Flashcards in Psych Deck (210):
Pathology in Korsakoff's
Hemorrhage + sclerosis in mammillary bodies, thalamic nuclei
Diffuse lesions in brainstem, cerebellum, limbic system
CBT vs SSRI in generalized anxiety discord (effectiveness)
CTB is as effective as SSRI
Rx of generalized anxiety
SSRI: paroxetine, escitalopram
SNRI: duloxetine, venlafaxine
SSRI/SNRI vs Benzo vs Buspirobe for generalized anxiety
SSRI/SNRI more effective
Defense mechanism in borderline personality
Alzheimer's develops psychotic Sx (hallucinations / delusions)
Dx borderline personality
- unstable relationships
- self-damage act
- can't accept loss
Cocaine intoxication Sx
Sympathetic (tachycardia, HTN, sweating, mydriasis)
+/- paranoia, psychosis
Freud's psychosexual development
1. Oral phase:
Put anything in mouth
2. Anal phase:
Pleasure in anal area
3. Phallic phase:
Manipulation of genitals = 1ry source of pleasure.
4. Latency phase:
Connections to siblings, other children/adults
5. Genital phase:
Relationship w/ opposite sex
Focused on genital area
SE of haloperidol (48hr)
Acute dystonia (torticollis)
It's reversible EPS
Due to DA blockade at nigrostriatial
Rx with benzotropine
Non-pharm Rx of insomnia
CBT to change believes, techniques, attention shift
High DA + NE
Hallucinations + delusions
Activity w/ fatigue
Conversion disorder population
Lack of concern regarding extreme decline in health.
Start suddenly after stress and ends suddenly
Not produced intentionally
Population at risk of suicide
Elderly white men
Unemployed , low income
Hx is abuse (sexual / physical)
Hx of suicide thoughts
FHx of suicide attempts
Schizophrenia = 6 mo
Schizophreform = 1-6 mo
Brief psychosis = < 1 mo
Schizoaffective = psychosis + mood
Schizoid PD = social withdrawal + no desire for relationships
What's discontinuation syndrome
After stopping SSRI
Diarrhea + GI upset
Insomnia, hyperarousal, lightheaded
Vertigo, tremor, paresthesia
Lasts 7 days if stop SSRI after 6wk use.
T/F: adults w/ ADHD impulsive + hyperactive as compared to kids
Patient w/ anorexia
Sever dehydration + orthostatic hypotension + electrolyte imbalance?
- Would you search pt belongings? Why?
- Confirm she's on Rx (contact professionals)
Pts w/ eating disorders use laxative & diuretics
Facility must be informed to look for contraband.
What's Cognitive behavioral Rx?
Recognize + correct false self-beliefs
What's dialectical behavioral Rx?
Part of psychoanalysis/psychodynamic Rx that
Teach patient to analyze what leads up to a problem and identifies alternatives.
Rx of Tourette's
Types of delusions
1. Nihilism = belief that aspects of life are meaningless or non-existing
E.g. Going to work is pointless b/c world is coming to an end
Or no one is real or arm is dead
2. Persecutory = others trying to harm him
3. Grandeur =inflated sense of self
4. Somatic = belief they have physical defect / disease.
My brain is melting
5. Reference = publicly known figures refer to him directly
Percentage of smokers succeed in quitting
T/F: genetics influence smoking persistence
What neuro system involved in reinforcing effect of nicotine
Percentage of population that experiment w/ smoking
Hallmark of PCP (phenocyclidine) intoxication
Dx psychogenic seizure
Cyclothoymia vs dysthymia
1. Cyclo: hypomania + mini depressive Sx for 2 years
2. Dysthymia: persistent mild depression
Hypnagogic vs hypnopompic hallucinations
Hypnoagogic: during sleeep
Hypnopompic: waking up
DOC delirium tremens
IV benzo (lorazepam
Use IM if > 65 YO
DOC panic disorder
1. Mental illness needs inpatient care
2. Danger to safety of patient or others.
Tourette associated w/?
Transform negative emotion to positive action
T/F: imipramine has sigmoidal relationship b/w plasma level and response
T/F: nortriptyline has sigmoidal relationship b/w response and level
F = Curvilinear
MOA of MAOi
Stop degradation of monoamine transmitters and increase their levels
(Serotonin, norepi, dopamine)
MOA of typical antipsychotic
Risperdione + clozapine
SE of clozapine (typical antipsychotic)
Risk for delirium in hospitalized pts
Vision / hearing impairment
Panic disorder associated w/
Asthma + social phobia
When to stop antidepressants
3 month for Rx
6 mo after Rx maintenance
Bipolar on lithium develops hypothyroidism
Don't stop lithium
Limbic system dz
How Dx alcoholism
Ask about problem by alcohol
Serotonin syndrome Sx
Anxiety + agitation + restless
HTN, tachy, fever, sweat, shiver
Hyperreflexia, tremor, rigidity
Rx serotonin syndrome
Stop all med
+/- benzo if anxious and agitated
SSRI + tramadol = ?
SSRI + tramadol = serotonin syndrome
MAOi + tamadol = serotonin syndrome
Maintenance drugs for bipolar
Child with ADHD has future risk of
Normal adult functioning
T/F: D/C SSRIs ass. w/ high rate of relapse
Signs of marijuana abuse
What's reaction formation
Coining extreme opposite
Autism spectrum disorder
Repetitive behavior + normal language
Absolute contraindication to electroconvulsive Rx
Relative = recent cerebral hemorrhage, ICP
T/F: 2/3 of suicide death at 1st attempt
T/F: risk of suicide is higher in blacks
Are SSRIs save in kids?
Yes 8-18 Yrs
SE of long term lithium
T/F: electroconvulsive therapy causes irreversible memory loss
Depression on SSRI => agitation , insomnia , sexual SE?
Rx with Mitrazpine = helps sleep , no agitation , rarely sexual. Helps appetite
NB: bupropion cause agitation!
Labs w/ lithium
Renal + thyroid
SE of anti-psychotics
Rx of neuroleptic syndrome
MOA of resperidone + SE
Dopamine D2 receptor blocker
T/F: phenelzine interacts with st Johns wort and
Levels become unpredictable
Anti depressant worsen HTN
Damage to parietal lobes (Rt + Lt)
Rt = contralateral hemi-neglect , dent deficit (anosagnosia)
Lt = Gerstmann's syndrome = Rt-Lt confusion, can't write, bad math
How to prevent benzo dependence
Use for short time
How are Atypical antipsychotics better than typical?
Cause less tardive dyskinesia
Sx suggestive of major depression
Withdrawal from family
T/F: anorexia nervosa causes:
MC SE of TCA?
What neurotransmitters decreased in depression
Mature defense mechanisms
In healthy adults:
1. Altruism = service to others to experience empathy.
2. Anticipation = palming for future discomfort.
3. Asceticism = deny pleasure from experience.
4. Humor = express feelings in comic way
5. Suppression = postpone attention to impulse.
1. Control = manage events to reduce inner conflicts.
2. Displacement = shift emotions
3. Externalizations = attribute personal matters to external world.
4. Inhibition = limit function to avoid anxiety.
5. Intellectualization = intellectual processing to avoid experiencing affect.
6. Isolation = separate Sth from associate affect.
7. Rationalization = rational explanation to justify action
8. Dissociation = modification of sense of self
9. Reaction formation = transforming unacceptable impulse into opposite
10. Repression = remove idea from conscious
11. Sexualize = bestowing sexual importance to objects
1. Acting out = impulsive action.
2. Block = block thought / impulse
3. Hypochondriasis = exaggerate illness to avoid situations.
4. Introjection = victim identity w/ aggressor
7. Somatization = unconscious expression is psychotic pain in physical Sx.
Denial = replace reality w wishes.
Distortion = reshaping reality
Is bupropion used in panic attacks? Why?
Drugs contraindicated with lithium
Antipsychotic causes high glucose
What antipsychotic cause withdrawal if stopped abruptly?
Venlafaxine (?) short half life and rapid clearance if D/C
Mood stabilizers used in maniac episodes
Monotherpay induces mania in Bipolar
What's Tarasoff decision
Inform authorities when patient show intent towards a person
Keep patient in office till safe disposition is made
Neurotransmitter in OCD?
How to shift safely from MOAi to SSRI
Allow for 2 wk wash out period between stopping MOAi and starting SSRI
T/F: repeated episodes of alcohol withdrawal increase risk of future Sx?
Use hospital environment as therapeutic intervention.
SE of olanzapine
Dry mouth (xerostomia)
Panic disorder + BPH
Addiction vs pseudo-addiction
Pseudo is how patients behave when pain is under treated and resolve completely when pain is effectively Rx.
What schizophrenic Sx respond well to anti psychotics
T/F: antipsychotic don't cause urinary incontinence
MAOi contraindicated with what food
1st line in ADHD
Does ADHD cause intellectual disability
Psychotherapy for panic disorder
Cause of seasonal affective
Melatonin in seasonal affective
SE of methylphenidate in ADHD
MCC of delirium
SE of antipsychotic + Rx
Tremor, Bradykinasia, micrographia
Rx: low dose, shift to atypical, anti-cholinergic
Anticonvulsant for mania
When dose delirium termens start + how long last
Start 3-7 days after stopping
Last 7-10 days
% of alcoholic develop DT
Death from DT
Death 35% if untreated + 5% of Rx
Pacing in Alzheimer's not Rx with anti cholinesterase
No additional Rx
Deal with paranoid patient
Explain diagnosis + Rx in details
Professional not too friendly
Piaget's Stage of cognition
1. Sensorimotor 0-2 Yrs
Explore via sensation + motor contact
2. Pre-operational 2-6
Symbols (words + images)
3. Concrete operational 7-12
Logical about concrete objects
Add + subtract
4. Formal operational >12
What's schizophrenia drift
Schizophrenia patient move to cities + become urban poor
It's not urban poor that cause the disease it's where patients end up
Approach patient in biological psychological social manner
Drugs cause depression (15)
Anticonvulsant: Metho + ethosuximide
Barbiturates: phenobarb + secobarb
BB: metoprolol, atenolol, carvedilol
Triad in Tourette's
Males (9x more )
Alpha2-adrenergic = clonidine (less efficacy, less SE)
Dopamine antagonist: Haloperidol + pimozide (more effective, more SE)
Cardiac side effect of anti-psychotic
Torsades de pointes
Anti-psychotics cause hypertensive encephalopathy
TCA + MAOi
Tyramine + MAOi
How to safely shift from one antipsychotic to another
Gradual reduction in dose of 1st drug then overlap with the 2nd drug before completely stopping the 1st one.
Rx of seasonal effective
early morning light therapy
T/F: Mania could be a Sx of MS
Is stammering ass with conversion disorder
Premenstrual dysphoric disorder Rx
During luteal phase lead to missing work.
Trazodone sexual SE
Rx of bulimia
SSRI esp. fluoxetine
Tardive dyskinesia high risk population
Hx or FHx of mood disorders or affective disorders.
How to deal with borderline personality clinic setting
Maintain caring but detached stance.
Combine conflict resolution + social learning to minimize aggression
Be constantly available on phone
Frequent visits to monitor and provide support.
When explaining to borderline personality;
1. Detailed + technical
2. Simple + clear + non technical
Do you prescribe drugs for borderline? Why?
Use it to self-harm themselves.
Drug contraindicated with MAOi (analgesics)
Goal of Rx in anorexia nervosa
Prevent death from malnutrition
DOC in alcohol withdrawal
Short-acting benzo (liver impairment = short)
Longing for cigarette
Sx in 2 hrs.
Palpitations + chest pain
Resp. depression => acidosis + low O2
Drugs cause mania
Steroids + anabolic steroids
Psychiatric disease with T1DM?
Adjustment disorder + MDD
Rx of delirium in ICU
IV haloperidol increase dose q3min
Rx of social phobias
Anti depressant doesn't cause weight gain
Anti depressant cause weight gain
Mirtazapine > SSRIs (paroxetine > fluoxetine)
% of elderly with depression
20% in community
40% in nursing homes
T/F: TCA contraindicated in elderly
True cause postural hypotension + falls.
Dressing and acting in manner of opposite sex
When does transvestism start?
Common in M or F?
Do they seek help?
Starts late childhood
M > F
Don't present for Rx
SE of amphetamine for ADHD
Transient insomnia + weight loss
Bipolar 1 vs 2
1: mania + depression
2: hypomania + depression
What's not considered conversion according to DSM 5
Sx limited to pain or sexual dysfunction
OCD risk in monozygotic twins?
OCD more in M or F?
F (adults + kids)
Shortest half life benzo?
Alprazolam (xanax) 12 hrs.
Body dysmorphic asso
SSRI in elderly
Risk of falls
Activated charcoal helps in 90% of toxins except?
Sleep terror vs nightmare
Sleep terror = can't remember nightmares
Nightmare = remember
Anxiety vs OCD
Compulsions in OCD only.
MC neuro SE of SSRI
Insomnia > headache
What personality doesn't learn form experience + or feel guilt
Atypical depression Sx
Worst in morning and better at evening (diurnal variation in mood)
When is MAOi DOC?
Rx of serotonin syndrome
Sleep abnormality in depression
Decreased REM latency
What's paraphilia? Example
Sexually arousing fantasies
T/F: Homosexuality is not paraphilia
MC endocrine SE of lithium
Hypothyroid > DI
Bupropion is contraindicated in?
Anorexia / bulimia
Hallucinations in narcolepsy
At sleep (hypnogogic)
On wakening (hypnopompic)
How to establish rapport?
Ask about feelings
How do disulfiram + Naltrexone work in alcoholism
Disulfiram = accumulates acetaldehyde
Naltrexone = decrease cravings
In bipolar when does mania recur if lithium stopped
Most effective mono therapy in alcoholism
Risk of schizophrenia in monozygotic
Anti depressant avoid in anorexia nervosa
T/F: lanugo hair in anorexia
Arrhythmia needs pacemaker
Rx of sducidal ideation
What overdose is more fatal?
Benzo or amitriptyline
TCA > benzo
T/F: opiates cause constricted pupils
Opiates: heroine, hydrocodone, oxycodone, hydromorphone, oxymorphone
Atypical cocaine dependence
Snorting (inflamed nares : big turbinates)
Dr reminded of relative by a patient?
Patient sexually attracted to Dr
T/F: Depression in kids presents as antisocial behaviors
T/F: kids with depression will have schizophrenia as adults
Psychosis + Parkinson's Rx
Atypical antipsychotics: queitapine + clozapine
OBGYN SE of antipsychotics
Typical antipsychotic (risperidone)
Block dopamine = high prolactin = amenorrhea, infertility, galactorrhea
Criteria for somatic symptom disorder
Excessive thoughts ass. with the Sx
=> seriousness of Sx
=> anxiety about general health
=> time + energy to figure out Dx
Rx of narcolepsy
Childhood gender identity disorder starts at? How?
Kids cross-dress + opposite gender games
Hate their genitals
Bupropion in panic disorder
Drugs for methamphetamine dependence?
Cognitive Rx only
School phobia vs truancy
Truancy: leave home but skip school
Phobia: Sx every morning disappear at weekends
Agitated with Hx of dystonia
Benzo vs haloperidol
Benzo with shortest elimination half life
Flooding vs grader exposure Rx in phobia
Flooding: exposed and asked to reintegrate the subject, and remain there till anxiety resolve
Exposure: showing picture then going there
Capgras syndrome in psych
Patient thinks person replaced by exact double that acts exactly like original
Rx PTSD (psych)
Atypical antipsychotics (quetiapine, olanzapine, risperidone)
To diagnose adult ADHD
When should Sx start?
Earliest SE of lithium
Valproic acid vs carbamazepine in bipolar
Valproate for maniac episodes
Carbamazepine if multiple maniac episodes, mixed or rapid cycling
Which SSRI doesn't cause D/C syndrome
Bcz long 1/2 life of 4-6 days
ID, Ego, superego
Unconscious = primitive + instinctive
Based on reality
Satisfied ID in realistic ways
Morals + standards
Acquired from parents, society and sense of right.
Drug not helpful in tardive dyskinesia
Vitamin E in tardive dyskinesia
Short duration of benefit
Metabolic SE of valproate
High ammonia due to low carnitine
Dx. Replace carnitine
Insomnia in depression on SSRI
Trazdone or zolpidem
Delirium tremens in >65 Rx
Short acting benzo (lorazepam)
Cough / URTI drug causes serotonin syndrome if used with SSRIs