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Flashcards in Psych - First Aid Deck (308)
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1
Q

Classical conditioning

A

Learning in which a natural response is elicited by a conditioned stimulus that previously was presented in conjunction with an unconditioned stimulus. Ex. Pavlov's dogs

2
Q

Classical conditioning usually deals with...

A

involuntary responses.

3
Q

Operant conditioning

A

learning in which a particular action is elicited becasue it produces a punishment or reward

4
Q

Operant conditioning usually deals with...

A

voluntary responses.

5
Q

Positive reinforcement

A

desired reward produces action (mouse presses button to get food)

6
Q

Negative reinforcement

A

target behavior (response) is followed by removal of averse stimulus (mouse presses button to turn off continuous loud noise)

7
Q

Punishment

A

repeated application of aversive stimulus extinguishes unwanted behavior

8
Q

Extinction

A

discontinuation of reinforcement (positive or negative) eventually eliminates the behavior. Can occur in operant or classical conditioning

9
Q

Transference

A

pt projects feelings about formative or other importnat persons onto physician (ex. psychiatrist is seen as a parent)

10
Q

Countertransference

A

doctor projects feelings about formative or other important persons onto pt (ex. pt reminds physician of younger sibling)

11
Q

Acting out

A

expressing unacceptable feelings and thoughts through actions Ex. tantrums

12
Q

Dissociation

A

temporary, drastic change in personality, memory, consciousness or motor behavior to avoid emotional stress ex. extreme forms can result in dissociative identity disorder

13
Q

Denial

A

avoiding the awareness of some painful reality ex. a common rxn in newly diagnosed AIDS and cancer pts

14
Q

Displacement

A

transferring avoided ideas and feelings to some neutral person or object Ex. mother yells at her child bc her husband yelled at her

15
Q

Fixation

A

partially remaining at a more childish level of development Ex. men fixating on sports games

16
Q

Identification

A

modeling behavior after another person who is more powerful ex. abused child identifies with abuser

17
Q

Isolation

A

separating feelings from ideas and events ex. describing murder in graphic detail with no emotional response

18
Q

Projection

A

attributing an unacceptable internal impulse to an external source ex. a man who wants another woman thinks his wife is cheating on him

19
Q

Rationalization

A

proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame Ex. after getting fired, claiming that the job was not important anyway

20
Q

Reaction formation

A

replacing a warded-off idea or feeling by an (unconsciously derived) emphasis on its opposite ex. a pt with libidinous thoughts enters a monastery

21
Q

Regression

A

turning back the maturational clock and going back to earlier modes of dealing with the world ex. seen in children under stress (illness, punishment, new sibling) - bedwetting in a previously toilet-trained child

22
Q

Repression

A

involuntary witholding an idea or feeling from conscious awareness Ex. not remembering a conflictual/traumatic experience; pressing bad thoughts into the unconscious

23
Q

Splitting

A

believing that people are either all good or all bad at different times due to intolerance of ambiguity ex. pt says that all nurses were cold/insensitive but the doctors were warm/friendly

24
Q

Splitting is often seen in...

A

borderline personality disorder.

25
Q

Altruism

A

alleviating guilty feelings by unsolicited generosity towards others Ex. mafia boss makes large donation to charity

26
Q

Humor

A

appreciating the amusing nature of an anxiety-provoking or adverse situation Ex. nervous med student jokes about boards

27
Q

Sublimation

A

replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one's value system Ex. teen's aggression toward his father is redirected to perform well in sports

28
Q

Suppression

A

intentional witholding of an idea or feeling from conscious awareness ex. choosing not to worry about the big game until it is time to play

29
Q

Long-term deprivation of affection in infants leads to...

A

-decreased muscle tone -poor language skills -poor socialization skills -lack of basic trust -anaclitic depression -weight loss -physical illness

30
Q

Deprivation in an infant for more than 6 months can...

A

lead to irreversible changes. Severe deprivation can result in death.

31
Q

The main physical abuser of children is usually...

A

the biological mother and usually occurs before the age of 3.

32
Q

Peak age of sexual abuse in children

A

9-12 (signs: genital, anal or oral trauma, STDs, UTIs)

33
Q

Evidence of physical abuse

A

-healed fractures on x-ray (esp. spinal) -burns -subdural hematomas -pattern marks/bruising -rib fractures -retinal detachment/hemorrhage

34
Q

The most common form of child maltreatment is...

A

child neglect which is the failure to provide a child with food, shelter, supervision, education and affection.

35
Q

Evidence of child neglect

A

-poor hygiene -malnutrition -withdrawal -impaired social/emotional development -FTT

36
Q

Attention Deficit Hyperactivity Disorder (ADHD)

A

-onset before 12 -poor impulse control -normal intelligence but has difficulty in school

37
Q

ADHD is associated with...

A

decreased frontal lobe volume/metabolism

38
Q

Treatment for ADHD

A

-methylphenidate -amphetamines -atomoxetine -behavioral interventions

39
Q

Conduct Disorder

A

-repetitive, pervasive behavior violating the basic rights of others (physical aggresion, property destruction, theft)

40
Q

After the age of 18, many with conduct disorder will meet the criteria for...

A

antisocial personality disorder.

41
Q

Oppositional Defiant Disorder

A

-enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms

42
Q

Tourette Syndrome

A

-onset before 18 -sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for more than 1 year

43
Q

Coprolalia is...

A

involuntary obscene speech. Seen in only 10-20% of those with Tourette's.

44
Q

Tourette's is associated with...

A

OCD and ADHD.

45
Q

Treatments for Tourette's

A

-antipsychotics -behavioral therapy

46
Q

Separation anxiety disorder

A

-onset 7-9 yrs -overwhelming fear of separation from home or loss of attachment figure -may lead to factitious physical complaints to avoid going to school

47
Q

Treatment for Separation anxiety disorder

A

-SSRIs -relaxation/behavioral interventions

48
Q

Pervasive developmental disorders are characterized by...

A

difficulties with language and failure to acquire or early loss of social skills.

49
Q

Pervasive developmental disorders

A

1. Autism spectrum disorder 2. Rett Disorder

50
Q

Autism is characterized by...

A

poor social interactions, communication deficits, repetitive behaviros and restricted interests.

51
Q

Autism must present in...

A

early childhood and may or may not be accompanied by intellectual disability. More common in boys.

52
Q

Rett disorder

A

-X-linked disorder almost exclusively in girls -symptoms appear at 1-4 yrs old -regression, loss of development and verbal abilities -ataxixa -intellectual disability -sterotyped hand-wrigning

53
Q

Alzheimer NT changes

A

decreased ACh

54
Q

Anxiety NT changes

A

increased NE decreased GABA and serotonin

55
Q

Depression NT changes

A

decreased NE, serotonin and dopamine

56
Q

Huntington NT changes

A

decreased GABA and ACh increased dopamine

57
Q

Parkinson NT changes

A

decreased dopamine increased serotonin and ACh

58
Q

Schizophrenia NT changes

A

increased dopamine

59
Q

Common causes of loss of orientation

A

-alcohol/drugs -fluid/electrolyte imbalance -head trauma -hypoglycemia -infxn -nutritional deficiencies

60
Q

Order of loss of orientation

A

1st - time 2nd - place last - person

61
Q

Retrograde amnesia

A

inability to remember things that occurred before a CNS insult

62
Q

Anterograde amnesia

A

inability to remember things that occured after a CNS insult (no new memories)

63
Q

Korsakoff amnesia

A

-classic anterograde amnesia caused by thiamine deficiency and the associated destruction of mammillary bodies -seen in alcoholics and associated with confabulations

64
Q

Dissociative amnesia

A

inability to recall important personal information, usually subsequent to severe trauma or stress

65
Q

Dissociative amnesia may be associated by...

A

dissociative fugae (abrupt travel or wandering during a period of dissociative amnesia)

66
Q

Cognitive disorder

A

-significant changes in cognition (memory, attention, language, judgement)

67
Q

Cognitive disorder includes...

A

delirium and dementia.

68
Q

Delirium

A

-waxing and waning level of consciousness with acute onset -rapid decrease in attention span and level of arousal -disorganized thinking, hallucinations, illusions, misperceptions, disturbance in sleep, cognitive dysfunction -abnormal EEG

69
Q

Delirium is usually secondary to...

A

another illness: -CNS disease -infxn -trauma -substance abuse/withdrawal -metabolic/electroly disturbances -hemorrhage -urinary/fecal retention

70
Q

If a patient has delirium, check for...

A

drugs with anticholinergic effects. Usually reversible.

71
Q

Dementia is a...

A

gradual decrease in intellectual ability or cognition without affecting levels of consciousness.

72
Q

Dementia is characterized by...

A

memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavioral/personality changes, impaired judgement. (EEG usually normal)

73
Q

A patient with dementia can develop...

A

delirium. Ex. a pt with AD who develps pneumonia is at increased risk for delirium.

74
Q

Irreversible causes of dementia

A

-Alzheimer disease -Lewy body dimentia -Huntington disease -Pick disease -cerebral infarcts -Creutzfeldt-Jakob disease -chronic substance abuse

75
Q

Reversible casues of dementia

A

-NPH -vitamin B12 deficiency -hypothyroidism -neurosyphilis -HIV

76
Q

In elderly pts, depression may present...

A

like dementia (pseudodementia).

77
Q

Psychosis

A

a distorted perception of reality characterized by delusions, hallucinations, and/or disorganized thinking

78
Q

Hallucinations

A

perceptions in the absence of external stimuli (seeing a light that is not actually present)

79
Q

Delusions

A

unique, false beliefs about oneself or others that persist despite the facts (thinking aliens are communicating with you)

80
Q

Disorganized speech

A

words and ideas are strung together based on sounds, puns or loose associations

81
Q

Visual hallucinations are more commonly a feature of...

A

medical illness (drug intoxication) than psychiatric illness.

82
Q

Auditory hallucinations are more commonly a feature of...

A

psychiatric illness (schizophrenia) than medical illness.

83
Q

Olfactory hallucinations often occur as...

A

an aura of psychomotor epilepsy and in brain tumors.

84
Q

Tactile hallucinations are common in...

A

alcohol withdrawal (formicatin = sensation of bugs crawling on one's skin); also seen in cocaine abuse.

85
Q

Hypnagogic hallucinations occurs...

A

while going to sleep.

86
Q

Hypnopompic hallucinations occur...

A

when waking from sleep.

87
Q

Schizophrenia is a...

A

chronic mental disorder with periods of psychosis, disturbed behavior and thought, and decline in functioning that lasts more than 6 months.

88
Q

Schizophrenia is associated with...

A

increased dopaminergic activity and decreased dendritic branching.

89
Q

Diagnosis of Schizophrenia requires 2 or more of the following:

A

1. delusions 2. hallucinations 3. disorganized speech (loose associations) 4. disorganized or catatonic behavior 5. negative symptoms (flat affect, social withdrawal, lack of motivation, lack of speech/thought)

90
Q

Brief sychotic disorder

A

less than one month, usually stress related

91
Q

Schizophreniform disorder

A

1-6 months

92
Q

Schizoaffective disorder

A

at least 2 wks of stable mood with psychotic symptoms plus a major depressive, manic or mixed episode

93
Q

In teens, psychosis/schizophrenia is associated with...

A

frequent cannabis use.

94
Q

Schizophrenia presents in men...

A

earlier (late teens to early 20s) than women (late 20s to early 30s).

95
Q

Delusional Disorder

A

fixed, persistent, untrue belief system lasting more than one month Ex. woman who genuinely believes she is married to a celebrity

96
Q

Dissociative Identity Disorder

A

presence of 2 or more distinct identities or personality states; more common in women

97
Q

Dissociative Identity Disorder is associated with...

A

hx of sexual abuse, PTSD, depression, substance abuse, borderline personality disorder and somatoform conditions

98
Q

Depersonalization/Derealization Disorder

A

persistent feelings of detachment or estrangement from one's own body, thoughts, perceptions and actions (depersonalization) or one's environment (derealization)

99
Q

Mood disorder

A

characterized by an abnormal range of moods or internal emotional states and loss of control over them; severity of mood causes distress and impairment in social and occupational functioning

100
Q

Mood disorders include...

A

major depressive disorder, bipolar disorder, dysthymic disorder and cyclothymic disorder

101
Q

Manic episode

A

distinct period of abnormally, persistently elevated, expansive or irritable mood and increased activity/energy lasting at least one week

102
Q

Diagnosis of Manic episode requires hospitalization or at least three of the following:

A

manics DIG FAST 1. Distractibility 2. Irresponsibility 3. Grandiosity 4. Flight of Ideas 5. increase in goal-directed Activity/psychomotor Agitation 6. decreased need for sleep 7. Talkativeness

103
Q

Hypomanic episode

A

like manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization; lasts at least 4 consecutive days

104
Q

Bipolar I is defined by...

A

the presence of at least 1 manic episode with or without a hypomanic or depressive episode.

105
Q

Bipolar II is defined by...

A

the presence of a hypomanic and a depressive episode.

106
Q

Between episodes in bipolar, pts mood and functioning usually...

A

returns to normal.

107
Q

Use of antidepressants can lead to...

A

increased mania. High suicide risk in bipolar.

108
Q

Treatment for Bipolar

A

-mood stabilizers (lithium, valproic acid, carbamazepine) -atypical antipsychotics

109
Q

Cyclothymic disorder

A

-dysthymia and hypomania -milder form of bipolar lasting at least 2 yrs

110
Q

In major depressive disorder (MDD), episodes usually last...

A

6-12 months.

111
Q

MDD episodes are charachterized by at least 5 of the following 9 symptoms for 2 or more weeks

A

-sleep disturbance -loss of interest (anhedonia) -guilt or feelings of worthlessness -energy loss and fatigue -concentration problems -appetite/weight changes -psychomotor retardation or agitation -suicidal ideations -depressed mood

112
Q

Pts with depression typically have the following changes in their sleep stages:

A

-decreased slow wave sleep -decreaesd REM latency -increased REM early in sleep cycle -increased total REM -repeated nighttime awakenings -early-morning awakening

113
Q

Persistent, depressive disorder (dysthymia)

A

depression, often milder, lasting at least 2 yrs

114
Q

Seasonal affective disorder

A

symptoms usually associated with winter season; improves in response to full-spectrum bright-light exposure

115
Q

Atypical depression is characterized by...

A

mood reactivity, reversed vegetative symptoms (hypersomnia and weight gain), leaden paralysis, and interpersonal rejection sensitivity

116
Q

Treatment of Atypical Depression

A

-MAO inhibitors -SSRIs

117
Q

Postpartum mood disturbances has onset within...

A

4 wks of delivery

118
Q

Maternal (postpartum) blues are characterized by...

A

depressed affect, tearfulness, and fatigue starting 2-3 days after delivery.

119
Q

Maternal blues usually resolves...

A

within 10 days. Treatment is supportive and requires follow-up.

120
Q

Postpartum depression is characterized by...

A

depressed affect, anxiety and poor concentration starting within 4 wks after delivery. It lasts 2 wks to a year or more.

121
Q

Postpartum psychosis is characterized by...

A

delusions, hallucinations, confusion, unusual behavior and possible homicidal/suicidal thoughts/attempts. Usually lasts days to wks.

122
Q

Pathologic grief is...

A

normal bereavement characterized by shock, denial, guilt and somatic symptoms. Duration varies (up to 6-12 months). May experience simple hallucinations (ex. hearing name called).

123
Q

Electroconvulsive therapy

A

treatment option for MDD refractory to other treatment and pregnant women with MDD; also considered when immediate response is necessary, in depression with psychotic features and for catatonia.

124
Q

ECT produces...

A

a relatively painless seizure in an anesthetized pt.

125
Q

Adverse effects of ECT include...

A

disorientation, temporary HA and partial amnesia (resolves).

126
Q

Risk factors for suicide completion

A

SAD PERSONS -sex (male) -age (teen or elderly) -depression -previous attempt -ethanol or drug use -loss of rational thinking -sickness -organized plan -no spouse -social support lacking

127
Q

Symptoms of anxiety disorder will...

A

interfere with daily functioning.

128
Q

Anxiety disorder includes...

A

panic disorder, phobias, and generalized anxiety disorder.

129
Q

Panic Disorder is defined by...

A

the presence of recurrent panic attacks (periods of intense fear and discomfort peaking in 10 min with at least 4 of the following): 1. palpitations 2. paresthesias 3. Abdominal distress 4. Nausea 5. intesnse fear of dying or losing control 6. light-headedness 7. chest pain 8. chills 9. choking 10 disconnectedness 11. sweating 12. shaking 13. shortness of breath *strong genetic component

130
Q

Treatment for Panic Disorder

A

-behavioral therapy -SSRIs -venlafaxine -benzodiazepines

131
Q

Diagnosis of Panic Disorder requires an attack followed by 1 month of at least 1 of the following:

A

1. persistent concern of additional attacks 2. worrying about the consequences of the attack 3. behavioral change related to the attacks

132
Q

Specific phobias can be treated with...

A

systematic desensitization.

133
Q

Types of specific phobia

A

-social anxiety disorder -agoraphobia

134
Q

Social Anxiety Disorder can be treated with...

A

SSRIs.

135
Q

Agoraphobia is...

A

exaggerated fear of open or enclosed places, using pulbic transportation, being in line or in crowds or leaving home.

136
Q

Generalized anxiety disorder is a pattern of...

A

uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation or event.

137
Q

Generalized anxiety disorder is associated with...

A

sleep disturbance, fatigue, GI disturbance and difficulty concentrating.

138
Q

Treatment for Generalized Anxiety Disorder

A

-SSRIs -SNRIs -Buspirone -Cognitive behavioral therapy

139
Q

Ego dystonic obsessive-compulsive disorder is...

A

inconsistent with one's own beliefs and attitudes.

140
Q

Treatment of OCD

A

-SSRIs -Clomipramine

141
Q

In PTSD, the disturbance lasts...

A

more than one month causing significant distress, negative cognitive alterations and/or impaired functioning.

142
Q

Treatment of PTSD

A

-psychotherapy -SSRIs

143
Q

Acute stress disorder lasts...

A

between 3 days and 1 month.

144
Q

Malingering

A

patient consciously fakes, profoundly exaggerates or claims to have a disorder in order to attain a specific secondary (external) gain (avoiding work or obtaining compensation)

145
Q

Pts who are malingering have...

A

poor compliance with treatment and follow-up tests and their complaints stop after the gain.

146
Q

Factitious disorders

A

pt consciously creates physical and/or psychological symptoms in order to assume "sick role" and to get medical attention (primary (internal) gain)

147
Q

Munchausen Syndrome

A

Chronic factitious disorder with predominantly physical signs and symptoms

148
Q

Munchausen Syndrome is characterized by...

A

a history of multiple hospital admissions and willingness to receive invasive procedures

149
Q

Munchausen Syndrome by proxy

A

when illness in a child or elderly pt is caused by the caregiver; motivation is to assume a sick role by proxy

150
Q

Somatic symptom, etc. is a category of disorders characterized by...

A

physical symptoms with no identifiable phyical cause; both the illness production and motivation are unconscious drives; symptoms are not intentionally produced or feigned

151
Q

Conversion disorder

A

-sudden loss of sensory or motor function, often following an acute stressor; pt is aware of but sometimes indifferent toward symptoms (la belle indifference)

152
Q

Illness anxiety disorder (hypochondriasis)

A

preoccupation with and fear of having a serious illness despite medical evaluation and reassurance

153
Q

Cluster A Personality Disorders (Weird)

A

1. Paranoid 2. Schizoid 3. Schizotypal (Accusatory, Aloof, Awakward)

154
Q

Cluster A Personality Disorders Features

A

-odd/eccentric -inability to develop meaningful social relationships -no psychosis -genetic association with schizophrenia

155
Q

Paranoid Personality Disorder

A

pervasive distrusta nd suspiciousness; projection is the major defense mechanism

156
Q

Schizoid Personality Disorder

A

Voluntary social withdrawal, limited emotional expression, content with social isolation

157
Q

Schizotypal Personality Disorder

A

eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness

158
Q

Cluster B Personality Disorder Features

A

-dramatic, emotioinal or erratic -genetic association with mood disorders and substance abuse

159
Q

Antisocial Personality Disorder

A

-disregard for and violation of rights of others, criminality, impulsivity *must be older than 18 and have a hx of conduct disorder before age 15

160
Q

Borderline Personality Disorder

A

-unstable mood and interpersonal relationships -impulsiveness -self-mutilation -boredome -sense of emptiness **more common in females

161
Q

A major defense mechanism of borderline personality disorder is...

A

splitting.

162
Q

Histrionic personality disorder

A

excessive emotionality and excitability attention seeking sexually provocative overly concerned with appearance

163
Q

Narcissistic personality disorder

A

-grandiosity -sense of entitlment -lackes empathy and requires excessive admiration -often demands the "best" and reacts to criticism with rage

164
Q

Cluster C personality disorder features

A

-anxious or fearful -genetic association with anxiety disorders

165
Q

Avoidant Personality Disorder

A

-hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others

166
Q

Dependent Personality Disorder

A

-submissive and clinging -excessive need to be taken care of -low self-confidence

167
Q

Anorexia is associated with...

A

decreased bone density metatarsal stress fractures amenorrhea lanugo anemia electrolyte disorders

168
Q

The osteoporosis seen in anorexia is partly due to...

A

decreased estrogen over time.

169
Q

Bulimia nervosa is associated with...

A

parotitis enamel erosion electrolyte disturbances alkalosis dorsal hand calluses (Russel sign)

170
Q

DDx for Sexual Dysfunction Disorders include:

A

-drugs (antihypertensives, neuroleptics, SSRIs and ethanol) -diseases (depression, diabetes, STDs) -psychological (performance anxiety)

171
Q

Sleep terror disorder occurs during...

A

slow-wave sleep, non-REM (thus, no memory upon arousal); most commonly in children.

172
Q

Nightmares occur during...

A

REM sleep (and thus, you have a memory of it).

173
Q

Triggers of sleep terror disorder include...

A

emotional stress, fever or lack of sleep.

174
Q

Narcolepsy is...

A

disordered regulation of sleep-wake cycles with the primary characteristic being excessive daytime sleepiness. *strong genetic component

175
Q

Narcolepsy is caused by a decrease in...

A

orexin production in the lateral hypothalamus.

176
Q

Narcolepsy is associated with (3):

A

1. hypnagogic/hypnopompic hallucinations 2. nocturnal and narcoleptic episodes that begin with REM 3. cataplexy

177
Q

Cataplexy is...

A

loss of all muscle tone following a strong emotional stimulus, such as laughter)

178
Q

Treatment for Narcolepsy:

A

-daytime stimulants (amphetamines, modafinil) -nighttime sodium oxybate (GHB)

179
Q

Substance use disorder is defined as a maladaptive pattern of substance use defined as 2 or more of the following signs in one year:

A

-tolerance -withdrawal -substance taken in larger amounts or over longer time, than desired -persistant desire/unsuccessful attempts to cut down -significant energy spent obtaining, using or recovering from substance -importnat social, occupational or recreational activities reduced -continued use in spite of the knowledge that it causes a problem -craving -recurrent use in physically dangerous situations -failure to fulfill major obligations at work, school, home -social/interpersonal conflicts

180
Q

6 Stages of Change in overcoming substance abuse

A

1. Precontemplation 2. Contemplation 3. Preparation/determination 4. Action/willpower 5. Maintenance 6. Relapse

181
Q

Nonspecific symptoms of intoxication with a depressant

A

-mood elevation -decreased anxiety -sedation -behavioral disinhibition -respiratory depression

182
Q

Nonspecific symptoms of withdrawal from a depressant

A

-anxiety -tremor -seizures -insomnia

183
Q

Depressants (4)

A

-alcohol -opioids -barbituates -benzodiazepines

184
Q

Symptoms of alcohol toxicity

A

-emotional lability -slurred speech -ataxia -coma -blackouts

185
Q

A sensitive indicator of alcohol use is...

A

serum gamma-glutamyltransferase (GGT).

186
Q

Symptoms of alcohol withdrawal

A

-if severe, can cause autonomic hyperactivity and DTs

187
Q

Treatment for DTs from alcohol withdrawal

A

benzodiazepines

188
Q

Symptoms of opioid intoxication

A

-euphoria -respiratory/CNS depression -decreased gag reflex -pupillary constriction -seizure

189
Q

Treatment for Opioid intoxication

A

Naloxone, Naltrexone

190
Q

Symptoms of Opioid withdrawal

A

-sweating -dilated pupils -piloerection -fever -rhinorrhea -yawning -nausea -stomach cramps -diarrhea

191
Q

Treatment for opioid withdrawal

A

-methadone -buprenorphine

192
Q

Symptoms of Barbituate intoxication

A

-low safety margin -marked respiratory depression

193
Q

Treatment of Barbituate intoxication

A

-assist respiration -increase BP

194
Q

Symptoms of Barbituate withdrawal

A

-delirium -CV collapse

195
Q

Symptoms of benzodiazepine intoxication

A

-greater safety margin -ataxia -minor respiratory depression

196
Q

Treatment of benzodiazepine intoxication

A

supportive; consider flumazenil (competitive benzodiazepine antagonist)

197
Q

Symptoms of withdrawal from Benzodiazepines

A

-sleep disturbance -depression -rebound anxiety -seizure

198
Q

Nonspecific symptoms of stimulant intoxication

A

-mood elevation -psychomotor agitation -insomnia -cardiac arrhythmias -tachycardia -anxiety

199
Q

Nonspecific symptoms of stimulant withdrawal

A

-post-use "crash" including depression, lethargy, weight gain and headache

200
Q

Stimulants (4)

A

1. amphetamines 2. cocaine 3. caffeine 4. nicotine

201
Q

Symptoms of Amphetamine intoxication

A

-euphoria -grandiosity -pupillary dilation-prolonged wakefulness and attention -HTN -tachycardia -anorexia -paranoia -fever -severe: cardiac arrest, seizure

202
Q

Symptoms of Amphetamine Withdrawal

A

-andhedonia -increased appetite -hypersomnolence -existential crisis

203
Q

Symptoms of Cocaine Intoxication

A

-impaired judgement -pupillary dilation -hallucinations -paranoid ideations -angina -sudden cardiac death

204
Q

Treatment of Cocaine intoxication

A

benzodiazepines

205
Q

Symptoms of cocaine withdrawal

A

-hypersomnolence -severe psychologic craving -depression/suicide

206
Q

Symptoms of caffeine intoxication

A

-restlessness -increased diuresis -muscle twitching

207
Q

Symptoms of caffeine withdrawal

A

-lack of concentration -HA

208
Q

Symptoms of nicotine intoxication

A

-restlessness

209
Q

Symptoms of nicotine withdrawal

A

-irritability -anxiety -craving

210
Q

Treatment for nicotine withdrawal

A

-nicotine patch, gum, etc. -buproprion/varenicline

211
Q

Hallucinogens (3)

A

-PCP -LSD -Marijuana

212
Q

Symptoms of marijuana intoxication

A

-belligerence -impulsiveness -fever -psychomotor agitation -analgesia -nystagmus -tachycardia -homicidality -psychosis -delirium -seizures

213
Q

Treatment for PCP intoxication

A

-benzodiazepines -rapid acting antipsychotic

214
Q

Symptoms of PCP withdrawal

A

-depression -anxiety -irritability -restlessness -anergia -disturbances of thought and sleep

215
Q

Symptoms of LSD intoxication

A

-perceptual distortion -depersonalization -anxiety -paranoia -psychosis

216
Q

Symtpoms of marijuana toxicity

A

-euphoria -anxiety -paranoid delusions -perception of slowed time -impaired judgment -social withdrawal -increased appetite -dry mouth -conjunctival injection -hallucinations

217
Q

Prescription form of marijuana is...

A

Dronabinol which is used as antiemetic (chemo) and appetite stimulant in AIDS.

218
Q

Symptoms of marijuana withdrawal

A

-irritability -depression -insomnia -nausea -anorexia *most peak at 48 hrs and last 5-7 days

219
Q

Marijuana is generally detectable in the urine for...

A

4-10 days.

220
Q

Heroin addicted pts are at increased risk for...

A

hepatitis, abscesses, overdose, hemorrhoids, AIDS, and right-sided endocarditis.

221
Q

If you suspect heroin addiction, look for...

A

track marks (needle sticks in vein).

222
Q

Treatment for heroin addiction

A

-Methadone -Naloxone + Buprenorphine -Naltrexone

223
Q

Methadone is a...

A

long-acting oral opiate; used for heroin detoxification

224
Q

Naloxone + Buprenorphine is a...

A

partial opioid agonist; long-acting with fewer withdrawal symptoms than methadone

225
Q

Naltrexone is...

A

a long-acting opioid antagonist used for relapse prevention once a pt is detoxified from heroin

226
Q

Complications of Alcoholism (5)

A

1. alcoholic cirrhosis 2. hepatitis 3. pancreatitis 4. peripheral neuropathy 5. testicular atrophy

227
Q

Treatment for Alcoholism

A

-Disulfiram

228
Q

Wernicke-Korsakoff syndrome is caused by..

A

thiamine deficiency. It has a triad of confusion, ophthalmoplegia and ataxia. May progress to irreversible memory loss, confabulation and personality change.

229
Q

Wernicke-Korsakoff is associated with...

A

periventricular hemorrhage/necrosis of the mammillary bodies.

230
Q

Treatment for Wernicke-Korsakoff is...

A

IV vitamin B1 (thiamine).

231
Q

Mallory-Weiss Syndrome is...

A

longitudinal, partial thickness tear at the GE junction caused by excessive vomiting. Often presents with hematemesis. Associated with pain.

232
Q

Delirium tremens is...

A

a life-threatening alcohol withdrawal syndrome that peaks 2-5 days after the last drink.

233
Q

Symptoms of Delirium tremens in order of appearance

A

-autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures) -psychotic symptoms (hallucinations, delusions) -confusion

234
Q

Treatment for Delirium tremens

A

-benzodiazepines

235
Q

Preferred drug for ADHD

A

Methylphenidate

236
Q

Preferred drug for alcohol withdrawal

A

benzodiazepines

237
Q

Preferred drugs for anxiety

A

-SSRIs -SNRIs -Buspirone

238
Q

Preferred drugs for bipolar

A

-mood stabilizers (lithium, valproic acid, carbamazepine) -atypical antipsychotics

239
Q

Preferred drug for bulimia

A

SSRI

240
Q

Preferred drugs for depression

A

-SSRIs -SNRIs -TCAs -Bupropion -Mirtazapine (esp. with insomnia)

241
Q

Preferred drugs for OCD

A

SSRIs clomipramine

242
Q

Preferred drugs for panic disorder

A

-SSRIs -venlafaxine -benzodiazepines

243
Q

Preferred drug for PTSD

A

SSRIs

244
Q

Preferred drug for schizophreina

A

antipsychotics

245
Q

Preferred drug for social phobias

A

-SSRIs -beta-blockers

246
Q

Preferred drug for tourette's

A

-antipsychotics (haloperidol, risperidone)

247
Q

CNS Stimulants (4)

A

1. methylphenidate 2. dextroamphetamine 3. methamphetamine 4. phentermine

248
Q

Mechanism of CNS Stimulants

A

-increase catecholamines at the synaptic cleft, esp. NE and DA.

249
Q

Clincial use of CNS stimulants

A

ADHD Narcolepsy Appetite control

250
Q

Antipsychotics (neuroleptics) (5)

A

1. Haloperidol 2. Trifluoperazine 3. Fluphenazine 4. Thioridazine 5. Chlorpromazine

251
Q

Mechanism of Antipsychotics

A

All typical antipsychotics block dopamine D2 receptors (increase cAMP).

252
Q

Clinical use of antipsychotics

A

-schizophrenia (mainly + symptoms) -psychosis -acute mania -Tourette's

253
Q

Antipsychotics are very slow to be removed from the body because...

A

they are highly lipid soluble and are stored in body fat.

254
Q

Toxicity of antipsychotics

A

-extrapyramidal system effects (dyskinesias) -endocrine side effects (galactorrhea) -dry mouth, constipation (from blocking muscarinic receptors) -hypotension (from blocking alpha-1 receptors -sedation (from blocking histamine receptors)

255
Q

Neuroleptic malignant syndrome

A

toxicity of antipsychotics causing rigidity, myoglobinuria, autonomic instability and hyperpyrexia

256
Q

Treatment forNeuroleptic malignant syndrome

A

-dantrolene -D2 agnoists (bromocriptine)

257
Q

Tardive dyskinesia

A

toxicity of antipsychotics casuing oral-facial movements

258
Q

High potency antipsychotics

A

-Trifluoperazine, Fluphenazine, Haloperidol *these cause neurologic side effects (EPS system)

259
Q

Low potency antipsychotics

A

-Chlorpromazine, Thioridazine *these cause non-neurologic side effects

260
Q

Chlorpromazine can also cause...

A

cornela deposits.

261
Q

Thioridazine can cause...

A

retinal deposits.

262
Q

Haloperidol can also cause...

A

NMS or tardive dyskinesia.

263
Q

Evolution of EPS side effects

A

-4 hr acute dystonia -4 day akathisia -4 wk bradykinesia -4 month tardive dyskinesia

264
Q

Atypical Antipsychotics (6)

A

1. Olanzpaine 2. Clozapine 3. Quetiapine 4. Risperidone 5. Aripiprazole 6. Ziprasidone

265
Q

Clinical use of atypical antipsychotics

A

-schizophrenia (+ and - symptoms) -Bipolar -OCD -anxiety disorder -depression -mania -tourette's

266
Q

Olanzapine/Clozapine may cause...

A

significant weight gain.

267
Q

Clozapine may cause...

A

agranulocytosis (requires weekly WBC monitoring) and seizure.

268
Q

Risperidone may increase...

A

prolactin (lactation/gynecomastia) leading to decreased GnRH, LH and FSH (irregular menstruation/fertility).

269
Q

Ziprasidone may...

A

prolong the QT interval.

270
Q

Clinical use of Lithium

A

-mood stabilizer for bipolar disorder -blocks relapse and acute manic episodes -SIADH

271
Q

Toxicity of Lithium

A

-tremor -sedation -edema -heart block -polyuria -teratogenesis

272
Q

Lithium causes polyuria because...

A

it is an ADH antagonist causing nephrogenic DI.

273
Q

Fetal cardiac defects from lithium include...

A

Ebstein anomaly and malformation of the great vessels.

274
Q

Buspirone mechanism

A

stimulates 5-HT(1A) receptors

275
Q

Use of Buspirone

A

-generalized anxiety disorder (1-2 wks to take effect) (does not interact with alcohol)

276
Q

SSRIs (4)

A

1. Fluoxetine 2. Paroxetine 3. Sertraline 4. Citalopram

277
Q

Mechanism of SSRIs

A

5-HT specific reuptake inhibitors

278
Q

Use of SSRIs

A

-depression -GAD -Panic disorder -OCD -bulimia -social phobias -PTSD

279
Q

Toxicity of SSRIs

A

-GI distress -sexual dysfunction -serotonin syndrome w/ any drug that increases 5HT (MAO inhibitors, SNRIs, TCAs)

280
Q

Serotonin Syndrome

A

-hyperthermia -confusion -myoclonus -CV collapse -flushing -diarrhea -seizures

281
Q

Serotonin Syndrome is treated with...

A

Cyproheptadine (5-HT2 receptor antagonist)

282
Q

For SSRIs to start taking effect, it takes...

A

4-8 wks.

283
Q

SNRIs (2)

A

Venlafaxine Duloxetine

284
Q

Mechanism of SNRIs

A

inhibit 5-HT and NE reuptake

285
Q

Use of SNRIs

A

depression -Venlafaxine also for GAD and panic disorder -Duloxetine also for diabetic peripheral neuropathy

286
Q

Toxicity of SNRIs

A

increased BP stimulant effects sedation nausea

287
Q

Tricyclic Antidepressants (7)

A

1. amitriptyline 2. nortriptyline 3. imipramine 4. desipramine 5. clomipramine 6. doxepin 7. amoxapine

288
Q

TCAs mechanism

A

block reuptake of NE and 5-HT

289
Q

Uses of TCAs

A

-depression -OCD (clomipramine) -fibromyalgia

290
Q

Toxicity of TCAs

A

-sedation -alpha-1 blocking effects (postural hypotension) -atropine-like effects (anticholinergic - tachycardia, urinary retention, dry mouth) -convulsions -coma -cardiotoxicity -respiratory depression -hyperpyrexia

291
Q

Tertiary TCAs (amitriptyline) have more...

A

anticholinergic effects than secondary TCAs (nortriptyline) have.

292
Q

Desipramine is less...

A

sedating but has higher seizure incidence.

293
Q

In the elderly, TCAs can cause...

A

confusion and hallucinations due to anticholinergic side effects (use nortriptyline).

294
Q

Treatment for cardiotoxicity from TCAs

A

NaHCO3.

295
Q

Monoamine oxidase inhibitors (4)

A

1. Tranylcypromine 2. Phenelzine 3. Isocarboxazid 4. Selegine (slective MAO-B inhibitor)

296
Q

Mechanism of MAO inhibitors

A

inhibition of MAO leading to increased levels of amine neurotransmitters (NE, 5-HT, DA)

297
Q

use of MAO inhibitors

A

-atypical depression -anxiety -hypochondria

298
Q

Toxicity of MAOIs

A

-hypertensive crisis (typically w/ ingestion of tyramine) -CNS stimulation

299
Q

MAOIs are contraindicated with...

A

SSRIs TCAs St. John's wort Meperidine Dextromethorphan

300
Q

Atypical Antidepressants

A

1. Buproprion 2. Mirtazapine 3. Trazodone

301
Q

Buproprion increases...

A

NE and DA

302
Q

Besides depression, buproprion is also used for...

A

smoking cessation.

303
Q

Toxicity of Buproprion

A

-stimulant effects -HA -seizure in bulimic pts

304
Q

Mirtazapine MOA

A

-alpha2-antagonist (increased release of NE and 5-HT) -potent 5-HT2 and 5-HT3 antagonist

305
Q

Toxicity of Mirtazapine

A

-sedation -increased appetite -weight gain -dry mouth

306
Q

Trazodone mechanism

A

-blocks 5-HT2 and alpha1-adrenergic receptors

307
Q

Trazodone is primarily used for...

A

insomnia.

308
Q

Toxicity of Trazodone

A

sedation nausea priapism postural hypotension