Flashcards in Psychiatry Deck (155):
Learning in which a particular action is elicited because it produces a punishment or reward. Usually deals with VOLUNTARY responses.
mature defense mechanisms
SASH - sublimation, altruism, suppression, humor
schizophrenia risk - 1) general population 2) parent or sibling of someone affected 3) monozygotic twin
Infant deprivation effects
2) poor language/socialization skills
3) lack of basic trust
4) reactive attachment disorder (infant withdrawn/unresponsive to comfort)
The 4 W's: Weak, wordless, waning, wary.
epidemiology of physical abuse in kids
40% of deaths in children
peak incidence of sexual abuse in kids
9-12 years old
Before age 12.
ADHD treatment and alternatives
1) stimulants (methylphenidate)
2) +/- CBT
3) atomoxetine, guanfacine, clonidine
increased head/brain size
Usually in early childhood.
percent of patients with ADHD that go on to adult ADHD
ADHD physical association
decreased frontal lobe volume/metabolism
conduct disorder treatment
antisocial personality disorder treatment
oppositional defiant disorder treatment
separation anxiety disorder treatment
CBT, play therapy, family therapy
common onset of separation anxiety disorder
Before age 18.
magic number for tourette's
symptoms longer than 1 year
incidence of coprolalia in tourette's
OCD + ADHD
psychoeducation + behavioral therapy
Treatment for intractable tics
low-dose high-potency antipsychotics (e.g, fluphenazine, pimozide) + tetrabenazine + clonidine
rett syndrome presentation
loss of development + loss of verbal abilities + ID + ataxia + stereotyped hand-wringing
neurotransmitter changes in Anxiety
increase in NE, decrease in GABA + 5-HT
neurotransmitter changes in depression
decrease in NE + dopamine + 5-HT
order of orientation loss
memory problems following severe trauma or stress
Findings in delirium
EEG abnormalities (as opposed to dementia, in which EEG is usually normal)
depression + hypothyroidism. This is why you need to measure TSH + B12 levels.
apraxia + aphasia + agnosia + loss of abstract thought + behavioral/personality chagnes + impaired judgment.
olfactory hallucinations. when do they happen?
usually in epileptics + brain tumors
gustatory hallucinations. when do they happen?
sensation of bugs crawling on one's skin
schizophrenia magic number
requires at least 2 of following:
3) disorganized speech
4) disorganized or catatonic behavior
5) negative symptoms (flat affect, social withdrawal, lack of motivation, lack of speech or thought)
brief pyschotic disorder magic number
less than 1 month
schizophreniform disorder magic number
schizoaffective disorder magic number
lifetime prevalence of schizophrenia
delusional disorder magic number
manic episode magic number
manic episode diagnosis
3 of DIGFAAST (FA 510)
hypomanic episode magic number + diagnostic criterion
4 consecutive days. No impairment in functioning.
cyclothymic disorder magic number
MDD magic number
MDD diagnosis caveat
Must include depressed mood or anhedonia
MDD treatment alternatives
SNRIs + mirtazapine + bupropion. ECT.
Peresistent depressive disorder (dysthymia) magic number
at least 2 years
changes in sleep stages during depression
decreased slow-wave sleep + decreased REM latency + increased REM early in sleep + increased Total REM sleep + repeated nighttime awakenings + early-morning awakening
early morning awakening
treatment for atypical depression
CBT and SSRIs are first line
most common form of depression
other features of atypical depression
long-standing interpersonal rejection sensitivity + mood reactivity (being able to experience improved mood in response to positive events, albeit briefly).
postpartum blues incidence
postpartum blues onset
2-3 days after delivery
postpartum blues treatment
supportive + followup to assess for depression
postpartum depression incidence
postpartum depression timeframe
within 4 weeks after delivery
postpartum psychosis incidence
nonintuitive RF's for postpartum psychosis
postpartum psychosis treatment
Hospitalization + initiation of atypical antipsychotic. ECT if refractory.
Pathologic grief diagnosis + caveat
>6 months + satisfies major depressive criteria. Hallucinations NOT pathologic grief.
treatment-refractory depression + depression with psychotic symptoms + acutely suicidal patients.
Grand-mal seizures in anesthetized patients.
disorientation + headache + partial anterograde/retrograde amnesia usually resolving in 6 months.
Panic attack diagnosis + Panic disorder diagnosis
at least 4 of PPANIICCCCSSS for attack + 1 month of at least 1 of following (persistent concern of additional attacks, worrying about consequences of attack, behavioral change related to attcks)
CBT + SSRIs + MAO inhibitors
GAD magic number
at least 6 months
adjustment disorder treatment
CBT + SSRIs
adjustment disorder magic numbr
impairment in function + less than 6 months
Feature of OCD. Behavior inconsistent with one's own beliefs and attitudes.
treatment for body dysmorphic disorder
Acute stress disorder magic number
Between 3 days and 1 month.
Acute stress disorder treatment
CBT. Pharmacotherapy usually NOT indicated.
malingering vs. somatic symptom disorder vs. factitious disorder
somatic -- no conscious attempt to deceive.
factitious -- chief goal is psychological (primary gain)
malingering -- chief goal is external (secondary gain).
CHRONIC factitious disorder with predominately physical signs/symptoms. History of hospitalization and willingness to undergo invasive procedures.
illness anxiety disorder
personality disorders -- A,B,C
"Weird, wild, worried"
major defense mechanism in paranoid personality disorder
conduct disorder vs. antisocial personality disorder
conduct is if 18 years old.
treatment for BPD
dialectical behavior therapy
schizoid vs. avoidant
avoidant people desire relationships with people, unlike schizoid people.
Obsessive-compulsive personality disorder vs. OCD
obsessive-compulsive is ego-syntonic (behavior consistent with one's own beliefs and attitudes). OCD is ego-dystonic.
anorexia magic number
less than 18.5
Fluid and electrolyte disturbances following feeding, especially hypophosphatemia. Can occur in malnourished patients, such as anorexics.
anorexia nervosa treatment
psychotherapy + nutritional rehabilitation are first line.
bulimia nervosa magic number
dorsal hand calluses from induced vomiting (seen in bulimia nervosa).
intense sexual arousal to atypical objects, situations, or individuals. characteristic of transvestism.
Discomfort resulting from involuntary vaginal muscle spasm, making penetration painful or impossible.
drugs associated with sexual dysfunction
antihypertensives + neuroleptics + SSRIs + ethanol
sleep phase in which sleep terror disorder occurs
hypocretin produced in
lateral hypothalamus (low in narcolepsy)
loss of muscle tone (narcolepsy)
sleep physiology in narcolepsy
episodes start with REM sleep
Daytime -- stimulants (amphetamines, modafinil).
Nighttime -- sodium oxybate (GHB).
substance abuse disorders caveat
at least 2
opioid intoxication presentation
euphoria + respiratory/CNS depression + decreased GAG reflex + pupillary constriction
benzo intoxication presentation
ataxia + minor respiratory depression
amphetamines intoxication presentation
pupillary dilation + paranoia + fever
cocaine intoxication presentation
pupillary dilation + hallucinations (including tactile) + paranoid ideations + angina + sudden cardiac death
cocaine intoxication treatment
alpha-blockers + benzodiazepines
DT mortality rate
opioid withdrawal presentation
sweating + dilated pupils + piloerection ("cold turkey") + fever + rhinorrhea + yawning + nausea + stomach cramps + diarrhea ("flu-like" symptoms")
barbiturate withdrawal presentation
delirium + life-threatening cardiovascular collapse
benzo withdrawal presentation
sleep disturbance + depression + rebound anxiety + seizures
amphetamine withdrawal presentation
anhedonia + increased appetite + hypersomnolence + existential crisis
hypersomnolence + malaise + severe psychological craving + depression/suicidality
nicotine withdrawal treatment
bupropion + varenicline
time frame of marijuana detection in urine
irritability + depression + insomnia + nausea + anorexia.
timeframe for marijuana withdrawal
Most symptoms peak in 48 hours and last for 5-7 days.
when do you use naltrexone for opioid rehab?
relapse prevention once detoxified (it is long-acting).
why does naloxone/buprenorphine have low abuse potential?
if injected, naloxone will precipitate withdrawal because of antagonism. When taken orally, naloxone isn't orally bioavailable, so doesn't have any antagonism.
approach to management of alcoholism
1) naltrexone is first line and can be initiated while the individual is still drinking. It blocks rewarding and reinforcing effects of alcohol.
2) disulfiram only used in abstinent patients with strong motivation to maintain abstinence.
ethyl glucuronide (EtG)
Commonly used biomarker to detect recent alcohol ingestion (metabolite of ethanol).
onset of withdrawal in alcoholism
6-12 hours after individuals top or dramatically decrease alcohol intake
DT timeframe, peaking...
2-4 days after last drink
presentation = HTN (can be severe) + profound agitation + global confusion + disorientation + hallucinations + fever + diaphoresis + tachycardia
alcoholic hallucinosis + timeframe
distinct condition from DT. visual hallucinations 12-48 hours after last drink.
first-line for social phobias
SSRIs + beta-blockers
high-potency antipsychotics + SE profile
(Try to Fly High P) --> Trifluoperazine, Fluphenazine, Haloperidol + pimozide
- neurologic side effects
typical antipsychotics treat...
treatment for extrapyramidal side effects of typical antipsychotics
benztropine + diphenhydramine
typical antipsychotics side effects (other than endocrine)
- muscarinic blockade (dry mouth + constipation)
- alpha 1 blockade (hypotension)
- histamine blockade (sedation)
dantrolene + D2 agonists (bromocriptine)
Low potency antipsychotics + SE profile
(Cheating Thieves) Chlorpromazine, thioridazine
- non-neurologic side effects (anticholinergic, antihistamine, alpha1 blockade)
chlorpromazine unique side effects
thioridazine unique side effect
evolution of EPS side effects
4 hr --> acute dystonia (muscle spasm, stiffness, oculogyric crisis)
4 day --> akathisia (restlessness)
4 week --> bradykinesia (parkinsonism)
4 month --> tardive dyskinesia
olanzapine + clozapine + quietiapine + risperidone + aripiprazole + ziprasidone
agranulocytosis + seizure
may increase prolactin (causing lactation and gynecomastia, leading to decreased GnRH, LH, and FSH, causing irregular menstruation and fertility issues.
not established; maybe inhibition of phosphoinositol cascade.
Lithium pharmacologic notes
1) narrow therapeutic window
2) almost exclusively excreted by kidneys
3) most reabsobred at PCT with Na+
fluoxetine + paroxetine + sertraline + citalopram
delay before SSRIs take effect
serotonin syndrome presentation
hyperthermia + confusion + myoclonus + cardiovascular instability + flushing + diarrhea + seizures.
drugs that cause serotonin syndrome
Anything that increases serotonin. MAOIs + SNRIs + TCAs + SSRIs
diabetic peripheral neuropathy treatment
block reuptake of norepinephrine + 5-HT
other indications for TCA's
peripheral neuropathy + chronic pain
tertiary TCA (more anticholinergic side effects than secondary TCA's)
convulsions + coma + cardiotoxicity + respiratory depression + hyperpyrexia + confusions and hallucinations in elderly (due to anticholinergic side effects)
TCA to use in old people
tranylcypromine + phenelzine + isocarboxazid + selegeline
MAO inhibition leads to inceased levels of amine neurotransmitters (NE + 5-HT + dopamine)
SSRIs + TCAs + St. John's wort + meperidine + dextromethorphan (to prevent serotonin syndrome)