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Psychiatry
Normal behavior

child making a fuss to go to school

Psychiatry 1
 Anxiety

Trichotillomania

Reactive attachment disorder

Psychiatry 2
 Oppositional defiant disorder

Psychiatry 3
 Adjustment disorder

Psychiatry 4
 Zolpidem: sleep hygience: nonbenzo benzo receptor agonist

Specific phobia

Psychiatry 5
 Acute stress disorder

PTSD

Psychiatry 6
Psychiatry 7
 OCD

Psychiatry 8
 Sertraline: OCD

Buspirone: GAD

Lorazepam: acute anxiety: risk of misuse and withdrawal

Structural abnormalities in orbitofrontal cortex and basal ganglia

Anxiety

Psychiatry 9
 Sertraline: OCD

Buspirone: GAD

Lorazepam: acute anxiety: risk of misuse and withdrawal

Social anxiety

Panic disorder

GAD

Psychiatry 10
 Venlafaxine

Buspirone: non-benzo anxiolytic, GAD in patients without comorbid

depression or panic sx

slower onset of action and weaker anxiolytic effects than benzos

Bupropion: non-serotonergic antidepressant inhibits reuptake of NE

and dopamine; worsens insomnia and anxiety due to activating
effects

Propranolol: performance type of social anxiety disorder

2nd gen antipsychotics: Quetiapine: treatment-resistant patients

GAD: have SE: sedation, metabolic effects

Psychiatry 11
 Zolpidem: sedative hypnotic- targets insomnia but doesn’t address
GAD

Pheochromocytoma

Serotonin syndrome

Psychiatry 12
 1. mental status changes

2. autonomic dysregulation

3. neuromuscular hyperactivity

discontinue antidepressants for 2 weeks before beginning an MAOI

for fluoxetine- 5 weeks

Mood

Tremors

Psychiatry 13
 Depressed

Psychiatry 14
 MDD

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Psychiatry 16
 decreased REM sleep latency: time from sleep onset to first REM
decreased slow-wave sleep and increased REM sleep duration and
density

Adjustment disorder

Psychiatry 17
 Dysthymia: Persistent depressive disorder

Psychiatry 18
 Substance use

Suicide

Psychiatry 19
Psychiatry 20
 Low 5-HIAA in CSF= suicidal behavior
5-HIAA= primary metabolite of serotonin

Postpartum

Seasonal Affective disorder

Psychiatry 21
 Therapy

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Psychiatry 23
 Bipolar disorder

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Psychiatry 25
 Lithium, Valproate, Quetiapine, Lamotrigine

if severe: combination therapy: Lithium or Valproate+ 2nd gen:

Quetiapine

MANIA: DIGFAST

distractibility

indiscretion

grandiosity

flight of ideas

activity increase

sleep deficit

talkativeness

Cushing

Psychiatry 26
 MEDS

SNRI

Venlafaxine:

SE: causes dose dependent HTN: monitor bp

tachycardia

Serotonin modulating antidepressant: Trazaodone- sedating

low dose for sleep induction

SE: orthostatic problems in elderly

Atypical antipsychotics

weight gain→ HTN

Aripiprazole and Ziprasidone: least likely to cause weight gain

Antipsychotics:

Haloperidol, Lurasidone, Olanzapine, Quetiapine: Bipolar

Clozapine: treatment-resistant schizophrenia- potential for life-

threatening agranulocytosis

Risperidone, Haloperidol: dopamine antagonists- psychosis or as

adjuncts to mood stabilizers in bipolar disorder treatment

Psychiatry 27
 can increase neuromuscular irritability and risk of seizures

Acute dystonia: give Benztropine: anticholinergic

Akathisia: propranolol

Psychiatry 28
 TCA

Amitryptiline: sedating

SE: cardiotoxicity, overdose, anticholinergic effects, orthostatic

hypotension

Psychiatry 29
 Modafinil: wakefulness-promoting- Narcolepsy

SSRI

Paroxetine and Sertraline: do not inhibit norepinephrine re-uptake

and are not associated w HTN

Mirtazapine: antagonized alpha-2-R’s- increased appetite and

sedation

Mirtazapine: 1st line antidepressant: stimulate appetite, weight

gain, somnolence

Escitalopram and Sertraline: caution in bipolar bc depression→

mania

Citalopram: MDD

Fluoxetine: pediatric depression, causes sexual dysfunction

headache, insomnia, nausea

SNRI

Duloxetine: analgesic: depression+neuropathic pain-diabetic

neuropathy

Venlaflaxine: SSRI non-responders; dose-dependent HTN due to

increased NE re-uptake inhibition at higher dose ranges

assess bp before starting venlafaxine and regularly monitor

throughout treatment.

MAOi: Phenelazine

not a 1st line antidepressant bc of its unfavorable SE and dietary

restrictions

hypotension

MAOI HTN crisis: after patients ingest foods containing tyramine, a

sympathomimetic; headache

Mood stabilizers:

Lamotrigine: bipolar

drug rash, Steven-Johnson syndrome (<10% BSA), TEN (>30%)

Valproic acid: bipolar

Psychiatry 30
 GI sx, hepatitis, pancreatitis, hepatic encephalopathy

Bupropion: NE-dopamine re-uptake inhibitor

augments SSRI

depression

smoking cessation

good for depressed w low energy, impaired concentration,

hypersomnia, no weight gain, smoking cessation

increased risk for seizures, less weight gain and fewer sexual
adverse effects

Zolpidem: non-benzo sleep medication

Psychiatry 31
 Lithium

Psychiatry 32
 long-tern maintenance with valproate, quetiapine and lamotrigine.

Psychiatry 33
 thiazide diuretics: can cause decrease in renal clearance of lithium

higher risk if toxicity in

dehydrated patients

elderly: low GFR and reduced volume of distribution

can increase lithium levels:

ACEi

Thiazide

NSAID

Tetracycline

Metronidazole

ECT

OSA

Psychiatry 34
 Serotonin syndrome

1. AMS

2. autonomic instability:

Psychiatry 35
 hyperthermia

HTN

tachycardia

mydriasis

3. neuromuscular excitability

hyperreflexia

ankle clonus

Homicide risk

Neuroleptic malignant syndrome

Psychiatry 36
Psychiatry 37
 Neuro-developmental

Tourette syndrome

Psychiatry 38
 2nd gen antipsychotics

Dementia

Psychiatry 39
Psychiatry 40
 Montreal cognitive assessment tool

Benzodiazepine withdrawal

Psychiatry 41
 irritability, tremors, perceptual changes, psychosis, elevated vital signs,
delirium, seizures

Autism

accelarated head growth, increased head volume

Rett syndrome

Psychiatry 42
 Specific learning disorder

Psychiatry 43
 Language disorder

Psychiatry 44
 Parkinson’s psychosis

Psychiatry 45
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 ADHD

Psychiatry 47
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 Personality

Psychiatry 51
 Borderline

Psychiatry 52
 history of childhood trauma

Gender dysphoria

Psychiatry 53
 Pyromania

Intermittent explosive disorder

Impulse control disorder
unable to restrain their aggressive impulses
remorse, dysphoria, embarrassment
<30min episodes
chronic

Psychiatry 54
 Disruptive mood dysregulation disorder
disproportionate verbal and physical outbursts
onset <10yo, persistent irritability or anger between episodes.
not >18yo

Histrionic

dramatic emotional displays

center of attention

Narcissistic

lack of empathy

interpersonal exploitation

Antisocial

Psychiatry 55
 Conduct

Paranoid

Psychiatry 56
 OCPD
perfectionism, assignments

Psychotic

Neuroleptic malignant syndrome

Psychiatry 57
 decreased central dopaminergic activity

Bromocriptine, Amantadine: dopaminergic meds

Dantrolene: direct-acting muscle relaxant w rapid onset of action-

reduces heat production and muscle rigidity

Psychiatry 58
 Extrapyramidal effects

Psychiatry 59
 Wilson’s disease

Psychiatry 60
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 Parkinson’s

Psychiatry 62
 Delusional disorder

Psychiatry 63
 Schizophrenia

lateral ventricular enlargement

decreased hippocampus and amygdala

Schizophreniform

Psychiatry 64
 Schizoaffective

Selective mutism
verbal at home, refuse to speak in specific social setting- school

Psychiatry 65
 Rx: CBT w

Postpartum blues, depression, psychosis

Antipsychotics

Psychiatry 66
 serotonin-dopamine antagonist

bind serotonin 2A

dopamine D2 receptors

Psychiatry 67
Psychiatry 68
 Lithium: check kidney and thyroid

Olanzapine: neutropenia, agranulocytosis

Valproate: drug-induced liver injury

Bupropion: seizures

Clozapine: neutropenia, seizures

Haloperidol: liver injury

Chlorpromazine: cholestatic jaundice

Lamotrigine: SJS, rashes

Trazaodone: priaprism

Psychiatry 69
 Substance-use disorders

Withdrawal

Psychiatry 70
 Use

Psychiatry 71
 Cocaine: weight loss, behavioral changes, erythema of nasal mucosa

Opioid use: euphoric, sedating effects

Cannabis: euphoria, paranoia

Substance-induced emergencies

Psychiatry 72
 PCP acts on

NMDA receptors: on hippocampus and limbic system- excitatory and

psychotic effects

Psychiatry 73
 Dopamine, NE, serotonin receptors- adrenergic, dopaminergic
effects

Sigma receptor complex: psychotic and anticholinergic effects

rx: Benzodiazepines- lorazepam, midazolam

Opioid

Clonidine: central, alpha-2-adrenergic agonist- reduces noradrenergic

hyperactivity

Psychiatry 74
 Alcohol

Psychiatry 75
 Use

Acamprostate

glutamate modulator at metabotropic glutamate receptor 5

reduces risk of relapse

excreted unchanged by kidney

safe to use in liver dz pt.

adjust dose in renal failure pt

Naltrxone: mu-opioid antagonist- 1st line

hepatotoxicity, contraindicated in liver dz pt.

Disulfiram

aldehyde dehydrogenase inhibitor- unpleasant reaction: flushed

skin, headache, nausea, vomiting

2nd line

Fomepizole

Psychiatry 76
 alcohol dehydrogenase inhibitor- antidote to treat methanol or
ethylene glycol poisoning

Naloxone: short-acting opioid antagonist- treats acute opioid

intoxication

alcohol withdrawal give benzos

Fetal alcohol syndrome

Psychiatry 77
 Cholinergic toxicity

Psychiatry 78
 Catatonia

EPS: give benztropine

NMS: dantrolene

SS: cyprohepatadine- serotonin antagonist

Methamphetamine intoxication

Psychiatry 79
 Phencyclidine intoxication

severe combativeness

sympathetic overactivity

psychosis

Psychiatry 80
 confusion

dissociation

nystagmus

ataxia

increased pain tolerance

Aggressive patient

Synthetic Cathinones (bath salts)

long- weeks

Psychiatry 81
 amphetamine-like properties

severe agitation

combativeness

psychosis

delirium

myoclonus

seizures- rarely

tachycardia

increased bp

Medication-induced psychotic disorder

Glucocorticoids

OTC antihistamines: anticholinergic- confusion, hallucinations

Alpha-adrenergic agents- Phenylephrine, Pseudoephedrine- constrict

blood vessels, decrease nasal congestion

Steroid use

Psychiatry 82
 Alprazolam
short-acting benzo- seizures if abruptly discontinued

Motivational interviewing

Eating disorders

Prophylaxis

Psychiatry 83
 Bulimia

Psychiatry 84
 bupropion is contraindicated

lowers seizure threshold

not for anorexia, bullimia

Anorexia

Psychiatry 85
 Sleep

Insomnia

Delayed sleep-wake disorder: circadian-rhythm disorder- night-owl

tendency w markedly late sleep and wake times

Psychiatry 86
 Advanced sleep-wake phase disorder: circadian rhythm abnormality-
early sleep and wake times

Shift work disorder: acute sleep disturbances after patients work

unconventional shifts

Narcolepsy

Body dysmorphic disorder

Psychiatry 87
Psychiatry 88
 REM sleep behavior disorder
complex motor behaviors that occur during REM sleep
muscle atonia

Psychiatry 89
 degeneration of the brainstem nuclei responsible for inhibiting spinal motor
neurons during normal REM sleep
incomplete or absent muscle atonia
dream enactment behaviors
awakened easily
alert and oriented
older adult men

frequent and recurrent- prodromal sign of neurodegeneration with onset of

Parkinson disease or dementia w Lewy bodies.

Non-REM sleep behavior disorder

younger pt, slow-wave N3 sleep

sleep terrors

sleep walking
on awakening- longer period of confusion before becoming fully alert, don’t
remember any concurrent dreams

Nightmare disorder
vivid recall of disturbing dream content
responsive to comfort

Nocturnal seizures
repititive and stereotypical movements.

Psychiatry 90
 during non-REM sleep- a stage of sleep that is densest during the first half of
the night- postictal confusion on awakening

Somatic symtoms disorders

Somatic symptom disorder

Psychiatry 91
 Factitious
intentional production of false physical or psychological signs or sx to
assume the sick role.
no secondary gain
no external reward
psychosocial stressors- workload, exams

Psychiatry 92
 Conversion
emotional trigger present

Psychiatry 93
 Psychogenic non-epileptic seizures

Miscellaneous

Psychotic disorder due to another medical condition

anti-NMDA receptor encephalitis- autoimmune encephalitis syndrome
anxiety
psychosis
cognitive dysfunction- memory impairment, seizure, autonomic instability,
dystonia, rigidity
young women (21)

ovarian teratoma

Korsakoff syndrome

retrograde and anterograde amnesia with intact long-term memory,

confabulation, apathy, lack of insight and hx of alcohol use disorder

complication of Wernicke encephalopathy- acute d/o of thiamine deficiency

1. encephalopathy

Psychiatry 94
 2. ataxia

3. oculomotor dysfunction

Parent management training

Dissociative amnesia

Psychiatry 95
 Defense mechanisms

Psychiatry 96
 PTSD

Intellectual disability

Psychiatry 97
Psychiatry 98
 Dissociative disorders

Psychiatry 99
 Preadolescents sexual behavior

Psychiatry 100
 Poisoning

Anticholinergic toxicity

Psychiatry 101
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Psychiatry 103
 SSRI

Overdose well tolerated

If AMS and physical exam findings- co-ingestant present: salicylates,

ethanol

Opioids

Methadone: long-acting opioid agonist- prevents withdrawal symptoms,

decreases cravings, reduces euphoric effects of opioid use, can be used
in pregnancy; neonatal abstinence syndrome expected

Naltrexone: opioid antagonist, maintenance- prevents relapse,

immediate withdrawal if they are actively using

Clonidine: alpha-2-adrenergic agonist, relieves autonomic sx of opioid

withdrawal. Doesn’t prevent withdrawal and craving.

Psychiatry 104
 Serotonin syndrome

Psychiatry 105
 Neurology

Creutzfeldt-Jakob disease

Psychiatry 106
 Parkinsons

Psychiatry 107
 Dementia

Psychiatry 108
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Psychiatry 111
 Dementia w Lewy bodies

severe sensitivity to antipsychotics: dopamine antagonists

1st gen: haloperidol

repeated falls, syncope, autonomic dysfunction, delusions, depression

Tremor

Functional tremor: involuntary movement, not neuro, improves w

distraction

Abrupt onset, static course- functional disability out of proportion to

tremor magnitude

Increased severity with attention and decreased with distraction

Complex features or clinical inconsistencies w known tremor- can

write words but not draw spirals- fingers are spared

Changeable features: shifting tremor frequency- chase the tremor

Cerebellar tremors: low frequency and high amplitude- increase as an

action approaches a target rather than ceasing with activity. Ataxia,
dysmetria, impaired RAM

Essential tremor: hands, worsened by anxiety, older adults- tremor

exacerbated by outstretched arms, more pronounced at the end of goal
directed movements

Psychiatry 112
 Orthostatic tremor: legs and trunk, when standing

Physiologic tremor: not normally visible, visible by increased

sympathetic activity (Caffeine, hyperthyroidism, anxiety). Low amplitude
and fast. Worsens w movement, improves w rest.

Multiple sclerosis

Psychiatry 113
 Antipsychotics

Psychiatry 114
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 Restless legs syndrome

Psychiatry 116
 check iron

Huntington disease

Psychiatry 117
 Fragile X

Psychiatry 118
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 CVS

Psychiatry 121
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 Endocrine

Psychiatry 123
 Primary adrenal insufficiency/ Addison’s disease:

mineralocorticoid deficiency- renal salt wasting, hypotension, weight loss,

hyponatremia, hyperkalemia, dietary salt craving

glucocorticoid deficiency: fatigue, anorexia, psych: irritability, depressed

mood→ hypotension

androgen deficiency: loss of libido and suppression of secondary sexual

characteristics: reduced pubic hair; women

dx: stimulation testing w cosyntropin- synthetic ACTH

if low cortisol after cosyntropin= PAI

GI

Psychiatry 124
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 Male repro

Psychiatry 126
Psychiatry 127
 SSRI: paroxetine, citalopram

topical anesthetics: lidocaine- prilocaine

TCA: Clomipramine

Female repro

Pregnancy

Psychiatry 128
 SSRI

Ethics

Psychiatry 129
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