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90 Cards in this Set

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Psychosis
-prominent hallucinations or delusions
-Sx don't occur only during episode of delirium
-Evidence to support med or substance related cause from lab, hx or physical
-disturbance not better accounted for by psychotic d/o not substance induced
Schizophrenia
2 or more for 1 month
-delusions
-hallucinations
-disorganized speech
-grossly disorganized or catatonic behavior
-Negative Sxs (like flattened affect)
R/o med, neuro, substance induced
At least 6 mo (includes prodromal or residual periods where above criteria not met)
schizoaffective d/o
-meet affective d/o criteria
-delusions or hallucinations for 2 weeks in absence of mood sxs.
-have mood sxs for substantial portion of psychotic illness
MDD
5 of symptoms including 1 or 2 for 2 weeks
-15% chance of committing suicide later in life
Manic
elevated mood for 1 week and 3 of following. (4 need to be present if mood is irritable)
-75% have psychotic features
Mixed episode
both criteria are present for nearly everyday and are filled for 1 week
hypomanic
Difference from mania
-4 day duration
-no psychotic features
-no social impairment
SAD triad
-irritability
-carbohydrate drawing
-hypersomnia
Epidemiology of MDD
-15% lifetime prevalence
-age is 40
-2x in women
-25-50% in elderly
-loss of parent b/4 age 11: later development of major depression
-1st degree relatives=2-3x more likely to have MDD
Course and Prognosis of MDE
-clears up after 6mo-1 year
-episodes occur more frequently as disorder progresses
-risk of subsequent MDE is 50% w/in 1st 2 years after 1st episode
-15% commit suicide
5HT syndrome
-autonomic instability
-hyperthermia
-seizures
-coma and death
adjunctive therapy for SSRI nonresponders
-T3/T4
-Li
-L-Tryptophan
ECT
-premedicate with Atropine
-general anesthesia
-muscle relaxant
-retrograde amnesia
Types of depression x4
1)melancholic: anhedonia; early morning awakening; anorexia; guilt
2)atypical: MAOI; hyperphagia; hypersomnia; leaden paralysis; hypersensitivity to personal rejection
3)Catatonic: catalepsy; purposeless motor activity; negativism/mutism; echolalia; bizarre postures
4)psychotic
Bipolar I epidemiology
-75% concordance in twins
-8-18x more likely in 1st degree relatives
-women and men affected equally
-ECT works well, need more sessions than MDD
Dysthmic disorder
-No discrete episodes, majority of time you are depressed for at least 2 years (In kids, for 1 year)
-not w/o symptoms for >2 months at a time
-no major depressive episode
DDs: 2 Ds: 2 years, 2 listed criteria, never asympto for >2 months
-Concentration; hopelessness; appetite; insomnia/hypersomnia; low self esteem; low energy
Course and PX of dysthmic d/o
-20% develop major depression
-20% get Bipolar
->25% have lifelong sxs
-onset b/4 25 in 50%
-never w/psychotic features
cyclothymic
-2 years of hypomania and depression w/many periods (diff from rapid cycling BPD).
-never Sx free for >2 months
-popular w/Borderlines
Panic attack
-can also occur w/sp phobia and PTSD
-subside w/in 25 min, rarely last >1 hr
-"sudden rush of fear"
-Palpitations; Abdominal distress; Numbness/nausea; Intense fear of death; Choking/chills/CP; sweating/shaking/SOB
(4 of them)
Panic disorder
-w/or w/o agoraphobia
1)No precipitant for panic attacks
2)At least one of the attacks has been followed by a min of 1 month of: worry of the attacks, change in behavior to avoid the attacks
-1st episode: may think they are going insane
-anticipatory anxiety
-usually 2x/week
-last 20-30 min
Specific phobia/social phobia
-intense anxiety when in situation that is tried to be avoided
-patient knows fear is excessive
-if <18, present for >6mo
-phobias are most common mental d/o
-F>M
-substance abuse is common
-neuro: too much NE, so B blockers
-use paxil for social ph; benzo or B blcok for sp ph during desensitize
OCD
-egodystonic (have insight)
-obsessions: suppresses thoughts, person knows they are product of his mind
-compulsion: no link b/w behavior and distress, but try to calm down w/behavior
-obsessions of locking door, symmetry
PTSD
-symptoms for 1 mo
-persistent sxs of arousal
-numbing of responsiveness (ltd affect, detachment feelings)
-comorbid w/substance abuse and depression
Acute stress disorder
PTSD but sx at most for 1 mo
-event occured <1 mo ago (PTSD: event at any time in past)
GAD
-persistent, excessive anxiety and hyperarousal for 6 mo
-difficult to control the worry
-3 of following: restless, muscle tension, fatigue, poor concentration, sleep problems
-more women
-pts seek help b/c of medical problem: fatigue or muscle tension
Adjustment d/o
-Sxs begin w/in 3 mo after event; end w/in 6 mo
-severe distress in excess
-not bereavement
-resolve w/in 6 mo after terminated stressor
-supportive TX is best; pharm for sxs (depression, insomnia, etc)
Paranoid PD
-suspicion of others
-preoccupation of trustworthiness
-reluctant to confide in others
-persistent grudges
-quick to counterattak
M>F
-may have transient psychosis: give meds
-psychotherapy
PMDD
-not severe or sufficient duration for MDD
-remittance of sxs in a week
most predictive factors for suicide
age >45 >> EtOH dependence>>rage or violence >>prior suicide attempt >> male gender
worst withdrawal
-etoh and benzos
substance abuse
-failure to fulfill obligations at home, work
-use in dangerous situations
-recurrent legal problems
-continued use despite interpersonal problems
receptors involved in etoh
activates: i)GABA ii)5-HT
Inhibits: i)glutamate receptors
what do etoh, meoh, and ethylene glycol cause
metabolic acidosis with increased anion gap
-1st step in management is CT to r/o subdural hematoma
treatment of etoh intox
ABCs and lytes and acid-base status
F.S to exclude hypoglycemia
thiamine, naloxone, folate
No gastric lavage
can give SSRI
EtOH w/drawal sxs:mild, moderate, severe
mild: irritable, tremor, insomnia
moderate: diaphoresis, fever, disorientation
severe:Seizure, DTs
5% get DTs, 15-20% mortality rate untreated
treatment of DTs
benzos tapered off
nutritional stuff
MgSO4 for postw/d seizures
wernicke:
korsakoff
w: ataxia, nystagmus, confusion
K: antero/retrograde amnesia; confabulation
causes of death for cocaine
seizure
arrhythmia
respiratory depression
drug screen pos x3 days
treatment of intox of coke
mild-moderate agitation: benzo
severe: haldol
symptomatic support
treatment of dependence on coke
psychotherapy
TCAs
DA agonists: amantadine, bromocriptine
diff b/w classic amphetamines and designer
classic: cause release of DA from nerve endings, stimulant effect
designer (MDMA): release DA and 5HT, getting stim and hallucinogenic
MOA PCP and ketamine
hallucinogen antagonizing NMDA glutamate receptors
activates DA neurons
Treat PCP intox
[PCP can cause seizure and coma]
i)Monitor BP, Temp, Lytes
ii)Acidify urine w/NH4Cl and Vit C
iii)Benzos for agitation and anxiety, spasms and seizures
iv)Haldol for psychotic symptoms/agitation
Eval for PCP
elevated CPK; AST
Benzos/sedative hypnotics:
i)Eval
ii)Treat
i)1 week positive urine screen
lytes, EKG
ii) ABCs, charcoal
flumazenil (causes seizures also)
barbiturate: alkalinize urine w/NaHCO3
Triad of opioid overdose
Rebels admire morphine
i)resp depression
ii)altered mental status
iii)miosis (pinpoint)
opioid w/d
-rhinorrhea
-piloerection
-yawning
-sweat/lacrimation
caffeine moa
-adenosine antagonist, causing increased cAMP
-stimulant effect via DA system
Defn of cognitive d/o
affect memory, attention, orientation, judgment
necessary minimum workup of dementia
CBC
TFTs
VDRL
CT
B12 Folate
Electrolytes
Treatment of delirium
-treat underlying cause
-antipsychotics 1st line (seroquel). Haldol PO/IM but not IV b/c of torsades
causes of delirium
-Iatro: BP meds, insulin, H2 receptor blocker, antiparkinsonians
-O2 hypoxia: bleed, central venous, pulm
-seizures: post ictal
diff b/w delirium and dementia
-delirium has immediate/recent memory impaired; dementia recent and longterm impaired
-symptoms worse at night in delirium; stable in dementia
-EEG changes in delirium
aphasia
problems with speech and understanding
Neurophys of AD
-decreased level of Ach (loss of NE neurons in locus ceruleus of brainstem)
-decreased NE: Basal nucleus of Meynert of midbrain.
Diff b/w vascular dementia and AD
-vascular caused by small brain infarcts, so pts w/focal neuro problems (hyperreflexia or paresthesia)
What are the cortical dementias and what are subcortical?
Cortical: AD, FTD, CJD
Subcortical: NPH, Huntingtons, Parkinson's, multi-infarct
Cortical=cognitive
subcort=affective and movement d/o
Treat Parkinson's as last resort
thallotomy or pallidotomy
CJD hallmarks
myoclonus
EPS
ataxia
long latency period b/w exposure and dz onset
EEG=periodic sharp waves/spikes
delirum, fever, nuchal rigidity, photophobia
meningitis; need LP
delirium+dilated pupils+tachycardia
utox; drug intox
delirium+elevated BP+papilledema
HTNive encephalopathy
CT/MRI
treat delirium
FEUD
Fluid
Electrolytes
Underlying Cause
Drug w/d. Avoid BeNZOS!
Methods of gathering information in children
-play, stories, drawing
-K-ABC: Intelligence for 2.5-12
-WISC-R: IQ for 6-16
-PIAT: academic achievement
MR DX criteria
-IQ <70
-Onset b/4 age 18. Most are mild (50-70 IQ)
Types of learning d/o and what must be r/o?
-R/o hearing or visual deficit
-Reading d/o: more boys
-Math d/o: girls
-Written expression: unknown.
Most common outpt diagnosis in kids?
-risk of developing ASPD?
-pharm therapy?
CD
-40%
-antipsychotics or Li for aggression
-SSRI for impulsivity, irritability, mood lability
Diff of ODD from CD?
-comorbidity?
-ODD doesn't involve violation of basic rights of others. Bad towards adults but good w/peers
-ADHD, substance abuse, mood d/o
what are the symptom categories for autism (x3)
-problems w/social interaction
-communication problems
-repetitive and stereotyped behavior and activities
treatment of autism
-Neuroleptics: control aggression, mood lability
-SSRi: repetitive actions
etiology of Tourettes
-treat tourettes
-impaired regulation of DA in Caudate
-clonidine or pimozide (DA-R antag)
Enuresis r/o dx's
-treatment of enuresis
-DX:
-urethritis, diabetes, seizures
-ADH or TCAs (imipramine)
-2x/week x3 months
etiology of enuresis
-genetics
-psychological
-small bladder or low nocturnal levels of ADH
r/o dx's for encopresis
Comorbidity
-metabolic: hypothyroid
-GI: anal fissure, IBD
-dietary factors
Comorbid w/CD and ADHD
dissociative amnesia
-1 episode of inability to recall imp personal info, usually involving traumatic or stressful event
-often unable to recall name or imp info but remember obscure information
dissociative fugue
-unaware that they have forgotten anything (unaware of their amnesia)
-assume new id and occupation after arriving to new place
-usually a response to traumatic event
-lasts up to days, forget their fugue
dissociative identity disorder
-2 or more id's that recurrently take control of their life
-can't recall other personality's info
-sxs like Borderline; same comorbidity as fugue and amnesia; 1/3 suicidal
levels of __ and impulsivity and aggression? (impulse d/o's)
-predisposing factors
-5HT
-child abuse, head trauma, seizures
anorexia dsm
-<15% ideal body weight
-fear of being fat
-amenorrhea
-distorted body image
Primary insomnia
-problem falling or maintaining sleep
-at least 3x/week x 1month
narcolepsy
-cataplexy (lose tone ass'd w/laughter)
-short REM latency
-sleep paralysis
-hypnagogic or hypnopompic
-repeated, sudden attacks of sleep in daytime x3months
hepatic encephalopathy
-asterixis
-tremors
-increased DTR
-personality change
-change in cognitive ability
HIV dementia
-MMSE goes down (demented) and forgetful
-behavioral change, apathy, social w/d
-weak, imbalance, ataxia
(aphasia, ataxia, apraxia)
hyperthyroidism
-can cause mild cognitive deficits in calculation and recent memory
-tremor
-brisk DTR
-myalgia and muscle wasting
-sensitive to heat
hypoglycemic delirium
-tachycardia
-tremor
-hn
-seizure
triad for MDD
-feeling ineffectual
-believing world is hostile to her
-knowing that things won't change
brain changes of schizo
enlarged ventricles and prominent sulciIED
brain abnormalities in IED
-5HT pathway of limbic system
buproprion required test with nicotine patch
frequent blood pressure monitoring
GAD characterized by
-anxiety about multiple events in conjunction w/ 3 for 6 mo
-impaired sleep
-poor concentration
-easy fatigue, irritable, muscle tension, restless