question

Symptoms of depression

answer

SIG E CAPS: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor changes, Suicidal ideation

question

Serotonin syndrome

answer

SSRIs and MAOIs spread 5 wks apart fever, myoclonus, mental status change, CV collapse

question

SSRI side efx

answer

Sexual side efx, insomnia, headache, tremor

question

Atypical antidepressants side efx

answer

Sedation, Weight change, Dec seizure threshold (bupropion), Priapism (trazodone)

question

TCA MOA

answer

Block reuptake of norepinephrine and 5-HT

question

TCA uses

answer

Depression, bed-wetting, OCD, chronic pain

question

TCA side efx

answer

Anticholinergic, sedation, orthostatics, arrhythmias, seizures, resp depression, confusion, hallucinations

question

TCAs toxicity

answer

Tri-C's: Convulsions, Coma, Cardiotoxicity (arrhythmias); resp depression, hyperpyrexia Nortriptyline in elderly

question

MAOI drugs

answer

phenelzine, tranylcypromine, isocarboxazid

question

MAOI clinical

answer

Atypical depression, anxiety, hypochondriacs

question

MAOI side efx

answer

hypertensive crisis, headache, dizziness, insomnia, othostatic hypotension, weight gain

question

Treat TCA overdose

answer

sodium bicarbonate

question

Signs and symptoms of mania

answer

DIG FAAST, Distractibility, Insomnia, Grandiosity, Flight of ideas, Activity, Agitation, pressured Speech, Thoughtlessness

question

Personality disorder criteria

answer

CAPRI- Cognition, Affect, Personal Relations, Impulse Control

question

Personality Disorder Clusters

answer

A:schizoid, schizotypal, paranoid/ B: antisocial, borderline, histrionic, narcissistic/ C:avoidant, dependent, ocd

question

Paranoid Personality Disorder

answer

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

question

Schizoid personality disorder

answer

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

question

Schizotypal personality disorder

answer

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

question

Antisocial personality disorder

answer

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

question

Borderline personality disorder

answer

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

question

Histrionic personality disorder

answer

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

question

Narcissistic personality disorder

answer

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

question

Avoidant personality disorder

answer

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

question

Dependent personality disorder

answer

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

question

Obsessive-compulsive personality disorder

answer

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

question

Substance abuse

answer

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

question

Substance dependence

answer

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

question

Alcohol MOA

answer

Activates GABA and serotonin receptors in the CNS. Inhibits glutamate receptors.

question

Alcohol metabolism

answer

Alcohol> acetaladehyde> acetic acid alcohol dehydrogenase, aldehyde dehydrogenase

question

Def conversion disorder

answer

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.

question

Alcohol withdrawal

answer

autonomic hyperactivity, hallucinations, and fluctuating activity levels, ranging from acute agitation to lethargy chlordiazepoxide PO or lorazepam IV or IM

question

olfactory and other unusual types of hallucinations, derealization episodes, mood lability, irritability, intermittent anger, and behavioral dyscontrol

answer

Tumors of the temporal lobe

question

Avoidant personality disorder

answer

intense need for connection and social interaction with others, coupled with an intense fear of rejection

question

good prognosis in schizophrenia

answer

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

question

Dx Schizophrenia

answer

Two for 6 mo: 1) Delusions 2) hallucinations 3) Disorganized speech 4) Disorganized/ catatonic behavior 5) Negative sx

question

Negative sx schizophrenia

answer

5 A's Anhedonia, Affect (flat), Alogia, Avolition (apathy), Attention (poor)

question

Subtypes of schizophrenia

answer

paranoid, disorganized, catatonic, undifferentiated, residual

question

Dopamine pathways affected in schizophrenia

answer

Prefrontal cortex (neg sx), Mesolimbic (pos sx)

question

Dopamine pathways affected by neuroleptics

answer

Tuberoinfundibular: hyperprolactinemia-> gynecomastia, galactorrhea Nigrostriatal: extrapyramidal side efx

question

Schizoaffective disorder dx

answer

Criteria for schizophrenia and MDD, manic, mixed Delusions or hallucinations for 2 wks w/o mood disorder

question

Delusional disorder dx

answer

1. Non bizarre fixed delusions 1mo, 2. Not meet criteria for schizophrenia, 3. Function not significantly impaired

question

Koro

answer

Patient believe penis is shrinking and will disappear causing his death

question

Amok

answer

Sudden unprovoked outbursts of violence which person has no recognition

question

Brain fas

answer

Headache, fatigue, visual disturbances in males

question

Major depressive episode dx

answer

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

question

Manic episode dx

answer

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

question

Mixed episode dx

answer

Criteria met for both manic and depressed, >1 wk

question

Hypomanic

answer

elevated, expansive, irritable mood, no impaired function, >4 days, no psychotic features

question

Major depressive disorder (MDD)

answer

At least one MD episode, No hx of mania or hypomania

question

Sleep problems assoc w/ depression

answer

difficulty falling asleep, early morning awakening

question

stages of grief

answer

Denial, Anger, Bargaining, Depression, Acceptance

question

Rapid cycling

answer

4 or more mood episodes in 1 year

question

Types of depressive disorders

answer

Melancholic, Atypical, Catatonic, Psychotic

question

Psychoanalysis not indicated for:

answer

ppl who have problems with reality testing, psychotic patients, severe cluster A or B personality disorders

question

Mature defenses

answer

altruism, humor, sublimation, suppression

question

Sublimation

answer

Satisfying socially objectionable impulses in an acceptable manner

question

Neurotic defenses

answer

Controlling, Displacement, Intellectualization, Isolation of affect, Rationalization, Reaction formation, Repression In OCD, hysterical, adults under stress

question

Immature defenses

answer

Acting out, Denial, Regression, Projection In children, adolescents, pscyhotics

question

Psychoanalysis is used in

answer

Cluster C pd, Anxiety disorders, OCD, problems coping, Anorexia, Sexual disorders, Dysthymic disorder

question

Psychoanalytically oriented psychotherapy and brief dynamic psychotherapy

answer

Similar to psychoanalysis, but briefer weekly for 6m-1.5y, face to face sessions

question

Focuses on development of social skills to help treat certain psychiatric disorders

answer

Interpersonal therapy - once weekly for 3-6m, improve interpersonal relations

question

Help patient feel safe during a difficult time

answer

Supportive psychotherapy, healthy individuals in a crisis, focus on empathy, understanding and education

question

Helping patients change behaviors that contribute to their symptoms

answer

Behavioral therapy

question

Classical conditioning

answer

Pavlov's dog

question

Operant conditioning

answer

positive or negative reward

question

Patient performs relaxation techniques while being exposed to anxiety provoking stimulus

answer

Systemic desensitization (behavioral conditioning) - phobias

question

Patient is confronted with anxiety stimulus and not allowed to withdraw

answer

Flooding and implosion (behavioral conditioning) - phobias

question

Negative stimulus paired with specific behavior

answer

Aversion therapy (behavioral conditioning) - used to treat addictions or paraphilias

question

Rewards are given after specific behaviors to positively reinforce

answer

Token economy (behavioral conditioning) - used for ADLs in disorganized or mentally retarded individuals

question

Physiological data given to patients as they try to ctrl physiological states

answer

Biofeedback (behavioral conditioning)- migraines, HTN, chronic pain, asthma, incontinence, agoraphobia,

question

Seeks to correct faulty assumptions and neg feelings

answer

Cognitive therapy- patient taught to identify maladaptive thoughts - depressive and anxiety disorders, paranoid pd, OCD, somatoform, eating disorders

question

Focuses on a patients sx by examing the connection btw thoughts and behaviors

answer

CBT- protocol or manual with homework depression, anxiety, substance abuse

question

TCA overdose

answer

IV sodium bicarbonate

question

major complications of TCAs

answer

3Cs- Cardiotoxicity, Convulsions, Coma

question

MAOIs more effective in

answer

atypical depression, hypersomnia, Inc appetite and Inc sensitivity to interpersonal rejection

question

Common side effects of TCAs

answer

Dry mouth, retention, fatigue, blurry vision (anticholinergic)

question

What to monitor when prescribing lithium

answer

lithium, creatinine, thyroid levels

question

Clozipine monitoring

answer

WBC ct - agranulocytosis

question

Chlorpromazine side efx

answer

Orthostatics, bluish skin, photosensitivity (typical antipsychotic)

question

Thioridazine assoc w/

answer

retinitis pigmentosa (typical antipsychotic)

question

Treat extrapyramidal side efx

answer

Reduce dose of antipsychotic, anticholinergic (Benztropine), antihistaminergic (Diphenhydramine/ Benadryl), antiparkinsonian (Amantadine)

question

FDA approved for mania

answer

quetiapine, olanzapine, aripiprazole, risperidone, ziprasidone

question

Benzos not metabolized by liver

answer

(LOT of them) Lorazepam, Oxazepam, Temazepam

question

Benzo overdose

answer

flumazenil, but inducing w/d quickly can lead to death

question

lesion to the right prefrontal area

answer

laughter, euphoria, and a tendency to joke and make puns

question

lesion to the left prefrontal area

answer

abolishes the normal mood-elevating influences of this area and produces depression and uncontrollable crying

question

Supportive psychotherapy

answer

close alliance, define current problems, solutions, shore up ego adjustment disorders, acute emotional crisis, chronic schizophrenia

question

Insight-oriented psychotherapy

answer

recognize transference/ countertransference, uncover unconscious wishes and defenses Anxiety, Depression, Somatoform, Dissociative, Personality, Neuroses, Trauma

question

Cognitive therapy

answer

Major depression, turn automatic thoughts into diff behavior

question

deficiencies of planning, monitoring, flexibility, and motivation, lesion

answer

Lesions in the dorsolateral area

question

Increases after nonepileptic seizures

answer

prolactin

question

peak withdrawal heroin

answer

48 hrs, starts 8-12

question

Peak withdrawal methadone

answer

3-8th day, starts 1-3 days

question

Partial complex seizures originate

answer

usually (90% of the time) originate in the temporal lobe.

question

Auras that consist of unpleasant odors often originate in the

answer

uncus, an area at the tip of the temporal lobe that is involved in processing olfactory sensations

question

Neurotransmitter associated with alzheimers

answer

Acetylcholine

question

Dysfunction of the orbitofrontal area causes

answer

disinhibition, irritability, lability, euphoria, and lack of remorse. Insight and judgment are impaired; patients are distractible

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