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109 Cards in this Set
- Front
- Back
What is the downward drift hypothesis?
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Chronic mental illness's tendency to cause its sufferers to move downward through social strata. Socioeconomic cost of schizophrenia is the result of drift, NOT its cause.
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Bleuler's classical model of schizophrenia:
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Four A's:
1. association 2. affect 3. autism 4. ambivalence |
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Levels of the following in depression changes:
1. cortisol 2. catecholamines 3. sex hormones 4. immune function |
1. cortisol is increased
2. catecholamines is decreased 3. sex hormones are decreased 4. immune function is decreased |
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What is the % risk mood disorders in 1st degree relatives of bipolar patients
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25%
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Abdominal pains + psychiatric Sxs (= manic or psychotic appearing) should cause concern for:
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porphyria
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Type of hallucinations seen in delirium:
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- any type
- visual |
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TYpe of hallucinations seen in schizophrenia-spectrum illness, including brief psychotic disorder:
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- auditory hallucinations
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Kluver-Bucy syndrome:
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Presents with:
- docility - lack of fear response - anterograde amnesia - hyperphagia - hypersexuality |
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Pick's disease:
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- form of dementia
- frontotermporal lobes are atrophied |
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Arnold-Chiari syndrome:
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- hydrocephalus
- cerebellar anatomic & functional abnL-ties |
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Punchdrunk syndrome:
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- acquired movement disorder
- associated with traumatic damage to the substantia nigra |
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Mobius syndrome:
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- congenital absence of the facial nerves and nuclei with resulting B/L facial paralysis
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amygdala damage results in:
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Kluver-Bucy syndrome
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hippocampus associated with:
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- short-term memory
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superior temporal gyri is associated with:
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- processing complex auditory information
- eg. understanding of language |
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Missing 3 consecutive periods:
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- anorexia nervosa
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Levels of biological hormones in anorexia:
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- increased BUN
- increased serum growth hormone - no change in TSH responsiveness to TRH - anemia |
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In major depression, what % of pts do NOT have blunted cortisol levels to a dexamethasone suppression test?
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50%
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In MDD, what % of patients do NOT show an increase of TSH with administration of TRH?
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30%
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What amt of methadone is needed in most addicts to experience a sufficient decrease of their cravings?
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> 60 mg/day
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What lab findings are elevated in alcoholics?
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- GGT
- AST/ALT ratio - uric acid levels - serum TGs - also can have macrocytic anemia |
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What is the best treatment for borderline personality disorder?
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- psychotherapy
- antidepressants, neuroleptics, and moo stabilizers have been shown to have some efficacy in treating TARGET Sxs |
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What is first-line pharmacotherapy for OCD?
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- fluvoxamine and other SSRIs (paroxetine, fluoxetine, sertraline)
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What % pts with depression respond to placebo effect?
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~30%
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What % of pts with depression respond to SSRI and TCAs?
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~65-75%
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Best studied psychotherapy for panic disorder?
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CBT
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1st line Rx for panic disorder with or without agoraphobia?
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SSRIs
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Best studied psychotherapy for MDD?
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interpersonal therapy - addresses relationships as a contributor of depression
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What is the purpose of supportive psychotherapy?
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- to strengthen a patient's defense mechanisms in order to return them to a previous level of functioning
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Specific therapy for PTSD?
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EMDR: eye movement desensitization and reprocessing
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Risk of completed suicide in MDD?
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10-15%
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Rx for narcolepsy?
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methylphenidate
[Ritalin] |
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Mean age of onset of Bipolar disorder:
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30
Range: childhood - 50 yrs |
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Left middle cerebral artery stroke associated with:
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depression
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Right middle cerebral artery stroke associated with:
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euphoria, inappropriate indifference, or mania
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Diffuse B/L frontal injury associated with:
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obsessive-compulsive behaviors
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What % of impotence in the age group btwn 30-50 y.o. have a psychological etiology?
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90%
After 50 y.o., the etiology becomes increasingly medically related. |
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What NT is shown to be lower in the CSF in patients with impulsivity, violence, or aggression?
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serotonin metabolite
(5-hydroxyindole acetic acid) 5-HIAA |
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% of children who suffer from schizophrenia if:
- 1 parent has schizophrenia - both parents have schizophrenia |
1 parent = children 12%
both parents = children 40% |
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Of all identical twin siblings with schizophrenia, about how many of their twins also have schizophrenia?
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50%
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OCD causes increased activity in what part of the brain?
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- caudate nucleus
- frontal lobes - cingulum *these changes are reversed after adequate pharmacologic or behavioral therapy |
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anomia:
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- inability to name objects outside of aphasia
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alexia
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- inability to read
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apraxia
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- inability to perform previously learned motor skills
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paralinguistic components of speech
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- refers to nonverbal communications such as facial expression and body movements
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prosopagnosia
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- inability to recognize faces despite perception of all the components
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neurovegetative signs
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- physiologic aspects of depression
- eg. changes in sleep, bowel habits, weight |
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sexual sadism
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- derivation of sexual pleasure from CAUSING mental or physical pain
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sexual masochism
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- derivation of sexual pleasure from RECEIVING mental or physical pain
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Koro
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- South and East Asians
- worry that the penis is shrinking into the abdomen |
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Zar
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- delusional possession by a spirit
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Taijin Kyofusho
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- belief that one's body is offensive to others
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Schizophrenic changes in the brain include:
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- decreased hippocampus, parahippocampal gyrus and amygdala
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ideas of reference
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- the delusion that others are focusing on you in some positive or negative way
- commonly seen in paranoid schizophrenia |
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loss of ego boundaries is commonly manifested as:
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- inappropriate conversational distance
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prodromal schizophrenia:
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- increasing negative Sxs in the absence of positive Sxs
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Sxs associated with schizophrenia NOT included in Dx-tic criteria:
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- short-term memory deficits
- unstable smooth-pursuit eye movements - decreased ability to habituate to repeated sensory stimuli (sensory gating abnL-ties) |
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Factors that increase risk for completed suicide:
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- white race
- male gender - older age - single/divorced - Protestant or Jewish religion |
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localized amnesia
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- memory loss surrounding a discrete period of time
- typically occurs after a traumatic event |
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continuous amnesia
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- memory loss of all events following a trauma, except for the immediate past
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Abnormal sleep patterns in depression include:
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- increased sleep latency (difficulty falling asleep)
- early morning awakening - increased wakefulness - REM sleep redistributed so most of it occurs in first half of the night - REM latency (period of time btwn falling asleep and starting REM sleep) decreases |
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Narcolepsy tetrad:
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- hypersomnia
- cataplexy (transient loss of motor tone associated with strong emotions) - sleep paralysis - hypnagogic hallucinations (occurs in wake to sleep transition) |
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catalepsy
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- state of immobility sometimes seen in catatonic states
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Doppelganger
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- belief in the existence of an identical counterpart
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Cacodemonomania
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- delusion of being poisoned by an evil spirit
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Fregoli syndrome
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- delusion that a person is taking the form of a number of people or creatures
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haptic hallucination:
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- a tactile hallucination in which one feels as if he is being touched, for example, by a phantom
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synesthesia
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- secondary sensation following an actual perception
- eg. the sensation of a color associated with taste - usually 2/2 neurologic dz or hallucinogen use (most notably LSD/acid) |
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derealization
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- sense that one's surroundings are strange or unreal
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depersonalization
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- the feeling that one's identity is lost or the feeling of being unreal or strange
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dereism
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- simple mental activity not in accordance with reality
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anterograde amnesia
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- loss of immediate or short-term memory
- pts are unable to form NEW memories |
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retrograde amnesia
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- loss of remote or previously formed memories
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astereognosis
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- inability to recognize an object by touch despite the tactile sensations being intact
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logorrhea
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- uncontrollable or excessive talking
- sometimes seen in mania |
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derailment
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- refers to abrupt interruption of an idea and then resuming after a period of time (a few seconds) to a new topic
- usually WITHOUT the patient being aware of the switch |
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illusion
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- misperception of an actual stimulus
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hallucination
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- perception in the absence of a stimulus
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micropsia
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- misperception of objects being smaller than they really are
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macropsia
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- misperception of objects being larger than they really are
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palinopsia
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- persistence of the visual image after the stimulus has been removed
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serotonin is produced in:
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- raphe nucleus of brain stem
(dorsal and medial) |
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dopamine is produced in:
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- substantia nigra
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NE is produced in:
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- locus ceruleus
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locus ceruleus is the:
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- "alarm" center of the brain
- hyperactive in anxiety states - center of most of the NE-containing neurons in the brain |
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hippocampus
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- part of limbic system
- memory |
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amygdala
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- emotional coding
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mammillary bodies
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- smells that contribute to a memory
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thalamus
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- the brain's relay center
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basal ganglia
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- coordinates motor activity
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normal pressure hydrocephalus triad includes:
CT changes include: |
1. confusion
2. gait ataxia 3. incontinence CT changes: - dilated ventricles |
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frontal sulcal widening is found in:
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- dementias that have underlying cerebral atrophy
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hypointensities found in sub-cortical areas are often indicative of:
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- lacunar strokes
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cerebellar atrophy is seen most often in:
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- congenital disorders
- alcoholism |
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MAOIs should not be used in conjunction with:
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- SSRIs
- TCAs - buspirone [BuSpar] - velafaxine [Effexor] |
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The psychiatric disorder that carries the greatest risk for suicide in both men and women:
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#1 is mood disorder
THEN: - alcohol dependency - schizophrenic |
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Most predictive factor of suicide risk:
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#1 is age 45 or greater
THEN: 2. alcohol dependence 3. rage or violence 4. prior suicidal behavior 5. male gender |
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Common iatrogenic cause of reversible psychiatric Sxs such as depression and psychosis:
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- glucocorticoids
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Hamilton
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- Depression Scale
- measure of depressive Sxs |
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Rorschach Test
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- projective test using inkblots
Measures: - perceptual accuracy - reality testing - integration of affective and intellectual functioning |
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dementia praecox
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- early term for schizophrenia
- coined by Kraeplin |
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dyscalculia:
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- difficulty with simple arithmetic
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verbigeration
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- repetitive and meaningless talking
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dysarthria
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- difficulty with articulation
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glossolalia
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- ability to speak a new language suddenly
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flight of ideas
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- represents a change of direction every sentence or two with identifiable connections or associations tying them together
- often Sx of manic behavior and reflects underlying racing thoughts |
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loosening of associations
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- lack of logical connections between ideas, but sentence structure remains intact
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tangential thought
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- never comes to the point, but remains logically connected and can be folloed
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circumstantial thought
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- finally reaches a point after much unnecessary detail and digressions
- can be seen in disorders such as OCD, but can also be seen in normal people |