Psych- First Aid for the Wards – Flashcards
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TCA MOA
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Block reuptake of norepinephrine and 5-HT
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TCA uses
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Depression, bed-wetting, OCD, chronic pain
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TCA side efx
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Anticholinergic, sedation, orthostatics, arrhythmias, seizures, resp depression, confusion, hallucinations
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TCAs toxicity
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Tri-C's: Convulsions, Coma, Cardiotoxicity (arrhythmias); resp depression, hyperpyrexia Nortriptyline in elderly
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MAOI drugs
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phenelzine, tranylcypromine, isocarboxazid
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MAOI clinical
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Atypical depression, anxiety, hypochondriacs
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MAOI side efx
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hypertensive crisis, headache, dizziness, insomnia, othostatic hypotension, weight gain
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Treat TCA overdose
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sodium bicarbonate
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Signs and symptoms of mania
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DIG FAAST, Distractibility, Insomnia, Grandiosity, Flight of ideas, Activity, Agitation, pressured Speech, Thoughtlessness
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Personality disorder criteria
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CAPRI- Cognition, Affect, Personal Relations, Impulse Control
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Personality Disorder Clusters
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A:schizoid, schizotypal, paranoid/ B: antisocial, borderline, histrionic, narcissistic/ C:avoidant, dependent, ocd
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Paranoid Personality Disorder
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At least 4 of: (1) suspects exploiting, harming, or deceiving (2) doubts about the loyalty or trustworthiness (3) reluctant to confide in others (4) reads hidden demeaning or threatening meanings into benign remarks or events (5) bears grudges (6) perceives attacks on his or her character, quick to react angrily or to counterattack (7) has recurrent suspicions of fidelity of spouse or sexual partner
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Schizoid personality disorder
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four: (1) neither desires nor enjoys close relationships/ family (2) chooses solitary activities (3) has little interest in sex (4) takes pleasure in few activities (5) lacks close friends or confidants (6) appears indifferent to the praise or criticism of others (7) shows emotional coldness, detachment, or flattened affectivity
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Schizotypal personality disorder
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five: 1) ideas of reference 2) odd beliefs or magical thinking 3) unusual perceptual experiences 4) odd thinking and speech 5) paranoid ideation 6) inappropriate or constricted affect 7) behavior or appearance that is odd, eccentric, or peculiar 8) lack of close friends 9) excessive social anxiety assoc w/ paranoid fears
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Antisocial personality disorder
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three: 1) failure to conform to lawful behaviors 2) repeated lying, use of aliases, or conning others for personal profit or pleasure 3) impulsivity or failure to plan ahead 4) irritability and aggressiveness, repeated physical fights 5) reckless disregard for safety of self 6) consistent irresponsibility 7) lack of remorse
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Borderline personality disorder
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five: 1) efforts to avoid real or imagined abandonment 2) unstable and intense interpersonal relationships alternating extremes 3) identity disturbance: markedly and persistently unstable self-image or sense of self 4) impulsivity in two self-damaging areas 5) recurrent suicidal behavior, gestures, or threats 6) affective instability, reactivity of mood 7) chronic feelings of emptiness 8) inappropriate, intense anger or difficulty controlling anger 9) transient, stress-related paranoid ideation or severe dissociative sx
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Histrionic personality disorder
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five: 1) is uncomfortable when not the center of attention 2) sexually seductive or provocative behavior 3) shifting and shallow expression of emotions 4) uses physical appearance to draw attention 5) speech is impressionistic and lacking in detail 6) self-dramatization, theatricality, and exaggerated expression of emotion 7) suggestible, easily influenced by others 8) considers relationships to be more intimate than they are
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Narcissistic personality disorder
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five: 1) grandiose sense of self-importance 2) fantasies of unlimited success, power, brilliance, beauty, or ideal love 3) believes he's "special" and unique and can only be understood by other special people 4) requires excessive admiration 5) has a sense of entitlement 6) is interpersonally exploitative, i.e., takes advantage of others 7) lacks empathy 8) often envious or believes others are envious 9) arrogant, haughty
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Avoidant personality disorder
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four: 1) avoids occupations that involve interpersonal contact, because of fears of criticism, disapproval, or rejection 2) unwilling to get involved with people unless certain of being liked 3) restraint in intimate relationships, fear of being shamed or ridiculed 4) preoccupied with being criticized or rejected socially 5) is inhibited in new interpersonal situations, inadequacy 6) views self as socially inept, personally unappealing, or inferior 7) reluctant to take personal risks or to engage in any new activities, may prove embarrassing
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Dependent personality disorder
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five: 1) difficulty making everyday decisions 2) needs others to assume responsibility for most major areas of his or her life 3) difficulty expressing disagreement with others, fear of loss of support or approval 4) difficulty initiating projects or doing things on his or her own 5) excessive lengths to obtain nurturance and support from others, do things that are unpleasant 6) uncomfortable or helpless when alone 7) seeks another relationship for care and support when relationship ends 8) unrealistically preoccupied with fears of being left to take care of himself
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Obsessive-compulsive personality disorder
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four: 1) preoccupied with details, rules, lists, order, organization, or schedules 2) perfectionism that interferes with task completion 3) devoted to work and productivity to the exclusion of leisure activities and friendships 4) overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values 5) unable to discard worn-out or worthless objects 6) is reluctant to delegate tasks or to work with others unless they submit to her way 7) adopts a miserly spending style toward both self and others; money is hoarded 8) shows rigidity and stubbornness
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Substance abuse
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1) failure to fulfill major role obligations at work, school, or home 2) Recurrent substance use in situations in which it is physically hazardous 3)Recurrent substance-related legal problems 4) Continued substance use despite having persistent or recurrent social or interpersonal problems
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Substance dependence
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1) Tolerance 2) Withdrawal 3) substance taken in larger amounts 4)There is a persistent desire or unsuccessful efforts to cut down or control substance use 5) A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover 6)Important social, occupational, or recreational activities are given up or reduced because 7) The substance use is continued despite knowledge of having a persistent physical or psychological problem
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Alcohol MOA
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Activates GABA and serotonin receptors in the CNS. Inhibits glutamate receptors.
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Alcohol metabolism
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Alcohol> acetaladehyde> acetic acid alcohol dehydrogenase, aldehyde dehydrogenase
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Def conversion disorder
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A change or loss of physical function. Recent psychologic stressor or conflict. Unconsciously produces the symptom. Cannot be explained by organic etiology. Not limited to pain or sexual dysfunction.
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Alcohol withdrawal
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autonomic hyperactivity, hallucinations, and fluctuating activity levels, ranging from acute agitation to lethargy chlordiazepoxide PO or lorazepam IV or IM
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olfactory and other unusual types of hallucinations, derealization episodes, mood lability, irritability, intermittent anger, and behavioral dyscontrol
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Tumors of the temporal lobe
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Avoidant personality disorder
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intense need for connection and social interaction with others, coupled with an intense fear of rejection
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good prognosis in schizophrenia
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late onset of the disease, obvious precipitating factors/stressors, acute onset, good premorbid functioning, the presence of mood disorder symptoms, the patient being married, a family history of mood disorders, good support systems, and the presence of positive symptoms
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Dx Schizophrenia
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Two for 6 mo: 1) Delusions 2) hallucinations 3) Disorganized speech 4) Disorganized/ catatonic behavior 5) Negative sx
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Negative sx schizophrenia
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5 A's Anhedonia, Affect (flat), Alogia, Avolition (apathy), Attention (poor)
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Subtypes of schizophrenia
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paranoid, disorganized, catatonic, undifferentiated, residual
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Dopamine pathways affected in schizophrenia
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Prefrontal cortex (neg sx), Mesolimbic (pos sx)
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Dopamine pathways affected by neuroleptics
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Tuberoinfundibular: hyperprolactinemia-> gynecomastia, galactorrhea Nigrostriatal: extrapyramidal side efx
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Schizoaffective disorder dx
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Criteria for schizophrenia and MDD, manic, mixed Delusions or hallucinations for 2 wks w/o mood disorder
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Delusional disorder dx
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1. Non bizarre fixed delusions 1mo, 2. Not meet criteria for schizophrenia, 3. Function not significantly impaired
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Koro
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Patient believe penis is shrinking and will disappear causing his death
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Amok
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Sudden unprovoked outbursts of violence which person has no recognition
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Brain fas
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Headache, fatigue, visual disturbances in males
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Major depressive episode dx
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Five in 2 wks: 1. Depressed mood, 2. Anhedonia, 3. Change in appetite, 4. Feelings of worthless ness, 5. Insomnia or hypersomnia, 6. Diminished concentration, 7. Psychomotor change, 8. Fatigue or loss of energy, 9. Recurrent thoughts of death or suicide
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Manic episode dx
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1. Distractible, 2. Grandiosity, 3. Inc goal activity, 4. Dec sleep, 5. Flight of ideas, 6. pressured speech, 7. Involved in activities with high risk
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Mixed episode dx
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Criteria met for both manic and depressed, >1 wk
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Hypomanic
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elevated, expansive, irritable mood, no impaired function, >4 days, no psychotic features
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Major depressive disorder (MDD)
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At least one MD episode, No hx of mania or hypomania
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Sleep problems assoc w/ depression
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difficulty falling asleep, early morning awakening
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stages of grief
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Denial, Anger, Bargaining, Depression, Acceptance
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Rapid cycling
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4 or more mood episodes in 1 year
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Types of depressive disorders
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Melancholic, Atypical, Catatonic, Psychotic
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Psychoanalysis not indicated for:
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ppl who have problems with reality testing, psychotic patients, severe cluster A or B personality disorders
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Mature defenses
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altruism, humor, sublimation, suppression
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Sublimation
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Satisfying socially objectionable impulses in an acceptable manner
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Neurotic defenses
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Controlling, Displacement, Intellectualization, Isolation of affect, Rationalization, Reaction formation, Repression In OCD, hysterical, adults under stress
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Immature defenses
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Acting out, Denial, Regression, Projection In children, adolescents, pscyhotics
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Psychoanalysis is used in
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Cluster C pd, Anxiety disorders, OCD, problems coping, Anorexia, Sexual disorders, Dysthymic disorder
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Psychoanalytically oriented psychotherapy and brief dynamic psychotherapy
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Similar to psychoanalysis, but briefer weekly for 6m-1.5y, face to face sessions
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Focuses on development of social skills to help treat certain psychiatric disorders
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Interpersonal therapy - once weekly for 3-6m, improve interpersonal relations
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Help patient feel safe during a difficult time
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Supportive psychotherapy, healthy individuals in a crisis, focus on empathy, understanding and education
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Helping patients change behaviors that contribute to their symptoms
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Behavioral therapy
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Classical conditioning
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Pavlov's dog
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Operant conditioning
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positive or negative reward
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Patient performs relaxation techniques while being exposed to anxiety provoking stimulus
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Systemic desensitization (behavioral conditioning) - phobias
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Patient is confronted with anxiety stimulus and not allowed to withdraw
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Flooding and implosion (behavioral conditioning) - phobias
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Negative stimulus paired with specific behavior
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Aversion therapy (behavioral conditioning) - used to treat addictions or paraphilias
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Rewards are given after specific behaviors to positively reinforce
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Token economy (behavioral conditioning) - used for ADLs in disorganized or mentally retarded individuals
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Physiological data given to patients as they try to ctrl physiological states
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Biofeedback (behavioral conditioning)- migraines, HTN, chronic pain, asthma, incontinence, agoraphobia,
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Seeks to correct faulty assumptions and neg feelings
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Cognitive therapy- patient taught to identify maladaptive thoughts - depressive and anxiety disorders, paranoid pd, OCD, somatoform, eating disorders
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Focuses on a patients sx by examing the connection btw thoughts and behaviors
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CBT- protocol or manual with homework depression, anxiety, substance abuse
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TCA overdose
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IV sodium bicarbonate
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major complications of TCAs
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3Cs- Cardiotoxicity, Convulsions, Coma
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MAOIs more effective in
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atypical depression, hypersomnia, Inc appetite and Inc sensitivity to interpersonal rejection
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Common side effects of TCAs
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Dry mouth, retention, fatigue, blurry vision (anticholinergic)
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What to monitor when prescribing lithium
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lithium, creatinine, thyroid levels
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Clozipine monitoring
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WBC ct - agranulocytosis
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Chlorpromazine side efx
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Orthostatics, bluish skin, photosensitivity (typical antipsychotic)
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Thioridazine assoc w/
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retinitis pigmentosa (typical antipsychotic)
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Treat extrapyramidal side efx
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Reduce dose of antipsychotic, anticholinergic (Benztropine), antihistaminergic (Diphenhydramine/ Benadryl), antiparkinsonian (Amantadine)
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FDA approved for mania
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quetiapine, olanzapine, aripiprazole, risperidone, ziprasidone
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Benzos not metabolized by liver
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(LOT of them) Lorazepam, Oxazepam, Temazepam
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Benzo overdose
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flumazenil, but inducing w/d quickly can lead to death
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lesion to the right prefrontal area
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laughter, euphoria, and a tendency to joke and make puns
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lesion to the left prefrontal area
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abolishes the normal mood-elevating influences of this area and produces depression and uncontrollable crying
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Supportive psychotherapy
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close alliance, define current problems, solutions, shore up ego adjustment disorders, acute emotional crisis, chronic schizophrenia
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Insight-oriented psychotherapy
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recognize transference/ countertransference, uncover unconscious wishes and defenses Anxiety, Depression, Somatoform, Dissociative, Personality, Neuroses, Trauma
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Cognitive therapy
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Major depression, turn automatic thoughts into diff behavior
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deficiencies of planning, monitoring, flexibility, and motivation, lesion
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Lesions in the dorsolateral area
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Increases after nonepileptic seizures
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prolactin
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peak withdrawal heroin
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48 hrs, starts 8-12
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Peak withdrawal methadone
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3-8th day, starts 1-3 days
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Partial complex seizures originate
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usually (90% of the time) originate in the temporal lobe.
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Auras that consist of unpleasant odors often originate in the
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uncus, an area at the tip of the temporal lobe that is involved in processing olfactory sensations
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Neurotransmitter associated with alzheimers
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Acetylcholine
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Dysfunction of the orbitofrontal area causes
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disinhibition, irritability, lability, euphoria, and lack of remorse. Insight and judgment are impaired; patients are distractible
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