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120 Cards in this Set
- Front
- Back
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Which anti-depressants can --> delirium
how to treat this? |
MAOI
IV BZ (lorazepam is a good one, b/c there is a short t 1/2) |
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how many days should you wait to give an SSRI, in a pt that has been previously treated with MAOI?
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14 days
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what is used to treat atypical depression?
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MOAI
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which etoh detox drugs are metabolized by the liver?
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chlordiazepoxide (librim)
diazepam |
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which etoh detox drug is good to give to someone w impaired liver fxn?
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oxazepam (serax)
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what effect do SSRIs have on post-synaptic 5HT-2 receptors?
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downregulates them
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which NSAID does not interfere with lithium metabolism?
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ASA
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what decreases lithium excretion?
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Metronidazole
ACE inhibitors Tetracycline Thiazide diuretics NSAIDS (not ASA) CCBs |
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what increases lithium clearance?
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Theophillline
Acetazolamide Caffeine Osmotic diuresis |
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side effects of lithium?
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nephrogenic DI
hypothyroid leukocytosis tremors acne sedation arrhythmias T wave flattening/inversion |
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What med can exacerbate tics?
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mehtylphenidate
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what is the MOA of treating Tourrette's?
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D2 antagonism (antipsychotics)
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what drugs can be used to treat OCD?
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Clomipramine
Fluvoxamine |
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What decresaes impulsiveness in Borderline PD?
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SSRI (esp fluoxetine)
haloperidol |
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If looking for immediate relief of GAD, what class of meds should be given?
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BZ
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Effect of lithium in pregnancy?
%? |
Ebstien's
7.7% |
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mood stabilizer that has causes fetal abnormalities if given during pregnancy?
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clonazepam
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Whath meds can be given to delirius pts?
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low-dose atypical antipsychotics
low-dose haldol |
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why do atypical antipsychotic meds --> orthostatic hypotension?
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alpha 1 blockade
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What drugs are used to treat PTSD and why?
which drug class is NOT effectve in PTSD? |
Clonidine: to decrease the re-experiencing of PTSD
SSRIs: to reduce the "numbness" associated w PTSD BZ not effective |
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What is the 1st line med for panic d/o?
other drugs to treat panic d/o? |
fluvoxamine
imipramine and phenelzine can also be used, but less desirable d/t side effects |
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which mood stabilizer --> pancreatitis?
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valproic acid
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how long should pts be treated for 1st episode of depression?
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at least 6 mos, usually 8-12 mos to prevent relapse
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how to treat drooling associated with clozapine?
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anti-cholinergic
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how to treat clozapine induced tachycardia?
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propanolol
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which of the atypical anti-psychotics are least likely to increase cholesterol or cause DM?
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aripiprazole
ziprasadone |
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which antidepression is used to treat depression and diabetic neuropathy?
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duloxetine
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what is the most common underlying cause for post-partum psychosis?
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underlying bipolar I d/o
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cortisol levels in MDD?
catecholamine levels? sex hormones? immune fxn? |
incresaed (50% fail dexamethasone suppression test)
decreased decreased decreased |
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which of the psych d/o has the strongest genetic association?
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bipolar I
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manifestations of porypheria?
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mania/psychosis + abdominal pain
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organic changes seen in Kluver-Bucy syndrome
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bilateral damage to amygdala
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what effect does starvation have on:
BUN cortisol TSH response GH |
increased
increased normal increased |
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what is the relationship between MDD and TSH?
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1/3 of pts have no increase in TSH wiht TRH administration
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what is cluster of sx seen in normal pressure hydrocephalus?
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ataxia
confusion incontinence |
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length of time sx need to be present in PTSD?
acute stress d/o? |
>4 wks
<4 wks |
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long term tx for Borderline PD?
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therapy and steady social support
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hwo does insight relate to psychosis?
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if pts have insight into their delusions/hallucinations, etc, they are not psychotic
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what fraction of pts with MDD respond to placebo?
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1/3
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what is the clinical course expected in a schizophrenic not on meds?
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unknown
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in men 30-50 yo, what % of impotence is related to pysiologic reasons?
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10%
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what is the % liklihood of a pt developing schizophrenia if:
1 parent has schizo both parents have schizo MZ twin has schizo |
12%
40% 50% |
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other than +/- sx of schizophrenia, what behavioral can be seen
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short-term memory deficits
unstable smooth eye pursuit can't habituate to repeated stimulus |
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treatment for normal pressure hydrocephalus
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shunt
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delirium + hemiparesis or other focal neuro signs
dx? confirm? |
CVA or mass
brain CT/MRI |
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delirium + elevated BP + papilledema
dx? confirm? |
HTN encephalopathy
brain CT/MRI |
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delirium + dilated pupils and tachycardia
dx? confirm? |
drug intox
urine toxicology screen |
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delirium + fever + nuchal rigidity + photophobia
dx? confirm? |
meningitis
lumbar puncture |
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delirium + tachy + tremor + thyromegaly
dx? confirm? |
thyrotoxicosis
T4, TSH |
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dementia w stepwise increase in severity + focal neuro signs
dx? confirm? |
multi-infarct dementia
CT/MRI |
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dementia + cogwheel rigidity + resting tremor
dx? confirm? |
PArkinson's dz
CT/MRI |
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dementia + ataxia "+ urinary incont + dilated cerebral ventricles
dx? confirm? |
NPH
CT/MRI |
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which, delirium or dementia has EEG changes
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delirium
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dementia + obesity + coarse hair + constipation + cold intolerance
dx? confirm? |
hypothyroid
T4, TSH |
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dementia + tremors + abnormal LFTs + kayser-Fleischer rings
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Wilson's dz
ceruloplasmin |
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Dementia + diminished position/vibration sense + argyll-robertson pupils
dx? confirm? |
neurosyph
CSP VDRL |
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what NT changes are seen in Alzheimer's Dz?
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decreased NE and ACh
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treatement for Alzheimer's Dz
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cholinesterase inhibitors (tacrine, donezepil, rivastigmine)
tx sx as necessary (BZ for anxiety, low dowse anti-psychotics for agitation/psychosis, antidepressants) |
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what is the main difference in presentation between Pick's dz and Alzheimer's dz
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personality changes are more prominent early in the pick's dz, but late in Alzheimer's
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what pathology is seen in pick's dz
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atrophy of fronto-temporal lobe
pick's bodies (intraneuronal bodies, not necessary for dx) |
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pathological changes seen in HD?
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daudate atrophy
cortical atrophy (sometimes) |
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which chromosome is involved in HD
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4q
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what cells are affected in Parkinson's dz
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loss of cells in substantia nigra of basal ganglia --> decreased DA and loss of dopaminergic tracts
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how are MOAIs connected to PArkinsons dz tx?
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MAO-B inhibitors inhibit breakdown of DA
ex - selegiline |
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surgical options for Parkinson's dz
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thalamotomy
pallidotomy |
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what causes cortical dementia
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alzheimer's
pick's CJD (see decline in mental fxn) |
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what causes subcortical dementia
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Huntington's
Parkinson's NPH multi-infarct dementia (see more prominent affective and movement sx) |
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hallmark sx of CJD?
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myoclonus
EPS ataxia LMNS |
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hallmark sx of NPH
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ataxia
incontinence dementia |
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pathologica changes seen in NPH
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enlarged ventricles, increased CSF pressure
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eiology of NPH
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idiopathic
or secondary to obstruction of CSF reabsorption |
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causes of delirium
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Impaired delivery of brain substrates
Metabolic Drug Endocrinopathy Liver dz Infrastructure Renal failure Infection Oxygen UTI Sensory deprivation |
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changes in sleep structure in elderly
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increased REM episodes (but duration is shorter) --> decreased total REM sleep
non-REM is increased (increased stage I and II, with decrease in stages III and IV) increased awakenings after sleep onset |
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what changes in sleep are seen in depressed young pts
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increased REM
decreased REM latency decreaed REM towards morning less than 25% delta sleep increased nighttime awakening |
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what is nml % of REM in YA?
REM latency? REM pattern? percentage delta? nighttime awakenings |
25%
90 min increased REM towards AM 35% 1-3 |
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what EEG pattern is seen in stage 1 of sleep?
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theta
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what EEG pattern is seen in stage 2 of sleep?
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sleep spindle
K complex |
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what EEG pattern is seen in stage 3 of sleep?
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delta waves
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what EEG pattern is seen in stage 4 of sleep?
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delta waves
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what EEG pattern is seen in REM?
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sawtooth
beta alpha theta |
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what stage of slep do sleep terrors, sleep walking, and bedwetting occur?
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stages 3 and 4
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what stage of sleep do nightares occur?
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REM
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what stage of sleep do night terrors occur?
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stages 3/4
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when in sleep does bruxim occur
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stage 2
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what is Kleine-Levin syndrome
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recurrent periods of ecessive leepiness daily for 1+ months
sleepiness not relieved by daytime naps often accompanied by hyperphagia |
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what is localized amnesia?
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memory loss ocuring during a particular time period, especially after a traumatic event
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what is selective amnesia/
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can't remember certain aspects of an event
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what is cotard syndrome
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delusion that nothing exists
feeling that body is disintegrated or that they are dead |
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what is fregoli syndrome?
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person takes the form of many other ppl/creatures
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what is pyshiologically occuring in a person w OCD
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increased metabolism in caudate nucleus, frontal lobe, and cigulum
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what is circumlocution?
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word substitution
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what structures shrink in schizophrenia
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hippocampus
parahyoppocampal gyrus amygdala |
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what is verbigeration
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repetitive meaningless talking
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what is glossolalia
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ability to speak new language suddenly
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si/sx of WErnicke's encephalopathy
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CN VI palsy (bilat)
horizontal nystagmus ataxia global confusion |
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what is oculogyric crisis?
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acute dystonia reaction with spasm of extraocular muscles
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what is trismus?
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spasm of jaw muscles
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can hallucinations + delusions = delusional d/o
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NO
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sx of tertiary syphilis
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sensory ataxia
+ romberg decreased vibration/proprioception in lwer extremities decresed DTR pupil abnormalities |
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mens rea
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criminal intent
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actus rea
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criminal act
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schizophrenia, residual type
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absence of + sx
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testamentary capacity
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competence required to write a will
1. ability to understand the writing/signning of awill 2. knowlege of potential heirs 3. understanding extent of one's assets 4. Lack of undue influence 5. Absence of delusions compromising rational thought |
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what --> not guilty by reason of insanity
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can't appreciate wrongfulness of act
can't conform to conduct laws |
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habeus corpus
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due process
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parens patriae
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state cares for people that can't care for themselves
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informed consent requires:
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1. mental competency
2. voluntary choice 3. risk-benefit analysis 4. alternative tx options |
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what makes someone an emancipated minor
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married
have kids in military self-supporting |
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when is parental consent not required for a minor:
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OB care
STD tx substance abuse |
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what type of therapy is useful in bulemia
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CBT
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rumination d/o
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repeated regurgitation and rechewing of food >1 month following nml fxnign
seen when there are multiple caregivers |
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how to confirm rumination d/o
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esophageal pH
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what is the #1 cause of halluciation in children
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substance induced
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common side effects from fluoxetine
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H/A and nausea
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describe progression with Rette d/o
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nml prenatal and perinatal development, till about 5 months
then, decreased head growth, stereotyped hand movt and decreased social interaction MR |
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what is the first line tx for Tourette's
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Clonidine (also good for ADHD, so good when there is comorbidity)
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medical tx for enuresis
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imipramine
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what happens to brain of anorexic pt
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ventricles enlarge
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#1 side effect from clonidine
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sedation
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what illness is associated with psychiatric issues
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strep --> OCD and Tourette's
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