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Flashcards in Psychiatry Deck (55):
1

acting out

unacceptable feelings and thoughts are expressed through actions, ie tantrums

2

dissociation

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

3

denial

avoidance of awareness of some painful reality, with newly diagnosed AIDS and cancer pts

4

displacement

process whereby avoided ideas and feelings are transferred to some neutral person or object (vs. projection), ie mother places blame on child because she is angry at her husband

5

fixation

partially remaining at a more childish level of development (vs. regression), ie men fixating on sports game

6

identification

modeling behavior after another person who is more powerful, ie abused child IDs himself as an abuser

7

isolation of affect

separation of feelings from ideas and events, ie describing murder in graphic detail with no emotional response

8

projection

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

9

rationalization

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

10

reaction formation

process whereby a warded off idea or feeling is replaced by an (unconsciously derived) emphasis on its opposite, ie pt with libidinous thoughts enteres a monastery

11

regression

turning back the maturational clock and going back to early modes of dealing with the world, ie seen in children under stress (bedwetting) and in patients with dialysis (crying)

12

repression

involuntary witholding of an idea or feeling from conscious awareness, ie not remembering a conflictual or traumatic experience or pressing bad thoughts into the unconscious

13

splitting

belief that people are either all good or all bad at different times due to intolerance of ambiguity, seen in borderline personality disorder

ex. a pt says that all the nurses are cold and insensitive but that the doctors are warm and friendly

14

altruism

guilty feelings alleviated by unsolicited generosity toward others, ie mafia boss makes large donation to charity

15

humor

appreciating the amusing nature of an anxiety-provoking or adverse situation, ie a nervous medical student jokes about the boards

16

sublimation

process whereby one replaces an unacceptable wish with an course of action that is similar to the wish but does not conflict with one's value system, ie actress uses experience of abuse to enhance her acting

17

suppression

voluntary witholding of an idea or feeling from conscious awareness (vs repression), ie choosing not to think about the USMLE until the week of the exam

18

What are the four mature ego defenses?

Mature women wear a SASH: sublimation, altruism, suppression, humor

19

Rett's disorder

X-linked disorder seen only in girls; symptoms start at age 1-4, followed by regression with loss of development, mental retardation, loss of verbal abilities, ataxia, and stereotyped hand wringing

20

Childhood disintegrative disorder

marked regression after 2 years of apparently normal development

significant loss of expressive or receptive language skills, social skills or adaptive behavior, bowel or bladder control, play or motor skills

common onset 3-4 years old, more in boys

21

dissociative amnesia

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

22

depersonalization disorder

persistent feelings of detachment or estrangement from one's own body, a social situation, or the environment

23

dissociative fugue

abrupt change in geographic location with inability to recall past, confusion about personal identity or assumption of a new identity; associated with traumatic circumstances

24

What are the diagnostic criteria for a manic episode?

Three or more of the following:

Maniacs DIG FAST
1. Distractibility
2. Irresponsibility
3. Grandiosity
4. Flight of ideas
5. increased in goal directed Activity/psychomotor Agitation
6. decreased need for Sleep
7. Talkativeness or pressured spech

25

What are the diagnostic criteria for major depressive disorder?

5/9 symptoms for at least 2 more weeks:
SIGECAPS
1. Sleep disturbance
2. Loss of Interest
3. Guilt or feelings of wrothlessness
4. loss of Energy
5. loss of Concentration
6. Appetite/weight changes
7. Psychomotor retardation or agitation
8. Suicidal ideations
9. Depressed mood

26

What are the symptoms of atypical depression?

hypersomnia, overeating, mood reactivity

associated with weight gain and sensitivity to rejection, most common subtye of depression

tx: MAOis, SSRIs

27

What are the risk factors for suicide completion?

SAD PERSONS

Sex (male)
Age (teens or elderly)
Depression
Previous attempts
Ethanol
Rational thinking
Sickness
Organized plan
No spouse
Social support lacking

28

What are the diagnostic criteria for panic disorder?

recurrent periods of intense fear and discomfort peaking in 10 minutes with 4 of the following:

PANICS

Palpitations
Paresthesias
Abdominal distress
Nausea
Intense fear of dying or losing control
lIght headedness
Chest pain
Chills
Choking
disConnectedness
Sweating
Shaking
Shortness of breath

Tx: CBT, SSRIs, TCAs, benzos

29

Tx for alcohol withdrawal

Benzos

30

Tx for anorexia/bulimia

SSRIs

31

Tx for anxiety

Benzos
Buspirione
SSRIs

32

Tx fo ADHD

Methylphenidate (ritalin)
Amphetamines (dexadrine)

33

Tx for atypical depression

MAOIs
SSRIs

34

Tx for Bipolar disorder

Lithium
Valproic acid
Carbamazepine
Lamotrigine
Atypical antipsychotics

35

Tx for depression

SSRIs
SNRIs
TCAs

36

Tx for Depression with insomnia

Mirtazapine (5HT antagonist and sedative)

37

Tx for OCD

SSRIs
Clomipramine

38

Tx for Panic disorder

SSRIs
TCAs
Benzos

39

Tx for PTSD

SSRIs

40

Tx for Schizophrenia

Antipsychotics

41

Tx for Tourette's

Antipsychotics (haloperidol)

42

Tx for Social phobias

SSRIs

43

Antipsychotics

Haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine --> all block D2 receptors

Uses: schizophrenia, psychosis, acute mania, Tourette's

can cause extrapyramidal system side effects and neuroleptic malignant syndrome

44

neuroleptic malignant syndrome

FEVER

Fever
Encephalopathy
Vitals unstable
Elevated enzymes
Rigidity of muscles

45

Atypical antipsychotics

Olanzapine, clozapine, quetiapine, risperiodne, aripiprazole, ziprasidone --> block 5HT2, dopamine, alpha, H1 receptors

Use: schizophrenia (better than typical for negative symptoms), olanzapine is also used for OCD, anxiety disorder, depression, mania, Tourette's

fewer extrapyramidal and anticholinergic side effects than traditional antipsychotics

Clozapine can cause angranulocytosis

46

What are the toxicities of lithium?

LMNOP

Lithium side effects
Movement (tremor)
Nephrogenic diabetes insipidus
hypOthyroidism
Pregnancy problems

47

Buspirone

Stimulates 5HT1A receptors for generalized anxiety disorder

doesnt cause sedation, addiction or tolerance --> doesnt interact with alcohol

48

TCAs

imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin, amoxapine --> block reuptake of NE and 5HT, block muscarinic cholinergic, alpha and H1 receptors

use: depression, bedwetting (imipramine), OCD (clomipramine), fibromyalgia

Toxicity: Convulsions, Coma, and Cardiotoxicity; also respiratory depression and hyperpyrexia

49

SSRIs

fluoxetine, paroxetine, sertraline, citalopram

uses: depression, OCD, bulimia, social phobias

AE: Gi distress, sexual dysfunction, "serotonin syndrome" --> hyperthermia, myoclonus, CV collapse, flushing, diarrhea, seizures

50

SNRIs

venlafaxine, duloxetine --> inhibit 5HT and NE reuptake

Use: depression. Venlafaxine --> GAD, duloxetine for diabetic peripheral neuropathy

AE: increased BP, sedation, nausea

51

MAOis

phenelzine, tranylcypromine, isocarboxazid, selegiline --> increase amine transmitters (NE, 5HT, DA_

use: atypical depression, anxiety, hypocondriasis

Toxicity: hypertensive crisis with tyramine ingestion and B-agonists

52

Buproprion

smoking cessation; increases NE and DA

toxicity: stimulant effects (tachy, insomnia), headache, seizure in bulimic patients, but NO sexual side effets

atypical antidepressant

53

Mirtazapine

atypical antidepressant
alpha 2 antagonist (increases release of NE and 5HT) and potent 5HT2 and 5HT3 antagonist

toxicity: sedation, increased appetite, weight gain, dry mouth

54

Maprotiline

atypical antidepressant

blocks NE reuptake

Toxicity: sedation, orthostatic hypotension

55

Trazodone

atypical antidepressant

primarily inhibits 5HT reuptake

Use: insomnia, as high doses are needed for antidepressant effects

Toxicity: sedation, nausea, priapism, postural hypotension