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84 Cards in this Set

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IQ tests
Wechsler Adult Intelligence Scale (WAIS) - ages 16-75
Stanford-Binet - ages 2-18
Objective personality test
Minnesota Multiphasic Personality Inventory (MMPI-2)
DSM-IV Schizophrenia
A)Two+ for at least 1 month:
1) Delusions
2) Hallucinations
3) Disorganized speech
4) Grossly disorganized or catatonic behavior
5) Negative symptoms
B) Causes social/occupational deterioration
C) At least six months (incl. prodromal or residual)
D) Not due to medical, neuro, substance
Schizophrenia subtypes
1) Paranoid
2) Disorganized
3) Catatonic
4) Undifferentiated
5) Residual
Criteria for Paranoid Type Schizophrenia
A) Preoccupation with 1+ delusions or frequent AH
B) No predominance of disorganized speech, disorganized or catatonic behavior, or inappropriate affect
Criteria for Disorganized Type Schizophrenia
A) Disorganized speech
B) Disorganized behavior
C) Flat/inappropriate affect
Criteria for Catatonic Type Schizophrenia
At least 2 of:
A) Motor immobility
B) Excessive purposeless motor activity
C) Extreme negativism or mutism
D) Peculiar voluntary movements/posturing
E) Echolalia or echopraxia
Schizophrenia:
1) Monozygotic concordance rate
2) Inheritance w/ 2 parents
3) Inheritance w/ one 1st degree relative
1) 50%
2) 40%
3) 12%
Dopamine pathways
1) Prefrontal cortical - negative sx
2) Mesolimbic - positive sx
3) Tuberoinfundibular - prolactin
4) Nigrostriatal - EPS when blocked
Neurotransmitter abnormalities in schizophrenia (non-dopamine)
1) ↑ serotonin
2) ↑ NE
3) ↓ GABA
Serotonin-antigonizing antipsychotics
risperidone
clozapine
In schizophrenia:
___ sx & ___ onset associated w/ better prognosis; ___ sx & ___ onset w/ worse.
Mood sx & acute onset associated w/ better prognosis; negative sx & gradual onset w/ worse.
SE of high potency neuroleptics
SE of low potency neuroleptics
High: EPS
Low: anticholinergic
EPS SE in order of onset
1) Dystonia
2) Akathisia
3) Parkinsonism
4) Tardive dyskinesia
Tx of EPS (except TD)
Anticholinergics (benztropine, amantadine)
Benzos
Tx of TD
Cholinomimetics
Benzos
Beta-blockers
Most likely to cause NMS
High-potency
Sx of NMS
Confusion
High fever
HTN
Tachycardia
Lead pipe rigidity
Sweating
Elevated CPK
Which antipsychotic can cause irreversible retinal pigmentation?
Clozapine
Which antipsychotic can cause deposits in lens and cornea?
Chlorpromazine
DSM-IV for schizoaffective d/o
A) Meet criteria for MDD, manic episode, or mixed episode, during which criteria for schizophrenia also met
B) Delusions/hall for 2 weeks WITHOUT mood sx
C) Mood sx for substantial portion of psychotic illness
D) Not due to medical condition or drugs
DSM-IV for Major Depressive Episode
A) At least five (incl. 1 or 2) for at least 2 weeks:
1) Depressed mood
2) Anhedonia
3) Change in appetite or weight
4) Worthlessness/guilt
5) Insomnia/hypersomnia
6) ↓ concentration
7) PMA/PMR
8) Fatigue/↓ energy
9) Recurrent thoughts of death/suicide
DSM-IV for Manic Episode
A) At least 1 week of abnormally and persistently elevated, expansive, or irritable mood w/ 3 (4 if irritable):
1) Distractibility
2) Inflated self-esteem/grandiosity
3) ↑ goal-directed activity
4) ↓ need for sleep
5) Flight of ideas/racing thoughts
6) Pressured speech/talkative
7) Risky activites
DSM-IV for Mixed Episode
Criteria met for both manic and major depressive episode, nearly every day for at least 1 week.
Hypomanic Episode
-At least 4 days
-No marked social/occupational impairment
-Does not require hospitalization
-No psychotic features
Sleep problems in MDD
1) Multiple awakenings
2) Initial & terminal insomnia
3) Hypersomnia
4) REM earlier in night
5) ↓ 3&4
Neuroendocrine abnormalities in MDD
1) High cortisol; failure to suppress in dexamethasone suppression test
2) Abnormal thyroid axis; blunted TSH response to TRH
Monozygotic and dizygotic concordance for MDD
50% and 10-25%
DSM-IV for Bipolar I
One manic or mixed episode
Monozygotic and dizygotic concordance for Bipolar I
75% and 5-25%
DSM-IV for Bipolar II
One+ MDE and 1+ hypomanic episode
DSM-IV for Dysthymic Disorder
A) Depressed mood most of the time on most days for at least 2 years (1 in chilren)
B) 2+ of:
1) Poor concentration/decision-making
2) Hopelessness
3) Poor appetite or overeating
4) Insomnia/hypersomnia
5) Low energy/fatigue
6) Low self-esteem
C) During the 2-year period:
1) Not without the sx for >2 months at a time
2) No MDE
DSM-IV for Cyclothymic Disorder
A) Numerous periods w/ hypomanic sx and periods w/ depressive sx for at least 2 years
B) Never sx-free for >2 months
C) No hx of MDE or manic episode
Neurotransmitter changes in anxiety
-↑ NE
-↓ GABA
-↓ serotonin
DSM-IV for panic attacks
Discrete period of intense fear and discomfort with at least 4 of:
-Palpitations
-Sweating
-Shaking
-Shortness of breath
-Choking sensation
-Chest pain
-Nausea
-Light-headedness
-Depersonalization
-Fear of losing control/going crazy
-Fear of dying
-Numbness or tingling
-Chills or hot flushes
DSM-IV for Panic Disorder
1) Spontaneous recurrent panic attacks
2) At least one followed by at least one month of:
-Persistent concern about having further attacks
-Worry about implications of attack
-Significant change in behavior
Pharm tx for Panic Disorder w/w/o Agoraphobia
SSRIs first-line
DSM-IV for Specific and Social Phobias
1) Persistent excessive fear
2) Exposure causes immediate anxiety response
3) Pt recognizes fear is excessive
4) Situation avoided or tolerated w/ intense anxiety
5) If under 18, lasts at least 6 months
Pharm tx for social phobia
Paroxetine, beta-blockers
DSM-IV for OCD
1) Either obsessions or compulsions
2) Pt is aware are unreasonable/excessive
3) Obsessions cause marked distress, are time consuming, or interfere w/ ADLs
Pharm & behavioral tx for OCD
Pharm: SSRIs, clomipramine
Behav: Exposure and response prevention (ERP)
DSM-IV PTSD
-Traumatic, potentially harmful or fatal event; initial reaction intense fear or horror
-Persistent re-experiencing
-Avoidance of stimuli associated w/ the trauma
-Numbing of responsiveness
-Persistent sx of increased arousal
-At least one month
Pharm tx for PTSD
TCAs (imipramine, doxepin); SSRIs; MAOIs; anticonvulsants (for flashbacks and nightmares)
Time lengths in acute stress disorder
Event occurred <1 month ago
Symptoms last <1 month
DSM-IV for GAD
1) Excessive anxiety & worry for at least 6 months
2) Difficult to control the worry
3) At least three of:
-Restlessness
-Fatigue
-Difficulty concentrating
-Irritability
-Muscle tension
-Sleep disturbance
Pharm tx of GAD
Buspirone; short course of benzos (clonazepam, diazepam); SSRIs; venlafaxine ER
DSM-IV of Adjustment Disorder
1) Development of emotional or behavioral sx w/in 3 months of a stressful (not life-threatening) event, producing either
-Severe distress
-Significant impairment in daily fx
2) Sx are not those of bereavement
3) Sx resolve w/in 6 months
DSM-IV for personality d/o
1) Pattern of behavior/inner experience manifested in 2+ of:
-Cognition
-Affect
-Personal relations
-Impulse control
2) The pattern:
-Is pervasive & inflexible in a broad range of situations
-Is stable; onset no later than adolescence/early adulthood
-Causes sig. distress in fx
-Not accounted for otherwise
Cluster A
-Types
-Family assoc
-Types: schizoid, schizotypal, paranoid
-Assoc: psychotic d/os
Cluster B
-Types
-Family assoc
-Types: antisocial, borderline, histrionic, narcissistic
-Assoc: mood d/os
Cluster C
-Types
-Family assoc
-Types: avoidant, dependent, obsessive compulsive
-Assoc: anxiety d/os
DSM-IV for substance abuse
1+ year w/ 1+ of:
1) Failure to fulfill obligations
2) Use in dangerous situations
3) Recurrent substance-related legal problems
4) Continued use despite social or interpersonal problems due to the substance use
DSM-IV for substance dependence
W/in a 12-month period, 3+ of:
1) Tolerance
2) Withdrawal
3) Using more than originally intended
4) Persistent desire or unsuccessful efforts to cut down
5) Significant time spent getting, using or recovering
6) Decreased social, occupational, recreational activities
Legal limit for intoxication in most states
BAL 80-100 mg/dL
Tx of acute EtOH intoxication
1) ABCs, electrolytes & acid-base
2) FSBG
3) Thiamine, naloxone, folate
Pharm tx for EtOH dependence
Disulfiram, SSRIs, naltrexone (reduces cravings)
Tx of EtOH withdrawal
1) Tapering benzo
2) Thiamine, folic acid, MVI
3) MgSulfate for postwithdrawal sz
Sx of Wernicke's encephalopathy
1) Ataxia
2) Confusion
3) Ocular abnormalities (nystagmus, gaze palsies)
Sx of Korsakoff's syndrome
1) Impaired recent memory
2) Anterograde amnesia
3) +/- confabulation
Order of nutrients in Wernicke-Korsakoff
Thiamine BEFORE glucose
Effect of cocaine
Blocks dopamine reuptake
Pharm tx of
-Cocaine intoxication
-Cocaine dependence
-Intox: benzos, Haldol, sx tx
-Dependence: TCAs, dopamine agonists (amantadine, bromocriptine)
-Classic amphetamines
-Substituted ("designer") amphetamines
-Dextroamphetamine (Dexedrine), methylphenidate (Ritalin), methamphetamine (crystal meth)
-MDMA (ecstasy), MDEA (eve)
Effect of
-Classic amphetamines
-Substituted amphetamines
-Release dopamine from nerve endings
-Release dopamine and serotonin from nerve endings; stimulant & hallucinogenic
How long is urine drug screen + after cocaine use?
3 days; longer in heavy users
How long is urine drug screen + after amphetamine use?
1-2 days
Effects of PCP
-Antagonizes NMDA glutamate receptors
-Activates dopaminergic neurons
Drug similar to PCP
Ketamine
Pathognomonic sx of PCP intox
Rotatory nystagmus
How long is urine drug screen + after PCP use, and what else is often elevated?
>1 week; CPK & AST
Effect of
-benzos
-barbiturates
-Increase frequency of Cl channel opening
-Increase duration of Cl channel opening
How long is urine drug screen + after sedative-hypnotic use?
1 week
Tx of barbiturate intoxication
Alkalinize urine w/ sodium bicarb to promote renal excretion
Tx for benzo intoxication
Flumazenil
What is the date rape drug?
GHB (gamma-hydroxybutyrate)
What is dextromethorphan?
An opiate
What can meperidine + MAOIs together cause?
Serotonin syndrome
How long is urine test + after opiate use?
12-36 hours
Sx of opiate withdrawal include
-Dysphoria
-Lacrimation, rhinorrhea
-Yawning
-Piloerection
-Muscle ache
Which opiate does not cause miosis?
Meperidine
How long is urine test + after MJ use?
Up to 4 weeks in heavy users
How long is serum test + after inhalant use?
4-10 hours
Effect of caffeine
-Adenosine antagonist → ↑ cAMP
-Stimulant effect (dopaminergic)
Pharm tx for smoking cessation
Zyban (bupropion), clonidine