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321 Cards in this Set
- Front
- Back
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Question
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Answer
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7 effects of long term deprivation on infants
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low muscle tone, poor language skills, poor socialization, lack of trust, anaclitic depression, weight loss, physical ilness
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mnemonic for infant deprivation
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the 4 W's (Wah Wah Wah Wah) weak wordless Wanting (socialy) wary
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deprivation for how long can lead to irreversible changes in infants
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greater than 6 months
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What is Anaclitic depression
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depression in an infant attributable to continued separation from caregiver
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Anaclitic depression what can it lead to
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failure to thrive infant becomes withdrawn
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depression in an infant attributable to continued separation from caregiver
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Anaclitic depression
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what is regression in children
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regression to younger behavior under stressful conditions
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causes of regression in children
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illness punishment new sibling fatigue etc...
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example of regression in children
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bedwetting in a previously toilet trained child
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features of ADHD
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loww attention span hyperactivity emotionally labile impulsive accident prone normal IQ
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Tx for ADHD
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Methylphenidate (Ritalin)
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5 childhood and early onst disorders
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ADHD conduct disorder oppositional defiant disorder Tourette's Separation anxiety disorder
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conduct disorder features
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continued behavior violating social norms after age 18 it is diagnosed as antisocial disorder
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continued behavior violating social norms
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conduct disorder
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oppositional defiant disorder
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child is non-compliant in the absence of criminality
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child is non-compliant in the absence of criminality
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oppositional defiant disorder
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Tourette's syndrome features
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motor/vocal tics involuntary profanity associated with OCD
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age of onset of Tourette's syndrome
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younger than 18
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Tx for Tourette's syndrome
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Haloperidol
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separation anxiety disorder features and onset
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fear of loss of attachment figure leading to fictitious physical ilnesses to avoid separation. onset at 7-8 years
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4 Pervasive developmental disorders
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-Autistic disorder -Asperger's disorder -Rett's disorder -Childhood disintegrative disorder
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Autistic disorder features
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patients have severe comunication and relationship problems
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Rett's disorder
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X-linked disorder seen only in girls (affected males die in utero). Characterized by loss of development and mental retardation appearing at approximately age 4. Stereotyped hand-wringing.
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Person demands only the best and most famous doctor in town
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narcissistic personality disorder
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nurse has episodes of hypoglycemia, but has no elevation in C-peptide
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Factitious disorder, surreptitious insulin
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55 yo man complains of lack of successful sexual contacts women and lack of ability to reach a full erection. Two years ago he had a MI
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fear of sudden death during intercourse
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15 yo girl with normal height and weight for her age has enlarged parotid glands with no other complaints. The mother found her hiding laxatives
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Bulimia
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Man on several meds (inc antidepressants, anti hypertensives) has mydriasis and is constipation
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TCA's caused via anticholinergic effects
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woman on maoi has hypertensive crisis after a meal
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Tyramine (wine or cheese
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3-yo with retinal detachment
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child abuse report it
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homeless man complains of bugs crawling on his skin. he has pneumonia
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delirium due to EtoH withdrawal
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man complains of bugs crawling on his skin aka
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formication
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formication
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man complains of bugs crawling on his skin
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war veteran is paralyzed by airplane engines
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ptsd
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unconscious teenager is rushed to the ER. he has pinpoint pupils and is seizing
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opioid overdose
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–X-linked disorder seen only in girls (affected males die in utero). Stereotyped hand-wringing.
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Rett disorder
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Childhood disintegrative disorder
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marked regression in multiple areas of functioning after at least 2 years of normal development. onset at 2-10 years
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marked regression in multiple areas of functioning after at least 2 years of normal development. onset at 2-10 years
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Childhood disintegrative disorder
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Asperger disorder
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a milder form of autism Children are of normal intelligence and lack social or cognitive deficits.
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a milder form of autism Children are of normal intelligence and lack social or cognitive deficits.
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Asperger disorder
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Child abuse Evidence of sexual
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Genital/anal trauma, STDs, UTIs
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Child abuse usual abuser physical vs sexual
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Usually female and the 1° caregiver Known to victim, usually male
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Child abuse # of deaths
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~3000 deaths/year in the United States
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Child abuse age of peak incidence
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9–12 years of age
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Neurotransmitter changes with disease Anxiety
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↑ NE, ↓ GABA, ↓ serotonin (5-HT).
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Neurotransmitter changes with disease ↑ NE, ↓ GABA, ↓ serotonin (5-HT).
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Anxiety
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Neurotransmitter changes with disease Depression
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––↓ NE and ↓ serotonin (5-HT).
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Neurotransmitter changes with disease ↓ NE and ↓ serotonin (5-HT).
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Depression
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Neurotransmitter changes with disease Alzheimer’s dementia
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↓ ACh.
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Neurotransmitter changes with disease ↓ ACh.
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Alzheimer’s dementia
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Neurotransmitter changes with disease Huntington’s disease
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––↓ GABA, ↓ ACh.
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Neurotransmitter changes with disease ↓ GABA, ↓ ACh.
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Huntington’s disease
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Neurotransmitter changes with disease Schizophrenia
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↑ dopamine.
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Neurotransmitter changes with disease ↑ dopamine.
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Schizophrenia
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Neurotransmitter changes with disease Parkinson’s disease
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↓ dopamine.
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Neurotransmitter changes with disease ↓ dopamine.
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Parkinson’s disease
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Anosognosia
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––unaware that one is ill.
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unaware that one is ill
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Anosognosia
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Orientation: order of loss
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1st––time; 2nd––place; last––person.
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Autotopagnosia
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unable to locate one’s own body parts.
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unable to locate one’s own body parts.
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Autotopagnosia
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Depersonalization
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body seems unreal or dissociated.
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body seems unreal or dissociated.
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Depersonalization
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Amnesia types name them
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Anterograde amnesia Korsakoff’s amnesia Retrograde amnesia–
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inability to remember things that occurred after a CNS insult
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Anterograde amnesia
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inability to remember things that occurred before a CNS insult.
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Retrograde amnesia
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describe with causes and mech Korsakoff’s
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classic anterograde amnesia that is caused by thiamine deficiency (bilateral destruction of the mammillary bodies), is seen in lcoholics, and associated with confabulations.
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Confabulation
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also known as false memory is the confusion of imagination with memory,
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also known as false memory is the confusion of imagination with memory,
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Confabulation
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Most common psychiatric illness on medical and surgical floors.
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Delirium
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1st thought in a patient with Delerium
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Often reversible. Check for drugs with anticholinergic effects.
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EEG in dementia
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normal
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EEG in Delirium
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Abnormal
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Waxing and waning level of consciousness; rapid ↓ in attention span and level of arousal––
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Delirium
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Gradual ↓ in cognition––memory deficits, aphasia, apraxia, agnosia, loss of abstract thought,
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Dementia
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Delirium description
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DeliRIUM = changes in sensoRIUM. Waxing and waning level of consciousness; rapid ↓ in attention span and level of arousal––
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Dementia description
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DeMEMtia characterized by MEMory loss. Gradual ↓ in cognition––memory deficits, aphasia, apraxia, agnosia, loss of abstract thought,
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Level of conscious changes in delerium and dementia
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Delirium - ↓ in attention span and level of arousal Dementia - Patient is alert; no change in level of consciousness.
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Hallucination vs. illusion vs. delusion vs. loose association Hallucinations
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perceptions in the absence of external stimuli.
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Hallucination vs. illusion vs. delusion vs. loose association perceptions in the absence of external stimuli.
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Hallucination
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Hallucination vs. illusion vs. delusion vs. loose association Illusions misinterpretations of actual external stimuli.
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misinterpretations of actual external stimuli.
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Hallucination vs. illusion vs. delusion vs. loose association misinterpretations of actual external stimuli.
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Illusions
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Hallucination vs. illusion vs. delusion vs. loose association Delusions
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false beliefs not shared with other members of culture/subculture that are firmly maintained in spite of obvious proof to the contrary.
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Hallucination vs. illusion vs. delusion vs. loose association false beliefs not shared with other members of culture or subculture that are firmly maintained in spite of obvious proof to the contrary.
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Delusions
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Hallucination vs. illusion vs. delusion vs. loose association Loose associations
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disorders in the form of thought (the way ideas are tied together).
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Hallucination vs. illusion vs. delusion vs. loose association disorders in the form of thought (the way ideas are tied together).
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Loose associations
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Hallucination types Visual and auditory hallucinations are common in
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schizophrenia.
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Hallucination types common in schizophrenia.
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Visual and auditory
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Hallucination types olfactory hallucination often occurs as
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as an aura of a psychomotor epilepsy.
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Hallucination types often occurs as an aura of a psychomotor epilepsy.
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olfactory hallucination
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Hallucination types Gustatory hallucination
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is rare.
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Hallucination types is rare.
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Gustatory
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formication
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the sensation of ants crawling on one’s skin
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Hallucination types Tactile
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common in DTs. Also seen in cocaine abusers (“cocaine bugs”).
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Sleeping/waking halucinations
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HypnaGOgic hallucination occurs while GOing to sleep. Hypnopompic hallucination occurs while waking from sleep.
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Schizophrenia definition
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Periods of psychosis and disturbed behavior with a decline in functioning lasting > 6 months
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Schizophrenia symps from 1-6 months
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schizophreniform disorder
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schizophreniform disorder
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Schizophrenia symps from 1-6 months
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Schizophrenia symps < 1 month
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brief psychotic disorder
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brief psychotic disorder
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Schizophrenia symps < 1 month
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Periods of psychosis and disturbed behavior with a decline in functioning lasting > 6 months
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Schizophrenia
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Schizophrenia Diagnosis requires
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Diagnosis requires 2 or more of the following 1. Delusions 2. Hallucinations––often auditory 3. Disorganized thought (loose associations) 4. Disorganized or catatonic behavior 5. “Negative symptoms”
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Schizophrenia "Negative symptoms”
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flat affect, social withdrawal, lack of motivation, lack of speech or thought
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strongest factor in schizophrenia etiology
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Genetic factors outweigh environmental factors
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schizophrenia lifetime prevalence and who gets it
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Lifetime prevalence––1.5% (males = females, blacks = whites). Presents earlier in men.
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combination of schizophrenia and a mood disorder.
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Schizoaffective disorder
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Schizoaffective disorder
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combination of schizophrenia and a mood disorder.
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Schizophrenia name the types
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1. Disorganized 2. Catatonic 3. Paranoid 4. Undifferentiated 5. Residual
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Hypomanic episode
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Like manic episode except mood disturbance but no marked impairment in social and/or occupational functioning or to there are no psychotic features.
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Like manic episode except mood disturbance but no marked impairment in social and/or occupational functioning or to there are no psychotic features.
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Hypomanic episode
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Manic episode description
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Distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week.
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Distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week.
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Manic episode
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features of a Manic episode
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3 or more of DIG FAST. 1. Distractibility 2. Irresponsibility––seeks pleasure without regard to consequences (hedonistic) 3. Grandiosity––inflated self-esteem 4. Flight of ideas––racing thoughts 5. ↑ in goal-directed Activity/psychomotor Agitation 6. ↓ need for Sleep 7. Talkativeness or pressured speech
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DOC for Bipolar disorder
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Lithium
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Cyclothymic disorder
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milder form of bipolar disorder lasting at least 2 years.
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milder form of bipolar disorder lasting at least 2 years.
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Cyclothymic disorder
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6 separate criteria sets exist for bipolar disorders with combinations of
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of manic (bipolar I), hypomanic (bipolar II), and depressed episodes.
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Bipolar disorder defined by
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1 manic or hypomanic episode defines bipolar disorder.
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? manic or hypomanic episode defines bipolar disorder.
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1
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Major depressive episode defined by
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at least 5 of the following for 2 weeks, including either depressed mood or anhedonia: SIG E CAPS. 1. Sleep disturbance 2. Loss of Interest (anhedonia) 3. Guilt or feelings of worthlessn 4. Loss of Energy 5. Loss of Concentration 6. Change in Appetite/weight 7. Psychomotor retardation or agitation 8. Suicidal ideations 9. Depressed mood
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Lifetime prevalence of major depressive episode
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5–12% male, 10–25% female.
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Major depressive disorder, recurrent––requires
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2 or more episodes with a symptom-free interval of 2 months.
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Dysthymia
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a milder form of depression lasting at least 2 years.
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a milder form of depression lasting at least 2 years.
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Dysthymia
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Risk factors for suicide completion
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SAD PERSONS. Sex (male), Age (teenager or elderly), Depression, Previous attempt, Ethanol or drug use, loss of Rational thinking, Sickness , Organized plan,No spouse or kids, Social support lacking.
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Sleep patterns of depressed patients
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1. ↓ slow-wave sleep 2. ↓ REM latency 3. ↑ REM early in sleep cycle 4. ↑ total REM sleep 5. Repeated nightime awakenings 6. Early-morning awakening (important screening question)
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Treatment option for major depressive disorder refractory to other treatment.
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Electroconvulsive
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Electroconvulsive therapy what it produces
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Produces a painless seizure.
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Major adverse effects of Electroconvulsive therapy
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Major adverse effects of ECT are disorientation, anterograde and retrograde amnesia.
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Panic disorder definition
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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, Chest pain, Chills, Choking, Sweating, Shaking, Shortnessof breath.
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Specific phobia wrt insight
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Person recognizes fear i excessive (insight), yet exposure provokes an anxiety response.
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Gamophobia
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(gam = gamete)––fear of marriage
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fear of marriage
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Gamophobia (gam = gamete)
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Algophobia
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(alg = pain)––fear of pain
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fear of pain
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Algophobia (alg = pain)
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Persistent reexperiencing of a previous traumatic event in the life of the patient as
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Post-traumatic stress disorder
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Adjustment disorder
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emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (e.g., divorce, moving) and lasting < 6 months.
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emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (e.g., divorce, moving) and lasting < 6 months.
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Adjustment disorder
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Malingering
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Patient consciously fakes or claims to have a disorder in order to attain a specific gain. conscious motivation
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Patient consciously fakes or claims to have a disorder in order to attain a specific gain conscious motivation
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Malingering
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Factitious disorder
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Consciously creates symptoms in order to assume “sick role” and to get medical attention. unconscious motivation
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Consciously creates symptoms in order to assume “sick role” and to get medical attention. unconscious motivation
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Factitious disorder
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Gain: 1°, 2°, 3°
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1° gain––what the symptom does for the patient’s internal psychic economy. 2° gain––what the symptom gets the patient (sympathy, attention). 3° gain––what the caretaker gets (like an MD on an interesting case).
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Somatoform disorders in general what and who
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Both illness production and motivation are unconscious drives. More common in women.
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Somatoform disorders name the 6 of them
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1. Conversion 2. Somatoform pain disorder 3. Hypochondriasis 4. Somatization disorder 5. Body dysmorphic disorder 6. Pseudocyesis
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Conversion disorder
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––motor or sensory symptoms (e.g., paralysis, pseudoseizure) that suggest neurologic or physical disorder, but tests and physical exam are negative; often follows an acute stressor; patient may be unconcerned about symptoms
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motor or sensory symptoms (e.g., paralysis, pseudoseizure) that suggest neurologic or physical disorder, but tests and physical exam are negative; often follows an acute stressor; patient may be unconcerned about symptoms
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Conversion disorder
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Somatoform pain disorder
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prolonged pain that is not explained completely by illness
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prolonged pain that is not explained completely by illness
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Somatoform pain disorder
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Hypochondriasis
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preoccupation with and fear of having a serious illness in spite of medical reassurance
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preoccupation with and fear of having a serious illness in spite of medical reassurance
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Hypochondriasis
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Somatization disorder
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variety of complaints in multiple organ systems with no identifiable underlying physical findings
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variety of complaints in multiple organ systems with no identifiable underlying physical findings
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Somatization disorder
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Body dysmorphic disorder
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––preoccupation with minor or imagined physical flaws; patients often seek cosmetic surgery
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preoccupation with minor or imagined physical flaws; patients often seek cosmetic surgery
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Body dysmorphic disorder
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Pseudocyesis
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––false belief of being pregnant associated with objective physical signs of pregnancy
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false belief of being pregnant associated with objective physical signs of pregnancy
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Pseudocyesis
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Personality trait
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an enduring pattern of perceiving, relating to, and thinking about the world
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an enduring pattern of perceiving, relating to, and thinking about the world
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Personality trait
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Personality disorder do they know
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person is usually not aware of problem.
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Personality disorder when
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Disordered patterns must be stable by early adulthood not usually diagnosed in children.
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Odd or eccentric; cannot develop meaningful social relationships. No psychosis; genetic association with schizophrenia.
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Cluster A personality disorders
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Cluster A personality disorders three types
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1. Paranoid 2. Schizoid 3. Schizotypal
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Cluster A personality disorders in general what and associaton
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Odd or eccentric; cannot develop meaningful social relationships. No psychosis; genetic association with schizophrenia.
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Cluster A personality disorders Paranoid
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distrust and suspiciousness; projection is main defense mechanism
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Cluster A personality disorders voluntary social withdrawal, limited emotional expression, content with social isolation, unlike avoidant
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Schizoid
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Cluster A personality disorders Schizoid
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voluntary social withdrawal, limited emotional expression, content with social isolation, unlike avoidant
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Cluster A personality disorders distrust and suspiciousness; projection is main defense mechanism
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Paranoid
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Cluster A personality disorders Schizotypal
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interpersonal awkwardness, odd beliefs or magical thinking, eccentric appearance
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Cluster A personality disorders interpersonal awkwardness, odd beliefs or magical thinking, eccentric appearance
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Schizotypal
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Cluster A,B,C personality disorders
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“Weird.” “Wild.” “Worried.”
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Cluster B personality disorders names
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1. Antisocial 2. Borderline 3. Histrionic 4. Narcissistic
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Cluster B personality disorders in general
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“Wild.” Dramatic, emotional, or erratic; genetic association with mood disorders and substance abuse.
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Cluster C personality disorders in general
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“Worried.” Anxious or fearful; genetic association with anxiety disorders.
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Cluster C personality disorders names
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1. Avoidant 2. Obsessive 3. Dependent
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Cluster C personality disorders Avoidant
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sensitive to rejection, socially inhibited, timid, feelings of inadequacy
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Cluster C personality disorders Dependent
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submissive and clinging, excessive need to be taken care of, low self-confidence
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Clinical findings in Bulima
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Body weight is normal. Parotitis, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand calluses from inducing vomiting.
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Substance abuse definition
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Maladaptive pattern leading to clinically significant impairment or distress. more severe than Substance dependance
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Substance dependence definition
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Maladaptive pattern of substance use without clinically significant impairment or distress
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Clinical findings in Bulima
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Body weight is normal. Parotitis, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand calluses from inducing vomiting.
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Substance abuse definition
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Maladaptive pattern leading to clinically significant impairment or distress. more severe than Substance dependance
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Substance dependence definition
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Maladaptive pattern of substance use without clinically significant impairment or distress
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Clinical findings in Bulima
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Body weight is normal. Parotitis, enamel erosion, electrolyte disturbances, alkalosis, dorsal hand calluses from inducing vomiting.
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Substance abuse definition
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Maladaptive pattern leading to clinically significant impairment or distress. more severe than Substance dependance
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Substance dependence definition
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Maladaptive pattern of substance use without clinically significant impairment or distress
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Intoxication from what drug causes Disinhibition, emotional lability, slurred speech, ataxia, coma, blackouts.
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Alcohol
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Intoxication from what drug causes CNS depression, nausea and vomiting, constipation, pupillary constriction
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Opioids
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Intoxication from what drug causes Psychomotor agitation, impaired judgment, pupillary dilation, hypertension, tachycardia,
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Amphetamines Cocaine
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Intoxication from what drug causes hallucinations, flashbacks, pupil dilation.
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LSD
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Intoxication from what drug causes hypertension, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death.
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Cocaine
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Intoxication from what drug causes euphoria, prolonged wakefulness and attention, cardiac arrhythmias, delusions, hallucinations, fever.
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Amphetamines
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Intoxication from what drug causes Belligerence, impulsiveness, fever, psychomotor agitation,
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PCP
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Intoxication from what drug causes vertical and horizontal nystagmus
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PCP
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Intoxication from what drug causes perception of slowed time
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Marijuana
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Intoxication from what drug causes Low safety margin, respiratory depression.
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Barbiturates
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Intoxication from what drug causes Greater safety margin. Amnesia, ataxia,
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Benzodiazepines
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Intoxication from what drug causes Addictive effects with alcohol.
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Benzodiazepines
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Intoxication from what drug causes Restlessness, insomnia, increased diuresis,
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Caffeine
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Describe withdrawal from Alcohol
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Tremor, tachycardia, hypertension, malaise, nausea, seizures, delirium tremens (DTs), tremulousness, agitation, hallucinations
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Describe withdrawal from Opioids
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Anxiety, insomnia, anorexia, sweating, dilated pupils, piloerection (“cold turkey”), fever, rhinorrhea, nausea, stomach cramps, diarrhea (“flulike” symptoms), yawning
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Describe withdrawal from Amphetamines
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“crash,” including depression, lethargy, headache, stomach cramps, hunger, hypersomnolence
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Describe withdrawal from Cocaine
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“crash,” including severe depression and suicidality, hypersomnolence, fatigue, malaise, severe psychological craving
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Describe withdrawal from PCP
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Recurrence of intoxication symptoms due to reabsorption in GI tract; sudden onset of severe, random, homicidal violence
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Describe withdrawal from Barbiturates
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Anxiety, seizures, delirium, life-threatening cardiovascular collapse
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Describe withdrawal from Benzodiazepines
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Rebound anxiety, seizures, tremor, insomnia
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what drugs withdrawal symptoms are nausea, seizures, delirium tremens (DTs), tremulousness, agitation, hallucinations
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Alcohol
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what drugs withdrawal symptoms are fever, rhinorrhea, nausea, stomach cramps, diarrhea (“flulike” symptoms), yawning
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Opioids
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what drugs withdrawal symptoms are “crash,” including depression, lethargy, headache, stomach cramps, hunger, hypersomnolence
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Amphetamines
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what drugs withdrawal symptoms are “crash,” including severe depression and suicidality, hypersomnolence, fatigue,
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Cocaine
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what drugs withdrawal symptoms are Recurrence of intoxication symptoms due to reabsorption in GI tract; sudden onset of severe, random, homicidal violence
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PCP
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what drugs withdrawal symptoms are Anxiety, seizures, delirium, life-threatening cardiovascular collapse
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Barbiturates
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what drugs withdrawal symptoms are Rebound anxiety, seizures, tremor, insomnia
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Benzodiazepines
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what drugs withdrawal symptoms are Headache, lethargy, depression, weight gain
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Caffeine Nicotine
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Heroin addiction #'s
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Approximately 500,000 U.S. addicts
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Heroin addiction users are at rick for
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hepatitis, abscesses, overdose, hemorrhoids, AIDS, and right-sided endocarditis.
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Alcoholism medical treatment
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disulfiram to condition the patient to abstain from alcohol use
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Delirium tremens who and and timing
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Life-threatening alcohol withdrawal syndrome that peaks 2–5 days after last drink.
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Life-threatening alcohol withdrawal syndrome that peaks 2–5 days after last drink.
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Delirium tremens
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Delirium tremens clinical findings
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In order of appearance autonomic system hyperactivity (tachycardia, tremors, anxiety) psychotic symptoms (hallucinations, delusions), confusion.
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Delirium tremens Tx
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benzodiazepines.
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Alcoholic cirrhosis wrt proteins
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hypoalbuminemia, coagulation factor deficiencies,
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Wernicke-Korsakoff syndrome due to
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Caused by vitamin B (thiamine) deficiency
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Wernicke-Korsakoff syndrome clinical findings and progression
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1 Triad of confusion, ophthalmoplegia, and ataxia (Wernicke’s encephalopathy). May progress to memory loss, confabulation, personality change (Korsakoff’s psychosis; irreversible).
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Associated with periventricular hemorrhage/necrosis, especially in mammillary bodies.
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Wernicke-Korsakoff syndrome
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Wernicke-Korsakoff syndrome micro findings
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periventricular hemorrhage and necrosis, especially in mammillary bodies.
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Wernicke-Korsakoff syndrome Tx
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Treatment: IV vitamin B1 (thiamine).
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Mallory-Weiss syndrome
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Longitudinal lacerations at the gastroesophageal junction caused by excessive vomiting. Associated with pain in contrast to esophageal varices.
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Longitudinal lacerations at the gastroesophageal junction caused by excessive vomiting
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Mallory-Weiss syndrome
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Complications of alcoholism 3 "other"
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peripheral neuropathy, testicular atrophy, hyperestrinism.
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psychiatric conditions Drug/s used to treat Alcohol withdraw
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Benzodiazepines
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psychiatric conditions Drug/s used to treat Anorexia/bulimia
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SSRIs
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psychiatric conditions Drug/s used to treat Anxiety
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Barbiturates Benzodiazepines Buspirone MAO inhibitors
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psychiatric conditions Drug/s used to treat Atypical depression
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MAO inhibitors
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psychiatric conditions Drug/s used to treat Bipolar disorder
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Mood stabilizers: --Lithium --Valproic acid --Carbamazepines
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psychiatric conditions Drug/s used to treat Depression
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SSRIs TCAs
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psychiatric conditions Drug/s used to treat Depression with insomnia
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Trazodone Mirtazapine
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psychiatric conditions Drug/s used to treat Obsessive/compulsive disorder
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SSRIs
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psychiatric conditions Drug/s used to treat Panic disorder
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TCAs Buspirone
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psychiatric conditions Drug/s used to treat Schizophrenia
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Antipsychotics
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Antipsychotics aka
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neuroleptics
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neuroleptics aka
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Antipsychotics
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Antipsychotics (neuroleptics) names
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Thioridazine, haloperidol, fluphenazine, chlorpromazine.
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Antipsychotics (neuroleptics) Mechanism
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Most antipsychotics block dopamine D receptors
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Antipsychotics (neuroleptics) Clinical use
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Schizophrenia, psychosis, acute mania, Tourette syndrome
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Antipsychotics (neuroleptics) Toxicity effects in general
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-EPS -endocrine -muscarinic blocking effect -alpha blocking effect -histamine blocking effect -Neuroleptic malignant syndrome -Tardive dyskinesia
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Antipsychotics (neuroleptics) Toxicity effects wrt Extrapyramidal system (EPS) side effects
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Evolution of EPS side effects: 4 h acute dystonia (twisting and repetitive movements) 4 d akinesia (inability to initiate movement) 4 wk akathisia (unpleasant sensations of "inner" restlessness) 4 mo tardive dyskinesia (repetitive, involuntary, purposeless movements) (often irreversible)
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Antipsychotics (neuroleptics) Toxicity effects wrt endocrine side effects
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e.g., dopamine receptor antagonism → hyperprolactinemia → gynecomastia
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Antipsychotics (neuroleptics) Toxicity effects wrt effects arising from blocking muscarinic , α , and histamine receptors.
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muscarinic (dry mouth, constipation), α (hypotension), histamine (sedation)
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Neuroleptic malignant syndrome what
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rigidity, myoglobinuria, autonomic instability, hyperpyrexia
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rigidity, myoglobinuria, autonomic instability, hyperpyrexia (treat with dantrolene and dopamine agonists).
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Neuroleptic malignant syndrome––
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Neuroleptic malignant syndrome Tx
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treat with dantrolene and dopamine agonists
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dystonia
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a neurological movement disorder in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures
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akinesia
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inability to initiate movement due to difficulty selecting and/or activating motor programs in the central nervous system.
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akathisia
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unpleasant sensations of "inner" restlessness that manifests itself with an inability to sit still or remain motionless,
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Tardive dyskinesia features
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repetitive, involuntary, purposeless movements. Features of the disorder may include grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking.
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a neurological movement disorder in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures
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dystonia
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inability to initiate movement due to difficulty selecting and/or activating motor programs in the central nervous system.
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akinesia
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unpleasant sensations of "inner" restlessness that manifests itself with an inability to sit still or remain motionless,
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akathisia
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Tardive dyskinesia mech
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probably due to dopamine receptor sensitization; results of long-term antipsychotic use.
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repetitive, involuntary, purposeless movements. Features of the disorder may include grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking.
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Tardive dyskinesia
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Atypical antipsychotics names
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It’s not atypical for OLd CLosets to RISPER. Clozapine, olanzapine, risperidone.
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Atypical antipsychotics Mechanism
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Block 5-HT2 and dopamine receptors.
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Atypical antipsychotics main Clinical use
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Treatment of schizophrenia; useful for positive and negative symptoms.
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Atypical antipsychotics Toxicity
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Fewer extrapyramidal and anticholinergic side effects than other antipsychotics. Clozapine may cause agranulocytosis (requires weekly WBC monitoring).
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Atypical antipsychotics "specific one" Clinical use
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Olanzapine is also used for OCD, anxiety disorder, depression, mania, Tourette syndrome.
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which Atypical antipsychotic may cause agranulocytosis
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Clozapine- (requires weekly WBC monitoring).
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Clozapine Toxicity
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Clozapine may cause agranulocytosis (requires weekly WBC monitoring).
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Lithium Mechanism
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Not established; possibly related to inhibition of phosphoinositol cascade.
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Lithium Clinical use
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Mood stabilizer for bipolar affective disorder; blocks relapse and acute manic events.
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Lithium Toxicity
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TANTO -Tremor -ADH antagonist (leads to polyuria via nephrogenic DI) -Narrow theraputic window (needs constant monitoring) -teratogenisis -hypOthyroid
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Buspirone Mechanism
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Stimulates 5-HT receptors
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Buspirone Clinical use
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Anxiolysis for generalized anxiety disorder. Does not cause sedation or addiction. Does not interact with alcohol.
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Anxiolysis for generalized anxiety disorder. Does not cause sedation or addiction. Does not interact with alcohol.
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Buspirone
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SSRIs names
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Fluoxetine, sertraline, paroxetine, citalopram.
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SSRIs Mechanism
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Serotonin-specific reuptake inhibitors.
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SSRIs Clinical use
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Endogenous depression, OCD.
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SSRIs Toxicity
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Fewer than TCAs. GI distress, sexual dysfunction (anorgasmia). “Serotonin syndrome” with MAO inhibitors
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Serotonin syndrome cause/mech
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It is the result of overstimulation of 5-HT1A receptors in central grey nuclei and the medulla and, perhaps, of overstimulation of 5-HT2 receptors.
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Serotonin syndrome main clinical findings
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hyperthermia, muscle rigidity, cardiovascular collapse.
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hyperthermia, muscle rigidity, cardiovascular collapse
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Serotonin syndrome
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Tricyclic antidepressants names
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CANDID: clomipramine amitriptyline nortriptyline desipramine Imipramine doxepin.
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Tricyclic antidepressants Mechanism
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Block reuptake of NE and serotonin.
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Tricyclic antidepressants Clinical use
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Major depression, bedwetting (imipramine), OCD (clomipramine).
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Tricyclic antidepressants Side effects
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Sedation, α-blocking effects, atropine-like (anticholinergic) side effects (tachycardia, urinary retention).
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Tricyclic antidepressants Toxicity not wrt elderly
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Tri-C’s: Convulsions, Coma, Cardiotoxicity (arrhythmias); also respiratory depression, hyperpyrexia.
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CANDID: clomipramine amitriptyline nortriptyline desipramine Imipramine doxepin.
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Tricyclic antidepressants
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Tricyclic antidepressants Toxicity wrt elderly
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Confusion and hallucinations in elderly due to anticholinergic side effects (use nortriptyline).
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Tricyclic antidepressants side effects wrt anticholinergic
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atropine-like anticholinergic) side effects (tachycardia urinary retention). 3° TCAs (amitriptyline) have more anticholinergic effects than do 2° TCAs (nortriptyline).
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Tricyclic antidepressants side effects wrt sedation
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they all cause sedation, but Desipramine is the least sedating
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Heterocyclic antidepressants names
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You need BUtane in your VEINs to MURder for a MAP of AlcaTRAZ. Bupropion Venlafaxine Mirtazapine Maprotiline Trazodone
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Heterocyclic antidepressants other uses
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Bupropion-smoking cessation. Venlafaxine- generalized anxiety disorder Mirtazapine - insomnia Trazodone - insomnia
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Bupropion Mech
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Mechanism not well known.
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Bupropion toxicity
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stimulant effects (tachycardia, insomnia), headache, seizure in bulimic patients. Does not cause sexual side effects.
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seizure in bulimic patients. Does not cause sexual side effects.
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Bupropion toxicity
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Venlafaxine mech
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Inhibits serotonin, NE, and dopamine reuptake.
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Venlafaxine toxicity
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stimulant effects, sedation, nausea, constipation, ↑ BP.
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Mirtazapine mech
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α2 antagonist (↑ release of NE and serotonin) and potent 5-HT2 and 5-HT3 receptor antagonist.
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Mirtazapine toxicity
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Toxicity: sedation, ↑ appetite, weight gain, dry mouth.
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Maprotiline mech
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Blocks NE reuptake.
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Maprotiline toxicity
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sedation, orthostatic hypotension.
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Trazodone mech
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Primarily inhibit serotonin reuptake.
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Trazodone toxicity
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sedation, nausea, priapism, postural hypotension.
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which Heterocyclic antidepressant Mechanism not well known.
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Bupropion
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which Heterocyclic antidepressant Inhibits serotonin, NE, and dopamine reuptake.
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Venlafaxine
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which Heterocyclic antidepressant stimulant effects, sedation, nausea, constipation, ↑BP.
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Venlafaxine
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which Heterocyclic antidepressant α2 antagonist (↑ release of NE and serotonin) and potent 5-HT2 and 5-HT3 receptor antagonist.
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Mirtazapine
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which Heterocyclic antidepressant sedation, ↑ appetite, weight gain, dry mouth.
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Mirtazapine
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which Heterocyclic antidepressant Blocks NE reuptake
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Maprotiline
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which Heterocyclic antidepressant sedation, orthostatic hypotension.
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Maprotiline
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which Heterocyclic antidepressant Primarily inhibit serotonin reuptake.
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Trazodone
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which Heterocyclic antidepressant sedation, nausea, priapism, postural hypotension.
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Trazodone
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Monoamine oxidase (MAO) Inhibitors Names
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Phenelzine, tranylcypromine.
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Monoamine oxidase (MAO) inhibitors Mechanism
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Nonselective MAO inhibition →↑ levels of amine neurotransmitters.
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Monoamine oxidase (MAO) inhibitors Clinical use
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Atypical depression (i.e., with psychotic or phobic features), anxiety, hypochondriasis.
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Monoamine oxidase (MAO) inhibitors Toxicity
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Hypertensive crisis with tyramine ingestion (in many foods) and meperidine; CNS stimulation.
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Monoamine oxidase (MAO) inhibitors what causes HTN crisis
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tyramine ingestion (in many foods) and meperidine
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Monoamine oxidase (MAO) inhibitors contraindications
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Contraindication with SSRIs or β-agonists (to prevent serotonin syndrome).
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Contraindication with SSRIs or β-agonists (to prevent serotonin syndrome).
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MAOI's
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what class are Phenelzine, tranylcypromine.
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MAOI's
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