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114 Cards in this Set
- Front
- Back
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What is Cotard syndrome?
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Nihilistic delusional content like the world doesn't exist
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What is Capgras syndrome?
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Belief that people have been replaced by imposters
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What is Folie a' deux?
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A shared delusion aroused in one person by the influence of another
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What is Simple schizophrenia?
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Disorder consisting of entirely negative symptoms, no positive
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When is Schizophreniform disorder diagnosed?
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When a patient's symptoms have lasted >1 mo, but <6 mo
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What is more likely to be involved in Schizophrenia; the amygdala/limbic system, or Acetylcholine?
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Amygdala is; Acetylcholine isn't
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What is the "Downward drift theory"?
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The tendency of chronic mental illness to cause patients with it to move down through the social strata
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What is the Stress-diathesis model?
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Susceptibility to chronic mental illness
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What is the result of the Downward Drift theory?
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Socioeconomic burden of schizophrenia
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What is Bleuler's classical model of schizophrenia?
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The four A's
-Association -Affect -Autism -Ambivalence |
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What are the 3 classic symptoms of catatonic schizophrenia?
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-Negativism
-Hypomotorism -Echolalia with echopraxia |
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What sleep change is most consistently linked with major depression?
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Increased early morning awakening
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What serum hormone is increased in depression?
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Cortisol
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What is cyclothymia?
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Cycling between dysthymia and hypomania
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What is double depression?
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MDD superimposed on dysthymia
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What is the % risk of a first-degree relative (like sibling) of a patient with Bipolar disorder developing the same?
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25%
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What diagnosis does amenorrhea in an ED automatically result in?
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Anorexia nervosa
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What changes are often seen in serum cortisol, RBC counts, GH, and BUN?
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-Cortisol increases
-Anemia -Higher GH -High BUN - due to increased catabolic pathways |
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What serum level tends to remain NORMAL in anorexic patients?
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TSH response to TRH
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Alprazolam
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Short-acting BDZ
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Chlordiazepoxide
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Longer-acting BDZ
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Phenelzine
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MAOI
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What % of patients with MDD do NOT show blunted cortisol levels in response to Dexamethasone suppression testing?
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50%
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Why does Dexamethasone suppression fail to suppress Cortisol release in 50% of patients with MDD?
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Because of abnormal feedback mechanisms in the HPA axis
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What type of depression is even MORE likely to show this failure to suppress cortisol with dexamethasone testing?
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PSYCHOTIC depression
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What % of patients with MDD do not show a responsive increase in TSH when given TRH?
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30%
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What does of Methadone is required to effectively reduce cravings in heroin addiction treatment?
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>60mg/day
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What is NOT increased by Methadone maintainance treatment?
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No increased risk of MDD
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Which antidepressants are most likely to cause dry mouth, dizziness due to hypotension, and urinary retention and hesitancy?
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TCA's - due to their anticholinergic and adrenergic blocking effects
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What are the 3 most common side effects of Fluoxetine?
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-GI upset
-Sexual dysfunction -Agitation |
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What are the 4 most common side effects of LITHIUM at higher doses?
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-Polydipsia
-Polyuria -Tremor -Mental confusion |
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What side effects can be seen with Valproic acid at normal vs higher levels?
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Normal - GI Upset
Higher - Tremor/SEDATION |
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What is the CLASSIC TRIAD of normopressure hydrocephalus?
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-Gait ATAXIA
-CONFUSION -INCONTINENCE |
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In what syndrome are oculomotor difficulties most commonly seen?
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Wernicke-korsakoff
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What are Frontal release signs and Perseveration findings commonly seen in?
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Dementia patients
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Does Alcohol DEPENDENCE require physiologic dependence?
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NO - just the inability to quit regardless of desire to quit or knowledge of the negative effects of alcoholism
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What LFT changes are seen in Alcoholics?
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-Increased GGT
-Increased AST and ALT with an increased AST:ALT ratio |
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What are 3 other abnormal lab findings commonly found in alcoholics?
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-Increased serum Uric acid
-Macrocytic anemia -Increased serum triglycerides |
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What is the duration of sx required for diagnosis of brief psychotic episode?
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<1 month
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What is "Identification"?
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Unconscious incorporation of someone else's traits into one's own manner - like teenage girls hairstyles being similar to a rockstar's
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How many ECT treatments are generally effective for
-Catatonic conditions -Major depression -Psychosis or mania |
Catatonia - 3-4
Major depression - 10 Psychosis/mania - 20/more |
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What is a risk with more ECT treatments, like 20-40?
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Short term memory loss
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What is a common drug for treating OCD?
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1. Fluvoxamine/SSRI's
2. Clomipramine |
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What is HEBEPHRENIA?
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Disorganized schizophrenia!
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What is typically seen in patients with Hebephrenia/disorganized Schizophrenia?
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Severely disorganized thoughts that are apparent when they talk - I came to restore my tranquility so I can get what's coming to me upside down
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What is Sexual Masochism?
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When patients get aroused by psychologically or physically punishing acts done to them by another person "fantasies of punishment"
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What is Sexual Sadism?
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The same thing as masochism, but the arousal comes from the patient doing the punishing of others
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What is Frotteurism?
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Sexual arousal achieved by touching or rubbing up against a nonconsenting person
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What type of sleep disorder is narcolepsy?
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REM sleep disorder
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Of Lithium, Chlorpromazine, Haloperidol, and Valproic acid, which is safe in pregnancy?
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NONE
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What sort of onset of schizophrenia is associated with better prognosis?
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Later in life, more acute
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Is the presence of obvious precipitating factors associated with better or worse prognosis for schizophrenia?
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Better!
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What is associated with better prognosis in schizophrenia; positive, or negative symptoms?
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Positive is better
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What is Dementia praecox? Who coined it?
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Early term for Schizophrenia - Kraepelin
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What is a commonly used measure of depression?
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Hamilton depression scale
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What is the Rorschcach test?
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Projective test using inkblots to measure perceptual accuracy, reality testing, and integration of affective and intellectual functioning
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What is a common iatrogenic cause of reversible depression and/or psychosis?
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Glucocorticoids like Prednisone!
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Most common illness in hospitalized psychiatric patients in the US:
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Schizophrenia!
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What is the MOST predictive factor of suicide risk?
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AGE >45
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What psychiatric disorder carries the GREATEST risk of suicide in both men and women?
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Mood disorder
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What percent of alcoholics and schizophrenics commit suicide?
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15% and 10%
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What should you avoid having patients take at the same time they're on lithium?
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NSAIDS (ibuprofen) - better to use aspirin
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What is the only medication that may improve symptoms of Tardive dyskinesia?
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Clonidine
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Which of the SSRIs are more or less likely to cause discontinuation syndrome?
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More likely - Paroxetine (short T1/2)
Less likely - Fluoxetine (active metabolite) |
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If a patient already on Carbamazepine for a seizure disorder develops MDD and needs an SSRI, which one would you want vs not want to prescribe?
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Want - Paroxetine - does not affect levels of carbamazepine
Don't want - Fluoxetine - it does |
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Side effect of Trazodone
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Priapism
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What are 3 common complaints of people on Valproate?
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-Weight gain
-Hair loss -GI distress |
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How is valproate metabolized?
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Extensively by the liver - do LFT's before and while giving
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2 common hematologic effects of Valproate:
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-Thrombocytopenia
-Leukopenia |
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What are 4 receptors that Mirtazepine acts as an antagonist at?
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-a2-adrenergic
-5HT2 -5HT3 -H1 |
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What are 3 unique side effects of Mirtazepine?
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-Increased appetite
-Weight gain -Sedation |
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What is a definite contraindication to TCAs?
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EKG changes and cardiac conduction abnormalities!
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What cardiac problem can the TCAs cause in overdose?
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Heart BLOCK
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Can TCAs be used in patients with prior cerebral infarcts?
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Yes that's ok
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What drug is frequently used to help control agitation in DELIRIUM?
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Haloperidol
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Which of the typical antipsychotics is least likely to cause orthostatic hypotension?
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Haloperidol
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Which is least likely to cause ortho hypotension; haloperidol, or risperidone and quetiapine? why?
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Haloperidol! - it has the least activity at alpha-1 receptors
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Why wouldn't you use lorazepam to treat delirium?
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It doesn't help with psychosis
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What drug sensitizes you to the effects of alcohol?
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Disulfiram
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What drug reduces alcohol craving?
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Naltrexone
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Which is more likely to raise prolactin levels and thus cause galactorrhea; risperidone or olanzapine?
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Risperidone
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What is a potential side effect of olanzapine that might reduce compliance?
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Weight gain
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What is a side effect of risperidone that should be monitored for in an old man?
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Orthostatic hypotension
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As a dose of risperidone increases, what other risk increases?
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Risk of EPS
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What drug may potentially help both Bipolar disorder and Trigeminal neuralgia?
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Gabapentin
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What drug can reduce the numbing symptoms of PTSD?
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Fluoxetine/SSRIs
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What drug can help reduce the acute symptoms of intense anxiety, fear, and palpitations in patients with PTSD?
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Clonidine
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What are the first 3 meds that should be given to a 25 yo male brought into the ED with lethargy and stupor?
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-Dextrose
-Naloxone -Thiamine |
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Why shouldn't Flumazenil be given in a patient with an apparent intoxication?
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It may reduce the seizure threshold
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What do many clinicians use for a first-time Heroin detox?
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Clonidine
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What is a med that may help both depression and chronic pain in feet that does not respond to analgesics?
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Amitriptyline
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How much do Risperidone and Olanzepine affect prolactin levels?
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Risperidone - increases 100X
Olanzepine - not at all |
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What drug is often used to treat impotence?
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Yohimbine
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What is Yohimbine's mechanism?
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a2-antagonist thus increases norepinephrine by blocking the autoreceptor
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What is Yohimbine a direct agonist of?
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Clonidine - a2-agonist
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How does Clonidine work?
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Decreases NE by acting as an agonist of the a2-autoreceptor
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What is considered the first line agent for treating primary insomnia?
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Benzodiazepines
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What BDZ helps patients fall asleep without remaining drowsy the next day?
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Temazepam - short acting
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What is the most safe drug to treat panic disorder with?
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An SSRI
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What is the most dangerous drug to use in a depressed patient with cardiac problems?
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TCA
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What adverse effect of BDZs has been seen in pregnancy exposure during the 1st trimester?
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Oral clefts
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Which 2 BDZs are MINIMALLY metabolized by the liver?
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-Lorazepam
-Oxazepam LO liver metabolism! |
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Which atypical antipsychotic is most associated with causing diabetes?
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Clozapine
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Which drug for tourettes interacts with Citalopram and may cause prolonged QTc intervals?
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Pimozide
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Which bipolar drug is associated with acute Pancreatitis?
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Valproic acid
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What drug for schizophrenia can cause agranulocytosis?
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Clozapine
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What drug for bipolar can cause agranulocytosis?
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Carbamazepine
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Which causes the worst discontinuation syndrome; Sertaline, Fluoxetine, Paroxetine, or Citalopram? Why?
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Paroxetine - shortest half life
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Why might a patient with bipolar on Lithium start peeing a lot?
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It causes nephrogenic diabetes insipidus
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Which is more likely to cause increased cholesterol levels; risperidone or olanzepine?
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Olanzepine
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What is the one antidepressant that does not cause sexual dysfunction?
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Bupropion
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What TCA causes the worst sexual dysfunction?
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Clomipramine
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What can help reduce sialorrhea and drooling in a patient with schizophrenia on Clozapine?
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Propylthiouracil - anticholinergic
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If a patient on Clozapine develops a persistent sinus tachycardia what should you consider doing?
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Give a b-blocker like Propanolol
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