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320 Cards in this Set

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7 effects of long term deprivation on infants
low muscle tone, poor language skills, poor socialization, lack of trust, anaclitic depression, weight loss, physical ilness
mnemonic for infant deprivation
the 4 W's (Wah Wah Wah Wah) weak wordless Wanting (socialy) wary
deprivation for how long can lead to irreversible changes in infants
greater than 6 months
What is Anaclitic depression
depression in an infant attributable to continued separation from caregiver
Anaclitic depression what can it lead to
failure to thrive infant becomes withdrawn
depression in an infant attributable to continued separation from caregiver
Anaclitic depression
what is regression in children
regression to younger behavior under stressful conditions
causes of regression in children
illness punishment new sibling fatigue etc...
example of regression in children
bedwetting in a previously toilet trained child
features of ADHD
loww attention span hyperactivity emotionally labile impulsive accident prone normal IQ
Tx for ADHD
Methylphenidate (Ritalin)
5 childhood and early onst disorders
ADHD conduct disorder oppositional defiant disorder Tourette's Separation anxiety disorder
conduct disorder features
continued behavior violating social norms after age 18 it is diagnosed as antisocial disorder
continued behavior violating social norms
conduct disorder
oppositional defiant disorder
child is non-compliant in the absence of criminality
child is non-compliant in the absence of criminality
oppositional defiant disorder
Tourette's syndrome features
motor/vocal tics involuntary profanity associated with OCD
age of onset of Tourette's syndrome
younger than 18
Tx for Tourette's syndrome
Haloperidol
separation anxiety disorder features and onset
fear of loss of attachment figure leading to fictitious physical ilnesses to avoid separation. onset at 7-8 years
4 Pervasive developmental disorders
-Autistic disorder -Asperger's disorder -Rett's disorder -Childhood disintegrative disorder
Autistic disorder features
patients have severe comunication and relationship problems
Rett's disorder
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.
Person demands only the best and most famous doctor in town
narcissistic personality disorder
nurse has episodes of hypoglycemia, but has no elevation in C-peptide
Factitious disorder, surreptitious insulin
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
fear of sudden death during intercourse
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
Bulimia
Man on several meds (inc antidepressants, anti hypertensives) has mydriasis and is constipation
TCA's caused via anticholinergic effects
woman on maoi has hypertensive crisis after a meal
Tyramine (wine or cheese
3-yo with retinal detachment
child abuse report it
homeless man complains of bugs crawling on his skin. he has pneumonia
delirium due to EtoH withdrawal
man complains of bugs crawling on his skin aka
formication
formication
man complains of bugs crawling on his skin
war veteran is paralyzed by airplane engines
ptsd
unconscious teenager is rushed to the ER. he has pinpoint pupils and is seizing
opioid overdose
–X-linked disorder seen only in girls (affected males die in utero). Stereotyped hand-wringing.
Rett disorder
Childhood disintegrative disorder
marked regression in multiple areas of functioning after at least 2 years of normal development. onset at 2-10 years
marked regression in multiple areas of functioning after at least 2 years of normal development. onset at 2-10 years
Childhood disintegrative disorder
Asperger disorder
a milder form of autism Children are of normal intelligence and lack
social or cognitive deficits.
a milder form of autism Children are of normal intelligence and lack
social or cognitive deficits.
Asperger disorder
Child abuse
Evidence of sexual
Genital/anal trauma, STDs, UTIs
Child abuse

usual abuser
physical vs sexual
Usually female and the 1° caregiver

Known to victim, usually male
Child abuse # of deaths
~3000 deaths/year in the United States
Child abuse age of peak incidence
9–12 years of age
Neurotransmitter changes with
disease

Anxiety
↑ NE, ↓ GABA, ↓ serotonin (5-HT).
Neurotransmitter changes with
disease

↑ NE, ↓ GABA, ↓ serotonin (5-HT).
Anxiety
Neurotransmitter changes with
disease

Depression
––↓ NE and ↓ serotonin (5-HT).
Neurotransmitter changes with
disease

↓ NE and ↓ serotonin (5-HT).
Depression
Neurotransmitter changes with
disease

Alzheimer’s dementia
↓ ACh.
Neurotransmitter changes with
disease

↓ ACh.
Alzheimer’s dementia
Neurotransmitter changes with
disease

Huntington’s disease
––↓ GABA, ↓ ACh.
Neurotransmitter changes with
disease

↓ GABA, ↓ ACh.
Huntington’s disease
Neurotransmitter changes with
disease

Schizophrenia
↑ dopamine.
Neurotransmitter changes with
disease

↑ dopamine.
Schizophrenia
Neurotransmitter changes with
disease

Parkinson’s disease
↓ dopamine.
Neurotransmitter changes with
disease

↓ dopamine.
Parkinson’s disease
Anosognosia
––unaware that one is ill.
unaware that one is ill
Anosognosia
Orientation:

order of loss
1st––time;
2nd––place;
last––person.
Autotopagnosia
unable to locate one’s own body
parts.
unable to locate one’s own body
parts.
Autotopagnosia
Depersonalization
body seems unreal or dissociated.
body seems unreal or dissociated.
Depersonalization
Amnesia types name them
Anterograde amnesia

Korsakoff’s amnesia

Retrograde amnesia–
inability to remember things that occurred after a CNS insult
Anterograde amnesia
inability to remember things that occurred before a CNS insult.
Retrograde amnesia
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.
Confabulation
also known as false memory is the confusion of imagination with memory,
also known as false memory is the confusion of imagination with memory,
Confabulation
Most common psychiatric
illness on medical and surgical
floors.
Delirium
1st thought in a patient with Delerium
Often reversible.
Check for drugs with
anticholinergic effects.
EEG in dementia
normal
EEG in Delirium
Abnormal
Waxing and waning level of consciousness; rapid
↓ in attention span and level of arousal––
Delirium
Gradual ↓ in cognition––memory deficits, aphasia,
apraxia, agnosia, loss of abstract thought,
Dementia
Delirium description
DeliRIUM = changes in sensoRIUM.

Waxing and waning level of consciousness; rapid
↓ in attention span and level of arousal––
Dementia description
DeMEMtia characterized by
MEMory loss.

Gradual ↓ in cognition––memory deficits, aphasia,
apraxia, agnosia, loss of abstract thought,
Level of conscious changes in delerium and dementia
Delirium - ↓ in attention span and level of arousal

Dementia - Patient is alert; no change in level of consciousness.
Hallucination vs. illusion
vs. delusion vs. loose association

Hallucinations
perceptions in the absence of external stimuli.
Hallucination vs. illusion
vs. delusion vs. loose association

perceptions in the absence of external stimuli.
Hallucination
Hallucination vs. illusion
vs. delusion vs. loose association

Illusions misinterpretations of actual external stimuli.
misinterpretations of actual external stimuli.
Hallucination vs. illusion
vs. delusion vs. loose association

misinterpretations of actual external stimuli.
Illusions
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.
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
Hallucination vs. illusion
vs. delusion vs. loose association

Loose associations
disorders in the form of thought (the way ideas are tied together).
Hallucination vs. illusion
vs. delusion vs. loose association

disorders in the form of thought (the way ideas are tied together).
Loose associations
Hallucination types

Visual and auditory hallucinations are common in
schizophrenia.
Hallucination types

common in schizophrenia.
Visual and auditory
Hallucination types

olfactory hallucination often occurs as
as an aura of a psychomotor epilepsy.
Hallucination types
often occurs as an aura of a psychomotor epilepsy.
olfactory hallucination
Hallucination types

Gustatory hallucination
is rare.
Hallucination types

is rare.
Gustatory
formication
the sensation of ants crawling on one’s skin
Hallucination types

Tactile
common in DTs. Also seen in cocaine abusers (“cocaine bugs”).
Sleeping/waking halucinations
HypnaGOgic hallucination occurs while GOing to sleep.

Hypnopompic hallucination occurs while waking from sleep.
Schizophrenia definition
Periods of psychosis and disturbed behavior with
a decline in functioning lasting > 6 months
Schizophrenia symps from 1-6 months
schizophreniform disorder
schizophreniform disorder
Schizophrenia symps from 1-6 months
Schizophrenia symps < 1 month
brief psychotic disorder
brief psychotic disorder
Schizophrenia symps < 1 month
Periods of psychosis and disturbed behavior with
a decline in functioning lasting > 6 months
Schizophrenia
Schizophrenia Diagnosis requires
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”
Schizophrenia "Negative symptoms”
flat affect,
social withdrawal,
lack of motivation,
lack of speech or thought
strongest factor in schizophrenia etiology
Genetic factors outweigh environmental factors
schizophrenia lifetime prevalence
and who gets it
Lifetime prevalence––1.5% (males = females,
blacks = whites). Presents earlier in men.
combination of schizophrenia and a mood disorder.
Schizoaffective disorder
Schizoaffective disorder
combination of schizophrenia and a mood disorder.
Schizophrenia name the types
1. Disorganized
2. Catatonic
3. Paranoid
4. Undifferentiated
5. Residual
Hypomanic episode
Like manic episode except mood disturbance but

no marked impairment in social and/or occupational functioning or to

there are no psychotic features.
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
Manic episode description
Distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at
least 1 week.
Distinct period of abnormally and persistently
elevated, expansive, or irritable mood lasting at
least 1 week.
Manic episode
features of a Manic episode
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
DOC for Bipolar disorder
Lithium
Cyclothymic disorder
milder form of bipolar disorder lasting at least 2 years.
milder form of bipolar disorder lasting at least 2 years.
Cyclothymic disorder
6 separate criteria sets exist for bipolar disorders with combinations of
of manic (bipolar I),
hypomanic (bipolar II),
and depressed episodes.
Bipolar disorder defined by
1 manic or hypomanic episode
defines bipolar disorder.
? manic or hypomanic episode
defines bipolar disorder.
1
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
Lifetime prevalence of major depressive episode
5–12% male, 10–25% female.
Major depressive disorder, recurrent––requires
2 or more episodes with a symptom-free
interval of 2 months.
Dysthymia
a milder form of depression lasting at least 2 years.
a milder form of depression lasting at least 2 years.
Dysthymia
Risk factors for suicide completion
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.
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)
Treatment option for major depressive disorder refractory to other treatment.
Electroconvulsive
Electroconvulsive therapy

what it produces
Produces a painless seizure.
Major adverse effects of Electroconvulsive therapy
Major adverse effects of ECT are disorientation, anterograde and
retrograde amnesia.
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.
Specific phobia

wrt insight
Person recognizes fear i
excessive (insight), yet exposure provokes an anxiety response.
Gamophobia
(gam = gamete)––fear of marriage
fear of marriage
Gamophobia (gam = gamete)
Algophobia
(alg = pain)––fear of pain
fear of pain
Algophobia (alg = pain)
Persistent reexperiencing of a previous traumatic event in the life of the patient as
Post-traumatic stress disorder
Adjustment disorder
emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (e.g., divorce, moving) and lasting
< 6 months.
emotional symptoms (anxiety, depression) causing impairment following an identifiable psychosocial stressor (e.g., divorce, moving) and lasting
< 6 months.
Adjustment disorder
Malingering
Patient consciously fakes or claims to have a disorder in order to attain a specific gain. conscious motivation
Patient consciously fakes or claims to have a disorder in order to attain a specific gain
conscious motivation
Malingering
Factitious disorder
Consciously creates symptoms in order to assume “sick role” and to get medical attention.
unconscious motivation
Consciously creates symptoms in order to assume “sick role” and to get medical attention.
unconscious motivation
Factitious disorder
Gain: 1°, 2°, 3°
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).
Somatoform disorders
in general what and who
Both illness production and motivation are unconscious drives. More common in women.
Somatoform disorders
name the 6 of them
1. Conversion
2. Somatoform pain disorder
3. Hypochondriasis
4. Somatization disorder
5. Body dysmorphic disorder
6. Pseudocyesis
Conversion disorder
––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
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
Conversion disorder
Somatoform pain disorder
prolonged pain that is not explained completely by illness
prolonged pain that is not explained completely by illness
Somatoform pain disorder
Hypochondriasis
preoccupation with and fear of having a serious illness in spite of medical reassurance
preoccupation with and fear of having a serious illness in spite of medical reassurance
Hypochondriasis
Somatization disorder
variety of complaints in multiple organ systems with no
identifiable underlying physical findings
variety of complaints in multiple organ systems with no
identifiable underlying physical findings
Somatization disorder
Body dysmorphic disorder
––preoccupation with minor or imagined physical flaws;
patients often seek cosmetic surgery
preoccupation with minor or imagined physical flaws;
patients often seek cosmetic surgery
Body dysmorphic disorder
Pseudocyesis
––false belief of being pregnant associated with objective physical signs of pregnancy
false belief of being pregnant associated with objective physical signs of pregnancy
Pseudocyesis
Personality trait
an enduring pattern of perceiving, relating to, and thinking about the world
an enduring pattern of perceiving, relating to, and thinking about the world
Personality trait
Personality disorder

do they know
person is usually
not aware of problem.
Personality disorder

when
Disordered patterns must be stable by early adulthood

not usually diagnosed in children.
Odd or eccentric; cannot develop meaningful social relationships. No psychosis; genetic association
with schizophrenia.
Cluster A personality disorders
Cluster A personality disorders
three types
1. Paranoid

2. Schizoid

3. Schizotypal
Cluster A personality disorders
in general what and associaton
Odd or eccentric; cannot develop meaningful social relationships. No psychosis; genetic association
with schizophrenia.
Cluster A personality disorders

Paranoid
distrust and suspiciousness;
projection is main defense mechanism
Cluster A personality disorders

voluntary social withdrawal, limited emotional expression, content with social isolation, unlike avoidant
Schizoid
Cluster A personality disorders

Schizoid
voluntary social withdrawal, limited emotional expression, content with social isolation, unlike avoidant
Cluster A personality disorders

distrust and suspiciousness;
projection is main defense mechanism
Paranoid
Cluster A personality disorders

Schizotypal
interpersonal awkwardness, odd
beliefs or magical thinking, eccentric appearance
Cluster A personality disorders

interpersonal awkwardness, odd
beliefs or magical thinking, eccentric appearance
Schizotypal
Cluster A,B,C personality disorders
“Weird.”

“Wild.”

“Worried.”
Cluster B personality disorders

names
1. Antisocial

2. Borderline

3. Histrionic

4. Narcissistic
Cluster B personality disorders
in general
“Wild.”

Dramatic, emotional, or erratic; genetic association
with mood disorders and substance abuse.
Cluster C personality disorders
in general
“Worried.”

Anxious or fearful; genetic association with anxiety
disorders.
Cluster C personality disorders

names
1. Avoidant

2. Obsessive

3. Dependent
Cluster C personality disorders

Avoidant
sensitive to rejection, socially
inhibited, timid, feelings of inadequacy
Cluster C personality disorders

Dependent
submissive and clinging,
excessive need to be taken care of, low self-confidence
Clinical findings in Bulima
Body weight is normal.
Parotitis,
enamel erosion,
electrolyte disturbances, alkalosis,
dorsal hand calluses from inducing vomiting.
Substance abuse definition
Maladaptive pattern leading to clinically significant impairment or distress. more severe than Substance dependance
Substance dependence definition
Maladaptive pattern of substance use without clinically significant impairment or distress
Clinical findings in Bulima
Body weight is normal.
Parotitis,
enamel erosion,
electrolyte disturbances, alkalosis,
dorsal hand calluses from inducing vomiting.
Substance abuse definition
Maladaptive pattern leading to clinically significant impairment or distress. more severe than Substance dependance
Substance dependence definition
Maladaptive pattern of substance use without clinically significant impairment or distress
Clinical findings in Bulima
Body weight is normal.
Parotitis,
enamel erosion,
electrolyte disturbances, alkalosis,
dorsal hand calluses from inducing vomiting.
Substance abuse definition
Maladaptive pattern leading to clinically significant impairment or distress. more severe than Substance dependance
Substance dependence definition
Maladaptive pattern of substance use without clinically significant impairment or distress
Intoxication from what drug causes

Disinhibition, emotional lability, slurred speech, ataxia, coma, blackouts.
Alcohol
Intoxication from what drug causes

CNS depression, nausea and vomiting, constipation, pupillary constriction
Opioids
Intoxication from what drug causes

Psychomotor agitation, impaired judgment, pupillary dilation, hypertension, tachycardia,
Amphetamines

Cocaine
Intoxication from what drug causes

hallucinations, flashbacks, pupil dilation.
LSD
Intoxication from what drug causes

hypertension, hallucinations (including tactile), paranoid ideations, angina, sudden
cardiac death.
Cocaine
Intoxication from what drug causes

euphoria, prolonged wakefulness and attention, cardiac arrhythmias, delusions, hallucinations, fever.
Amphetamines
Intoxication from what drug causes

Belligerence, impulsiveness, fever, psychomotor agitation,
PCP
Intoxication from what drug causes

vertical and horizontal nystagmus
PCP
Intoxication from what drug causes

perception of slowed time
Marijuana
Intoxication from what drug causes

Low safety margin, respiratory depression.
Barbiturates
Intoxication from what drug causes

Greater safety margin. Amnesia, ataxia,
Benzodiazepines
Intoxication from what drug causes

Addictive effects with alcohol.
Benzodiazepines
Intoxication from what drug causes

Restlessness, insomnia, increased diuresis,
Caffeine
Describe withdrawal from

Alcohol
Tremor, tachycardia, hypertension, malaise,
nausea, seizures, delirium tremens (DTs), tremulousness, agitation, hallucinations
Describe withdrawal from

Opioids
Anxiety, insomnia, anorexia, sweating,
dilated pupils, piloerection (“cold turkey”), fever, rhinorrhea, nausea, stomach cramps, diarrhea (“flulike” symptoms), yawning
Describe withdrawal from

Amphetamines
“crash,” including depression, lethargy,
headache, stomach cramps, hunger, hypersomnolence
Describe withdrawal from

Cocaine
“crash,” including severe depression and suicidality, hypersomnolence, fatigue,
malaise, severe psychological craving
Describe withdrawal from

PCP
Recurrence of intoxication symptoms due to
reabsorption in GI tract; sudden onset of
severe, random, homicidal violence
Describe withdrawal from

Barbiturates
Anxiety, seizures, delirium, life-threatening
cardiovascular collapse
Describe withdrawal from

Benzodiazepines
Rebound anxiety, seizures, tremor, insomnia
what drugs withdrawal symptoms are

nausea, seizures, delirium tremens (DTs), tremulousness, agitation, hallucinations
Alcohol
what drugs withdrawal symptoms are

fever, rhinorrhea, nausea, stomach cramps, diarrhea (“flulike” symptoms), yawning
Opioids
what drugs withdrawal symptoms are

“crash,” including depression, lethargy, headache, stomach cramps, hunger, hypersomnolence
Amphetamines
what drugs withdrawal symptoms are

“crash,” including severe depression and suicidality, hypersomnolence, fatigue,
Cocaine
what drugs withdrawal symptoms are

Recurrence of intoxication symptoms due to reabsorption in GI tract; sudden onset of severe, random, homicidal violence
PCP
what drugs withdrawal symptoms are

Anxiety, seizures, delirium, life-threatening
cardiovascular collapse
Barbiturates
what drugs withdrawal symptoms are

Rebound anxiety, seizures, tremor, insomnia
Benzodiazepines
what drugs withdrawal symptoms are

Headache, lethargy, depression, weight gain
Caffeine

Nicotine
Heroin addiction #'s
Approximately 500,000 U.S. addicts
Heroin addiction users are at rick for
hepatitis, abscesses, overdose,
hemorrhoids, AIDS, and right-sided endocarditis.
Alcoholism

medical treatment
disulfiram to condition the patient to abstain from alcohol use
Delirium tremens

who and and timing
Life-threatening alcohol withdrawal syndrome that peaks 2–5 days after last drink.
Life-threatening alcohol withdrawal syndrome that peaks 2–5 days after last drink.
Delirium tremens
Delirium tremens

clinical findings
In order of appearance
autonomic system hyperactivity (tachycardia, tremors, anxiety)

psychotic symptoms (hallucinations, delusions),

confusion.
Delirium tremens

Tx
benzodiazepines.
Alcoholic cirrhosis

wrt proteins
hypoalbuminemia,

coagulation factor deficiencies,
Wernicke-Korsakoff syndrome

due to
Caused by vitamin B (thiamine) deficiency
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).
Associated with periventricular hemorrhage/necrosis, especially in mammillary bodies.
Wernicke-Korsakoff syndrome
Wernicke-Korsakoff syndrome

micro findings
periventricular hemorrhage and necrosis, especially in mammillary bodies.
Wernicke-Korsakoff syndrome

Tx
Treatment: IV vitamin B1 (thiamine).
Mallory-Weiss syndrome
Longitudinal lacerations at the gastroesophageal junction caused by excessive vomiting.
Associated with pain in contrast to esophageal varices.
Longitudinal lacerations at the gastroesophageal junction caused by excessive vomiting
Mallory-Weiss syndrome
Complications of alcoholism

3 "other"
peripheral neuropathy,

testicular atrophy,

hyperestrinism.
psychiatric conditions
Drug/s used to treat

Alcohol withdraw
Benzodiazepines
psychiatric conditions
Drug/s used to treat

Anorexia/bulimia
SSRIs
psychiatric conditions
Drug/s used to treat

Anxiety
Barbiturates
Benzodiazepines
Buspirone
MAO inhibitors
psychiatric conditions
Drug/s used to treat

Atypical depression
MAO inhibitors
psychiatric conditions
Drug/s used to treat

Bipolar disorder
Mood stabilizers:
--Lithium
--Valproic acid
--Carbamazepines
psychiatric conditions
Drug/s used to treat

Depression
SSRIs
TCAs
psychiatric conditions
Drug/s used to treat

Depression with insomnia
Trazodone
Mirtazapine
psychiatric conditions
Drug/s used to treat

Obsessive/compulsive disorder
SSRIs
psychiatric conditions
Drug/s used to treat

Panic disorder
TCAs
Buspirone
psychiatric conditions
Drug/s used to treat

Schizophrenia
Antipsychotics
Antipsychotics aka
neuroleptics
neuroleptics aka
Antipsychotics
Antipsychotics (neuroleptics)

names
Thioridazine,
haloperidol,
fluphenazine,
chlorpromazine.
Antipsychotics (neuroleptics)

Mechanism
Most antipsychotics block dopamine D receptors
Antipsychotics (neuroleptics)

Clinical use
Schizophrenia, psychosis, acute mania, Tourette syndrome
Antipsychotics (neuroleptics)

Toxicity effects in general
-EPS
-endocrine
-muscarinic blocking effect
-alpha blocking effect
-histamine blocking effect
-Neuroleptic malignant syndrome
-Tardive dyskinesia
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)
Antipsychotics (neuroleptics)

Toxicity effects
wrt endocrine side effects
e.g., dopamine receptor antagonism →
hyperprolactinemia → gynecomastia
Antipsychotics (neuroleptics)

Toxicity effects
wrt effects arising from blocking muscarinic , α , and
histamine receptors.
muscarinic (dry mouth, constipation),
α (hypotension),

histamine (sedation)
Neuroleptic malignant syndrome

what
rigidity, myoglobinuria, autonomic instability, hyperpyrexia
rigidity, myoglobinuria, autonomic instability, hyperpyrexia (treat with dantrolene and dopamine agonists).
Neuroleptic malignant syndrome––
Neuroleptic malignant syndrome

Tx
treat with dantrolene and dopamine agonists
dystonia
a neurological movement disorder in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures
akinesia
inability to initiate movement due to difficulty selecting and/or activating motor programs in the central nervous system.
akathisia
unpleasant sensations of "inner" restlessness that manifests itself with an inability to sit still or remain motionless,
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.
a neurological movement disorder in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures
dystonia
inability to initiate movement due to difficulty selecting and/or activating motor programs in the central nervous system.
akinesia
unpleasant sensations of "inner" restlessness that manifests itself with an inability to sit still or remain motionless,
akathisia
Tardive dyskinesia

mech
probably due to dopamine receptor sensitization; results of long-term antipsychotic use.
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.
Tardive dyskinesia
Atypical antipsychotics

names
It’s not atypical for OLd CLosets to RISPER.

Clozapine, olanzapine, risperidone.
Atypical antipsychotics

Mechanism
Block 5-HT2 and dopamine receptors.
Atypical antipsychotics

main Clinical use
Treatment of schizophrenia; useful for positive and
negative symptoms.
Atypical antipsychotics

Toxicity
Fewer extrapyramidal and anticholinergic side effects
than other antipsychotics.

Clozapine may cause
agranulocytosis (requires weekly WBC monitoring).
Atypical antipsychotics

"specific one" Clinical use
Olanzapine is also used for
OCD, anxiety disorder, depression, mania, Tourette
syndrome.
which Atypical antipsychotic may cause agranulocytosis
Clozapine- (requires weekly WBC monitoring).
Clozapine

Toxicity
Clozapine may cause
agranulocytosis (requires weekly WBC monitoring).
Lithium

Mechanism
Not established; possibly related to inhibition of
phosphoinositol cascade.
Lithium

Clinical use
Mood stabilizer for bipolar affective disorder; blocks
relapse and acute manic events.
Lithium

Toxicity
TANTO
-Tremor
-ADH antagonist (leads to polyuria via nephrogenic DI)
-Narrow theraputic window (needs constant monitoring)
-teratogenisis
-hypOthyroid
Buspirone

Mechanism
Stimulates 5-HT receptors
Buspirone

Clinical use
Anxiolysis for generalized anxiety disorder. Does not cause sedation or addiction.
Does not interact with alcohol.
Anxiolysis for generalized anxiety disorder. Does not cause sedation or addiction.
Does not interact with alcohol.
Buspirone
SSRIs

names
Fluoxetine,
sertraline,
paroxetine,
citalopram.
SSRIs

Mechanism
Serotonin-specific reuptake inhibitors.
SSRIs

Clinical use
Endogenous depression, OCD.
SSRIs

Toxicity
Fewer than TCAs.
GI distress, sexual dysfunction
(anorgasmia). “Serotonin syndrome” with MAO inhibitors
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.
Serotonin syndrome

main clinical findings
hyperthermia, muscle
rigidity, cardiovascular collapse.
hyperthermia, muscle
rigidity, cardiovascular collapse
Serotonin syndrome
Tricyclic antidepressants

names
CANDID:
clomipramine
amitriptyline
nortriptyline
desipramine
Imipramine
doxepin.
Tricyclic antidepressants

Mechanism
Block reuptake of NE and serotonin.
Tricyclic antidepressants

Clinical use
Major depression, bedwetting (imipramine), OCD (clomipramine).
Tricyclic antidepressants

Side effects
Sedation, α-blocking effects, atropine-like (anticholinergic) side effects (tachycardia,
urinary retention).
Tricyclic antidepressants

Toxicity not wrt elderly
Tri-C’s: Convulsions, Coma, Cardiotoxicity (arrhythmias); also respiratory depression,
hyperpyrexia.
CANDID:
clomipramine
amitriptyline
nortriptyline
desipramine
Imipramine
doxepin.
Tricyclic antidepressants
Tricyclic antidepressants

Toxicity wrt elderly
Confusion and hallucinations in elderly due to anticholinergic side
effects (use nortriptyline).
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).
Tricyclic antidepressants

side effects wrt sedation
they all cause sedation, but Desipramine is the least sedating
Heterocyclic antidepressants

names
You need BUtane in your VEINs to MURder for a MAP of AlcaTRAZ.

Bupropion
Venlafaxine
Mirtazapine
Maprotiline
Trazodone
Heterocyclic antidepressants
other uses
Bupropion-smoking cessation.
Venlafaxine- generalized anxiety disorder
Mirtazapine - insomnia
Trazodone - insomnia
Bupropion

Mech
Mechanism not well known.
Bupropion

toxicity
stimulant effects (tachycardia, insomnia), headache, seizure in bulimic patients. Does not cause sexual side effects.
seizure in bulimic patients.
Does not cause sexual side effects.
Bupropion toxicity
Venlafaxine

mech
Inhibits serotonin, NE, and dopamine reuptake.
Venlafaxine

toxicity
stimulant effects, sedation, nausea, constipation, ↑
BP.
Mirtazapine

mech
α2 antagonist (↑ release of NE and serotonin) and potent 5-HT2 and 5-HT3 receptor antagonist.
Mirtazapine

toxicity
Toxicity: sedation, ↑ appetite, weight gain, dry mouth.
Maprotiline

mech
Blocks NE reuptake.
Maprotiline

toxicity
sedation, orthostatic
hypotension.
Trazodone

mech
Primarily inhibit serotonin reuptake.
Trazodone

toxicity
sedation, nausea, priapism, postural hypotension.
which Heterocyclic antidepressant

Mechanism not well
known.
Bupropion
which Heterocyclic antidepressant

Inhibits serotonin, NE, and dopamine reuptake.
Venlafaxine
which Heterocyclic antidepressant

stimulant effects, sedation, nausea, constipation, ↑BP.
Venlafaxine
which Heterocyclic antidepressant

α2 antagonist (↑ release of NE and serotonin) and potent 5-HT2 and 5-HT3 receptor antagonist.
Mirtazapine
which Heterocyclic antidepressant

sedation, ↑ appetite, weight gain, dry mouth.
Mirtazapine
which Heterocyclic antidepressant

Blocks NE reuptake
Maprotiline
which Heterocyclic antidepressant

sedation, orthostatic hypotension.
Maprotiline
which Heterocyclic antidepressant

Primarily inhibit serotonin reuptake.
Trazodone
which Heterocyclic antidepressant

sedation, nausea, priapism, postural hypotension.
Trazodone
Monoamine oxidase (MAO) Inhibitors

Names
Phenelzine, tranylcypromine.
Monoamine oxidase (MAO)
inhibitors

Mechanism
Nonselective MAO inhibition →↑ levels of amine neurotransmitters.
Monoamine oxidase (MAO)
inhibitors

Clinical use
Atypical depression (i.e., with psychotic or phobic features), anxiety, hypochondriasis.
Monoamine oxidase (MAO)
inhibitors

Toxicity
Hypertensive crisis with tyramine ingestion (in many foods) and meperidine; CNS
stimulation.
Monoamine oxidase (MAO)
inhibitors what causes HTN crisis
tyramine ingestion (in many foods) and meperidine
Monoamine oxidase (MAO)
inhibitors

contraindications
Contraindication with SSRIs or β-agonists (to prevent serotonin
syndrome).
Contraindication with SSRIs or β-agonists (to prevent serotonin
syndrome).
MAOI's
what class are

Phenelzine, tranylcypromine.
MAOI's