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221 Cards in this Set

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  • Back
What medical causes should be included in the differential diagnosis for ADHD?
Lead intoxication
Hyperthyroidism
What are the four categories of symptoms patients must suffer from to be diagnosed with somatization disorder?
Pain syndrome (4)
GI symptoms (2)
Sexual symptom (1)
Pseudoneurologic (1)
What medical conditions may mimic a panic disorder or other anxiety disorders?
Dysrhythmias
Mitral Valve Prolapse
Hyperthyroidism
Asthma
Pheochromocytoma
In depression, how are most patients' appetite and sleep pattern affected?
In typical depression, appetite decreases and sleep decreases
In atypical depression, appetite and sleep both increase
What is the mnemonic for remembering the 8 symptoms of depression?
SIGECAPS
Sleep, Interest, Guilt, Energy
Concentration, Appetite, Pleasure, Suicidality
What is mixed mania?
Co-occurence of manic and depressive symptoms in the same week
What percentage of children with bipolar disorder also have ADHD?
70%
What is the age requirement in diagnosing ADHD?
Onset of symptoms must have occurred before the age of 7
Is Lithium indicated in the treatment of children with bipolar?
Yes, it has been used effectively in children and adolescents for years
What is the most distinctive side effect of lamotrigine?
A rash that can progress to Stevens-Johnson syndrome
How is Asperger disorder differentiated from Autistic disorder?
There is preservation of language development with Asperger
How is "brief psychotic disorder" differentiated from "schizophreniform disorder"?
BPD - psychotic symptoms present less than a month
Schizophreniform - symptoms present >1month but less than 6months
Over 6 months = schizophrenia
What is folie a deux?
Delusional symptoms from one person influencing delusions in another person
What percent of children with Gender identify disorder have symptoms persisting into adulthood?
10%
2/3 of males become homosexual men
What is a pseudohallucination?
When a hallucination is recognized as unreal
What is Capgras syndrome?
The false perception that someone has been replaced by a double
What medications are used in treating obsessional thoughts?
Medications with affinity for serotonin receptors like Clomipramine and SSRIs
What is verbigeration and in what condition is it often seen?
Constant repetition of syllables and sounds, seen in schizophrenia
What is alexithymia?
Inability to describe or recognize one's own emotions
What is Charles Bonnet syndrome?
Visual hallucinations in people who recently developed blindness
What is a doppelganger?
A visual hallucination of one's own body that leads to the belief that one has a double
What is the concordance rate of schizophrenia in monozygotic twins?
40-50%
Children born during which season have a higher rate of developing schizophrenia?
Winter months - possibly a viral cause
Genetic linkage studies have linked schizophrenia to which chromosome?
6
What is the mechanism of LSD?
Blocks serotonin receptors in the brain
What is the mechanism of PCP?
Acts as an antagonist at the NMDA receptors
Through what mechanism does clonidine improve schizophrenic symptoms?
Acts as an alpha-2 agonist leading to a decrease in the release of norepinephrine
What percentage of people with an acute onset of schizophrenia have a lack of insight?
97%
Does schizophrenia have a better prognosis if it has an acute or insidious onset?
Acute onset has better prognosis that responds better to treatment
What is Othello syndrome?
Delusions of jealousy on the part of husbands about their wives
What body type in men is more prone to schizophrenia?
Tall, thin asthenic type
What percent of patients with acute schizophrenia show significant depressive symptoms?
Around 50%
Are structural abnormalities in patients with schizophrenia more common on the right or left side of the brain?
Left side
What is the most common kind of delusion in patients with delusional disorder?
Persecution - Present in about 83% of patients
Is erotomania more common in men or women?
Erotomania is the delusion of having a secret lover and is more common in women
What is another name for the phenomenon of "derailment"?
Loose associations
Present in about 45% of patients with schizophrenia - most common thought disorder
What is the recurrence rate of postpartum psychosis in future pregnancies?
70%
Postpartum depression has a recurrence rate of 50%
What is the risk of bipolar illness in a first-degree relative of someone with bipolar?
7-8%
Which antidepressant class is associated with peripheral neuropathy?
MAOIs - thought to be due to a pyridoxine deficiency
What causes increased cortisol levels in many depressed patients?
A disturbance in the HPA axis
How is REM sleep altered in patients with depressive disorders?
Decrease in latency to the onset of REM
Increase in the total duration of REM sleep
What does "double depression" mean?
Refers to major depressive disorder superimposed on dysthymia
What are typical features of atypical depression?
Increase in appetite and weight
Hypersomnia
Rejection sensitivity
Reactive mood
How long after delivery can a patient be diagnosed with postpartum depression?
It must occur in the four weeks after delivery
Is there a higher rate of depression among boys or girls in the prepubertal age group?
Boys, although there is a higher lifetime prevalence in females
What percent of patients with major depression have a positive dexamethasone suppression test?
50%
Do cholesterol levels tend to be high or low in patients with major depression disorder?
Low levels of cholesterol
How is mania distinguished from hypomania?
In mania, the person must experience significant social and occupational dysfunction
What is the treatment of choice in patients suffering from post partum depression?
ECT is very effective if the patient is refusing to take care of themselves or their baby
What percent of patients diagnosed with bipolar eventually commit suicide?
10-15%
What is Veraguth's fold?
The main fold in the upper eyelid that is angulated upward and backward more commonly in depressed patients
What are features of benzodiazepine withdrawal?
Anxiety
Delirium
Depression
Seizures
Constipation and Diarrhea
How long does the anxiolytic buspirone take to work?
4-6 weeks
What is the mechanism of buspirone?
5HT1A agonist - an anxiolytic
Is GABA activity increased or decreased in patients with anxiety disorders?
Decreased GABA
Increased NE
What is the name of the small retropontine structure in the brain that is the source of all the brain's adrenergic innervation?
Locus ceruleus
Stimulation causes panic attacks
What is the most common site of pain in women with pain disorder?
In men?
Women - headache
Men - back ache
Is hypochondriasis more common in men or women?
Equal prevalence between 3-13%
What is the average number of personality states in a patient with dissociative identity disorder?
13
What is cynophobia?
Fear of dogs
What is mysophobia?
Fear of dirt and germs
What is the most common psychosurgical procedure performed for treatment-resistant OCD?
Cingulotomy
Decribe the defense mechanism of sublimation -
Unacceptable aggressive ideas or wishes are rechanneled into another form that is acceptable to society
Brain imaging studies show pathological involvement of which parts of the brain in patients with panic disorder?
Temporal lobes - particularly the hippocampus
What is the prevalence of depression in the elderly population?
Dementia?
Depression - 10-15%
Dementia - 5%
What is pseudodementia?
Cognitive changes occuring in depression - particularly in the elderly
What MRI changes may be seen in patients with Alzheimers disease?
Periventricular hyperintensities
What medications may be helpful in treating enuresis?
TCA's - imipramine
Desmopressin
What is Kleine Levin syndrome?
Characterized by hypersomnia, hyperphagia, sexual disinhibition, and sometimes psychosis.
At what age do children develop the concept of permanence of death?
4-5 years old
What percentage of intracranial injuries seen in children younger than 1 year are due to physical abuse?
Over 95%
What causes pediatric autoimmune neuropsychiatric disorder?
Associated with a Strep A infeciton
Characterized by OCD and tics
What percentage of children diagnosed with conduct disorder will have antisocial personality disorder in adulthood?
40%
During what stage of sleep do nightmares occur?
Night terrors?
Nightmares - REM sleep
Night terrors - non-REM sleep in the first 1/3 of sleep
Neuroleptic-induced parkinsonism is caused by blockade of D2 receptors in which part of the brain?
The caudate at the termination of the nigrostriatal dopamine neurons
Name some medications that can be used to treat neuroleptic induced parkinsonism-
Benztropine
Amantadine
Diphenhydramine (benadryl)
What is akathisia?
The signs or feeling of restlessness including jitteriness, pacing, and rocking motions
What are the best drugs to treat neuroleptic induced akathisia?
Beta blockers
What is the only antipsychotic to have minimal risk of tardive dyskinesia?
Clozapine
What are some objective signs of neuroleptic malignant syndrome?
High fever, sweating, increased blood pressure
Elevated CPK, liver enzymes and plasma myoglobin
What three medications are sometimes used to treat neuroleptic malignant syndrome?
Dantrolene
Bromocriptine
Amantadine (less common)
What two drugs are common causes of malignant hypertension?
Succinylcholine
Halothane
What class of drugs are clonidine and guanfacine?
Presynaptic a2 agonists
Name some important psychiatric clinical applications for alpha2 agonists-
ADHD
Opioid withdrawal
Tourette's
PTSD
Name three classes of drugs used to treat Tourette's disorder-
Dopamine blockers
Atypical antipsychotics
a2 agonists
What is the primary indication of amantadine use in psychiatry?
Treating extrapyramidal signs and symptoms, although not as effective for tardive dyskinesia
What are the clinical indications for gabapentin?
Hypnotic
Anxiolytic
Decreases craving for alcohol
What are the psychiatric clincial indications for antihistamines?
Treatment for extrapyramidal side effects and also used as hypnotics
What are clinical indications for barbiturates?
Anesthesia for ECT
Seizures
Narcoanalysis (Amytal interview)
Sleep aids
Withdrawal from sedatives
Name the three nonbenzodiazepine GABA agonists-
The "Z drugs"
Zolpidem (ambien)
Zaleplon (sonata)
Eszopiclone (lunesta)
What drug is used to reverse the adverse effects of benzodiazepines?
Flumazenil
Why was the benzodiazepine triazolam banned in Great Britain?
Alleged association with serious aggressive behavior and abnormal thinking
What is the mechanism for the insomina drug ramelteon?
Targets the melatonin receptors in the suprachiasmatic nucleus to regulate the sleep-wake cycle
What drug has the trade name Wellbutrin?
Bupropion
What is the mechanism of action of bupropion?
A norepinephrine and dopamine reuptake inhibitor
What drug has the trade name Zyban used in smoking cessation regimens?
Bupropion
What medications might be given to treat an acute agoraphobic episode?
Alprazolam
Propanolol
What is the acute management of clozapine-induced agranulocytosis?
Discontinue medication
Give Granulocyte Colony Stimulating Factor
What is the treatment for Korsakoff's syndrome
No effective treatment
Institutionalization may be necessary
What diagnosis is suggested by psychotic symptoms, dry skin and mouth, mydriasis, tachycardia, restlessness and hallucinations?
Anticholinergic intoxication
What drugs may be useful in treating acute cocaine intoxication?
Antipsychotics and benzodiazepines may be helpful
What may be the psychiatric presentation of L-dopa intoxication?
Mania
Depression
Schizophreniform disorder
What is the ER treatment for a patient presenting with acute dystonia due to an antipsychotic?
Decrease dose of antipsychotic
Benztropine or diphenhydramine IM
What is the ER treatment for a patient with a hypertensive crisis on MAOIs?
Alpha adrenergic blockers (phentolamine)
or nifedipine
What is the treatment of a patient who has hyperventilation due to anxiety?
Breathing into a paper bag
Patient education
Antianxiety medication
What is the ER treatment of a patient presenting in a manic episode?
Rapid tranquilization with antipsychotics
Restraints if necessary
Restore lithium levels
Can opioid withdrawal be life threatening?
No
What is the ER treatment of opioid intoxication?
IV naloxone
How is PCP intoxication treated in the ER?
Serum and urine assay
Medical monitoring
Benzos may interfere with excretion
Antipsychotics may worsen symptoms
What is the appropriate management of a patient who comes to the ER with panic and terror due to PTSD?
Reassurance
Avoid hospitalization and encourage return to work/responsibilities to avoid invalidism
Assess suicidality
What medical treatment may be effective in the ER for priapism?
Intracorporeal epinephrine
Mechanical or surgical drainage may also be necessary
What is the treatment in the ER for a patient presenting with tardive dyskinesia?
None available
What are the five diagnostic subtypes of schizophrenia?
Paranoid
Disorganized
Catatonic
Undifferentiated
Residual
How is schizophrenia differentiated from delusional disorder?
In delusional disorder, the delusions are nonbizarre and occur without any other psychotic symptoms
Can agoraphobia be diagnosed without panic disorder?
Yes, agoraphobia without panic disorder is more common that panic disorder with agoraphobia
What is the lifetime prevalence of a specific phobia?
25% lifetime prevalence
How is GAD treated?
SSRIs, buspirone, beta-blockers and relaxation techniques
What are the symptoms of PTSD?
Re-experiencing traumatic event
Dissociation
Numbing
Avoidance
Hyperarousal
What neurotransmitter is most implemented in OCD?
Serotonin
How is OCD treated?
Clomipramine, SSRIs
Systematic densitization and flooding
What are the three Cluster A personality disorders?
Paranoid
Schizoid
Schizotypal
What are the four Cluster B personality disorders?
Antisocial
Borderline
Histrionic
Narcissistic
What are the three Cluster C personality disorders?
Avoidant
Dependent
Obsessive-compulsive
In which personality disorder is there a paradoxical combination of self-centeredness and feelings of worthlessness?
Narcissistic
What are the signs of substance dependence?
Tolerance
Withdrawal
Repeated excessive use
Failure to cut down
Reduction in other activities
Lots of time spent obtaining
How does chronic alcohol use affect cholesterol profiles?
HDL increases
LDL decreases
Which medication has the best empirical support showing efficacy in alcohol rehabilitation?
Naltrexone - an opiate antagonist
What is the triad of clinical features in Wernicke syndrome?
Nystagmus
Ataxia
Mental confusion
What are the symptoms of Korsakoff syndrome?
Anterograde amnesia
Confabulation
Is pupillary constriction or dialation seen in opioid intoxication?
Pupillary constriction
Is pupillary constriction or dialation seen in cocaine intoxication?
Pupillary dialation
What drugs are useful in treating the autonomic symptoms of opioid withdrawal?
Clonidine - alpha 2 agonist
What are the two subtypes of anorexia nervosa?
Restricting type
Binge eating/purging type
What is the IQ range that classifies a person as mild mental retardation?
50-70
What is the IQ range that classifies a person as mild mental retardation?
35-50
What is the triad of symptoms in autistic disorder?
Impaired social interactions
Impaired ability to communicate
Restricted repertoire of interests
What genetic diseases are associated with an increased risk of autistic disorder?
Fragile X
Tuberous sclerosis
What is the estimated prevalence of ADHD in school age children?
3-5%
What is the most common diagnosis in outpatient child psychiatric clinics?
Conduct disorder
What medical therapy may be indicated in Tourette's disorder?
Low doses of high-potency neuroleptics - haloperidol or pimozide
What three disorders are classified as "cognitive disorders"?
Delirium
Dementia
Amnestic disorders
What are some possible infectious causes of delirium?
UTIs
Meningitis
Sepsis
What's the name for the worsening of delirium or dementia in the evening?
Sundowning
How is dementia commonly differentiated from delirium?
Delirium tends to be more sudden in onset and have an identifiable precipitant
What is the prevalence of dementia in patients over the age of 85?
20%
What are the three A's of diagnosing dementia?
Aphasia
Apraxia
Agnosia
(Disturbance of executive function)
What part of the brain may be abnormal on autopsy in a patient with Huntington's disease?
Atrophy of the caudate
What changes are typical on neuroimaging in a patient with Pick's dementia?
Frontal and temporal atrophy
What is the clinical triad of Creutzfeldt-Jakob?
Dementia
Myoclonus
Abnormal EEG
What is the mechanism of action of Tacrine?
Acetylcholinesterase inhibitor
How are amnestic disorders differentiated from dementia?
Amnestic disorders have isolated memory loss without impairment of other cognitive function
What brain structures are often damaged in patients with amnestic disorders?
Mammillary bodies
Fornix
Hippocampus
What's the difference between Dissociative identity disorder and Depersonalization disorder?
Dissociative identity is aka multiple personality disorder
Depersonalization is recurrent experiences of feeling detatched from the body
What are the two basic categories of sleep disorders?
Dyssomnias
Parasomnias
What are the four classic stages of the sexual response cycle?
Desire
Excitement
Orgasm
Resolution
Which stage of sleep occupies about half of the night in adults?
Stage 2
What is Delta sleep?
Slow wave sleep composed of stages 3 and 4
In what stage of sleep does nightmare disorder occur?
REM sleep
In what stage of sleep does sleep terror disorder occur?
Delta sleep (stages 3 and 4)
What are the elements of Freud's topographic model of the mind?
Unconscious
Preconscious
Conscious
What are the elements of Freud's structural model of the mind?
Id
Ego
Superego
Which psychologist said the most important process of human development is the gradual individuation and separation of the infant from the mother?
Mahler
What psychologist developed attachment theory?
Bowlby
What is the male:female ratio of autistic disorder?
5:1 male predominance
What percent of patients with autistic disorder have mental retardation?
75%
What percent of school age children have conduct disorder?
10%
9:1 male predominance
What is the male:female ratio of school age children with oppositional defiant disorder?
1:1
What is the diagnosis for a child with excessive shyness with strangers but normal social involvement with familiar people?
Social phobia in childhood
What are the characteristic features of "cortical dementia"?
Early appearance of aphasia with difficulties in memory and calculation
What are the early features of "subcortical dementia"?
Characterized by an early appearance of dysarthria, motor symptoms, slowed cognition and personality changes
What parts of the brain are effected by Pick disease?
Neurodegernation of the frontal and temporal lobes
What is the clinical presentation of Pick disease?
Personality and language changes around the age of 50
Are people who are innately tolerant to alcohol more or less likely to develop alcohol abuse?
More likely
Which substance induced disorder may present with flu like symptoms - nausea, muscle aches, sweating, diarrhea, fever, rhinorrhea?
Opioid withdrawal
How is PCP ingested?
Inhalation of smoke from other drugs laced with PCP
What is the concordance rate of schizophrenia in monozygotic twins?
A little over 50%
In the glutamate hypothesis of schizophrenia, is there hyperfunction or hypofunction of the NMDA receptors?
Hypofunction
What are the subtypes of Delusional Disorder?
Persecutory
Grandiose
Erotomanic
Jealous
Somatic
Mixed
What is the criteria for diagnosing a mixed mood episode?
Presnece of both manic and depressive symptoms for at least 1 week
What symptoms characterize a mood episode with Melancholic features?
Loss of pleasure
Anorexia
Psychomotor retardation/agitation
Excessive guilt
Depressive symptoms worse in the morning
What is the diagnostic criteria for rapid cycling?
Having four or more mood episodes yearly
What is the diagnostic difference between Bipolar II and Cyclothymic disorder?
Bipolar II: Hypomania and Major depressive episode
Cyclothymic: Hypomania and depressive features without Major Depression diagnosis
What is the male:female ratio of major depressive disorder?
1:2 male:female
When is ECT indicated for major depressive disorder?
Unresponsive to antidepressants
Contraindications to antidepressants
Immediate risk of suicide
History of good response to ECT
What is the diagnosis for a patient with an almost continuous depressed mood for at least 2 years?
Dysthymic disorder
How long do manic episodes typically last without treatment?
3 months
What infections should be on the differential diagnosis for mood disorders?
Neurosyphilis
Hepatitis
Mononucleosis
HIV
Are mood disorders more common after a left sided or right sided CVA?
Left sided CVA
What is the lifetime prevalence of panic disorder?
3%
Which two personality disorders are most associated with somatization disorder?
Borderline and antisocial
Is hypochondriasis more common in men or women?
Equal prevalence
Is factitious disorder more common in men or women?
Men
Which two personality disorders are most common in patients exhibiting factitious disorder?
Antisocial and Dependent
What is jamais vu?
A sense of familiar things being strange
What medications might be given to treat paraphilias?
Antiandrogens
GnRH analogues
Do increases in serotonin levels promote sleep or disrupt sleep?
Promotes sleep
What is the name of the brain structure that influences sleep through serotonergic systems?
Dorsal raphe nucleus
What is the name of vivid hallucinations when falling asleep?
Hypnagogic hallucinations
What is the name of vivid hallucinations when awakening?
Hypnopompic hallucinations
What pharmacotherapy may be used to treat circadian rhythm sleep disorder?
Short-term use of benzodiazepines
Melatonin
What are treatment options for adjustment disorder?
Remove or reduce stressors
Cognitive or psychodynamic phsychotherapy
Anxiolytic or antidepressant medication
Which three personality disorders tend to remit over lifetime?
Borderline
Antisocial
Avoidant
Which two personality disorders tend to exacerbate over lifetime?
Paranoid
Schizoid
What are the primary side effects of the low-potency antipsychotics?
Sedation and anticholinergic
What is the appropriate treatment of acute dystonia due to antipsychotic medication?
IM or IV anticholinergic medication like benztropine
Does alprazolam have a long or brief duration of action?
Brief
Which two benzodiazepines have good efficacy for long-term treatment of panic disorder?
Alprazolam and Clonazepam
What are the clinical indications for Buspirone?
GAD
Social phobia
What medication should you switch to if the sedative side effects of diazepam are especially bothersome for someone being treated for GAD?
Buspirone
Which are generally less sedating - tertiary or secondary amine tricyclic antidepressants?
Secondary amines like desipramine and nortriptyline
What is the mechanism of venlafaxine?
Norepinephrine and serotonin reuptake inhibitor
Which class of antidepressants is most likely to cause cardiac arhythmias?
TCAs
Which antidepressant medication may cause priapism in males?
Trazodone (an MAOI)
What is the purpose of administering atropine during ECT?
Reduces airway secretions
What is the alternative medicine kava used for?
Mild anxiety and insomnia
What is the alternative medicine Valerian used for?
Insomnia
What alternative medicine treatment has the possible effect of mood stabilization in bipolar disorder?
Omega-3 fatty acids
A patient is taking an herbal medication as an anxiolytic and develops dermatitis over the flexor surfaces of the hands and feet. What medicine was most likely used?
Kava
Which defense mechanism is defined as an unacceptable thought or feeling that is transformed into its opposite (like fear being transformed into bravado)?
Reaction formation
What is the requirement for a mental patient to be deemed competent to stand trial?
Must be able to understand charges and rationally consult with an attorney
What is meant by "therapeutic privilege"?
When a clinician elects not to divulge information about a procedure because the information would be extremely harmful for the patient to know