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252 Cards in this Set
- Front
- Back
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Stanford Binet IQ test
How do you calculate it? mean? st. dev? |
(mental age/chronological age) * 100
mental age = age that averaged to score of the test taker mean = 100 st. dev = 15 |
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What is the diagnosis
a. IQ<70 b. IQ<40 c. IQ < 20 |
a. Mental retardation
b. Severe c. Profound |
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What is the difference between habituation and sensitization to a stimulus?
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habituation = decreased response to repeated stimulation
sensitization = increased response to repeated stimulation |
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What is the process of classical conditioning?
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Pavlov's dog
Natural response (salivation) is elicited by a conditioned/learned stimulus (bell) when presented with an unconditioned stimulus (food) |
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What is operant conditioning?
4 types |
learning in which an action is elicited because it produces an award
positive reinforcement neg. reinforcement punishment extinction |
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operant conditioning
what is positive reinforcement |
desired reward produces action
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operant conditioning
what is negative reinforcement |
desired removal of aversive stimulus elicits behavior
(mouse presses button to avoid shock) |
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operant conditioning
what is punishment |
application of aversive stimulus extinguishes unwanted behavior
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operant conditioning
what is extinction |
discontinuation of reinforcement eliminates behavior
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What is a reinforcement schedule
2 types |
pattern of reinforcement, determines how quickly a behavior is learned or extinguished
continuous --> reward after every response, extinguishes quickly (vending machine) variable ratio --> reward after random responses, extinguishes slowly (slot machine) |
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What is tranference?
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Patient projects feelings of another onto the physician (ex: treat physician like parent)
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Psych -
What is countertransferance? |
Doctor projects feelings about formative or other important persons onto patient
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What is the central goal of Freud's structural theory of the mind
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Make patient aware of his/her unconscious
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Freud
a. what is the Id b. What is the ego c. what is the superego |
a. Primal urges - food, sex, aggression
b. Mediator between Id and socially accepted behavior c. Moral values, conscience, can lead to self-blame and attacks on ego |
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Social learning
Behavior achieved by following reward of closer and closer approximations to desired behavior |
shaping
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Social learning
Behavior acquired from watching others and assimilating |
modeling
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What are ego defenses
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Unconscious mental processes the ego undertakes to resolve conflict and prevent depression/anxiety
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Immature ego defenses
Unacceptable feelings and thoughts are expressed through actions (ex. tantrum) |
Acting out
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Immature ego defenses
Temporary drastic change in personality, memory, consciousness, or motor behavior to avoid emotional distress what can this lead to |
dissociation
can result in dissociative identity disorder (multiple personality disorder) |
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Immature ego defenses
Avoidance of awareness of some painful reality what type of non-psych patients often exhibit this type of behavior |
denial
Newly diagnosed AIDS or Cancer patients |
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Immature ego defenses
Process whereby avoided ideas and feelings are transferred to a neutral person or object ex: mom blames child because she is mad at husband |
displacement (vs. projection)
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Immature ego defenses
Partially remaining at a more childish level of development (men and sports) |
fixation (not regression)
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Immature ego defenses
Modeling behavior after a more powerful person (ex: abused child identifies himself as an abuser) |
identification
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Immature ego defenses
Separation of feelings from ideas and events (describing gruesome murder without emotion) |
isolation of affect
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Immature ego defenses
An unacceptable internal impulse is attributed to an external source ex: man who wants to cheat thinks his wife is cheating on him |
projection
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Immature ego defenses
Process by which a warded off idea or feeing is replaced by an (unconciously derived) emphasis on the opposite ex: guy who thinks about sex joins a monestary |
reaction formation
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Immature ego defenses
Proclaiming logical reasons for actions actually performed for other reasons to avoid self-blame ex: after getting fired, claiming the job was 'not important' |
rationalizaiton
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Immature ego defenses
Turning back the maturational clock and going back to earlier modes of dealing with the world a. how is this seen in kids after a traumatic event b. how is this seen in dialysis patients |
regression
a. kids after trauma --> bedwetting b. adults on dialysis --> crying |
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Immature ego defenses
involuntary withholding of an idea not remembering traumatic event |
repression
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Immature ego defenses
Belief that people are all good or all bad at times due to intolerance of ambiguity (ex: all nurses are cold, all doctors are warm and friendly) what disease is this associated with? |
splitting
borderline personality |
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4 mature ego defenses
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Sublimation, Altruism, Suppression, Humor
MATURE women wear a SASh |
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mature ego defenses
Guilty feelings alleviated by unsolicited generosity towards others |
altruism
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mature ego defenses
Appreciating amusing nature of an anxiety-provoking situation |
humor
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mature ego defenses
Process whereby one replaces an unacceptable wish witha course of action that is similar to the wish but does not conflict with one's value system ex: abused actress uses pain to enhance her acting |
Sublimation
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mature ego defenses
Voluntary withholding of an idea or feeling from conscious awareness |
Suppression
(repression would be involuntary) |
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4 Effects of infant deprivation
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"Wah Wah Wah Wah!"
-Weak = decrease muscle tone, weight loss, physical illness -wordless = poor language skills -wanting = anaclictic depression, poor social skills -wary = lack of basic trust |
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Effects of infant deprivation
What if deprivation lasts > 6 months? What can severe deprivation lead to? |
irreversible changes
severe --> death |
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What is anaclitic depression
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Depression in an infant due to lack of interaction with caregiver
low physical development, perceptual-motor skills low, language skills delayed |
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A child presents with:
-healed fractures on xray -cigarette burns -subdural hematomas -multiple bruises -retinal hemorrhage or detachment what should you be suspicious of? |
Physical child abuse
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Child abuse - physical vs. sexual
who is the usual abuser |
physical = female, primary care giver
sexual = known to victim, male |
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Child comes in with genital/anal trauma, STD, UTIs
what should you be suspicious of? What is the peak age to watch out for this? |
sexual abuse
age 9-12 |
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How many deaths per year can be attributed to physical child abuse
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3000 deaths per year in USA
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Child comes in with:
-poor hygeine -malnutrition -withdrawal -impaired social/emotional development -failure to thrive what shoudl you suspect? what should you do? |
Child neglect = failure to provide food, shelter, supervision, education, affection
report to CPS |
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what is the most common form of child matreatment
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neglect
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When hospitalized, a child who is potty trained starts wetting the bed
what is going on? |
child is regressing to younger patterns of behavior to cope with stressful situation
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Child < 7 yo is having trouble in school, comes in with
-hyperactivity -motor impairment -emotional lability -limited attention span, poor impulse control a. dx? b. pathology? c. course of disease? d. treat? |
a. ADHD
b. decreased frontal lobe volume c. 50% proceed into adulthood form d. Methylphenidate, amphetamines, atomoxetine |
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Patient presents with repetitive and pervasive behavior that violates social norms (physical aggression, destruction of property, theft)
dx? what if patient is over 18 yo? |
conduct disorder
antisocial personality disorder |
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Patient has enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms
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Oppositional defiant disorder
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Patient is < 18 yo, comes in with
-sudden, rapid, recurrent, non-rhythmic stereotyped motor movements or vocalizations dx? associated disorder? one treatment? |
Tourette's Syndrome
Associated with OCD Treat with antipsychotics (haloperidol) |
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Tourette's
a. lifetime prevalnce in general population b. what is coprolalia and how often is it found |
a. 0.1 - 1% in general pop
b. obscene speech, 20% of patients |
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A 7-9 year old comes in with
-overwhelming fear of separation from home or loss of attachment figures -often lies about being sick to avoid going to school dx? |
separation anxiety disorder
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Disorder characterized by
-difficulties with language -failure to acquire or early loss of social skills |
pervasive developmental disorder
autism, asperger's, rhett's, childhood disintegrative disorder |
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Young boy presents with
-severe language impairment -poor social skills -focuses on objects more than people -repetitive behavior, low IQ -sometimes has special abilities dx? treat? |
Autism
Behavioral and supportive therapy to improve communication and social skills |
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A kid's parents bring him in because he has
-problems with social relationships -Repetitive behavior -All-absorbing interests You find a child with normal intelligence, with no verbal or cognitive deficits or language impairment dx? |
Asperger's
milder form of autism |
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Patient is a girl, 1-4 yo, comes in with
-loss of development -mental retardation -loss of verbal abilities -ataxia -stereotyped hand wringing dx? transmission? who is this seen in? |
Rhett's disorder
x-linked seen in girls, often 1-4 yo |
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Child with 2 years normal development comes in with
-loss of expressive or receptive language skills -loss of social skills, adaptive behavior -loss of bowl/bladder control, play, motor skills dx? who does this affect? |
childhood disintegrative disorder
often boys, commonly between 3-4 yo |
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Disease characterized by
-Low GABA, low serotonin -High NE |
Anxiety
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NT changes in disease
Depression what happens to NE, 5-HT, and DA? |
NE, 5-HT, DA all down
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Alzheimer's
what NT is affected? |
Decreased Ach
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Huntington's
affect on GABA, ACh, and DA? |
GABA and ACh down
DA up |
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What is the NT change seen with schizophrenia
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high DA
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Parkinson's
how are DA, 5-HT, and ACh affected? |
DA down
5-HT, ACh up |
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when testing a patient's orientation, what should you find out if they know?
what is the order of deficits seen when someone loses their orientation |
-does patient know who he or she is?
-date/time? -present circumstances? Order of loss: 1. time 2. place 3. person |
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5 conditions that commonly cause loss of orientation
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alcohol/drugs
fluid/electrolyte imbalance head trauma hypoglycemia nutritional deficiencies |
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What is retrograde amnesia
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can't remember things that occurred before a CNS insult
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Patient has inability to remember things that occurred after a CNS insult
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anterograde amnesia
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Korsakoff's amnesia
a. type of amnesia b. cause c. progression d. who is this seen in |
a. anterograde
b. thiamine deficiency c. bilateral destruction of mamillary bodies, can lead to retrograde amnesia d. alcoholics, associated with confabulations |
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Type of amnesia when a person cannot recall important personal info (usually after trauma or stress)
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dissociative amnesia
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Patient has
-waxing and waning level of consciousness with acute onset -rapid decrease in attention span, level of arousal -acute changes in mental status -disorganized thinking -visual hallucinations -illusions -misperceptions -distrurbance in sleep-wake -cognitive dysfunction dx? what are some common causes? |
DeliRIUM (= changes in sensoRIUM)
often secondary to -drugs with anticholinergic effects -CNS disease -infection -trauma -substance abuse/withdrawal |
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most common pyschiatric illness seen on medical/surgical floors
what will you see on EEG |
delirium
abnormal EEG |
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Patient has
-gradual decrease in cognition with no change in consciousness -memory deficits -aphasia -apraxia -agnosia -loss of abstract thought -behavioral/personality changes -impaired judgement -patient is alert, without psychotic symptoms dx? common causes? |
dementia
Alzheimer's Vascular thrombosis Hemorrhage HIV Pick's Disease Substance abuse CJD |
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Commonly implicated in which gradual neuro disease?
Alzheimer's Vascular thrombosis Hemorrhage HIV Pick's Disease Substance abuse CJD |
Dementia
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Elderly person who is depressed may present with dementia-like symptoms
dx? |
pseudodementia
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Delirium vs. dementia
a. onset b. EEG c. reversible? |
Delirium - acute, abnormal EEG, reversible
Dementia - gradual, normal EEG, irreversible |
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What is this called?
Perceptions in the absence of external stimuli (seeing a light that is not actually there) |
hallucination
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What is this called?
Misinterpretation of actual external stimuli (seeing a light and thinking it is the sun) |
illusion
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What is this called?
False beliefs not shared with other members of culture, firmly disputed by proof |
delusions
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what are loose associations
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disorders in the form of thought (the way ideas are tied together)
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Type of hallucination commonly seen in
delirium |
visual
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Type of hallucination commonly seen in
schizophrenia |
auditory
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Type of hallucination commonly seen in
alcohol withdrawal, cocaine abusers |
tactile (sense of ants or bugs on skin)
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Type of hallucination commonly seen in
while going to sleep |
hypnaGOgic while GOing to sleep
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Type of hallucination commonly seen in
while waking up from sleep |
hypnoPOMPic
POMPous as soon as you wake up |
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Schizophrenia
a. increased activity in what NT? b. decrease in what brain structure |
a. increase dopamine
b. decreased dendritic branching |
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Patients who use marijuana as teens are more at risk for what psychiatric disease?
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schizophrenia
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-Delusions
-Hallucinations (auditory often) -Disorganized speech (loose associations) -Disorganized or catatonic behavior -Negative symptoms = flat affect, social withdrawal, lack of motivation, lack of speech or though how many of these do you need to make a diagnosis? lifetime prevalence? |
2/5 to diagnose schizophrenia
1.5% lifetime risk |
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Schizophrenic symptoms for
a. < 1 month b. 1-6 months c. > 6 months |
a. brief psychotic disorder
b. schizophreniform disorder c. schizophrenia |
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Patient has
-at least 2 weeks of stale mood with psychotic sympotms -Major depressive, manic, or mixed episode dx? 2 types? |
schizoaffective disorder
bipolar (manic or mixed) depressive (hypomanic) |
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5 types of schizophrenia
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1. paranoid (delusions)
2. Disorganized (speech, behavior, affect) 3. Catatonic (automatisms) 4. Undifferentiated (elements of all types) 5. Residual |
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patient has delusions and hallucinations for > 6mo.
dx? |
paranoid schizophrenia
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patient has disorganized thought/speech and flat affect for >6mo
dx? |
disorganized schizophrenia
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patient has positive schizophrenic symptoms, but only at low intensity
dx? |
residual schizophrenia
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Genetic vs. environment
which means more in the etiology of schizophrenia |
genetic
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prevalence of schizophrenia
a. males v. females b. blacks v. whites |
males = females
blacks = whites |
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How does the onest of schizophrenia differ in men and women
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men = late teens to early 20s
women = late 20s to early 30s |
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Patient has a fixed, persistent, nonbizarre belief system last > 1 month
-functioning is not impaired dx? course? |
delusional disorder
self-limited |
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Development of delusions in a person in a close relationship with someone in delusion disorder
dx? course? |
Shared psychotic disorder (folie a deux)
resolves upon separation |
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Patient has 2 or more distinct personality states
dx? which gender more commonly? associated with what? |
dissociative identity disorder
women history of sexual abuse |
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Patient has persistent feelings of detachment or estrangement from one's own body, social situations, or the environment
dx? |
depersonalization disorder(dissociative disorder)
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Patient has abrupt change in geography due to natural disaster/war/etc.
now experiences -amnesia about past, personal idenitity -seems to have taken on new identity dx? what must you rule out? course? |
dissociative fugue
must rule out substance abuse or general medical condition can lead to significant distress or impairment |
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-Distractability
-Irresponsibility (seeking pleasure without regard for consequences) -Grandiosity -Flight of ideas -goal directed Activity/psychomotor Agitation -need for Sleep decreased -Talkativeness (pressured speech) How many/what time course to diagnose? |
Need 3 or more of the symptoms for at least 1 week
Maniacs DIG FAST Distractability Irresponsibility Grandiosity Flight of ideas Activities/Agitation Sleep Talkative |
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How is a hypomanic episode different from a manic episode
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Not severe enough to impair social/occupational function or necessitate hospitalization
no psychosis |
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Bipolar I vs. Bipolar II
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I = manic or mixed episode
II = hypomanic episode |
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Bipolar disorder
a. how to treat b. how not to treat |
a. Mood stabilizers (Li, valproic acid, carbamazepine), atypical antipsychotics
b. antidepressants can lead to increased mania |
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Patient has cycles of dysthymia and hypomania for 2 years
dx? |
cyclothymic disorder
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Requirements to diagnose Major Depressive episode
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at least 5 of the SIGECAPS + anhedonia or depressed mood
for at least 2 weeks |
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Major depressive episodes
most last how long? how do they resolve? |
6-12 months
most are self-limited |
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Requirements for a major depressive disorder
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2 or more major depressive episodes with a symptom-free interval of 2 months
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What is dysthymia
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mild depression lasting at least 2 years
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What is the treatment for seasonal affective disorder
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full-spectrum light exposure
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lifetime prevalence of major depressive episode for
a. males b. females |
a. 5-12%
b. 10-25% |
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How is atypical depression different from typical?
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atypical = hypersominia, overeating, super sensitive to getting feelings hurt, mood reactivity (can respond to positive events)
typical = hyposomnia, anorexia, persistent sadness |
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most common subtype of depression
associated with what 2 signs? treat? |
atypical depression
weight gain, sensitivity to rejection MAOI, SSRI |
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Woman has a baby, now has
-depressed affect -tearfulness -fatigue dx? how long should it last? treat? how common is it? |
maternal blues
10 days supportive 50-85% |
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Woman has a baby, now has
-depressed affect -anxiety -poor concentration dx? how long does it last? treat? how common is it? |
Postpartum depression
2 weeks - 2 months antidepressants, psychotherapy 10-15% |
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Woman has a baby, now has
-delusions -confusion -unusual behavior -possibile homicidal/suicidal ideation dx? how long does it last? treat? how common is it? |
Postpartum psychosis
days - 4-6weeks antipsychotics, antidepressants, inpatient hospitalization 0.1-0.2% |
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Electroconvulsive therapy
a. when do you use it? b. what does it cause? c. side effects? |
a. major depression refractory to other treatment
b. painless seizure in anesthetized patient c. disorientation, retro/anterograde amnesia for 6 months |
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10 risk factors for suicide
(mnemonic) |
SAD PERSONS
Sex (male) Age (teen or elderly) Depression Previous attempt Ethanol or drugs Rational thinking Sickness (medical, 3 or more meds) Organized plan No spouse Social support lacking |
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suicide
what gender tries more? what gender completes more? |
women try more
men complete more |
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Patient has 10 minute recurrent periods with at least 4 of the following
-Palpitations, Paresthesias -Abdominal distress -Nausea -Intense fear, lIght headedness -Chest pain, Chills, Choking, disConnectedness -Sweating, Shaking, Shortness of breath treat? |
Panic disorder
Cognitive behavioral therapy SSRI TCA Benzodiazepines |
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Panic disorder
a. is genetics to blame? b. what do people with this disorder fear? |
a. strong genetic component
b. fear having another attack! |
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Treatment for specific phobia
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Systemic desnsitization
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Treatment for social phobia
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SSRIs/BZDs
Cog therapy: Identifying, Challenging, Rationalizing alternatives |
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How does OCD differ from Obsessive compulsive personality disorder?
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OCD = recurring thoughts or sensations (obsessions) relieved by compuslive actions --> ego dystonic (inconsistent with patient's beliefs)
OCPD = obsession with orderliness and perfection, ego-syntonic (patient believes in it) |
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OCD
what other disorder is it associated with? how do you treat? |
Tourette's
SSRIs, clomipramine |
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War flashbacks
diagnosis if it lasts a. 1 month b. 2days-1 month treat? |
a. PTSD
b. acute stress disorder psychotherapy, SSRIs |
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Patient has uncontrollable anxiety for at least 6 months, unrelated to anything specific
-sleep disturbance -fatigue -GI disturbance -difficulty concentrating treat? |
Generalized anxiety
benzodiazepines, buspirone, SSRI |
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Patient has depression/anxiety following identifiable psycosocial stressor, lasting < 6 months
(or > 6 months if chronic stressor) |
adjustment disorder
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Patiently consciously fakes or claims to have disorder to attain a specific gain
what will happen to patient if you try to give them meds? what will happen once they reach their goal? |
malingering
avoid meds complaints cease after gain |
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How is malingering different factitious disorder
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malingering - pretending to be sick for secondary gain
factitious disorder - pretending to be sick to get medical attention |
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patient has a chronic factitious disorder with predominantly physical signs and symptoms
-history of multiple hospital admissions -willingness to receive invasive procedures |
Munchausen's syndrome
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Factitious disorder in which caregiver causes illness in child
a. what is the motivation |
Munchausen's by proxy (form of child abuse)
motivation is to assume a sick role by proxy |
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Category of disorders characterized by physical symptoms with no identifiable physical cause
a. gender assoc. b. what is causing the illness production/motivation? |
Somatoform disorder
unconscious drives, not intentionally feigning |
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Woman comes in with
-variety of complaints in mult organ systems over years at least 4 pain, 2 GI, 1 sexual, 1 pseudoneurologic |
Somatization disorder
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Patient has sudden loss of sensory or motor function (paralysis, blindness, mutism)
following acute stressor patient is aware but indifferent dx? to whom does this occur |
conversion disorder (w/ la belle indifference)
adolescents and young adults |
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patient is preoccupied with having a serious medical illness despite evaluation and reassurance
tx? |
MAOIs
hypochondriasis |
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Patient is preoccupied with minor or imagined defect in appearance --> emotional distress, impaired functioning, cosmetic surgery
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body dysmorphic disorder
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Patient has prolonged pain with no physical findings
-pain is the focus of the clinical presentation dx? what plays a role in the severity, exacerbation, or maintenance of pain |
pain disorder
psychological factors |
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An enduring, repetitive pattern of perceiving, relating to, and thinking about the environment and oneself
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personality trait
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in early adulthood, person develops an inflexible, maladaptive, rigidly pervasive pattern of behavior that causes subjective distress or impaired function
person is unaware of problem |
personality disorder
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3 cluster A personality disorders
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Paranoid, Schizoid, Schizotypal
type A = Accusatory, Aloof, Awkward |
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Type of personality disorders characterized by
-oddness, eccentricity -inability to develop meaningful social relationships -no psychosis what psychaitric condition are these genetically associated with? |
cluster A personality disorders
schizophrenia |
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Patient has pervasive distrust and suspiciousness
projection is a major defense mechanism |
Paranoid (cluster A) personality disorder
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Patient has voluntary social withdrawal, limited emotional expression, content with social isolation
personality disorder? |
schizoid (cluster A)
schizoiD = Distant |
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how is schizoid personality disorder different than avoidant?
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schizoid = content to be isolated
avoidant = not content to be isolated |
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patient has
-eccentric appearance -odd beliefs/magical thinking -interpersonal awkwardness personality disorder? |
shizotypal
schizoTypal = magical Thinking |
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What are the characteristics of cluster B personality disorders?
genetically associated with what? |
Dramatic, emotional/erratic
(B = Bad to the Bone) Mood disorders, substance abuse |
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4 cluster B personality disoders
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antisocial
borderline histrionic narcissistic |
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Personality disorder
Disregard for and violation of rights of others -criminal -conduct disorder if < 18 -often males |
antisocial (cluster B)
antiSOCial = SOCiopath |
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Personality disorder
-unstable mood and interpersonal relationships -impulsiveness -self-mutilation --sense of emptiness -females > males dx? what is a major defense mechanism |
Borderline personality (cluster B)
splitting |
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Personality disorder
-excessive emotionality, excitability -attention seeking -sexually provocative -overly concerned with appearance dx? |
Histrionic personality (cluster B)
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Personality disorder
-grandiosity -sense of entitlement -lacks empathy -requires admiration |
narcissistic (cluster B)
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How do you characterize type C personality disorders
genetic association with what type of disorders |
anxious, fearful
anxiety disorders |
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three types of cluster C personality disorders
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Avoidant, Obsessive Compulsive, Dependent
Cluster C = Cowardly, Compulsive, Clingy |
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Personality disorder
-hypersensitive to rejection -socially inhibited -timid -feeling inadequate different from schizoid? |
avoidant (cluster C)
desires personal relationships (whereas schizoid is content to be isolated) |
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Personality disorder
-preoccupation with order, control, perfectionism -ego syntonic |
Obsessive compulsive personality disorder (cluster C)
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Personality disorder
-Submissive and clingy -excessive need to be take care of -low self confidence |
Dependent (cluster C)
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Schizoid vs. schizotypal vs. schizophrenic vs. schizoaffective
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schizoid < schizotypal < schizophrenic < schizoaffective
schizotypal = schizoid + odd thinking schizophrenic = greater odd thinking than schizotypal schizoaffective = schizophrenic psychotic symptoms + bipolar or depressive mood disorder |
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Schizophrenia symptoms
a. < 1 month b. 1-6 months c. > 6 mo. |
a. brief psychotic disorder, stress related
b. schizophreniform c. schizophrenia |
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Disease with
-excessive dieting, possibly with purging -intense fear of gaining weight -body image disotrtion -high exercise physical exam: -body weight < 85% of ideal -metatarsal stress fractures -amenorrhea -anemia -electrolyte disturbance dx? who is this seen in? coexisting psychological disorders? associated medical conditions? |
anorexia nervosa
adolescent girls coexists with depression decreased bone density |
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Disease characterized by
-binging and purging --> self induced vomiting, laxatives, emetics, diuretics -body wt. maintained to normal range Physical exam: -parotitis -enamel erosion -electrolyte disturbance -alkalosis -dorsal hand callouses from inducing vomiting (Russell's sign) dx? |
bulimia nervosa
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Disorder characterized by persistent discomfort with one's sex --> significant distress and impaired functioning
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Gender identity disorder
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Difference between transexualism and transvestism?
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transsexualism = desire to live as the opposite sex (surgery or hormones)
transvestism = paraphilia, wearing clothes of opposite sex |
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7 maladaptive patterns of substance abuse?
How many and over what time must you exhibit these to be diagnosed with substance dependence? |
1. tolerance
2. withdrawal 3. substance taken in larger amounts than intended 4. persistent desire 5. lots of time and energy on substance 6. social, occupational, recreational activities reduced 7. use despite physical or psychological problems 3 symptoms in last year |
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4 characteristics of substance abuse
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1. failure to fulfill obligations ant work, school, or home
2. use in physically hazardous conditions 3. use despite legal trouble 4. use despite persistent problems caused by use |
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Behavioral, physiologic, and cognitive state caused by cessation or reduction of heavy and prolonged substance abuse
how can you characterize the usual symptoms |
withdrawal
symptoms are usually opposite of those seen in intoxication |
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6 stages of change in overcoming substance addiction
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1. precontemplation - "no problem"
2. contemplation - problem, but unwilling to change 3. prep/determination = getting ready to change 4. action/willpower = change 5. maintenance 6. relapse |
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What is the drug? Withdrawal sympotms?
Intoxication symptoms: -nonspecific--> mood elevation, low anxiety, sedation, behavioral disinibition, respiratory deptression |
depressants
nonspecific --> anxiety, tremor, seizure, insomnia |
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What is the drug? treat?
Intoxication symptoms: -emotional lability -slurred speech -ataxia -blackouts, coma -GGT sensitive -AST = 2x ALT |
alcohol
naltrexone |
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What are the symptoms of
a. mild alcohol withdrawal b. major c. treat? |
a. similar to other depressants
b. delirium tremens c. benzodiazepines |
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Intoxication symptoms - what's the drug and treatment?
-CNS depression -N/V -constipation -pupillary constriction (pinpoint) -seizures |
opioids (morphine, heroin, methadone)
treat: naloxone, naltrexone |
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Withdrawal symptoms:
-sweating -dilated pupils -piloerection -flu-like drug? treat? |
opioids
symptomatic treatment |
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Drug intoxication - what drug and how do you treat
-Marked respiratory depression -has low safety margin |
barbiturates
treat with symptom management (assist respirations, increase BP) |
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Withdrawal symptoms of barbiturates?
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delirium
life threatening CV collapse |
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Barbituarates vs. bezos
safety margin |
Barbs = low safety margin
Benzos = greater safety margin |
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Symptoms of benzodiazepine intoxication
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ataxia, minor respiratory depression
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In general, what happens when you are intoxicated on stimulants?
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mood elevation, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety
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general symptoms of withdrawal from a stimulant
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post-use crash --> depression, lethargy, weight gain, headache
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patient takes amphetamines, now has
-impaired judgment -pupillary dilation -prolonged wakefulness and attention -delusions -hallucinations -fever dx? |
intoxication
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patient was on amphetamines, now has
-stomach cramps -hunger -hypersomnolence dx? |
amphetamine withdrawal
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Patient comes in with
-impaired judgment -pupillary dilation -hallucinations (tactile) -paranoid ideations -angina -sudden cardiac death he's on drugs! dx? how do you treat? |
cocaine intoxication
benzodiazepines |
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patient comes in with
-suicidality -hypersomnolence -malaise -severe psychological craving he's withdrawing from which drug? |
cocaine!
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Symptoms of caffeine intoxication
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-restlessness
-increased diuresis -muscle twitching |
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Symptoms of nicotine intoxication
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restlessness
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person is trying to quit smoking, now has
-Irritability -anxiety -craving how do you treat? |
Nicotine withdrawal
Nicotine patch, gum. lozenge bupropion/varenicline |
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Substance abuse
patient has -belligerence -impulsiveness -fever -psychomotor agitation -vertical and horizontal nystagmus -tachycardia -homicidality -psychosis -delirium drug intoxcation? |
PCP
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Substance abuse
Symptoms of PCP withdrawal |
-depression
-anxiety -irritability -restlessness -anergia -disturbances of thought and sleep |
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Substance abuse
-marked anxiety or depression -delusions -visual hallucinations -FLASHBACKS -pupillary dilation what drug intoxication does he have |
LSD
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Drug intoxication
-euphoria -anxiety -paranoid delusions -perception of slowed time -impaired judgment -social withdrawal -high appetite -dry mouth -hallucinations what drug |
marijuana
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patient has withdrawal symptoms of a drug, including
-irritability -depression -insomnia -nausea -anorexia symptoms peak for 48 hours, last 5-7 days dx? how long can the drug be detected in the urine? |
marijuana withdrawal
detected up to 1 month in urine |
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You see track marks in a junkie's arms - what drug do they take?
what are 6 things they are at an increased risk for having? |
Heroin
-hepatitis -abscess -overdose -hemerroids -AIDS -right sided endocarditis |
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name of a long acting oral opiate used to help people in heroin detox or long term maintenance
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methadone
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What is suboxone
how does it compare with methadone? |
suboxone = naloxone + buprenorphine (partial agonist)
longer acting, fewer withdrawal symptoms (only if injected), lower abuse potential (b/c naloxone is not active if taken orally) |
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Alcoholism - what are the characteristics
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-tolerance
-dependence --> withdrawal symptoms = tremor, tachycardia, HTN, malaise, nausea, delirium tremens |
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complications of alcoholism
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-Cirrhosis
-Hepatitis -Pancreatitis -Peripheral neuropathy -Testicular atrophy |
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Patient has triad of
-confusion -ophthalmoplegia -ataxia progresses to -irreversible memory loss -confabulation -personality change dx? caused by? associated with what conditions? treat? |
Wenicke-Korsakoff syndrome (seen in alcoholism)
Thiamine deficiency periventricular hemorrhage/necrosis of mammillary bodies IV vitamin B1 (thiamine) |
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Alcoholic patient presents with
-hematemesis -pain on imaging, you see longitudinal lacerations at the gastroesophageal junction, which you suspect are because of excessive vomiting dx? treat? |
Mallory-Weiss Syndrome
disulfuram (to prevent patient from abusing alcohol), supportive care (like AA) |
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how does the hematemesis from mallory weiss syndrome compare to that from esophageal varices?
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mallory weiss = caused by excessive vomiting, associated with pain
varices = dilated veins, no pain |
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Patient quit drinking 2-5 days ago, now presents with
-tachycardia, tremors, anxiety, seizures -hallucinations, delusions -confusion dx? treat? |
Delirium tremens
benzodiazepines |
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Treatment for psychiatric conditions
alcohol withdrawal |
benzodiazepines
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Treatment for psychiatric conditions
Anorexia/bulimia |
SSRI
|
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Treatment for psychiatric conditions
Anxiety |
Benzodizepines
Buspirone SSRI |
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Treatment for psychiatric conditions
ADHD |
Methylphenidate (ritalin)
Amphetamines (Dexedrine) |
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Treatment for psychiatric conditions
Atypical depression |
MAOI
SSRI |
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Treatment for psychiatric conditions
Bipolar |
Li, Valproic acid, Carbamazepine
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Treatment for psychiatric conditions
Depression |
SSRI, SNRI, TCAs
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Treatment for psychiatric conditions
Panic disorder |
SSRIs
TCAs Benzodiazepines |
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Treatment for psychiatric conditions
PTSD |
SSRIs
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Treatment for psychiatric conditions
Schizophrenia |
Antipsychotics
|
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Treatment for psychiatric conditions
Tourette's |
Halopeidol (antipsychotic)
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Treatment for psychiatric conditions
Social phobia |
SSRI
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3 CNS stimulants used for ADHD, narcolepsy, appetite control
MOA? |
Methylphenidate, dextroamphetamine, mixed amphetamine salts
increase catecholamines at the synaptic cleft, especially NE and dopamine |
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Halperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine
class of drugs? mechanism? |
typical antipsychotics
block D2 receptors (increases cAMP) |
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Schizophrenia (pos. symptoms), psychosis, mania, tourette's
what class of drugs should you use? 3 high potency variants and what are their side effects? 2 low potency variants and what are their side effects? |
typical antipsychotics
high potency: haloperidol, trifluoperazine, fluphenazine --> EPS symptoms low potency: chlorpromazine, thioridazine --> anticholinergic, antihistaminergic, a-blockers |
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What is a typical antipsychotic that causes
a. corneal deposits b. retinal deposits |
a. Chlorpromazine --> Corneal
b. Thioridazine --> reTinal |
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Typical antipsychotics
how fast are they absorbed and removed from body |
highly lipid soluble and stored in body fat --> slow to be removed from body
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Typical antipsychotics
3 side effects |
1. EPS
2. Endocrine (dopamine receptor antagonism --> hyper PRL --> galactorrhea) 3. anticholinergic, antiadrenergic, antihistaminergic |
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Typical antipsychotics
2 toxicities |
Neuroleptic malignant syndrome
Tardive dyskinesia |
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Patient has schizophrenia, takes perphenazine. Soon develops
-Fever -Encephalopathy - delirium, lethargy -Vitals unstable - unstable BP -Elevated enzymes - CPK -Rigidity of muscles dx? how do you treat? |
neuroleptic malignant syndrome
Symptoms = "FEVER" treat: dantrolene (muscle relaxant), bromocriptine (dopamine agonist) |
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Patient taking typical antipsychotic for a LONG time gets
-oral-facial movements that are off-putting to others what is going on? can you help this person? |
Tardive dyskinesia
irreversible |
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Typical antipsychotics
How do EPS side effects evolve over the course of a. 4 hours b. 4 days c. 4 weeks d. 4 months |
a. acute dystonia (muscle spasm, stiffness, oculogyric crisis)
b. akinesia (parkinson's symptoms = tremor, rigidity, slowness, postural instab) c. akathisia (restlessness) d. tardive dyskinesia |
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OLANzapine, CLOZapine, QUETIapine, RISPERidone, Aripiprazole, Ziprasadone
type of drugs |
Atypcial antipsychotics
it's ATYPICAL for Old Closets to Quietly Risper from A to Z |
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Atypical antipsychotics
MOA what is their clinical use |
blocks 5-HT2, Dopamine, alpha, and H1 receptors
positive and negative schizophrenia symptoms |
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Atypical antipsychotics
drug to treat schizophrenia, OCD, anxiety disorder, depression, mania, Tourette's |
Olanzapine
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Atypical antipsychotics
a. how are they different from typical antipsychotics b. which 2 cause significant weight gain c. which causes agranulocytosis and what should you do when giving this drug |
fewer EPS and anticholinergic side effects
b. olanzapine and clozapine c. clozapine - watch CLOZely (weekly WBC monitoring) |
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Mood stabilizer used for bipolar disoder, that also blocks relapse and acute manic events, SIADH
MOA |
Lithium
Not established, possibly related to PIP cascade inhibition |
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LIthium toxicity symptoms
(4) |
LMNOP
Lithium toxicity = -Movement (tremor) -Nephrogenic DI -hypOthyroidism -Pregnancy problems (teratogen) |
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2 fetal cardiac defects from Lithium use in a pregnant person
|
1. Ebstein anomaly = opening of tricuspid valve is displaced toward apex of RV
2. malformation of great vessels |
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If giving Lithium treatment for bioplar disorder, how closely should you monitor the serum levels?
how is the drug excreted? Where is it mostly reabsorbed? |
Watch closely because it has a narrow therapeutic window
Excreted by kidneys Reabsorbed by proximal convoluted tubules following Na (can be reabsorbed if sweating--> volume depletion, diuretics, NSAIDS) |
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Drug that is used for generalized anxiety disorder
this drug does not interact with alcohol, does not cause sedation, addiction, or tolerance MOA? |
Buspirone
Stimulates 5-HT1A receptors "I'm always anxious for the BUS to be ON time, so I take BUSpirON" |
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Antidepressants
that block NE reuptake |
TCAs
SNRI Maprotiline |
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Antidepressants
that block 5-HT reuptake (3) |
SSRIs
TCAs Trazadone |
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|
Antidepressants
block a2 receptors on Noradrenergic neurons |
Mirtazapine (TCA)
|
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|
Class of drugs
-imipramine -amitriptyline -despiramine -nortriptyline -clomipramine -doxepin -amoxapine MOA? |
TCAs
blocks reuptake of NE and 5-HT |
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3 side effects of TCAs
|
1. sedation
2. anti-adrenergic 3. anticholinergic |
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how do secondary and tertiary TCAs compare
|
secondary = less anticholinergic effects - nortriptyline, desipramine
tertiary = more anticholinergic effects --> amitryptiline, imipramine |
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TCA with the least sedating and lowest seizure threshold
|
despiramine
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toxicity of TCAs
how about in elderly how do you treat |
TriC's = Convulsions, Coma, Cardiotoxicity (arrhythmias)
+ respiratory depression, hyperpyrexia in elderly: confusion and hallucinations (anticholinergic) treat: NaHCO3 for cardiotoxicity |
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Fluoxetine, Paroxetine, Sertraline, Citalopram
type of drugs? MOA? |
SSRI - prevent serotonin reuptake
|
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Drugs used for Depression, OCD, bulimia, social phobias
Side effects? |
SSRIs
fewer than TCAs; GI distress, sexual dysfunction |
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|
Patient took MAOI with SSRI, now has
-hyperthermia -muscle rigidity -CV collapse -flushing -diarrhea -seizures how do you treat? |
Serotonin syndrome
cyproheptadine = 5-HT2 receptor antagonist |
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Patient with OCD is given SSRIs. How long should they wait beore the drug takes effect
|
drug takes 2-4 weeks to have an effect
|
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Venlafaxine, Duloxetine
type of drug? MOA? |
SNRI
inhibit reuptake of serotonin, NE (Duloxetine has bigger effect on NE) |
|
|
SNRIs used for...?
Venlafaxone especially good for...? Duloxetine especially good for...? |
Depression
Generalized anxiety disorder, chronic pain Diabetic peripheral neuropathy |
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Negative effects of SNRIs
|
Duloxetine, Venlafaxone
high BP, stimulant effects, sedation, nausea |
|
|
Phenelzine, tranylcypromine, isocarboxazid, selegiline
type of drug? MOA? |
MAOI
non-selective MAO inhibition --> increases levels of amine NTs (NE, 5-HT, DA) (selegeline is an MAO-B specific inhibitor) |
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|
Drug to treat
-atypical depression -anxiety -hypochondriasis toxicity effects? Don't take these with what other types of drugs |
MAOI
-hypertensive crisis with Tyramine and beta-agonists -CNS stimulation Don't take with SSRIs or meperidine (could cause serotonin syndrome) |
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|
4 atypical antidepressants
|
Bupropion
Mirtazapine Maprotiline Trazadone |
|
|
Antidepressant used for smoking cessation as well
MOA? Toxicity? |
Bupropion
increases NE and DA (unknown mechanism) Tox: stimulant (tachycardia, insomnia), headache, seizure in bulimics No sexual side effects |
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Atypical antidepressant
MOA of mirtazapine toxicity |
a2 antag --> increases NE and 5-HT release, blocks 5HT2 and 3
Tox: sedation, appetite high, wt. gain, dry mouth |
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Atypical antidepressants
maprotiline MOA? tox? |
blocks NE reuptake
tox: sedation, orthostatic hypotension |
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|
Atypical antidepressants
Drug used for insomnia MOA? tox? |
Trazadone
inhibits serotonin reuptake tox: sedation, nausea, priapism postural hypotension (trazaBONE) |
