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255 Cards in this Set

  • Front
  • Back

classical conditioning =

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)

features of classical conditioning:

(2)

1. ~~stimulus

2. **involuntary**

operant conditioning =

learning in which a particular action is elicited b/c it produces a punishment or reward

features of operant conditioning:

(2)

1. ~~reward

2. **voluntary**

terms wrt operant conditioning:

1. positive reinforcement

2. negative reinforcement

3. punishment

4. extinction

negative reinforcement =

**removal** of aversive stimulus
(e.g. loud noise) by performing the target behavior (press the button)

punishment =

repeated administration of aversive stimulus extinguishes unwanted behavior

extinction =

discontinuation of reinforcement (pos OR neg), which eventually eliminates behavior

(can occur in EITHER operant OR classical conditioning)

transference =

pt projects feelings about formative or other important figure onto physician

e.g. pt's dad was confident, so the doctor must be confident

counter-transference =

doctor projects feelings about formative or otherwise important person (e.g. son) onto pt

e.g. pt reminds doctor of her son

ego defenses = defense mechanisms =

unconscious mental processes used to resolve conflict and prevent undesirable feelings

mature defense mechanisms:

SASH

Suppression

Altruism

Sublimation

Humor

Suppression =

**intentional** withholding of idea or feeling from conscious awareness

- **the ONLY defense mech. that's conscious**

Sublimation =

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

immature defense mechanisms:

acting out

dissociation

denial

displacement

fixation

identification

isolation of affect

projection

rationalization

reaction formation

regression

repression

splitting

acting out =

expressing unacceptable feelings through misbehavior,

e.g. tantrums

dissociation =

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

fixation =

acting at a more-childish level of development,

e.g. watching the football game when you know you've got responsibilities

identification =

modeling behavior after a more-powerful person (good or bad)

- how abused can become abusers

isolation of affect =

no emotion;

separating feelings from events

projection =

attributing an unacceptable, internal impulse to someone else

e.g. a man who wants another woman believes his wife is cheating on him

rationalization =

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

reaction formation =

replacing a warded-off feeling by emphasis on its opposite

e.g. you hate your kids but you buy them nice clothes

regression =

turning back the maturity and using earlier modes of dealing with the worlds

e.g. sudden bed-wetting in an older child

repression =

involuntary withholding of a feeling from consciousness

- NOT a conscious withholding like suppression

splitting =

categorizing e/t and e/b into either ALL good or ALL bad

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

**the four W's of depriving an infant of affection:**

Weak

Wordless

Wanting (socially)

Wary

deprivation of affection for >6 mths may lead to _________________ changes

irreversible

severe deprivation can result in:

infant death

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.)

3 signs of sexual abuse in children:

1. anal/oral trauma

2. STD's

3. *UTI's*

the child abuser is usually the closest caregiver, and therefore usually:

the mother

the sexual abuser of a child is usually:

(2)

1. known to the child

2. a male

child abuse causes ~__________ deaths per year

3,000

- 80% of those are <3 y.o.

peak incidence of sexual child abuse =

(range)

9-12 y.o.

child neglect =

failure to provide a child with adequate food, shelter, supervision, education, and/or affection

evidence of child neglect:

(5)

1. poor hygiene

2. malnutrition

3. withdrawal

4. impaired social/emotional development

5. failure to thrive

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

treatment of ADHD =

(3)

1. CNS stimulant (Methylphenidate, amphetamines)

2. Atomoxetine (SNRI)

3. behavioral

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

after 18 yo, kids with conduct disorder will be diagnosed with:

Antisocial Personality Disorder

oppositional defiant disorder =

enduring defiance of authority figures WITHOUT serious violations of social norms

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**

treatment for Tourette's =

(2)

1. antipsychotics

2. behavioral

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

treatment of separation anxiety disorder =

(2)

1. SSRI's

2. relaxation/behavioral therapy

pervasive developmental disorders are characterized by:

difficulties with language and failure to acquire/early loss of social skills

2 examples of pervasive developmental disorders:

1. autism spectrum

2. Rett disorder

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

Rett disorder =

X-linked disorder seen almost exclusively in girls (affected males die in utero or soon after)

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

"alert and oriented x3" ~~

(3)

pt's ability to know:

1. who he is

2. where he is

3. date and time

7 common causes of loss of orientation:

1. alcohol

2. drugs

3. fluid/electrolyte imbalance

4. head trauma

5. hypoglycemia

6. inf

7. nutritional deficiencies

order of loss of orientation goes in this order:

first, don't know time/date

then, can't say where you are

last, don't know who you are

retrograde amnesia =

inability to remember things that occurred BEFORE a CNS insult

anterograde amnesia =

NO NEW memory

Korsakoff amnesia =

classic anterograde amnesia caused by thiamine deficiency and the associated destruction of mammillary bodies

3 other features of Korsakoff amnesia:

1. may also include retrograde amnesia

2. seen in alcoholics

3. associated with confabulations (filling in gaps of memory with made-up events)

dissociative amnesia =

inability to recall important personal info, usually subsequent to severe trauma or stress

dissociative amnesia may be accompanied by:

dissociative fugue

(abrupt travel or wandering during the period of dissociative amnesia)

cognitive disorder =

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

cognition disorder includes:

(2)

1. dementia

2. delirium

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

delirium is the m.c. presentation of AMS in:

the inpatient setting

- check for drugs with anticholinergic effects

treatment of delirium =

1. address UC

2. optimize brain conditions with O2, hydration, pain relief, etc.

3. Haloperidol (antipsychotic)

Tolerate, Anticipate, Don't Agitate

features of dementia:

(4

1. *gradual dec. in cognition

2. no change in consciousness (unlike delirium)

3. usually irreversible

4. nl EEG

dementia is characteried by:

(6)

1. **memory deficits

2. aphasia

3. agnosia

4. loss of abstract thought

5. behavior/personality changes

6. impaired judgment

in elderly pts, depression can sometimes look like:

dementia

- called pseudodementia

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)

reversible causes of dementia:

(5)

1. NPH (nl P hydrocephalus)

2. B12 deficiency

3. hypothyroidism

4. neurosyphilis

5. HIV (partially)

a pt with dementia can easily develop:

delirium

psychosis =

a distorted perception of reality

~~ hallucinations,
delusions,
and/or disorganized thinking

- CAN occur in with medical illnesses, not just psychiatric ones

"disorganized speech" ~~

words strung together with loose associations

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)

schizophrenia =

psychosis + disturbed behavior + decline in function

**>6 months**

4 features of schizophrenia:

1. ~~ inc. DOPA activity

2. ~~dec. dendritic branching

3. genetics and environment contribute

4. pts are at increased risk for suicide

frequent cannabis use is associated with:

schizophrenia/psychosis in teens

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)

in men, schizophrenia presents:

late teens, early 20's

- late 20's, early 30's in women

brief psychotic disorder =

psychosis **<1 month**

- usually stress-related (e.g. losing job)

schizophreniform disorder =

schizophrenic symps ***1-6 mths***

schizoaffective disorder =

***at least 2 weeks*** of *stable mood* with psychotic symps,

PLUS a major depressive, manic, or mixed episode

2 subtypes of schizoaffective disorder:

1. bipolar schizoaffective

2. depressive schizoaffective

delusional disorder =

fixed, persistent, untrue belief system lasting

**>1 month**

- functioning otherwise not impaired

e.g. a woman who believes she is married to a celebrity

dissociative identity disorder =

(formerly known as multiple personality disorder )

presence of 2 or more distinct identities or personality states

- more common in women

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

depersonalization/derealization disorder =

persistent feelings of detachment or estrangement from:

1. one's own body, thoughts, perceptions, and actions (depersonalization part)

or

2. one's environment (derealization)

mood disorder =

abnl range of moods or emotional states, with loss of control over them

=> causes impairment of social and occupational functioning

4 common mood disorders:

1. MDD

2. Bipolar Disorder (I and II)

3. dysthymic disorder

4. Cyclothymic disorder

- psychotic features may be present in all save dysthymic disorder

a manic episode has to last for at lesast __________________ in order to be diagnosed as such

1 week

diagnosis of mania requires either hospitalization or:

DIG FAST

Distractibility

Irresponsibility

Grandiosity

Flight of thought

Activity/Agitation

Sleep (decreased)

Talking (pressured speech)


(remember, psychosis can be present)

hypomania =

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

Bipolar Disorder I =

at least 1 manic episode +/- hypomanic or depressive state

Bipolar Disorder II =

hypomanic episode + depressive episode

in the maintenance phase of Bipolar Disorders, the pt's mood and functioning are:

nl

use of antidepressants in a pt with Bipolar may cause:

mania

Cyclothymic disorder =

dysthymia + hypomania

lasting AT LEAST 2 years

dysthymia = persistent depressive disorder =

mild depression, lasting at least 2 years

(MDD WITHOUT serious symps like anhedonia or suicidal ideations)

treatment of Bipolar Disorder =

(2)

1. mood stabilizers

- Li2+, valproate, CBZ

2. atypical antipsychotics

Major Depressive disorder (MDD): depressive episodes usually last:

6 to 12 months

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

6 changes in sleep stages in pts with depression:

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)

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

treatment of atypical depression =

(2)

1. MAOI's

2. SSRI's

what is the m.c. subtype of depression?

atypical depression

postpartum mood disturbances occur within:

4 weeks of delivery

postpartum blues =

depressed affect, tearfulness, and fatigue 2-3 days after delivery,

ending within 10 days

treatment for postpartum blues =

reassurance

- follow up for postpartum depression

postpartum depression =

depressed affect, anxiety, and poor concentration

- **lasts 2 wks to 1 year+**

treatment for postpartum depression =

(2)

1. antidepressants

2. psychotherapy

postpartum psychosis =

delusions/hallucinations, confusion, unusualy behavior, and possible homicidal/suicidal ideations

- usually lasts 4-6 weeks

treatment for postpartum psychosis =

(4)

1. antipsychotics

2. antidepressants

3. possible inpatient hospitalization

4. assessment of child safety

nl bereavement is characterized by:

(5)

1. shock

2. denial

3. guilt

4. somatic symps

5. (s/ts) simple hallucinations

duration of nl bereavement ~~

6-12 months

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

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)

ECT produces a painless:

sez

in an anesthetized pt

adverse effects of ECT include:

(3)

1. disorientation

2. temporary HA

3. partial anterograde/retrograde amnesia that resolves within 6 months

risk factors for completing a suicide:

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

wrt suicide, women:

try more often;

men succeed more often

anxiety disorder =

inappropriate fear or worry that results in social/occupational impairment


**anxiety = **physical manifestation**

4 types/exampes of anxiety disorders:

1. panic disorder

2. GAD

3. phobias

4. OCD

panic disorder = at least 4 of the following:

PANICS L

Palpitations

Paresthesias

Abdominal distress

Nausea

Intense fear of death or loss of control

Chest pain

Chills

Choking

disConnectedness

Sweating

Shaking

SOB

Lightheadedness

panic disorders have a strong:

genetic component

treatment for Panic Disorder =

1. CBT

2. SSRI's

3. Venlafaxine

4. Benzo's

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

people with phobias recognize:

that the fear is excessive

- treated with systemic desensitization

social anxiety disorder = a type of phobia =

exaggerated fear of embarrassment in social situations, e.g. speaking to a crowd

treatment for social anxiety disorder =

SSRI's

GAD =

at least *6 months* of uncontrollable anxiety that is NOT related to anything specific

features of GAD:

1. sleep disturbance

2. fatigue

3. GI issues

4. difficulty concentration

treatment of GAD =

(4)

1. SSRI's

2. SNRI's

3. Buspirone

4. CBT

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)

OCD =

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

treatment of OCD =

(2)

1. SSRI's

2. Clomipramine

Body Dysmorphic disorder =

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

PTSD =

persistent re-experience of previous traumatic event

that lasts **>1 month**

features of PTSD =

(5)

1. nightmares or flashbacks

2. intense fear

3. helplessness

4. horror

5. hypervigilance

treatment for PTSD =

(2)

1. psychotherapy

2. SSRI's

Acute Stress Disorder =

PTSD symps that last *between 3 days and 1 month*

Somatoform disorders =

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

3 examples of a Somatoform Disorder:

1. Somatization disorder

2. Conversion disorder

3. Hypochondriasis

Somatic symp. disorder = Somatization Disorder =

1. variety of complaints

2. spanning multiple organ systems

3. with anxiety about symps

conversion disorder =

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

in conversion disorder, the pt is aware of the neuro loss but is often:

unconcerned

- called la belle indifference

with PD's the pt is usually NOT:

aware of a problem

PD's are split into 3 clusters, A, B and C, which are often characterized as:

Weird,

Wild,

and Worried

Cluster A PD's include:

(3)

1. Paranoid PD

2. Schizoid

3. Schizotypal

Paranoid PD often includes _________________ (defense mechanism)

projection

Schizoid:

(3)

1. voluntary social withdrawal

2. limited emotional expression

3. *content* with social isolation (doesn't want friends)

schizoiD = Distant

Schizotypal:

(4)

1. eccentric appearance

2. odd beliefs

3. magical thinking

4. interpersonal awkwardness

Cluster B PD's =

(4)

1. Histrionic

2. Antisocial

3. Narcissistic

4. Borderline

Histrionic PD:

(4)

1. attn-seeking

2. sexually provocative

3. vain

4. excessively emotional

Antisocial PD

(3)

1. = conduct disorder of adults

2. disregard for morality, social norms

3. ~~setting fires, torturing animals (sociopath)

to be diagnosed with Antisocial PD, you need to be:

(2)

1. >18 y.o.

2, diagnosed with conduct disorder before age 15

Narcissistic PD:

(4)

1. entitlement

2. lack of empathy

3. reacts to criticism with rage

4. demands the best

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

Cluster C PD's include:

(3)

1. Avoidant PD

2. OCPD

3. Dependent PD

Avoidant PD:

(5)

1. hypersensitive to rejection

2. socially inhibited

3. timid

4. feelings of inadequacy

5. **unlike schizoid, desires relationships with others**

OCPD:

(3)

1. perfectionism

2. order

3. ego-syntotic - behaviors are consistent with beliefs

Dependent PD:

(3)

1. submissive and clingy

2. low self-confidence

3. excessive need to be taken care of

Anorexia Nervosa =

excessive dieting +/- purging

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

osteoporosis from anorexia is caused by:

decreased EST over time

Bulimia Nervosa =

binge eating +/- purging

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)

gender dysphoria =

persistent cross-gender identification and discomfort with one's own sex

transexualism =

desire to live as the opposite sex,

often through surgery or hormone treatment

transvestism =

cross-dressing

- NOT gender dysphoria

sexual dysfunction includes:

1. sexual desire disorders

2. sexual arousal disorders (like ED)

3. orgasmic disorders

4. sexual pain disorders

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)

sleep terror =

periods of screaming in the middle of the night

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

narcolepsy = falling straight into REM sleep; caused by:

decreased orexin production in the L hypothalamus

- strong genetic component

narcolepsy is associated with:

1. hypnagogic or hypnopompic hallucinations

2. cataplexy
(loss of all muscle tone following a strong emotional stimulus, e.g. laughter)

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