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120 Cards in this Set

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