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56 Cards in this Set

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Alcohol withdrawal
specifically delirium tremens, characterized in this patient by delirium with visual hallucinations, impaired alertness and attention, coarse tremor, tachycardia and hypertension. Cocaine withdrawal is characterized by sad mood; fatigue, increased appetite; insomnia or hypersomnia and vivid unpleasant dreams.
Amphetamine intoxication
is characterized by euphoria; hypervigilance; mistrust; stereotypies; delirium; anxiety; agitation; irritability; pupillary dilation; fever; blood pressure changes (tachycardia or bradycardia); nausea or vomiting; evidence of weight loss; arrhythmias; seizures; or coma.
Opiate intoxication
characterized by euphoria, sedation, analgesia with risk of burns (e.g., cigarette burns), and pupillary constriction (pupillary dilation occurs with severe overdose), and a risk of respiratory depression and death.
Benzodiazepine
characterized by disinhibition, slurred speech, incoordination, unsteady gait, nystagmus, drowsiness, impaired memory and, if severe, stupor or coma.
Opiate withdrawal
characterized in this patient by aches and pains, lacrimation, rhinorrhea, and piloerection. Other signs can include papillary dilatation, diarrhea, yawning, fever and insomnia
Cocaine intoxication
can include euphoria, stereotypies, delirium, papillary dilatation, hyper- or hypotension, perspiration, nausea or vomiting, evidence of weight loss; chest pain; myocardial infarction; cardiac arrhythmia; stroke; placental abruption and seizures.
Benzodiazepine withdrawal
include anxiety and agitation, tremor, insomnia, hallucinations or illusions, nausea or vomiting and seizures
Anticholinergic toxicity
characterized by the expression “red as a beet (skin flushing), dry as a bone (dry mucous membranes); blind as a bat (impaired accommodation) and mad as a hatter (delirium).”
Sedative-hypnotic intoxication
characterized in his case by disinhibition, combativeness, ataxia, slurred speech and impaired memory. In severe cases, stupor or coma can occur.
Amphetamine withdrawal
characterized by fatigue, insomnia or hypersomnia, increased appetite and vivid unpleasant dreams
Neuroleptic side effects
include (neurologic and neuromuscular effects) dystonia, Parkinsonism, akinesia, tardive dyskinesia, neuroleptic malignant syndrome, drowsiness; catatonia, delirium, (endocrine and metabolic effects) weight gain, diabetes, lactation, amenorrhea, agranulocytosis, seizures, postural hypotension; (anticholinergic effects) dry mouth and other mucous membranes, urinary retention, constipation and sexual dysfunction; and the hyposerotonergic effect of obsessions and compulsions.
Inhalant intoxication
characterized in his case by disinhibition, dizziness, reduced concentration, delirium, visual hallucinations, injected conjunctivae, a red perioral rash from “huffing,” a funny breath odor and tremor. Other symptoms include dizziness, nystagmus, incoordination, slurred speech, ataxia, lethargy, hyporeflexia, psychomotor slowing, tremor, muscle weakness, blurred vision or diplopia, and euphoria, stupor or coma.
Marijuana intoxication
characterized by euphoria, sensation of slowed time, reduced attentiveness, conjunctival injection, increased appetite with craving for sweets, dry mouth, tachycardia and, occasionally, hallucinations.
Lysergic acid diethylamide(LSD) intoxication
characterized by euphoria, anxiety, hallucinations including kaleidoscopic hallucinations, illusions, distortions including dysmegalopsia and synesthesias, pupillary dilation, tachycardia, sweating, palpitations, blurred vision, tremors or incoordination
Cocaine withdrawal
characterized by sad mood; fatigue, increased appetite; insomnia or hypersomnia and vivid unpleasant dreams
Alcohol intoxication
characterized by euphoria, incoordination, slurred speech, sedation, ataxia, nystagmus, impaired memory and, in severe cases, respiratory depression and death.
Tourette’s disorder (GTD)
Five to seven is the modal onset age of GTD. This patient’s GTD signs are motor and vocal tics, with no choreiform movements
Huntington’s disease
presents with rigidity, dystonia, dementia (actually, mental retardation) or mood disorder. Choreiform movements are rare in children with Huntington’s
Wilson’s disease
typically begins at age 16 and is characterized by dementia, cirrhosis, corneal Kayser-Fleischer rings, rigidity, akinesia, dystonia and wing-beating tremor—a coarse tremor centering on the shoulders in which patients move their arms as though they were trying to fly.
Parkinson’s disease
begin before 21 but that is extremely rare
juvenile variants
Huntington’s, Wilson’s and Parkinson’s diseases have very rare juvenile variants
Attention deficit hyperactivity disorder
characterized by being unable to sit still and talking out of turn, but it is not associated with tics unless a tic disorder patient also has ADHD
The disorder responds to dopaminergic antagonists
Tourette’s disorder (GTD
like neuroleptics or clonidine, an alpha-2 adrenergic agonist that inhibits pre-synaptic norepinephrine release and decreases activity of locus ceruleus projections to the corpus callosum. Monozygotic exceeds dizygotic concordance. CSF homovanilic acid is decreased. X-linked recessive transmission is improbable, but autosomal dominant inheritance is possible. Thirty to 60% of GTD patients have OCD.
Sydenham’s chorea
characterized in this case by dysarthric speech, choreiform movements, clumsy gait and dropping objects.
Schizophrenia
characterized by formal thought disorder, first rank symptoms, emotional blunting and, early in the course, hallucinations or delusions.
Obsessive compulsive personality disorder
characterized by preoccupation with orderliness, perfectionism and mental and interpersonal control.
Huntington’s disease
characterized by choreoathetosis, dementia or other cognitive dysfunction, and atypical mood disorders.
PANDAS
(Pediatric autoimmune neurologic disorder associated with streptococcal infection) with a history of untreated sore throat caused by streptococcal infection.
Neuroleptic induced movement disorder
diagnosed only if the patient took a neuroleptic drug.
Seizure disorder
requires a history of brief episodic abnormal behaviors including impaired consciousness (grand mal, partial complex and absence seizures), involuntary movements (simple partial, partial complex and grand mal), or abnormal perceptions or mood states (simple partial seizures).
Schizoaffective disorder
characterized by episodes of mania or depression during which the patient may also have findings (e.g., formal thought disorder, first rank symptoms, emotional blunting) more typical of schizophrenia than mood disorder and, most important, the patient has had mood-incongruent hallucinations or delusions lasting two or more weeks
Caudate hyperperfusion
OCD
Frontal hypoperfusion
schizophrenia, schizoaffective disorder, bipolar disorder, major depressive episode with melancholic features and attention deficit hyperactivity disorder
Dominant parietal infarction
causes alexia, agraphia, acalculia, finger agnosia, left-right disorientation, ideokinetic dyspraxia, right hand kinesthetic dyspraxia or conduction aphasia.
basal ganglia diseases
Huntington’s disease, Sydenham’s chorea, neuroacanthocytosis, post-encephalitic Parkinson’s disease, manganese toxicity, carbon monoxide toxicity) can present with similar symptoms, although in these conditions the clinical picture is more atypical than in primary OCD.
Secondary OCD
can also be caused by HIV infections, temporal or frontal lobe partial complex seizures, brain tumors, traumatic brain injury, porphyria and neuroleptics that block serotonin.
Histories of gestation, labor and delivery problems
frequent in OCD patients than in the general population. Serotonin plays a large role in the disorder.
Tardive dyskinesia
results from long-term neuroleptic use, particularly but not exclusively atypical neuroleptics.
conversion disorder
a diagnosis that is best avoided clinically, even though it appears on exams
Delusional disorder
characterized by systematized delusions
Dissociative disorder
another diagnosis best avoided clinically even though it appears on exams, is characterized by part of a person’s personality operating independently from the rest of his or her personality
Dopamine antagonists
treatment of choice for GT
Tourette’s disorder
childhood-onset condition characterized by motor and vocal tics
Serotonin reuptake inhibitors
pharmacologic treatment of choice for OCD
Bipolar I disorder
manic episodes with stimulus-bound hyperactivity, irritable mood, rapid speech, racing thoughts, grandiose delusions and hypersexuality; and major depressive episodes, characterized by sustained anxious mood, severe guilt, anhedonia and suicidal thoughts. She never hallucinated or had delusions outside of manic or depressive episodes
Schizoaffective disorder
characterized by one or more periods lasting two weeks or more of hallucinations or delusions not associated with episodes of mania or major depression and, sometimes, signs of schizophrenia (e.g., formal thought disorder, first rank symptoms or emotional blunting) that occur during episodes of mania or major depression.
Schizophrenia
which cannot be diagnosed in the presence of a major mood disorder, is characterized by emotional blunting; formal thought disorder; first rank signs; and, early in the illness, delusions or hallucinations.
Delusional disorder
characterized by systematized delusions in the absence of mood disorder, first rank symptoms, formal thought disorder or emotional blunting.
Cyclothymic disorder
mild variant of bipolar disorder characterized by chronic low-grade mood swings including hypomania or depression, lasting most of the time for at least two years, with well periods not exceeding two months and without any manic or major depressive episodes.
Sensitization
characterized by progressively longer mood disorder episodes and progressively shorter remissions, with progressively less stress—eventually, no stress at all—required to trigger episodes.
Adjustment disorder
characterized by marked distress and impaired social functioning in response to an identifiable stressor, but where symptoms are not severe enough to meet criteria for another disorder. Except for military acute inpatient units, try to avoid diagnosing adjustment disorder because a more severe or chronic disorder is more likely.
bipolar II disorder
the patient has one or more major depressive episodes and one or more hypomanic episodes, but no manic episodes. Bipolar patients have a 10-15% lifetime suicide risk.
Antisocial personality disorder
characterized by childhood conduct disorder followed by lifelong adulthood selfishness; callousness; lack of concern for others; lack of remorse for hurtful behaviors; impulsivity, high novelty seeking and low harm avoidance; law-breaking; inability to maintain a job or marriage; low reward dependence; irritability; fighting or violence; lying or using an alias.
Somatization disorder
characterized by four or more medically-unexplained pain symptoms, two or more medically-unexplained gastrointestinal symptoms other than pain, and one medically-unexplained sexual symptom, one pseudoneurologic symptom, all spread over multiple years with onset before age 30.
Major depressive episode (with melancholic features)
characterized in this case by guilty ruminations, sustained anxiety, anorexia and anhedonia. passive suicidal ideation
Schizoaffective disorder
characterized by mood disorder episodes requiring hospitalization, and a greater-than-two-week period with hallucinations in the absence of mood disorder