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116 Cards in this Set

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Abnormal tests w/ schizophrenia
1 - PET scan of DA-R (decreased)
2 - EEG w/decreased alpha-adrenergic activity
3 - Patient can't follow moving visual target
4 - CT = lateral and third ventral enlargement
Ideal qualities for patient undergoing insight-oriented psychotherapy
-can tolerate high frustration levels
-good capacity for insight
-good impulse control --> can talk about feelings w/o acting them out
-moderate to high intelligence
-no cognitive dysfunctions
Periodic Limb Movement D/o
-frequent stereotyped movements (mostly legs)
-accompanied by brief (unaware) arousal and disruption of sleep patterns
--> causes daytime tiredness
-check w/bed partner
MCC (1 and 2) of psychiatry malpractice claims
1 - Improper Tx (33%)
2 - Suicide (20%) --> attempt or complete
Tumor causing HA + papilledema + homonymous hemianopsia + visual problems + seizures + visual hallucinations of light/movement
occipital lobe tumors
Best SSRI for not impairing erections
fluoxetine (may retard ejaculation/orgasm/sex drive)
Blood test for recent grand mal seizures
Spike in prolactin concentration 20 minutes post-ictal
-less reliable w/partial complex
-not at all reliable w/simple partial and status epilepticus
Tx for Tourette's
Neuroleptics + Alpha-2 Anatagonists
(haloperidol) (clonidine, guanfacine)
Clozapine and leukopenia (SE)
-levels and Tx
Mild --> 3000-3500 --> monitor, check CBC 2x/week
Moderate --> 2000-3000 --> stop clozapine (can restart when better)
Uncomplicated agranulocytosis --> protective isolation, bone marrow specimen, d/c clozapine forever
Schizophrenic patient on traditional antipsychotics --> next steps
Switch to lower dose w/ 5HT-DA antagonists (2nd gen/atypical APs, lke olanzapine)
Don't use carbamazepine as an anticonvulsant w/ ___(other med) b/c ____
clozapine --> increased risk of agranulocytosis
clozapine (500 mg/day) used in pt with well-controlled schizophrenia --> experiences 2 grand-mal seizures --> Tx?
1 - d/c clozapine
2 - add phenobarbital
3 - restart clozapine at 1/2 dose
Psychotic Sx in PD patient
clozapine
-spares nigrostriatal DA system
-anticholinergic
-may HELP PD!
Tx of acute/severe panic d/o w/no Hx of substance abuse
1 - start SSRIs (like paroxetine) w/BZD (like alprazolam)
2 - Taper off BZD over several weeks
3 - SSRI alone continued
DOC for Panic D/o
SSRIs
DOC for OCD
SSRIs (at higher doses)
DOC for hyperarousal
Beta blockers
DOC for GAD
SSRIs or buspirone (nonBZD anxiolytic)
Reaction Formation
Have unacceptable urge/thought/feeling --> replace w/opposite
Cocaine rewards user via ___ system
DA
TD interventions
1 - D/c med
--> if can't:
2 - Lower dose
--> if doesn't work
3 - Add clozapine
Seizures of unpleasant smell
Temporal lobe (uncus)
-partial complex
Time remaining in urine for:
THC
PCP
Alprazolam (BZDs)
3-4 wks
8 days
3 days
Ramelteon
Mimics melatonin
-decreases time to sleep onset (and increases time asleep)
-MC SE = HA
-CI w/severe hepatic impairment, " COPD, " sleep apnea
-no rebound insomnia or w/d Sx
-good for pts w/substance abuse Hx
Dx:
carbamazepine for 3 wks, then high fever, chills, bleeding gums, fatigue, pallor
acute aplastic anemia
SE of Ritalin (Methylphenidate)
-insomnia --> don't take after noon
-lower appetite, HA, GI upset, tics (rare)
Cognitive Impairment
+
Motor deficits
+
Behavioral Changes of Subcortical Dementia (moods changes, psychomotor slowing, forgetfulness, impaired attention and concentration)
HIV dementia
Psych Sx in 90% of terminal patients
Delusions
Drug to decrease sleep attacks + lessen cataplexy in narcolepsy
Modafinil
-stimulant, but w/o AE of some similar meds
-increases monoamines and histamine
-monitor, b/c can develop tolerance
Opiate Intoxication Tx
1 - Insure adequate ventilation
-monitor tracheopharyngeal secretions
-mechanical ventilation
2 - IV naproxene
-usually 4-5 ,g total sufficient
-buprenorphine may require higher doses
Tx APAP or ASA OD
Forced diuresis
ECT anesthetic
Methohexital IV
-lower cardiac risk
-rapind unconsciousness and duration of only 5-7 min
At what age to kids learn about reversibility?
7-11 y/o
At what age to kids learn about humor?
5-6 y/o
Fluoxetine affects (neurotransmitter)
Seratonin
Visual hallucination of transparent phantom of patient's own body
Autoscopic psychosis
Patient takes a med --> sustained spasms of neck/trunk/tongue/face/EO m. --> Med? Dx? Tx?
Med = Typical high-potency antipsychotic (like haliperidol)
Dx = acute dystonic reaction (caused DA-R blockade in nigrostiatum)
Tx = anticholinergics
Neurotransmitter that stimulates appetite
Neuropeptide Y
Broca's Aphasia
Comprehension

No Fluent speech, No Spontaneous speech, No Repetition, No Naming
Wernicke's Aphasia
Fluent, Spontaneous speech,

No Comprehension, No Repetition, No Naming
Conduction Aphasia
Fluent, Spontaneous speech, Comprehension,

No Repetition, No Naming
Global Aphasia
No Fluent, No Spontaneous speech, No Comprehension, No Repetition, No Naming
Anomic Aphasia
Fluent, Spontaneous speech, Comprehension, Repetition

No Naming
Factors predicting good outcome w/schizophrenia
-F
-20-25 onset
-middle to high SEC
-stable occupation
-FHx affective d/o (not schizo)
-good social support
-precipitating factor
-rapid onset
Age at which kids learn about irreversibility
2-4 y/o
Lesion causes uncontrolled laughter, euphoria, jokes, puns --> where?
R prefrontal
(R = robot, pre = car --> Data in Generations)
Lesion causes dysphoria, lack of laughter --> where?
L prefrontal
(L = laughter, w/o it you lose it!)
Lesion causes decrease in planning/monitoring/motivation/flexibility, trivia fixation, echoing --> where?
dorsolateral
25 y/o F c personality changes in last 6 months
-bizarre behavior
-hyposexuality
-emotional intensity
-perseverative interactions (viscosity)
TLE (temporal lobe epilepsy)
Perseverative interactions
Viscosity
20 month old M runs around, periodically returning to mom for check and quick hug
Rapprochement
-mobility and exploring but frequent "refueling" w/caregiver
- normal
A "blankie" is an example of a
Transitional object
Projective identification
1 - Patient projects own traits onto another
2 - Convinces other that they have those traits/identify with projection
3 - Both have oneness or union

MCC = Borderline personality d/o
Sleep deprivation has a ___ effect on depressed patients and can trigger ____ in BP patients

Tx?
Antidepressant
A manic episode
Long-acting BZD (ex: clonazepam 1 mg qhs)
After antidepressant isn't working, raise dose to ___ and keep there for ___ before declare unsuccessful
maximum
4-5 weeks
MC post-ECT SE
headache
post-ECT SE
#1 = HA
Others = nausea, muscle soreness
Rare = memory impairment (retro and antero), interictal confusion, CV changes
Monitor these w/Lithium
-Plasma Lithium level
-Thyroid function tests
-Creatinine
-Urinalysis
-ECGs (if >50 y/o)
Not characteristic of Normal Bereavement
1 - guilt about anything other than events surrounding death
2 - thoughts of death other than that patient would be better off dead w/o loved one
3 - morbid preoccupation w/worthlessness
4 - marked psychomotor preoccupation
5 - marked/prolonged functional impairment
6 - hallucinations other than of loved one
___ very effective when added to antidepressants in Tx of refractory depression
Lithium (others = thyroid hormones, stimulants, estrogens, light therapy)
ECT CI
-recent MI
-increased ICP (tumor, mass)
-aneurysms
-bleeding d/o
-condition disrupting BBB
3 y/o M assumes that you see what he does, even on opposite sides of a sculpture
ego-centrism (normal)
-2-7 y/o
-stage of cognitive development
Age of ego-centrism in kids' cognitive development
2-7 y/o
22 y/o F
-SOB in anxiety-provoking situations
-perioral tingling, carpopedal Sx
-derealization
-all Sx fade w/situation
-never out of blue
Dx? Tx?
Dx = hyperventilation
-causes hypokalemia and respiratory alkalosis --> decreased cerebral blood flow and Ca++

Tx = breathe into paper bag
Chronic, treated schizophrenia
+
noncommunicative in bed
+
confused and disoriented w/severe muscle rigidity and fever (103 F), high BP, leukocytosis

Dx? Tx?
Dx: NMS

Tx: dantrolene followed by bromocriptine (sometimes amantadine)
Post-stroke, increased risk period for depression is ___ years and ___ increase in mortality risk
12 years
8x
Euphoria w/suspiciousness
+
agitation/anxiety/hyperactivity
+
sympathetic stimulation (HTN, tachycardia, arrythmias, dilated pupils, sweating, chills)
+
visual/tactile hallucinations
cocaine intoxication
false perception of having "lost everything" (money, status, strength, health, internal organs)
Cotard syndrome
Main mechanism of action for amphetamines
released stored monoamines in synaptic clefts
Main mechanism of action for cocaine
inhibits NT reuptake (esp catecholamines, esp esp DA)
Main mechanism of action for BZDs
increase affinity of GABA-type-A-Receptors
Main mechanism of action for barbituates
increase affinity of GABA-type-A-Receptors
Main mechanism of action for PCP
NMDA asparate receptor activation (glutamate)
Main mechanism of action for antipsychotics
Block DA-R
autonomic hyperactivity (tachycardiac, HTN)
+
hallucinations, disoriented
+
fluctuating activity levels (agitation to lethargy)

Dx? Fatality level?
EtOH w/d delirium

20% if not Txed
Cataplexy vs Catalepsy
Cataplexy = sudden and transient episode of loss of muscle tone, often triggered by emotions
Catalepsy = nervous condition characterized by muscular rigidity and fixity of posture regardless of external stimuli, often found in psychotic pts --> "waxy" posture
If suspect DTs from clinical picture, next step is
check for autonomic instability
Urine tox + for heroin and cocaine, high fever, agitation, multiple excoriated lesions on UE, heart murmur
-->Dx<--
-->next step<--
Draw blood cultures and admit him to a medical floor
Naloxone used for
Cocaine OD
Urine tox + for heroin and cocaine, high fever, agitation, multiple excoriated lesions on UE, heart murmur
-->admitted and on IV antibiotics<--
Dark streaks on fingernails, calm/alert/oriented
-->next step?
ECG
(splinter hemorrhages)
blocking vs derailment
thought stops, pause and...
blocking = totally new thought begins
derailment = same thought continues OR stop entirely
loosening of ideas vs derailment
Loosening of ideas = a whole series of derailments
flight of ideas
a nearly continuous flow of rapid speech that jumps from topic to topic, usually based on discernible associations, distractions, or plays on words, but sometimes disorganized and incoherent
-indicates disorganized thought process such as in mania or schizophrenia
Alzheimer disease on PET scan
blue areas (decreased activity) in parietal cortex
PET scan w/blue areas (decreased activity) in parietal cortex
Alzheimer disease
Non-specific white spots on MRI brain
unidentified bright objects
-indicate bipolar d/o or MDD in elderly
MRI of brain of elderly pt w/MDD or bipolar
Non-specific white spots (unidentified bright objects)
Cut-off between adult and child Weschler Intelligence Scale
15 y/o
MMPI-2 (test)
Minnesota Multiphasic Inventory (personality test)
Blessed Rating Scale
Functional test, caregiver administered
(like WCST, but not given by pro)
WCST (test)
Wisconsin Card Sorting Test --> Functional
Rey-Osterrieth Test
Cognitive test --> reproduce complex line-drawing
-elucidate any secondary effect of brain injury in neurological patients, test for dementia, or study degree of cognitive development in children
Bender-Gestalt test
Figure copying --> evaluate visual-motor maturity to screen for developmental disorders, or to assess neurological function or brain damage.
Wada test
Hemisphere dominance for Language
-inject Na+ amobarbital into R carotid a. -->if person losing language for a bit, the R is the dominant language center; then fo L (usual one)
5 y/o M
Acute onset "running from lions trying to eat him" in last 24h
Substance-induced Psychotic D/o
(he ate something)
3 y/o F
-into ER for broken arm
-->greenstick ulnar fracture
-multiple fractures of different ages and increased density at metapyseal plate
-several bruises on thorax and wrist
-CBC = normocytic, normochromic anemia w/basophilic stippling
-mom = "she fell out of her bunk bed"
DD? Now what?
1 - child abuse
-basophilic stippling a red herring --> kids frikkin eat things
2 - Admit, call DCFS, give CaEDTA (edetate calcium disodium) for led poisoning
Newly Dx'ed Tourette syndrome
Begin clonidine (safer) --> if doesn't work --> haloperidol
Meds for enuresis
Imipramine or DDAVP (antidiuretical)
Teaching a 4 y/o not to steal - what to do and why?
Help the kid return the items to the store - *MODELING* - shows the kid the correct behavior and why what she's doing is wrong
MRI of schizophrenic brain shows
Decreased temporal lobe size
Decreased temporal lobe size on brain MRI
psychosis
Thrombocytopenia is a common SE of
(any antiepileptic, but esp)
Valproic Acid
Patient comes in psychotic and threatening his wife w/violence --> what do you do and why?
Hospitalize (voluntary or involuntary)
-duty to protect supersedes duty to inform (if do former, won't *need* to do latter!)
-Tarasoff 1 and 2
If patient is found ______ she will have to stand trial once she is sane, if she is found _______ she will not
Unfit to stand trial
NG by reason on insanity
"Stomach medication" that can cause a "thick tongue" with slurring of words and dyphagia
-what is this?
-what's the med?
TD
Compazine (Prochlorperazine) or Reglan (Metoclopramide)
--> dopamine D2 receptor antagonist --> can cause TD just like APs
Non-specific white spots on MRI brain
unidentified bright objects
-indicate bipolar d/o or MDD in elderly
MRI of brain of elderly pt w/MDD or bipolar
Non-specific white spots (unidentified bright objects)
Cut-off between adult and child Weschler Intelligence Scale
15 y/o
MMPI-2 (test)
Minnesota Multiphasic Inventory (personality test)
Blessed Rating Scale
Functional test, caregiver administered
(like WCST, but not given by pro)
WCST (test)
Wisconsin Card Sorting Test --> Functional
Rey-Osterrieth Test
Cognitive test --> reproduce complex line-drawing
-elucidate any secondary effect of brain injury in neurological patients, test for dementia, or study degree of cognitive development in children
Bender-Gestalt test
Figure copying --> evaluate visual-motor maturity to screen for developmental disorders, or to assess neurological function or brain damage.
Wada test
Hemisphere dominance for Language
-inject Na+ amobarbital into R carotid a. -->if person losing language for a bit, the R is the dominant language center; then fo L (usual one)
5 y/o M
Acute onset "running from lions trying to eat him" in last 24h
Substance-induced Psychotic D/o
(he ate something)
Compazine (Prochlorperazine) or Reglan (Metoclopramide)
-serious SE
Tardive Dyskinesia