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255 Cards in this Set
- Front
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classical conditioning =
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learning in which a natural response (saliva) is elicited by a learned (conditioned) stimulus (the bell) that previously was presented with an unconditioned stimulus (food)
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features of classical conditioning:
(2) |
1. ~~stimulus
2. **involuntary** |
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operant conditioning =
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learning in which a particular action is elicited b/c it produces a punishment or reward
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features of operant conditioning:
(2) |
1. ~~reward
2. **voluntary** |
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terms wrt operant conditioning:
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1. positive reinforcement
2. negative reinforcement 3. punishment 4. extinction |
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negative reinforcement =
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**removal** of aversive stimulus
(e.g. loud noise) by performing the target behavior (press the button) |
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punishment =
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repeated administration of aversive stimulus extinguishes unwanted behavior
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extinction =
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discontinuation of reinforcement (pos OR neg), which eventually eliminates behavior
(can occur in EITHER operant OR classical conditioning) |
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transference =
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pt projects feelings about formative or other important figure onto physician
e.g. pt's dad was confident, so the doctor must be confident |
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counter-transference =
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doctor projects feelings about formative or otherwise important person (e.g. son) onto pt
e.g. pt reminds doctor of her son |
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ego defenses = defense mechanisms =
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unconscious mental processes used to resolve conflict and prevent undesirable feelings
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mature defense mechanisms:
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SASH
Suppression Altruism Sublimation Humor |
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Suppression =
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**intentional** withholding of idea or feeling from conscious awareness
- **the ONLY defense mech. that's conscious** |
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Sublimation =
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replacing an unacceptable drive or feeling (e.g. sexual, violent) with a nl/noble one that doesn't conflict with one's value system
e.g. teenager's aggression toward father is redirected to perform well in sports |
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immature defense mechanisms:
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acting out
dissociation denial displacement fixation identification isolation of affect projection rationalization reaction formation regression repression splitting |
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acting out =
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expressing unacceptable feelings through misbehavior,
e.g. tantrums |
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dissociation =
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temporary, drastic change in:
personality memory consciousness or behavior to avoid emotional stress e.g. go out and spend $2,000 when nly you're frugal |
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fixation =
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acting at a more-childish level of development,
e.g. watching the football game when you know you've got responsibilities |
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identification =
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modeling behavior after a more-powerful person (good or bad)
- how abused can become abusers |
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isolation of affect =
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no emotion;
separating feelings from events |
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projection =
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attributing an unacceptable, internal impulse to someone else
e.g. a man who wants another woman believes his wife is cheating on him |
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rationalization =
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purporting rational reasons for actions actually performed for other reasons, usually to avoid self-blame
e.g. after getting fired, saying that the job was bad for you anyway |
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reaction formation =
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replacing a warded-off feeling by emphasis on its opposite
e.g. you hate your kids but you buy them nice clothes |
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regression =
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turning back the maturity and using earlier modes of dealing with the worlds
e.g. sudden bed-wetting in an older child |
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repression =
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involuntary withholding of a feeling from consciousness
- NOT a conscious withholding like suppression |
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splitting =
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categorizing e/t and e/b into either ALL good or ALL bad
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long-term effects of depriving an infant of affection:
(7) |
1. dec. muscle tone
2. poor language skills 3. poor socialization skills 4. lack of basic trust 5. anaclitic depression (infant withdrawn, unresponsive) 6. wt. loss 7. physical illness |
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**the four W's of depriving an infant of affection:**
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Weak
Wordless Wanting (socially) Wary |
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deprivation of affection for >6 mths may lead to _________________ changes
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irreversible
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severe deprivation can result in:
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infant death
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evidence of physical abuse of a child:
(5) |
1. spiral fractures on X-ray
2. burns 3. subdural hematomas 4. retinal hemorrhages/detachment 5. pattern bruises (of belt, etc.) |
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3 signs of sexual abuse in children:
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1. anal/oral trauma
2. STD's 3. *UTI's* |
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the child abuser is usually the closest caregiver, and therefore usually:
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the mother
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the sexual abuser of a child is usually:
(2) |
1. known to the child
2. a male |
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child abuse causes ~__________ deaths per year
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3,000
- 80% of those are <3 y.o. |
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peak incidence of sexual child abuse =
(range) |
9-12 y.o.
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child neglect =
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failure to provide a child with adequate food, shelter, supervision, education, and/or affection
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evidence of child neglect:
(5) |
1. poor hygiene
2. malnutrition 3. withdrawal 4. impaired social/emotional development 5. failure to thrive |
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facets of ADHD:
(7) |
1. onset before 12 y.o.
2. limited attn. span 3. poor impulse control 4. hyperactivity 5. hyperactivity and inattention must be seen at BOTH school AND home 6. nl intelligence, but difficulties in school 7. associated with dec. frontal lobe volume/metabolism |
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treatment of ADHD =
(3) |
1. CNS stimulant (Methylphenidate, amphetamines)
2. Atomoxetine (SNRI) 3. behavioral |
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conduct disorder =
(4 examples) |
behavior that violates others and shows a poor sense of morality
1. physical aggression 2. stealing 3. setting fires 4. torturing animals |
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after 18 yo, kids with conduct disorder will be diagnosed with:
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Antisocial Personality Disorder
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oppositional defiant disorder =
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enduring defiance of authority figures WITHOUT serious violations of social norms
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Tourette's syndrome =
(4) |
1. onset before 18 y.o.
2. motor AND vocal tics for >1 year 3. coprolalia (obscene speech) only found in 10-20% 4. **associated with ADHD, OCD** |
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treatment for Tourette's =
(2) |
1. antipsychotics
2. behavioral |
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separation anxiety disorder =
(3) |
1. onset around 8 years
2. overwhleming fear of separation form home or attachement figure 3. m.c.ly manifests as SCHOOL REFUSAL |
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treatment of separation anxiety disorder =
(2) |
1. SSRI's
2. relaxation/behavioral therapy |
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pervasive developmental disorders are characterized by:
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difficulties with language and failure to acquire/early loss of social skills
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2 examples of pervasive developmental disorders:
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1. autism spectrum
2. Rett disorder |
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autism spectrum disorder:
(7) |
1. poor social interactions
2. communication deficits 3. ritualized behaviors 4. incredibly-specific interests 5. MUST present in early childhood 6. may be accompanied by ID 7. more common in boys |
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Rett disorder =
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X-linked disorder seen almost exclusively in girls (affected males die in utero or soon after)
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symps of Rett disorder:
(6) |
1. start between 1 and 4 y.o.
2. loss of development 3. loss of verbal abilities 4. intellectual disability 5. ataxia 6. stereotyped hand-wringing |
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"alert and oriented x3" ~~
(3) |
pt's ability to know:
1. who he is 2. where he is 3. date and time |
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7 common causes of loss of orientation:
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1. alcohol
2. drugs 3. fluid/electrolyte imbalance 4. head trauma 5. hypoglycemia 6. inf 7. nutritional deficiencies |
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order of loss of orientation goes in this order:
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first, don't know time/date
then, can't say where you are last, don't know who you are |
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retrograde amnesia =
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inability to remember things that occurred BEFORE a CNS insult
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anterograde amnesia =
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NO NEW memory
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Korsakoff amnesia =
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classic anterograde amnesia caused by thiamine deficiency and the associated destruction of mammillary bodies
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3 other features of Korsakoff amnesia:
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1. may also include retrograde amnesia
2. seen in alcoholics 3. associated with confabulations (filling in gaps of memory with made-up events) |
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dissociative amnesia =
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inability to recall important personal info, usually subsequent to severe trauma or stress
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dissociative amnesia may be accompanied by:
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dissociative fugue
(abrupt travel or wandering during the period of dissociative amnesia) |
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cognitive disorder =
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significant change in cognition (memory, attn, language, judgment) from previous level of function.
associated with abnormalities in CNS, a general medical condition, meds, or substance use |
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cognition disorder includes:
(2) |
1. dementia
2. delirium |
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features of delirium:
(5) |
1. waxing and waning lvl of consciousness
2. acute onset 3. hyperactive OR decreased arousal 4. visual hallucinations common 5. cognitive dysfunctions 6. usually secondary to another illness 7. abnl EEG |
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delirium is the m.c. presentation of AMS in:
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the inpatient setting
- check for drugs with anticholinergic effects |
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treatment of delirium =
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1. address UC
2. optimize brain conditions with O2, hydration, pain relief, etc. 3. Haloperidol (antipsychotic) Tolerate, Anticipate, Don't Agitate |
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features of dementia:
(4 |
1. *gradual dec. in cognition
2. no change in consciousness (unlike delirium) 3. usually irreversible 4. nl EEG |
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dementia is characteried by:
(6) |
1. **memory deficits
2. aphasia 3. agnosia 4. loss of abstract thought 5. behavior/personality changes 6. impaired judgment |
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in elderly pts, depression can sometimes look like:
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dementia
- called pseudodementia |
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irreversible causes of dementia =
(7) |
1. Alz
2. LBD 3. Hungtington dz 4. Pick dz 5. cerebral infarcts 6. CJ dz 7. chronic substance abuse (due to neurotoxicity of drugs) |
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reversible causes of dementia:
(5) |
1. NPH (nl P hydrocephalus)
2. B12 deficiency 3. hypothyroidism 4. neurosyphilis 5. HIV (partially) |
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a pt with dementia can easily develop:
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delirium
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psychosis =
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a distorted perception of reality
~~ hallucinations, delusions, and/or disorganized thinking - CAN occur in with medical illnesses, not just psychiatric ones |
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"disorganized speech" ~~
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words strung together with loose associations
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types of hallucinations:
(7 |
1. visual
2. auditory 3. olfactory 4. guastatory (rare) 5. tactile (esp. in alcohol withdrawal) 6. hypnagogic (upon going to sleep) 7. hypnopompic (upon waking) |
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schizophrenia =
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psychosis + disturbed behavior + decline in function
**>6 months** |
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4 features of schizophrenia:
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1. ~~ inc. DOPA activity
2. ~~dec. dendritic branching 3. genetics and environment contribute 4. pts are at increased risk for suicide |
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frequent cannabis use is associated with:
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schizophrenia/psychosis in teens
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diagnosis of shczophrenia requires 2 or more of the following:
(5) |
1. delusions
2. hallucinations 3. disorganized speech 4. disorganized or catatonic behavior 5. negative symps (e.g. flat affect) |
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in men, schizophrenia presents:
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late teens, early 20's
- late 20's, early 30's in women |
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brief psychotic disorder =
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psychosis **<1 month**
- usually stress-related (e.g. losing job) |
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schizophreniform disorder =
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schizophrenic symps ***1-6 mths***
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schizoaffective disorder =
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***at least 2 weeks*** of *stable mood* with psychotic symps,
PLUS a major depressive, manic, or mixed episode |
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2 subtypes of schizoaffective disorder:
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1. bipolar schizoaffective
2. depressive schizoaffective |
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delusional disorder =
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fixed, persistent, untrue belief system lasting
**>1 month** - functioning otherwise not impaired e.g. a woman who believes she is married to a celebrity |
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dissociative identity disorder =
(formerly known as multiple personality disorder ) |
presence of 2 or more distinct identities or personality states
- more common in women |
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dissociative identity disorder is associated with a history of the following:
(6) |
1. sexual abuse
2. PTSD 3. depression 4. substance abuse 5. Borderline PD 6. somatoform conditions |
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depersonalization/derealization disorder =
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persistent feelings of detachment or estrangement from:
1. one's own body, thoughts, perceptions, and actions (depersonalization part) or 2. one's environment (derealization) |
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mood disorder =
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abnl range of moods or emotional states, with loss of control over them
=> causes impairment of social and occupational functioning |
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4 common mood disorders:
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1. MDD
2. Bipolar Disorder (I and II) 3. dysthymic disorder 4. Cyclothymic disorder - psychotic features may be present in all save dysthymic disorder |
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a manic episode has to last for at lesast __________________ in order to be diagnosed as such
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1 week
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diagnosis of mania requires either hospitalization or:
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DIG FAST
Distractibility Irresponsibility Grandiosity Flight of thought Activity/Agitation Sleep (decreased) Talking (pressured speech) (remember, psychosis can be present) |
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hypomania =
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a less-severe mania that DOESN'T cause marked impairment in social and/or occupational functioning and doesn't require hosp.
- NO psychosis - must last at least 4 days to be diagnosed as such |
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Bipolar Disorder I =
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at least 1 manic episode +/- hypomanic or depressive state
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Bipolar Disorder II =
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hypomanic episode + depressive episode
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in the maintenance phase of Bipolar Disorders, the pt's mood and functioning are:
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nl
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use of antidepressants in a pt with Bipolar may cause:
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mania
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Cyclothymic disorder =
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dysthymia + hypomania
lasting AT LEAST 2 years |
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dysthymia = persistent depressive disorder =
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mild depression, lasting at least 2 years
(MDD WITHOUT serious symps like anhedonia or suicidal ideations) |
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treatment of Bipolar Disorder =
(2) |
1. mood stabilizers
- Li2+, valproate, CBZ 2. atypical antipsychotics |
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Major Depressive disorder (MDD): depressive episodes usually last:
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6 to 12 months
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to diagnose MDD, must have 5 of these 9 symps for **2 or more weeks**
- MUST include anhedonia and depressed mood, as well get worse as time progresses |
SAG E CAPS D
Sleep disrupted Anhedonia Guilt Energy loss/fatigue Concentration probs Appetite/wt changes (drop in 5% of BW) Suicidal Ideations Depressed mood |
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6 changes in sleep stages in pts with depression:
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1. dec. slow-wave sleep
2. dec. REM latency 3. inc. REM early in sleep cycle 4. inc. total REM sleep 5. repeated nighttime awakenings 6. early-morning awakening (critical screening question) |
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atypical depression:
(5) |
1. ability to experience (brief) elevations in mood
2. hypersomnia (can't stay awake) 3. wt gain 4. leaden paralysis or arms/legs 5. sensitivity to interpersonal rejection |
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treatment of atypical depression =
(2) |
1. MAOI's
2. SSRI's |
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what is the m.c. subtype of depression?
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atypical depression
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postpartum mood disturbances occur within:
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4 weeks of delivery
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postpartum blues =
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depressed affect, tearfulness, and fatigue 2-3 days after delivery,
ending within 10 days |
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treatment for postpartum blues =
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reassurance
- follow up for postpartum depression |
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postpartum depression =
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depressed affect, anxiety, and poor concentration
- **lasts 2 wks to 1 year+** |
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treatment for postpartum depression =
(2) |
1. antidepressants
2. psychotherapy |
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postpartum psychosis =
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delusions/hallucinations, confusion, unusualy behavior, and possible homicidal/suicidal ideations
- usually lasts 4-6 weeks |
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treatment for postpartum psychosis =
(4) |
1. antipsychotics
2. antidepressants 3. possible inpatient hospitalization 4. assessment of child safety |
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nl bereavement is characterized by:
(5) |
1. shock
2. denial 3. guilt 4. somatic symps 5. (s/ts) simple hallucinations |
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duration of nl bereavement ~~
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6-12 months
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pathologic grief is characterized by:
(4) |
1. excessively intense grief
2. lasts >12 months 3. grief can be delayed or denied 4. s/ts, depressive symps and psychosis |
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ECT = treatment for:
(3) |
1. MDD that is refractory to other treatments
2. *pregnant women* with MDD 3. depression in which immediate response is required (e.g. on the verge of suicide, catatonia) |
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ECT produces a painless:
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sez
in an anesthetized pt |
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adverse effects of ECT include:
(3) |
1. disorientation
2. temporary HA 3. partial anterograde/retrograde amnesia that resolves within 6 months |
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risk factors for completing a suicide:
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SAD PERSONS
Sex (male) Age (teen or elderly) Depression Previous attempt Ethanol or durg use (including 3+ prescriptions) loss of Rational thinking Sickness (medical illness) Organized plan No spouse (divorced, widowed, or single) Socially unsupported |
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wrt suicide, women:
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try more often;
men succeed more often |
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anxiety disorder =
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inappropriate fear or worry that results in social/occupational impairment
**anxiety = **physical manifestation** |
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4 types/exampes of anxiety disorders:
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1. panic disorder
2. GAD 3. phobias 4. OCD |
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panic disorder = at least 4 of the following:
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PANICS L
Palpitations Paresthesias Abdominal distress Nausea Intense fear of death or loss of control Chest pain Chills Choking disConnectedness Sweating Shaking SOB Lightheadedness |
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panic disorders have a strong:
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genetic component
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treatment for Panic Disorder =
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1. CBT
2. SSRI's 3. Venlafaxine 4. Benzo's |
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diagnosis of Panic Disorder requires:
(3) |
1. attack +
2. >1 month of 3. >1 of the following: - persistent concern of additional attacks - worrying about the consequences of the attack - behavioral change related to attacks |
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people with phobias recognize:
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that the fear is excessive
- treated with systemic desensitization |
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social anxiety disorder = a type of phobia =
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exaggerated fear of embarrassment in social situations, e.g. speaking to a crowd
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treatment for social anxiety disorder =
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SSRI's
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GAD =
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at least *6 months* of uncontrollable anxiety that is NOT related to anything specific
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features of GAD:
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1. sleep disturbance
2. fatigue 3. GI issues 4. difficulty concentration |
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treatment of GAD =
(4) |
1. SSRI's
2. SNRI's 3. Buspirone 4. CBT |
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adjustment disorder =
(5) |
1. emotional symps
2. causing impairment 3. following an *identifiable* psychosocial stressor (divorce, loss of job, etc.) 4. that last **<6 months** (5. lasting >6 months if stressor is chronic) |
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OCD =
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recurring, unwanted thoughts that are relieved by a the performance of repetitive actions
- OCD is ego-dystonic; unlike OCPD, the actions are NOT consistent with your values |
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treatment of OCD =
(2) |
1. SSRI's
2. Clomipramine |
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Body Dysmorphic disorder =
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PD that has a preoccupation with a minor or imagined defect in appearance, leading to significant emotional distress or impaired functioning
- pts often seek cosmetic surgery |
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PTSD =
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persistent re-experience of previous traumatic event
that lasts **>1 month** |
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features of PTSD =
(5) |
1. nightmares or flashbacks
2. intense fear 3. helplessness 4. horror 5. hypervigilance |
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treatment for PTSD =
(2) |
1. psychotherapy
2. SSRI's |
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Acute Stress Disorder =
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PTSD symps that last *between 3 days and 1 month*
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Somatoform disorders =
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group of disorders in which a pt's psychological stress manifests as physical symps
- pts are NOT lying about physical symps - more common in women |
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3 examples of a Somatoform Disorder:
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1. Somatization disorder
2. Conversion disorder 3. Hypochondriasis |
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Somatic symp. disorder = Somatization Disorder =
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1. variety of complaints
2. spanning multiple organ systems 3. with anxiety about symps |
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conversion disorder =
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sudden loss of a neuro function (motor OR sensory)
- often following an acute stressor (rejected by a girl) - more common in females, adolescents, and young adults |
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in conversion disorder, the pt is aware of the neuro loss but is often:
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unconcerned
- called la belle indifference |
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with PD's the pt is usually NOT:
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aware of a problem
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PD's are split into 3 clusters, A, B and C, which are often characterized as:
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Weird,
Wild, and Worried |
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Cluster A PD's include:
(3) |
1. Paranoid PD
2. Schizoid 3. Schizotypal |
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Paranoid PD often includes _________________ (defense mechanism)
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projection
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Schizoid:
(3) |
1. voluntary social withdrawal
2. limited emotional expression 3. *content* with social isolation (doesn't want friends) schizoiD = Distant |
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Schizotypal:
(4) |
1. eccentric appearance
2. odd beliefs 3. magical thinking 4. interpersonal awkwardness |
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Cluster B PD's =
(4) |
1. Histrionic
2. Antisocial 3. Narcissistic 4. Borderline |
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Histrionic PD:
(4) |
1. attn-seeking
2. sexually provocative 3. vain 4. excessively emotional |
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Antisocial PD
(3) |
1. = conduct disorder of adults
2. disregard for morality, social norms 3. ~~setting fires, torturing animals (sociopath) |
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to be diagnosed with Antisocial PD, you need to be:
(2) |
1. >18 y.o.
2, diagnosed with conduct disorder before age 15 |
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Narcissistic PD:
(4) |
1. entitlement
2. lack of empathy 3. reacts to criticism with rage 4. demands the best |
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Borderline PD:
(6) |
1. sense of emptiness
2. boredom 3. impulsivity/unstable mood 4. self-mutilation/ suicide attempts 5. female > male 6. major defense mechanism = splitting |
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Cluster C PD's include:
(3) |
1. Avoidant PD
2. OCPD 3. Dependent PD |
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Avoidant PD:
(5) |
1. hypersensitive to rejection
2. socially inhibited 3. timid 4. feelings of inadequacy 5. **unlike schizoid, desires relationships with others** |
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OCPD:
(3) |
1. perfectionism
2. order 3. ego-syntotic - behaviors are consistent with beliefs |
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Dependent PD:
(3) |
1. submissive and clingy
2. low self-confidence 3. excessive need to be taken care of |
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Anorexia Nervosa =
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excessive dieting +/- purging
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|
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features of anorexia nervosa:
(9) |
1. body image distortion
2. hypergymnastia 3. BMI <17 4. dec. bone density 5. amenorrhea 6. lanugo (fine body hair) 7. anemia 8. hypokalemia/arrhythmias 9. depression common |
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osteoporosis from anorexia is caused by:
|
decreased EST over time
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Bulimia Nervosa =
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binge eating +/- purging
|
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features of bulimia Nervosa:
(6) |
1. body wt near nl
2. erosion of enamel 3. parotitis 4. electrolyte disturbances 5. alkalosis 6. Russel's sign (calluses on knuckles, due to inducing vomiting) |
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gender dysphoria =
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persistent cross-gender identification and discomfort with one's own sex
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|
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transexualism =
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desire to live as the opposite sex,
often through surgery or hormone treatment |
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transvestism =
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cross-dressing
- NOT gender dysphoria |
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sexual dysfunction includes:
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1. sexual desire disorders
2. sexual arousal disorders (like ED) 3. orgasmic disorders 4. sexual pain disorders |
|
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differential dx of sexual dysfunction includes:
(3) |
1. drugs
(SSRI's, alcohol, etc.) 2. dz (depression, STD's, etc.) 3. psychological (e.g. performance anxiety) |
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sleep terror =
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periods of screaming in the middle of the night
|
|
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5 features of sleep terror:
|
1. occurs during SLOW-wave sleep (3 and 4)
2. mc. in kids 3. NO memory (since it's not during REM) 4. triggers may include stress, fever, lack of sleep 5. usually self-limiting |
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narcolepsy = falling straight into REM sleep; caused by:
|
decreased orexin production in the L hypothalamus
- strong genetic component |
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narcolepsy is associated with:
|
1. hypnagogic or hypnopompic hallucinations
2. cataplexy (loss of all muscle tone following a strong emotional stimulus, e.g. laughter) |
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treatment of narcolepsy =
(2) |
1. daytime, CNS stimulants
- methylphenidate, amphetamines, Modafinil 2. nighttime, sodium oxybate (GHB) |
|
|
substance use disorder =
(11 facets) |
maladaptive pattern of substance use with 2 or more of the following for at least **1 year**
1. tolerance 2. withdrawal 3. substance taken in large amounts 4. desire to cut down 5. lack of success in cutting down 6. significant energy spent obtaining/using/recovering from substance 7. social/occupational activities reduced b/c of substance use 8. continued use in spite of knowing the problems it causes 9. craving 10. recurrent use in physically dangerous situations 11. failure to fulfill major obligations at work/school/home |
|
|
6 stages of change in overcoming substance addiction:
|
1. precontemplation
(not yet acknowledging that there's a problem) 2. contemplation (acknowledging problem, but not yet ready to change) 3. preparation/determination (getting ready to change behavior) 4. action/willpower (actually changing behaviors) 5. maintenance (maintaining the behavior change) 6. relapse |
|
|
heroin addiction => increased risk for:
(6) |
1. hepatitis
2. abscesses 3. OD 4. hemorrhoids 5. AIDS 6. right-sided endocarditis |
|
|
3 treatments for heroin addiction:
|
1. Methadone
2. Naloxone + Buprenorphine 3. Naltrexone check - thought this was for alcohol addiction only |
|
|
Methadone =
|
long-acting oral opioid
- for heroin detox or long-term maintenance |
|
|
Naloxone =
|
opioid partial agonist
- long-acting with fewer withdrawal symps than Methadone |
|
|
Buprenorphine =
|
mixed opioid agonist-antagonist
|
|
|
5 complications of alcoholism:
|
1. alcoholic cirrhosis
2. hepatitis 3. pancreatitis 4. peripheral neuropathy 5. testicular atrophy |
|
|
treatment of alcoholism =
(3) |
1. Disulfirim
(prevents breakdown of alcohol, causing intense nausea, HA) 2. Naltrexone (mech = 3. support like AA |
|
|
Wernicke-Korsakoff syndrome =
|
triad of confusion, ataxia, and ophthalmoplegia (Wernicke encephalopathy) + memory loss with confabulation (filling in gaps of memory with made-up ones)
|
|
|
W-K syndrome is associated with:
|
periventricular hemorrhage/necrosis of mamillary bodies
|
|
|
Wernicke encephalopahty (and thus W-K syndrome) is caused by:
|
thiamine deficiency (Vit. B1)
- thus treatment = IV B1 |
|
|
Mallory-Weiss syndrome =
|
longitudinal, partial-thickness tear at the gastroesophageal junction,
caused by excessive vomiting |
|
|
2 features of Mallory-Weiss syndrome:
|
1. often presents with hematemesis
2. ~~ PAIN (vs. esophageal varices) |
|
|
Delirium Tremens (DTs) =
|
life-threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink
|
|
|
symps of DTs, in order of appearance:
|
1. autonomic system hyperactivity
(tachy, tremors, anxiety, sez's) 2. psychosis 3. confusion |
|
|
treatment of DTs =
|
Benzo's
|
|
|
mechanism of CNS stimulants like Methylphenidate, Phentermine, amphetamines:
|
increase catecholamines at the synaptic cleft,
esp. DOPA and NOR |
|
|
clinical use of CNS stimulants:
(3) |
1. ADHD
2. narcolepsy 3. appetite control (they dec. appetite) |
|
|
typical antipsychotics = neuroleptics = first-gen antipsychotics:
(5 total) |
1. Haloperidol
2. Fluphenazine 3. Trifluoperazine 4. Chlorpromazine 5. Thioridazine |
|
|
mechanism of firt-gen antipsychotics:
|
all block D2 r's,
thereby increasing [cAMP] |
|
|
indications for first-gen antipsychotics =
|
1. Schizophrenia of primarily-pos. symps
2. psychosis 3. acute mani 4. Tourette's |
|
|
all first-gen antipsychotics are highly lipid soluble, and thus stored in:
|
fat
==> slow to be removed from the body |
|
|
SE's of first-gen antipsychotics:
(5) |
1. endocrine (e.g. hyperprolactinemia => galactorrhea)
2. antiMuscarinic (=> dry mouth, constipation, urinary retention 3. hypotension (blocking a1 r's) 4. antihistamine effects 5. extra-pyramidao syst. SE's (HIGH potency only) |
|
|
3 HIGH-potency neuroleptics:
|
1. Haloperidol
2. Fluphenazine 3. Trifluoperazine - Try to Fly HIGH |
|
|
Extra-pyramidal symps have a progression:
|
4-hour acute dystonia (muscle spasms, stiffness, oculogyric crisis)
4-day akathisia (restlessness) 4-week bradykinesia 4-month tardive dyskinesia |
|
|
treatment for EPSymps =
(2) |
1. Benztropine (anticholinergic)
or 2. Diphenhydramine |
|
|
special SE's of Haloperidol =
(2) |
1. NMS
2. Tardive dyskinesia |
|
|
2 low-potency neuroleptics:
|
4. Chlorpromazine
5. Thioridazine - CHeating THieves are low |
|
|
special SE of Chlorpromazine =
|
Corneal deposits
|
|
|
special SE of Thioridazine =
|
reTinal deposits
|
|
|
SE's of LOW-potency neuroleptics =
|
non-neurologic SE's
1. anticholinergic 2. antihistamine 3. a1-blocking effects (reconcile these side effects with the general ones ones found a few above - do ALL first-gen antipsychotics show anticholinergic SE's, or just the LOW potency ones? see Neuro syllabus) |
|
|
NMS = Neuroleptic Malignant Syndrome =
|
FEVER
Fever Encephalopathy Vitals unstable Enzymes increase Rigidity of muscles |
|
|
treatment for NMS =
(2) |
1. Dantrolene (check mech)
2. D2 agonists like Bromocriptine |
|
|
atypical antipsychotics = second-gen antipsychotics:
(6 total) |
1. Olanzapine
2. Clozapine 3. Quetiapine 4. Risperidone 5. Aripiprazole 6. Ziprasidone - it's atypical for OLd ClOZets to QUIETly Risper from A to Z |
|
|
indications for atypical antipsychotics:
(7) |
1. Schizophrenia (positive and negative symps)
also for: 2. Bipolar Disorder 3. OCD 4. anxiety disorder 5. depression 6. mania 7. Tourette's |
|
|
second-gen antipsychotics have fewer EPS and anticholinergic SE's than first-gen; some special SE's:
|
1. Olanzapine and Clozapine may cause significant wt gain
2. Clozapine may cause agranulocytosis or sez (can't produce granulocytes => constant risk of inf.) 3. Risperidone may increase prolactin (=> lactation, gynecomastia) (=> dec. GnRH, LH, and FSH => menstruation/fertility issues) 4. Ziprasidone may prolong QT interval |
|
|
Clozapine must be:
|
watched closely, due to risk of agranulocytosis
- check WBC's weekly |
|
|
2 indications for Lithium:
|
1. mood stabilizer for Bipolar
(relapse, acute manic events) 2. SIADH |
|
|
SE's of Lithium:
(4) |
1. Tremor
2. Nephrogenic diabetes insipidus 3. Hypothyroidism 4. Pregnancy probs |
|
|
fetal cardiac defects due to Lithium uuse:
(2) |
1. Ebstein anomaly
2. malformation of great vessels |
|
|
narrow therapeutic window of Lithium requires:
|
close monitoring of its serum levels
|
|
|
metabolism of Lithium:
(2) |
1. 100% renal excretion
2. most resorbed at the proximal convoluted tubules following Na+ reabsorption |
|
|
mechanism of Buspirone:
|
stimulator of 5-HT1A r's
|
|
|
indication for Buspirone:
|
GAD
|
|
|
features of Buspirone:
(4) |
1. does NOT cause sedation, addiction, or tolerance
2. takes 1-2 weeks to take effect 3. does NOT interact with alcohol 4. DOES interact with Barbs, Benzo's |
|
|
4 SSRI's:
|
1. Ci-talo-pram
2. Fluoxetine 3. Paroxetine 4. Sertraline - FLashbacks PAralyze SEnior CItizens |
|
|
indications for SSRI's:
(7) |
1. MDD
2. GAD 3. panic disorder 4. OCD 5. Bulimia 6. social phobias 7. PTSD |
|
|
SE's of SSRI's:
|
1. GI distress
2. sexual dysfunction (anorgasmia, dec. libido) 3. SER Syndrome if given with SNRI's, TCA's, MAOI's |
|
|
7 symps of SER Syndrome:
|
1. hyperthermia
2. confusion 3. myoclonus 4. CV collapse 5. flushing 6. diarrhea 7. sez's |
|
|
treatment for SER Syndrome:
|
Cyproheptadine
(5-HT2 r' antagonist) |
|
|
4 meds that cause risk of SER Syndrome:
|
SSRI's
SNRI's TCA's MAOI's |
|
|
2 SNRI's:
|
1. Venlafaxine
2. Duloxetine |
|
|
mechanism of SNRI's:
|
inhibit reuptake of SER and NOR
|
|
|
indications for SNRI's:
|
1. MDD
2. GAD and panic disorders (Venlafaxine) 3. diabetic peripheral neuropathy (Duloxetine) |
|
|
SE's of SNRI's:
(4) |
1. inc. BP
2. stimulant effects 3. sedation 4. nausea |
|
|
TCA's:
(6) |
1. Am-i-trip-tyline
2. Nor-triptyline 3. Imipramine 4. Desipramine 5. Clomipramine 6. Doxepin 7. Amoxapine (tetracyclic classified as TCA) |
|
|
mechanism of Tricyclic Antidepressants (TCA's):
|
block reuptake of SER and NOR
|
|
|
indications for TCA's:
(3) |
1. MDD
2. fibromyalgia 3. OCD (Clomipramine) |
|
|
SE's of TCA's:
( |
1. sedation
2. ortho/postural hypotension (due to a1-blocking) 3. anticholinergic (tachy, dry mouth, etc.) |
|
|
tertiary TCA's like Amitriptyline have more anticholinergic effects than:
|
secondary ones like Nortriptyline
|
|
|
Desipramine is less sedating than other TCA's, but has a higher:
|
sez incidence
|
|
|
OD of TCA's =>
|
1. triple-C's: Convulsions, Coma, Cardiotoxicity (arrhythmias)
2. respiratory depression 3. hyperpyrexia 4. confusion/hallucinations in elderly due to anticholinergic SE's (therefore use Nortriptyline in elderly) |
|
|
treatment for TCA arrhythmias =
|
NaHCO3
|
|
|
MAOI's:
( |
1. Phenelzine
2. Tranylcypromine 3. Isocarboxazid 4. Selegeline (selective for MAOB) |
|
|
MAOI's =>
|
dec . breakdown of SER, NOR, DOPA
=> inc. in all three (all amine NT's) |
|
|
indications for MAOI's:
(3) |
1. atypical depression
2. anxiety 3. hypochondriasis |
|
|
SE's of MAOI's:
|
1. risk of hypertensive crisis with ingestion of tyramine (wine and cheese)
2. CNS stimulation |
|
|
MAOI's are contraindicated with:
(5) |
1. SSRI's/SNRI's
2. TCA's 3. St. John's wort 4. Meperidine 5. Dextromethorphan ~~SER Syndrome |
|
|
3 Atypical Antidepressants:
|
1. Bupropion
2. Mir-ta-zapine 3. Trazodone |
|
|
2 indications for Bupropion:
|
1. MDD
2. smoking cessation |
|
|
mechanism of Bupropion:
|
increases NOR and DOPA
(mech unknown) |
|
|
SE's of Bupropion =
(3) |
1. stimulant effects (tachy/insomnia)
2. HA 3. sez. NO sexual SE's |
|
|
2 mechanisms of Mirtazapine:
|
1. alpha2-antagonist
=> inc. release of NOR and SER 2. potent 5HT2 and 5HT3 r' antagonist |
|
|
4 SE's of Mirtazapine:
|
1. sedation
2. inc. appetite 3. wt gain 4. dry mouth |
|
|
mechanism of Trazodone:
|
blocks 5HT2 and a1-adrenergic r's
|
|
|
indications for Trazodone:
|
insomnia,
since high doses are needed for antidepressant effects |
|
|
SE's of Trazodone:
(4) |
1. sedation
2. nausea 3. postural hypotension 4. priapism |
