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