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331 Cards in this Set

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Psychosis defined by presence of one of the following:
1. delusional thinking
2. hallucinations
3. diordered thought process
olfactory hallucinations often assoc with?
Auras of epilepsy
Tactile hallucinations seen in..?
drug abuse, alcohol withdrawal
negative symtpoms of schizophrenia?
5 As:
Anhedonia, affect (flat), alogia, avolition, attention (poor)
highest functioning subtype of schizophrenia?
paranoid
disorganized type schizophrenia?
- disorganized speech
- disorganized behavior
- flat or inappropriate affect
concordance rate of schizophrenia among monozygotic twins?
50%
risk of having schizophrenia if one first-degree relative is affected?
12%
dopamine pathways affected in schizophrenia?
Prefrontal cortical - negative symptoms
Mesolimbic - responsible for positive symptoms
which drugs excite dopaminergic pathways?
cocaine, amphetamines
significant improvement is noted in what % of schizophrenic patients who take an antipsychotic medication?
70%
name the typical neuroleptics?
chlorpromazine, thioridazine, trifluoperazine, haloperidol
what are the high potency typical antipsychotics?
haloperidol and trifluoperzine
Theorist: separation-individuation and early infantile development
Mahler
Theorist: stages of psychosocial development throughout the life cycle
Erikson
Theorist: psychosexual development and unconscious conflicts
Freud
Theorist: stages of cognitive development
Piaget
Theorist: uses terms 'shadow' 'archetype' 'animus'
Jung
Theorist: stages of moral development
Kohlberg
Theorist: self-psychology, resilient sense of self is due to empathic care-giving
Kohut
Theorist: object relations and infant-mother interaction
Klein
Theorist: defined 'transitional object' as comforting substitute for primary caregiver
Winnicott
Theorist: emphasized central importance of interpersonal relationships
Sullivan
Where's the satiety center located in the brain?
Ventromedial nucleus of the hypothalamus
What do the left and right prefrontal area of the brain do?
Left = "Lifts" mood
Right = "Reduces" mood
What is the orbitofrontal region of the frontal lobe involved in?
Insight/judgment, remorse, inhibition, stability
What is the dorsolateral region of the frontal lobe involved in?
Planning, monitoring, flexibility, motivation
4 year old girl is noticed to have lost ability ability to play, speak, control bowel movements..
Childhood disintegrative disorder
How to distinguish between Rett's and childhood disintegrative disorder?
Rett's - earlier onset (usually six months after birth), with characteristic hand sterotypies
Nocturnal enuresis can be diagnosed after age..?
5
Which medication can effectively treat sleep terrors?
Diazepam
Personality change, preoccupation/perseveration with a single theme, total loss of sex drive, emotional intensity. Otherwise normal physical exam..
Temporal lobe epilepsy
Child has a generalized siezure, bloody diarrhea, vomiting, and muscle twitching. What did he eat?
Arsenic
A tumor in this part of the brain can present with headache, papilledema, and homonymous hemianopsia...
Occipital lobe
Urine vanillymandelic acid (VMA) can be used to diagnose..?
Pheochromocytoma
Risk of daughter (with affected father) for developing Huntington's?
1 in 2
NMS pharmacologic treatment?
Bromocriptine or dantrolene
What is perphenazine?
High potency typical antipsychotic
17 year old boy is diagnosed with shizophrenia. What is the risk that one of his siblings will develop the disease?
10%
First line drugs for the treatment of akathisia?
Beta blockers (propranolol) and benzos (lorazepam)
Benztropine and diphenhydramine are of what class of drugs?
Anticholingerics
What % of diagnosed shizophrenics commit suicide?
10%
Which drugs can produce psychoses similar to schizophrenia?
Cocaine, amphetamines, PCP, and LSD
This syndrome manifests as a visual hallucination of a transparent phantom of one's own body
Autoscopic psychosis
Under hypnosis, a woman who was sexually abused pleads "Daddy please don't hurt me." This is an example of?
Abreaction (aka reenactment)
Woman is diagnosed with MDD. What is the chance that her identical twin sister will develop the disease?
70%
Which medication could cause acne, thirst, and food to taste funny?
lithium
Prevalence of clinical depression among patients post-stroke?
35-45%
Risk for suicide in patients with mood disorders?
10-15%
Craving for sweets is seen in which affective disorder?
Seasonal affective disorder
Which medication would you use to augment fluoxetine in the treatment of major depression?
Lithium
Which medication would you use to augment fluoxetine in the treatment of major depression?
Lithium
What are the contraindications for ECT?
Recent MI, increased ICP, aneurysms, bleeding disorders, etc.
What are the contraindications for ECT?
Recent MI, increased ICP, aneurysms, bleeding disorders, etc.
Prevalence of alcohlism in patients with MDD?
35%
Prevalence of alcohlism in patients with MDD?
35%
Memory gaps, significant problems with autobiographical memory, fluctuation in skills, changes in mannerisms/affect, are indicative of...?
Dissociative identity disorder
Memory gaps, significant problems with autobiographical memory, fluctuation in skills, changes in mannerisms/affect, are indicative of...?
Dissociative identity disorder
Onset of antianxiety effects of Buspirone? More or less sedating than benzos..?
Three weeks. Less sedating.
Onset of antianxiety effects of Buspirone? More or less sedating than benzos..?
Three weeks. Less sedating.
Vietnam vet startles and hyperventilates whenever he hears a sharp noise. These symptoms of autonomic hyperarousal can be treated with..?
Beta blockers
What condition is often associated with Restless Leg?
Pregnancy
Vietnam vet startles and hyperventilates whenever he hears a sharp noise. These symptoms of autonomic hyperarousal can be treated with..?
Beta blockers
Which class of drugs can have significant effects on sexual function?
Beta blockers, in specific, propranolol
What condition is often associated with Restless Leg?
Pregnancy
Lifetime prevalence of all personality disorders in the general population?
10-20%
Which class of drugs can have significant effects on sexual function?
Beta blockers, in specific, propranolol
Restless leg vs periodic limb movement disorder?
Periodic - (aka nocturnal myoclonus)
Restless leg
Lifetime prevalence of all personality disorders in the general population?
10-20%
Restless leg vs periodic limb movement disorder?
Periodic - (aka nocturnal myoclonus)
Restless leg
Which medication would you use to augment fluoxetine in the treatment of major depression?
Lithium
What are the contraindications for ECT?
Recent MI, increased ICP, aneurysms, bleeding disorders, etc.
Prevalence of alcohlism in patients with MDD?
35%
Memory gaps, significant problems with autobiographical memory, fluctuation in skills, changes in mannerisms/affect, are indicative of...?
Dissociative identity disorder
Onset of antianxiety effects of Buspirone? More or less sedating than benzos..?
Three weeks. Less sedating.
Vietnam vet startles and hyperventilates whenever he hears a sharp noise. These symptoms of autonomic hyperarousal can be treated with..?
Beta blockers
What condition is often associated with Restless Leg?
Pregnancy
Which class of drugs can have significant effects on sexual function?
Beta blockers, in specific, propranolol
Lifetime prevalence of all personality disorders in the general population?
10-20%
Restless leg vs periodic limb movement disorder?
Periodic - (aka nocturnal myoclonus)
Restless leg
Which medication would you use to augment fluoxetine in the treatment of major depression?
Lithium
What are the contraindications for ECT?
Recent MI, increased ICP, aneurysms, bleeding disorders, etc.
Prevalence of alcohlism in patients with MDD?
35%
Memory gaps, significant problems with autobiographical memory, fluctuation in skills, changes in mannerisms/affect, are indicative of...?
Dissociative identity disorder
Onset of antianxiety effects of Buspirone? More or less sedating than benzos..?
Three weeks. Less sedating.
Vietnam vet startles and hyperventilates whenever he hears a sharp noise. These symptoms of autonomic hyperarousal can be treated with..?
Beta blockers
What condition is often associated with Restless Leg?
Pregnancy
Which class of drugs can have significant effects on sexual function?
Beta blockers, in specific, propranolol
Lifetime prevalence of all personality disorders in the general population?
10-20%
Restless leg vs periodic limb movement disorder?
Periodic - (aka nocturnal myoclonus)
Restless leg
Time till 'peak' of opiate withdrawal symtpoms?
48 hours
How long does intoxication with a hallucinogen last?
8-12 hours
Treatment for alcohol-withdrawal delirium?
Benzos such as chlordiazepoxide (librium)
What can you use to treat some acute symptoms of opioid withdrawal?
Clonidine (alpha 2 adrenergic agonist)
This illicit substance can produce vertical nystagmus?
PCP
PCP toxicity should be treated with...?
Benzos or antipsychotics
If both of your parents are alcoholic, how much greater risk do you have of becoming alcoholic than the general population?
3 to 4 times higher
Marijuana impairs the operation of motor vehicles for how long after its use?
8-12 hours
Which drug can cause tremors, HTN, tachycardia, mydriasis, hyperthermia, sweating, blurry vision, and false perceptions (ie. of being able to fly)?
LSD
Which TCA has been used to treat OCD?
Clomipramine
Which adjuvant to an SSRI can be given to resolve sexual side effects?
Cyproheptadine
Which drugs can increase lithium levels to toxic levels?
Several NSAIDs, ie ibuprofen
High fever, chills, bleeding gums, extreme fatigue, and pallor associated with carbamazepine?
Acute aplastic anemia
Which antipsychotic is recommended for treatment-refractory psychosis?
Clozapine
How long does lithium take to come to steady state with regular administration?
5-8 days
What's the best anticonvulsant for patients taking clozapine who experience seizures?
Phenobarbitol
Treatment of PTSD hyperarousal?
Clonidine, beta blockers
Elderly man with psychotic depression, prostatic hypertrophy, CAD, orthostatis hypotension - what med...?
Haldol, fluphenazine - low in anticholinergic side effects
Which medication reduces/delays REM sleep?
Desipramine
Boy with enuresis and ADHD... treatment?
Imipramine
Mechanism of typical neuroleptics?
Dopamine antagonists
Mechanisms of atypical neuroleptics?
Antagonize serotonin and dopamine receptors
Which neuroleptics have a higher incidence of EPS than anticholinergic effects?
High potency neuroleptics (haldol and trifluoperazine)
Which neuroleptics have primarily anticholinergic side effects?
Low potency neuroleptics - chlorpromazine and thioridazine
Tardivwe dyskinesia occurs most often in....?
Older women after at least 6 months
Mortality rate of NMS?
20%
Weight gain, sedation, orthostasis, ECG changes, hyperprolactinemia, hematologic effects, and dermatologic conditions can be associated with which class of drugs?
Antipsychotics
Schizophreniform duration of symptoms?
1-6 months
These are criteria for which disorder: have had delusions or hallucinations for 2 weeks in the absence of mood disorder symptoms, meet criteria for major depressive episode, manic episode, or mixed episode....?
Schizoaffective disorder
Delusional disorder?
Nonbizarre fixed delusions for at least 1 month
Echopraxia?
Mimics behavior
CT scan of patients with schizophrenia?
Enlargement of the ventricles and diffuse cortical atrophy
Difference between schizophrenia and delusional disorder?
Delusional disorder has nonbizarre delusions, daily functioning is not significantly impaired, and does not meet the DSM criteria for schizophrenia
List some extrapyramidal symptoms?
Dystonia
Parkinsonism
Akathisia
Treatment for EPS side effects of antipsychotics?
Antiparkinsonian agents (benztropine, amantadine) and benzodiazepines
What are anticholinergic symptoms? Seen with which antibiotics?
Dry mouth, constipation, blurred vision. Seen with low potency traditional and atypical antipsychotics
Shared psychotic disorder?
Folie a deux - patient develops the same delusional symptoms as somone he is in a close relationship with
What is Koro? Amok? Brain fag?
Koro - belief of disappearing penis
Amok - sudden unprovoked outbursts of violence of which person has no recollection
Brain fag - Headache, fatigue, and visual disturbances
To have a MDD, you must have one of which two symptoms (in addition to others...)?
Depressed mood or anhedonia
Risk of a patient who has been previously hospitalized for MDD for committing suicide?
15%
What % of manic patients have psychotic symptoms?
75%
Differences between mania and hypomania?
Mania lasts at least 7 days (as opposed to 4 days)
Marked social/occupational functioning
May require hospitalization
May have psychotic features
What are potential medical causes of a manic episode?
Hyperthyroidism, tmeporal lobe seizures, MS, neoplasia, HIV
What medications can cause mania?
Corticosteroids
Antidepressants
Average age of onset for MDD?
40
Triad for seasonal affective disorder?
Irritability
Carbohydrate drawing
Hypersomnia
Concordance rate of MDD for monozygotic twins?
50%
Symptoms of serotonin syndrome?
Autonomic instability, hyperthermia, and seizures
TCA side effects?
Sedation, weight gain, orthostasis, and anticholinergic side effects
(anti HAM)
Which medications are often useful in the treatment of atypical depression?
MAOIs
Atypical depression?
Hypersomnia, hyperphagia, reactive mood, and hypersensitivity to interpersonal rejection
Bipolar I diagnostic criteria? Lifetime prevalence?
One manic or mixed episode. 1%
Concordance rates of bipolar I disorder for monozygotic twins?
75%
Bad side effects of lithium
arrhythmias, seizures, goiter/hypothyroidism, polyuria, polydipsia
Pharmacotherapy for bipolar
Lithium, carbamazepine, valproic acid, and olanzapine
Diagnostic criteria for bipolar II disorder?
History of one or more MD episodes and at least one hypomanic episode
Cyclothymia?
numerous periods with hypomanic symptoms and periods with depressive symptoms for at least 2 years
Panic attacks may be mistaken by patients for...?
MI
DSM criteria for panic disorder
Recurrent panic attacks with no obvious precipitant
At least 1 month of persistent concern about addtl attacks, worry about implications, change in behavior
Effective treatment of anxiety symptoms in pts with panic disorder?
Benzos
Maintenance treatment of panic disorder?
SSRIs
50-75% of pts with agoraphobia have coexisting..?
Panic disorder
Most common mental disorders in the US?
Phobias
What disorders are found more commonly in phobic patients/
Substance related disorders, MDD
Treatment for social phobia?
Paroxetine
Lifetime prevalence of OCD?
2 to 3%
OCD is often co-morbid with what..?
Tourette's
Onset of OCD is often triggered by..?
Stressful life event
Treatment for OCD?
SSRIs, clomipramine
Symptoms of PTSD? Criteria?
Increased arousal, avoidance of stimuli associated with the trauma, persistent reexperiencing, etc. Must be present for at least 1 month
GAD criteria? Prevalence
Persistent, excessive anxiety and hyperarousal for at least 6 months
Association with somatic complaints - restlessness, fatigue, muscle tension, sleep disturbance, etc.
Prevalence up to 45%
Pharm treatment of GAD?
Buspirone, benzos, SSRIs, venlafaxine XR
Adjustment disorder is brought on by..? Defined as...?
Non-life threatening stressful event
Maladaptive behavioral/emotional symptoms within 3 months after a stressful event
Severe distress in excess of what would be expected
Symptoms resolve within 6 months
PD manifests in problems with...?
Cognition
Affect
Personal Relations
Impusle control
Avoidant PD vs schizoid PD?
Schizoid PD prefers to be alone
Which PD is characterized by unstable moods, behaviors, and interpersonal relationships?
Borderline
Which PD is characterized by excessive emotionality and attention seeking?
Histrionic
Who's more functional: the borderline or the histrionic?
Histrionic
What defense mechanism is often used by histrionic patients?
Regression
Which PD is marked by poor self-confidence and a fear of separation?
Dependent PD
OCPD: ego-syntonic or ego-dystonic?
Ego syntonic
Abuse
failure to fulfill obligations
Use in dangerous situations
Recurrent legal problems
Continued use despite problems
Dependence
at least 3 of these within a 12 month period
Withdrawal
Tolerance
Increasing use
Desire to cut down
Significant time spent
Decreased activities
Continued use despite physical/psychological problem
Lifetime prevalence of substance abuse or dependence?
17%
Alcohol activates which receptors?
GABA and Serotonin
how many Americans are alcoholics?
7-10%
Screen for alcohol abuse?
CAGE questionnaire
At which BAL can you start to see the effects of alcohol in a novice drinker?
20-50 mg/dL
Metabolic problem with ethanol or methanol intoxication?
Metabolic acidosis with increased anion gap
Treatment of acute alcohol intoxication...
ABCs, glucose level, thiamine, naloxone (for any opioids that may have been ingested), and folate
Atypical depression?
Hypersomnia, hyperphagia, reactive mood, and hypersensitivity to interpersonal rejection
Bipolar I diagnostic criteria? Lifetime prevalence?
One manic or mixed episode. 1%
Concordance rates of bipolar I disorder for monozygotic twins?
75%
Bad side effects of lithium
arrhythmias, seizures, goiter/hypothyroidism, polyuria, polydipsia
Pharmacotherapy for bipolar
Lithium, carbamazepine, valproic acid, and olanzapine
Diagnostic criteria for bipolar II disorder?
History of one or more MD episodes and at least one hypomanic episode
Cyclothymia?
numerous periods with hypomanic symptoms and periods with depressive symptoms for at least 2 years
Panic attacks may be mistaken by patients for...?
MI
DSM criteria for panic disorder
Recurrent panic attacks with no obvious precipitant
At least 1 month of persistent concern about addtl attacks, worry about implications, change in behavior
Effective treatment of anxiety symptoms in pts with panic disorder?
Benzos
Cocaine intox?
euphoria, dilated pupils, tactile hallucinations, fight-or-flight response
Wernicke's?
ataxia, confusion, and ocular abnormalities
Korsakoff's?
Impaired recent memory, anterograde amnesia, +/- confabulation
Classic amphetamines are used medically in the treatment of?
Narcolepsy, ADHD, and depressive disorders
Amphetamine intox looks a lot like what...?
Cocaine intox
Rotatory nystagmus is pathognomonic for...?
PCP
How to treat benzo OD?
Maintain ABCs..
Flumazenil
Opiate intoxication?
contstricted pupils, drowsiness, constipation, and respiratory depression
Treatment of opiate OD?
Administer naloxone or naltrexone (opiate antagonists).
Opiate withdrawal?
Dysphoria, yawning, rhinorrhea, piloerection, muscle ache, dilated pupils
Treatment of moderate opiate withdrawal?
clonidine and/or buprenorphine
Is withdrawal from opiates life-threatening?
No
Which drug causes conjunctival injection and dry mouth?
Marijuana
Cigarette smoking during pregnancy is associated with...?
Low birth weight and persistent pulmonary HTN of the newborn
Perfect score on MMSE?
30
Hallmarks of delirium?
Clouding of consciousness
Acute onset
Lasts 3 days to 2 weeks
Orientation impaired
Immediate/recent memory impaired
Visual hallucinations common
Symptoms fluctuate
Usually reversible
Awareness reduced
EEG changes
Differential for delirium?
AEIOU TIPS
Alcohol
Electrolytes
Iatrogenic
Oxygen hypoxia
Uremia/hepatic encephalopathy
Trauma
Infection
Poisons
Seizures (post-ictal)
Treatment for catatonic depression?
Antidepressants and antipsychotics
Visual Agnosia?
inability to recognize a previously known object
Name the cholinesterase inhibitors?
Tacrine
Donepezil
Rivastigmine
Which dementia involves intraneuronal inclusion bodies?
Pick's disease/frontotemporal dementia
List the subcortical dementias? How do they differ from the cortical dementias?
Huntington's, Parkinson's, NPH, multi-infarct dementia.
Have more prominent affective and movement symptoms
Carbidopa doeWs what?
Prevents conversion of levodopa to dopamine in the periphery
Treatment for Parkinson's disease?
Levodopa, Carbidopa
Amantadine
Anticholinergics
Dopamine agonists
MOA B-inhibitors
What does NPH produce first in terms of symptoms?
Gait disturbance
Dementia + cogwheel rigidits + resting tremor =
Parkinson's
Lewy body dementia
Dementia + diminished position sensation + megaloblasts =
VB12 deficiency
Dementia + tremor + abnormal LFTs + Kayser-Fleischer rings =
Wilson's disease
Delirium + dilated pupils + tachycardia =
drug intox
Delirium + tachycardia + tremor + thyromegaly =
Thyrotxicosis
Delirium + elevated BP + papilledema =
Hypertensive encephalopathy
T or F? Benzos are good to use in delirious patients...
FALSE
What can cause amnestic disorders?
Hypoglycemia, hypoxia, trauma, tumor, szs, CVA, MS, HSV encephalitis, substance use
Pseudodementia?
presence of apparent cognitive deficits in patients with MDD
Mirtazapine side effects
Increased appetite, sedation
How does REM sleep change in the elderly?
increased episodes of shorter duration
Which sedative-hypnotics should be used in the elderly?
Hydroxyzine and zolpidem --> these are safer than the more sedating benzos
Second most common cause of MR?
Fragile X
Conduct disorder conveys what risk of developing ASPD in adulthood?
40%
Difference between ODD and conduct disorder?
ODD does not involve violation of the basic rights of others
Subtypes of ADHD?
Inattentive
Hyperactive-impulsive
Combined type
Improvement in ADHD patients on Ritalin is seen in what %?
75%
ADHD onset is before what age?
7
Dextroamphetamine is used to treat..?
ADHD
Pemoline was used to treat what? What's the problem with it?
ADHD
Liver failure
Autism
Problems with social interaction
Impairments in communication
Repetitive and sterotyped patterns of behavior and activities
Autism is often associated with which other medical conditions?
Fragile X, tuberous sclerosis, MR, and szs
Rett's disorder is seen only in...? Onset...? How to distinguish from childhood disintegrative?
Girls
Between 5-48 months
Decreasing rate of head growth
Stereotyped hand movements
Coprolalia
repetitive speaking of obscene words
Tourette's concordance rate in monozygotic twins?
50%
amnesia is a prominent symptom in all of the dissociative disorders except...?
Depersonalization disorder
If a patient is unable to recall their name or other important information but will remember obscure details, it's likely...?
Dissociative amnesia
Difference between dissociative amnesia and dissociative fugue?
Fugue - unaware that they have forgotten anything
Dissociative identity disorder?
Two or more distinct personalities that alternately control their behaviors and thoughts
Somatization disorder must present before what age...?
30
Criteria for conversion disorder?
At least one neurological symptom that cannot be explained by a medical disorder, substance abuse
Psych factors associated with initiation of symptom
Symptoms of conversion disorder may resolve after what treatment?
Sodium amobarbital interview
Fears in hypochondriasis last at least how long?
6 months
90% of patients with body dysmorphic disorder have comorbid...?
depression
Factitious disorder
Intentionally producing medical or psychological symptoms in order to assume the sick role
Munchhausen
another name for factitious disorder with primarily physical symptoms
Patients usually feel remorseful after episodes of aggressive behavior in this disorder
Intermittent explosive disorder
Impulsiveness and aggression has been associated with low levels of..?
Serotonin
One fourth of patients with bulimia nervosa have comorbid...?
Kleptomania
Subtypes of anorexia?
restrictive - eat little and may vigorously exercise
binge-eating/purging - eat in binges followed by purging/exercise
diagnostic criteria for anorexia nervosa
Body weight at least 15% below normal
Intense fear of gaining weight
Disturbed body image
Amenorrhea
Mortality of anorexia
10%
Which is more ego-dystonic - bulimia or anorexia?
Bulimia
Subcategories of bulimia?
Purging and nonpurging
Criteria for the binge eating of bulimia?
Occurs at least twice a week for 3 months
Electrolyte abnormality in bulimia?
Hypochloremic hypokalemic alkalosis
Treatment for anorexia?
Antidepressants for adjunctive treatment - paroxetine or pirtazapine
Dyssomnias, parasomnias
Dysomnias - disturbances in sleep
Parasomnias - abnormal events in behavior or physiology during sleep
Sleep spindles and k-complexes are seen in which type of sleep?
Stage 2 - light sleep
Sawtooth waves are seen in what type of sleep?
REM
Primary insomnia - time criteria?
Disturbance occurs 3+ times per week for at least one month
Zolpidem and zalepon can be used to treat..?
primary insomnia
Cataplexy occurs in...?
Treat with...?
Narcolepsy
Sodium oxalate
Small doses of ..... can be effective for treating night terror disorder?
diazepam
How do dopamine and serotonin affect libido?
Dopamine - enhances
Serotonin - inhibits
Dyspareunia
Genital pain associated with sexual intercourse
Gender identity usually develops by what age?
3
When are the Id, Ego, and Superego formed?
Id - birth
Ego - after birth
Superego - by age 6
Repression vs suppression?
Suppression is a conscious act
Classical conditioning?
Operant conditioning?
Classical - stimulus evokes a conditioned response - Pavlov
Operant - behaviors are learned when followed by positive or negative reinforcement
Linehan developed which type of psychotherapy?
Dialectical behavioral therapy - treatment for borderline, teaches coping skills, solution-focused therapy
True or false? - all antidepressants are considered equally effective in treating MDD
True
TCAs can be used for which other conditions besides depression?
OCD, Enuresis, Migraine headaches, Insomnia
Name the TCAs
Imipramine
Amitriptyline
Trimipramine
Nortriptyline
Despramine
Clomipramine
Doxepin
Which TCA is least likely to cause orthostatic hypotension?
Nortriptyline
Which TCA is the most serotonin specific and can be used in the treatment of OCD?
Clomipramine
Mainstay of treatment for TCA OD?
IV Sodium bicarbonate
side effects of TCAs
anti-HAM, weight gain, lethal OD
Major complications of TCAs
3 Cs
Convulsions, coma, cardiotoxicity
name the MAOIs
phenelzine, tranylcypromine, isocarboxazid
This condition is initially characterized by lethargy, restlessness, confusion, flushing, diaphoresis, tremor, and myoclonic jerks
serotonin syndrome
which SSRI has the longest half life?
fluoxetine
Which SSRI has the highest risk for GI involvement?
sertraline
which SSRI is most serotonin specific and the most activating?
Paroxetine
which SSRI is approved currently only for use in OCD?
fluvoxamine
What is Escitalopram?
Lexapro - SSRI
Give an example of:
SNRI
NDRI
SARI
SNRI - Venlafaxine
NDRI - Bupropion
SARI - Nefazodone, and trazodone
This drug is used to aid in smoking cessation and seasonal affective disorder and ADHD?
Bupropion
Buproprion confers an increased risk of what side effects at high doses?
Seizures and psychosis(due to the dopaminergic effect)
Sedation and priapism are potential side effects of..?
Trazadone
Which drug is useful in the treatment of refractory MDD in patients who need to gain weight?
Mirtazapine
Low potency antipsychotics have a higher incidence of which side effects? Lower?
Higher - anticholinergic and antihistaminic side effects
Lower - EPS and NMS
Name the low potency antipsychotics?
Chlorpromazine
Thioridazine
dopamine inhibits secretion of which chemical messengers?
Prolactin and acetylcholine
Irreversible retinal pigmentation can be caused by...? Deposits in lens and cornea can be caused by...?
Thiroidazine
Chlorpromazine
Seizures are more likely to be caused by which potency antipsychotics?
Low potency
Clozapine side effects?
Agranulocytosis, seizures
Olanzapine side effects?
Hyperlipidemia, glucose intolerance, weight gain, and liver toxicity
onset of action of lithium takes how long?
5 to 7 days
Toxic range of lithium?
> 1.5
important high yield side effects of lithium?
Hypothyroidism and nephrogenic diabetes insipidus
Carbamazepine is useful in treating what types of mood disorders? What neuro condition?
Mixed episodes and rapid-cycling bipolar disorder.
Trigeminal neuralgia
Which medication can cause leukopenia, nyponatremia, aplastic anemia, and agranulocytosis?
Carbamazepine
How do NSAIDs affect Lithium levels? impaired renal function?
NSAIDs - increase
Impaired renal function - increase
What drug can cause hepatotoxicity, thrombocytopenia, and neural tube defects during pregnancy?
Valproic acid
First line anxiolytics?
Benzos
Chlordiazepoxide and diazepam are what types of benzos?
Long acting
Olanzapine side effects?
Hyperlipidemia, glucose intolerance, weight gain, and liver toxicity
onset of action of lithium takes how long?
5 to 7 days
Toxic range of lithium?
> 1.5
important high yield side effects of lithium?
Hypothyroidism and nephrogenic diabetes insipidus
Carbamazepine is useful in treating what types of mood disorders? What neuro condition?
Mixed episodes and rapid-cycling bipolar disorder.
Trigeminal neuralgia
Which medication can cause leukopenia, nyponatremia, aplastic anemia, and agranulocytosis?
Carbamazepine
How do NSAIDs affect Lithium levels? impaired renal function?
NSAIDs - increase
Impaired renal function - increase
What drug can cause hepatotoxicity, thrombocytopenia, and neural tube defects during pregnancy?
Valproic acid
First line anxiolytics?
Benzos
Chlordiazepoxide and diazepam are what types of benzos?
Long acting
HAM side effects can be caused by...?
TCAs and low-potency antipsychotics
Hyperprolactinemia can be caused by...?
High potency traditional antipsychotics
Isoniazid can cause which psychiatric symptom?
Psychosis
Criteria for involuntary admission?
Patient is found by two staff physicians to be potentially harmful or unable to care for self.
Principle of parens patriae
Competence vs capacity?
Competence - legal term decided by a judge
Capacity - clinical term
The most important factor in assessing a patient's risk of violence is....?
History of violence
M'Naghten?
Stringent test of statutory criteria for being declared 'insane'
To successfully argue a case of malpractice, a patient must prove which conditions?
1. there is an established standard of care
2. the physician breached his responsibility to the plaintiff
3. this breach caused injury or damage to the plaintiff
4Ds of malpractice?
Dereliction of a Duty that led Directly to Damages