Step 1 - Psych 3

denniskwinn's version from 2015-04-25 16:14


Question Answer
Alcohol withdrawal TxBenzodiazepines
Anorexia/Bulemia txSSRIs
Anxiety txBenzodiazepines, Buspirone, SSRIs
ADHD txMethylphenidate (Ritalin) , Amphetamines (Dexedrine)
Atypical depression txMAO inhibitors, SSRIs
Bipolar disorder Tx“mood stabilizer” = Li, Valproic acid, Carbamazepine
Depression TxSSRIs, SNRIs, TCAs
Depression with insomnia txMirtazapine
Obsessive-compulsive disorder txSSRIs, Clomipramine
Panic disorder txSSRIs, TCA, Benzodiazepines
Schizophrenia TxAntipsychotics
Tourette’s syndrome txAntipsychotics (haloperidol)
Social phobias txSSRIs
Methylphenidate mechanism↑ presynaptic NE vesicular release (like amphetamines) - Mechanism for relieving ADHD sx is not known. - aka ritalin
Antipsychotics aka neurolepticsHaloperidol, trifluoperazine, thioridazine, chlorpromazine
Antipsychotics mechanismblock D2 receptors (↑ cAMP)
High potency antipsychoticshaloperidol, trifluoperazine, fluphenazine - neurolgic side effects
Low potency antipsychoticsthioridazines, chlorpromazine
Antipsychotics clinical useschizophrenia (primarily positive sx), psychosis, acute mania, Tourette’s syndrome
Antipsychotics toxicity ( 1. Stored in body fat - very slow to be removed from body 2. Extrapyramidal side effects 3. Endocrine side effects (hyperPL) 4. SE arising from blocking muscarinic (dry mouth, constipation), alpha hypotension and histamine (sedation) 5. Neuroleptic malignant syndrome (NMS), 6. Tardive dyskinesia
EPS side effects 1. 4h acute dystonia (muscle spasm, stiffness, oculogyric crisis) 2. 4d akinesia (parkinsonian symptoms) 3. 4 wk akathisia (restlessness) 4. 4mo tardive dyskinesia
NMS (neuroleptic malignant syndrome)rigidity, myoblobinuria, autonomic instability, hyperpyrexia - FEVER: fever, encephalopathy, vitals unstable, elevated enzymes, rigidity of muscles
NMS txdantrolene, agonists (bromocriptine)
Atypical antipsychoticsOlanzapine, clozapine, quetiapine, risperidone, aripiprazolem ziprasidone
Atypical antipsychotics mechanismBlock 5-HT2, alpha H1, and dopamine receptors
Clinical use for atypical antipsychoticsSchizophrenia (+ and - symptoms), Olanzapine for OCD, anxiety disorder, depression, maina, tourette’s syndrome
Atypical antipsychotics toxicityFewer EPS and anticholinergic SE, may cause significant weight gain, clozapine may cause agranulocytosis (requires weekly WBC monitoring)
Lithium mechanismNot established -
Lithium clinical useMood stabilizer for bipolar disorder, blocks relapse and acute manic events, also SIADH
Lithium side effectsLMNOP - Movement (tremor), Nephrogenic diabetes insipidus, HypOthyroidism, Pregnancy problems
Buspirone mechanismstimulates 5-HT receptors
Buspirone clinical useGeneralized anxiety disorder - does not cause sedation, addiction or tolerance - does not interact with alcohol (vs. Barbiturates, benzos)
Draw antidepressants picture452
Tricyclic antidepressants (7)Imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, doxepin, amoxapine
Tricyclic mechanismBlock NE and serotonin reuptake
Tricyclic side effectsSedation, alpha blocking effects, atropine-like (anticholinergic) side effects (tachycardia urinary retention), tertiary TCAs (amitriptyline) have more anticholinergic effects that secondary TCAs. Despramine is the least sedating and has lower seizure threshold
TCA toxicityConvulsions, Coma, Cardiotoxicity - also resp depression, hyperpyrexia, confusion and hallucinations in elderly due to anticholinergic side effects
Treatment for TCA toxicityNaHCO3 for CV toxicity
SSRIs (4)Fluoxetine, paroxetine, sertraline, citalopram
SSRIs clinical useDepression, OCD, bulimia, social phobias
SSRI toxicity Fewer than TCAs - GI distress, sexual dysfunction, “serotonin syndrome” with any drug that ↑ serotonie (MAOI) - hyperthermia, muscle rigidity, CV collapse, flushing, diarrhea seizures
Tx for SSRI toxicitycyproheptadine (5-HT2 receptor antagonist)
SNRIs (2) Venlafaxine, Duloxetine
SNRI mechanismInhibit serotonin and NE reuptake
SNRI clinical usedepression, venlafaxine also used in generalized anxiety disorder; duloxetine is also indicated for diabetic peripheral neuropathy. Duloxetine has greater effect on NE.
SNRI toxicity↑ BP most common; also stimulant effects, sedation, nausea
MAOIs (4)Phenelzine, tranylcypromine, isocarboxazid, selegiline (selective MAO-B inhibitor)
MAOI mechanismNonselective MAO inhibition → ↑ levels of amine neurotransmitters
MAOI clinical useAtypical depression, anxiety, hypochondriasis
MAOI toxicityHypertensive crisis w/tyramine ingestion and beta-agonists, CNS stimulation, contraindicated with SSRIs or meperidine (to prevent serotonin syndrome)
Bupropion (wellbutrin)atypical antidepressant, also used for smoking cessation. ↑ NE and dopamine via unknown mechanisms
Bupropion toxicitystimulant effects (tachycardia, insomnia) headache, seizure in bulimic patients, No sexual side effect
Mirtazapineatypical antidepressant - alpha2 antagonist (↑ release of NE and Serotonin) and potent 5-HT2 and 5-HT receptor antagonist.
Mirtazapine toxicitysedation, ↑ appetite, weight gain, dry mouth
Maprotilineatypical antidepressant - blocks NE reuptake
Maprotiline toxicitySedation, orthostatic hypotension
Trazodoneatypical antidepressant - primarily inhibits serotonin reuptake. Used for insomnia as high doses are needed for antidepressant effects.
Trazodone toxicitysedation, nausea, priapism, postural hypotension


Question Answer
WISCIQ test for children 6-16
Intelligent quotientStanford-Binet calculates IQ as mental age/chronological age x100, Mean is defined at 100 w/standard deviation of 15, IQ<70 - diagnosis of mental retardation, IQ<40 - severe MR, <10 - profound
Habituationrepeated stimulation leads to decreased response
Sensitizationrepeated stimulation leads to increased response
Classical conditioningLearning in which a natural response is elicited by a conditioned, or learned, stimulus that previously was presented in conjunction with an unconditioned stimulus. (Pavlov’s classical experiments w/dogs)
Operant conditioning1. Learning in which a particular action is elicited because it produces a reward
Positive reinforcement1. Type of operant 2. Desired reward produces action (mouse presses button to get food)
Negative reinforcement1. Type of operant 2. Removal of aversive stimulus elicits behavior (press button avoid shock)
Punishment1. Type of operant 2. Application of aversive stimulus extinguishes unwanted behavior
Extinction1. Type of operant 2. Discontinuation of reinforcement eliminates behavior
Reinforcement schedulesPattern of reinforcement determines how quickly a behavior is learned or extinguished
Continuous reinforcement schedules 1. Reward received after every response - rapidly extinguished. 2. Think vending machine - stop using it if it does not deliver
Variable ratio reinforcement schedule1. Reward received after random number of responses, slowly extinguished 2. Think slot machine - continue to play even if it rarely rewards
TransferencePatient projects feelings about formative or other important persons onto physician (e.g. Psychiatrist = parent)
CountertransferenceDoctor projects feelings about formative or other important persons onto patient
IdPrimal urges, food, sex and aggression. The id “drives” - instinct - entirely subconscious ( I want it)
EgoMediator between primal urges and behavior accepted in reality - “take it an you will get in trouble”
SuperegoMoral values, conscience, can lead to self-blame and attacks on ego - “you know you can’t have it, taking it is wrong”
Oedipus complexRepressed sexual feelings of a child for the opposite-sex parent, accompanied by rivalry with same-sex parent. First described by freud
Shapingbehavior achieved following reward of closer and closer approximations of desired behavior
Modelingbehavior acquired by watching others and assimilating actions into one’s own repetoire
Erikson’s stages of psychosocial development1. 8 stages of normal development, each posing a new crisis 2. Unsuccessful completion of a stage may manifest as psycosocial maladaption later in life.
Acting out1. Immature ego defense 2. Unacceptable feelings and thoughts are expressed through actions 3. Tantrums
Dissociation1. Immature ego defense 2. Temporary, drastic change in personality, memory, consciousness or motor behavior to avoid emotional stress 3. Extreme forms can result in dissociative identity disorder
Denial1. Immature ego defense 2. Avoidance of awareness of some painful reality 3. A common rxn in newly diagnosed AIDS pts
Displacement1. Immature ego defense 2. Process whereby avoided ideas and feelings are transferred to some neutral person or object (vs. Projection) 3. Mother places blame on child because she is angry at her husbanc
Fixation1. Immature ego defense 2. Partially remaining at a more childish level of development (vs. Regression) 3. Men fixating on sports games
Identification1. Immature ego defense 2. Modeling behavior after another person who is more powerful (though not necessarily admired) 3. Abused child identifies him/herself as abuser
Isolation of affect1. Immature ego defense 2. Separation of feelings from ideas and events 3. Describing murder in graphic detail with no emotional response
Projection1. Immature ego defense 2. Unacceptable internal impulse is attributed to external source 3. A man who wants another woman thinks his wife is cheating on him.
Rationalization1. Immature ego defense 2. Proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame 3. After getting fired, claiming that the job was not important anyway
Reaction formation1. Immature ego defense 2. Process whereby a warded-off idea or feeling is replaced by an (unconsciously derived) emphasis on its opposite 3. A patient with libidinous thoughts enters a monastery
Regression1. Immature ego defense 2. Turning back the maturational clock and going back to earlier modes of dealing with the world 3. Seen in children under stress(bedwetting) and patients on dialysis(crying)
Repression1. Immature ego defense 2. Involuntary withholding of an idea or feeling from conscious awareness 3. Not remembering a conflictual or traumatic experience, pressing bad thoughts into the unconscious
Splitting1. Immature ego defense 2. Belief that people are either all good or all bad at different times due to intolerance of ambiguity. Seen in borderline personality disorder
Altruism1. Mature ego defense 2. Guilty feelings alleviated by unsolicited generosity towards others 3. Mafia boss makes a large donation
Humor1. Mature ego defense 2. Appreciating the amusing nature of an anxiety-provoking or adverse situation 3. Nervous medical student jokes about the boards
Sublimation1. Mature ego defense 2. Replaces an unacceptable wish with a course of action that is similar to the wish but does not conflict with one’s value system 3. Actress uses experience of abuse to enhance her acting
Suppression1. Mature ego defense 2. Voluntary withholding of an idea or feeling from conscious awareness (vs. Repression) 3. Choosing not to think about the USMLE until the week of the exam