fix this?
Ataxia, coarse tremor, fascicular twitching
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+)
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
Drugs that might precipitate mania?
Any anti-depressants really -> TCAs, venlafaxine esp high risk
So this is a potential consequence if pt w/ bipolar comes in w/ depressed phase and is incorrectly dx and prescribed antidepressant
What drugs should you caution pts to avoid during benzodiazepine tx?
Anything that causes sedation! Benzos (esp long-acting ones) already causes sedation as a common side effect,; adding anything that also causes sedation might increase risk of falls and impaired balance -> think 1st generation antihistamines, barbiturates, neuroleptics, alcohol
Don't even worry about drugs causing P450 interactions, worry about sedation first!
2 types of operant conditioning?
Reinforcement (main goal is to INCREASE behavior): positive (give reward to increase behavior), negative (removes punishment to increase behavior)
Punishment (main goal is to DECREASE behavior): positive (give punishment to decrease behavior), negative (remove reward to decrease behavior)
Pt on med for mood swings and sleep problems now presents w/ constipation, dry skin, hair loss, and weight gain. What's the med?
Lithium! These are sx of hypothyroidism (well known lithium side effects) esp if they're in assc. w/ bradycardia
Don't even think about clozapine even if that causes weight gain too -> the prominent toxicities are agranulocytosis and seizures for that one
What does long-term alcohol use do to GABA and NMDA receptors? Other neurotransmitters?
Downregulates GABA-A receptors
Upregulates NMDA receptors
Also increases synthesis of excitatory mediators like NE, serotonin, dopamine
What's the appropriate length before following up postpartum blue?
2 weeks -> b/c if sx persists after 2 wks it'll be considered postpartum depression and need to start considering using antidepressants
What receptor is involved in nicotine dependence? What drug targets this?
Stimulation of a4b2-nicotinic ACh receptor in CNS
Varenicline is a partial agonist (competes w/ nicotine) -> reduces withdrawal cravings and attenuating rewarding effects
How do you distinguish bet. bulimia and anorexia w/ eating/purging type?
If there's amenorrhea and osteoporosis & BMI under certain level -> anorexia
Timeline for PTSD vs. acute stress disorder?
Acute stress disorder
Both opioid withdrawal and cocaine intoxication present w/ dilated pupils. How do you tell them apart?
Yawning and lacrimation are specific to opioid withdrawal!
What are sx of benzodiazepine withdrawal and what's the feared complication?
Tremors, anxiety, depersonalization, dysphoria, psychosis
Might get seizures! (like alcohol withdrawal)
How do you distinguish bet. schizoaffective disorder and major depressive/bipolar disorder w/ psychotic features?
Schizoaffective: psychosis must occur in absence of mood episode at some point but mood sx have to be present for most of the illness
Major depressive/bipolar w/ psychotic features: psychotic sx occur exclusively during mood episodes
2 most immediate sx of marijuana use?
Tachycardia and conjunctival injection
PTSD/acute stress disorder vs. normal grief?
Normal grief can have hallucination component (as long as there are no other psychotic, severe mood sx, behavioral problems)
But hallucinations are NOT the same thing as nightmares and flashbacks present in PTSD or acute stress disorder!
What's the majority of overdose deaths in the US?
Pt likes to keep very clean and spends 3-4 hrs a day washing hands. Got fired from a job for "refusing to touch keyboards." OCD or specific phobia?
OCD -> b/c compulsive washing is a prominent feature
What is the atypical antipsychotic most likely to cause EPS? Least likely?
Most likely to cause EPS: risperidone
Least likely: clozapine -> so use this if antipsychotics are causing tardive dyskinesia, but only used as last resort b/c of agranulocytosis
Main characteristic of ATYPICAL depression that sets it apart from major depression? And why is this clinically important?
Mood reactivity (improvement in mood in response to something positive)
If this is present, MAOIs might be useful