1A: Dt 4 - 2

Front 1

What is a manic episode?
Features?

Back 1

Distinct period of abnl and persistent expansive, elevated, or irritable mood lasting at least 1 week

-Distractibility
-Irresponsibility
-Grandiosity (inflated self-esteem)
-Dec'd need for sleep
-Flight of ideas
-PRESSURED speech

Front 2

What is a hypomanic episode?

Back 2

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 psychoses

Front 3

Bipolar disorder:
Type I vs Type II
Treatment

Back 3

1 manic (type 1) or hypomanic (type 2) episode

Depressive syx occur eventually

Use of antidepressants can increase mania

High suicide risk

Tx: mood stabilizers--Lithium, valproate, carbamazepine

Front 4

Lithium:
Use
AE

Back 4

-Mood stabilizer for mania/acute bipolar disorder
-Can use for SIADH release

Mech unknown

AE:
Nephrogenic diabetes insipidus
Teratogen
Hypothy

Front 5

What ia cyclothymic disorder?

Back 5

Dysthymia (mild chronic depression) and hypomania; milder form of bipolar disorder lasting at least 2 years

Front 6

What is the milder form of bipolar disorder?

Back 6

Cyclothymia

Front 7

What mood stabilizers are used in the treatment of bipolar disorder?

Back 7

Lithium
Valproate
Carbamazepine
Atypical antipsychotics

Front 8

What are the potential side effects of lithium?

Back 8

Tremor
Hypothy
Netrogenic diabetes insipidus
Teratogen

Front 9

Major depressive episode:
Symptoms

Back 9

SIGECAPS
Sleep disturbance
Interest (loss of)--anhedonia
Guilt or feelings of worthlessness
Loss of energy
Loss of concentration
Appetite/weight changes
Psychomotor retardation/agitation
Suicidal ideations
Depressed mood

Front 10

Specific criteria for diagnosis of major depressive disorder.

Back 10

Recurrent, 2 or more major depressive episodes; symptom free interval of 2 months

Front 11

Atypical depression:
How does it differ from major clinical depression?

Back 11

Hypersomnia
Overeating
Mood reactivity (ability to experience improved mood in response to positive events vs persistent sadness)

Associated with weight gain, sensitivity to rejection

Most common subtype of depression

Front 12

Treatment of atypical depression.

Back 12

MAOI and SSRIs

Front 13

Maternal blues vs Postpartum depression

Back 13

Maternal blues: 50-85% incidence rate; characterized by depressed affect, tearfulness, fatigue
Resolves within 10 days
Tx: supportive

Postpartum depression: 10-15% incidence rate. Characterized by depressed affect, anxiety, poor concentration.
Last at least 2 weeks
Tx: antidepressants, psychotx

Front 14

TCA:
Suffix
MOA
Use
AE

Back 14

-pramine, -tyline

Use: Major depression, fibromyalgia

MOA: Blocks reuptake of NE and 5HT

AE: sedation, alpha-blocking effects, atropine-like (antichol) effects (tach, urinary retention)

Front 15

Clonidine:
MOA

Back 15

Central alpha-2 adrenergic antagonist

Front 16

What are the toxicities associated with TCAs?

Back 16

Tri-C's
Convulsions
Coma
Cardiotoxicity (arrhythmias)--give bicarb

Front 17

SSRIs:
Suffix
MOA
Use
AE

Back 17

-etine; sertraline, citalopram

MOA: 5HT reuptake inhibition

Use: Depression, OCD< bulimia, social p hobias

AEs:
Sexual dysfn
Serotonin syndrome with drug that increases serotonin (MAO-I)-->hyperthermia, muscle rigidity, CV collapse, flushing, diarrhea

Front 18

SNRIs:
Examples
MOA
Use
AEs

Back 18

Venlafaxine
Duloxetine

This drugs inhibit both 5HT and NE reuptake

Use: Depression

AE: hypertension (inc'd NE!), sedation, nausea

Front 19

MAO-I:
MOA
Use
AE

Back 19

Nonselective MAO inhibition-->inc'd levels of amine neurotransmitters (NE, 5HT, DA)

Use: atypical depression, anxiety, hypochondriasis

Tox: hypertensive crisis with tyramine ingestion (Wine and CHEESE EFFECT) and beta-agonists, CNS stimuln

Contraindicated w/SSRIs to prevent serotonin syndrome

Note: aged food has tyramine, even beer

Front 20

Atypical antidepressants:
Examples
MOA
Use
AEs

Back 20

Buproprion- inc'd NE and DA
Tox: stimulant effects, no sexual side effects

Mirtazapine:
alpha-2 antagonist (inc'd release of NE and 5HT) and 5HT2/3 receptor antagonist
Tox: sedation, inc'd appetite (anti-histamine side effect), weight gain, dry mouth

Trazodone:
Inhibits 5HT reuptake
Use for insomnia, PRIAPISM (TrazoBONE--persistent penile erection)

THESE CAN BE ADDED WITH SSRIs

Front 21

A patient mentions he has thoughts of suicide. What questions should you ask to determine how high-risk he is?

Back 21

SAD PERSON:
Sex
Age
Depression
Previous attempt
EtOH or drug use
Rational thinking
Sicknesses
Organized plan
No spouse
Social support

Front 22

A patient tries to commit suicide by slitting her wrists. After appropriate medical care in the ER, what questions would you ask the patient to determine her level of commitment of trying to take her own life?

Back 22

What did you do after you slit your wrists?

Cry for help maybe?

Front 23

A 28 year-old woman has symptoms of mild depression for 6 years.

Diagnosis?

Back 23

Dysthymia

Front 24

2 months after loss of her spouse, a 42 year-old female is having trouble eating, concentrating, and sleeping.

She sleeps only 2-3 hours each night.

Plan?

Back 24

Insomnia, normal bereavement

Address insomnia (trazodone, Ambien)

Front 25

SSRI:
MOA

Back 25

Inhibit reuptake of 5HT

Front 26

SNRI:
MOA

Back 26

Inhibit reuptake of 5HT and NE

Front 27

TCA:
MOA

Back 27

Inhibit reuptake of 5HT and NE

Front 28

MAOI:
MOA

Back 28

Inhibit monoamine oxidase-->inhibit breakdown of NE

Front 29

Benzodiaezepines:
MOA

Back 29

Inc GABA

Front 30

Barbiturates: MOA

Back 30

Inc GABA

Front 31

Typical neuroleptics:
MOA

Back 31

Block dopamine

Front 32

Atypical neuroleptics:
MOA

Back 32

Block DA and 5-HT

Front 33

Drug class:
Fluoxetine

Back 33

SSRI

Front 34

Drug class:
Sertraline

Back 34

SSRI

Front 35

Drug class:
Paroxetine

Back 35

SSRI

Front 36

Drug class:
Citalopram

Back 36

SSRI

Front 37

Drug class:
Fluvoxamine

Back 37

SSRI

Front 38

Drug class:
Imipramine

Back 38

TCA

Front 39

Drug class:
Amitriptyline

Back 39

TCA

Front 40

Drug class:
Desipramine

Back 40

TCA

Front 41

Drug class:
Nortriptyline

Back 41

TCA

Front 42

Drug class:
Clomipramine

Back 42

TCA

Front 43

Drug class:
Doxepin

Back 43

TCA

Front 44

Drug class:
Phenelzine

Back 44

MAOI

Front 45

Drug class:
Tranylcypromine

Back 45

MAOI

Front 46

Drug class:
Selegiline

Back 46

MAOI

Front 47

Drug class:
Buporpion

Back 47

NDRI (NE, DA reuptake inhibitor)

Front 48

Drug class:
Venlafaxine

Back 48

SNRI

Front 49

Drug class:
Duloxetine

Back 49

SNRI

Front 50

Drug class:
Milnacipran

Back 50

SNRI

Front 51

Drug class:
Nefazodone

Back 51

SNRI

Front 52

Drug class:
Desvenlafaxine

Back 52

SNRI

Front 53

Identify drug:
SE: Pripism

Back 53

Trazodone

Front 54

Identify drug:
Lowers seizure threshold

Back 54

Bupoprion

Front 55

Identify drug:
Works well with SSRIs
Increases REM sleep

Back 55

Trazodone

Front 56

Identify drug:
Appetite stimulant likely to result in weight gain

Back 56

Mirtazapine

Front 57

Identify drug:
Can be used for smoking cessation

Back 57

Buporpion

Front 58

Identify drug:
Can be used for bedwetting in children

Back 58

Imipramine

Front 59

Symptoms of TCA overdose

Back 59

Tri-C's:
Convulsions
Coma
Cardiotoxicity
Resp depression

Front 60

Symptoms of serotonin syndrome

Back 60

Muscle rigidity
Hyperthermia
Cardiovascular collapse

Front 61

What is malingering?

Back 61

Patient consciously fakes or claims to have a disorder in order to attain a specific secondary sign (avoiding work, obtaining drugs)

Avoids tx by medical personnel; complaints cease after gain

Front 62

What is a factitious disorder?

Back 62

Patient consciously creates physical and/or psychological syx in order assume sixk role and get medical attention

Chronic factitious disorder = Munchausen's syndrome (characterized by multiple hospital admissions and willingness to receive invasive procedures)

Front 63

A patient on whom you wish to obtain an MRI tells you he cannot go through with it because of claustrophobia.

Plan?

Back 63

Give this patient 2 benzos: 1 before the event, another 1 to take in case it doesn't work before event

Front 64

A young woman is anxious about her first pap smear and is told to relax and to imagine going through the steps of the exam.

What does this process exemplify?

Back 64

Systematic desensitization

Front 65

A woman has flashbacks about her boyfriend's death one month ago following a hit-and-run accident.

She often cries and wishes for death of the culprit.

Diagnosis?

Back 65

Normal bereavement

Front 66

A nurse has episodes of hypoglycemia.

Blood analysis reveals no elevation in C-protein.

What is her diagnosis?

Back 66

Factitious disorder--conscious actions with unconscious motivation

Front 67

What is a somatoform disorder?

Back 67

Illness production and motivation are unconscious

Ex: somatization, conversion, hypochondriasis, body dysmorphic disorder, pain disorder

Front 68

What is somatization disorder?

Back 68

Variety of complaints in multiple organ systems (at least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic) over a period of years


Note: This is a type of somatoforom disorder

Front 69

What is conversion?

Back 69

Sudden loss of sensory or motor fn, often following acute stressor

Patient is aware of but indifferent toward syx (paralysis, blindness, mutism)


Note: This is a type of somatoforom disorder

Front 70

What is hypochondriasis?

Back 70

Preoccupation with and fear of having serious illness despite medical evaluation and reassurance

Note: This is a type of somatoforom disorder

Front 71

Hypertensive crisis can result from ingestion of tyramine while taking _____.

Back 71

MAOIs

Front 72

Panic disorder:
Treatment

Back 72

Cognitive behavioral therapy
SSRIs
TCAs
Benzodiazepines

Front 73

Buspirone:
MOA
Use

Back 73

5HT1a receptor agonist
Generalized anxiety disorder

Front 74

What is a pain disorder?

Back 74

Prolonged pain with no physical findings

Pain is focus of clinical presentation and psyc factors play role in severity, exacerbation, maintenance of pain


Note: This is a type of somatoform disorder

Front 75

Personality trait vs disorder

Back 75

Trait: enduring, repetitive pattern of perceiving, relating to, and thinking about environment and onself

Personality disorder--inflexible, maladaptive pervasive pattern of behavior causing distress and/or impaired functioning
Person is usually not aware of problem

Front 76

Identify somatoform disorder:
Unexplained pain

Back 76

Pain disorder

Front 77

Identify somatoform disorder:
Patient with normal anatomy convinced part of their anatomy is abnormal

Back 77

Body dysmorphic disorder

Front 78

Identify somatoform disorder:
Unexplained loss of sensory or motor function--tests and PE are negative

Back 78

Conversion disorder

Front 79

Identify somatoform disorder:
Unwavering belief by patient that she has a specific disease despite medical reassurance

Back 79

Hypochondriasis

Front 80

Identify somatoform disorder:
Unexplained complaints in multiple organ systems

Back 80

Somatization

Front 81

Identify somatoform disorder:
False belief of being pregnant

Back 81

Pseudocyesis

Front 82

Identify personality disorder:
Excessive need to be taken care of, submissive and clinging behavior
Low self-confidence
Fears of separation and losing support

Back 82

Dependent PD

Front 83

Identify personality disorder:
Grandiosity
Feelings of entitlement
Lack of empathy

Back 83

Narcissistic PD

Front 84

Identify personality disorder:
Suicide attempts
Unstable mood and behavior
Sense of emptiness, loneliness

Back 84

Borderline PD

Front 85

Identify personality disorder:
Distrustful
Suspicious
Litigious

Back 85

Paranoid

Front 86

Identify personality disorder:
Life long voluntary social withdrawal
No psychosis
Emotional expression is limited

Back 86

Schizoid

Front 87

Identify personality disorder:
Feelings of inadequacy
Hypersensitive to rejection or criticism
Socially inhibited
Shy

Back 87

Avoidant

Front 88

Identify personality disorder:
Constant mood of unhappiness and pessimism

Back 88

Depressive PD

Front 89

Identify personality disorder:
Odd appearance, thoughts, and behavior
No psychosis
Social akwardness

Back 89

Schizotypal

Front 90

Identify personality disorder:
Controlling
Perfectionistic
Orderly, stubborn

Back 90

Obsessive-Compulsive

Front 91

Identify personality disorder:
Criminality
Unable to conform to social norms
Disregard for others' rights

Back 91

Anti-social

Front 92

Identify personality disorder:
Excessively dramatic, emotional, extroverted
Sexually provocative behavior
Unable to maintain intimate relationships

Back 92

Histrionic

Front 93

Identify personality disorder:
A 40 year-old woman tells you she is in love with you. You refer her to someone else and she attempts suicide.

Personality disorder?

Back 93

Borderline Personality Disorder; she's splitting (people are all good or all bad)

Front 94

A 30-year old owman tells you you're the best docto she's ever had but your nurse is disrespectful.

On a subsequent visit, she threatens to change doctors because you do not feel a particular lab test is necessary.

You notice several symmetric cuts on her left forearm.

Personality disorder?

Back 94

Borderline Personality Disorder (you're all good or you're all bad--esp when you don't order that lab test)

Front 95

A 55-year old woman presents wearing all black including a black miniskirt and black feather boa. She is wearing excessive lipstick, and you notice her having conversations with many other patients in the waiting room.

Personality disorder?

Back 95

Histrionic PD

Front 96

A person demands only the best and most famous doctor in town.

Personality disorder?

Back 96

Narcissistic PD

Front 97

What medications are effective in helping to prevent relapse in recovering alcoholics?

Back 97

Alcoholic anonymous is tried and true best relapse prevention

Disulfiram
Naltrexone

Topiramate
Acamprosate

Front 98

gamma-glutamyltransferase

Back 98

Indicator of alcohol use

Front 99

Pinpoint pupils

Back 99

Opioid excess (morphine, heroin, methadone)

Front 100

Intoxication effects of barbiturates

Back 100

marked respiratory depression

Front 101

This hallucinogen can cause flashbacks even months after use.

Back 101

LSD

Front 102

Wernicke-Korsakoff Syndrome:
Pathophys
Presentation

Back 102

Thiamine (B1) deficiency

Triad of confusion, ophthalmoplegia, ataxia; may progress to irreversible memory loss, confabulation, personality change

ASSOCIATED WITH ALCOHOLISM

Front 103

Mallory-Weiss Syndrome:
Pathophys
Presentation

Back 103

Longitudinal lacerations at gastroesophageal jn caused by excessive vomiting (secondary to alcoholism)

Often presents with hematemesis, pain (esophageal varices)

Front 104

Withdrawal from ______ is life-threatening.

Back 104

Severe alcoholism (presents with delerium tremens)
Benzos
Barbiturates

Front 105

What is delerium tremens?
Treatment?

Back 105

Life-threatening alcohol withdrawal that peaks 2-5 days after last drink

PResnts with tach, tremors, anx, seizures, hallucinations, delusions

Tx: benzos

Front 106

Identify drug causing:
post-op constipation, respiratory depression

Back 106

opioid OD

Front 107

Identify drug causing:
severe depression
headache
fatigue
insomnia/hypersonmia
hunger

Back 107

coke/amphetamine withdrawal

Front 108

Identify drug causing:
Pinpoint pupils
N/V
seizures

Back 108

opioid OD

Front 109

Identify drug causing:
belligerence
impulsiveness
nystagmus
homocidal ideations
psychosis

Back 109

PCP overdose

Front 110

Identify drug causing:
headache
anxiety/depression
weight gain

Back 110

withdrawal from caffeine or nicotine

Front 111

Identify drug causing:
anxiety/depression
delusions
hallucinations
flashbacks

Back 111

LSD intoxication

Front 112

Identify drug causing:
rebound anxiety
tremors
seizures
life-threatening

Back 112

withdrawal from EtOH, benzos, barbiturates (all can be lifethreatening)

Front 113

Identify drug causing:
anxiety
piloerection
yawning
fever
rhinorrhea
nausea
diarrhea

Back 113

Opioid withdrawal

Front 114

Cutoff for macrosomia

Back 114

Macrosomia = big baby FYI

Cutoff = 4kg

Front 115

Macrosomia:
Cut off
Pathophys

Back 115

Macrosomia = big baby; cutoff = 4kg

High glucose levels in mom enter fetal circuln-->high blod glucose levels in fetus-->fetus responds by increasing insulin

Fetal pancreatic islets will undergo DIFFUSE HYPERPLASIA

Note: Maternal insulin CANNOT cross placenta