Neuro Part 10

Front 1

features of Prefrontal Lobe Syndrome:

(3)

Back 1

1. disinhibition

2. return of immature reflexes

3. perseveration

Front 2

Reward Circuit =

Back 2

DOPA-activated brain network active in pleasure-seeking and addiction

Front 3

Biogenic Amine Neurotransmitters =

Back 3

Monoamines

e.g. DOPA, NOR, SER, ACH

Front 4

Monoamine Theory of Mood Disorder =

Back 4

Hypothesis that mood problems are related to imbalances in the monoamines

Front 5

DOPA is involved in:

(6)

Back 5

1. Parkinsonism

2. mood

3. fear

4. pleasure

5. addiction

6. schizophrenia

Front 6

Schizophrenia can have both Positive and Negative symptoms; Positive symptoms include:

(2)

Back 6

hallucinations and delusions

(additions to nl experience)

Front 7

Negative symptoms of Schizophrenia include:

(2)

Back 7

restricted emotional range or affect

Front 8

NOR is involved in:

(5)

Back 8

1. mood

2. anxiety

3. arousal

4. learning

5. memory

Front 9

SER (an Indolamine) is involved in:

(6)

Back 9

1. mood

2. sleep

3. pain

4. appetite

5. sexual drive

6. impulse regulation

Front 10

in the brain, ACH (an Amine) is involved in:

(3)

Back 10

1. behavior

2. mood

3. cognitive function

Front 11

Choline Acetyltransferase = enzyme involved in:

Back 11

synthesis of ACH

Front 12

GABA is an AA NT important for _____________________________________ and is related to _______________

Back 12

inhibition of neuronal firing;

anxiety

Front 13

Enkephalins and Endorphins are both:

Back 13

endogenous opioid cmpds of the brain

Front 14

4 features of Panic Disorder:

Back 14

1. episodic attacks of sudden-onset, intense anxiety

2. usually <30 minutes

3. associated with **cardiac or respiratory symptoms and fear of impending death**

4. can occur with agoraphobia

Front 15

the Folstein Mini-Mental State Exam is used at the bedside to follow:

(2)

Back 15

1. improvement or

2. deterioration

of cognitive function in patients with suspected neurological dysfunction such as delirium or dementia.

Front 16

features of REM sleep:

(4)

Back 16

1. fast eye movements

2. atonia

3. low-amplitude, high-frequency brain waves

4. suppression of sympathetic activity as shown by miosis (pupil constriction), and penile and clitoral erection.

Front 17

Stage 1 Sleep is characterized by:

(2)

Back 17

1. low-voltage *theta* wave activity at 3 to 7 cps.

2. Quickly changes to the next stage

(alpha and Beta waves ~~ awake)

Front 18

features of Stage 2 Sleep:

(4)

Back 18

1. spindle-shaped waves at 12 to 14 cps

2. slow, high-amplitude groups of waves called K-complexes.

3. It makes up 45% of sleep time in young adults, more than any other one stage.

4. associated with bruxism

Front 19

Bruxism =

Back 19

Tooth Grinding

- usually during stage 2 sleep

- a chronic condition that can lead to tooth and gum problems, jaw pain, and HA

Front 20

Stage 3 and 4 sleep:

(4)

Back 20

1. collectively known as slow-wave or DELTA sleep

2. high-voltage delta waves at 1 to 3 cps

3. takes up about 25% of sleep time

4. Delta is the deepest part of NREM sleep and can be associated with unusual behavioral characteristics such as somnambulism, enuresis, and night terrors.

Front 21

Sleepwalking occurs during:

(+ 3 facts)

Back 21

**DELTA sleep (3 or 4)**

- no memory
- begins in childhood
- has a genetic component

Front 22

features of Sleep Terror Disorder (Night Terrors):

(3)

Back 22

1. **cannot be awakened**

2. NO memory of having a dream.

3. occurs during DELTA (slow-wave) sleep.

Front 23

REM Latency =

Back 23

time to the first REM period after falling asleep; average is 90 minutes

Front 24

REM Sleep Behavior Disorder (RBD)

Back 24

Rare condition that includes episodes of REM **without** muscle atonia. The resulting physical activity associated with dreaming or nightmares can lead the patient with this disorder to harm himself or his sleep partner during REM sleep

Front 25

Sleep Architecture

Back 25

Structure of a night's sleep including five to six cycles of NREM sleep followed by a REM period. Each cycle takes about 90 minutes.

Front 26

Fatal Familial Insomnia, due to PrP(B) accum, =>

Back 26

degeneration of the thalamus (nec. for arousal and consciousness)
=> complete inability to sleep
=> dementia

- fatal within 1 to 2 years

Front 27

Dyssomnias =

Back 27

problems in the **timing, quality, or amount of sleep**

- they include insomnia, breathing-related sleep disorder, narcolepsy, and hypersomnias.

Front 28

Parasomnias =

Back 28

abnormalities in **physiology or behavior associated with sleep**

- include bruxism, nightmare disorder, sleep terror disorder, sleepwalking disorder, and RBD

Front 29

to diagnose insomnia, difficulty sleeping must be present for:

to diagnose narcolepsy, episodes must occur:

Back 29

at least 1 month


DAILY, for at least 3 months

Front 30

Primary Hypersomnias =

(3)

(Klein-Levin and Menstrual-Associated Syndromes)

Back 30

1. Recurrent bouts of excessive sleepiness occurring almost daily for at least 1 month

2. Sleepiness is not relieved by daytime naps

3. Often accompanied by hyperphagia (overeating)

Front 31

Circadian Rhythm Sleep Disorder

Back 31

• Sleepiness at inappropriate times during the day because of inability to sleep at appropriate times

• Delayed sleep phase type involves falling asleep and waking later than desired

• Jet lag type lasts 2-7 days after a change in time zones

• Shift work type involves changes in scheduled work hours that cause mixed insomnia and sleepiness, leading to errors in performance at work and home

Front 32

3 features of Restless Leg syndrome:

Back 32

1. => frequent motion and insomnia

2. **more common with aging, pregnancy, and kidney disease**

3. ~~ DOPA deficiency

Front 33

Central Sleep Apnea ~~

Back 33

airway is open but ***NO respiratory effort***
(more common in the elderly)

Front 34

Obstructive Sleep Apnea

Back 34

m.c. SA where respiratory effort occurs, but **airway obstruction** prevents air from reaching the lungs

~~ middle-aged, male (8:1), obese

Front 35

Pickwickian Syndrome

Back 35

SA-related condition in which *daytime sleepiness results from airway obstruction.* It is seen primarily in people who have central obesity and a short, fat neck, a body habitus that leads to mechanical obstruction of diaphragmatic movement

Front 36

Continuous Positive Airway Pressure (CPAP) keeps:

Back 36

the airway open

Front 37

Hypnagogic means:

Back 37

Upon falling asleep

Front 38

Hypnopompic means:

Back 38

Upon awakening

Front 39

Cataplexy =

Back 39

sudden physical collapse caused by the loss of all muscle tone after a strong emotional stimulus, such as anger, laughter, or sexual stimulation.

Front 40

Sleep Paralysis =

Back 40

inability to move the body for a few seconds after waking

Front 41

features of Generalized Anxiety Disorder (GAD):

(3)

Back 41

1. persistent symptoms of anxiety, including hyperarousal and excessive worrying

2. over at least a **6-month period**

3. CANNOT be related to a specific person or situation

Front 42

features of PTSD:

(5)

Back 42

1. anxiety

2. re-experiencing

3. hyperarousal

4. emotional numbing

5. avoidance

Front 43

Acute Stress Disorder (ASD) =

Back 43

PTSD symptoms lasting <4 weeks

Front 44

Obsession =

Back 44

Recurrent, unwanted, intrusive, negative feelings, thoughts, and images

Front 45

Compulsion =

Back 45

Nonpleasurable, nonsatisfying, repetitive actions which relieve anxiety associated with obsessions

Front 46

Hyperarousal symptoms:

(4)

Back 46

1. anxiety

2. increased startle response

3. impaired sleep

4. hypervigilance (e.g., jumping at every sound).

Front 47

Cognitive-behavioral therapy

Back 47

Attempts to identify and then change problematic cognitions

Front 48

Systematic desensitization = treatment of phobias which involves:

Back 48

exposure to *increasing doses* of fear-provoking stimulus while pairing it with a relaxing stimulus

Front 49

Flooding =

Back 49

direct exposure to actual fear stimulus while preventing avoidance/escape behaviors

Front 50

treatment for insomnia:

(4)

Back 50

1. sleep routine

2. exercise

3. anti-histamines

4. short (2-week) course of Benzo

Front 51

treatment for narcolepsy:

(1)

Back 51

a CNS stimulant like methylphenidate

Front 52

management of SA:

(2)

Back 52

1. wt loss

2. CPAP

Front 53

Benzo's end in:

(2)

Back 53

"-zolam",

"-zepam"

Front 54

mechanism of Benzo's:

Back 54

GABA r' enhancers

(sedation-hypnotics)

Front 55

indications for Benzo's:

(6)

Back 55

1. anxiety disorder

2. panic disorder

3. insomnia (short-term)

4. status epilepticus (anticonvulsant)

5. alcohol withdrawal

6. pre-anesthetic

Front 56

common/mild SE's of Benzo's:

(4)

Back 56

1. drowsiness

2. memory impairment

3. dec. coordination

4. **somnolence (near-sleep)**

Front 57

severe SE's of Benzo's:

(4)

Back 57

1. pot. for abuse/addiction

2. respiratory depression

3. neonatal toxicity/withdrawal

4. teratogen (cleft lip)

Front 58

Interactions of Benzo's:

(4)

Back 58

1. H met.

2. Clonazepam and Diazapam have a longer half-life and LOWER potency

3. others are the inverse

4. L.O.T. (loraze-, oxaze-, and temazepam) DON'T req. H metabolism, have NO active metabolites, and are short-acting
=> use in elderly/liver dz pts

Front 59

Benzo's are contraindicated in:

(3)

Back 59

1. SA

2. narrow-angle glaucoma

3. respiratory insufficiency

Front 60

precaution with Benzo's: abrupt discontinuation =>

Back 60

withdrawal, active or history of alcohol abuse

=> addiction, co-administration with other CNS depressants

=> respiratory depression

Front 61

Buspirone =

used to treat: [2]

Back 61

SER (5-HT1A) r' *partial agonist*

- used to treat GAD, chronic anxiety

(INeffective for acute anxiety)

Front 62

SE's of Buspirone =

(3)

Back 62

1. dizziness

2. drowsiness

3. HA's

Front 63

Busiporone interactions:

(3)

Back 63

1. H met.

2. oral admin

3. dosing is BID

Front 64

Flumazenil =

Back 64

potent Benzo antagonist that reverses Benzo effects on the CNS

Front 65

features of Flumazenil:

(3)

Back 65

1. competitively inhibits Benzo on GABA-A r's

2. used for Benzo OD or toxicity

3. carries risk of ppt'd an abrupt Benzo withdrawal
(=> sez's)

Front 66

3 non-Benzo hypnotics:

Back 66

1. Zolpidem

2. Zaleplon

3. Eszopiclone

Front 67

non-Benzo hypnotics' mechanism:

Back 67

GABA-r' agonists that bind at Benzo's binding site

Front 68

1 indication for non-Benzo hypnotics:

Back 68

short-term insomnia

Front 69

SE's of non-Benzo hypnotics:

(4)

Back 69

1. drowsiness

2. *unsteady gait*

3. **rebound insomnia**

4. memory impairment

Front 70

metabolism of non-Benzo hypnotics:

(2)

Back 70

1. by p450
=> affected by inducers/inhibitors of p450

2. but don't affect other enzymes themselves

Front 71

Ramelteon =

Back 71

melatonin r' agonist

(m1 and m2 specifically, in the suprachiasmatic nucleus of the hypothalamus)

- no abuse pot.

Front 72

indication for Ramelteon =

Back 72

sleep-onset insomnia

(insomnia strikes when you try to fall asleep at the beginning of the night)

Front 73

SE's of Ramelteon =

(4)

Back 73

1. nausea

2. dizziness

3. HA

4. fatigue

Front 74

stimulated amygdala =>

Back 74

anger/aggression,

fear/anxiety

Front 75

Kluver-Bucy syndrome = loss of BOTH amygdalas =>

(3)

Back 75

1. disinhibited behavior

2. hypersexuality

3. hyperorality (excessive compulsion to put something in mouth)

Front 76

the hypothalamus regulates:

Back 76

the ANS

(fight/flight, rest/digest)

Front 77

4 types of "sedative-hypnotics" :

Back 77

1. Benzo's

2. Barbs

3. sedating antihistamines

4. non-Benzo hypnotics

Front 78

Non-Benzo hypnotics offer less tolerance/dependence than Benzo's but they lack _________________________________________________ that Benzo's offer

(3)

Back 78

they lack the anxiolytic, anticonvulsant, and muscle-relaxant properties that Benzos offer

Front 79

anxiety disorders (except for PTSD) don’t occur __________________

Back 79

after 35

Front 80

psychosis =

Back 80

alterations in sensory perceptions, such as hallucinations,

and abnormalities in thought processes, such as delusions

Front 81

reality testing =

Back 81

process by which an individual determines what is real and what is imagined.

- impairment in this process manifests as psychosis

Front 82

Hallucination =

Back 82

False perception

Front 83

Delusions =

Back 83

False belief

Front 84

Flattened Affect =

Back 84

Lack of appropriate display of mood variations

Front 85

during a Prodromal Phase, the patient:

Back 85

avoids social activities and is quiet and passive

- occurs BEFORE the first psychotic episode

Front 86

during the Psychotic/Active Phase, the patient:

Back 86

loses touch with reality.

- This loss is commonly assoc. w/ +symptoms such as hallucinations and delusions

Front 87

excessive DOPA activity =>

Back 87

positive symptoms of schizophrenia

(DOPA Hypothesis)

Front 88

Thought Blocking =

Back 88

abrupt halt in the train of thinking, *often because of hallucinations*

Front 89

Word Salad =

Back 89

uttering unrelated combos of words or phrases

Front 90

Perseveration =

Back 90

Repeating the same word or phrase over and over

Front 91

Loose Associations =

Back 91

Loss of logical meaning between words or thoughts

Front 92

echolalia =

Back 92

repeating the speaker's words exactly

Front 93

alogia/poverty of speech =

Back 93

lack of the informative content typically seen in normal speech

Front 94

magical thinking =

Back 94

the idea that thoughts cause or prevent external events from happening

Front 95

ideas of reference =

Back 95

false conviction that one is the subject of attn.

Front 96

3 features of Psychotic Disorder caused by general Medical Condition (PDMC)

Back 96

1. Hallucinations that are *visual* and original from the ones before
(rather than auditory and recurrent)

2. Occurs in the context of an acute medical illness

3. Symptoms NOT due to delirium or dementia

Front 97

features of Brief Psychotic Disorder:

(2)

Back 97

1. psychotic and residual symptoms b/w 1 day and 1 month

2. ~~precipitating psychosocial factors (e.g., job loss)

Front 98

Paranoid Subtype of Schizophrenia ~~

(3)

Back 98

1. persecution

2. older age of onset

3. better-functioning than other subtypes

Front 99

Schizophreniform Disorder:

(2)

Back 99

1. Schizophrenic symptoms lasting ***<6 months***
(at 6 mths+, it's Schizophrenia)

2. cognitive functions are relatively intact, despite significant impairment in thought form, content, and mood

Front 100

Schizoaffective Disorder =

(4)

Back 100

1. ****fits criteria for both a mood disorder and schizophrenia
(depression = mood disorder)****

2. psychotic symptoms present for at least 2 weeks without mood symptoms

3. chronic social and occupational impairment (though less than in schizophrenia)

4. "this celebrity loves me" - includes hearing voices

Front 101

Undifferentiated Schizophrenia ~~

(2)

Back 101

1. characteristics of more than one subtype

2. voices in head

Front 102

signs of Schizotypal personality disorder:

(3)

Back 102

1. = Schizophrenia LITE:

2. bizarre behavior and odd thought patterns

but

3. Negative symptoms only - NO hallucinations or delusions

Front 103

features of Undifferentiated Schizophrenia:

(5)

Back 103

1. insidious onset

2. prominent thought disorder

3. hallucinations

4. marked functional impairment

5. social isolation before onset

Front 104

symps of Disorganized Schizophrenia:

(6)

Back 104

1. ***onset before 25 years of age***

2. Incoherent speech

3. mirror gazing

4. facial grimacing

5. poor grooming

6. inappropriate emotional responses (silliness)

Front 105

signs of Borderline Personality Disorder:

(4)

Back 105

1. extreme mood swings

2. uncontrollable anger

3. episodic suicidal thoughts

4. transient episodes of paranoia

Front 106

Delusional Disorder =

(2 parts)

Back 106

1. delusional system ***present for at least 1 month***

2. absence of other thought disorders

Front 107

Substance-Induced Psychotic Disorder ~~

(2)

Back 107

1. **prominent** hallucinations (often visual or tactile) or delusions

2. use OR withdrawal

Front 108

First-generation (typical) antipsychotics:

(3)

Back 108

1. Haloperidol – HIGH potency

2. Perphenazine – MID potency

3. Chlorpromazine – LOW potency

Front 109

mechanism of first-gen antipsychotics:

Back 109

**HIGH affinity** D2 r' antagonists

Front 110

Second-generation (atypical) antipsychotics:

(6)

Back 110

1. Aripiprazole

2.Clozapine

3. Olanzapine

4. Quetiapine

5. Risperidone

6. Ziprasidone

Front 111

mech. of second-gen (atypical) antipsychotics:

(2)

Back 111

slightly weaker D2 r' antagonists

and

STRONG 5HT-2α r' antagonists

Front 112

indications for ALL anti-psychotics (first AND second-gen):

(2)

Back 112

1. schizophrenia

2. other psychoses (secondary to mood disorders, delirium, and intoxication)

Front 113

wrt antipsychotic efficacy, first and second-gen antipsychotics are just about the same, except for Clozapine, which is consistently:

(3)

Back 113

1. more efficacious for schizophrenia

and

2. ***lacks extrapyramidal SE's***

but

3. mainly used *for refractory schizophrenia* b/c of its potentially life-threatening side effect (agranulocytosis)

Front 114

general SE's of antipsychotics:

(2)

Back 114

1. inc. risk of torsades (due to inc. QT interval)

2. inc. rate of death in elderly patients with dementia-related psychosis.

Front 115

SE's continued: low-potency antipsychotics =>

(1 => 6)

Back 115

anticholinergic SE's:

1. blurred vision

2. constipation

3. dry mouth

4. orthostatic hypotension

5. sedation

6. urinary retention

Front 116

HIGH-potency antipsychotics =>

(class of SE's)

Back 116

dopaminergic antagonism

=> extrapyramidal symptoms (see below)

Front 117

4 extrapyramidal symptoms of HIGH-potency antipsychotics:

Back 117

1. acute dystonia

2. akathisia (feeling of inner restlessness that manifests internal and externally)

3. Parkinsonism

4. Tardive dyskinesia (develops after 6+ months as a result of chronic D2 blockade)

Front 118

other effects of DOPA blockage:

(4)

Back 118

1. hyperprolactinemia
(esp. Haloperidol and Risperidone

2. metabolic syndrome
(second-gen)

3. insulin resistance and dyslipidemia
(second-gen)
(independent of the associated weight gain)

4. Neuroleptic Malignant Syndrome
(rare but potentially fatal)

Front 119

hyperprolactinemia =>

(3)

Back 119

1. osteoporosis

2. amenorrhea

3. gynecomastia

Front 120

metabolic syndrome =>

(4)

Back 120

1. weight gain

2. diabetes

3. hyperlipidemia

4. HTN

Front 121

signs of Neuroleptic Malignant Syndrome:

(6)

Back 121

1. confusion

2. vital sign instability

3. extreme hyperthermia

4. rhabdomyolysis

5. renal failure

6. CV collapse

Front 122

NMS is like MH except induced by antipsychotics; treated with:

Back 122

Dantrolene

Front 123

interactions of antipsychotics:

Back 123

H met

Front 124

Second-gen agents are generally prescribed as the first-line agents for psychosis in order to lessen the risk of EPS, though they do carry the risk of metabolic syndrome.

Back 124

Among the second-generation agents, clozapine is both high-risk (agranulocytosis, metabolic side effects, myocarditis) and high-reward (higher efficacy, low risk of EPS).

Front 125

A strong association exists between the negative symptoms in schizophrenia and:

Back 125

abnormalities of the prefrontal cortex

Front 126

affect =

Back 126

feeling or emotion