Adam Shared "Psychiatry" - 66 Picmonics

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Psychiatry

Postpartum Depression 12190
Postpartum Blues
40%-80% of women
Onset: 2-3 days and resolves in 10-14 days
Mild depression, tearfulness, irritability
Treatment: Reassurance & monitoring
Postpartum depression
8%-15% of women
Onset: Within 4 weeks
Moderate to severe depression, sleep or appetite disturbance, low energy, psychomotor changes, guilt, concentration difficulty, suicidal ideation
Treatment: Antidepressants (SSRI), psychotherapy
In breastfeeding patients, sertraline is preferred as levels in infant sera are usually undetectable
Paroxetine can also be used
Electroconvulsive therapy is considered a safe treatment option in the perinatal period for resistant cases
Postpartum psychosis
0.1%-0.2% of women
Onset: Variable Days to weeks
Delusions, hallucinations, thought disorganization, bizarre behavior
Treatment: Antipsychotics, antidepressants, mood stabilizers Hospitalization; do not leave mother alone with infant (risk of infanticide)
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Narcolepsy 521
Disordered regulation of sleep-wake cycles; 1° characteristic is excessive daytime sleepiness (awaken feeling rested)
Caused by decreased hypocretin (orexin) (measured from CSF fluid) production in lateral hypothalamus
Hypocretin-1 (orexin-A, measureable in CSF) and hypocretin-2 (orexin-B) promote wakefullness and inhibit REM
Hypnagogic (just before sleep) or hypnopompic (just before awakening) hallucinations
Nocturnal and narcoleptic sleep episodes that start with REM sleep
Cataplexy (loss of all muscle tone following strong emotional stimulus, such as laughter) in some patients
Treated with muscarinic agonists
Sodium oxybate (can also be used for non cataplexic narcolepsy) and SSRIs
Strong genetic component
Treatment: daytime stimulants (eg, amphetamines (secondary), modafinil (primary)) and nighttime sodium oxybate (GHB)
Minimum episde count of 3 times per week for 3 months
Diagnosis polysomnography and multiple sleep latency tests (demonstrates ↓ sleep latency and sleep-onset REM periods)
Findings: mult iple spon taneous awaken ings, reduced sleep efficiency and latency of rapid eye movement (REM) sleep
Rapid eye movement sleep latency ≤15 minutes
Cataplexy: SNRI (eg, venlafaxine) or SSRI, and a tricyclic antidepressant can also be considered
Sodium oxybate (gamma-hydroxybutyrate): improves nocturnal sleep, relieve daytime sleepiness, cataplexy treatment
Rarely used due to abuse potentia l and restrictive regulations
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Mirtazapine and Varenicline (Atypical Antidepressants)
Mirtazapine
Mirtazapine
α2-antagonist (Increased release of NE and 5-HT)
α2-antagonist (Increased release of NE and 5-HT)
Potent 5-HT2 and 5-HT3 receptor antagonist and H1 antagonist
Potent 5-HT2 and 5-HT3 receptor antagonist and H1 antagonist
Toxicity: sedation (which may be desirable in depressed patients with insomnia), increased appetite, weight gain (which may be desirable in elderly or anorexic patients), dry mouth
Toxicity: sedation (which may be desirable in depressed patients with insomnia), increased appetite, weight gain (which may be desirable in elderly or anorexic patients), dry mouth
Considered a first line antidepressant
Considered a first line antidepressant
Varenicline
Varenicline
Nicotinic ACh receptor partial agonist
Nicotinic ACh receptor partial agonist
Used for smoking cessation (decreases both cravings and decreasing the rewarding effects of nicotine)
Used for smoking cessation (decreases both cravings and decreasing the rewarding effects of nicotine)
Toxicity: sleep disturbance
Toxicity: sleep disturbance
Has been associated with mood changes and suicidality as well as cardiovascular events in patients with pre-existing cardiovascular disease
Has been associated with mood changes and suicidality as well as cardiovascular events in patients with pre-existing cardiovascular disease
More effect ive than bup ropion or nicotine replacement therapy
More effect ive than bup ropion or nicotine replacement therapy
It can partially stimulate the receptor, thereby reducing symptoms of nicotine withdrawal
It can partially stimulate the receptor, thereby reducing symptoms of nicotine withdrawal
It also prevents the nicotine in cigarette smoke from binding the receptor, reducing the rewarding effects of smoking
It also prevents the nicotine in cigarette smoke from binding the receptor, reducing the rewarding effects of smoking
Blackbox suicide warning has been removed
Blackbox suicide warning has been removed
However monitored for psychiatric symptoms (eg, agitation , depression , suicidal behavior, suicidal ideation)
However monitored for psychiatric symptoms (eg, agitation , depression , suicidal behavior, suicidal ideation)
Advised to discontinue tx and contact physician immediately if they experience any behavioral and/or mood changes
Advised to discontinue tx and contact physician immediately if they experience any behavioral and/or mood changes
Might increase the risk of adverse cardiovascular events
Might increase the risk of adverse cardiovascular events
Dose reduction is indicated in individuals with moderate renal insufficiency
Dose reduction is indicated in individuals with moderate renal insufficiency
Very small chance of seizure and epilepsy is not a contraindication
Very small chance of seizure and epilepsy is not a contraindication
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Bupropion
Indications
Depression
Smoking Cessation
Mechanism of Action
Increase Dopamine and NE
Side Effects
Stimulant Side Effects
Seizure
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1 min
Inhalant Abuse 11794
Commonly abused inhalants include glue, toluene, nitrous oxide ("whippets"), amyl nitrite ("poppers"), and spray paints
Abused by sniffing, huffing (inhaled from a saturated cloth), or bagging (bag over mouth or nose) to concentrate the inhaled substance
Acute intoxication: brief transient euphoria and loss of consciousness and vary depending on the specific chemicals inhaled
Inhalants are highly lipid soluble and produce immediate effects that typically last 15-45 minutes
Act as central nervous system depressants and may cause death.
Dermatitis (glue sniffer's rash) due to chemical exposure can be seen around the mouth or nostrils
Rapidly eliminated and are not included in most routine hospital toxicology screens
Liver function tests may be elevated with repeated use
Boys age 14-17 are at highest risk for inhalant abuse
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Parkinson's Disease Assessment
Assessment
Decreased Dopamine
Older Adult
Cogwheel Rigidity
Bradykinesia
Shuffling Gait
Resting Tremor
Pill-Rolling
Mask-Like Face
Cognitive Decline
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2 mins
Opioid Abuse and Withdrawal Assessment
Abuse Assessment
Euphoria
Miosis
CNS Depression
Abuse Withdrawal
Yawning
Gooseflesh
Sweating
Rhinorrhea
Kicking Movements
Consideration
Naloxone
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1 min
Electroconvulsive Therapy 516
Used mainly for treatment-refractory depression, depression with psychotic symptoms, and acutely suicidal patients
Catatonia
Postpartum psychosis in treatment refractory patients
Bipolar mania
When pharmacotherapy contraindicated due to comorbid medical illness or poor tolerability
Emergency conditions (rapid response): Refusal to eat or drink, Imminent risk for suicide
Produces grand mal seizure in an anesthetized patient
Adverse effects include disorientation, temporary headache, partial anterograde/retrograde amnesia usually resolving in 6 months
Safe in pregnancy
Safety
No absolute contraindications
Risk with: Severe cardiovascular disease, recent MI, Space-occupying brain lesion, Recent stroke, unstable aneurysm
Only if its a RECENT MI, stroke or unstable aneurysm
Anterograde AND retrograde amnesia
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Neuroleptic Malignant Syndrome
FEVER Acronym
Fever
Encephalopathy
Vital Signs Unstable
Elevated Enzymes
Rigidity of muscles
Reversal Agent
D2 Agonists
Bromocriptine
Dantrolene
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2 mins
Alcohol Withdrawal Syndrome 3187
Withdrawal should be treated with a benzodiazepine to control symptoms and prevent progression to DT
Lorazepam, an intermediate-duration benzodiazepine, often given intravenously, is preferred in the hospital setting
Often preferred in the hospital setting , as it is safer in patients with possible liver disease and has no active metabolites
Intermediate duration benzodiazepine
Adj unctive management: IV fluids, frequent monitoring of vital signs, thiamine, folate , and nutritional support
Longer-acting benzos (eg, chlordiazepoxide), have active metabolites , are generally not used in patients with possible liver disease
Mild Withdrawal
Anxiety, insomnia, tremors, diaphoresis, palpitations, gastrointestinal upset, intact orientation
6-24 hours since last drink
Seizures
Single or multiple generalized tonic-clonic
12-48 hours since last drink
Alcoholic hallucinosis
Visual, auditory, or tactile; intact orientation; stable vital signs, alert sensorium
Develops 12-48 hours after the last drink and usually resolves within 24-48 hours
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Suicide Risk Factors
Depression
Previous Attempt
No Support System
Access to Firearms or Medications
Substance Abuse
Physical or Sexual Abuse
Chronic Illness or Pain
Extremes of Age
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2 mins
Cocaine Intoxication Assessment
Euphoria
Delusions
Mydriasis
Hallucinations
Agitation
Hypertension
Arrhythmias
Hyperthermia
Seizures
Nasal Septum Perforation
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2 mins
Acute Intermittent Porphyria (AIP)
Pathophysiology
Autosomal Dominant
Inhibited Porphobilinogen Deaminase
Increased Serum Porphobilinogen
Increased Serum Delta-ALA
Increased Urinary Porphyrin Precursors
Signs & Symptoms
Precipitated By P450 Inducers
Painful Abdomen
Polyneuropathy
Psychological Disturbances
Port Wine-Colored Urine
Treatment
Glucose and Hemin
Considerations
Avoid Triggers
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3 mins
Lithium
Indications
Bipolar Disorder
Mechanism of Action
Mood Stabilizer
Unknown Mechanism
Side Effects
Nephrogenic Diabetes Insipidus
Hypothyroidism
Movement (Tremor)
Heart Block
Contraindication
Pregnancy (Ebstein's Anomaly)
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1 min
Valproic Acid
Indications
First Line Tonic-Clonic Seizure Treatment
Bipolar Disorder
Migraine Prophylaxis
Mechanism of Action
Increases GABA Concentration
Blocks Voltage-Gated Na+ Channels
Side Effect
GI Distress
Contraindication
Contraindicated in Pregnancy
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1 min
CNS Stimulants
Indications
Attention Deficit Hyperactivity Disorder (ADHD)
Obesity
Mechanism of Action
Increase Catecholamines at Synaptic Cleft
Increase Norepinephrine
Increase Dopamine
Drug Names
Methylphenidate (Ritalin)
Methamphetamine
Side Effect
Potential for Abuse
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56 secs
High Potency Antipsychotic Drugs
High Potency Drugs
Fluphenazine
Trifluoperazine
Haloperidol
Side Effects
Extrapyramidal Symptoms
Short Term
Dystonia
Torticollis
Long Term
Tardive Dyskinesia
Parkinson's-like Symptoms
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1 min
Dextromethorphan
Antitussive (antagonizes NMDA glutamate receptors); mild analgesic
Synthetic codeine analog
Has mild opioid effect when used in excess
Naloxone can be given for overdose
Mild abuse potential
May cause serotonin syndrome if combined with other serotonergic agents
Can cause dissociative symptoms and hallucinations
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Random Disorders Treatment 8875
Hoarding disorder
Cognitive-behavioral therapy (CBT) specifically targeted to hoarding behaviors is the most effective treatment
SSRIs are not effective unless patient ALSO has OCD
Shared psychotic disorder (folie a deux, delusional disorder)
Separate the pair to break the chain of reinforcing each other's beliefs
Dominant individual, typically requires psychiatric treatment (sometimes inpatient), other individual requires treatment only sometimes
Conversion disorder (functional neurological symptom disorder)
Education & self-help techniques - first-line
Cognitive behavioral therapy - second-line
Physical therapy for motor symptoms
Delusional disorder
Antipsychotics
Cognitive-behavioral therapy
Gambling Disorder
CBT, gamblers anonymous
SSRI, naltrexone
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Phencyclidine (PCP) Intoxication Assessment
Violent Behavior
Motor Issues
Nystagmus
Increased Pain Tolerance
Tachycardia
Delirium
Psychosis
Seizures
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2 mins

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