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319 Cards in this Set
- Front
- Back
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How does Stanford-Binet calculate IQ?
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mental age/chronological age x 100
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Wechsler Adult Intelligence Scale (WAIS III)
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uses 14 subtypes (7 verbal, 7 performance) - can quantify intellectual decline
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Wechsler Intelligence Scale for Children (WISC)
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used for children between ages 6-16
mean is identified as 100, with a standard deviation of 15 "kids WISC cookie crumbs off the table" |
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Mental Retardation IQ
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IQ<70 is one of the criteria for diagnosis of mental retardation (MR)
IQ<40 severe MR IQ<20 profound MR |
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Habituation
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results when repeated stimulation results in a decreased response
* 3 yo girl getting daily heel sticks - no longer cries |
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Sensitization
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results when repeated stimulus results in an increased response
* 3 yo boy who receives weekly allergy injections - cries more and more with each one |
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Classical Conditioning
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Learning in which a natural response (salivation) is elicited by a conditioned, or learned, stimulus (bell) that previously was presented in conjucntion with and unconditioned stimulus
*Pavlov's classical experiments with dogs - ringing the bell provoked salivation |
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Operant Conditioning
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Learning in which a particular action is elicited because it produces a reward
Positive reinforcement - desired reward produces action (mouse pushes button to get a treat) Negative reinforcement - removal of adverse stimuli elicits behavior (mouse presses a button to stop shock) Punishment - application of aversive stimulus extinguishes unwanted behavior Extinction - discontinuation of reinforcement eliminates behavior |
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What are the 2 reinforcement schedules?
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pattern of reinforcement determines how quickly a behavior is learned or extinguished
continuous - reward received after every response - rapidly extinguished (vending machine - if you don't get food - stop putting money in) Variable ratio - reward received after random number of responses. slowly extinguished (slot machine - keep putting money in even if it rarely rewards) |
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Transference
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patient projects feeling about formative or other important persons onto physician (patient develops feelings for doctor)
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countertransference
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doctor projects feelings about formative or other important persons onto patient (doctor develops feelings towards a patient
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What is the central goal of Freud's structural theory of the mind?
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to make the patient aware of what is hidden in his/her unconscious
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Id
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primal urges, food, sex, and aggression. The id "drives"; Instinct. entirely subconscious (born with it)
"I want it" |
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Ego
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mediator between primal urges and behavior accepted in reality - develop this later on
mediates the Id and Superego "take it and you will get in trouble" |
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Superego
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moral values, conscience; can lead to self-blame and attacks on ego
controls the ego "you know you can't have it. Taking it is wrong." |
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Oedipus complex
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repressed sexual feelings for parent of the opposite sex; accompanied by rivalry with same-sex parent. First described by Freud
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2 concepts of social learning
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Shaping - behavior acheived following reward of closer and closer approximations of desired behavior - mom gives treat to child after they pick up one toy soon the child picks up all the toys
modeling - behavior acquired by watching others and assimilating actions into one's own repertoire (med student models behavior off of resident they admire) |
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Erikson's stages of psychosocial development
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8 stages of normal development, each posing a new crises. Unsuccessful completion of a stage may manifest as psychosocial maladaption later in life. examples include oral sensory stage at 0 to 12-18 months, where trust vs. mistrust is crises and adolescence stage at 12-20 years, where identity vs. role confusion is crisis
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Stage where trust vs. mistrust is crisis
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oral sensory stage at 0- 12-18 months
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Stage where identity vs. role confusion is crisis
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Adolescence stage at 12-20 years
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Ego defenses
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unconscious mental processes of the ego used to resolve conflict and prevent feelings of anxiety and depression
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Mature ego defenses
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Mature women wear a 'SASH'
Sublimination Altruism Suppression Humor |
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Acting out
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unacceptable feelings and thoughts are expressed through actions - tantrums
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tantrums are an example of what type of ego defense?
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acting out
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Dissociation
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temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress
ex. dissociative identity disorder (multiple identity disorder) |
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Denial
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avoidance of awareness of some painful reality
ex. a common reaction when someone finds out they have HIV |
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Displacement
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process whereby avoided ideas and feelings are transferred to some neutral person or object
ex. mother places blame on child because she is angry at father *neutral object is key!!! don't confuse with projection |
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Fixation
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partially remaining at a more childish level of development (vs. regression)
ex. men fixating on sports games |
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Identification
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modeling behavior after another person who is more powerful (though not necessarily admired)
ex. abused child identifies himself as an abuser |
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Isolation of affect
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separation of feelings from ideas and events
ex. describing murder in graphic detail with no emotional response |
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Projection
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an unacceptable internal impulse is attributed to an external source
ex. man who is cheating on his wife things that his wife is cheating on him |
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Rationalization
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Proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame
ex. after getting fired, claiming that the job was not important anyway |
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Reaction formation
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process whereby a warded off idea or feeling is replaced by an (unconsciously derived) emphasis on its opposite
ex. patient with libidinous thoughts enters a monastery |
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Regression
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turning back the maturational clock and going back to earlier modes of dealing with the world
ex. seen in children under stress (ex. bedwetting) and in patients on dialysis (crying) |
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Repression
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involuntary witholding of an idea or feeling from consciousness
ex. not remembering a conflictual or traumatic experience; pressing bad thoughts into the unconsciousness |
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Splitting
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belief that all people are either good or bad at different times due to intolerance or ambiguity - seen in borderline personality disorder
ex. patient says that all the nurses are cold and insensitive but the doctors are warm and friendly |
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Altruism
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guilty feelings alleviated by unsolicited generosity towards others
ex. mafia boss makes a large donation to charity |
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Humor
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appreciating the amusing nature of an anxiety-provoking or adverse situation
ex. nervous medical student jokes about the boards |
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Sublimation
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Process whereby one replaces an unacceptable wish with a course of action that is similar to the wish but does not conflict with one's value system
ex. actress uses experience of abuse to enhance her acting. Think of sublimation as it is used in chemistry; a substance changing from a solid to a gas |
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Suppression
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voluntary withholding of an idea or feeling from conscious awareness
ex. choosing not to think about the USMLE until the week of the test vs. repression (which is unconscious) |
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If an infant is deprivived what can the baby suffer from? If the baby is depriveved for how long for it to become irreversible
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4 W's 'weak, wordless, wanting (socially), wary'
1) decreased muscle tone 2) poor language skills 3) poor socialization skills 4) lack of basic trust 5) anaclitic depression 6) weight loss 7) physical illness * more than 6 months of deprivation can cause these things to be irreversible *can result in DEATH |
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Signs of physical abuse of a child. Who usually causes abuse? how many deaths/yr in US from child abuse?
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healed fractures on x-ray, ciagarette burns, subdural hematoma, multiple bruises, retinal hemorrhage or detachment
usually from a female who is the primary care giver about 3000 children die each year in the US from physical abuse |
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What are signs of sexual abuse on a child?
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genital/anal trauma, STDs, UTIs
males who know the child most often do this peak incidence 9-12 years of age |
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Child neglect
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failure to provide a child with adequate food, shelter, supervision, education and/or affection. Most common form of child maltreatement. Evidence: poor hygiene, malnutrition, withdrawl, impaired social/emotional development, failure to thrive. As with child abuse it must be reported to local child protective services
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What is the most common form of child maltreatment?
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Child neglect - must be reported to child protective services
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What is anaclitic depression (hospitalism)?
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Depression in an infant attributable to continued separation from caregiver. Infant becomes withdrawn and unresponsive. Reverisble, but prolonged separation can result in failure to thrive or other developmental disturbances (delayed speech)
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Regression in children
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children regresses to younger patterns of behavior under conditions of stress such as physical illness, birth of new sibling, or fatigue such as bedwetting in a perviously toilet-trained child with hospitalization
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What are childhood and early-onset disorders?
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ADHD, Conduct disorder, Oppositional defiant disorder, Tourette's syndrome, Separation anxiety disorder
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ADHD
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limited attention span and poor impulse control. onset before age 7! Characterized by hyperactivity, motor impairment, and emotional liability. Normal intelligence, but commonly coexists with difficulties in school. May continue into adulthood in as many as 50% of individuals. Associated with decreased frontal lobe volume
tx. methylphenidate (ritalin), amphetamines (dexedrine_, atomoxetine (nonstimulatn SNRI) |
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When must ADHD present by? What other things are associated with it??
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onset before age 7
normal intellgence, often has difficulities in school, decreased frontal lobe volumes |
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What do you use to treat ADHD?
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methylphenidate (ritalin), ampheatmines (Dexedrine), atomoxetine (nonstimulant SNRI)
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Conduct disorder
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repetitive and pervasive behavior violating social norms (physical aggression, destruction of property, theft). After the age of 18 diagnosed with antisocial personality disorder
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Those with conduct disorder over 18 have this diagnosis
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antisocial personality disorder
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Oppositional defiant disorder
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enduring pattern of hostile, defiant behavior towards authority figures in the absence of serious violations of social norms
*not criminal activity |
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Tourette's syndrome
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characterized by sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements or vocalizations (tics) that persist for > 1 year. Lifetime prevalence of 0.1-1% in the general population. Coprolalia (obscene speech) found in only 20% of patients. Associated with OCD. Onset <18 years old. tx. antipsychotics (ex. haloperidol)
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what other psychiatric condition is tourettes associated with? what is the treatment for tourettes?
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OCD - treat tourettes with haloperidol (antipsychotic)
must diagnose tourettes before age 18 |
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Coprolalia
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obsene speech seen in only 20% of people with tourettes
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What are the different antipsychotic drugs?
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'Haloperidol + -azines'
Haloperidol - for tourettes Trifluoperazine Fluphenazine Thioridazine Chlorpromazine |
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What is the MOA of typical antipsychotics?
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block dopamine D2 receptors (increase cAMP)
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What are typical antipsychotics used for?
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schizophrenia (mainly for positive symptoms), psychosis, acute mania, tourettes syndrome
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What are the high potency antipsychotics?
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haloperidol, trifluoperazine, fluphenazine - have neurologic side effects
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What are the low potency antipsychotics?
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thioridazine, chlorpromazine - non-neruologic side effects
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SE of Chlorpromazine?
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it is a low potency antipsychotic - SE include corneal deposits
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SE of Thioridazine
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low potency antipsychotic - SE reTinal deposits
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What are the toxicities of the typical antipsychotics?
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- highly lipid soluable - stored in body fat; thus very slow to be removed from body
- extrapyramidal system side effects: 4 hrs acute dystonia (muscle spasm, stiffness, oculogyric crisis), 4 d akinesia (parkinsoniam symptoms), 4 week akathisia (restlessness), 4 mo tardive dyskinesia - endocinre side effects - dopamine receptor antagonist (so can't inhibit prolactin - get hyperprolactinemia and gynecomastia) - SE from blocking muscarinic (parasympathetic) dry mouth, constipation and alpha (hypotension) and histamine (sedation) receptors Other toxicities: Neuroeleptic malingnant syndrome - rigidity, myoglobinuria, autonomic instability, hyperpyrexia. tx. dantrolene, agonists (bromocrptine) Tardive dyskinesia - sterotype oral-facial movements due to long term antipsychotic use. often reversible! |
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Tardive dyskensia and Neuroleptic maligant syndrome are toxicites of what?
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typical antipsychotic drugs - block dopamine D2 receptors
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Symptoms of neuroleptic malignat syndrome?
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toxicity of typical antipsychotic drugs (block dopamine D2 receptor)
'FEVER' Fever Encephalopathy Vitals unstable Elevated enzymes Rigidity of muscles tx. dantrolene or agonists (bromocryptine) |
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separation anxiety disorder
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overwhelming fear of separation from home or loss of attachment figure. May lead to factitious physcial complaints to avoid going to school
common onset age 7-9 |
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What disorder can lead to factitious physical complaints?
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Separation anxiety disorder - make up complaints so they don't have to go to school
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What are the pervasive developmental disorders?
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Autistic disorder, Asperger's disorder, Rett's disorder, Childhood disintegrative disorder
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Autistic disorder
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severe language impairment and poor social interactions. Greater focus on objects than people. Characterized by repetitive behavior and usually below normal intelligence. Rarely, may have unusual abilities (savants). More common in boys.
tx. behavioral and supportive therapy to improve communication and social skills |
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Asperger's disorder
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milder form of autism. Characterized by all-absorbing interests, repetitive behavior, and problems with social relationships. Children are of normal intelligence and lack verbal or cognitive deficits. No language impairment
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Rett's disorder
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X-linked disorder seen almost exclusively in girls (affected males die in utero or shortly after birth). Normal to age 4, followed by regression characterized by loss of development, mental retardation, loss of verbal abilities, atazia, and sterotyped hand-wringing
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disorder in girls where they are normal until age 4 - at that point regression occurs
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Rett's syndrome - x-linked disorder
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stereotyped hand wringing in a young girl
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Rett's syndrome - x-linked - usually only in girls
regression, loss of development, MR, loss of verbal abilities, ataxia |
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Childhood disintegrative disorder
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marked regression in mutiple areas of functioning after at least 2 years of apparently normal development. Significant loss of expressive or receptive language skills, social skills or adaptive behavior, bowel or bladder control, play or motor skills. Common onset between 3-4 years of age. most common in boys
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What are the neurotransmitter changes in anxiety?
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increased: NE
decreased: GABA, serotonin |
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What are the NT changes in depression?
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decreased: NE, serotonin, dopamine
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What are the NT changes in Alzheimer's dementia?
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decreased: Ach
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What are the NT changes in Huntington's disease?
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Decreased: GABA and Ach
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What are the NT changes in Schizophrenia?
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Increased: dopamine
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What are the NT changes in parkinson's
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Decreased: dopmaine
Increased: Ach |
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Orientation
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Person's ability to tell who they are, what date and time it is, and what their personal circumstances are
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what are common causes of loss of orientation? What goes first?
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Alcohol, drugs, electrolyte disturbances, hypoglycemia, head trauma, nutritional deficiencies
order of loss: 1st time; 2nd place; 3rd person |
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Retrograde amnesia
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inability to remember things that occured before a CNS insult
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anterograde amnesia
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inability to remember things that occur after a CNS insult - can't make new memories
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Korsakoff's amnesia
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classic anterograde amnesia caused by thiamine deficiency - leads to bilateral destruction of mammilary bodies. may also have some retrograde amensia - seen in alcoholics and is associated with confabulations
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Bilateral destruction of mammilary bodies
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Thiamine deficiency: Wiernkie Korsakoff's
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Dissociative amnesia
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inability to recall imporant personal information, usually subsequent to severe trauma or stress
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Delirium
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waxing and waning level of consciouness with acute onset! rapid decrease in attention span and level of arousal. Acute changes in mental status, disorganized thinking, hallucinatios, illusions, misperceptrions, disturbance in sleep-wake cycle, cognitive dysfunction
*most common psychiatric illness on surgical floors - abnormal EEG *look for drug cause |
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What is the most common psych diagnosis on surgical floors?
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delirium
abnormal EEG Check for drugs with anticolinergic effects - usually reversible!!!! |
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Delirium vs. dementia
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Delirium - abnormal EEG - acute
dementia - normal EEG - chronic, gradual |
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Dementia
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gradual decline in cognition with no change in consciousness - characterized by memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavorial/personalitiy changes, impaired judgement. Patient is alert
increased incidence with age. more often gradual onset NORMAL EEG! caused by alzheimer's disease, vascular thrombosis/hemorrhage (may have acute/subacute onset), HIV, Picks disease, substance abuse, CJD. usually irreversible |
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In elderly patients depression can look like what?
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dementia - pseudodemtia
memory loss! irreversible normal EEG gradual onset |
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Hallucinations
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perceptions in the absence of external stimuli (seeing light that is not actually present)
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Illusions
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misinterpretation of actual external stimuli (seeing light and thinking it is the sun)
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Delusions
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fixed false belief - not shared with other members of culture/subculture that are firmly maintained in spite of obvious proof to the contrary (thinking the CIA is spying on you)
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Loose associations
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disorders in the form of thought (the way ideas are tied together)
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What psychiatric disorder are visual hallucinations common?
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delirium
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What psychiatric disorder are auditory hallucinations common?
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schizophrenia
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What disorder are olfactory hallucinations common?
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often occurs are an aura of psychomotor epilepsy
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Gustatory hallucinations
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very rare
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What disorder are tactile hallucinations common?
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alcohol withdrawl (ex. formication - the sensation of ants crawling on one's skin). Also seen in cocaine abusers (cocaine bugs)
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Hypnagogic hallucinations
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happens when GOing to sleep
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Hypompic hallucinations
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occurs when waking from sleep (POMPous upon wakening)
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Schizophrenia diagnosis
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periods of psychosis and disturbed behavior with a decline in functioning for > 6 months. Associated with increased dopaminergic activity, decreased dendritic branching.
Need 2 of the positive symptoms for diagnosis 1. delusions 2. hallucinations - often auditory 3. disorganized speech 4. disorganzied or catatonic behavior negative symptoms: flat affect, social withdrawl, lack of motivation, lack of speech or thought |
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What NT is seen in schizophrenia
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increased dopaminergic activity, decreased dendritic branching
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Things that increase risk of schizophrenia
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marijuana use is a major risk factor for schizophrenia in teens
genetic factors outweight environmental factors 1.5% lifetime prevalence men=women and blacks=whites in prevlence presents earlier in men (late teens to 20s) and early 30s in women |
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What psychiatric disease does genetic factors outweight environmental factors for the disease?
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schizophrenia
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What are the 5 subtypes of schizophrenia?
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1. Paranoid (delusions)
2. Disorganized (with regard to speech, behavior, affect 3. catatonic (automatisms) 4. undifferentiated (elements of all types) 5. residual (normal now but had symptoms in the past |
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Brief psychotic disorder
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<1 month of schizophrenic symptoms, usually stress related
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Schizophreniform disorder
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schizophrenia symptoms for 1-6 months
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Schizoaffective disorder
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at least 2 weeks of stable mood with psychotic symptoms, plus a major depressive, manic or mixed (both) episode. 2 subtypes: bipolar or depressive
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Delusional disorder
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fixed, persistent, nonbizarre belief system lasting > 1 month. Functioning otherwise not impaired. Often self-limited
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development of delusions in a person in a close relationship with someone with delusional disorder.
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Shared psychotic disorder (folie a deux)
Often resolves upon separation |
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dissociative identity disorder
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formerly known has multiple personality disorder. Presence of 2 or more distinct identities or personality states. More common in women. Associated with a history of sexual abuse
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Population that dissociated identity disorder is common in
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women
also seen in people with a past of sexual abuse *used to be called multiple personality disorder |
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persistent feelings of detachment or estrangment from oneself
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depersonalization disorder
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Dissociative fugue
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abrupt change in geographic location with inability to recall past, confusion about personal identity, or assumption of new identity. Associated with traumatic circumstances (natural disasters, war time, trauma). Leads to significant distress or impairment. Not the result of substance abuse or general medical condition
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abrupt change in geographical location with inability to recall past, confusion about personal identity - associated with traumatic circumstances
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Dissociative fugue
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increased risk of what in people with schizophrenia?
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suicide
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Manic episode
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distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week. Often disturbing to the patient. Diagnosis requires 3 of the following for diagnosis:
'DIG FAST' Distractibility Irresponsibility - seeks pleasure without regard to consequences (hedonistic) Grandiosity - inflated self-esteem Flight of ideas - racing thoughts Activity (goal directed)/agitation (psychomotor) increased Sleep - decreased need Talkativeness or pressured speech |
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What do you need to diagnose a manic episode?
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3 of the DIG FAST for at least 1 week
Distractibility Irresponsibility Grandiosity Flight of ideas Activity/agitation increased Sleep - decreased need Talkativeness or pressured speech |
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hyopmanic episode
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like manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitilization. No psychotic features
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Bipolar disorder
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Presence of 1 manic episode (bipolar I) (1 week or longer of 3 of the DIG FAST symptoms) or hypomania (bipolar II) episode.
Depressive symptoms always occur eventually. Patient's mood and functioning usually return to normal between episodes. Use of antidepressants can increase mania - engagement in pleasurable activities with potentially painful consequences can be seen. HIGH suicide risk tx. mood stablizers (lithium, valproic acid, carbamazepine), atypical antipsychotics (Olanzapine, clozapine, quetiapine, risperidone, aripirprazole, ziprasidone) |
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concern with use of antidepressants in bipolar?
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can lead to manic episodes
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How do you treat bipolar disorder?
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mood stablizers (lithium, valproic acid, carbamazepine) and atypical antipsychotics
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cyclothymic disorder
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(bipolar III)milder form of bipolar disorder lasting at least 2 years
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Atypical antipsychotics
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'It's ATYPICAL or Old CLOSets to QUIETly RiSPER from A to Z'
olzanpine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone |
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What do antipsychotics do?
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block 5-HT (serotonin), a, H1 and dopamine receptors
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What are atypical antipsychotics used for?
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Schizophrenia (for positive and negative symptoms).
Olanzapine also used for OCD, anxiety disorder, depression, mania, tourette's syndrome |
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Toxicity of atypical antipsychotics
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fewer extrapyrimidal and anticolinergic symptoms than traditional antipsychotics. Olanzapine/colzapine can cause signifcant weight gain.
Clozapine can cause agranulocytosis (requires weekly WBC monitoring) |
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What atypical antipsychotics can cause weight gain?
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Olanzapine, clozapine
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What is the side affect of Clozapine?
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agranulocytosis (WBC must be monitored weekly)
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Lithium - MOA and what is it used for?
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don't know MOA might inhibit phosphoinositol cascade
uses: mood stablizer for bipolar disorder; blocks relapse and actue manic events. Also used for SIADH. |
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Toxicity of lithium?
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'LMNOP'
Movement (tremor) Nephrogenic diabetes insipitous (blocks ADH receptor) hypOthyroidism Pregnancy problems (affects the fetal kidney) - also sedation, edema, heart block * narrow therapeutic window - requires close monitoring of serum levels!!! |
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Major depressive episode
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Characterized by at least 5 of the following 9 symptoms for 2 weeks (symptoms must include patient-reported depressed mood or anhedonia)
'SIG E CAPS' Sleep disturbance Interest loss (anhedonia) Guilt or feelings of worthlessness Energy loww Concentration loss Appetite/weight changes Psychomotor retardation or agitation Suicidal ideations + depressed mood |
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To be diagnosed with major depressive episode must have what?
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2 weeks of 5 of more of SIG E CAPS + depressed state reported by patient
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Major depressive disorder, recurrent
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requires 2 or more major depressive episodes with a symptom free interval of 2 months
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dysthymia
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milder form of depression lasting at least 2 years
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seasonal affective disorder
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associated with winter season; improves in response to full-spectrum light exposure
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Lifetime prevalence of major depressive episode
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5-12% male
10-25% female |
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What sleep patterns are seen in depressed patients?
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- decreased slow-wave sleep
- decreased REM latency - increased REM early in sleep cycle - increase total REM sleep - repeated nighttime awakenings - early-morning awakening (important screening question) |
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symptoms of atypical depression
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overeating, increased sleep, mood reactivity (ability to experience improved mood in response to positive events vs. persistent sadness). Associated with weight gain and sensitivity to rejection
*most common subtype of depression |
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what is the most common subtype of depression?
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atypical depression
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How do you treat atypical depression?
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MAO inhibitors, SSRI's
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Types of MAOIs and MOA of monoamine oxidase inhibitors (MAOI's)
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'PITS'
Phenelzine, Isocarboxazid, Tranylcypromine, selegiline (selective MAO-B inhibitor) MOA: nonselective MAO inhibition - causes increased levels of amine neurotransmitters |
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toxicity of MAOI's
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hypertensive crisis with tyramine ingestion (tyramine blocks MAO-A's)) - in many foods: wine and cheese and B agonists
also CNS stimulation Contraindicated in SSRIs or meperidine (to prevent seratonin syndrome) |
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What can you not take if you are taking an MAOI?
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SSRIs or meperidine - to prevent seratonin syndrome
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SNRIs drugs and MOA
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seratonin norepinephrine receptor inhibitor - so increased levels of seratonin and NE in synapse
Venlafexine (effexor) Duloxetine (cymbalta) |
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uses for SNRIs and toxicities
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depression!
venlafaxine also used in generalized anxiety disorder duloxetine is also indicated for diabetic peripheral neuropathy - has greater effect on NE toxicities: increase BP; stimulant effects, sedation, nausea |
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Methylphenidate MOA and use
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Ritalin
MOA: increase presynaptic NE vesicular release (like amphetamines). However the mechanisms for relieving ADHD symptoms is not known use: ADHD! |
|
|
Methylhenidate is like what drug?
|
amphetamines - we don't know how it helps with ADHD - it increases release of presynaptic NE`
|
|
|
SSRIs drug and MOA
|
Fluoxetine, paroxetine, setraline, citalopram
MOA - inhibits reuptake of serotonin-specific - so increased amount postsynaptically |
|
|
uses of SSRIs and toxicities
|
depression (can also use for atypical depression along with MAO inhibitors), OCD, bulemia, social phobias
toxicities: fewer than TCAs. GI distress, sexual dysfunction (anorgasmia). Seratonin syndrome with any drug that increases seratonin (MAOI's, SNRIs, SSRIs) hyperthermia, muscle rigidity, CV collapse, flushing, diarrhea, seizures tx. cyproheptadine (seratonin antagonist) |
|
|
What causes seratonin syndrome? What are symptoms? How do you treat it?
|
Anything that increases serotonin - MAOIs, SSRIs, SNRIs
symptoms: flushing, diarrhea, CV collapse, hyperthermia, muscle rigidity, seizures *life threatening drug reaction! tx. cyproheptadine (serotonin antagonist |
|
|
cyproheptadine
|
used to treat serotonin syndrome - increased serotonin in the synapse - CV collapse, seizures, hyperthermia, diarrhea, flushing - can lead to death
|
|
|
Electroconvulsive therapy (ECT)
|
treatment option for major depressive disorder refractory to other treatment. Produces a painless seizure in an anesthetized patient. Major adverse effects are disorientation and anterograde/retrograde amenesia (can be minimalized when ECT is performed unilaterally)
|
|
|
What are adverse effects of ECT?
|
disorientation and anterograde/retrograde amnesia (can be minimized when ECT is performed unilaterally)
|
|
|
What are the risk factors for suicide?
|
'SAD PERSONS
Sex (male) Age (teenager or elderly) Depression Previous attempt Ethanol or drug use Rational thinking Sickness (medical illness, 3 or more prescription medications) Organized plan No spouse (divorced, widowed, or single especially if childless) Social support lacking. * women attempt it more, men are more successful |
|
|
How long does it usually take for antidepressants to have an affect?
|
2-3 weeks or longer!
|
|
|
Panic disorder diagnosis
|
presence of recurrent periods of intense fear and discomfort peaking in 10 minutes with at least 4 of the following: 'PANICS'
Palpitations, paresthesias Abdominal distress Nausea Intense fear of dying or loosing control, lIghtneadedness Chest pain, chills, choking, disConnectedness Sweating, shaking, shortness of breath |
|
|
How do you treat panic disorders?
|
cognitive behavorial therapy, SSRIs, TCAs, benzodiazepines
|
|
|
Tricyclic antidepressants and MOA
|
'DDAANCI'
Desipramine, doxepin, amoxapine, amitryptyline, clomipramine, imipramine MOA: block reuptake of NE and serotonin |
|
|
uses of tricyclic antidepressants and SE
|
use: major depression, bedwetting (imipramine), OCD (clomipramine, fibromyalgia, panic disorder
SE: sedation, alpha blocking effects, atropine like effects (anti-cholinergic): tachycardia, urinary retention. tertiary TCAs (amtriptyline) have more anticolinergic SE than do secondary TCAs (nortriptyline). Despiramine is the least sedating and has lower seizure threshold |
|
|
what is imipramine used for?
|
it is a TCA antidepressant
can be used for bedwetting |
|
|
What is clomipramine used for?
|
it is a TCA antidepressant - can be used for OCD
|
|
|
what TCAs have the most anticolinergic SE's (urinary retention, tachycardia)?
|
tertiary TCAs have more of these effectes (amitriptyline)
secondary TCAs have less anticholinergic effect (nortriptyline) |
|
|
What of the TCAs is least sedating and has a lower seizure threshold?
|
desipramine
|
|
|
toxicity of TCA's
|
Tri-C's: Convulsions, Coma, Cardiotoxicity (arrhythmias); also respiratory depression, hyperpyrexia. Confusion and hallucinaations in elderly due to anticholinergic SE (nortriptyline)
tx: NaHCO3 for CV toxicity |
|
|
Convulsions, coma, cardiotoxicity (arrhythmias) are toxicities of what class of drugs?
|
TCA's (Tri-C's)
treat cardiotoxicity with NaHCO3 |
|
|
Specific phobia
|
fear that is excessive or unreasonable and interferes with normal function. Cued by presence or anticipation of a specific object or situation. Person recognizes fear is excessive. Can treat with systemic desensitixation (expose to phobia slowly)
|
|
|
What condition do you treat with systemic desensitization?
|
specific phobia - expose person to phobia slowly
|
|
|
Social phobia
|
social anxiety disorder - exaggerated fear of embarassment in social situations (public speaking, using restrooms). tx. SSRIs
|
|
|
What is the treatment for social phobia?
|
SSRIs
|
|
|
OCD
|
recurring, intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress; relieve in part by the performance of repetitive actions (compulsions). Ego dystonic: behavior inconsistent with ones own beliefs and attitudes (vs. obsessive compulsive personality disorder). associated with tourette's disorder - treatment: SSRIs, clomipramine (TCA)
|
|
|
What is OCD associated with? what do you use to treat it?
|
associated with tourettes syndrome
tx. SSRIs, clomipramin (TCA) |
|
|
Post traumatic stress disorder
|
persistent reexperiencing of a previous traumatic event - may involve nightmares or flashbacks, intense fear, helplessness, or horror. Leads to avoidence of stimuli associated with the trauma and persistently increased arousal. disturbance lasts > 1 month with symptoms starting > 1 mo after the event, an causes significant distress and/or impaired functioning
tx. psychotherapy, SSRIs |
|
|
what is the treatment for post traumatic stress disorder?
|
psychotherapy, SSRIs
|
|
|
acute distress disorder
|
symptoms last 2 day - 1 month
if last more than 1 month then post traumatic stress disorder |
|
|
generalized anxiety disorder
|
pattern of uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation or event. Associated with sleep disturbances, fatigue, and difficultly concentrating.
tx. benzodiazepines, buspirone, SSRIs |
|
|
What is the treatment for anxiety disorder? how long do the symptoms have to be there for the diagnosis?
|
6 months or more of symptoms
tx. benzodiazepines, buspirone, SSRIs |
|
|
Adjustment disorder
|
emotional symptoms (anxiety, depression) causing impariment following an identifiable psychosocial stressor (divorce, illness) and lasting <6 mo (> 6 months in presence of chronic stressor)
|
|
|
malingering
|
patient consciously fakes or claims to have a disorder in order to attain a specific secondary gain (avoiding work, obtaining drugs). Avoid treatment by medical personnel; complaints cease after gain (vs. factitious disorder)
|
|
|
Factitious disorder
|
patient consicously creates physical and/or psychological symptoms in order to assure "sick role" and to get medical attention (primary gain)
|
|
|
Munchausen's syndrome
|
chronic factitious disorder - predominately physcial signs and symptoms. Characterized by a history of multiple hospital admissions and willingness to receive invasive procedures
|
|
|
Munchausen's syndrome by proxy
|
when illness in a child is caused by the caregiver. Motivation is to assume a sick role by proxy. Form of child abuse!
|
|
|
assume sick role with primary gain to get attention
|
factitious disorder
chronic = munchausen's syndrome |
|
|
assume sick role with primary gain of avoiding work or obtaining drugs
|
malingering
|
|
|
Personality trait
|
enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself that is exhibited in a wide range of important social and personal contexts
|
|
|
personality disorders
|
inflexible, maladaptive, and rigidly pervasive pattern of behavior causing subjective distress and/or impaired functioning: person is usually not aware of the problem. Stable by early adulthood; not usually diagnosed in children
|
|
|
Somatoform disorders what are they? who are they most common in?
|
group of disorders characterized by physical symptoms with no identifiable physical cause. Both illness production and motivation are unconscious drives. Symptoms not intentially produced or feigned. Most common in women!
|
|
|
What are the 5 types of somatoform disorders?
|
somatization disorder, coversion, hypochondriasis, body dysmorphic disorder, pain disorder
|
|
|
Somatization disorder
|
type of somatoform disorder - unconscious
variety of complaints in multiple organ systems (at least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic) over a period of years) |
|
|
Conversion disorder
|
form of somatoform disorder - unconscious
motor or sensory symptoms (eg. paralysis, blindness, mutism) often following an acute stressor; patient is aware of but indifferent towards symptoms) (la belle indifference) |
|
|
hypochondriasis
|
form of somatoform disorder - unconscious
preoccupation with and fear of having a serious illness despite medical evaluation and reassurance |
|
|
body dysmorphic disorder
|
preoccupation with minor or imagined defect in appearnce, leading to significant emotional distress or imparied functioning; patients often repeatedly seek cosmetic surgery
|
|
|
a woman is preoccupied with many parts of her body, she feels like they are all ugly - she has gotten a lot of plastic surgery
|
body dysmorphic disorder
|
|
|
Pain disorder
|
form of somatoform disorder - unconscious
prolonged pain with no physical findings |
|
|
Types of personality disorder
|
A - Wierd
B - Wild C - Worried |
|
|
generalized anxiety disorder
|
pattern of uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation or event. Associated with sleep disturbances, fatigue, and difficultly concentrating.
tx. benzodiazepines, buspirone, SSRIs |
|
|
What is the treatment for anxiety disorder? how long do the symptoms have to be there for the diagnosis?
|
6 months or more of symptoms
tx. benzodiazepines, buspirone, SSRIs |
|
|
Adjustment disorder
|
emotional symptoms (anxiety, depression) causing impariment following an identifiable psychosocial stressor (divorce, illness) and lasting <6 mo (> 6 months in presence of chronic stressor)
|
|
|
malingering
|
patient consciously fakes or claims to have a disorder in order to attain a specific secondary gain (avoiding work, obtaining drugs). Avoid treatment by medical personnel; complaints cease after gain (vs. factitious disorder)
|
|
|
Factitious disorder
|
patient consicously creates physical and/or psychological symptoms in order to assure "sick role" and to get medical attention (primary gain)
|
|
|
Munchausen's syndrome
|
chronic factitious disorder - predominately physcial signs and symptoms. Characterized by a history of multiple hospital admissions and willingness to receive invasive procedures
|
|
|
Munchausen's syndrome by proxy
|
when illness in a child is caused by the caregiver. Motivation is to assume a sick role by proxy. Form of child abuse!
|
|
|
assume sick role with primary gain to get attention
|
factitious disorder
chronic = munchausen's syndrome |
|
|
assume sick role with primary gain of avoiding work or obtaining drugs
|
malingering
|
|
|
Personality trait
|
enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself that is exhibited in a wide range of important social and personal contexts
|
|
|
generalized anxiety disorder
|
pattern of uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation or event. Associated with sleep disturbances, fatigue, and difficultly concentrating.
tx. benzodiazepines, buspirone, SSRIs |
|
|
What is the treatment for anxiety disorder? how long do the symptoms have to be there for the diagnosis?
|
6 months or more of symptoms
tx. benzodiazepines, buspirone, SSRIs |
|
|
Adjustment disorder
|
emotional symptoms (anxiety, depression) causing impariment following an identifiable psychosocial stressor (divorce, illness) and lasting <6 mo (> 6 months in presence of chronic stressor)
|
|
|
malingering
|
patient consciously fakes or claims to have a disorder in order to attain a specific secondary gain (avoiding work, obtaining drugs). Avoid treatment by medical personnel; complaints cease after gain (vs. factitious disorder)
|
|
|
Factitious disorder
|
patient consicously creates physical and/or psychological symptoms in order to assure "sick role" and to get medical attention (primary gain)
|
|
|
Munchausen's syndrome
|
chronic factitious disorder - predominately physcial signs and symptoms. Characterized by a history of multiple hospital admissions and willingness to receive invasive procedures
|
|
|
Munchausen's syndrome by proxy
|
when illness in a child is caused by the caregiver. Motivation is to assume a sick role by proxy. Form of child abuse!
|
|
|
assume sick role with primary gain to get attention
|
factitious disorder
chronic = munchausen's syndrome |
|
|
assume sick role with primary gain of avoiding work or obtaining drugs
|
malingering
|
|
|
Personality trait
|
enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself that is exhibited in a wide range of important social and personal contexts
|
|
|
Types of personality disorder
|
Cluster A - Weird
Cluster B - Wild Cluster C - Worried |
|
|
Cluster A personality disorders types and general characteristics
|
WEIRD
odd or eccentric; inability to develop meaningful social relationships. No psychosis; genetic association with schizophrenia types: paranoid, schizoid, schizotypal |
|
|
Paranoid personality disorder
|
Cluster A disorder: pervasive, distant and suspiciousness; projection is a major defense mechanism
|
|
|
Schizoid personality disorder
|
cluster A personality disorder
voluntary social withdrawl, limited emotional expression, content with social isolation schizoiD = Distant loner |
|
|
Schizotypal personality disorder
|
cluster A disorder
eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness schizoTypal = magical Thinking |
|
|
Cluster B personality disorder characteristics and types
|
WILD: dramatic, emotional, or erratic; genetic association with mood disorders and substance abuse
Types: antisocial, borderline, histrionic, narcissistic |
|
|
Antisocial personality disorder
|
cluster B: disregard for and violation of rights of others, criminality; males>females; conduct disorder if <18 years
|
|
|
Borderline personality disorder
|
cluster B: unstable mood and interpersonal relationships, impulsiveness, self-mutilation, sense of emptiness; females>males; splitting is a major defense mechanism
|
|
|
Histrionic personality disorder
|
excessive emotionality and excitability, attention seeking, sexually provocative, overly concerned about appearance
|
|
|
WHAT ARE THE EIGHTS STEPS TO DTD?
|
EQUIPMENT
OVERBOOTS, (SHUFFLE PIT) AND HOOD DECON OVERGARMENT REMOVAL OVERBOOTS AND GLOVE REMOVAL MONITORING MASK REMOVAL MASK DECON REISSUE POINT |
|
|
personality disorder whose major defense mechanism is projection
|
paranoid - cluster A
WEIRD |
|
|
personality disorder whose major defense mechanism is splitting
|
borderline - cluster B
Wild |
|
|
Cluster C personality disorder general characteristics and types
|
WORRIED: anxious or fearful; genetic association with anxiety disorders
types: avoidant, obsessive compulsive, dependent |
|
|
What is the genetic association with cluster C personality disorders?
|
associated with anxiety disorders
|
|
|
Avoidant personality disorder
|
cluster C: worried
hypersensitive to rejection, socially inhibited, timid, feelings of inadequacy, desires relationships with others (vs. schizoid) |
|
|
Obsessive compulsive personality disorder
|
cluster C
preoccupation with order, perfectionism, and control; ego syntonic: behavior consistent with one's own beliefs and attitudes (vs. OCD) |
|
|
dependent personality disorder
|
cluster C
submissive and clinging, excessive need to be taken care of, low self confidence |
|
|
progression of "schizo"
|
schizoid<Schizotypal<Schizophrenic (greater odd thinking than schizotypal)<Schizoaffective (schizophrenic psychotic symptoms + bipolar or depressive mood disorder)
|
|
|
schizophrenia time course
|
<1mo - brief psychotic disorder, usually stress related
1-6 months - schizophreniform disorder >6 months - schizophrenia |
|
|
Anorexia nervosa
|
excessive dieting +/- purging; intense fear of gaining weight; body image distortion and increase exercise, leading to body weight <85% ideal. Associated with decreased bone density, severe weight loss, metatarsal stress fractures, amenorrhea, anemia, and electrolyte disturbances. Seen primarily in adolescent girls. Commonly exists with depression
|
|
|
bulimia nervosa
|
binge eating +/- purging; followed by self-induced vomiting or use of laxatives, diuretics, or emetics. body weight often maintained within normal range. associated with parotitis, enamal errosion, electrolyte distrubances, alkalosis, dorsal hand calluses from inducing vomiting (Russell's sign)
|
|
|
russel's sign is associate with what?
|
bulemia nervosa
calluses on dorsal aspect of hand from inducing vomiting |
|
|
Gender identity disorder
|
strong persistent cross-gender identification. characterized by persistent discomfort with one's sex, causing significant distress and/or impaired functioning
|
|
|
Substance dependence
|
maladaptive pattern of substance use defined as 3 or more of the following signs in 1 year:
-tolerance - need more to achieve same effect - withdrawl - substance taken in larger amounts or over longer time than desired - persistant desire or unsuccessful attempts to cut down - significant energy spent obtaining, using or recovering from substance - important social, occupational, or recreational activities because of substance use - continued use in spite of knowing the problems that it causes |
|
|
substance abuse
|
maladaptive pattern leading to clinicially significant impairment or distress. Symptoms have NEVER met criteria for substance dependence
- recurrent use resulting in failure to fulfill major obligations at work, school or home - recurrent use in physically hazardous situations - recurrent substance related legal problems - continued use in spite of persistent problems caused by use |
|
|
substance withdrawl
|
behavoiral, physiologic, and cognitive state caused by cessation or reduction of heavy and prolonged substance use. Signs and symptoms often opposite to those seen in intoxification
|
|
|
substance abuse has never what??
|
met criteria for substance dependence
|
|
|
depressant drugs:
|
alcohol, opioids (morphine, heroin, methadone), barbiturates, benzodiazepines
|
|
|
stimulant drugs:
|
amphetamines, cocaine, caffeine, nicotine
|
|
|
Hallucinogen drugs:
|
PCP, LSD, Marijuana
|
|
|
symptoms of alcohol intoxification
|
disinhibition, emotional liabilty, slurred speech, ataxia, coma, blackouts, serum y-glutamyltransferase (GGT) - sensitive indicator of alcohol use
|
|
|
What drugs can you use to prevent relapse from alcohol?
|
Naltrezone, disulfiram
|
|
|
withdrawl symptoms of alcohol
|
tremor, tachycardia, HTN, malaise, nausea, seizures, delirium tremens (DTs - life threatening), tremulousness, agitation, hallucinations (tactile)
|
|
|
what is the treatement for DT's
|
Benzodiazepines
|
|
|
symptoms of opioid intoxification
|
morphine, heroin, methadone
CNS depression, nausea, vomiting, constipation, pupillary constriction (pinpoint pupils), seizures (overdose is life threatening) |
|
|
if someone has pinpoint pupils what drug could they be on?
|
opioids - morphine, heroin, methadone
|
|
|
what drugs do you treat opioid intoxification with?
|
naloxone, naltrezone
|
|
|
What are symptoms of opioid withdrawl?
|
anxiety, insomnia, anorexia, sweating, dilated pupils, piloerection (cold turkey), fever, rinorrhea, nausea, stomach cramps, diarrhea, yawning
|
|
|
How do you treat opioid withdrawl?
|
symptomatic, naloxone + buprenorphine (suboxone), methadone
|
|
|
Symptoms of barbiturate intoxification
|
low safety margin, respiratory depression
|
|
|
treatment for barbituate intoxification
|
symptom mangement (assist respiration, increase BP)
|
|
|
drug that causes respiratory depression - low safety margin
|
barbiturates
|
|
|
withdrawl symptoms from barbiturates
|
anxiety, seizures, delirium, life-threatening CV collapse
|
|
|
symptoms of benzodiazepine intoxification
|
greater safety margin. amnesia, ataxia, somnolence, minor respiratory depression. additive effects with alcohol.
|
|
|
what do you treat benzodiazepine intoxification with?
|
flumazenil (competitive GABA antagonist)
|
|
|
What are the symptoms of benzodiazepine withdrawl?
|
rebound anxiety, seizures, tremor, insomnia
|
|
|
symptoms of amphetamine intoxification
|
psychmotor agitation, impaired judgement, pupillary dilitation, HTN, tachycardia, euphoria, prolonged wakefulness and attention, cardiac arrhythmias, delusions, hallucinations, fever
|
|
|
symptoms of amphetamine withdrawl
|
post use "crash", including depression, lethargy, headache, stomach cramps, hunger, hypersomnolence
|
|
|
symptoms of cocaine intoxification
|
euphoria, psychomotor agitation, impaired judgement, tachycardia, pupillary dilitation, HTN, hallucinations, paranoid ideations, angina, sudden cardiac death
*cocaine blocks the reuptake of NE, serotonin, and dopamine |
|
|
treatment for cocaine intoxification
|
benzodiazepines
|
|
|
symptoms of cocaine withdrawl
|
post use "crash", including severe depression and suicidality, hypersomnolence, fatigue, malaise, severe psychological craving
|
|
|
symptoms of caffeine intoxification
|
restlessness, insomnia, increased diuresis, muscle twitching, cardiac arrythmias
|
|
|
symptoms of caffeine withdrawl
|
headache, lethargy, depression, weight gain
|
|
|
symptoms of nicotine intoxification
|
restlessnesss, insomnia, anxiety, arrhythmias
|
|
|
symptoms of nicotine withdrawl
|
irritability, headache, anxiety, weight gain, craving
|
|
|
what drug do you use to treat nicotine withdrawl
|
buproprion, varenicline
|
|
|
symptoms of PCP intoxification
|
Belligerence, impulsiveness, fever, pscyhomotor agitation, vertical and horizonal nystagmus, tachycardia, ataxia, homocidality, psychosis, delirium
|
|
|
what drug is someone taking if they have horizontal and vertical nystagmus?
|
PCP
|
|
|
symptoms of PCP withdrawl?
|
depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep
|
|
|
symptoms of LSD intoxification
|
marked anxiety or depression, delusions, visual hallucinations, flashbacks, pupillary dilation
|
|
|
what drug is someone taking if they have flashbacks?
|
LSD
|
|
|
symptoms of marijuana intoxification
|
euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, social withdrawal, increased appetite, dry mouth, hallucinations
|
|
|
symptoms of marijuana withdrawal?
|
irritability, depression, insomnia, nausea, anorexia. most symptoms peak in 48 hours and last for 5-7 days. can be detected in urine up to 1 month after use
|
|
|
heroin addiction
|
users at increased risk of hepatitis, abscesses, overdose, hemorrhoids, AIDS, and right sided-endocarditis. look for track marks (needle sticks in veins). symptoms of opioid intoxification (pin point pupils, respiratory depression, coma)
|
|
|
treatment for heroin addiction?
|
naloxone (narcan), naltrexone - competitively inhibits opoids
|
|
|
what is a long acting oral opioid? What is it used for?
|
methadone - used for heroin detox or long-term maintenance
|
|
|
Suboxone
|
naloxone + buprenophine (partial agonist); long acting with fewer withdrawal symptoms than methadone. naloxone is not active when taken orally, so withdrawal symptoms occur only if injected (lower abuse potential)
|
|
|
alcoholism
|
physiologic tolerance and dependence with symptoms of withdrawal (tremor, tachycardia, HTN, malaise, nausea, DTs) with intake is interrupted
|
|
|
complications of alcholism
|
cirrhosis, hemorrhoids, hepatitis, pancreatitis, peripheral neuropathy, testicular atropy
|
|
|
Wernicke-Korsakoff syndrome
|
Wernicke triad: ataxia, ophthalmoplegia, confusion
Korsakoff: memory loss, confabulations, hallucinations *hemorrhage of mammillary bodies tx. IV thiamine (B1) |
|
|
hemorrhage of mammilary bodies is seen in what? what is the tx?
|
wernicke-korsakoff syndrome - thiamine deficiency (vit B1)
tx. IV thiamine (vit B1) |
|
|
Mallory-Weiss syndrome
|
longitudinal lacerations at the gastroesophageal junction caused by excessive vomiting. often presents with hematemesis. Associated with pain (vs. esophageal varices)
|
|
|
tx. for alcoholism
|
disulfiram (to condition patient to abstain from alcohol use), supportive care. alcoholics anonymous and other peer support groups are helpful in sustaining abstience
|
|
|
Delirium tremens (DTs)
|
life-threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink. Symptoms in order of appearnce: autonomic system hyperactivity (tachycardia, tremors, anxeity, seizures), psychotic symptoms (hallucinations, delusions), confusion
|
|
|
what do you use to treat DTs?
|
benzodiazepines
|
|
|
drug used for alcohol withdrawal?
|
benzodiazepines
|
|
|
drug used for bulemia?
|
SSRIs
|
|
|
drug used for anxiety
|
buspirone, SSRIs, benzodiazepines
|
|
|
drug used for ADHD
|
methylphenidate (ritalin), amphetamines (dexedrine)
|
|
|
drug used for atypical depression
|
MAO inhibitors, SSRIs
|
|
|
drug used for bipolar disorder
|
lithium, valproic acid, carbamazepine, atypical antipsychotics
|
|
|
drugs used for depression
|
SSRIs, SNRIs, TCAs
|
|
|
drugs used for depression with insomnia
|
mirtazapine
|
|
|
drug used for OCD
|
SSRIs, Clomipramine
|
|
|
drug used for panic disorder
|
SSRIs, TCAs, Benzodiazepines
|
|
|
drug used for PTSD
|
SSRIs
|
|
|
drug used for schizophrenia
|
antipsychotics
|
|
|
drug used for tourettes syndrome
|
antipsychotics (haloperidol)
|
|
|
drug used for social phobias
|
SSRIs
|
|
|
Buspirone MOA and use
|
stimulates 5HT (serotonin) receptors
has NO hypnotic effects used for: generalized anxiety disorder, does not cause sedation, addiction, or tolerance. Does not interact with alcohol (vs. barbiturates, benzodiazepines) |
|
|
Where does Maprotiline work?
|
blocks NE reuptake - atypical antidepressant
|
|
|
Where does mirtazapine work?
|
a2 receptor antagonist - atypical antidepressant
|
|
|
Where dose trazodone work?
|
blocks 5-HT reuptake - atypical antidepressant
|
|
|
What are the atypical antidepressants?
|
BMMT
bupropion (wellbutrin) Mirtazapine Maprotiline Trazodone |
|
|
Buproprion uses and toxicity
|
atypical antidepressant
used for smoking cessation. increases NE and dopamine via unknown mechanisms toxicity: stimulant effects (tachycardia, insomnia), headache, seizure in bulimic patients. No sexual side effects. |
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seizure occurs in bulimic patient - what drug was she given?
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buproprion - causes seziures because of electrolyte imbalance
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Mirtazapine
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Atypical Antidepressant
a2 antagonist (increase release of NE and serotonin) and potent 5-HT2 and 5-HT3 receptor antagonist toxicity: sedation, increased appetite, weight gain, dry mouth |
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Maprotiline
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atypical antidepressant
blocks NE reuptake toxicity: sedation, orthostatic hypotension |
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Trazodone
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atypical antidepressant
inhibits serotonin reuptake. used for insonmia, as high doses are needed for antidepressant effects toxicity: sedation, nausea, pripism (lasting erection), postural hypotension "trazaBONE due to male-specific side effects" |
