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What are the mature ego defenses? SASH: sublimation, altruism, suppression, humor
Unacceptable feelings and thoughts are expresses through actions. This describes? Acting out
Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress. Dissociation
Avoidance of awareness of some painful reality. Denial
Process whereby avoided ideas and feelings are transferred to some neutral person or object. Displacement
Partially remaining at a more childish level of development. Fixation
Modeling behavior after another person who is more powerful (though not necessarily admired). Identification
Separation of feelings from ideas and events. Isolation of affect
An unacceptable internal impulse is attributed to an external source. Projection
Proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame. Rationalization
Process whereby a warded-off idea or feeling is replaced by an (unconsciously derived) emphasis on its opposite. Reaction formation
Turning back the maturational clock and going back to earlier modes of dealing with the world. Regression
Involuntary withholding of an idea or feeling from conscious awareness. Repression
Belief that people are either all good or all bad at different times due to intolerance of ambiguity. Splitting
Guilty feelings alleviated by unsolicited generosity toward others. Altruism
Appreciating the amusing nature of an anxiety-provoking or adverse situation. Humor
Process whereby one replaces an unacceptable wish with a course of action that is similar to the wish but does not conflict with one's value system Sublimation
Voluntary withholding of an idea or feeling from conscious awareness. Suppression
Mafia boss makes large donation to charity. Altruism
Nervous medical student jokes about the boards. Humor
Aggressive impulses used to succeed in business ventures. Sublimation
Choosing not to think about the USMLE until the week of the exam. Suppression
What neurotransmitters are associated with anxiety? increased NE, dec GABA, dec serotonin
What neurotransmitters are associated with depression? dec NE, dec serotonin, dec dopamine
What neurotransmitters are associated with Alzheimer's dementia? dec ACh
What neurotransmitters are associated with Huntington's disease? dec GABA, dec ACh
What neurotransmitters are associated with schizophrenia? inc dopamine
What neurotransmitters are associated with Parkinson's disease? dec dopamine, inc ACh
Inability to remember things that occurred before a CNS insult. Retrograde amnesia
Inability to remember things that occurred after a CNS insult. Anterograde amnesia
Classic anterograde amnesia caused by thiamine deficiency. Korsakoff's amnesia
Leads to bilateral destruction of mammillary bodies. Korsakoff's amnesia
Seen in alcoholics, and associated with confabulations. Korsakoff's amnesia
Inability to recall important personal information, usually subsequent to severe trauma or stress Dissociative amnesia
Waxing and waning level of consciousness Delirium
Rapid decrease in attention span and level of arousal. Delirium
Characterized by acute changes in mental status, disorganized thinking, hallucinations (often visual), illusions, misperceptions, disturbance in sleep-wake cycle, cognitive dysfunction. Delirium
Most common psychiatric illness on medical and surgical floors. Abnormal EEG. Delirium
Gradual decrease in cognition characterized by memory deficits, aphasia, apraxia, agnosia, loss of abstract though, behavioral/personality changes, impaired judgment. Patient alert with no change in level of consciousness. Dementia
What is the difference between dementia and delirium? delirium has change in level of consciousness and abnormal EEG. dementia has no change in level of consciousness with normal EEG.
Which is reversible, dementia or delirium? delirium
What is it called when someone has perceptions in the absence of external stimuli? hallucinations
What is it called when someone has misinterpretations of actual external stimuli? illusions
What is it called when someone has false beliefs not share with other members of culture/subculture that are firmly maintained in spite of obvious proof to the contrary? delusions
What are disorder in the form of thought (the way ideas are tied together)? loose associations
Which type of hallucinations are common in delirium? visual hallucinations
Which type of hallucinations are common in schizophrenia? auditory hallucinations
What often occurs as an aura of psychomotor epilepsy? olfactory hallucination
Which type of hallucinations are common in alcohol withdrawal (e.g. fornication - ants) and also seen in cocaine abusers? tactile hallucinations
Which type of hallucination occurs while GOing to sleep? hypnaGOgic hallucination
Which type of hallucination occurs while waking from sleep? hypnopompic hallucination
Periods of psychosis and disturbed behavior with a decline in functioning lasting >6 months describes what? schizophrenia
How do you diagnose schizophrenia? 2+ of ff ("positive symptoms"): 1. delusions 2. hallucinations - auditory 3. disorganized speech (loose association) 4. "negative symptoms" - flat affect, social withdrawal, lack of motivation, lack of speech or thought
Unstable mood and interpersonal relationships, impulsivenesss, sense of emptiness seen more in females than males describes which personality disorder? borderline
Borderline personality disorder is associated with which major defense mechanism? splitting
Imipramine is commonly used for what? bedwetting
What is the MOA of TCAs? block reuptake of NE and serotonin
What age do children begin cooperative play? 4 yrs
Patients with major depressive disorder experience which type of sleep? increased REM
Motor or sensory symptoms such as paralysis, blindness, or mutism following an acute stressor describes what? conversion disorder (somatoform)
What distinguishes PTSD from acute stress disorder? PTSD lasts >1 month and Acute stress disorder lasts between 2 days to 1 month
Patient is belligerent, impulsive, has fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, ataxia, and delirium. What did this patient take? PCP
Excessive emotionality and excitability, attention seeking, sexually provocative, and overly concerned with appearance describes which personality disorder? histrionic
MOA of methylphenidate (ritalin)? inc presynaptic NE vesicular release (like amphetamines)
Tx for alcohol withdrawal? benzodiazepines
Tx for anorexia/bulimia? SSRIs
Tx for anxiety? benzodiazepines (venlafaxine), buspirone, SSRIs (paroxetine, sertraline)
Tx for ADHD? methylphenidate (ritalin), amphetamines (dexedrine)
Tx for atypical depression? MAO inhibitors, SSRIs
Tx for bipolar disorder? "mood stabilizers": lithium, valproic acid, carbamazepine, atypical antipsychotics
Tx for depression? SSRIs, NSRIs, TCAs
Tx for depression w/ insomnia? mirtazapine
Tx for OCD? SSRIs, clomipramine
Tx for panic disorder? SSRIs, TCAs, benzodiazepines
Tx for PTSD? SSRIs
Tx for schizophrenia (positive symptoms)? antipsychotics (neuroleptics)
Tx for Tourette's syndrome? antipsychotics (haloperidol)
What are the extrapyramidal SE of antipsychotics (neuroleptics) that occur after 4 hrs? acute dystonia (muscle spasm, stiffness, oculogyric crisis)
What are the extrapyramidal SE of antipsychotics (neuroleptics) that occur after 4 days? akinesia (parkinsonian symptoms)
What are the extrapyramidal SE of antipsychotics (neuroleptics) that occur after 4 wks? akathisia (restlessness)
What are the extrapyramidal SE of antipsychotics (neuroleptics) that occur after 4 months? tardive dyskinesia
What are the symptoms for neuroleptic malignant syndrome (NMS) that occur with antipsychotics? (FEVER) fever, encephalopathy, vitals unstable, elevated enzymes, rigidity of muscles
Tx for schizophrenia (useful for both positive and negative symptoms)? atypical antipsychotics
MOA of antipsychotics (neuroleptics)? block dopamine D2 receptors
What are the antipsychotics (neuroleptics)? Hally took flight to chicago: haloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine
Which antipsychotics (neuroleptics) have high potency? haloperidol, trifluoperazine, fluphenazine
Which antipsychotics (neuroleptics) have low potency? thioridazine, chlorpromazine - non-neurologic SE
What are the endocrine SE of antipsychotics (neuroleptics)? galactorrhea from hyperprolactinemia from dopamine receptor antagonism
What are the SE from blocking muscarinic, alpha, and histamine receptors? M (dry mouth, constipation), alpha (hypotension), and histamine (sedation)
What are the atypical antipsychotics? COARQZ: clozepine, olanzapine, risperidone, aripiprazole, quetiapine, ziprasidone
MOA of atypical antipsychotics? block 5-HT2, a, H1, and dopamine (D4) receptors
Which atypical antipsychotic is also used for OCD, anxiety, depression, mania, Tourette's? olanzapine
Which atypical antipsychotic may cause agranulocytosis so it requires weekly WBC monitoring? clozapine
Which atypical antipsychotic is associated with hyperprolactinemia which can cause amenorrhea with the least SE? Risperidone
What are the SE of Lithium? movement (tremor), nephrogenic DI, hypothyroidism, pregnancy problems
What other drugs can cause lithium toxicity? thiazides and NSAIDs
MOA of buspirone? stimulates 5-HT1A receptors
What is buspirone used for? GAD b/c does not cause sedation or addition
What are the TCAs? (I CAN DAD) imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin, amoxapine
Which channels are affected with TCAs? fast Na channel conduction is blocked -> arrhythmia -> MCC of death
Clinical use for TCAs? major depression, bedwetting, OCD
Which TCA is used for OCD? clomipramine
What are the SE of TCAs? atropine-like (anticholinergic) SE (tachycardia, urinary retention)
Which TCAs have more anticholinergic effects? Tertiary TCAs (amitriptyline) > secondary TCAs (nortriptyline)
Which TCA is the least sedating? desipramine
What are the toxicities in TCAs? Tri-C's: convulsions, coma, cardiotoxicity (arrhythmias)
What are the other toxicities in TCAs besides the tri-C's? respiratory depression and hyperpyrexia
What toxicity occurs with nortriptyline (TCA) in the elderly? confusion and hallucinations due to anticholinergic SE
What is the tx for CV toxicity with TCAs? NaHCO3
What are the SSRIs? fluoxetine, paroxetine, sertraline, citalopram
Clinical use for SSRIs? depression, OCD, anxiety
Toxicity of TCAs? GI distress, sexual dysfunction (anorgasmia)
How long does it take for antidepressants to have an effect? 2-3 wks
What toxicity occurs with SSRIs and any drug that increases serotonin (e.g. MAO inhibitors)? serotonin syndrome - hyperthermia, muscle rigidity, CV collapse, flushing, diarrhea
Tx of serotonin syndrome? cyproheptadine
MOA of cyproheptadine? histamine antagonist w/ nonspecific 5HT1 & 5HT2 receptor antagonist properties
How does bupropion (wellbutrin) work? increase NE and dopamine via unknown mechanism
Toxicity of bupropion (wellbutrin)? stimulant effects (tachycardia, insomnia), headache, seizure in bulimic patients
Which antidepressant is good b/c it has no sexual SE? bupropion (wellbutrin)
Which antidepressant is also used in GAD? venlafaxine
How does venlafaxine work? inhibits serotonin and NE reuptake
What toxicity can occur with venlafaxine? MC inc BP, also stimulant effects, sedation, nausea
How does duloxetine work? inhibits serotonin and NE reuptake
What is an indication for duloxetine? diabetic peripheral neuropathy
Toxicity of duloxetine? same as venlafaxine
MOA of mirtazapine? a2 antagonist (inc release of NE and serotonin) and potent 5-HT2 and 5-HT3 receptor antagonist
Toxicity of mirtazapine? sedation, inc appetite, weight gain, dry mouth
MOA of maprotiline? blocks NE reuptake
Toxicity of maprotiline? sedation, orthostatic hypotension
MOA of trazodone? primarily inhibit serotonin reuptake
Clinical use of trazodone? insomnia, as high doses are needed for antidepressant effects
Toxicity of trazodone? sedation, nausea, pripism, postural hypotension
What is the drug of choice for patients with depression and sleep disorders? trazodone
What drug can trazodone be used with to treat depression accompanied with insomnia? fluoxetine (SSRI)
What are the MAO inhibitors? phenelzine, tranylcypromine
MOA of MAO inhibitors? nonselective MAO inhibition -> inc levels of amine NTs
Clinical use of MAO inhibitors? atypical depression, anxiety, hypochondriasis, resistant depression
Toxicity of MAO inhibitors? hypertensive crisis with tyramine ingestion and B-agonists; CNS stimulation
MAO inhibitors are CI with which drugs? SSRIs or meperidine (to prevent serotonin syndrome)
What makes serotonin? tryptophan
What is the other byproduct of tryptophan other than serotonin? niacin
Tx for acute anxiety? alprazolam
Tx for chronic anxiety? clonazepam
What is the MOA of meperidine? block reuptake of 5-HT
Created by: eandres1



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