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320 Cards in this Set
- Front
- Back
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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failure to thrive infant becomes withdrawn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. |
Asperger disorder
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Child abuse
Evidence of sexual |
Genital/anal trauma, STDs, UTIs
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Child abuse
usual abuser physical vs sexual |
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 |
↑ NE, ↓ GABA, ↓ serotonin (5-HT).
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Neurotransmitter changes with
disease ↑ NE, ↓ GABA, ↓ serotonin (5-HT). |
Anxiety
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Neurotransmitter changes with
disease Depression |
––↓ NE and ↓ serotonin (5-HT).
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Neurotransmitter changes with
disease ↓ NE and ↓ serotonin (5-HT). |
Depression
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Neurotransmitter changes with
disease Alzheimer’s dementia |
↓ ACh.
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Neurotransmitter changes with
disease ↓ ACh. |
Alzheimer’s dementia
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Neurotransmitter changes with
disease Huntington’s disease |
––↓ GABA, ↓ ACh.
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Neurotransmitter changes with
disease ↓ GABA, ↓ ACh. |
Huntington’s disease
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Neurotransmitter changes with
disease Schizophrenia |
↑ dopamine.
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Neurotransmitter changes with
disease ↑ dopamine. |
Schizophrenia
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Neurotransmitter changes with
disease Parkinson’s disease |
↓ dopamine.
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Neurotransmitter changes with
disease ↓ dopamine. |
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 |
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. |
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 |
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. |
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–– |
Delirium
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Gradual ↓ in cognition––memory deficits, aphasia,
apraxia, agnosia, loss of abstract thought, |
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 |
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. |
Hallucination
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Hallucination vs. illusion
vs. delusion vs. loose association Illusions misinterpretations of actual external stimuli. |
misinterpretations of actual external stimuli.
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Hallucination vs. illusion
vs. delusion vs. loose association misinterpretations of actual external stimuli. |
Illusions
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Hallucination vs. illusion
vs. delusion vs. loose association Delusions |
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. |
Delusions
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Hallucination vs. illusion
vs. delusion vs. loose association Loose associations |
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). |
Loose associations
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Hallucination types
Visual and auditory hallucinations are common in |
schizophrenia.
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Hallucination types
common in schizophrenia. |
Visual and auditory
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Hallucination types
olfactory hallucination often occurs as |
as an aura of a psychomotor epilepsy.
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Hallucination types
often occurs as an aura of a psychomotor epilepsy. |
olfactory hallucination
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Hallucination types
Gustatory hallucination |
is rare.
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Hallucination types
is rare. |
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 |
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 |
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 |
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. |
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. |
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. |
1
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Major depressive episode
defined by |
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 |
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 |
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 |
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 |
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. |
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 |
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 |
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 |
Both illness production and motivation are unconscious drives. More common in women.
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Somatoform disorders
name the 6 of them |
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 |
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 |
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 |
person is usually
not aware of problem. |
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Personality disorder
when |
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. |
Cluster A personality disorders
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Cluster A personality disorders
three types |
1. Paranoid
2. Schizoid 3. Schizotypal |
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Cluster A personality disorders
in general what and associaton |
Odd or eccentric; cannot develop meaningful social relationships. No psychosis; genetic association
with schizophrenia. |
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Cluster A personality disorders
Paranoid |
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 |
Schizoid
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Cluster A personality disorders
Schizoid |
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 |
Paranoid
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Cluster A personality disorders
Schizotypal |
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 |
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 |
1. Antisocial
2. Borderline 3. Histrionic 4. Narcissistic |
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Cluster B personality disorders
in general |
“Wild.”
Dramatic, emotional, or erratic; genetic association with mood disorders and substance abuse. |
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Cluster C personality disorders
in general |
“Worried.”
Anxious or fearful; genetic association with anxiety disorders. |
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Cluster C personality disorders
names |
1. Avoidant
2. Obsessive 3. Dependent |
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Cluster C personality disorders
Avoidant |
sensitive to rejection, socially
inhibited, timid, feelings of inadequacy |
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Cluster C personality disorders
Dependent |
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. |
Alcohol
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Intoxication from what drug causes
CNS depression, nausea and vomiting, constipation, pupillary constriction |
Opioids
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Intoxication from what drug causes
Psychomotor agitation, impaired judgment, pupillary dilation, hypertension, tachycardia, |
Amphetamines
Cocaine |
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Intoxication from what drug causes
hallucinations, flashbacks, pupil dilation. |
LSD
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Intoxication from what drug causes
hypertension, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death. |
Cocaine
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Intoxication from what drug causes
euphoria, prolonged wakefulness and attention, cardiac arrhythmias, delusions, hallucinations, fever. |
Amphetamines
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Intoxication from what drug causes
Belligerence, impulsiveness, fever, psychomotor agitation, |
PCP
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Intoxication from what drug causes
vertical and horizontal nystagmus |
PCP
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Intoxication from what drug causes
perception of slowed time |
Marijuana
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Intoxication from what drug causes
Low safety margin, respiratory depression. |
Barbiturates
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Intoxication from what drug causes
Greater safety margin. Amnesia, ataxia, |
Benzodiazepines
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Intoxication from what drug causes
Addictive effects with alcohol. |
Benzodiazepines
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Intoxication from what drug causes
Restlessness, insomnia, increased diuresis, |
Caffeine
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Describe withdrawal from
Alcohol |
Tremor, tachycardia, hypertension, malaise,
nausea, seizures, delirium tremens (DTs), tremulousness, agitation, hallucinations |
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Describe withdrawal from
Opioids |
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 |
“crash,” including depression, lethargy,
headache, stomach cramps, hunger, hypersomnolence |
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Describe withdrawal from
Cocaine |
“crash,” including severe depression and suicidality, hypersomnolence, fatigue,
malaise, severe psychological craving |
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Describe withdrawal from
PCP |
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 |
Anxiety, seizures, delirium, life-threatening
cardiovascular collapse |
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Describe withdrawal from
Benzodiazepines |
Rebound anxiety, seizures, tremor, insomnia
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what drugs withdrawal symptoms are
nausea, seizures, delirium tremens (DTs), tremulousness, agitation, hallucinations |
Alcohol
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what drugs withdrawal symptoms are
fever, rhinorrhea, nausea, stomach cramps, diarrhea (“flulike” symptoms), yawning |
Opioids
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what drugs withdrawal symptoms are
“crash,” including depression, lethargy, headache, stomach cramps, hunger, hypersomnolence |
Amphetamines
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what drugs withdrawal symptoms are
“crash,” including severe depression and suicidality, hypersomnolence, fatigue, |
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 |
PCP
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what drugs withdrawal symptoms are
Anxiety, seizures, delirium, life-threatening cardiovascular collapse |
Barbiturates
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what drugs withdrawal symptoms are
Rebound anxiety, seizures, tremor, insomnia |
Benzodiazepines
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what drugs withdrawal symptoms are
Headache, lethargy, depression, weight gain |
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 |
disulfiram to condition the patient to abstain from alcohol use
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Delirium tremens
who and and timing |
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 |
In order of appearance
autonomic system hyperactivity (tachycardia, tremors, anxiety) psychotic symptoms (hallucinations, delusions), confusion. |
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Delirium tremens
Tx |
benzodiazepines.
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Alcoholic cirrhosis
wrt proteins |
hypoalbuminemia,
coagulation factor deficiencies, |
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Wernicke-Korsakoff syndrome
due to |
Caused by vitamin B (thiamine) deficiency
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Wernicke-Korsakoff syndrome
clinical findings and progression |
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 |
periventricular hemorrhage and necrosis, especially in mammillary bodies.
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Wernicke-Korsakoff syndrome
Tx |
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" |
peripheral neuropathy,
testicular atrophy, hyperestrinism. |
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psychiatric conditions
Drug/s used to treat Alcohol withdraw |
Benzodiazepines
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psychiatric conditions
Drug/s used to treat Anorexia/bulimia |
SSRIs
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psychiatric conditions
Drug/s used to treat Anxiety |
Barbiturates
Benzodiazepines Buspirone MAO inhibitors |
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psychiatric conditions
Drug/s used to treat Atypical depression |
MAO inhibitors
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psychiatric conditions
Drug/s used to treat Bipolar disorder |
Mood stabilizers:
--Lithium --Valproic acid --Carbamazepines |
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psychiatric conditions
Drug/s used to treat Depression |
SSRIs
TCAs |
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psychiatric conditions
Drug/s used to treat Depression with insomnia |
Trazodone
Mirtazapine |
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psychiatric conditions
Drug/s used to treat Obsessive/compulsive disorder |
SSRIs
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psychiatric conditions
Drug/s used to treat Panic disorder |
TCAs
Buspirone |
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psychiatric conditions
Drug/s used to treat Schizophrenia |
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 |
Thioridazine,
haloperidol, fluphenazine, chlorpromazine. |
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Antipsychotics (neuroleptics)
Mechanism |
Most antipsychotics block dopamine D receptors
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Antipsychotics (neuroleptics)
Clinical use |
Schizophrenia, psychosis, acute mania, Tourette syndrome
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Antipsychotics (neuroleptics)
Toxicity effects in general |
-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 |
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 |
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. |
muscarinic (dry mouth, constipation),
α (hypotension), histamine (sedation) |
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Neuroleptic malignant syndrome
what |
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 |
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 |
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 |
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 |
It’s not atypical for OLd CLosets to RISPER.
Clozapine, olanzapine, risperidone. |
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Atypical antipsychotics
Mechanism |
Block 5-HT2 and dopamine receptors.
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Atypical antipsychotics
main Clinical use |
Treatment of schizophrenia; useful for positive and
negative symptoms. |
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Atypical antipsychotics
Toxicity |
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 |
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 |
Clozapine may cause
agranulocytosis (requires weekly WBC monitoring). |
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Lithium
Mechanism |
Not established; possibly related to inhibition of
phosphoinositol cascade. |
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Lithium
Clinical use |
Mood stabilizer for bipolar affective disorder; blocks
relapse and acute manic events. |
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Lithium
Toxicity |
TANTO
-Tremor -ADH antagonist (leads to polyuria via nephrogenic DI) -Narrow theraputic window (needs constant monitoring) -teratogenisis -hypOthyroid |
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Buspirone
Mechanism |
Stimulates 5-HT receptors
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Buspirone
Clinical use |
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. |
Buspirone
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SSRIs
names |
Fluoxetine,
sertraline, paroxetine, citalopram. |
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SSRIs
Mechanism |
Serotonin-specific reuptake inhibitors.
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SSRIs
Clinical use |
Endogenous depression, OCD.
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SSRIs
Toxicity |
Fewer than TCAs.
GI distress, sexual dysfunction (anorgasmia). “Serotonin syndrome” with MAO inhibitors |
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Serotonin syndrome
cause/mech |
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 |
hyperthermia, muscle
rigidity, cardiovascular collapse. |
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hyperthermia, muscle
rigidity, cardiovascular collapse |
Serotonin syndrome
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Tricyclic antidepressants
names |
CANDID:
clomipramine amitriptyline nortriptyline desipramine Imipramine doxepin. |
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Tricyclic antidepressants
Mechanism |
Block reuptake of NE and serotonin.
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Tricyclic antidepressants
Clinical use |
Major depression, bedwetting (imipramine), OCD (clomipramine).
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Tricyclic antidepressants
Side effects |
Sedation, α-blocking effects, atropine-like (anticholinergic) side effects (tachycardia,
urinary retention). |
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Tricyclic antidepressants
Toxicity not wrt elderly |
Tri-C’s: Convulsions, Coma, Cardiotoxicity (arrhythmias); also respiratory depression,
hyperpyrexia. |
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CANDID:
clomipramine amitriptyline nortriptyline desipramine Imipramine doxepin. |
Tricyclic antidepressants
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Tricyclic antidepressants
Toxicity wrt elderly |
Confusion and hallucinations in elderly due to anticholinergic side
effects (use nortriptyline). |
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Tricyclic antidepressants
side effects wrt anticholinergic |
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 |
they all cause sedation, but Desipramine is the least sedating
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Heterocyclic antidepressants
names |
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 |
Bupropion-smoking cessation.
Venlafaxine- generalized anxiety disorder Mirtazapine - insomnia Trazodone - insomnia |
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Bupropion
Mech |
Mechanism not well known.
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Bupropion
toxicity |
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. |
Bupropion toxicity
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Venlafaxine
mech |
Inhibits serotonin, NE, and dopamine reuptake.
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Venlafaxine
toxicity |
stimulant effects, sedation, nausea, constipation, ↑
BP. |
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Mirtazapine
mech |
α2 antagonist (↑ release of NE and serotonin) and potent 5-HT2 and 5-HT3 receptor antagonist.
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Mirtazapine
toxicity |
Toxicity: sedation, ↑ appetite, weight gain, dry mouth.
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Maprotiline
mech |
Blocks NE reuptake.
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Maprotiline
toxicity |
sedation, orthostatic
hypotension. |
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Trazodone
mech |
Primarily inhibit serotonin reuptake.
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Trazodone
toxicity |
sedation, nausea, priapism, postural hypotension.
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which Heterocyclic antidepressant
Mechanism not well known. |
Bupropion
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which Heterocyclic antidepressant
Inhibits serotonin, NE, and dopamine reuptake. |
Venlafaxine
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which Heterocyclic antidepressant
stimulant effects, sedation, nausea, constipation, ↑BP. |
Venlafaxine
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which Heterocyclic antidepressant
α2 antagonist (↑ release of NE and serotonin) and potent 5-HT2 and 5-HT3 receptor antagonist. |
Mirtazapine
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which Heterocyclic antidepressant
sedation, ↑ appetite, weight gain, dry mouth. |
Mirtazapine
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which Heterocyclic antidepressant
Blocks NE reuptake |
Maprotiline
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which Heterocyclic antidepressant
sedation, orthostatic hypotension. |
Maprotiline
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which Heterocyclic antidepressant
Primarily inhibit serotonin reuptake. |
Trazodone
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which Heterocyclic antidepressant
sedation, nausea, priapism, postural hypotension. |
Trazodone
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Monoamine oxidase (MAO) Inhibitors
Names |
Phenelzine, tranylcypromine.
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Monoamine oxidase (MAO)
inhibitors Mechanism |
Nonselective MAO inhibition →↑ levels of amine neurotransmitters.
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Monoamine oxidase (MAO)
inhibitors Clinical use |
Atypical depression (i.e., with psychotic or phobic features), anxiety, hypochondriasis.
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Monoamine oxidase (MAO)
inhibitors Toxicity |
Hypertensive crisis with tyramine ingestion (in many foods) and meperidine; CNS
stimulation. |
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Monoamine oxidase (MAO)
inhibitors what causes HTN crisis |
tyramine ingestion (in many foods) and meperidine
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Monoamine oxidase (MAO)
inhibitors contraindications |
Contraindication with SSRIs or β-agonists (to prevent serotonin
syndrome). |
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Contraindication with SSRIs or β-agonists (to prevent serotonin
syndrome). |
MAOI's
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what class are
Phenelzine, tranylcypromine. |
MAOI's
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