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55 Cards in this Set

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Potential side effect from dopamine blockade by antipsychotics?
Increases prolactin concentration, which may lead to galactorrhea, impotence, menstrual dysfunction, and decreased libido.
Unique side effect of thioridazine.
retinal pigment deposits
Unique side effect of clozapine.
(monitor CBCs weekly)
Unique side effect of chlorpromazine.
jaundice and photosensitivity
Signs and symptoms of mania.
Distractability, Insomnia, Grandiosity, Flight of ideas, Activities agitation, Sexual indiscretion/Shopping sprees, Talkativeness
Classic presentation of bipolar disorder.
A history of mania alternating with depression.
Age of onset for bipolar disorder
Between 16 and 30 years of age
First line of treatment for bipolar disorder
Lithium and Valproic acid
Second line of treatment for bipolar disorder
Carbamazepine, olanzapine, and gabapentin
Side effects of lithium
Think: Brain, Thyroid, Kidneys
Brain: tremor
Thyroid: hypothyroidism, weight gain
Kidneys: nephrogenic diabetes insipidus, thirst
Organ dysfunction with valproic acid use
Liver disfunction
SE of carbamazepine
bone marrow depression
Bipolar I vs Bipolar II
Bipolar I: mania + MDE
Bipolar II: hypomania + MDE
Mania vs hypomania
Hypomania = mild mania wihtout psychosis that does not cause occupational dysfunction
Hypomania + moderate depression
for > 2 years
Bipolar epidemiology:
Prevalence, gender ratio, age of onset, suicide rate
prevalence = 1%
male:female ratio = 1:1
age of onset = 20's
suicide rate = 10-15%
Signs and symptoms of typical Depression
Sleep (decr), Interest (decr), Guilt, Energy (decr), Concentration (decr), Appetite (decr), Psychomotor agitation, Suicidal ideation (2/3 of patients)
Pyschiatric disorder that has the greatest risk of suicide
Sleep cycle disturbance in depression
Decreased REM sleep
Feature that worsens the prognosis of depression
Psychotic features: typically mood congruent delusions/hallucinations
S/S of atypical depresion
Weight gain, hypersomnia, rejection sensitivity
Treatment of atypical depression
MAOI: Phenelzine, Tranylcypromine
Depression for > 2 years
Adjustment disorder
Depression that occurs within 3 months of a stressor (job loss, move) and resolves by 6 months
Gender with greater incidence of depression
Risk of antidepressant use in bipolar patients
Antidepressants can trigger mania or hypomania in bipolar patients
First line drug treatment of depression
SSRI: Fluoxetine, Sertraline, Paroxetine
MOA and SE of TCA's
MOA: prevents reuptake of NE and serotonin

SE: Tri-A's
Antimuscarinic (orthostatic hypotension)
Arrthymia (cardiac, fatal)
Second line drug treatment of depression
TCA: Nortriptyline, Amitriptyline
MOA and SE of SSRI's
MOA: prevent reuptake of serotonin

SE: sexual dysfunction, insomnia, anorexia
Dietary caution with use of MAOI
Foods containing tyramine (red wine and aged cheese) may cause hypertensive crisis.

Same can happen with MAOI and SSRI or meperidine.
Unique SE of trazodone
Priapism: painful, sustained erection without sexual arousal or desire
Unique SE of bupropion
Decreased seizure threshold
Atypical antidepressants
Bupropion, Trazodone
Serotonin syndrome
Fever, myoclonus, mental status change, cardiovascular collapse
Most effective treatment of depression
Electroconvulsive therapy; use if immediate treatment is necessary.
Depression developing after the loss of a loved one, but limited to one year only. S/S for > 1 yr = depression.
Can grief include illusion or hallucinations?
Yes, but a normal grieving person knows that they are only illusions or hallucinations, whereas a depressed person believes the illusions or hallucinations are real.
Signs that grief is actually depression
Feelings of worthlessness, psychomotor retardation, and suicidal ideations.
Treatment of grief/bereavement
Support, pscythotherapy. No drugs needed for grief because it is self-limiting.
Cluster A PDs
Cluster B PDs
Cluster C PDs
Paranoid PD
Axis II
distrustful/suspicious of other people

There are no hallucinations/delusions as seen in paranoid schizophrenia.
Schizoid PD
Axis II
isolated, "loner"
Patient is content with being alone.
Schizotypal PD
Axis II
Odd behavior, perception, appearance
Magical thinking, ideas of reference
Borderline PD
Axis II
Volatile, unstable mood, impulsive
Pts exhibit "splitting": people are either all good or all bad
Antisocial PD
Axis II
Violate rights of others, social norms, and laws.
Cruel to people and animals.
Strong association with alcoholism and drug abuse as well as somatization disorder.

Must show s/s by age 15, and cannot be diagnosed until age 18. Younger than 18 = conduct d/o.
Histrionic PD
Axis II
Attention-seeking, overly-dramatic, and inappropriately seductive
Narcissistic PD
Axis II
Egocentric and lacking empathy; grandiose

Pts react with rage when critisized.
Axis II
Preoccupied with perfectionism, order, and control
anal-retentive, stubborn
very inefficient
Avoidant PD
Axis II
Socially inhibited, rejection sensitive, fear of being disliked or ridiculed
Pts are loners, but desire to have friends.
Dependent PD
Axis II
Submissive, clingy, highly dependent of others
Cannot make decisions alone

e.g. a wife who stays with her abusive husband
Axis II d/o that most close resembles schizophrenia
Schizotypal PD

Schizotypal pts may become psychotic.
Axis II d/o that has suicidal ideations
Borderline PD