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Flashcards in Psych Review Deck (425):
1

Mood disorder definition

  • Abnormal range of moods or internal emotional states and loss of control over them
  • Severity of moods causes distress and impairment in social and occupational functioning
  • Episodic superimposed psychotic features (delusions or hallucinations) may be present

2

Mood disorder examples

  • major depressive disorder
  • bipolar disorder
  • dysthymic disorder
  • cyclothymic disorder

3

Manic episode definition

  • Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy lasting at least 1 week.
  • Often disturbing to patient.

4

Manic episode diagnostic criteria

DIG FAST:

  • Distractibility
  • Irresponsibility
  • Grandiosity
  • Flight of Ideas
  • Activity/Agitation Increase
  • Sleep changes
  • Talkativeness

5

Hypomanic episode

  • Like manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization.
  • No psychotic features.
  • Lasts at least 4 consecutive days.

6

Bipolar I

presence of at least 1 manic episode with or w/o hypomanic or depressive episode

7

Bipolar II

presence of hypomanic and depressive episode

8

Bipolar Disorder General Characteristics

  • Pt’s mood and fcn usually return to normal between episodes
  • Antidepressants can precipitate mania
  • High suicide risk
  • Rx:
    • Mood stabilizers (lithium, valproic acid, carbamazepine)
    • Atypical antipsychotics

9

Cyclothymic disorder

  • Dysthymia and hypomania
  • Milder form of bipolar d/o lasting at least 2 years

10

Major depressive disorder

  • Major depressive episodes usually lasting 6-12mos
  • May be self-limited

11

Major depressive episode

A least 5 of the following for 2+ weeks (symptoms must include pt-reported depressed mood / anhedonia):

SIG E CAPS:

  • 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

12

Persistent depressive disorder (dysthymia)

Depression, often milder, lasting at least
2 years

13

Sleep changes in depression

  • Decreased:
    • Slow-wave (non-REM) sleep
    • REM latency
  • increased:
    • REM early in sleep cycle
    • Total REM sleep
  • Repeated nighttime awakenings
  • Early-morning wakening (terminal insomnia)

14

Atypical depression

Most common subtype

  1. Mood reactivity (experience improved mood in response to positive events, albeit briefly)
  2. “Reversed” vegetative symptoms (hypersomnia, hyperphagia)
  3. Leaden paralysis (heavy feeling in arms and legs)
  4. Long-standing interpersonal rejection sensitivity

15

Rx Major Depressive Disorder

  • 1st line:
    • CBT
    • SSRIs
  • 2nd line:
    • SNRIs
    • Mirtazapine
    • Bupropion
  • Electroconvulsive therapy in select pts

16

Rx Atypical Depression

  • 1st line:
    • CBT
    • SSRIs
  • 2nd line:
    • MAOIs (effective but worse risk profile)

17

Psychiatric genetics

Both genetic and environmental factors involved

  • Ex: in bipolar d/o and schizophrenia, lifetime risk in gen population (~ 1%) < parent/sibling (~10%) < monozygotic twin (~50%)

18

NT changes in Alzheimer's

  • DEcreased Ach
  • INcreased Glu

19

NT changes in Anxiety

  • INcreased NE
  • DEcreased GABA, 5-HT

20

NT changes in Depression

  • DEcreased NE, 5-HT, DA

21

NT changes in Huntington's

  • INcreased DA
  • DEcreased GABA, Ach

CAG repeat → Caudate loses Ach & GABA

22

NT changes in Parkinson's

  • DEcreased DA
  • INcreased Ach

23

NT changes in Schizophrenia

INcreased DA

24

Orientation

Pt ability to know person, place, time.

  • Order of loss:
    • 1st—time
    • 2nd—place
    • last—person
  • Common causes of loss:
    • EtOH
    • drugs
    • fluid/electrolyte imbalance
    • head trauma
    • hypOglycemia
    • infxn
    • nutritional deficiency

25

Retrograde amnesia

Inability to remember things that occurred before a CNS insult

26

Anterograde amnesia

Inability to remember things that occurred after a CNS insult (decreased acquisition of new memory)

27

Korsakoff syndrome

Vit B1 / thiamine deficiency + Destruction of mammillary bodies → Amnesia (anterograde > retrograde)

  • Seen in alcoholics as a late neuropsychiatric manifestation of Wernicke encephalopathy
    • Confabulation

28

Dissociative amnesia

  • Inability to recall important personal information
  • Usually subsequent to severe trauma or stress
  • May be accompanied by dissociative fugue

29

Dissociative fugue

  • abrupt travel or wandering during a period of dissociative amnesia
  • assoc w/traumatic circumstances

30

Dissociative identity disorder

  • aka multiple personality disorder
  • 2+ distinct identities or personality states
    • More common in women
  • Assoc w/
    • sexual abuse
    • PTSD
    • depression
    • substance abuse
    • borderline personality
    • somatoform conditions

31

Depersonalization/ derealization disorder

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

32

Most common presentation of altered mental status in inpatient setting

Delirium

33

Delirium Definition

Delirium = changes in sensorium

  • Acute onset “waxing and waning” level of consciousness
  • Rapid DEcrease in attention span, level of arousal
  • Disorganized thinking, hallucinations (visual), illusions, misperceptions, disturbance in sleep-wake cycle, cognitive dysfcn.
  • Diffuse slowing EEG (vs dementia)
  • Reversible

34

Delirium Causes

  • Usually 2° to other illness (CNS disease, infxn, trauma, substance abuse/withdrawal, metabolic/electrolyte disturbances, hemorrhage, urinary/fecal retention)
  • May be caused by medications (anticholinergics), esp in elderly

35

Delirium Rx

  • Aimed at addressing underlying condition
    • T-A-DA approach (Tolerate, Anticipate, Don’t Agitate) helpful for management.
  • Haloperidol may be used as needed
  • Use benzos for alcohol w/d

36

Postpartum mood disturbance onset

w/i 4 weeks of delivery

37

Maternal (postpartum) “blues”

  • 50–85% incidence rate
  • Depressed affect, tearfulness, and fatigue starting 2-3 days after delivery
  • Usually resolves w/i 10 days
  • Rx: supportive
    • Follow up to assess for possible postpartum depression

38

Postpartum depression

  • 10–15% incidence rate
  • Characterized by depressed affect, anxiety, and poor concentration
  • Rx:
    • CBT
    • SSRIs

39

Postpartum psychosis

  • 0.1–0.2% incidence rate
  • Mood-congruent delusions, hallucinations, and thoughts of harming the baby or self
  • Risk factors:
    • Hx of bipolar or psychotic d/o
    • 1st pregnancy
    • family history
    • recent discontinuation of psychotropic medication
  • Rx:
    • hospitalization + atypical antipsychotic
    • if insufficient, ECT may be used

40

Anxiety disorder

  • Inappropriate experience of fear/worry and physical manifestations incongruent w/magnitude of perceived stressor
  • Symptoms interfere with daily fcn
  • Includes panic disorder, phobias, generalized anxiety disorder, and selective mutism

41

Rx Anxiety Disorder

  • CBT
  • SSRIs
  • SNRIs

42

Panic Attack

Periods of intense fear + discomfort peaking in 10 min with at least 4 of the following:

  • Palpitations
  • Paresthesias
  • dePersonalization or derealization
  • Abdominal distress or Nausea
  • Intense fear of dying
  • Intense fear of losing control or “going crazy”
  • LIght-headedness
  • Chest pain
  • Chills
  • Choking
  • Sweating
  • Shaking
  • Shortness of breath

43

Panic Disorder

  • Recurrent panic attacks
  • Dx requires attack followed by 1+ month of 1+ of the following: ƒ
    • Persistent concern of additional attacks ƒ
    • Worrying about consequences of attack
    • Behavioral change related to attacks
  • Strong genetic component

44

Panic Disorder Rx

  • 1st line:
    • CBT
    • SSRIs
    • Venlafaxine
  • Benzos occasionally used in acute setting

45

Phobia

  • Severe, persistent fear or anxiety due to presence or anticipation of a specific object or situation.
  • Person recognizes fear is excessive.
  • Can be treated with systematic desensitization.

46

Social anxiety disorder

Exaggerated fear of embarrassment in social situations (eg, public speaking, using public restrooms).

47

Social Anxiety Disorder Rx

  • Normal:
    • CBT
    • SSRIs
    • venlafaxine
  • Occasional anxiety-inducing situations:
    • Benzo
    • β-blocker (performance anxiety / stage fright)

48

Agoraphobia

  • Exaggerated fear of open or enclosed places, using public transportation, being in line or in crowds, or leaving home alone
  • Assoc w/ panic disorder

49

Agoraphobia Rx

  • CBT
  • SSRIs
  • MAO inhibitors

50

Generalized anxiety disorder

  • Anxiety lasting > 6mos unrelated to a specific person, situation, or event
  • Assoc w/restlessness, irritability, sleep disturbance, fatigue, muscle tension, difficulty concentrating

51

Generalized anxiety disorder Rx

  • 1st line:
    • CBT
    • SSRIs
    • SNRIs
  • 2nd line:
    • Buspirone
    • TCAs
    • Benzos

52

Adjustment disorder

  • Emotional symptoms (anxiety, depression) causing impairment
  • Lasts < 6mos following identifiable psychosocial stressor (divorce, illness)
  • Lasts > 6mos in presence of chronic stressor

53

Adjustment disorder Rx

  • CBT
  • SSRIs

54

Obsessive-compulsive disorder

  • Recurring intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress
  • Relieved in part by performance of repetitive actions (compulsions)
  • Ego-dystonic--behavior inconsistent w/one’s own beliefs and attitudes (vs OCPD).
  • Assoc w/Tourette syndrome

55

OCD Rx

  • 1st line:
    • CBT
    • SSRIs
    • Clomipramine

56

Body dysmorphic disorder

  • Preoccupation w/minor or imagined defect in appearance → significant emotional distress or impaired fcn
  • Pts often repeatedly seek cosmetic treatment

57

Body dysmorphic disorder Rx

CBT

58

Post-traumatic stress disorder

Exposure to prior trauma (eg, witnessing death, experiencing serious injury or rape) →

  • intrusive reexperiencing of event (nightmares, flashbacks)
  • avoidance of associated stimuli
  • changes in cognition or mood (fear, horror)
  • persistently increased arousal.

Disturbance lasts > 1 mo w/significant distress or impaired social-occupational fcn

Symptoms usually do NOT recur after recovery

59

Post-traumatic stress disorder Rx

  • 1st line:
    • CBT
    • SSRIs
    • venlafaxine

60

Acute stress disorder

Similar to PTSD, but lasts 3 days to 1 month

61

Acute stress disorder Rx

  • CBT
  • pharmacotherapy usually NOT indicated

62

Malingering

  • Patient consciously fakes, profoundly exaggerates, or claims to have a disorder in order to attain a specific 2° gain (avoiding work, obtaining compensation).
  • Poor compliance with treatment or diagnostic test follow-up
  • Complaints cease after gain (vs factitious disorder)

63

Factitious disorders

Patient consciously creates physical and/or psychological symptoms in order to assume “sick role” and to get medical attention (1°/internal gain)

64

Factitious disorder imposed on self (Munchausen syndrome)

  • Chronic factitious disorder with predominantly physical signs and symptoms
  • Characterized by a history of multiple hospital admissions and willingness to undergo invasive procedures

65

Factitious disorder imposed on another (Munchausen syndrome by proxy)

  • Illness in a child/elderly pt caused or fabricated by caregiver
  • Motivation to assume sick role by proxy
  • Form of child/elder abuse

66

Somatic symptom and related disorders

  • physical symptoms causing significant distress and impairment that are NOT intentionally produced or feigned
  • More common in women

67

Somatic symptom disorder

  • Variety of bodily complaints (pain, fatigue) lasting months to years
  • Assoc w/excessive, persistent thoughts and anxiety about symptoms
  • May co-occur with medical illness

68

Conversion disorder (functional neurologic symptom disorder)

  • Loss of sensory or motor function (paralysis, blindness, mutism), often following acute stressor
  • Pt is aware of but sometimes indifferent toward symptoms (“la belle indifference”)
  • More common in females, adolescents, and young adults

69

Illness anxiety disorder

  • Excessive preoccupation with acquiring or having a serious illness, often despite medical evaluation and reassurance
  • Minimal somatic symptoms.

70

Pseudocyesis

  • False, nondelusional belief of being pregnant
  • May have signs and symptoms of pregnancy but is NOT pregnant

71

4 Types of Somatic-Related Disorders

  1. Somatic symptom disorder
  2. Conversion disorder (functional neurologic symptom disorder)
  3. Illness anxiety disorder
  4. Pseudocyesis

72

Personality trait

An enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself

73

Personality disorder

  • Inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning
  • person usually not aware of problem
  • Usually presents by early adulthood

74

Types of Personality Disorders

3 clusters: A, B, and C (Weird, Wild, and Worried)

75

3 Types of Cluster A Personality Disorders

“Weird” (Accusatory, Aloof, Awkward):

  • Paranoid
  • Schizoid
  • Schizotypal

76

Characteristics of Cluster A personality disorders

  • “Weird” (Accusatory, Aloof, Awkward)
    • Odd or eccentric
    • Inability to develop meaningful social relationships
  • No psychosis
  • Genetic association w/schizophrenia

77

Paranoid PD

Cluster A

  • Pervasive distrust and suspiciousness
  • Projection is major defense mechanism

78

Schizoid PD

Cluster A

  • Voluntary social withdrawal
  • Limited emotional expression
  • Content with social isolation (vs avoidant)
  • Schizoid = distant

79

Schizotypal PD

Cluster A

  • Eccentric appearance
  • Odd beliefs, superstitions, magical thinking
  • Interpersonal awkwardness
  • schizotypal = magical thinking

80

4 Types of Cluster B personality disorders

“Wild” (Bad to the Bone):

  1. Antisocial
  2. Borderline
  3. Histrionic
  4. Narcissistic

81

Characteristics of Cluster B personality disorders

  • “Wild” (Bad to the Bone)
    • Dramatic, emotional, erratic
  • Genetic association w/mood disorders and substance abuse

82

Antisocial PD

Cluster B

  • Disregard for/violation of rights of others, criminality, impulsivity
  • Males > females
  • must be ≥ 18yo and have Hx conduct disorder before 15yo
    • Conduct disorder if <18yo
  • Antisocial = sociopath

83

Borderline PD

Cluster B

  • Unstable mood & interpersonal relationships
  • impulsivity
  • self-mutilation, suicidality
  • sense of emptiness
  • females > males
  • Splitting is major defense mechanism
  • Rx: dialectical behavior therapy

84

Histrionic PD

Cluster B

  • Excessive emotionality and excitability
  • attention-seeking
  • sexually provocative
  • overly concerned with appearance

85

Narcissistic PD

Cluster B

  • Grandiosity, sense of entitlement
  • Lacks empathy & requires excessive admiration
  • Often demands the “best” and reacts to criticism with rage

86

3 Types of Cluster C personality disorders

“Worried” (Cowardly, Compulsive, Clingy):

  1. Avoidant
  2. Obsessive-Compulsive
  3. Dependent

87

Characteristics of Cluster C personality disorders

  • “Worried” (Cowardly, Compulsive, Clingy)
    • Anxious or fearful
  • Genetic association with anxiety disorders

88

Avoidant PD

Cluster C

  • Hypersensitive to rejection
  • Socially inhibited, timid
  • Feelings of inadequacy
  • Desires relationships w/others (vs schizoid)

89

Obsessive-compulsive PD

Cluster C

  • Preoccupation w/order, perfectionism, control
  • Ego-syntonic: behavior consistent with one’s own beliefs and attitudes (vs OCD)

90

Dependent PD

Cluster C

  • Submissive and clingy
  • Excessive need to be taken care of
  • Low self-confidence
  • Pts often get stuck in abusive relationships

91

Substance use disorder

Maladaptive pattern of substance use defined as 2+ of the following in 1 year: ƒ

  • Tolerance: need more to achieve same effect
  • Withdrawal
  • Substance taken in larger amounts, or over longer time, than desired
  • Persistent desire/unsuccessful attempts to cut down
  • Significant energy spent obtaining, using, or recovering from substance
  • Impt social, occupational, or recreational activities reduced
  • Continued use despite knowing substance causes physical and/or psychological problems ƒ
  • Craving
  • Recurrent use in physically dangerous situations
  • Failure to fulfill major obligations at work, school, or home
  • Social/interpersonal conflicts

92

6 Stages of change in overcoming substance addiction

  1. Precontemplation—not yet acknowledging that there is a problem
  2. Contemplation—acknowledging that there is a problem, but not yet ready or willing to make change
  3. Preparation/determination—getting ready to change behaviors
  4. Action/willpower—changing behaviors
  5. Maintenance—maintaining behavior changes
  6. Relapse—returning to old behaviors and abandoning new changes

93

Depressant Intoxication

  • mood elevation
  • Decreased anxiety
  • sedation
  • behavioral disinhibition
  • respiratory depression

94

Depressant Withdrawal

  • anxiety
  • tremor
  • seizures
  • insomnia

95

4 examples of depressants

  1. Alcohol
  2. Opioids
  3. Barbiturates
  4. Benzodiazepines

96

Alcohol Intoxication

  • Emotional lability
  • slurred speech
  • ataxia
  • coma
  • blackouts
  • Serum γ-glutamyltransferase (GGT)—sensitive indicator of alcohol use
  • AST value is twice ALT value

97

Alcohol withdrawal

  • Mild withdrawal: symptoms similar to other depressants.
  • Severe alcohol withdrawal: autonomic hyperactivity and DTs (5–15% mortality rate).

Rx for DTs: benzodiazepines.

98

Opioid Intoxication

  • Euphoria
  • respiratory and CNS depression
  • decreased gag reflex
  • pupillary constriction (pinpoint)
  • seizures (overdose)

Rx: naloxone, naltrexone

99

Most common cause of drug overdose death

Opioids

100

Opioid Withdrawal

  • Sweating
  • dilated pupils
  • piloerection (“cold turkey”)
  • yawning
  • “flu-like” symptoms: fever, rhinorrhea, nausea, stomach cramps, diarrhea

Rx: long-term support, methadone, buprenorphine

101

Barbiturate Intoxication

  • Low safety margin
  • marked respiratory depression

Rx: symptom management (eg, assist respiration, increase BP)

102

Barbiturate Withdrawal

  • Delirium
  • life-threatening cardiovascular collapse

103

Benzodiazepine Intoxication

  • Greater safety margin
  • Ataxia
  • minor respiratory depression

Rx: flumazenil (benzo receptor antagonist, rarely used--can precipitate seizures)

104

Benzodiazepine Withdrawal

  • Sleep disturbance
  • depression
  • rebound anxiety
  • seizure

105

Stimulant Intoxication

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

106

Stimulant Withdrawal

  • post-use “crash,” incl depression, lethargy
  • increased appetite
  • sleep disturbance
  • vivid nightmares

107

4 examples of stimulants

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

108

Amphetamine Intoxication

  • Euphoria, grandiosity
  • pupillary dilation
  • prolonged wakefulness and attention
  • HTN, tachycardia
  • anorexia
  • paranoia
  • fever
  • Severe: cardiac arrest, seizures

Rx: benzodiazepines for agitation and seizures

109

Cocaine Intoxication

  • Impaired judgment
  • pupillary dilation
  • hallucinations (including tactile)
  • paranoid ideations
  • angina
  • sudden cardiac death

Rx: α-blockers, benzodiazepines.

  • β-blockers NOT recommended

110

Caffeine Intoxication

  • Restlessness
  • increased diuresis
  • muscle twitching

111

Caffeine Withdrawal

  • Headache
  • difficulty concentrating
  • flu-like symptoms

112

Nicotine Intoxication

Restlessness

113

Nicotine Withdrawal

  • Irritability
  • anxiety
  • restlessness
  • difficulty concentrating

Rx: nicotine patch, gum, or lozenges; bupropion/varenicline.

114

4 examples of hallucinogens

  1. Phencyclidine (PCP)
  2. Lysergic acid diethylamide (LSD)
  3. Marijuana (cannabinoid)
  4. MDMA (ecstasy)

115

PCP Intoxication

  • Violence
  • impulsivity
  • psychomotor agitation
  • nystagmus
  • tachycardia, HTN
  • analgesia
  • psychosis, delirium
  • seizures
  • Trauma is most common complication

Rx: benzodiazepines, rapid-acting antipsychotic.

116

LSD Intoxication

  • Perceptual distortion (visual, auditory)
  • depersonalization
  • anxiety
  • paranoia
  • psychosis
  • possible flashbacks

117

Marijuana Intoxication

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

Pharmaceutical form is dronabinol (tetrahydrocannabinol isomer): used as antiemetic (chemotherapy) and appetite stimulant (in AIDS).

118

Dronabinol

  • Pharmaceutical form of marijuana (tetrahydrocannabinol isomer)
  • used as antiemetic (chemotherapy) and appetite stimulant (in AIDS)

119

Marijuana Withdrawal

  • Irritability
  • anxiety
  • depression
  • insomnia
  • restlessness
  • decreased appetite

Generally detectable in urine for up to 1 month.

120

MDMA Intoxication

Hallucinogenic stimulant:

  • euphoria
  • disinhibition
  • hyperactivity

Life-threatening effects include:

  • HTN
  • tachycardia
  • hyperthermia
  • hyponatremia
  • serotonin syndrome

121

MDMA Withdrawal

  • Depression
  • fatigue
  • change in appetite
  • difficulty concentrating
  • anxiety

122

Heroin addicts at increased risk for?

  • hepatitis
  • HIV
  • abscesses
  • bacteremia
  • right-heart endocarditis

123

Methadone

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

124

Naloxone + buprenorphine

  • Antagonist + partial agonist.
  • Naloxone is not orally bioavailable, so withdrawal symptoms occur only if injected (lower abuse potential).

125

Naltrexone

Long-acting opioid antagonist used for relapse prevention once detoxified.

126

Alcoholism

  • Physiologic tolerance and dependence w/symptoms of withdrawal (tremor, tachycardia, hypertension, malaise, nausea, DTs) when intake is interrupted.
  • Complications: alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy, testicular atrophy.
  • Rx:
    • disulfiram (condition pt to abstain)
    • acamprosate
    • naltrexone
    • supportive care
  • Support groups (AA) are helpful in sustaining abstinence and supporting pt and family.

127

Wernicke-Korsakoff syndrome

  • Vitamin B1 (thiamine) deficiency
  • Wernicke: reversible confusion + ophthalmoplegia + ataxia
  • Korsakoff: irreversible memory loss, confabulation, personality change
  • Assoc w/
    • periventricular hemorrhage
    • mamillary body necrosis
    • damage to dorsomedial and anterior thalamic nuclei
  • Rx: IV vitamin B1 + glucose

128

Mallory-Weiss syndrome

  • Partial thickness tear at gastroesophageal junction caused by excessive/forceful vomiting
  • Often presents with hematemesis, misdiagnosed as ruptured esophageal varices

129

Delirium Tremens

2-10 days since last drink -- life-threatening

  • Autonomic hyperactivity (tachycardia, tremors, anxiety, seizures)
  • HTN
  • Profound agitation
  • Global confusion
  • Disorientation
  • Hallucinations
  • Fever
  • Diaphoresis

Classically occurs in hospital setting (2-4 days postop) in alcoholics not able to drink as inpatients

  • Rx: benzos

130

Alcoholic hallucinosis

  • Distinct condition from DT
  • Characterized by visual hallucinations 12-48 hrs after last drink.
  • Rx: benzodiazepines (eg, chlordiazepoxide, lorazepam, diazepam).

131

Preferred Rx ADHD

Stimulants (methylphenidate, amphetamines)

132

Preferred Rx Alcohol Withdrawal

Benzodiazepines (chlordiazepoxide, lorazepam, diazepam)

133

Preferred Rx Bipolar Disorder

  • Lithium
  • Valproic acid
  • Atypical antipsychotics (Quetiapine)

134

Preferred Rx Bulimia Nervosa

SSRIs

135

Preferred Rx Depression

SSRIs

136

Preferred Rx Generalized Anxiety Disorder

  • SSRIs
  • SNRIs

137

Preferred Rx OCD

  • SSRIs
  • venlafaxine
  • clomipramine

138

Preferred Rx Panic Disorder

  • SSRIs
  • venlafaxine
  • benzodiazepines

139

Preferred Rx PTSD

  • SSRIs
  • venlafaxine

140

Preferred Rx Schizophrenia

Atypical antipsychotics

141

Preferred Rx Social Anxiety Disorder

  • SSRIs
  • venlafaxine
  • Performance only:
    • β-blockers
    • benzodiazepines

142

Preferred Rx Tourette Syndrome

  • Antipsychotics (eg, fluphenazine, pimozide)
  • tetrabenazine

143

Electroconvulsive therapy

  • Produces grand mal seizure in anesthetized pt
  • Use:
    • Rx-refractory depression
    • Depression w/psychotic symptoms
    • Acutely suicidal pts
  • S/E: usually resolve in 6mos
    • disorientation
    • temporary headache
    • partial antero-/retrograde amnesia
  • Safe in pregnancy

144

Normal Grief

  • Shock, denial, guilt, sadness, anxiety, yearning, somatic symptoms
  • Hallucinations of deceased person are common
  • Duration varies widely; usually <6mos

145

Pathologic Grief

  • Persistent and causes functional impairment
  • Can meet criteria for major depressive episode

146

Delusional disorder

  • Fixed, persistent, false belief system lasting > 1 month
  • Functioning otherwise not impaired (eg, a woman genuinely believes she is married to a celebrity when she is not)
  • Can be shared by individuals in close relationships (folie à deux)

147

Schizophrenia Definition

  • Chronic mental disorder w/periods of psychosis, disturbed behavior and thought, and decline in fcn lasting > 6 months
  • Assoc w/
    • increased dopaminergic activity
    • decreased dendritic branching
  • Ventriculomegaly on brain imaging

148

Schizophrenia Dx Criteria

Req at least 1 of #1-3 plus one other symptom in list (first 4 are “positive” symp):

  1. Delusions
  2. Hallucinations—often auditory
  3. Disorganized speech
  4. Disorganized or catatonic behavior
  5. Negative symptoms (affective flattening, avolition, anhedonia, asociality, alogia)

149

Brief psychotic disorder

  • lasting < 1 month
  • usually stress-related

150

Schizophreniform disorder

lasting 1-6 months

151

Schizoaffective disorder

  • > 2 weeks of hallucinations or delusions w/o major mood episode (major depression or mania)
  • plus periods of concurrent major mood episode with schizophrenic symptoms

152

Lifetime prevalence and presentation time of schizophrenia

  • Lifetime prevalence—1.5% (males = females, African Americans = Caucasians).
    • Presents earlier in men (late teens-early 20s vs late 20s-early 30s in women)
  • Increased risk for suicide
  • Frequent cannabis use assoc w/psychosis/schizophrenia in teens.

153

Psychosis

  • Distorted perception of reality characterized by delusions, hallucinations, and/or disorganized thinking
  • Can occur in pts with medical illness, psychiatric illness, or both

154

Delusions

  • Unique, false beliefs that persist despite the facts (thinking aliens are communicating with you).
  • Types:
    • persecutory
    • referential
    • grandiose
    • erotomanic
    • somatic

155

Disorganized thought

Speech may be incoherent (“word salad”), tangential, or derailed (“loose associations”)

156

Hallucinations

  • Perceptions in the absence of external stimuli (seeing a light that is not actually present).
  • Contrast wi/illusions: misperceptions of real external stimuli

157

7 Types of Hallucinations

  1. Visual
  2. Auditory
  3. Olfactory
  4. Gustatory
  5. Tactile
  6. Hypnagogic
  7. Hypnopompic

158

Visual Hallucinations

more commonly a feature of medical illness (drug intoxication) than psychiatric illness.

159

Auditory Hallucinations

more commonly a feature of psychiatric illness (schizophrenia) than medical illness

160

Olfactory Hallucinations

often occur as aura of temporal lobe epilepsy (burning rubber) and in brain tumors

161

Gustatory Hallucinations

rare, but seen in epilepsy

162

Tactile Hallucinations

common in alcohol withdrawal and stimulant use → delusional parasitosis, “cocaine crawlies.”

163

Hypnagogic Hallucinations

  • occurs while going to sleep
  • sometimes seen in narcolepsy

164

Hypnopompic Hallucinations

  • occurs while waking from sleep (pompous upon awakening)
  • sometimes seen in narcolepsy

165

Infant deprivation effects

4 W’s: Weak, Wordless, Wanting (socially), Wary:

  • Failure to thrive
  • ƒPoor language/socialization skills
  • ƒLack of basic trust
  • Reactive attachment disorder (infant withdrawn/unresponsive to comfort)

Deprivation for > 6 months can lead to irreversible changes

Severe deprivation can result in infant death

166

Child Abuse - Physical Signs

  • Fractures (ribs, long bone spiral, multiple in different stages of healing)
  • bruises (trunk, ear, neck; in pattern of implement)
  • burns (cigarette, buttocks/thighs)
  • subdural hematomas
  • retinal hemorrhages
  • During exam, children often avoid eye contact

167

Child Abuse - Sexual Signs

  • Genital, anal, or oral trauma
  • STIs
  • UTIs

168

Likely abuser in physical child abuse

biological mother

169

Likely abuser in sexual child abuse

Known to victim, usually male.

170

Epidemiology of physical child abuse

40% of deaths in children

171

Epidemiology of sexual child abuse

Peak incidence 9–12 years old

172

Child neglect

  • Failure to provide a child with adequate food, shelter, supervision, education, and/or affection
  • Most common form of child maltreatment
  • Evidence:
    • poor hygiene
    • malnutrition
    • withdrawal
    • impaired social/emotional development
    • failure to thrive.
  • As with child abuse, suspected child neglect must be reported to local CPS.

173

Vulnerable child syndrome

  • Parents perceive the child as especially susceptible to illness or injury
  • Usually follows a serious illness or life-threatening event
  • Can result in missed school or overuse of medical services

174

Attention-deficit hyperactivity disorder

  • Onset before age 12
  • Limited attention span + poor impulse control
  • Hyperactivity, impulsivity, and/or inattention in multiple settings (school, home, places of worship, etc)
  • Normal intelligence, but commonly coexists with difficulties in school
  • Continues into adulthood in as many as 50% of individuals

175

ADHD Rx Options

  • Stimulants (methylphenidate) +/- CBT
  • alternatives:
    • atomoxetine
    • guanfacine
    • clonidine

176

Autism spectrum disorder

  • Assoc w/Chrom 11 or 15 defects
  • Poor social interactions, social communication deficits, repetitive/ritualized behaviors, restricted interests
  • Must present in early childhood
  • May have intellectual disability
  • Rarely accompanied by unusual abilities (savants)
  • More common in boys
  • Assoc w/increased head/brain size

177

Rett syndrome

  • X-linked dominant disorder seen almost exclusively in girls
  • MECP2 gene mutations
  • Symptoms usually apparent around 1-4yrs
  • Regression w/loss of development, loss of verbal abilities, intellectual disability, ataxia, stereotyped hand-wringing

178

Conduct disorder

  • Repetitive and pervasive behavior violating basic rights of others or societal norms (aggression to ppl/animals, destruction of property, theft) at < 18yo
    • After age 18, many will meet criteria for Antisocial PD

Rx both: psychotherapy such as CBT.

179

Oppositional defiant disorder

  • Enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms
  • Rx: psychotherapy such as CBT

180

Separation anxiety disorder

  • Common onset at 7-9yo
  • Overwhelming fear of separation from home or loss of attachment figure
  • May lead to factitious physical complaints to avoid going to or staying at school
  • Must be present for >4 weeks in kids and >6 mos in adults

Rx: CBT, play therapy, family therapy

181

Tourette syndrome

  • Onset before 18yo
  • Sudden, rapid, recurrent, nonrhythmic, stereotyped motor AND vocal tics for > 1 yr
    • Coprolalia (involuntary obscene speech) found in only 10–20% of pts
  • Assoc w/OCD and ADHD

182

Tourette syndrome Rx options

  • psychoeducation
  • behavioral therapy
  • For intractable and distressing tics:
    • high-potency antipsychotics (fluphenazine, pimozide)
    • tetrabenazine
    • guanfacine
    • clonidine

183

Dementia

  • Decrease in intellectual function w/o affecting level of consciousness.
  • Memory deficits, apraxia, aphasia, agnosia, loss of abstract thought, behavior/personality changes, impaired judgment.
    • Dementia → memory loss
  • Increased incidence with age
  • EEG usually normal
  • Usually irreversible
  • A pt w/dementia can develop delirium (eg. demented pt w/pneumonia @ increased risk delirium)

184

Irreversible causes of dementia

  • Alzheimer disease
  • Lewy body dementia
  • Huntington disease
  • Pick disease
  • cerebral infarct
  • Creutzfeldt-Jakob disease
  • chronic substance abuse (due to neurotoxicity of drugs)

185

Reversible causes of dementia

  • hypothyroidism
  • depression
  • vitamin B12 deficiency
  • normal pressure hydrocephalus
  • neurosyphilis

186

Pseudodementia

  • In elderly pts, depression and hypothyroidism may present like dementia.
  • Screen for depression and measure TSH, B12 levels.

187

Eating disorders most common in?

young females

188

Anorexia nervosa

  • Excessive dieting, exercise, or binge eating/purging with BMI < 18.5 kg/m2
  • intense fear of gaining weight
  • Distortion or overvaluation of body image
  • Assoc w/decreased bone density, severe weight loss, metatarsal stress fractures, amenorrhea (loss of pulsatile GnRH secretion), lanugo, anemia, electrolyte disturbances
  • Commonly coexists with depression

189

Refeeding syndrome

  • can occur in significantly malnourished patients
  • increased insulin → hypophosphatemia → cardiac complications

190

Anorexia nervosa Rx

Psychotherapy and nutritional rehabilitation

191

Bulimia nervosa

  • Binge eating w/recurrent inappropriate compensatory behaviors (self-induced vomiting, using laxatives or diuretics, fasting, excessive exercise) occurring weekly for at least 3mos
  • Overvaluation of body image
  • Body weight often w/i normal range
  • Assoc w/parotitis, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand calluses (Russell sign)

192

Bulimia nervosa Rx options

  • psychotherapy
  • nutritional rehabilitation
  • antidepressants

193

Binge eating disorder

  • Regular episodes of excessive, uncontrollable eating without inappropriate compensatory behaviors.
  • Increased risk of diabetes.

194

Binge eating disorder Rx

  • 1st line: psychotherapy such as CBT
  • SSRIs

195

Gender dysphoria

  • Strong, persistent cross-gender identification that leads to persistent discomfort with sex assigned at birth, causing significant distress and/or impaired functioning.
  • Transgender individuals may have gender dysphoric disorder.

196

Transsexualism

desire to live as the opposite sex, often through surgery or hormone treatment.

197

Transvestism

  • Paraphilia, not gender dysphoria.
  • Wearing clothes (eg, vest) of the opposite sex (cross-dressing).

198

4 Types of sexual dysfunction

  1. sexual desire disorders (hypoactive sexual desire or sexual aversion)
  2. sexual arousal disorders (erectile dysfunction)
  3. orgasmic disorders (anorgasmia, premature ejaculation)
  4. sexual pain disorders (dyspareunia, vaginismus)

199

Sexual dysfunction DDx

  • ƒDrugs (eg, antihypertensives, neuroleptics, SSRIs, ethanol) ƒ
  • Diseases (eg, depression, diabetes, STIs)
  • ƒPsychological (eg, performance anxiety)

200

Sleep terror disorder

  • Periods of terror with screaming in the middle of the night; occurs during slow-wave/deep (stage N3) sleep.
  • Most common in children.
  • Occurs during non-REM sleep (no memory of arousal) as opposed to nightmares, which occur during REM sleep (memory of a scary dream).
  • Cause unknown, but triggers include emotional stress, fever, or lack of sleep.
  • Usually self-limited.

201

Narcolepsy

  • Disordered regulation of sleep-wake cycles
  • 1° characteristic: excessive daytime sleepiness (awaken feeling rested)
  • Caused by decreased hypocretin (orexin) production in lateral hypothalamus
  • Strong genetic component
  • Assoc w/
    • Hypnagogic or h            ypnopompic hallucinations
    • Nocturnal and narcoleptic sleep episodes that start with REM sleep
    • Cataplexy (loss of all muscle tone following strong emotional stimulus, such as laughter)

202

Narcolepsy Rx Options

  • daytime stimulants (eg, amphetamines, modafinil)
  • nighttime sodium oxybate (GHB)

203

Disruptive Mood Dysregulation Disorder

  • a depressive disorder
  • ›Severe recurrent temper outbursts manifested verbally and/or behaviorally that are grossly out of proportion in intensity or duration to the provocation
  • Outbursts occur 3 or more times/week for at least 12mos
  • ›Mood between temper outbursts is persistently irritable or angry most of the day, nearly every day
  • ›Diagnosis should not be made for 1st time before age 6 or after age 18.

204

Major Affective Disorder Comparison

A image thumb
206

Persistent Depressive Disorder

Same symptoms as major depression, but for 2+ years

207

Major depressive disorder with psychotic features

  • Depression for >2 weeks

AND

  • Psychotic symptoms DURING depressive episode

(compare to schizoaffective, which has psychotic episodes only OUTSIDE of mood disturbance episodes)

 

208

Chronic Tic Disorder

1+ motor OR verbal tics (not both) for > 1yr

209

Classical conditioning

  • Learning in which a natural response (salivation) is elicited by a conditioned, or learned, stimulus (bell) that previously was presented in conjunction with an unconditioned stimulus (food).
  • Usually deals with involuntary responses.
  • Ex: Pavlov

210

Operant conditioning

  • Learning in which a particular action is elicited because it produces a punishment or reward.
  • Usually deals with voluntary responses.

211

Reinforcement

Target behavior (response) is followed by desired reward (positive) or removal of aversive stimulus (negative).

212

Punishment

Repeated application of aversive stimulus (positive) or removal of desired reward (negative) to extinguish unwanted behavior.

213

Extinction

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

214

Transference

Patient projects feelings about formative or other important persons onto physician (eg, psychiatrist seen as parent).

215

Countertransference

Doctor projects feelings about formative or other important persons onto patient (eg, pt reminds physician of younger sibling).

216

Ego defenses

Mental processes (unconscious or conscious) used to resolve conflict and prevent undesirable feelings (eg, anxiety, depression).

217

Acting out

  • Expressing unacceptable feelings and thoughts through actions.
  • Tantrums

218

Denial

  • Avoiding the awareness of some painful reality.
  • A common reaction in newly diagnosed AIDS and cancer patients.

219

Displacement

  • Transferring avoided ideas and feelings to a neutral person or object (vs projection).
  • Mother yells at her child, because her husband yelled at her.

220

Dissociation

  • Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress.
  • Extreme forms can result in dissociative identity disorder (multiple personality disorder).

221

Fixation

  • Partially remaining at a more childish level of development (vs regression).
  • Adults fixating on video games.

222

Idealization

  • Expressing extremely positive thoughts of self and others while ignoring negative thoughts.
  • A patient boasts about his physician and his accomplishments while ignoring any flaws.

223

Identfication

  • Modeling behavior after another person who is more powerful (tho not necessarily admired).
  • Abused child later becomes a child abuser.

224

Intellectualization

  • Using facts and logic to emotionally distance oneself from a stressful situation.
  • In a therapy session, patient diagnosed with cancer focuses only on rates of survival.

225

Isolation (of affect)

  • Separating feelings from ideas and events.
  • Describing murder in graphic detail with no emotional response.

226

Passive aggression

  • Failing to meet the needs/expectations of others as an indirect show of opposition.
  • Disgruntled employee is repeatedly late to work.

227

Projection

  • Attributing an unacceptable internal impulse to an external source (vs displacement).
  • A man who wants to cheat on his wife accuses his wife of being unfaithful.

228

Rationalization

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

229

Reaction formation

  • Replacing a warded-off idea or feeling by an (unconsciously derived) emphasis on its opposite (vs sublimation).
  • A patient with libidinous thoughts enters a monastery.

230

Regression

  • Involuntarily turning back the maturational clock and going back to earlier modes of dealing with the world (vs fixation).
  • Seen in children under stress such as illness, punishment, or birth of a new sibling (eg, bedwetting in a previously toilet-trained child when hospitalized).

231

Repression

  • Involuntarily withholding an idea or feeling from conscious awareness (vs suppression).
  • A 20-year-old does not remember going to counseling during his parents’ divorce 10 years earlier.

232

Splitting

  • Believing that people are either all good or all bad at different times due to intolerance of ambiguity.
  • Commonly seen in borderline personality disorder.
  • A patient says all the nurses are cold and insensitive but the doctors are warm and friendly.

233

Mature Defenses

  1. Sublimation
  2. Altruism
  3. Suppression
  4. Humor

234

Sublimation

  • Replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one’s value system (vs reaction formation).
  • Teenager’s aggression toward his father is redirected to perform well in sports

235

Altruism

  • Alleviating negative feelings via unsolicited generosity.
  • Mafia boss makes large donation to charity.

236

Suppression

  • Intentionally and temporarily withholding an idea or feeling from conscious awareness (vs repression).
  • Choosing to not worry about the big game until it is time to play.

237

Humor

  • Appreciating the amusing nature of an anxiety- provoking or adverse situation.
  • Nervous medical student jokes about the boards.

238

  • Expressing unacceptable feelings and thoughts through actions.
  • Tantrums

Acting out

239

  • Avoiding the awareness of some painful reality.
  • A common reaction in newly diagnosed AIDS and cancer patients.

Denial

240

  • Transferring avoided ideas and feelings to a neutral person or object.
  • Mother yells at her child, because her husband yelled at her.

Displacement

241

  • Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress.

Dissociation

242

  • Partially remaining at a more childish level of development.
  • Adults fixating on video games.

Fixation

243

  • Expressing extremely positive thoughts of self and others while ignoring negative thoughts.
  • A patient boasts about his physician and his accomplishments while ignoring any flaws.

Idealization

244

  • Modeling behavior after another person who is more powerful (tho not necessarily admired).
  • Abused child later becomes a child abuser.

Identfication

245

  • Using facts and logic to emotionally distance oneself from a stressful situation.
  • In a therapy session, patient diagnosed with cancer focuses only on rates of survival.

Intellectualization

246

  • Separating feelings from ideas and events.
  • Describing murder in graphic detail with no emotional response.

Isolation (of affect)

247

  • Failing to meet the needs/expectations of others as an indirect show of opposition.
  • Disgruntled employee is repeatedly late to work.

Passive aggression

248

  • Attributing an unacceptable internal impulse to an external source.
  • A man who wants to cheat on his wife accuses his wife of being unfaithful.

Projection

249

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

Rationalization

250

  • Replacing a warded-off idea or feeling by an (unconsciously derived) emphasis on its opposite.
  • A patient with libidinous thoughts enters a monastery.

Reaction formation

251

  • Involuntarily turning back the maturational clock and going back to earlier modes of dealing with the world.
  • Seen in children under stress such as illness, punishment, or birth of a new sibling (eg, bedwetting in a previously toilet-trained child when hospitalized).

Regression

252

  • Involuntarily withholding an idea or feeling from conscious awareness.
  • A 20-year-old does not remember going to counseling during his parents’ divorce 10 years earlier.

Repression

253

  • Believing that people are either all good or all bad at different times due to intolerance of ambiguity.
  • Commonly seen in borderline personality disorder.
  • A patient says all the nurses are cold and insensitive but the doctors are warm and friendly.

Splitting

254

  • Replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one’s value system.
  • Teenager’s aggression toward his father is redirected to perform well in sports

Sublimation

255

  • Alleviating negative feelings via unsolicited generosity.
  • Mafia boss makes large donation to charity.

Altruism

256

  • Intentionally and temporarily withholding an idea or feeling from conscious awareness.
  • Choosing to not worry about the big game until it is time to play.

Suppression

257

  • Appreciating the amusing nature of an anxiety- provoking or adverse situation.
  • Nervous medical student jokes about the boards.

Humor

258

Haloperidol

  • Potent Typical antipsychotic
    • Blocks D2 receptors → increases cAMP
  • Use:
    • Schizophrenia positive symp
    • Sedation
  • S/E:
    • extrapyramidal
    • neurologic (PD)
    • endocrine
    • QT prolongation

259

Fluphenazine

  • Potent typical antipsychotic
    • Blocks D2 receptors → increases cAMP
  • Use: Schizophrenia positive symp
  • S/E:
    • extrapyramidal
    • neurologic (PD)
    • endocrine
    • QT prolongation

260

Thioridazine

  • Low-potency typical antipsychotic
    • Blocks D2 receptors → increases cAMP
  • Use: Schizophrenia positive symp
  • S/E: 
    • iris pigmentation / retinal deposits
    • anticholinergic
    • antihistamine
    • a1 blockade
    • QT prolongation
    • arrhythmia

261

Chlorpromazine

  • Low-potency typical antipsychotic
    • Blocks D2 receptors → increases cAMP
  • Use: Schizophrenia positive symp
  • S/E: 
    • Corneal deposits
    • anticholinergic
    • antihistamine
    • a1 blockade → reduce BP
    • QT prolongation

262

Olanzapine

  • Atypical antipsychotic
    • Blocks D2 and 5-HT2 receptors
  • Use: Schizophrenia positive and negative symp
  • S/E:
    • Weight gain (Olanzapine → Obese)
    • QT prolongation

263

Clozapine

  • Atypical antipsychotic
    • Blocks D2 and 5-HT2 receptors
  • Use: Rx-resistant Schizophrenia
  • S/E:
    • Agranulocytosis (watch BM clozely)
    • Myocarditis
    • Seizures
    • Weight gain
    • QT prolongation

264

Quetiapine

  • Atypical antipsychotic
    • Blocks D2 and 5-HT2 receptors
  • Use:
    • Schizophrenia positive & negative symp
    • Bipolar d/o maintenance
  • S/E: 
    • Cataracts
    • Abuse potential
    • QT prolongation

265

Risperidone

  • Atypical antipsychotic
    • Blocks D2 and 5-HT2 receptors
  • Use: Schizophrenia positive and negative symp
  • S/E:
    • HypERprolactinemia (→ galactorrhea, irreg menses)
    • QT prolongation

266

Aripiprazole

  • Atypical antipsychotic
    • Blocks D2 and 5-HT2 receptors
  • Use: Schizophrenia positive and negative symp
  • S/E:
    • Akathisia (agitation/distress)
    • QT prolongation
    • LOW incidence sedation / weight gain / diabetes

267

Ziprasidone

  • Atypical antipsychotic
    • Blocks D2 and 5-HT2 receptors
  • Use: Schizophrenia positive and negative symp
  • S/E: QT prolongation

268

Fluoxetine

  • SSRI
    • 4-8 weeks to take effect
  • Use:
    • depression
    • anxiety d/o
    • OCD
    • panic d/o
  • S/E:
    • SIADH
    • sexual dysfcn
    • serotonin synd

269

Paroxetine

  • SSRI
    • 4-8 weeks to take effect
  • Use:
    • Social Phobia
    • Erectile Dysfunction
    • depression
    • anxiety d/o
    • OCD
    • panic d/o
  • S/E:
    • Preg Cat D (heart defects)
    • SIADH
    • sexual dysfcn
    • serotonin synd

270

Sertraline

  • SSRI
    • 4-8 weeks to take effect
  • Use:
    • PTSD
    • depression
    • anxiety d/o
    • OCD
    • panic d/o
  • S/E:
    • SIADH
    • sexual dysfcn
    • serotonin synd

271

Citalopram

  • SSRI
    • 4-8 weeks to take effect
  • Use:
    • depression
    • anxiety d/o
    • OCD
    • panic d/o
  • S/E:
    • SIADH
    • sexual dysfcn
    • serotonin synd

272

venlafaxine

  • SNRI
  • Use:
    • depression
    • anxiety d/o
    • panic d/o
    • PTSD
  • S/E:
    • HTN
    • stimulant fx
    • sedation

273

Duloxetine

  • SNRI
  • Use:
    • depression
    • anxiety d/o
    • panic d/o
    • PTSD
  • S/E:
    • HTN
    • stimulant fx
    • sedation

274

Amitriptyline

  • TCA
    • Blocks NE and 5-HT reuptake
  • Use:
    • Peripheral neuropathy
    • Chronic pain
    • Major depression
    • Migraine prophylaxis
  • S/E:
    • Convulsions
    • Coma
    • Cardiotoxicity / QT prolongation (inhibition of fast Na+ channels)
    • Anticholinergic

275

Nortriptyline

  • TCA
    • Blocks NE and 5-HT reuptake
  • Use:
    • Major depression
    • Peripheral neuropathy
    • Migraine prophylaxis
  • S/E: Fewest anticholinergic, BP (a1) effects

276

Imipramine

  • TCA
    • Blocks NE and 5-HT reuptake
  • Use: 2nd line for bed-wetting
  • S/E:
    • Convulsions
    • Coma
    • Cardiotoxicity / QT prolongation (inhibition of fast Na+ channels)
    • Anticholinergic

277

Desipramine

  • TCA
    • Blocks NE and 5-HT reuptake
  • Use:
    • Major depression
    • Peripheral neuropathy
    • Migraine prophylaxis
  • S/E: fewest of all TCAs, esp M1 blocking effects

278

Clomipramine

  • TCA
    • Blocks NE and 5-HT reuptake
  • Use: 2nd line for OCD (Clomipramine)
  • S/E:
    • Convulsions
    • Coma
    • Cardiotoxicity / QT prolongation
    • Anticholinergic

279

Doxepin

  • TCA
    • Blocks NE and 5-HT reuptake
  • Use: Insomnia
  • S/E:
    • convulsions
    • coma
    • cardiotoxicity / QT prolongation
    • anticholinergic

280

Amoxapine

  • TCA
    • Blocks NE and 5-HT reuptake
  • Use:
    • major depression
    • OCD
    • peripheral neuropathy
    • migraine prophylaxis
  • S/E:
    • convulsions
    • coma
    • cardiotoxicity / QT prolongation
    • anticholinergic

281

Tranylcypromine

  • MAOI
    • Decreases breakdown of DA / NE / 5-HT
  • Use:
    • Atypical depression
    • Anxiety d/o
  • S/E:
    • HTN crisis w/tyramine (wine, cheese, nuts)
    • CNS stim
    • Dec REM sleep
    • Serotonin synd w/other meds that inc 5-HT

282

Phenelzine

  • MAOI
    • Decreases breakdown of DA / NE / 5-HT
  • Use:
    • Atypical depression
    • Anxiety d/o
  • S/E:
    • HTN crisis w/tyramine (wine, cheese, nuts)
    • CNS stim
    • Dec REM sleep
    • Serotonin synd w/other meds that inc 5-HT

283

Isocarboxazid

  • MAOI
    • Decreases breakdown of DA / NE / 5-HT
  • Use:
    • Atypical depression
    • Anxiety d/o
  • S/E:
    • HTN crisis w/tyramine (wine, cheese, nuts)
    • CNS stim
    • Dec REM sleep
    • Serotonin synd w/other meds that inc 5-HT

284

Selegiline

  • MAO-B selective inhibitor
    • Decreases breakdown of DA / NE / 5-HT
  • Use:
    • Slow progression of Parkinson's symptoms
  • S/E:
    • HTN crisis w/tyramine (wine, cheese, nuts)
    • CNS stim
    • Serotonin synd w/other meds that inc 5-HT

285

Lithium

  • Blocks dephosphorylation of IP3/DAG
  • Use: Bipolar d/o
  • S/E:
    • Movement d/o (tremor)
    • Nephrogenic DI
    • HypOthyroidism
    • Pregnancy prob
      • Ebstein anomaly → R atrium bigger, L heart smaller, BP lower
  • Toxicity w/Thiazides, NSAIDs, ACEIs, dehydration

286

Buspirone

  • Partial agonist at 5-HT1A receptors
    • Slow onset
  • Use: Generalized anxiety d/o
  • S/E:
    • Serotonin Synd
    • Extrapyramidal symp
  • Does NOT cause:
    • interaxn w/EtOH
    • sedation / addiction / tolerance
    • sexual dyfcn 

287

Bupropion

  • Atypical antidepressant
    • Increases NE and DA
  • Use:
    • Atypical depression
    • Smoking cessation
  • S/E:
    • Seizures in eating d/o pts
    • Stimulant fx
  • NO sexual dysfcn (bupropion for proper sex)

288

Mirtazapine

  • Atypical antidepressant
    • α2 Blocker
    • Also blocks 5-HT2, 5-HT3 receptors
  • Use: Atypical depression
  • S/E:
    • Sedation
    • Increased appetite
    • Weight gain
    • Dry mouth

289

Trazodone

  • Atypical antidepressant
    • Blocks α1, 5-HT2, H1 receptors
    • Also weakly inhibits 5-HT reuptake
  • Use:
    • Insomnia (inc REM sleep)
    • Atypical depression
  • S/E: trazzzobone
    • Priapism 
    • Sedation
    • Postural hypOtension

290

Phenobarbital

  • Barbiturate
    • Binds GABAA receptor → inc duration of Cl- channel opening → hyperpolarization
  • Use:
    • Sedation
    • Anxiety
    • Simple Complex, Partial Complex, and Tonic-Clonic Seizures (1st line in neonates)
    • Insomnia
  • S/E:
    • Poss fatal resp and CV depression
    • CNS depression (worse w/EtOH)
    • Low therapeutic index
  • P450 inducer
  • C/I: Porphyria

291

Pentobarbital

  • Barbiturate
    • Binds GABAA receptor → inc duration of Cl- channel opening → hyperpolarization
  • Use:
    • Sedation
    • Anxiety
    • Seizures
    • Insomnia
  • S/E:
    • Poss fatal resp and CV depression
    • CNS depression (worse w/EtOH)
    • Low therapeutic index
  • P450 inducer
  • C/I: Porphyria

292

Thiopental

  • Barbiturate
    • Binds GABAA receptor → inc duration of Cl- channel opening → hyperpolarization
  • Use:
    • Induction of anesthesia
    • Sedation
  • S/E:
    • Poss fatal resp and CV depression
    • CNS depression (worse w/EtOH)
    • Low therapeutic index
  • P450 inducer
  • C/I: Porphyria

293

Secobarbital

  • Barbiturate
    • Binds GABAA receptor → inc duration of Cl- channel opening → hyperpolarization
  • Use:
    • Sedation
    • Anxiety
    • Seizures
    • Insomnia
  • S/E:
    • Poss fatal resp and CV depression
    • CNS depression (worse w/EtOH)
    • Low therapeutic index
    • P450 inducer
  • C/I: Porphyria

294

Diazepam

  • Benzodiazepine
    • Binds GABAA receptor → inc frequency of Cl- channel opening → hyperpolarization
  • Use: Status epilepticus
  • S/E:
    • Dependence
    • CNS depression worse w/EtOH

295

Lorazepam

  • Benzodiazepine
    • Binds GABAA receptor → inc frequency of Cl- channel opening → hyperpolarization
  • Use:
    • Status epilepticus
    • No active metabolite → elderly, liver failure
  • S/E:
    • Dependence
    • CNS depression worse w/EtOH

296

Oxazepam

  • Short-acting Benzodiazepine
    • Binds GABAA receptor → inc frequency of Cl- channel opening → hyperpolarization
  • Use: No active metabolite → better for elderly, liver failure
  • S/E:
    • Dependence
    • CNS depression worse w/EtOH

297

Benzos better for elderly / liver failure pts

No active metabolite (desmethyldiazepam) → metabolized by phase II processes (conjugation), which are less affected than phase I in liver disease

LOTem of Benzos save the Liver:

  • Lorazepam
  • Oxazepam
  • Temazepam

298

Short-acting benzos

Higher addictive potential

ATriOM:

  • Alprazolam
  • Triazolam
  • Oxazepam
  • Midazolam

299

Temazepam

  • Benzodiazepine
    • Binds GABAA receptor → inc frequency of Cl- channel opening → hyperpolarization
  • Use:
    • Insomnia (maintain sleep)
    • No active metabolite → better for elderly, liver failure
  • S/E:
    • Dependence
    • CNS depression worse w/EtOH

300

Triazolam

  • Short-acting Benzodiazepine
    • Binds GABAA receptor → inc frequency of Cl- channel opening → hyperpolarization
  • Use: Insomnia (getting to sleep)
  • S/E:
    • Dependence
    • CNS depression worse w/EtOH

301

Midazolam

  • Short-acting Benzodiazepine
    • Binds GABAA receptor → inc frequency of Cl- channel opening → hyperpolarization
  • Use:
    • Gen anesthesia for short procedures
    • Seizures
  • S/E: Anterograde amnesia → date-rape drug

302

Chlordiazepoxide

  • Benzodiazepine
    • Binds GABAA receptor → inc frequency of Cl- channel opening → hyperpolarization
  • Use:
    • Anxiety
    • Spasticity
    • EtOH withdrawal, DTs
  • S/E:
    • Dependence
    • CNS depression worse w/EtOH 

303

Alprazolam

  • Short-acting Benzodiazepine
    • Binds GABAA receptor → inc frequency of Cl- channel opening → hyperpolarization
  • Use:
    • Panic d/o
    • Specific phobias
    • Anxiety
  • S/E:
    • Dependence
    • CNS depression worse w/EtOH

304

Clonazepam

  • Benzodiazepine
    • Binds GABAA receptor → inc frequency of Cl- channel opening → hyperpolarization
  • Use: Rx-resistant myoclonic / absence seizures
  • S/E:
    • Dependence
    • Tolerance
    • CNS depression worse w/EtOH 

305

Flunitrazepam

  • Benzodiazepine
    • Binds GABAA receptor → inc frequency of Cl- channel opening → hyperpolarization
  • Use: abused as date-rape drug

306

Benzo receptor agonist

  • Same action as benzos, but chemically different
  • Dec latency to fall asleep + inc sleep time
  • Less dependence
  • Less anxiolytic
  • Can still give flumazenil for OD

307

Eszopiclone

  • GABA BZ1 (benzo) receptor agonist
    • Dec latency to fall asleep + inc sleep time
  • Use: Insomnia
  • S/E:
    • Sleepwalking
    • Ataxia
    • HA
    • Confusion
  • Less dependence, less anxiolytic

308

Zolpidem

  • GABA BZ1 (benzo) receptor agonist
    • Dec latency to fall asleep + inc sleep time
  • Use: Insomnia
  • S/E:
    • Sleepwalking
    • Ataxia
    • HA
    • Confusion
  • Less dependence, less anxiolytic

309

Zaleplon

  • GABA BZ1 (benzo) receptor agonist
    • Dec latency to fall asleep + inc sleep time
  • Use: Insomnia (short-term)
  • S/E:
    • Sleepwalking
    • Ataxia
    • HA
    • Confusion
  • Less dependence, less anxiolytic

310

Ramelteon

  • Type 1 and 2 melatonin receptor agonist
  • Use: insomnia

311

Suvorexant

  • Orexin antagonist
  • Use: Prevents stimulation / "wake" signals

312

Antihistamines for insomnia

  • Drugs:
    • Diphenhydramine
    • Doxylamine
    • Hydroxyzine
  • Use: Best for pts w/allergies and pruritis that disrupt sleep patterns
  • Tolerance develops w/i 4 days
  • S/E: anticholinergic

313

Carbamazepine

  • Anti-epileptic
    • Inc Na+ channel inactivation in cortical neurons
  • Undergoes autoinduction (t1/2 decreases) → slowly increase dose to keep therapeutic
  • Use: 1st line for
    • Trigeminal neuralgia
    • Simple and Complex Partial Seizures
    • Tonic-Clonic Seizures
    • Bipolar d/o mania
  • S/E:
    • Blood dyscrasias
    • Liver toxicity
    • SIADH
    • SJS
    • Hyponatremia
    • Diplopia
    • Ataxia
    • Teratogenesis
  • P450 inducer

314

Valproic Acid

  • Anti-epileptic
    • Increases Na+ channel inactivation
    • Inhibits GABA transaminase → inc GABA
  • Use:
    • Tonic-Clonic Seizures (1st line)
    • Simple and Complex Partial Seizures
    • Absence Seizures
    • Myoclonic Seizures
    • Bipolar d/o maintenance
  • S/E:
    • BM suppression (thrombocytopenia)
    • Teratogen → Neural tube defects
    • Pancreatitis
    • Hepatotoxicity (can be fatal)
    • Tremor
    • Weight gain
    • Alopecia

315

Stevens-Johnson Syndrome (SJS)

  • Prodrome of malaise and fever followed by rapid onset of erythematous/purpuric macules (oral, ocular, genital)
  • Skin lesions progress to epidermal necrosis and sloughing

316

5 Typical Antipsychotic Drugs

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

317

10 Atypical Antipsychotic Drugs

  1. Aripiprazole
  2. Asenapine
  3. Clozapine
  4. Olanzapine
  5. Quetiapine
  6. Risperidone
  7. Iloperidone
  8. Lurasidone
  9. Paliperadone
  10. Ziprasidone

318

4 SSRI Drugs

  • Fluoxetine
  • Paroxetine
  • Sertraline
  • Citalopram

319

6 SNRI Drugs

  1. Venlafaxine
  2. Desvenlafaxine
  3. Duloxetine
  4. Maprotiline
  5. Milnacipran
  6. Levomilnacipran

320

TCA Drugs

  • Amitriptyline
  • Nortriptyline
  • Imipramine
  • Desipramine
  • Clomipramine
  • Doxepin
  • Amoxapine

321

MAOI Drugs

  • Tranylcypromine
  • Phenelzine
  • Isocarboxazid
  • Selegiline

322

Atypical Antidepressant Drugs

  • Bupropion
  • Mirtazapine
  • Trazodone

323

Barbiturate Drugs

  • Phenobarbital
  • pentobarbital
  • thiopental
  • secobarbital

324

Benzodiazepine Drugs

  • Diazepam
  • lorazepam
  • triazolam
  • temazepam
  • oxazepam
  • midazolam
  • alprazolam
  • chlordiazepoxide

325

Non-Benzo Hypnotics

  • Zolpidem
  • Zaleplon
  • Zopiclone

326

Flumazenil

  • Competitive antagonist at GABA benzodiazepine receptor
  • Use: Reversal of benzo OD

327

Beta-blockers

1st line for short-term treatment of anxiety (stage fright)

328

Cyproheptadine

  • 1st gen antihistamine
  • 5-HT1A and 5-HT2A blocker
  • Use: Serotonin syndrome

329

Methylphenidate

  • Stimulant
  • Inhibits DAT and NET → decreases reuptake of DA and NE
  • Use: ADHD
  • S/E
    • Tic disorders (transient and chronic)
    • DA elevation – may worsen pre-existing psychosis
    • Abuse potential
  • Interactions
    • CYP 2D6 inhibitors (SSRIs)
    • MAOIs
    • TCAs
    • Phenytoin
    • Clonidine

330

Amphetamines

  • Stimulants
  • Inhibit DAT and NET → decrease reuptake of DA and NE and enhance DA release
  • Use: ADHD
  • S/E: CV events

331

Atomoxetine

  • NON-stimulant
  • Selective NE reuptake inhibitor
  • Use: ADHD
  • S/E:
    • Severe liver disease
    • Potential suicidal ideation

332

ADHD Rx Preference

  1. Stimulants
  2. Non-stimulants
  3. TCAs, Bupropion
  4. Clonidine, Guanfacine

333

Escitalopram

  • SSRI
  • Helps restore memory post-stroke

334

Maprotiline

  • SNRI
  • Use: Depression
  • S/E:
    • Orthostatic HypOtension
    • Sedation

335

Prochlorperazine

  • Potent typical antipsychotic
    • Blocks D2 receptors → increases cAMP
  • Use:
    • Schizophrenia positive symp
    • Anti-emetic in adults
  • S/E:
    • extrapyramidal
    • endocrine
    • neurologic (PD)
    • QT prolongation

336

Promethazine

  • Potent typical antipsychotic
    • Blocks D2 receptors → increases cAMP
  • Use:
    • Schizophrenia positive symp
    • Anti-emetic in kids
  • S/E:
    • extrapyramidal
    • endocrine
    • neurologic (PD)
    • QT prolongation

337

Trifluoperazine

  • Potent typical antipsychotic
    • Blocks D2 receptors → increases cAMP
  • Use: Schizophrenia positive symp
  • S/E:
    • extrapyramidal
    • endocrine
    • neurologic (PD)
    • QT prolongation

338

Rx for tyramine-induced crisis w/MAOI

Phentolamine

339

Akasthisia

Restlessness w/inability to sit still

(Extrapyramidal effect of antipsychotics)

340

Tardive Dyskinesia

Repetitive, rhythmic, involuntary movements (lip smacking, choreoathetoid mvmt) after prolonged antipsychotic use

341

DRESS Syndrome

Drug Rxn w/Eosinophilia & Systemic Symptoms

  • 2-8wks after drug exposure
    • Anticonvulsants
    • Allopurinol
    • Sulfonamides
    • Antibiotics
  • Fever
  • Generalized LAD
  • Facial Edema
  • Morbiliform Skin Rash
  • Internal Organ Dysfcn

342

3 High-Potency Typical Antipsychotics

  1. Trifluoperazine
  2. Fluphenazine
  3. Haloperidol

Tri to Fly High

  • Neuro side effects (extrapyramidal)

343

2 Low-Potency Typical Antipsychotics

  1. Chlorpromazine
  2. Thioridazine

Cheating Thieves are Low

  • Non-neuro side effects (antihistamine, anticholinergic, alpha blocking)

344

Desvenlafaxine

  • SNRI
  • Use:
    • depression
    • anxiety d/o
    • panic d/o
    • PTSD
  • S/E:
    • HTN
    • stimulant fx
    • sedation

345

Levomilnacipran

  • SNRI
  • Use:
    • depression
    • anxiety d/o
    • panic d/o
    • PTSD
  • S/E:
    • HTN
    • stimulant fx
    • sedation

346

Milnacipran

  • SNRI
  • Use:
    • depression
    • anxiety d/o
    • panic d/o
    • PTSD
  • S/E:
    • HTN
    • stimulant fx
    • sedation

347

Asenapine

  • Atypical antipsychotic
    • Blocks D2 and 5-HT2 receptors
  • Use: Schizophrenia positive and negative symp
  • S/E:
    • QT prolongation
    • Metabolic syndrome

348

Iloperidone

  • Atypical antipsychotic
    • Blocks D2 and 5-HT2 receptors
  • Use: Schizophrenia positive and negative symp
  • S/E: QT prolongation

349

Paliperidone

  • Atypical antipsychotic
    • Blocks D2 and 5-HT2 receptors
  • Use: Schizophrenia positive and negative symp
  • S/E: QT prolongation

350

SSRI uses

  • Depression
  • Gen anxiety d/o
  • Social anxiety d/o
  • Panic d/o
  • OCD
  • Bulimia
  • PTSD
  • Premature ejaculation
  • PMDD

351

SNRI uses

  • Depression
  • Gen anxiety d/o
  • Diabetic neuropathy
  • Social anxiety d/o (Venlafaxine)
  • Panic d/o (Venlafaxine)
  • PTSD (Venlafaxine)
  • OCD (Venlafaxine)

352

Typical Antipsychotic uses

  • Schizophrenia positive symptoms
  • Psychosis
  • Bipolar d/o
  • Delirium
  • Tourette
  • Huntington's
  • OCD

353

Atypical Antipsychotic uses

  • Schizophrenia positive and negative symptoms
  • Bipolar d/o
  • OCD
  • Anxiety d/o
  • Depression
  • Mania
  • Tourette

354

CNS Stimulant uses

  • ADHD
  • Narcolepsy
  • Appetite control

355

TCA uses

  • Major depression
  • OCD (Clomipramine)
  • Peripheral neuropathy
  • Chronic pain
  • Migraine prophylaxis

356

Rx TCA-induced Arrhythmia

NaHCO3

357

5 Drugs C/I with MAOIs

  1. SSRIs
  2. TCAs
  3. St John's Wort
  4. Meperidine (Demerol)
  5. Dextromethorphan

358

Varenicline

  • Nicotinic Ach Receptor Partial Agonist
  • Use: Smoking cessation
  • S/E: Sleep disturbance

359

Antidepressant MOAs

A image thumb
361

Guanfacine

  • α2 Agonist
  • Use:
    • ADHD
    • Tourette
    • HTN emergency

362

Clonidine

  • α2 Agonist
  • Use:
    • ADHD
    • Tourette
    • HTN emergency

363

Sodium Oxybate

  • GHB
  • Use: Nighttime Narcolepsy

364

Modafinil

  • Non-amphetamine CNS Stimulant
  • Use: Preferred Rx for Narcolepsy (Daytime)

365

Pimozide

  • Antipsychotic
  • Use: Tourette

366

NTs associated w/sleep

SANDman:

  • Serotonin → initiate sleep
  • Ach → induction of REM sleep
  • NE → decreases during REM sleep
  • DA → arousal and wakefulness

367

Introjection / Identification

  • Features of external world or another person are unconsciously taken in and made part of self
  • Opposite of projection
  • Teenager adopts style and mannerisms of rock star

368

  • Features of external world or another person are unconsciously taken in and made part of self
  • Opposite of projection
  • Teenager adopts style and mannerisms of rock star

Introjection / Identification

369

Benzo uses

  • Anxiety
  • Spasticity
  • EtOH withdrawal, DTs
  • Night terrors
  • General anesthesia
  • Insomnia
  • Seizures (Clonazepam, Lorazepam)

370

Most common cause of intellectual disabilty

Fetal Alcohol Syndrome

371

Social learning

behavior acqured by watching other persons and assimilating their actions into own behavioral repertoire

372

Confabulation

  • Pt unconsciously makes up explanations to fill in gaps in recent memory
  • Pt often does not realize the explanations are untrue
  • Assoc w/alcohol abuse (Korsakoff)
  • Distinguished from malingering by setting of memory loss and pt unawareness of lack of truth

373

Ethyl Glucuronide

  • Commonly-used biomarker to detect recent alcohol ingestion
  • Water-soluble, direct metabolite of EtOH formed when EtOH conjugates w/activated glucuronic acid
  • Positive almost immediately after EtOH intake and can be used for up to 5 days after

374

Gamma-Glutamyltransferase

  • Biologic marker of EtOH consumption over exended period of time--useful screening test
  • Will be elevated before LFTs (ALT, AST, ALP) are altered

375

Minor Alcohol Withdrawal

6-24h since last drink

  • Anxiety
  • Nausea/Vomiting
  • Tremor
  • Insomnia

376

Major Alcohol Withdrawal

10-72h since last drink

  • Visual & auditory hallucinations
  • Whole body tremor
  • Vomiting
  • Diaphoresis
  • HTN
  • Seizures in severe cases

377

Circadian rhythm driven by

Suprachiasmatic nucleus of hypothalamus

378

Circadian rhythm controls

Nocturnal release of:

  • ACTH
  • Prolactin
  • Melatonin
  • NE

379

Suprachiasmatic nucleus of hypothalamus

  • Drives circadian rhythm
  • Regulated by environment (light)
  • SCN → NE release → Pineal gland → Melatonin

380

Two main stages of sleep

  • REM
  • Non-REM

381

REM Sleep occurs how often

Every 90 min

382

REM Sleep characteristics

  • Inc Ach
  • Loss of motor tone / mm paralysis
  • Inc brain O2 use
  • Variable pulse and BP
  • Dreaming, nightmares
  • Penile/clitoral tumescence
  • May have memory processing fcn

383

Assoc w/Decreased REM Sleep

  1. Alcohol
  2. Benzos
  3. Barbiturates
  4. NE

384

Rx Bedwetting

  1. Oral Desmopressin
  2. Imipramine (more side effects)

385

Rx night terrors

Benzos

386

Rx Sleepwalking

Benzos

387

EEG: Awake, eyes open

Beta waves (>12 Hz)

A image thumb
388

EEG: Awake, eyes closed

Alpha waves (8-13 Hz)

A image thumb
389

EEG: Stage N1

  • Light Sleep
  • Theta waves (4-7 Hz)

A image thumb
390

EEG: Stage N2

  • Deeper sleep
  • Sleep spindles
  • K-complexes (high-amplitude single spike followed by trough)

A image thumb
391

EEG: Stage N3

  • Deepest Non-REM sleep / "slow wave" sleep
  • Delta waves (<4 Hz)

A image thumb
392

EEG: REM Sleep

  • Beta waves (>12 Hz)
  • Sawtooth waves
  • PGO Spikes (transient large-amplitude potentials in occipital area)

A image thumb
393

Bruxism occurs during which sleep stage?

Stage N2

394

What controls EOM during REM sleep?

PPRF (conjugate gaze center)

395

Sleepwalking occurs during which sleep stage?

Stage N3

396

Night Terrors occur during which sleep stage?

Stage N3

397

Bedwetting occurs during which sleep stage?

Stage N3

398

Dreaming occurs during which sleep stage?

REM

399

Penile/clitoral tumescence occurs during which sleep stage?

REM

400

Mu receptor effects

  • Physical dependence
  • Euphoria
  • Resp & Cardiac depression
  • Reduced GI motility
  • Sedation
  • Analgesia

401

Kappa receptor effects

  • Miosis
  • Dysphoria
  • Sedation
  • Analgesia (PNS)

402

Delta receptor effects

  • Antidepressant
  • Analgesia (PNS)

403

Learning Disorder

  • Child has difficulties in key academic skills (reading, writing, math)
  • Performance well below average for age
  • Displays anxiety, inattention, hyperactivity when under stress

404

Trichotillomania

  • Hair-pulling disorder
  • Recurrent pulling of hair
  • Repeated attempts to decrease or stop behavior

405

Med of choice for Rx-resistant schizophrenia

Clozapine

406

TCA effects + MOA

  • Block NE & 5-HT reuptake → antidepressant effects, seizures, tremors
  • Block central & peripheral muscarinic Ach receptors → anticholinergic effects
  • Block peripheral a1 receptors → orthostatic hypOtension
  • Block cardiac fast Na+ channels → arrhythmia
  • Block H1 receptors → sedation, increased appetite

407

Rx Drug-Induced Parkinsonism

Anti-PD Muscarinic Blocker (Benztropine, Trihexphenidyl)

408

TCA Side Effects

  • Convulsions
  • Coma
  • Cardiotoxicity / QT prolongation (inhibition of cardiac fast Na+ channels)
  • Anticholinergic

409

Transitioning from MAOI to other serotonergic drug

Wait 2wks after stopping MAOI to start serotonergic drugs to allow MAO regeneration

410

Rx Benzo toxicity

Flumazenil

411

5-HT1A Stimulation

  • Antidepressant
  • Anxiolytic
  • Temperature (decrease)/regulation

412

5-HT2A Stimulation

  • Short-term anxiogenic
  • Temperature (increase)/regulation
  • Sexual function regulation
  • Insomnia
  • Hallucinations
  • Weight gain (long-term)
  • Apathy (long-term)

413

5-HT2C Stimulation

Appetite decrease

414

5-HT3 Stimulation

  • Nausea
  • Increased GI motility

415

DA Agonism Side Effects

  • —Psychomotor activation
  • —Aggravation of psychosis

416

Lamotrigine

  • Anti-epileptic
    • Blocks voltage-gated Na+ channels
  • Use:
    • Simple and Complex Partial Seizures
    • Tonic-Clonic Seizures
    • Absence Seizures
    • Bipolar d/o maintenance (dec risk depressive episode)
  • S/E:
    • SJS
    • Aseptic meningitis
    • Teratogenic → cleft palate

417

5-HT Withdrawal Syndrome

  • Flu-like symptoms
  • Insomnia
  • Nausea
  • Imbalance
    • Gait instability
    • Dizziness/lightheadedness
    • Vertigo
  • Sensory disturbances
    • Paresthesia
    • “Electric shock” sensations
    • Flashes of light
  • Hyperarousal

418

Frontal Lobe Fcn

  • Executive fcn
    • complex tasks
    • motivation
    • organization
    • planning
    • purposeful action
  • Personality
    • social behavior
    • emotional behavior

419

Left Frontal Lobe Lesion

  • Apathy
  • Depression

420

Right Frontal Lobe Lesion

Disinhibited behavior

421

Corpus Callosum lesion

  • "Split-brain" syndrome
  • Lack of interhemispheric transfer of information (can't retrieve w/one hand an object palpated w/other)

422

Parietal Lobe lesion

  • Difficulties w/spatial and visual perception
  • Non-dominant (usually R): hemi-neglect, constructional apraxia, denial of problem
  • Dominant (usually L): Gerstmann Syndrome w/R-L confusion and difficulty w/writing and math

423

Temporal Lobe lesion

  • Language disturbance
  • Sensory interpretation problems
  • Impaired memory
  • Behavioral changes (hyperorality, hypersexuality)
  • Non-dominant (usually R): problems w/nonverbal memory, including musical ability
  • Dominant (usually L): verbal memory problems, including word recognition

424

Sleep Hygeine measures

  • Maintain regular sleep schedule
  • Avoid naps
  • Avoid alcohol, smoking, large meals near bedtime
  • Keep bedroom quiet, dark, & cool
  • Exercise regularly, but not too close to bedtime

425

Sleep Stimulus Control measures

  • Bed is only for sleep & sex
  • Go to bed only when sleepy
  • Leave bed & go to another room when unable to sleep
  • Fixed wake-up time, including weekends

426

Sleep Relaxation methods

  • Progressive mm relaxation
  • Relaxation response (abd breathing, focus on peaceful image)

427

Sleep restriction methods

  • Restrict sleep to time actually spent sleeping (keep diary)
  • Increase time in bed in 15-30min intervals when sleep efficiency is >90%