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200 Cards in this Set

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This psychiatric thought disorder indicating a loss of goal directed thought process: the patient brings in many irrelevant details and comments, but eventually will get back to the point. Diagnosis?
Circumstantiality.
This is a term for a fabricated word made up by the patient, which is usually a combination of existing words. Word?
Neologism.
If a patient is still struggling and attempting violence while in full restraints, what medications should you use in order to temporarily sedate the patient?
IM combination of Haloperidol and Lorazepam (which both decreases the dose of antipsychotic necessary and protects against dystonic reactions.
What is the estimated rate at which soldiers returning from Iraq and Afganistan are have PTSD? Is the rate higher amongst men or women?
The rate is estimated at 17%; women have highere rates of returning with PTSD.
Rarely, cognitive impairments may occur as the first manifestation of this immunodeficiency disease. Diagnosis?
HIV; HIV-associated dementia is a disorder caused by the direct toxic effect of HIV on the brain. A CD4 count below 200 is usually associated with HIV dementia since this disorder typically occurs in the more advanced stages of AIDS.
This phobia is a persistent and overwhelming fear of humiliation or embarrassment in social or performance situations. This leads to high levels of distress and avoidance of those situations. Often physical symptoms of anxiety such as blushing, trembling, seating, or tachycardia are triggered when the patient feels under evaluation or scrutiny. Diagnosis?
Social phobia.
This term describes the feeling of the subjective sense that the environment is strange or unreal, as if reality had been changed. Diagnosis?
Derealization.
This term refers to the feeling that one is falling apart or not one's self, that one's self is unreal or detached. Diagnosis?
Depersonalization.
This term refers to the situation in which the patient senses that his or her thoughts are being stolen, are leaking out of the mind, or are being sent out to others across radio or television. Diagnosis?
Thought broadcasting.
This is the belief that oneself, others, or the world are either nonexistent or are coming to an end. Diagnosis?
Nihilism.
This is a form of thinking similar to that of preoperational-phase children (Jean Piaget) in which thoughts and ideas are believed to have special powers (eg. to cause or stop outside events). Diagnosis?
Magical thinking.
Does malingering involve secondary or primary gain?
Secondary; eg. someone malingering in the hospital so that they uphold the secondary benefit of not being taken to jail.
Does factitious disorder involve primary or secondary gain?
Primary; the primary reception of healthcare is the gain.
Children in this approximate age range are in the Eriksonian stage of autonomy vs. shame and doubt. Age range?
1-3 years old.
Children in this approximate age range are in the Eriksonian stage of basic trust vs. mistrust. Age range?
0-1 year old.
Children in this approximate age range are in the Eriksonian stage of initiative vs. guilt. Age range?
3-5 years old.
People in this approximate age range are in the Eriksonian stage of intimacy vs. isolation. Age range?
21-40 years old.
People in this approximate age range are in the Eriksonian stage of generativity vs. stagnation. Age range?
40-65 years old.
Who is thought of as the founder of self-psychology?
Heinz Kohut.
Who is know for his theories of Psycho-social development throughout the life-cycle?
Erik Erikson.
Who is known for his work on Cognitive development?
Jean Piaget.
Who is the main proponent of the object relations school of psychoanalysis and wrote extensively on early stages of infant-mother interaction?
Melanie Klein.
A "Transitional object" for a child, usually a toy or a blanket, is something that represents a comforting substitute in the place of the child's primary caregiver. Thanks to a transitional object, the child can tolerate separation from the mother without excessive anxiety. Who coined the term "Transitional object"?
D.W. Winnicott, a British pediatrician with a keen interest in psychoanalysis, who focused his attention on the early mother-child relationship.
What is the name of the Piaget cognitive stage between the ages of 18-24 months?
Sensorimotor.
What is the name of the Piaget cognitive stage between the ages of 2 to 5-7 years?
Preoperational.
What is the name of the Piaget cognitive stage between the ages of 6-11 years?
Concrete operational.
What is the name of the Piaget cognitive stage between the ages of 11 years to adulthood?
Formal operational.
In this Erikson stage the infant's needs are promptly and emphatically met; the infant learns to see the world as a benign and nurturing place. Age range? Stage name?
0-18 months; Trust vs. Mistrust
This Erikson stage corresponds to Freud's anal stage and Mahler's separation-individuation stage. During this period, if allowed to experiment with his or her new motility and curiosity about the environment, and if at the same time he or she is provided with enough nurturance, the child acquires a health self-esteem and sense of autonomy. Age range? Stage?
18-36 months; Autonomy vs. Shame and doubt
In this Erikson stage the child expands his or her explorations of the outside world and has omnipotent fantasies about his or her own powers. During this stage, in a good psychosocial environment, the child develops a capacity for self-reflection, manifested by the child's feeling guilty when rules are broken, without losing enthusiasm for independent exploration. Age range? Stage?
3-5 years; Initiative vs. Guilt
This Erikson stage is equivalent to Freud's period of latency. The child's psychological growth depends on his or her opportunity to learn new skills and take pride in accomplishments. Age range? Stage?
5-13 years; Industry vs. Inferiority
If this Erikson stage is mastered successfully, the young individual enters adulthood with a solid sense of identity, knowing his or her role in society. Age Range? Stage?
13-21 years; Identity vs. Role confusion
This Erikson stage involves the adult developmental task of learning to make and honor commitments to other people and to ideas. Age Range? Stage?
21-40 years; Intimacy vs. isolation
In this Erikson stage the focus of the individual starts shifting from personal accomplishments and needs to concern for the rest of society and the nurturing of the next generation. Age range? Stage?
40-60 years; Generativity vs. Stagnation
In this Erkison stage the main developmental task is accepting life as it is, without desire to change the past or change others. When this stage is mastered, the individual acquires the wisdom necessary to face the inevitability of death with equanimity and without dread. Age range? Stage?
60-death; Integrity vs. despair
What might the physical effects of be on children that are emotionally deprived from a young age, and possibly birth?
Failure to thrive; although the relationships between emotional deprivation and failure to thrive are complex, the fact that children who are emotionally deprived do not grow well even when an adequate amount of food is available is well proven. Due to lack of adequate nurturing, children can become apathetic, withdrawn, and less interested in feeding, which in turn causes failure to thrive and, in extreme cases, death.
Object permanence is the recognition that an object continues to exist even if the object cannot be perceived. Who is the person responsible for the idea of Object Permanence?
Piaget.
At what age does the realization of object permanence take place and what Piaget cognitive development stage is it a part of?
Object permanence is reached during the preoperational stage of cognitive development, around 2-6 years of age.
Between the ages of 2-4 years of age children attempt to master a world that is largely outside of their control by the use of this type of play in which they can exact revenge, modify the outcome of any situation, or otherwise improve their condition in life. What type of play is this?
Fantasy play.
What is the major development of middle childhood, which is typically describe as the time period between ages 6-12?
Going to school.
The onset of puberty and the development of an overt interest in the opposite sex typically occur in what age range of life?
Adolescence 12-15.
The consolidation of personality and a growing concern with cultural values and ideologies occur in late adolescence, which is typically defined by what age range?
17-20 years of age.
Cataplexy refers to a sudden loss in muscle tone triggered by strong emotions, which take place during full wakefulness. Cataplexy is thought to be due to an abnormal intrusion of REM sleep phenomena in periods of wakefulness. Thus, it is usually treated with medications that reduce REM sleep, such as what drugs?
Antidepressants!!!
Which stage of sleep is characterize by increased heart rate and blood pressure and penile or clitoral nocturnal erections?
REM.
What is the chromosome association with Prader-Wili?
Chromosome 15- Long arm
What is the most common form of inherited mental retardation, and the second most common single cause of mental retardation?
Fragile X syndrome!!!
Why do patients with Fragile X syndrome have enlarged testicles?
Elevated Gonadotropin levels.
This is a pervasive developmental disorder characterized by a devastating deterioration progressive deterioration of cognitive, social, and motor functions that starts between 5 months and 18 months of age after a period of normal development? Diagnosis?
Rett syndrome.
Does major depression increase or decrease the latency of REM sleep?
DECREASES THE LATENCY!!!
What is the psychiatric disorder that has been most associated with disruptions in biological rhythms?
Depression.
Dystonic reactions are an adverse side effect of neuroleptic medications secondary to blockage of dopamine receptors in the nigrostriatal system. They are usually associated with high-potency neuroleptics such as Haloperidol, and usually occur within hours to 3 days and are more frequent in males and young people. Dystonic reactions are sustained spasmodic contraction of the muscles of the neck, trunk, tongue, face, and extraocular muscles. What is the anticholinergic drug that provides rapid treatment of acute dystonia?
Diphenhydramine.
In the case of Alzheimer's disease which appears between the ages of 40 and 50, what is the gene on Chromosome 14 that is involved in 70-80% of cases?
PRE-senilin 1.
In the case of Alzheimer's disease which appears between the ages of 40 and 50, what is the gene on Chromosome 1 that is involved in 20-30% of cases?
PRE-senilin 2.
2-3% of Alzheimer cases, which appear after the age of 50, are attributable to what gene mutation found on Chromosome 21?
B-amyloid precursor protein gene (APP).
Severe anterograde memory deficits with an inability to form new memories are the main feature of this syndrome associated with chronic alcoholism. Remote memories are relatively preserved. The disorder is because of dietary Thiamine deficiency and subsequent damage of the thiamine-dependent structures of the brain (mammilary bodies and the regions surrounding the third and fourth ventricles). Diagnosis?
Korsakoff syndrome.; retrograde amnesia is also present, with the most severe loss of memory occurring for events that were closer to the beginning of the disorder.
Partial complex seizures usually (90% of the time) originate in the temporal lobe. Auras that consist of unpleasant odors often originate in this area at the tip of the temporal lobe which is involved in processing olfactory sensations. Origination site?
Uncus.
It has been proven that the dysfunction of which neurotransmitter pathways is implicated in obsessive compulsive disorder?
Serotoninergic pathways; this theory is supported by the anti-obsessional effects of medications that increase the concentration of serotonin in the synaptic cleft, such as SSRI and clomipramine ( a tricyclic).
What is the are the major type of neurotransmitter pathways that are thought to be dysfunctional in anxiety disorders?
Norepinephrine pathways.
What is the neurotransmitter that is most associated with classic antidepressant drugs, as well as venalfaxine, mirtazapine, and bupropion?
Norepinephrine!!!
What area of the brain is affected in a patient with Conduction aphasia?
Left arcuate fasciculus region; produces deficits in only naming and repetition.
What area of the brain is affected in a patient with Global aphasia?
Perisylvian region; produces deficits in all areas of aphasia, comprehension, repetition, and naming.
What area of the brain is affected in a patient with Anomic aphasia?
Left angular gyrus; only affects naming.
Within the diencephalon, the dorsal medial nucleus of the thalamus and the mammillary bodies appear necessary for memory formation. These two structures are damaged in thiamine-deficient states usually seen in chronic alcoholics and their inactivation is associated with what syndrome???
Korsakoff syndrome!!!
A lesion to this right sided area of the brain may produce laughter, euphoria, and a tendency to joke and make puns. In contrast a lesion to this left sided area of the brain abolishes normal mood-elevating influences of this area and produces depression and uncontrollable crying. Area name?
Right and left-sided Prefrontal Cortex.
A patient with injury to this part of the brain may have disinhibition, irritability, lability, euphoria, and lack of remorse. Insight and judgement are impaired; patients are distractible. These features are reminiscent of the diagnoses of antisocial personality disorder, intermittent explosive disorder, and episodic dyscontrol syndrome. What region of the brain is most likely affected?
Orbitofrontal region of the Frontal Lobe.
Patients with lesions in this region of the brain have deficiencies of planning, monitoring, flexibility, motivation. Patients may be unable to use foresight and feedback or to maintain goal directedness, focus, or a sustained effort. They appear inattentive and undermotivated, cannot plan novel cognitive activity, and exhibit a tendency to linger on trivial thoughts. They may echo the examiner's questions and react primarily to details of environmental stimuli- missing the forest for the trees. What region of the brain is most likely affected?
Dorsolatera region of the Frontal Lobe.
This disorder is characterized by apparently normal development though at least the first two years of life. During this time, age-appropriate skills such as verbal and nonverbal communication, social relationships, bowel and bladder control, and play all develop normally. The disease manifests itself as a clinically significant loss of previously acquired skills before the age of 10. In Rett disorder the onset of the disease usually occurs earlier, usually 6 months after birth, and there are characteristic hand stereotypies that do not occur with this disorder. Diagnosis?
Childhood disintegrative disorder.
Nocturnal enuresis is usually diagnosed in childhood, although adolescent onset does occur. This treatment of choice is generally the most effective treatment with success in over 50% of all cases. Successful responses with this treatment also tend to be maintained over time. It also does not have the side effects of pharmacotherapies. Bladder training, while sometimes effective, is decidedly less so than the bell and pad. Likewise, psychotherapy has not been shown to be effective in treating this disorder though it may be helpful in dealing with the emotional difficulties that arise secondary to this disorder. Treatment of choice?
Classical conditioning with a bell (or buzzer) pad.
Vocal tics such as grunting, barking, throat clearing, coprolalia (the repetitive speaking of vulgarities), shouting and simple and complex motor tics are characteristic of Tourette syndrome. What are the two classes of pharmacologic treatment used in this disorder?
Neuroleptics such as Haloperidol and Pimozide, and Alpha-2 agonists such as Clonidine, and Guanfacine.
Common side effects of the drug Methylphenidate, which is used to treat ADHD, include loss of appetite and weight, irritability, oversensitivity and crying spells, headaches, and abdominal pain. Insomnia may occur, particularly when this agent is dispensed late in the day. There is another less frequent complication of treatment with this stimulant that can cause significant impairment. Side effect?
Tics; whether this is the drug causing tics or the unmasking of a pervious tic predisposition is unclear.
Sleep terrors occur in 3% of children and 1% of adults. Although specific treatment for this disorder is seldom required, in rare cases it is necessary. In small doses at bedtime this drug improves the condition and sometimes completely eliminates the attacks. Drugs?
Diazepam (Valium).
This diagnosis in can be difficult to make in younger children because symptoms of this disorder differ in younger age groups from those symptoms seen in adults. Often aggression and irritability replace sad affect, and poor school functioning or refusal to go to school may be the prominent manifestations. Psychotic symptoms are present in 1/3 of the cases of children with this disorder. Diagnosis?
Childhood Major Depression.
A child with the presence of symptoms including being angry, spiteful and vindictive, losing his/her temper quickly, and deliberately annoying others for at least 6 months is characteristic of this disorder. It is also characteristic that the child will deny that he or she has a problem, blaming it instead on others. While sometimes the behavior starts outside the home, other times the disorder starts at home and then is carried to school and other arenas. The patient will likely not have a history of agressive behavior toward animals or others, and will not have been destructive or in trouble with the law, making conduct disorder less likely. Diagnosis?
Oppositional Defiant Disorder.
What sedating medication must be used with extreme caution in the elderly, if at all, because of their potential for delirium or paradoxical excitation effect?
BENZODIAZEPINES!!!
The nucleus basalis of Meynert is involved in patients with what type of dementia?
Alzheimer's dementia.
This condition occurs in nutritionally deficient alcoholics and is due to a thiamine deficiency and consequent damage of the thiamine-dependent brain structures, including the mammillary bodies and the dorsomedial nucleus of the thalamus. It presents with confusion, ataxia, and sixth-nerve paralysis. This is a medical emergency and can rapidly resolve with the immediate supplementation of thiamine. This diagnosis should be considered in any patient brought into the emergency room unresponsive. Diagnosis?
Wernicke Encephalopathy!!!
Neuroleptic malignant syndrome (NMS) is a life-threatening complication of antipsychotic treatment. Symptoms include muscle rigidity and dystonia, akinesia, mutism, obtundation, and agitation. The autonomic symptoms include high fever, sweating, and increased blood pressure and heart rate. In addition to supportive treatment, the most commonly used medication for the condition is Dantrolene, followed by what dopamine agonist?
Bromocroptine (although sometimes amantidine is used); bromocriptine and amantidine possess direct dopamine receptor agonist effects and may serve to overcome the antipsychotic-induced dopamine receptor blockade. Dantrolene is a muscle relaxant.
What are the abnormal findings found on EEG in Schizophrenic patients?
Decreased alpha activity and increased theta and delta activity.
What are the abnormal findings found on PET scan in Schizophrenic patients?
Increase in D2 receptors in the caudate nucleus of drug-free Schizoprenics.
What are the abnormal findings found on eye movement examination in Schizophrenic patients?
Patient will be unable to follow a moving visual target accurately.
What are the abnormal findings found on CT scan in Schizophrenic patients?
CT scans have consistently shown enlarged lateral and third ventricles, as well as reductions in cortical volume in Schizophrenic patients.
Late onset of disease, obvious precipitating factors/stressors, an acute onset, good premorbid functioning, the presence of mood disorder symptoms, the patient being married, a family history of mood disorders, good support systems, and the presence of positive symptoms (as opposed to negative symptoms) are all factors weighting towards what type of prognosis for patients with Schizophrenia.
A GOOD PROGNOSIS!!!
What is the minimum time period for diagnosis of MDD?
2 weeks.
What is the name of the disorder that is differentiated from Schizophrenia only by the length of time of the duration of symptoms?
Schizophreniform disorder.
Schizophreniform disorder and chronic schizophrenia differ only in the duration of the symptoms and the fact that the impaired social or occupational functioning associated with chronic schizophrenia is not required to diagnose Schizophreniform disorder. What is the time period necessary to diagnose Schizophreniform disorder?
At least 1 month and less than 6 months; otherwise it would be classified as a brief psychotic episode, or overt schizophrenia.
Does Paranoid Schizophrenia develop earlier or later in life, and what kind of prognosis is it associated with?
Tends to develop LATER, and is associated with a BETTER prognosis.
This diagnosis is made when the required criteria for Schizophrenia are met (delusions, hallucination, disorganized speech or behavior, and/or negative symptoms; duration of disturbance, including prodromal and residual period, of at least 6 months with at least 1 month of active symptoms) and the patient experiences a major depressive or manic episode at some point in the course of the illness. Diagnosis?
Schizoaffective disorder.
What is the life-long prevalence of Schizophrenia?
1%.
What effect do families that are overtly hostile and overly controlling have on patients with Schizophrenia and their treatment outcomes?
Leads to increased rate of relapse of the Schizophrenia.
What psychiatric symptom is present in 90% of terminally ill patients?
DELUSIONS!!!; delusions may be reversed if their cause is treatable (eg. a delusion occurring secondary to a medication intoxication). The delusions are usually repsonsive to antipsychotic medication. Symptoms of anxiety and depression may also occur, but not with such overwhelming frequency as is seen with delusions.
What is the preferred type of psychotherapy in cases where patients are undergoing acute life crises and are feeling overwhelmed?
SUPPORTIVE psychotherapy; the goals of supportive therapy are to reduce patients' symptoms and help them better cope with their surrounding environments.
This term refers to the awareness by a patient that he or she is not alone or unique in his or her suffering and that others share similar symptoms and difficulties. This often occurs in self help groups and is a powerful healing factor. What is this called?
Universalization.
This term refers to the sense that a self-help group is working towards a common goal.
Group cohesion.
This term refers to the confirmation of a patient's reality though comparison with other group member's experiences and conceptualizations.
Validation.
This term refers to the notion that the group may come to have a framework of beliefs and ideas about issues that is common to everyone in the group.
Shared belief system.
This type of psychotherapy is characterized by an emphasis on the nurturing, caring role of the therapist and a focus on current reality. Although insight-oriented strategies such as interpretations can be used, they are not the main therapeutic instruments. This type of psychotherapy aims to foster and maintain a positive transference all the time in order to provide the patient with a consistently safe and secure atmosphere. Consolation, advice, reality testing, environmental manipulation, reassurance, and encouragement are strategies commonly used is in this type of psychotherapy.
SUPPORTIVE psychotherapy.
This is a type of cognitive distortion that comes between the time an event occurs externally and the time when the person having the distortion has an emotional reaction to the external event. For example, the belief that "I am so ugly" is a cognitive distortion of this type that may occur in between a person complimenting another on their new dress (the external event) and the person in the dress exclaiming, "You must be crazy!" (prompted by the emotional reaction of dismay). What type of cognitive distortion is this?
AUTOMATIC THOUGHTS!!!; every psychopathological disorder has its own particular profile of distorted automatic thought, which if known, can provide the framework for cognitive work to stop them.
Once this type of distortion is recognized and characterized, cognitive therapy is used to unravel them by testing them, identifying their maladaptive underlying assumptions, and testing the validity of those assumptions as well. What is this type of therapy used to treat?
Automatic thoughts (Cognitive distortions).
What is the best type of therapy to treat social phobia?
Cognitive-behavioral therapy.
In this type of therapy, the therapist uses primarily clarification, confrontation, and interpretation as tools. Which type of therapy is this most likely?
Dynamic psychotherapy.
How is the lymphocytic proliferation response to mitogens affected in patients with depression?
Decreased response.
How are both core temperature and REM sleep affected in patients with depression?
Increased core temperature and REM sleep.
What finding are the on a PET scan of the brain of a patient with depression?
Decreased anterior brain metabolism.
The prevalence of this postpartum condition is very high at 20-40%. Symptoms include tearfulness, irritability, anxiety, and mood lability. Symptoms usually emerge during the first 2-4 days after birth, peak between days 5 and 7, and resolve by the end of the second week postpartum. This condition resolves spontaneously and usually the only interventions necessary are support and reassurance. Diagnosis?
Postpartum blues.
Weight gain, metallic taste, acne, hypothyroidism, and polyuria are common complaints with treatment of what mood stabilizing medication?
Lithium.
What are the medications that are most often used in the maintenance of long-term treatment of bipolar disorder?
Lithium, Valproate, and Carbamazepine.
While there are many physicians that believe that patients with Dysthymic disorder should not be treated pharmacologically, there are a number of studies that show positive responses in these patients to what type of medication?
Antidepressants; Venalfaxine and Bupropion.
What are the two medications that are the treatment of choice for patients with Dysthymic disorder?
Venalfaxine and Bupropion; there is also a subgroup of patients that will respond to MAOIs as well.
This postpartum condition is relatively common, occurring in about 10-15% of new mothers. Symptoms are indistinguishable from those characteristic of non-psychotic major depression and usually develop insidiously over the 6 months following the delivery, and occasionally the symptoms start during pregnancy. Ambivalence toward the child and doubts about the mother's own parenting abilities are common, but the rate of suicide is low. Diagnosis?
Postpartum depression.
Sleep deprivation has an antidepressant effect in depressed patients and may trigger a manic episode in bipolar patients. If an acute manic episode is triggered in a bipolar patient, due to sleep deprivation or altered sleeping patterns, who has previously been well controlled on their medication, what medical management can be used to abort the episode are return the patient to stable?
Long-acting benzodiazepines will allow the patient to return to normal sleep patterns and generally will abort the manic episode.
What is a key symptom that, when present, points to a diagnosis of post partum depression rather than post partum blues?
Anhedonia.
Among the antidepressants in common use, which one is thought to carry a slightly lower risk of unmasking mania in a patient?
Bupropion.
The marked shifts of mood seen in cylclothymic disorder can be confused with the affective instability of what personality disorder?
Borderline personality disorder.
What are the three foods that must be absolutely, completely avoided while a patient is on an MAOI?
Aged cheese (cheddar), red wine, and cured meats.
What non-SSRI, added to an SSRI that is already being used, has been proven to be affective in the treatment of refractory depression?
Lithium; more than on mechanism of action is probably involved, although Lithium's ability to increase the presynaptic release of serotonin is best understood. Other augmentation strategies include the use of thyroid hormones, stimulants, estrogens, and light therapy.
Why is the addition of a second SSRI or an MAOI to a patient's regimen with refractory depression, not recommended?
Possible incitement of Serotonin Syndrome.
In MDD how is the REM latency (period of time between falling asleep and the first period of REM sleep) affected?
The REM latency is SHORTENED!!!
What class of medication has been considered to be more effective in treating Melancholic Depression?
TCA antidepressants.
What class of medication has been considered to be more effective in treating Atypical Depression?
MAOIs.
Panic disorder responds to a variety of psychotropic medications, including SSRIs, TCAs, and Benzodiazepines. Which is the treatment of choice?
SSRIs; given the abuse potential of Benzos, and the significant side effects of the TCAs, SSRIs are preferred.
What is the medical treatment of choice for the patient with OCD?
SSRIs; treatment of OCD symptoms may require higher dosages and longer trial periods than those recommended for depression. Drug trials should be no less than 12 weeks.
What is used to treat the autonomic symptoms of hyperarousal associated with PTSD?
Beta-blockers.
TCAs, buspirone (a non-benzodiazpine anxiolytic), and SSRIs are all effective in treating Generalized Anxiety Disorder, but which is the treatment of choice?
BUSPIRONE!!! given that it has a very low incidence of side effects and is particularly effective in the treatment of GAD.
Which SSRI has not been shown to impair the ability to have an erection?
Fluoxetine; although like other SSRIs it may cause retarded ejaculation, decreased sex drive and difficulty reaching orgasm.
Perphenazine is known to cause what sexual side effect?
Impaired ejaculation.
Among Beta-blockers, which one is most likely to cause impotence, or the inability to maintain an erection?
Propranolol; furthermore, thorough its effect on the serotonin system, propranolol can also inhibit orgasm and reduced sex drive.
In this disorder there is a pervasive pattern of depressive cognition and behavior which begins in early adulthood and persists throughout life. Patients with this personality disorder are pessimistic, anhedonic, self-doubting, and chronically unhappy. Their moods do not fluctuate as much as those with dysthymic disorder, as dysthymia is episodic and usually occurs after some precipitating event. These patients may be at great risk fro developing dysthymia or major depression. Diagnosis?
Depressive personality disorder.
Withdrawal symptoms from short acting drugs such as heroin or morphine can start within 8 to 12 hours after the last dose and generally reach peak severity how long after the last dose?
48 hours.
Most cases of intoxication are over within how many hours?
8 to 12 hours; but prolonged drug-induced psychoses may occur, especially with PCP, from which the psychosis may last several weeks
When alcohol use has been heavy and prolonged, how soon can withdrawal phenomena start to show after drinking cessation?
8 hours.
Benzodiazepines are the preferred treatment for alcohol withdrawal delirium, with Diazepam and chlordiazepoxide (Librium) the most commonly used. Elderly patients or patients with severe liver damage may better tolerate intermediate acting benzodiazepines such as which?
Lorazepam and Oxazepam.
When the patient has a history of alcohol withdrawal seizures, what medication should be administered during the detoxification process?
Magnesium sulfate.
When a patient presents with alcohol withdrawal delirium, Chlordiazepoxide should be given PO, or is this is not possible, Lorazepam should be given IV or IM. Why should antipsychotic medications not be given to patients with alcohol withdrawal delirium, even when they have hallucinations and agitation resembling psychosis?
Because the syndrome is not psychosis and is being cause by the withdrawal of substance, and antipsychotic medications may further lower the seizure threshold.
Which two classes of medication, when used together, have a therapeutic potentiation effect in treating psychoses?
Antipsychotics and Benzodiazepines.
What is the most serious adverse side effect associated with administration of Flumazenil for benzodiazepine overdose?
Precipitation of seizures, especially in those patients with a preexisting seizure disorder.
Because of the risk of hypothyroidism associated with Lithium use, how often are patients advised to ave their TSH levels drawn?
6 months; also every 6 months, patients should have the signs and symptoms of both hyper- and hypothyroidsim reviewed with them, to double check that they are not experiencing any of the symptoms. T3RU and BUN blood test should be repeated every year on patients taking Lithium.
Which is the TCA that is effective at treating obsessive compulsive disorder in both adults and children?
Clomipramine; its efficacy is thought to be related to its effects on inhibition of serotonin reuptake. SSRIs are also effective medications for the treatment of OCD.
A mild leukopenia, with or without clinical symptoms such as lethargy, fever, sore throat, or weakness in a patient taking Clozapine, should cause the psychiatrist to monitor the patient closely with and institue a minimum of twice-weekly CBC test with differentials included. What is the range of WBCs considered to be mild leukopenia for a patient on Clozapine?
WBC = 2,000-3,000
A serious leukopenia observed in a patient taking Clozapine should prompt a psychiatrist to get daily CBCs and stop clozapine. It may be re-instituted after WBCs normalize. What is the WBC range of concern for this more serious consideration?
WBC = 2,000-3,000
With an uncomplicated (no signs of infection) agranulocytosis (< 2,000 WBCs), in a patient taking Clozapine, the patient should be placed in protective isolation, the Clozapine should be discontinued, and a bone marrow biopsy may be warranted to see if progenitor cells are being suppressed. Can the Clozapine ever be started again in this patient?
NO!!!
In cases of symptomatic high-dose lithium toxicity (> 3mEq/L) what is the emergency treatment of choice?
Emergency Dialysis.
This drug mimic's melatonin's sleep-inducing properties. It has a high affinity for melatonin MT1 and MT2 receptors in the brain. The half-life of this drug is between 1-2.5 hours. This drug reduces time to sleep onset and to a lesser extent, increases the amount of time spent in sleep. The most common side effect is headache. It SHOULD NOT be used in patients with severe hepatic impairment, severe sleep apnea, or severe COPD!!! There has been no evidence found of rebound insomnia or withdrawal effects from this drug. Which drug is this?
Ramelteon.
Carbamazepine can cause aplastic anemia, agranulocytosis, thrombocytopenia, and leucopenia. It also has a risk of toxicity to what specific organ?
Liver; it can cause hepatotoxicity. Because of these possible side effects, a CBC, platelet count, reticulocyte count, serum electrolytes, SGOT, SGPT, LDH, and pregnancy test (in appropriate patients, since carbamazepine raises the risk a baby will be born with spina bifida) should all be drawn before treatment with carbamazepine is instituted. SGOT, SGPT, and LDH should be drawn every month for the first two months, and thereafter, every 3 months.
If a patient with Generalized Anxiety Disorder (GAD) has previously been taking this first drug then it is unlikely that the patient will then respond to Buspirone. The lack of response may be caused by the absence of some nonanxiolytic effects of this first drug as opposed to Buspirone; that is, because the patient has become used to the muscle relaxant and general sense of well-being effects of this first drug, she may well fail to see the treatment effects of Buspirone, which tend to be more effective in reducing the cognitive symptoms of GAD over the somatic symptoms anyway. What is this first drug that de-potentiates the action of Buspirone?
BENZODIAZEPINES!!!
Which SSRI is associated with causing very little weight gain side effects in patients?
Sertraline.
If a patient develops hypothyroidism as a side effect of their Lithium treatment for mood stabilization, but has been successfully treated on Lithium for sometime, what would be the appropriate next step in management?
Treat the hypothyroidism with Levothyroixine!!! Do not stop the Lithium!!!
If a patient is found to be suffering from acute dystonia from her antipsychotic medication, what IM delivered medication should be given in an emergency room setting in order to decrease the amount of time suffering this side effect?
Benztropine (anticholinergic) or Diphenhydramine (antihistaminic with anticholinergic properties) should be administered IM; if possible, for longer-term treatment, the offending antipsychotic should be decreased, and benztropine or diphenhydramine can be prescribed PO to prevent recurrence.
Which two atypical antipsychotics (serotonin-dopamine antagonists) are associated with a greater risk than any other atypicals of abnormalities in fasting glucose levels, as well as hyperosmolar diabetes and ketoacidosis?
Clozapine and Olanzapine.
Discontinuation of the offending antipsychotic medication or a dosage decrease are the initial interventions recommended when tardive dyskinesia is first diagnosed. If discontinuation is not possible and dosage decreases are not effective, which atypical antipsychotic is the only drug that has been proven effective in ameliorating and suppressing the symptoms of tardive dyskinesia?
CLOZAPINE!!!
In 2007, the FDA reported the presence of an idiosyncratic drug response to certain sedative-hypnotics in a small percentage of patients, causing a dissociative-like state. During these states, patients had episodes of sleep-walking, binge-eating, aggressive outbursts, and night driving, all during which the patient was completely unaware of the behavior. Which two drugs are now both required to have warning labels describing this effect because they are most associated with it?
Zolpidem and Zalepon.
When a patient suffers from akathisia, the subject feels restless, couple with a need to move. Patients may rock, pace, sit, and stand back and forth, or generally appear jittery. Once it has been recognized, the offending antipsychotic should be reduced as much as possible. What are the most efficacious drugs in reducing the side effect of akathisia?
B-blockers like Propranolol; though benzodiazepines and anticholinergics may also be somewhat effective.
This anesthetic agent is commonly used for ECT. It has lower cardiac risks than other barbiturates. Used IV, it produces rapid unconsciousness and patients reawaken quickly thereafter since the duration of action is only 5-7 min. What anesthestic is this?
Methohexital!!!
Flumenazil can precipitate seizures in patients with what underlying medical condition?
SEIZURE DISORDER!!!
Ritalin is well known to cause insomnia, and thus should not be given after what time of day?
NOON!!!; other side effects include reduced appetite, headache, GI upset, and the emergence of tics.
There is no cure for narcolepsy, but stimulants such as methylphenidate, pemoline, and amphetamine ca ameliorate daytime sleepiness. Medications that reduce REM are used if cataplexy is also present. What medications does this include?
SSRIs and TCAs.
This drug is a stimulant that has recently been approved by the FDA to reduce the number of sleep attacks and to improve psychomotor performance in narcolepsy. What drug is this?
Modafinil.
This drug is the preferred treatment for psychotic symptoms in patients with Parkinson disease. Because of its relative sparing of the nigrostriatal dopaminergic system and its anticholinergic effects, this drug does not worsen and may in fact ameliorate parkinsonian symptoms. Typical antipsychotic medications, on the contrary, tend to aggravate the extrapyramidal symptoms of a patient with Parkinson disease. What is the medication that is used to treat the psychotic symptoms?
Clozapine!!!
How do Erythromycin and Carbamazepine interact?
Erythromycin increases the level of Carbamazepine.
How do Theophylline or Cisplatin, and Carbamazepine interact?
Theophylline or Cisplatin can decrease the level of Carbamazepine.
How do Hormonal Contraceptives or Warfain, and Carbamazepine interact?
Carbamazepine can decrease the levels of both Hormonal contraceptives and Warfarin.
What is the half life of Lithium and how long does it take for the drug to reach a steady state in the body?
The half-life of Lithium is about 20 hours, thus equilibrium is reached after 5 to 7 days of regular intake because steady state is reached after approximately 5 half-lives of a particular drug being administered.
Propranolol and other beta-blockers can be used to treat akathisia, but since beta-receptor blockade causes bronchospasm these medications are contraindicated in patients with asthma. If a patient has asthma, what is a better treatment for akathisia?
Benzodiazepine.
The connection between thyroid function and mood disorder has been known for more than a century, since 19th century physicians noticed that hypothyroidism was accompanied by depression. All the hormones of the hypothalamic-pituitary-thyroid axis have been used in the treatment of depression, alone or in combination with other agents. What are the two most commonly used hormones?
Levothyroixine and liothyronine.
Approximately 5-10% of caucasian individuals metabolize these two TCA drugs at a much slower rate than the general population because of an inherited deficiency of the P450 isozyme 2D6. Theses individuals, known as poor metabolizers, develop toxic levels at very low medication doses. What are the two drugs whose metabolism is effected by this deficiency?
Nortriptyline and Desipramine.
Patients experiencing seizures on while taking Clozpine should have Clozapine temporarily discontinued and this anticonvulsant begun. The occurrence of seizures during Clozapine treatment is dose related and increases considerably with dosages greater than 400 mg/day. What drug is considered to be the safest and the best tolerated anticonvulsant for patients taking Clozapine who experience seizures?
Phenobarbital; it should be started after Clozapine is stopped, then Clozapine can be restarted at 50% of its previous dosage and gradually raised.
Patients experiencing seizures on while taking Clozpine should have Clozapine temporarily discontinued and an anticonvulsant begun. The occurrence of seizures during Clozapine treatment is dose related and increases considerably with dosages greater than 400 mg/day. What drug is SHOULD NOT be administered to patients taking Clozapine who experience seizures?
Carbamazepine!!! because the bone marrow suppression risk with this medication can increase the risk for agranulocytosis with Clozapine!!!
High potency neuroleptics, such as Haloperidol and Fluphenazine, being low in anticholinergic side effects and less likely to cause postural hypotension, are preferred to low-potency medications such as Chlorpromazine in what type of patients?
Elderly patients; especially those with cardiovascular problems and those with prostatic hypertrophy.
This atypical antipsychotic is not recommended in elderly patients because of it anticholinergic side effects and its risk for causing agranulocytosis. Drug?
Clozapine.
This neuroleptic medication is the least appropriate to use in the case of a patient with a cardiac history because of it can cause fatal arrhythmias by prolonging the QT interval. Drug?
Thioridazine.
This atypical antipsychotic is should be avoided for use in elderly patients because it causes significant orthostatic hypotension. Drug?
Olanzapine.
Practically every class of medication has been used to treat PSTD, but these two drugs are particularly useful. They can be used alone or in combination with other medications, to treat symptoms of hyperarousal. These drugs block the adrenergic symptoms of hyperarousal, which in turn may allow patients with PTSD to better control feelings of anger, rage, or panic. Drugs?
Clonidine (alpha-2-agonist), and Propranolol (Beta-antagonist)
Which TCA is used for the effective treatment of nocturnal enuresis?
IMIPRAMINE!!!
What is the most important adverse side effect associated with Sildenafil?
Myocardial Infarction; while the drugs themselves do not pose an increased risk of death, the increased O2 demand and stressed placed on the heart by sexual activity, in a heart already affected by an underlying condition such as atherosclerotic disease may precipitate a heart attack
What is the Lithium level considered to be effective for acute mania?
Between 1 and 1.5 mEq/L; levels above 1.5 mEq/L carry a risk of toxicity that outweighs the potential benefits.
What effect do TCAs have on the heart?
They slow cardiac conduction, and in patients with preexisting prolonged QRS or in any persons with toxic dosages, TCAs can cause fatal heart block.
This disorder is characterized by excessive worry over many aspects of one's life, including work, family, finances, health, etc. Patient with generalized anxiety disorder have a hard time keeping these worries our of their mind, and find them to be very distressing. They also often have symptoms such as fatigue, restlessness, difficulty concentrating, irritability, and sleep disturbance. Diagnosis?
Generalized Anxiety Disorder (GAD).
This condition is characterized by excessive anxiety about multiple events, in conjunction with three or more of the following symptoms for a period of at least six months: impaired sleep, poor concentration, easy fatigability, irritability, muscle tension, or restlessness. Diagnosis?
Generalized Anxiety Disorder (GAD).
Clonazepam is a longer-acting benzodiazepine used in the treatment of panic disorder. Although cessation of this drug can be associated with withdrawal symptoms, the onset of withdrawal is not particularly rapid after cessation of usage. Which is the short-acting benzo that is commonly used to treat panic disorder that is associated with significant withdrawal symptoms such as generalized seizures and confusion?
Alprazolam.
Can a woman have a diagnosis Anorexia Nervosa in the presence of normal menses?
NO!!!
You should always have a high index of suspicion for this diagnosis in children (especially young girls) with sudden onset of behavioral problems, families with unstable economic backgrounds, or parents with a history of drug/alcohol abuse?
Physical/sexual abuse.
Patients with intoxication of this drug often present with severe agitation, impulsivity, impaired judgement, psychosis, paranoia, or hallucinations. These symptoms develop shortly after ingestion of the drug. Physical signs such as nystagmus, hypotension, tachycardia, ataxia, dysarthria, muscle rigidity, seizures, or coma may also be evident. Diagnosis?
PCP intoxication.
A delusion is a fixed false belief not consistent with cultural norms. Individuals with this type of delusion typically believe they have special powers, extraordinary accomplishments, or a special relationship with God. Diagnosis?
Grandiose delusions.
Which antidepressant has the potential side effect of priapism?
Trazadone.
What is the potential sexual side effect of the antidepressant Trazadone?
Pirapism.
What are the two main antipsychotic medications that come in Depot forms?
Haloperidol and Fluphenazine.
This condition is associated with chronic alcohol use. It typically develops within 12 to 24 hours of last drink and resolves within 24 to 48 hours. Unlike Delirium Tremens, sensorium is intact and vital signs are usually normal in this condition. Diagnosis?
Alcoholic Hallucinosis.
Schizophrenic catatonic type patients benefit most from what type of medications/therapy?
Catatonic Schizophrenia is best treated with benzodiazepines or ECT, in addition to antipsychotic therapies.
For the general population, the lifetime risk of developing bipolar disorder is 1%. An individual with a first degree relative, however, who suffers from bipolar disorder has what percentage risk of developing the condition in his/her lifetime?
5-10%
Treatment of PTSD is best accomplished with a combination of SSRIs and exposure or cognitive therapy. Why should Benzodiazepine use be avoided in patients with PTSD?
PTSD is strongly associated with substance abuse, thus the prescribing of addictive medications like benzodiazepines should be avoided when possible.
Problems commonly associated with this mood disorder are depression, agoraphobia, GAD, and substance abuse. Observational studies have show that 1/3 to 1/2 of patient meet DSM-IV criteria for major depression at initial presentation, while greater than 60% have had one or more lifetime episodes of major depression. Approximately 40% of patients with this disorder meet the criteria for agoraphobia. Diagnosis?
Panic disorder.
Adjustment disorder is characterized by emotional or behavioral symptoms that develop within three months of exposure to an identifiable stressor and that rarely last more than six months after the stressor has ended. The patient experiences marked distress in excess of what would be expected from exposure to the stressor. What is the treatment of choice for a patient diagnosed with Adjustment disorder?
Psychodynamic psychotherapy or brief cognitive psychotherapy. These two methods focus on developing coping mechanisms and on improving the individual's response to and attitude about stressful situations.
Which antidepressant is a helpful adjunctive treatment for those patients suffering from depressive symptoms and sleep disturbances?
Trazadone.
The mechanism of action of antipsychotic medications primarily consists of dopamine-D2 receptor blockade. The added serotonin receptor binding of atypical antipsychotics reduces the likelihood of what type of side effects?
Extrapyramidal side effects.
The onset of these symptoms always occurs before 3 years of age in children. The condition is characterized by qualitative impairments in communication and social interaction. These patients tend to indulge in repetitive, stereotyped behavior with strange preoccupations. Diagnosis?
Autism.
This disorder is a rare pervasive developmental disorder that that occurs more commonly in boys. It is characterized by a period of normal development for at least two years, followed by a loss of previously acquired skills in at least two areas: expressive or receptive language social skills, bowel or bladder control, or play and motor skills. These children then develop autistic symptoms. The etiology is unknown in most cases, though CNS pathology is thought to play a causative role in some children. The prognosis is poor, with most children severely disabled for life. Diagnosis?
Childhood disintegrative disorder.
Occuring almost exclusively in girls, this syndrome is a rare pervasive developmental disorder. The condition is characterized by an initial period of normal development (typically until six months of age) followed by the loss of hand coordination and the development of peculiar stereotyped hand movements. Other common features include deceleration of head growth, poor coordination, seizures, ataxia, mental retardation, and diminished social interactions. Diagnosis?
Rett syndrome.
This syndrome is characterized by qualitative impairment in social interaction and restricted, repetitive, and stereotyped patterns of behavior. Unlike patients with autistic disorder, children suffering this syndrome have normal cognitive and language development. Diagnosis?
Asperger syndrome.
The treatment of choice for this type of phobia is assertiveness training, which is a component of cognitive-behavioral psychotherapy (CBT). SSRI drugs are the first-line drugs in the management of this phobia, either alone or in combination with CBT. Diagnosis?
Social phobia.
This disorder presents with the same symptoms observed in PTSD, but the symptoms are present for less than four weeks. This is differentiated from adjustment disorder because it involves legitimate traumatic/life-threatening event, and the reaction to the event is not considered to be out of proportion to the stressor. Diagnosis?
Acute stress disorder.
What is the first-line pharmacotherapy for treating persistent enuresis in children? Second-line?
Desmopressin; TCAs such as imipramine.