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406 Cards in this Set
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The most important factor to consider when deciding whether a patients distress over bodily appearance represents body dysmorphic disorder or delusional disorder, somatic type is the:
a. presence of depression and suicidal ideations b. prescence of comorbid substance abuse c. intensity with which the patient insists on the perceived body deficits d. patient's intelligence and sophistication e. degree of actual social pressures on the patient to look attractive |
C. INTENSITY WITH WHICH THE PATIENT INSISTS ON THE PERCEIVED BODY DEFICITS
Cant diagnosis either if it occurs exclusively during depression Diagnosis of delusional d/o somatic type can be made in people with body dsymorphic d/o only if their preoccupation with imagined defect in appearance is held with a delusional intensity |
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Which of the following meidications is adequate as monotherapy for generalized tonic clonic seizures in an adult?
a. Gabapentin b. Tiagabine c. Ethosuximide d. Valproate e. Clonazepam |
D. VALPROATE
Gabapentin - mimic the chemical structure of the neurotransmitter GABA. Is renally excreted. FDA approved as adjuctive tx for partial seizures Tiagabine - potent selective reuptake inhibitor of GABA, used for bipolar and anxiety. Risk of Steven Johnson Syndrome, and seizure risk. Ethosuximde is used for Absence Seizures as first line, Second line is Valproate Clonazepam is used for partial seizures but not as monotherapy |
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Prolonged ingestion of high doses of pyridoxine in fad diets or megavitamin therapies may cause what type of neuropathy?
a. multifocal motor neuropathy b. subacute sensory neuropathy c. mononeuropathy multiplex d. demylinating polyneuropathy e. susceptibility to compression neuropathies |
D. SUBACUTE SENSORY NEUROPATHY
Multifocal motor neuropathy - progressive muscle disorder characterized by muscle weakness in the hands, with differences from one side of the body to the other in the specific muscles involved. It affects men much more than women. Symptoms also include muscle wasting, cramping, and involuntary contractions or twitching of the leg muscles. may be mistaken for ALS. etiology is autoimmune with +AntiGM1 Ab. TX - rituximab, IVIG, cyclophosphamide, azathioprine Subacute Sensory Neuropathy - can be due to excess of B6 (pyridoxine) compression neuropathies are seen in alcoholics Mononeuritis multiplex is a brain/nervous system (neurological) disorder that involves damage to at least two separate nerve areas. S/S: Abnormal sensation,Burning pain, Difficulty moving a part of the body (paralysis), Inability to move a part of the body, Lack of control over movement in a part of the body, Lack of or decreased sensation in any part of the body, Numbness and tingling. Causes polyarthritis nodosa, DM. SLE, RA, Amyloidsis, lyme dz, leprosy Demyleinating polyneuropathy- GBS, MLD |
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2 y/o child with a favorite wool blanket cries if unable to find it and resists leaving the house or going to bed without it. Which of the following concepts best describes the child's attachment to the blanket?
a. transitional object b. magical thinking c. object inconstancy d. separation anxiety e. regression |
TRANSITIONAL OBJECT
Transitional object - a physical object, which takes the place of the mother-child bond. Common examples include dolls, teddy bears or blankets. Donald Woods Winnicott introduced the concepts of transitional objects and transitional experience in reference to a particular developmental sequence. Also Ainswork confirmed attachments serve to reduce anxiety. object that acts as secure base as explores the world. Magical thinking - creative weaving fantasy to explain the world. Ages 2.5 to 6 y/o - associative logic Object constancy is last part of Mahler's concept of seperation and individuation process. 1. differentiaion (5-10mths) 2. Practicing (10-15 mths) 3. Rapprochement (18-24 mths) 4. Consolidation & Object constancy (24-36 mths) Seperation anxiety -is part of Mahlers also and is in the 10-15 month range, part of practacing Regression -When confronted by stressful events, people sometimes abandon coping strategies and revert to patterns of behavior used earlier in development |
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The treatment of choice for severe lithium intoxication is:
a. hemodialysis b. thiazide therapy c. managment of dehydration d. forced diuresis with mannitol therapy e. forced diuresis with furosemide therapy |
HEMODIALYSIS
Treatment for Lithium Intoxication varies depending on level Mild to Moderate - level of 1.5 to 2.0 *Early S/S - coarse tremor, dysarthria, ataxia, GI symptoms, heart changes, renal dysfunction, vomiting and abdominal pain Moderate to Severe - level 2 - 2.5 *Late S/S - impaired consciousness, myoclonus, muscular fasciculations, seizure, coma Severe - level > 2.5 tx - stop lithium, treat dehydration Unabsorbed in GI can remove by kayexaly, golytel, glycol soluation, polystyrene sulfate Dont use activated Charcoal For large ingesting may consider gastric lavage but depends on patients level of consciousness If severe Hemodialysis Risk factors for lithium toxicity *exceeding recommended dose *renal impairment *low sodium diet *drug interactions *dehydration |
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Which of the following defense mechanisms is most relevant to psychodynamic theories of the etiology and evolution of delusional disorder?
a. supression b. isolation of affect c. projection d. anticipation e. repression |
PROJECTION
Suppression - conscious or semiconscious postponing attention to impluse or conflict (mature defense) Isolation of Affect - split or separate from affect. Cognition (thoughts, concepts, ideas) is never divorced from emotion. Conflict can be avoided by separating the cognitive content (for instance, a disturbing or depressing idea) from its emotional correlate. The subject is fully aware of the facts or of the intellectual dimensions of a problematic situation but feels numb. Casting away threatening and discomfiting feelings is a potent way of coping with conflict in the short-term. It is only when it become habitual that it rendered self-defeating (neurotic defense) Projection - use to protect themselves from recognizing unacceptable impulses in themselves.We all have an image of how we "should be". Freud called it the "Ego Ideal". But sometimes we experience emotions and drives or have personal qualities which don't sit well with this idealized construct. Projection is when we attribute to others these unacceptable, discomfiting, and ill-fitting feelings and traits that we possess. This way we disown these discordant features and secure the right to criticize and chastise others for having or displaying them. When entire collectives (nations, groups, organizations, firms) project, Freud calls it the Narcissism of Small Differences. Anticipation - realistic anticipation or planning for future inner discomforts (mature defense) Goal oriented and implies careful planning or worrying and premature but realistic affective anticipation. Repression - The removal from consciousness of forbidden thoughts and wishes. The removed content does not vanish and it remains as potent as ever, fermenting in one's unconscious. It is liable to create inner conflicts and anxiety and provoke other defense mechanisms to cope with these. (neurotic defense) |
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Across all cultures, which of the following stressful life changes is correlated with the greatest increase in death and illness during the subsequent 2 years?
a. divorce b. death of a spouse c. death of a close family member d. incarceration e. personal injury/illness |
DEATH OF A SPOUSE
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Following a drug overdose, a patient is brought to the emergency department with a fever, confusion, rapid heart rate, dry mouth, urinary retention, and dilated & unresponsive pupils. Which of the following medications would be the best treatment for this drug overdose syndrome?
a. haloperidol b. benztropine c. propanolol d. physostigmine e. trihexyphenidyl |
PHYSOSTIGMINE
Physostigmine - acetylcholinesterase inhibitor. Intilirum, or eserine) 1-2 mg IV or IM 30 min Used to treat overdose on anticholinergic. Should only be used in severe overdose because of hypotension and bronchial constriction. Physostigmine is used to treat myasthenia gravis, glaucoma, Alzheimer's disease and delayed gastric emptying. It has been shown to improve the short term memory Also used as antidote to belladonna and GHB. "hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter".[6] These associations reflect the specific changes of warm, dry skin from decreased sweating, blurry vision, decreased sweating/lacrimation, vasodilation, and central nervous system effects on muscarinic receptors, type 4 and 5. This set of symptoms is known as anticholinergic toxidrome, and may also be caused by other drugs with anticholinergic effects, such as diphenhydramine, phenothiazine antipsychotics and benztropine. |
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S/S of heroin withdrawal (opioid)
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Early symptoms of withdrawal include:
Agitation, Anxiety, Muscle aches, Increased tearing, Insomnia, Runny nose, Sweating, Yawning Late symptoms of withdrawal include: Abdominal cramping, Diarrhea, Dilated pupils, Goose bumps, Nausea, Vomiting |
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Good Prognostic Factors For Schizophrenia
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Late onset
obvious precipitating factor acute onset good promorbid social, sexual and work history mood d/o symptoms married FH of mood d/o good support systems positive symptoms |
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Bleuler's 4 A's of Schizophrenia
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He described the four "A's", symptoms which he thought were characteristic of schizophrenia:
Ambivalence Autism flattened Affect loosening of Associations. |
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Schneider First Rank Symptoms
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First Rank Symptoms - a group of symptoms that Schneider proposed were diagnostic of schizophrenia in the absence of overt brain disease.
Auditory hallucinations of a specific type: 1) Audible thoughts: a voice anticipating or repeating the patients thoughts aloud. 2) Two or more voices discussing the patient in the third person. 3) Voices commenting on the patient's behaviour. Thought alienation: 1)Thought insertion. 2)Thought withdrawal. 3)Thought broadcasting. Passivity phenomena: 1)Experiences of bodily influence. 2)Made acts/impulses/affects - experiences which are imposed on the individual or influenced by others. Delusional perceptions (A two stage process) where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. "The traffic light is green therefore I am the King". |
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Kreaplin
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Kraepelin 1896:
Dementia praecox - grouped together all of the above with the addition of dementia paranoides. He considered hallucinations, delusions, thought disorder, negativism and emotional blunting to be characteristic of dementia praecox. He also observed that the onset was usually in early adult life and often progressed to a "demented" end stage. However he realised that the breakdown was not intellectual, the onset was not necessarily in adolescence and the prognosis was not always poor. |
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Neuroleptic Malignant Syndrome
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muscular cramps, fever, symptoms of instability of the autonomic nervous system such as unstable blood pressure, and changes in cognition, including agitation, delirium and coma. Other symptoms may include muscle tremors and pharyngitis.
Symptoms overview Increased body temperature >100.4 degrees °F, or >38 °C Confused or altered consciousness Diaphoresis "sweat shock" Rigid muscles Autonomic imbalance A mnemonic used to remember the features of NMS is FEVER.[7] F—Fever E—Encephalopathy V—Vitals unstable E—Elevated enzymes (elevated CPK) R—Rigidity of muscles |
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Features in NMS but not in Serotonin Syndrome
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Bradykinesia
Muscle rigidity Laboratory values (WBC & CK) |
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Serotonin Syndrome
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Mild symptoms may only consist of increased heart rate, shivering, sweating, dilated pupils, myoclonus (intermittent tremor or twitching), as well as overresponsive reflexes.
Moderate intoxication includes additional abnormalities such as hyperactive bowel sounds, high blood pressure and hyperthermia; a temperature as high as 40 °C (104 °F) is common in moderate intoxication. The overactive reflexes and clonus in moderate cases may be greater in the lower limbs than in the upper limbs. Mental status changes include hypervigilance and agitation. Severe symptoms include severe increases in heart rate and blood pressure that may lead to shock. Temperature may rise to above 41.1 °C (106.0 °F) in life-threatening cases. Other abnormalities include metabolic acidosis, rhabdomyolysis, seizures, renal failure, and disseminated intravascular coagulation; these effects usually arise as a consequence of hyperthermia. Management is based primarily on stopping the usage of the precipitating drugs, the administration of serotonin antagonists such as cyproheptadine, and supportive care including the control of agitation, the control of autonomic instability, and the control of hyperthermia |
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TX for Neuroleptic Malignant Syndrome
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NMS is an emergency, and can lead to death if untreated.
The first step is to stop neuroleptic drugs and to treat the hyperthermia aggressively, such as with cooling blankets or ice packs to the axillae and groin. Many cases require intensive care and circulatory and ventilatory support. Medications: Dantrolene sodium and bromocriptine may be used. Apomorphine may be used however its use is supported by little evidence. Benzodiazepines may be used to control agitation. Highly elevated CPK can damage the kidneys, therefore aggressive hydration may be required. Volume resuscitation is paramount. Benzodiazepines, dantrolene, and dopaminergic agents are a few pharmaceutical families that can be used to treat various degrees of NMS. If it is recognized early enough, NMS is not fatal, but still, 10% of cases do result in patient death. |
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Symptoms of NMS
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fever
sweating increase pulse increase blood pressure muscle rigidity dytonia akinesia agitation |
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Percentage of Schizophrenics that attempt Suicide
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50%
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Risk Factors for Suicide in Schizophrenics
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College Education
Depression High Ambitions Living Alone |
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Medical Drugs Linked to Depression
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Methyldopa
OCP Steriods Beta Blockers |
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Serotonin Syndrome
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Agitation/restlessness
diarrhea rapid changing blood pressure increase HR hallucinations increase body temperature loss coordinations nausea/vomiting increase DTR Change MS - confusion myoclonus shivering/tremor ataxia |
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Treatment for Seretonin Syndrome
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BZD (ativan, valium)
IV Fluids Cyroheptadine Stop medication causing |
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Common agents causing Seretonin syndrome when mixed with SSRI or SNRI's
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MAOI
Meperidine Cough medication (dextrometh) LSD Ecstasy Triptans |
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Most common Genetic Cause of Mental Retardation
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Fragile X
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Most Common Cause of Mental Retardation
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Downs syndrome
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Part of brain area associated with sleep arousal
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reticular system
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Area of brain associated with damage in Parkinson's Disease
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basal ganglia - specifically the substantia Nigra
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Blockage of H2 receptors causes what
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weight gain
Sedation |
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Antipsychotic with the greatest sedation
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Chlorpromazine (Thorazine)
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Which of the following represent a disorder of the content of thought?
a. world salad b. tangentiality c. neologisms d. obsessions e. loosening of associations |
OBSESSIONS
Rest are all form of thought disorders -word salad -tangentiality -neologism -loosening of association |
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Prader Willi Syndrome
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S/S - hypotonia, short stature, hyperphagia, obesity, behavioral issues (specifically OCD-like behaviors), small hands and feet, hypogonadism, and mild mental retardation
Chromosomal Abnormality - small deletion on 15q on paternal chromosome The paternal gene origin is lost due to deletion and the maternal genes are silenced due to imprinting Maternal deletion on chromosome 15 leads to Angelman Syndrome |
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Williams Syndrome
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rare neurodevelopmental disorder caused by a deletion of about 26 genes from the long arm of chromosome 7
characterized by a distinctive, "elfin" facial appearance, along with a low nasal bridge; an unusually cheerful demeanor and ease with strangers; developmental delay coupled with unusual (for persons who are diagnosed as developmentally delayed) language skills; and cardiovascular problems, such as supravalvular aortic stenosis and transient hypercalcaemia. |
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Wilson's Disease
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autosomal recessive genetic disorder in which copper accumulates in tissues; this manifests as neurological or psychiatric symptoms and liver disease. It is treated with medication that reduces copper absorption or removes the excess copper from the body, but occasionally a liver transplant is required
The condition is due to mutations in the Wilson disease protein (ATP7B) gene Liver biopsy is gold standard *Kayser-Fleischer ring, RTA, cardiomegaly, tremor, rigidity, chorea, tonic, hypoparathyroidsim, depression and suicide, seizures Autosomal recessive Diagnosis in adolescence Test - plasma ceruloplasmin low (<0.2g/L), also 24 hour urine for copper Treatment - chelating agents (Pencillamine) |
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Erickson's Eight Stages
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Trust and Mistrust (0-1 y/o)
Autonomy vs Shame & Doubt (1-3 y/o) Initiative vs Guilt (3-5 y/o) Industry vs Inferiority (6-11 y/o) Identity vs Role Confusion (11-20/21 y/o) Intimacy vs Isolation (20-40 y/o) Generative vs Stagnation (40 - 65 y/o) Ego Integrity vs Despair (>65 y/o) |
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Anticipation
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earlier in sub-sequential generation
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Amplification
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gene abnormality is unstable and tends to expand with further transmission
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EEG finding for Beta Waves
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Due to Benzodiazepines or Barbiturates
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EEG finding of Periodic Complexes Seen in what conditions
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CJ Virus (prion)
Subacute Sclerosing Panenchephalitis (SSPE) Myoclonis |
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Phenylketonuria (PKU)
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autosomal recessive genetic disorder characterized by a deficiency in the hepatic enzyme phenylalanine hydroxylase (PAH).
This enzyme is necessary to metabolize the amino acid phenylalanine ('Phe') to the amino acid tyrosine. Detect increase phenylpyruvate in the urine Leads to Mental Retardation and seizures if untreated Treatment is diet restriction PKU is normally detected using the HPLC test, but some clinics still use the Guthrie test, part of national biochemical screening programs. Most babies in developed countries are screened for PKU soon after birth |
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Cluster A Personality Disorders
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Schizoid Personality-characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, and emotional coldness.
Schizotypical Personality- characterized by a need for social isolation, odd behavior and thinking, and often unconventional beliefs Paranoid Peronality- characterized by paranoia and a pervasive, long-standing suspiciousness and generalized mistrust of others. Those with the condition are hypersensitive, are easily slighted, and habitually relate to the world by vigilant scanning of the environment for clues or suggestions to validate their prejudicial ideas or biases. They tend to be guarded and suspicious and have quite constricted emotional lives. Their incapacity for meaningful emotional involvement and the general pattern of isolated withdrawal often lend a quality of schizoid isolation to their life experience |
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Cluster B Personality Disorders
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Cluster B (dramatic, emotional or erratic disorders)
Antisocial personality disorder- a pervasive disregard for the law and the rights of others. Borderline personality disorder- extreme "black and white" thinking, instability in relationships, self-image, identity and behavior. Histrionic personality disorder- pervasive attention-seeking behavior including inappropriate sexual seductiveness and shallow or exaggerated emotions. Narcissistic personality disorder - a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. |
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Cluster C personality Disorders
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Cluster C (anxious or fearful disorders)
Avoidant personality disorder- social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction. Dependent personality disorder- pervasive psychological dependence on other people. Obsessive-compulsive personality disorder - characterized by rigid conformity to rules, moral codes and excessive orderliness. |
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Cluster A Personality Disorders
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Schizoid Personality-characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, and emotional coldness.
Schizotypical Personality- characterized by a need for social isolation, odd behavior and thinking, and often unconventional beliefs Paranoid Peronality- characterized by paranoia and a pervasive, long-standing suspiciousness and generalized mistrust of others. Those with the condition are hypersensitive, are easily slighted, and habitually relate to the world by vigilant scanning of the environment for clues or suggestions to validate their prejudicial ideas or biases. They tend to be guarded and suspicious and have quite constricted emotional lives. Their incapacity for meaningful emotional involvement and the general pattern of isolated withdrawal often lend a quality of schizoid isolation to their life experience |
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Cluster B Personality Disorders
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Cluster B (dramatic, emotional or erratic disorders)
Antisocial personality disorder- a pervasive disregard for the law and the rights of others. Borderline personality disorder- extreme "black and white" thinking, instability in relationships, self-image, identity and behavior. Histrionic personality disorder- pervasive attention-seeking behavior including inappropriate sexual seductiveness and shallow or exaggerated emotions. Narcissistic personality disorder - a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. |
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Cluster C personality Disorders
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Cluster C (anxious or fearful disorders)
Avoidant personality disorder- social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction. Dependent personality disorder- pervasive psychological dependence on other people. Obsessive-compulsive personality disorder - characterized by rigid conformity to rules, moral codes and excessive orderliness. |
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Two Types of Narcissistic person
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Glen Gabbard suggested NPD could be broken down into two subtypes.[22] He saw the "oblivious" subtype as being grandiose, arrogant and thick-skinned and the "hypervigilant" subtype as easily hurt, oversensitive and ashamed.
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What is Projective Identification
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Feel something inside and project that feeling to another so that they then take on the feeling.
term first introduced by Melanie Klein of the object relations school of psychoanalytic thought in 1946. It refers to a psychological process in which a person engages in the ego defense mechanism projection in such a way that his behavior towards the object of projection invokes in that person precisely the thoughts, feelings or behaviors projected. |
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Treatment for Borderline Personality Disorder
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#1 is DBT
Also psychodynamic, social skills training. Insight is not helpful for these patients. No FDA approved Medications |
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APA guidelines for treatment of Borderline Personality disorder with medications
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Affective Disregulation - Mood Lability, Anger, temper and depression
-> SSRI or related antidepressants, if partial response add klonopin or low dose neuroleptic, then MAOI and mood stabilizers Impulse/discontrol behaviors, aggressive, catty, promiscuisity -> SSRI, then low dose antipsychotic, then lithium/MAIO or atypical neuroleptics Cognitive Perceptual Difficulties - transient psychosis/paranoia -> low dose anitpsychotic and neuroleptics, SSRI, or low dose Clozaril |
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Dialectical behavior therapy (DBT)
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developed by Marsha M. Linehan to treat persons with borderline personality disorder (BPD)
DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of mindful awareness, distress tolerance, and acceptance largely derived from Buddhist meditative practice. 4 Components *Mindfulness *Interpersonal Effectiveness *Emotional Regulation *Distress Tolerance |
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What is Mindfulness component of DBT
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What and How Skill
Not judging, living in the moment, imagery based way, relaxation |
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Antipsychotics with Risk of Seizures
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chlorpromazine
Loxapine Clozapine |
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Neuroleptic Malignant Syndrome
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Fever
Autonomic Dysregulation (HTN, Tachy, Urin incont, diaphersis) Rigidity (lead pipe) Granulocytosis ( Increased LDH, LFTs, CPK, and myoglobinemia) Orientation Changes (confusion and Coma) |
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Antipsychotic that Causes Priapism
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Thioridazine (mellaril)
Secondary to adrenergic blockade |
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Psychotropics with Narrow Theraperutic Index
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Thiorizadizine
Mesoridazine Lithium TCA's MAOI's |
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Where are D1 and D4 receptors
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In the Prefrontral cortex, but not in the nigrostriatal pathway (basal ganglia)
Thought to be maybe a reason that clozapine improves negative symptoms without the EPS |
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Risk with Clozapine and lithium combination
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Increase risk for NMS and seizures
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Risk with Clozapine and Carbamazepine combination
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increase risk for bone marrow suppression
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What other disorder do patient being treated with Clozapine have increase risk of exacerbating
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OCD
treat by adding SSRI |
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Drugs that cause Agranulocytosis
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Clozapine
Chlorpromazine |
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Drug with Side Effect of Retrograde Ejaculation
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thioradazine
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Drug known for its side effect of hypersalivation
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clozapine
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Drug with side effect of reversible cholestatic Jaundice
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Chlorpromazine
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Side effect for Retinitis Pigmentosa
(Leticular Pigmentation) |
Thioridazine dosage over 800mg/day
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Drug that Side Effect is Cataracts
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Quetiapine
Need to do yearly eye exams on patient that are on seroquel |
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Mechanism of action leading to hyperprolactinemia
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Blockage of D2 receptors reaching approximately 70% in the tuberoinfundibular pathway
See with FGA's and Risperdal |
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Side Effect of Hyperprolactemia
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Menstral Irregularities, galactorrea, breast enlargment, decreased libido
Hirutism, infertility, gyncomastia increased osteoporosis (due to decrease estrogen and testosterone) Increase Cardiovascular Risks Depression Possible increase risk of Breast Cancer |
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Drugs that are known to cause QTC prolongation
Most to least |
Thiorizadine (35.8 msec)
Ziprasidone (20.6 msec) Quetiapine (14.5 msec) paliperidone (12.3 msec) Risperidone (10 msec) Olanzapine (6.4 msec) Halperidol (4.7 msec) |
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Infection that has propensity for the temporal and infromedial frontal lobe
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HSV
Can have loss of sensation of smell (anosmia) Also may present with olfactory and gustatory hallucinations |
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Acute viral infection that travels centripetally along peripheral nerves to the CNS
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Rabies
Variable incubation for 10 days to longer |
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Piaget's Model of Cognitive Development
4 Stages |
1) Sensorimotor Stage (Birth to 18/24 mths)
*Object Permancy -child able to maintain mental image of object 2) Pre-Operational Thought - prelogical (2-6 y/o) *Egocentric thinking *Magical Thinking 3) Concrete Operations (7-11 y/o) *Rational and logical thought process *concept of Conservation 4) Formal Operations (12 y/o and up) *Abstract thinking -ability to manipulate ideas and theoretical constructs *Deductive Reasoning - ability to go from general to particular *Conceptual thinking develops- ability to define concepts or ideas |
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Chess and Thomas Theory of Temperment
9 observable behaviors |
Activity Level
Rhythmicity approach or withdrawal response adaptability to change in environment threshold of responsiveness intensity of given reaction mood degree of distractablity persistence in face of obstacles |
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What are the three categories for children according the Chess and Thomas
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Easy
Difficult Slow to warm up |
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Who did attachment theory
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Bowlby - 3 stages of mother-infant separation
Ainsworth -development 7 steps to determine quality and strength of attachment. Thought that by 2 y/o >60% have secure attachments |
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Important aspects of the child's emotional and cognitive development in Preschool age (2.5 to 6 y/o)
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Egocentricity - child preceptions that all life events revolve around him/her
Magical thinking - creative weaving of reality and fantasy to explain how things occur in the world (associative logic) Body Image Anxiety - feels that whole body is vulnerable when any body part is injured |
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Which Second generation Antipsychotic has the highest risk for Tardive Dyskinesia
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Risperdone
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What is cause of Tardive Dyskinesia
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Long term D2 receptor blockage in the nigrostriatal
Persists in 2/3 pt even once stop offending agent |
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Things that exacerbate TD movements
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emotional stress
volitional motor activity attempts to inhibit the movement low dose anticholinergic meds withdrawal of antipsychotic medications |
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Things that decrease TD movements
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absent in sleep
reduced with sedation suppressed by dose increase of antipsychotic medications improved or clinically reversed with clozpine or olanzipine |
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When do you see a festinating gait
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Parkinson's dz
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When do you see scissor Gait
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spastic cerebral palsy
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When do you see antalgic gait
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motion to avoid pain
osteoarthritis pelvic griddle pain |
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When do you see a cerebellar gait
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spinocerebellar ataxia
cerebellum problem |
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When do you see a pigeon gait
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Hip Dysplasia
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When do you see Propulsive gait
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Stiff with head and neck bent
manganese toxicity Parkinson dz Carbon Monoxide poisoning |
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When do you see Steppage gait
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Damage to Peroneal nerve
Polio Multiple Sclerosis syphilis (tabes Dorsalis) |
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When do you see Stomping Gait
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Fredrich ataxis
Pernicius anemia Tabes Dorsalis Multiple Sclerosis Peripheral Nerve Damage |
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When Do you see Spastic Gait
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Sturge-Weber Syndrome
Cerbral Palsy CVA Multiple Sclerosis Brain tumor/abscess |
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When do you see a Myopathic Gait (Waddling)
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Pregnancy
muscular dystrophy congenital hip dysplasia |
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When do you see a magnetic gait
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Normal Pressure Hydrocephalus
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When do you see trendelenburg gait
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L5 Radiculopathy
Poliolyelitis |
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When do you see wide based gait
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Cerebellum problems
Alcoholics |
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When do you see an Apraxic gait
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Normal pressure hydrocephalus
not sure which foot |
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When do you see Astasia Abasia
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Faking, act like going to fall but never fall
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Pinpoint Pupils
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Miosis
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Dilated Pupils
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Mydriasis
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Creutzfeldt Jakob Disease
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is a degenerative neurological disorder (brain disease) that is incurable and invariably fatal. It is the most common among the types of transmissible spongiform encephalopathy found in humans
t symptom of CJD is rapidly progressive dementia, leading to memory loss, personality changes and hallucinations. This is accompanied by physical problems such as speech impairment, jerky movements (myoclonus), balance and coordination dysfunction (ataxia), changes in gait, rigid posture, and seizures. The duration of the disease varies greatly, but sporadic (non-inherited) CJD can be fatal within months or even weeks Prion Disease |
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What are the Prion Diseases
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Creutzfeldt-Jakob disease
Fatial Familial Insomnia Gerstmann-Straussler-Scheinker Syndrome Kuru Varient Creutzfeldt Jakob Disease |
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What is SSPE
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Subacute sclerosing panencephalitis (SSPE) is a rare chronic, progressive encephalitis that affects primarily children and young adults, caused by a persistent infection of immune resistant measles virus
Characterized by a history of primary measles infection usually before the age of 2 years, followed by several asymptomatic years (6–15 on average), and then gradual, progressive psychoneurological deterioration, consisting of personality change, seizures, myoclonus, ataxia, photosensitivity, ocular abnormalities, spasticity, and coma. |
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MAO-A
MAOI selective A drugs |
MAO-A is also found in the liver, gastrointestinal tract, and placenta
Serotonin, melatonin, norepinephrine, and epinephrine are mainly broken down by MAO-A Both A and B break down Dopamine Brofaromine, Metralindole, Minaprine, Moclobemide, Pirlindole, Toloxatone, |
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MAO-B
MAOI selective B drugs |
MAO-B is mostly found in blood platelets
Phenethylamine is mainly broken down by MAO-B Both A and B break down Dopamine selegiline and rasagiline - no dietary restriction at low dose |
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MAOI Inhibitors no selective for A or B
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isocarboxazide
phenelzine pheniprazine linezolid hydralazine |
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Reversible MAOI
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Meclopamide
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Medication for Restless Leg Syndrome
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pramipexole
Ropinirole |
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What is Ebstein's anomaly
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congenital heart defect in which the opening of the tricuspid valve is displaced towards the apex of the right ventricle of the heart.
Risk of this for women on lithium tx while pregnant and also those with WPW |
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Heart Anomalies with Down Syndrome
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Complete AV canal Defect (60%)
VSD (32%) Tetralogy Fallot (6%) ASD (1%) Isolated Mitral Cleft (1%) |
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Donald Winecott Theory
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Object relations theory is a psychodynamic theory within psychoanalytic psychology. The theory describes the process of developing a mind as one grows in relation to others in the environment. The "objects" of the theory are both real others in one's world, and one's internalized images of others. Object relationships are initially formed during early interactions with primary care givers. These early patterns can be altered with experience, but often continue to exert a strong influence throughout life.
transitional objects good-enough mother |
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Melanie Klein Theory
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She was a leading innovator in theorizing object relations theory.
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Heinz Kohut Theory
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best known for his development of Self psychology, an influential school of thought within psychodynamic/psychoanalytic theory which helped transform the modern practice of analytic and dynamic treatment approaches
Self Object Mirroring |
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First Generation Antipsychotics
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Low Potency
*Chlorpromazine *Thioridazine *Mesoridazine Medium Potency *Perphenazine *Loxapine *Trifluoperazine *Thiothixene High Potency *Halperidol *Fluphenazine *Pimozide |
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Most Atypical Second Generation
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Quetiapine
Clozapine |
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Second Generation Anti-psychotics
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quetiapine
clozapine ziprasidone apriprazole olanzapine risperdone paliperidone |
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SGA that does not block 5HT-2A and D2
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Apriprazole
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SGA - 1st line if SI or suicidal Behaviors
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Clozapine
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Heterocyclic Antidepressant - Amoxapine
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Strong norepi but weak 5HT reuptake inhibitor. Metabolite 7-hydroxyamoipine has D2 receptor blocake activity. Dose 200-300mg day with up to 600mg in inpatient setting
NO single dose to excide 300 Has significant blockage of cholinergic, histimine, and alpha 1 adrenergic S/E - dry mouth, urinary hesitancy, dizziness, sedation, weight gain High Potential for seizures, and deadly in overdose |
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Pseudoparkinsonism
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akinesia (absence of movement)
Bradykinesia Rigidity in arms and shoulder hypersalivation mask-like facies cogwheel rigidity postural difficulty - shuffling gait |
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Test to assess for Akathesia
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Barnes Akathesia Scale
4-items scored 0-5 *Objective *Subjective - awareness of Reslessness *Subjective- Distress related to restlessness *Global Clinical Assessment of Akathesia |
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At what age can a child draw a circle
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3 y/o
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At what age can a child draw a +
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4 y/o
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At What age can a child draw a square
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5 y/o
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At what age can a child draw a triange
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6 y/o
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Age for Social Smile
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0-3 months
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Age for stranger anxiety
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8-12 months
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Age for sitting unassisted
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5-7 months
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Reason for mild depression 2 days after a birth is due too...
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changes in hormone levels
awareness of increased responsibilities stress of child birth fatigue |
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Most common defense mechanism used in patients with multiple personality disorder
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Dissociation
Now called Dissociative Identity Disorder |
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What are the Mature Defense Mechanisms
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Altruism
Humor Sublimation Suppression |
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Which personality disorder is alcoholism linked too
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antisocial
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First Do No Harm refers to which following core ethical principle
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Nonmaleficence
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At What age does the formation of small peer groups who share values, speech patterns, and manners first seen
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8 years old
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Gadolinium contrast MRI is used to diagnose diseases affecting what structure of the brain
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Blood-brain barrier
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What are the Features of major depressive episode with atypical features
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overeating
oversleeping younger age of onset hystroid dysphoria more sever psychomotor slowing interpersonal rejection sensitivity more likely coexisting panic d/o somatization d/o |
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Types of patient that hypnosis in contraindicated for
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pt with strong attachments/inappropriate attachements
poor reality testing emotionally fragile paranoid problems with trust |
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Most common pain syndrome associated with HIV infection
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Peripheral Neuropathy
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Infant engages in interactive games such as peek-a-boo demonstrates the concept of what cognitive ability
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Object permanence
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Egocentrism
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self centered
selfish preoccupation with ones own needs lack of interest in others Age 2-7 |
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Object permanence
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Piaget
Birth to 2 y/o understand objections exist independent of themself |
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Conservation
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example water same in to different jars
ability to recognize shapes may change but objects still maintain their characteristics Age 7-11 |
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What test is recommended to establish diagnosis of brain death
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Apnea Test
EEG shows no electrical activity. Associated with loss of higher brain function and all brainstem function, respiration, gag and corneal reflex |
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What is Phalen's Test
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Test for carpal tunnel syndrome
The patient is asked to hold their wrist in complete and forced flexion (pushing the dorsal surfaces of both hands together) for 30-60 seconds. This maneuver moderately increases the pressure in the carpal tunnel and has the effect of pinching the median nerve between the proximal edge of the transverse carpal ligament and the anterior border of the distal end of the radius. By compressing the median nerve within the carpal tunnel, characteristic symptoms (such as burning, tingling or numb sensation over the thumb, index, middle and ring fingers) conveys a positive test result and suggests carpal tunnel syndrome. |
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What is the Hot Bath Test
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Old test used for Multiple Sclerosis diagnosis
A person suspected of having MS was immersed in a hot tub of water, and the appearance of neurological symptoms or worsening of symptoms was taken as evidence that the person had MS. |
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What is Cold Caloric Test
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is a test of the vestibulo-ocular reflex that involves irrigating cold or warm water or air into the external auditory canal.
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What is Methacholine Provocation Test
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Used to assess asthma
20 percent fall in FEV1 |
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Most common co-morbid with ADHD
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mathematical disorders
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Common defense mechanisms for hypochondriasis and Body Dysmorphic disorder
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repression
displacement |
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Prevalence of Schizophrenia
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1%
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Prevalence of Mood Disorder
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5%
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Condition where Lithium is contraindicated
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Sick Sinus Syndrome
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observation
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uses your senses, tool or number, calculations, or measurements
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CT finding for Huntington's
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Enlargement of ventricles due to atrophy of the head of the caudate nucleus
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Skinner
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Operant Conditioning
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Palvov
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Classical Conditioning
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Memory of specific event
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Episodic memory
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Memory for automatic skills/speaking/grammer
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implicit memory
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Which SSRI's are most selective inhibitors of serotonian reuptake
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citalipram
escitalopram |
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SSRI with significant anticholinergic activity at higher dosages
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paroxetine
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Learning is thought to take place as a result of the contiguity of environment events
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classical
Pavlov |
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Learning is thought to occur as a result of the consequence of a person's actions and resultant effect on the environment
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operant conditioning
Instrumental Skinner |
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When do Post-traumatic seizures occur
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within less then one year after injury
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First line treatment for partial seizures
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Carbamazepine
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Therapeutic Level for Valproic Acid
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50-100
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What is the therapeutic level for the anticonvulsant Phenytoin
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10 to 20
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Majority of symptoms experienced by patients in the initial phase post-concussion resolved in what time frame
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three to six months
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Somatic Manifestation of Post-Concussive Syndrome include
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Headache
Sleep disturbances Diminished libido Dizziness fatigue photophobia tinnitis decrease tolerance for alcohol hypersensitivity to noise |
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Cognitive symptoms associated with post-concussive syndrome include
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diminished concentration
diminished attention memory problems perseveration dyspraxia poor motivation vacuous appearance |
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Post brain injury patient are susceptible to which effects when prescribing neuroleptics
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increase sedation
hypotension extrapyramidal effects |
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Idiosyncratic reactions occur in 5% of patients getting contrast. What are some of these reactions?
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hypotension
flushing nausea urticaria anaphylaxis |
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Which has the greater risk for side effects Ionic contrast or Nonionic contrast
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Ionic Contrast
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Risk Factors for contrast-induced side effects are
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Age less then 1
Age > 60 asthma allergies CV disease prior contrast reaction |
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What is the CT spatial resolution
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less then 1mm
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Why is CT contraindicated in pregnancy
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Because it using ionized radiation
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What are T1 and T2 Images with MRI useful for
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T1 - optimal visualization of normal anatomy
T2 weighted images detect areas of pathology |
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Which is better for visualization of the posterior fossa and brainstem
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MRI
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What is the spatial resolution for PET scan
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4 to 8 mm
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Spatial resolution for Single Photon Emission Computer Tomography (SPECT)
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more than 8mm
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Indications for CT imaging
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Dementia
New-onset pychosis Movement disorder anorexia nervosa prolonged catatonia new onset affective disorder personality change after 50 y/o |
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Rates of Depression in amputees
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35 to 58%
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Rates of Depression in stroke patients
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25-30%
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Percentage of Men that report premature ejaculation
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30%
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Definition for Erectile Dysfunction
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Inability to retain or maintain a satisfying erection until completion of sexual activity, causing marked distress or interpersonal difficulties
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What is Peyronie's Disease
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An erection with a curved shaft secondary to fibrosis
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Organically based erectile dysfunction can be treated successful with what agents
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yohimbine
alprostadil papaverine testosterone |
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Define Infertility
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Failure to conceive after one year of regular sexual intercourse or inability to carry a pregnancy to live birth
NOTICE ITS ONE YEAR! |
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Infertility is diagnosed in what percentage of couples of child bearing age
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1 in 6
17% |
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Percentage of women under 25 years of age that suffer from infertility
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approximately 10%
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Percentage of women 35-40 years of age that suffer from infertility
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approximately 25%
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Percentage of women that suffer from major depression during the first six months after a spontaneous abortion
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10 to 50%
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For menopause to be diagnosed, menses must be absent for how many consecutive months
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12
1 YEAR |
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Median Age of the onset of the perimenopause, defined as the time of transition from regular menstrual function to the complete cessation of menses is approximately
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47 years of age
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Prevalence of major and minor depression during pregnancy is approximately
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10%
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Percentage of women with bipolar disorder that relapse withing the acute post-partum period
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50-60%
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What is the percentage of neural tube defects in pt treated with valproic acid in the first trimester
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~5%
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Risk of spina bifida after first trimester prenatal exposure to carbamazepine
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1%
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Post-partum blues is a time-limited condition involving mood lability that occurs in what percentage of post-partum women
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50-75%
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What is the time frame for post-partum blues
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Develops within 2 to 3 days after delivery and last up to 2 weeks
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Post-partum depression develops when
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Major depression within 4 weeks of delivery
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Time frame requirement for Acute Stress Disorder
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Symptoms must last at least 2 days - 4 weeks, and occur within 4 weeks of the trauma
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Lifetime risk for developing post-traumatic stress disorder in a community sample
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1-3%
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Principles when evaluating a person immediately following a traumatic event include
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Establish rapport with the patient
gently encourage the patient to review the trauma and surrounding events identify the aspect of the trauma that was most distressing to the patient pay attention to practical and immediate concerns brought on by the trauma |
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Principles in treatment following a traumatic event include
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convey whatever is known about the traumatic even to the patient
Educate the patient about common responses to trauma review how the patient has preveiously managed crises to recall the patients strengths encourage patient to use existing supports |
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Which TCA is effective for treatment of OCD and which is not
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Effective - Clomipramine
Ineffective - Imipramine |
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Lifetime prevalence of Bipolar disorder
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1-4%
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Causes of Secondary Mania include
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thyrotoxicosis
multiple sclerosis HIV infection SLE steriods anticholinergic agents hypoglycemia electrolyte imbalance stroke |
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Which anticonvulsant level will drop after 8-12 weeks of treatment due to enzyme induction
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carbamazepine
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Maintenance treatment for bipolar disorder should continue for how long after the first and any subsequent manic episode
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At least one year
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DSM Criteria for Manic Episode
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Grandiosity
distinct period of abnormally or persistently elevated, expansive or irritable mood lasting 1 week or any duration if hospitalized decreased need for sleep racing thoughts distractibility increase in goal oriented behavior or PMA excessive involvement in pleasurable activities |
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Contraindications for lithium therapy
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Renal Impairment
Myasthenia gravis Pregnancy Fluid and Salt imbalances |
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Side Effects of Carbamazepine
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Aplastic Anemia
Thrombocytopenia Toxic Epidermal Necrolysis Hepatitis agranulocytosis rash erythema multiforme Steven Johnson Syndrome Hyponatremia edema SLE arrythmia teratogen |
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Percentage of eating disorder patient that are male
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5-10%
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What vision disturbance is found in patients with pituitary tumor that protrudes through the diaphragma sella
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Bitemporal hemianopia
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What serum antibody is found in patient with Myasthenia gravis
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Acteylcholine Receptor Ab
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In a patient with dementia, the occurance of intermittent confusion, hallucinations, and psychotic behaviors, with unusual sensitivity to the extrapyramidal effects of neuroleptic drugs would suggest what diagnosis
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Diffuse Lewy Body Disease
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What disorder of childhood puts the patient at greatest risk of developing panic disorder as an adult
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separation anxiety disorder
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Primary psychological task of school-age children is achieving which of the following
a. identity b. autonomy c. attachment d. competence e. individuation |
COMPETENCE
Erikson Competence from Industry vs. Inferiority (Childhood, 7 to 12 years) Psychosocial Crisis: Industry vs. Inferiority Main Question: "Am I successful or worthless?" Virtue: Competence Related Elements in Society: division of labor |
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According to Erikson's Theories, Which of the following psychological issues would be most salient for a 75 y/o?
a. appreciating the achievements of one's parents b. establishing new interests c. Maintaining old friendships d. Creating a better world for others e. finding meaning in what one has done |
FINDING MEANING IN WHAT ONE HAS DONE
Wisdom Ego Integrity vs. Despair (Seniors, 65 years onwards) Psychosocial Crisis: Ego Integrity vs. Despair Main Question: "Have I lived a full life?" Virtue: Wisdom |
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Leading nongenetic cause of mental retardation in the United States
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Fetal Alcohol Syndrome
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What antipsychotic medication is best to avoid in patients with Parkinson's disease
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clozapine
Parkinson medications and clozapine have increase risk on NMS |
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MRI finding for HIV-associated Dementia
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Diffuse and confluent white matter change in TS sequence, without any mass effect and without any enhancement with gadolinium
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CT and MRI for Toxoplasmosis
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Thin-walled ring-enhancing lesions, surrounding edema;
Multiple ring enhancing lesions on CT or MRI |
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Gait characterized by postural instability accompanied by festination and truncal rigidity
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Parkinson's disease
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drug of abuse that exerts its effects primarily through serotonin release and reuptake inhibition
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Methylenedioxymethamphetamine
(MDMA) Esctasy |
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Changes in sleep due to aging
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Delta wave amplitude decreases and proportionally less time is spent in stage 3 and stage 4 sleep
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In a forensic evaluation if the defendant tells you of unsolved cases what should you do
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Avoid detailed descriptions of the defendant's past offense history
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Discuss Desipramine
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TCA
It inhibits the reuptake of norepinephrine and to a lesser extent serotonin. It is used to treat depression, but not considered a first line treatment since the introduction of SSRI antidepressants. Desipramine is an active metabolite of imipramine. Can be used for neuropathic pain and also ADD FDA cautions use in patient with arrythmia due to risk of sudden death. manufacturer also warn that some patients may have seizures before cardiac dysrhythmias and death |
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Child Behavior Checklist (CBCL)
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Widely-used method of identifying problem behavior in children. It is a component in the Achenbach System of Emperically Based Assessment.
2 Versions, Score items 0(no) - 2(very true) Preschool version for 18 months to 5 years old has 100 questions School-age Version for children 6-18 y/o has 120 questions |
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Wide Range Achievement Test (WRAT)
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Wide Range Achievement Test 4 (WRAT4) is an achievement test which measures an individual's ability to read words, comprehend sentences, spell, and compute solutions to math problems.
The test currently is in its fourth revision The test is appropriate for individuals ages 5-94 years. The WRAT4 provides two equivalent forms (Blue and Green), which enables retesting within short periods of time without potential practice effects that occur from repeating the same items. The alternate forms also may be administered together in a single examination |
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Vineland Adaptive Behavior Scales (VABS)
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The leading instrument for supporting the diagnosis of intellectual and developmental disabilities
Now includes these forms: Survey Interview, Parent/Caregiver Rating, Teacher Rating, Expanded Interview All Vineland-II forms aid in diagnosing and classifying intellectual and developmental disabilities and other disorders, such as autism, Asperger Syndrome, and developmental delays. The scales of the Vineland II were organized within a three domain structure: Communication, Daily Living, and Socialization. With Vineland-II you can measure adaptive behavior of individuals with: Intellectual and Developmental Disabilities Autism spectrum disorders (ASDs) ADHD Post-traumatic brain injury Hearing impairment Dementia/Alzheimer’s disease |
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Kaufman Assessment Battery For Children (K-ABC)
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Administration: 25 to 55 minutes (core battery, Luria model), 35 to 70 minutes (core battery, CHC model)
Scores: Scores/ Interpretation: Age-based standard scores, age equivalents, and percentile ranks standardized test that assesses intelligence and achievement in children aged two years, six months to 12 years, six months |
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According to WHO, which is the number one psychiatric cause of lost years of healthy life as measured by disability-adjusted life years for individuals between ages 15 to 40 years
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Unipolar Major Depression
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Exploration of transference is needed for a reparative emotional experience in which form of psychotherapeutic treatment
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Psychoanalytic psychotherapy
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40 y/o patient experienced delirium, tremor, diaphoresis, rigidity, hyperpyrexia, and myoclonus is making the transition from the use of clomipramine to phenelzine. The patient is likely experiencing what
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Serotonin Syndrome
Clomipramine is a TCA Phenelzine is MAOI Serotonin syndrome encompasses a wide range of clinical findings. Mild symptoms may only consist of increased heart rate, shivering, sweating, dilated pupils, myoclonus (intermittent tremor or twitching), as well as overresponsive reflexes. Moderate intoxication includes additional abnormalities such as hyperactive bowel sounds, high blood pressure and hyperthermia; a temperature as high as 40 °C (104 °F) is common in moderate intoxication. The overactive reflexes and clonus in moderate cases may be greater in the lower limbs than in the upper limbs. Mental status changes include hypervigilance and agitation. Severe symptoms include severe increases in heart rate and blood pressure that may lead to shock. Temperature may rise to above 41.1 °C (106.0 °F) in life-threatening cases. Other abnormalities include metabolic acidosis, rhabdomyolysis, seizures, renal failure, and disseminated intravascular coagulation; these effects usually arise as a consequence of hyperthermia. |
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Wisconsin Card Sorting Test (WCST)
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is a neuropsychological test of "set-shifting", i.e. the ability to display flexibility in the face of changing schedules of reinforcement.
patients with acquired brain injury, neurodegenerative disease, or mental illness such as schizophrenia. It has been considered a measure of executive function because of its reported sensitivity to frontal lobe dysfunction. As such, the WCST allows the clinician to assess the following "frontal" lobe functions: strategic planning, organized searching, utilizing environmental feedback to shift cognitive sets, directing behavior toward achieving a goal, and modulating impulsive responding. The test can be administered to those 6.5 years to 89 years of age. |
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Block Design Test
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subtest on many intelligence tests that measures visuospatial and motor skills. The testee is required to take blocks that have all white sides, all red sides, and red and white sides and arrange them according to a pattern. They are timed on this task and compared to a normative sample
Good performance on the block design test is indicative of appropriate functioning of the parietal and frontal lobes. Head injury, Alzheimer's disease, and stroke can severely reduce the performance of an individual on the block design test. Additional evidence suggests impairment in block design performance among schizophrenic and bipolar disorder patient populations, though this represents only preliminary findings. Best test of Spatial Ability |
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Digit symbol substitution test
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neuropsychological test sensitive to brain damage, dementia, age and depression. It isn’t sensitive to the location of brain-damage (except for damage comprising part of the visual field)
sists of (e.g. nine) digit-symbol pairs (e.g. 1/-,2/┴ ... 7/Λ,8/X,9/=) followed by a list of digits. Under each digit the subject should write down the corresponding symbol as fast as possible. The number of correct symbols within the allowed time (e.g. 90 or 120 sec) is measured. The DSST contained in the Wechsler Adult Intelligence Scale is called Digit Symbol (WAIS-R) or Digit Symbol-Coding (WAIS-III). To examine the role of memory in Digit-Symbol-Coding performance, |
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Boston Naming Test
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Purpose: Designed to measure object naming from line drawings.
Description: The Boston Naming Test (BNT) represents a measure of object naming from line drawings that takes into account the finding that patients with dysnomia often have greater difficulties with the naming of low frequency objects. Thus, instead of there being a simple category of anomia, naming difficulties may be rank ordered along a continuum. Items have been rank ordered in terms of their ability to be named, which is thought to be correlated with their frequency. This type of picture-naming vocabulary test is useful in the examination of children with learning disabilities and the evaluation of brain-injured adults. Scoring: The BNT contains 60 items. Suggested Uses: Recommended as a supplement to the Boston Diagnostic Aphasia Examination |
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Susto
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Hispanic Culture-bound syndrome that is attributed to a frightened event that causes the soul to leave the body and results in unhappiness and sickness
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Locura
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(Latin America) a severe form of chronic psychosis, attributed to an inherited vulnerability, the effect of multiple life difficulties, or a combination of the two. Symptoms include incoherence, agitation, auditory and visual hallucinations, inability to follow rules of social interaction, unpredictability, and possible violence.
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Mal De Ojo
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(Spain and Latin America) the Spanish term for the evil eye. Evil eye occurs as a common idiom of disease, misfortune, and social disruption throughout the Mediterranean, Latin American, and Muslim worlds.
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Songue Dormido, or sangue dormido
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(Portuguese Cape Verdeans) Literally "sleeping blood". Symptoms include pain, numbness, tremor, paralysis, convulsions, stroke, blindness, heart attack, infection, and miscarriage.
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ataque de nervios
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an idiom of distress principally reported among Latinos from the Caribbean, but also among many Latin American and Latin Mediterranean groups. Symptoms include uncontrollable shouting, attacks of crying, trembling, heat in the chest rising to the head, and verbal or physical aggression. Ataques de nervios frequently occur as a result of a stressful family event, especially the death of a relative, but also a divorce or fight with a family member.
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koro
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(Malaysia) an episode of sudden and intense anxiety that the penis (or in the rare female cases, the vulva and nipples) will recede into the body and possibly cause death. The syndrome occasionally occurs in local epidemics.
This syndrome occurs throughout south and east Asia under different names: suo yang (China); jinjinia bemar (Assam); and rok-joo (Thailand). It has been identified in isolated cases in the United States and Europe, as well as among diasporic ethnic Chinese or Southeast Asians. |
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latah
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(Malaysia and Indonesia) hypersensitivity to sudden fright, often with echopraxia, echolalia, command obedience, and dissociative or trancelike behavior. The Malaysian syndrome is more frequent in middle-aged women.
Similar syndromes include: amurakh, irkunii, ikota, olan, myriachit, and menkeiti (Siberian groups); bah-tschi, bah-tsi, and baah-ji (Thailand); imu (Ainu & Sakhalin, Japan); and mali-mali and silok (Philippines). |
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amok or mata elap
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(Malaysia) a dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive, or homicidal behavior directed at people and objects. The episode tends to be precipitated by a perceived insult or slight and seems to be prevalent only among males. The episode is often accompanied by persecutory ideas, automatism, amnesia for the period of the episode, exhaustion, and a return to premorbid state following the episode. Some instances of amok may occur during a brief psychotic episode or constitute the onset or exacerbation of a chronic psychotic process.
Similar to cafard or cathard (Polynesia), mal de pelea (Puerto Rico), iich'aa (Navaho), and syndromes found in Laos, Papua New Guinea, and the Philippines. Similar also to the nascent American folk-category of going postal. |
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What does a study population that is not representative of the populations being treated do to a research study
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Effects the External validity
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Diagnostic Criteria For Gender Identity Disorder
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Strong Preference for playmates of the other sex
a repeated stated desire to be, or insistence that he or she is the other sex In Girls, insistence of wearing only stereotypical masculine clothing In Boys, assertion that the penis or testes are disgusting and will disappear |
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Pt with OCD, Which of region of the brain is most likely to show increased activity on PET scanning
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Caudate
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Treatment for Akathesia
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The first-line treatment of akathisia is usually a beta-blocker, such as propranolol or metoprolol. Benzodiazepines such as clonazepam are also effective. The antihistamine cyproheptadine is also effective, though with shorter effect than beta blockers. Benztropine and Trihexyphenidyl can also be used to treat this condition.
One study showed that vitamin B6 is effective for the treatment of neuroleptic-induced akathisia N Acetyl Cysteine also showed a positive effect on akathisia in an RCT. |
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Freuds Preconscious
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the word preconscious is applied to thoughts which are unconscious at the particular moment in question, but which are not repressed and are therefore available for recall and easily capable of becoming conscious.
Example is 5 y/o able to recall his address after being prompted to do so, information is stored at preconscious level |
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Characteristic lesions seen in the CT scan of patient who have had coma associated with carbon monoxide poisoning is located in which brain area
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Globus Pallidus
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Which behaviors theory fits with
A behavior will most likely decrease in frequency if it is incompatible with a behavior that is positively reinforced |
Operant Conditioning
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Operant Conditioning
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the use of consequences to modify the occurrence and form of behavior. Operant conditioning is distinguished from classical conditioning (also called respondent conditioning, or Pavlovian conditioning) in that operant conditioning deals with the modification of "voluntary behavior" or operant behavior. Operant behavior "operates" on the environment and is maintained by its consequences, while classical conditioning deals with the conditioning of respondent behaviors which are elicited by antecedent conditions. Behaviors conditioned via a classical conditioning procedure are not maintained by consequences.
Reinforcement is a consequence that causes a behavior to occur with greater frequency. Punishment is a consequence that causes a behavior to occur with less frequency. Extinction is the lack of any consequence following a behavior. When a behavior is inconsequential, producing neither favorable nor unfavorable consequences, it will occur with less frequency. When a previously reinforced behavior is no longer reinforced with either positive or negative reinforcement, it leads to a decline in the response. |
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Positive reinforcement
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(Reinforcement) occurs when a behavior (response) is followed by a stimulus (commonly seen as pleasant) that increases the frequency of that behavior. In the Skinner box experiment, a stimulus such as food or sugar solution can be delivered when the rat engages in a target behavior, such as pressing a lever.
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Negative reinforcement
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(Escape) occurs when a behavior (response) is followed by the removal of a stimulus (commonly seen as unpleasant) thereby increasing that behavior's frequency. In the Skinner box experiment, negative reinforcement can be a loud noise continuously sounding inside the rat's cage until it engages in the target behavior, such as pressing a lever, upon which the loud noise is removed
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Positive punishment
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(Punishment) (also called "Punishment by contingent stimulation") occurs when a behavior (response) is followed by a stimulus, such as introducing a shock or loud noise, resulting in a decrease in that behavior
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Negative punishment
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(Penalty) (also called "Punishment by contingent withdrawal") occurs when a behavior (response) is followed by the removal of a stimulus, such as taking away a child's toy following an undesired behavior, resulting in a decrease in that behavior.
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Avoidance learning
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is a type of learning in which a certain behavior results in the cessation of an aversive stimulus. For example, performing the behavior of shielding one's eyes when in the sunlight (or going indoors) will help avoid the aversive stimulation of having light in one's eyes
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Noncontingent reinforcement
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refers to delivery of reinforcing stimuli regardless of the organism's (aberrant) behavior. The idea is that the target behavior decreases because it is no longer necessary to receive the reinforcement. This typically entails time-based delivery of stimuli identified as maintaining aberrant behavior, which serves to decrease the rate of the target behavior. As no measured behavior is identified as being strengthened, there is controversy surrounding the use of the term noncontingent "reinforcement"
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Classical conditioning
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(also Pavlovian or respondent conditioning, Pavlovian reinforcement) is a form of associative learning that was first demonstrated by Ivan Pavlov.
The typical procedure for inducing classical conditioning involves presentations of a neutral stimulus along with a stimulus of some significance. The neutral stimulus could be any event that does not result in an overt behavioral response from the organism under investigation. Pavlov referred to this as a conditioned stimulus (CS). Conversely, presentation of the significant stimulus necessarily evokes an innate, often reflexive, response. Pavlov called these the unconditioned stimulus (US) and unconditioned response (UR), respectively. If the CS and the US are repeatedly paired, eventually the two stimuli become associated and the organism begins to produce a behavioral response to the CS. Pavlov called this the conditioned response (CR). |
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Case Control Studies are appropriate for answering what time of epidemiological question
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Disease where in the incidence is low
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Apraxia
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inability to care out motor activities on verbal command despite intact comprehension and motor function
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Transcutaneous Electrical Nerve Stimulation (TENS) is most effective when used for what purpose
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Peripheral Neuralgia
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Bell's Palsy
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is a dysfunction of cranial nerve VII (the facial nerve) that results in inability to control facial muscles on the affected side
Bell's palsy is characterized by facial drooping on the affected half, due to malfunction of the facial nerve (VII cranial nerve), which controls the muscles of the face. Facial palsy is typified by inability to control movement in the facial muscles. The paralysis is of the infranuclear/lower motor neuron type. The facial nerves control a number of functions, such as blinking and closing the eyes, smiling, frowning, lacrimation, and salivation. They also innervate the stapedial (stapes) muscles of the middle ear and carry taste sensations from the anterior two thirds of the tongue. Clinicians should determine whether the forehead muscles are spared. Due to an anatomical peculiarity, forehead muscles receive innervation from both sides of the brain. The forehead can therefore still be wrinkled by a patient whose facial palsy is caused by a problem in one of the hemispheres of the brain (central facial palsy). If the problem resides in the facial nerve itself (peripheral palsy) all nerve signals are lost on the ipsilateral (same side of the lesion) half side of the face, including to the forehead (contralateral forehead still wrinkles). |
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Horner's Syndrome
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clinical syndrome caused by damage to the sympathetic nervous system
Signs found in all patients on affected side of face include; ptosis (which is drooping of the upper eyelid from loss of sympathetic innervation to the superior tarsal muscle, also known as Müller's muscle), upside-down ptosis (slight elevation of the lower lid), and miosis (constricted pupil), and anhidrosis (decreased sweating on the affected side of the face). dilation lag (slow response of the pupil to light), Enophthalmos (the impression that the eye is sunk in) loss of ciliospinal reflex and bloodshot conjunctiva may occur depending on the site of lesion. Sometimes there is flushing of the face is on the affected side of the face due to dilation of blood vessels under the skin. The clinical features of Horner's syndrome can be remembered using the mnemonic, "Horny PAMELa" for Ptosis, Anhydrosis, Miosis, Enophthalmos and Loss of ciliospinal reflex. In children Horner syndrome sometimes leads to a difference in eye color between the two eyes (heterochromia). This happens because a lack of sympathetic stimulation in childhood interferes with melanin pigmentation of the melanocytes in the superficial stroma of the iris. |
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Lateral medullary syndrome
Wallenberg's syndrome and posterior inferior cerebellar artery syndrome |
disease in which the patient has difficulty with swallowing or speaking or both owing to one or more patches of dead tissue (known as an infarct) caused by interrupted blood supply to parts of the brain.
This syndrome is characterized by sensory deficits affecting the trunk (torso) and extremities on the opposite side of the infarction and sensory deficits affecting the face and cranial nerves on the same side with the infarct. Specifically, there is a loss of pain and temperature sensation on the contralateral (opposite) side of the body and ipsilateral (same) side of the face. This crossed finding is diagnostic for the syndrome. The affected persons have difficulty in swallowing (dysphagia) resulting from involvement of the nucleus ambiguus, as well as slurred speech (dysphonia, dysarthria). Damage to the spinal trigeminal nucleus causes absence of pain on the ipsilateral side of the face, as well as an absent corneal reflex. The spinothalamic tract is damaged, resulting in loss of pain and temperature sensation to the opposite side of the body. The damage to the cerebellum or the inferior cerebellar peduncle can cause ataxia. Damage to the hypothalamospinal fibers disrupts sympathetic nervous system relay and gives symptoms analogous to Horner's syndrome. Nystagmus and vertigo, which may result in falling, caused from involvement of the region of Deiters' nucleus and other vestibular nuclei. Onset is usually acute with severe vertigo. Palatal myoclonus may be observed due to disruption of the central tegmental tract. |
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Trigeminal Neuralgia
tic douloureux |
characterised by episodes of intense facial pain that usually last from a few seconds to several minutes or hours. The episodes of intense pain may occur paroxysmally. To describe the pain sensation, patients may describe a trigger area on the face, so sensitive that touching or even air currents can trigger an episode. It affects lifestyle as it can be triggered by common activities such as eating, talking, shaving and toothbrushing. The attacks are said by those affected to feel like stabbing electric shocks, burning, pressing, crushing, exploding or shooting pain that becomes intractable.
Individual attacks usually affect one side of the face at a time, lasting from several seconds to a few minutes and repeat up to hundreds of times throughout the day. The pain also tends to occur in cycles with remissions lasting months or even years. 10-12% of cases are bilateral, or occurring on both sides. This normally indicates problems with both trigeminal nerves since one serves strictly the left side of the face and the other serves the right side. Pain attacks typically worsen in frequency or severity over time. Many patients develop the pain in one branch, then over years the pain will travel through the other nerve branches. |
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Treatment for Trigeminal Neuralgia
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Anticonvulsants are a common treatment strategy for trigeminal neuralgia. *Carbamazepine is the first line drug; second line drugs include baclofen, lamotrigine, oxcarbazepine, phenytoin, gabapentin, and sodium valproate.
Uncontrolled trials have suggested that clonazepam and lidocaine may be effective. Low doses of some antidepressants such as amytriptiline are thought to be effective in treating neuropathic pain Botox can be injected into the nerve by a physician, and has been found helpful using the "migraine" pattern adapted to the patient's special needs. Patients may also find relief by having their neurologist implant a neuro-stimulator. Many patients cannot tolerate medications for years, and an alternative treatment is to take a drug such as gabapentin and apply it externally. |
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Though many symptoms can be associated with panic attacks, the cardinal symtpoms that appears to be central to the pathophysiology of the syndrome is:
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Hyperventilation
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Psychotropic drugs associated with weight gain
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mirtazapine
phenelzine lithium olanzapine |
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Why test stool for Phenolphthalein
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If found in stool indication of laxative abuse,
However off market in US |
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What Axis II diagnosis is related to high rates of obesity
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Mental Retardation
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Agents found effective in Weight loss
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Sibrutramine
Dexfenfluramine (removed from market as associated with cardiovascular disease Phentermine - not associated with CV dz Phenylpropanolamine - sympathomimetic |
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Criteria for AIDS in HIV pt
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CD4 count < 200
% lymphocytes below 14 Kapasi's Sarcoma Candidiasis of esophagus HIV encephalopathy |
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Common CNS opportunistic infections in HIV patients
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Histoplasmosis
Toxoplasmosis Cryptococcus Mycobacterium Avium Interacellular |
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Zidovudine (AZT) associated with
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headache
agitation insominia mania depression irritability |
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Acyclovic associated with
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Visual hallucinations
Confusion Hyperacusis Insomnia Depersonalization hyperesthesia agitation |
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Associated with Pentamidine treatment
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euphoria
visual hallucinations hyperacusis hypertension |
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HIV associated dementia affects what percentage of asymptomatic HIV patients
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5%
2/3 of pt with AIDS defining illness manifest HIV dementia |
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Secondary cause of death in HIV pts
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suicide
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Contraindications for transplant
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acute SI
Dementia Active substance abuse Intractable noncompliance |
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Percentage of homeless adults reported to have history of psychiatric hospitalization
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15-30%
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Some of the Criteria for narcissistic personality disorder
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A lust for power thought beauty, love, brilliance or money
entitlement stunted empathy displays of contempt |
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During a Family crisis meeting the focus on the meeting should be what?
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impact on all the members of the relevant family system not just the identified patients problem
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Percentages of marriages involving physical violence at some point
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1/3 to 50%
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Statistics for homicides occurring within the family
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1/5th of all homicides
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Prevalence of psychosocial difficulty in all children is approximately what percentage
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10-15% (approximately 12)
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Areas to assess in children
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cognitive status
temperament sociability family relations general health reaction to stress quality of attachments parental competency family resources community resources |
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Percentage of ADHD children that suffer from learning disabilities
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greater then 30%
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Typical starting dosage for methylphenidate in children with ADHD
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2.5 to 5 mg
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Pemoline starting dosage for children with ADHD
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18.75 to 37.5mg
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Discuss issues with concomitant use of stimulants and tricyclic antidepressants
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Coadministration of stimulants and TCA's or Anticonvulsants has been associated with increase in the serum levels of BOTH medications
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Complications of cocaine abuse and dependence involve what
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anosmia
acute MI stroke pulmonary edema seizures arrhymias perforation of the nasal septum hepatitis depression panic hypertension ruptured of ascending aorta bronchitis abruptio placentae |
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Which metabolites are detected in the urine longer cocaine or amphetamines
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Cocaine metabolites can be detected for 2 to 3 days after use, whereas amphetamines metabolites can be detected 1 or 2 days after use
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Metabolites of Marijuana (cannabinoids) can be detected in the urine for up to how long
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30 days!
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Some of the Pharmacologic managment of cocaine craving and withdrawal may include what agents
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Dopamine agonist (bromocriptine, amantadine, mazindol)
TCAs (Desipramine) Beta-blockers have only been show to be helpful in acute cocaine intoxication not with withdrawal or cravings. |
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Signs and Symptoms of Opioid Withdrawal
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Yawning
Lacrimation Rhinorrhea Dilated Pupils increase RR |
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Lifetime prevalence of alcohol dependence among cocaine dependent patients is
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greater then 60%
62% accounts for 12 million Americans |
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Life-Threatening causes of agitation include
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WHHHIMP
W- wernicke's encehpalopathy H- Hypertension H- Hypoxia H- Hypoglycemia I- Intracranial Bleeds M- Meningitis or metabolic derangements P- Poisonings |
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Appropriate dosage equivalents for glucocorticoids preparations
*prednisone *Methylprednisolone *dexamthasone *Cortisone *Hydrocortisone |
Prednisone - 5 mg
Methylprednisolone - 4 mg Dexamethasone - 0.75 mg Cortisone - 25 mg Hydrocortisone - 20mg |
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List some Adverse Effects of glucocorticoids
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thin-fragile skin
osteoporosis myopathy/muscle weakness peptic ulcers HA aseptic necrosis of femoral head sodium retention hypertension menstrual irregularities manifestations of latent diabetes |
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Pt has sudden, painless onset of paresis of the Right upper and lower face, inability to abduct the right eye and paresis of the left arm and leg. Where is the lesion?
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Damaged right abducen (CN VI) and facial nerves (CN VII) and the corticospinal tract to left limb
PONS CN VI and VII originate in pons |
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Pt has Left ptosis and dilated and unreactive left pupil with external deviation of the left eye, Right hemiparesis, and right sided hyperactive DTR and + Babinski sign. NO aphasia or hemianopsia. Where is the lesion
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MIDBRAIN
Left Oculomotor palsy and right hemiparesis, no visual or language deficits so has to be brainstem not cerebrum |
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Which two lobes might cause a lesion causing a left superior homonymous quadrantanopia?
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OCCIPITAL LOBE AND TEMPORAL LOBE
This visual field loss is usually found with destruction of right temporal and or inferior occipital lobe *due to brain tumor or occlusion of posterior cerbral artery Alternatively an optic tract lesion may occasionally be responsible |
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pt with gait impairment and right sided decreased hearing. The right corneal reflex is absent. Entire right side of the face is weak. Auditory acuity is diminished on the right. Left side hyperactive DTR with babinski sign. Right sided difficulty with rapid alternating movments. What structure is involved
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CEREBELLOPONTINE ANGLE STRUCTURE
Right sided corneal reflex loss, facial weakness and hearing impairment indicate damage of Trigeminal (V), Facial (VII), and acoustic (VIII) cranial nerves. These all emerge together from the brainstem at the cerbellopontine angle. The right sided dysdiadochokinesia reflects right sided cerebellar damage. The left sided DTR is common with compression of the pons Common cerbellopontine lesions are menengiomas and acoustic neuromas, which are often manifestations of neurofibromatosis (particularly the NF2 varient) |
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Interscapular back pain, paraparesis with hyperreflexia, loss of sensation below the umbilicus, and incontinence where is the lesions?
a. C7 b. T4 c. T10 d. L1 e. S2 f. none of the above |
T10
umbilicus is the landmark for T10 |
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50 y/o male presention with mild dementio has absent reflexes, loss of position and vibration sensation, and ataxia. Which areas are affected?
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CEREBRUM AND SPINAL CORDS POSTERIOR COLUMNS
Conditions that cause dementia and dysfunction of the posterior columns of the spinal cord and the cerbellar system are combined system disease *pernicious anemia *tabes dorsalis *spinocerebellar degenerations *heavy metal toxins It is frequently damaged by hereditary disease |
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55 y/o women thought to have depression, is then found to have right-sided optic atrophy and left-sided papilledema. What is the lesion
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FRONTAL LOBE
FOSTER-KENNEDY SYNDROME Right frontal lobe tumor compresses the underlying right optic nerve, causing optic atrophy and raised intracranial pressure cause papilledema of the left optic nerve. There are important asymmetrical differences in the frontal lobes. The left frontal lobe is involved in controlling language related movement, whereas the right frontal lobe plays a role in non-verbal abilities. Left frontal damage usually manifests as pseudodepression and right frontal damage as pseudopsychopathic Sexual behavior can also be effected by frontal lesions. Orbital frontal damage can introduce abnormal sexual behavior, while dorolateral lesions may reduce sexual interest |
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two structures comprise the posterior columns of the spinal cord
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Fasciculus cuneate
Fasciculus gracilis |
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What structure in the spinal cord carries temperature sensation
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lateral spinothalamic tract
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What spinal cord level is the nipples correlated to
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T4
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What spinal cord level is the umbilicus correlated to
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T10
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Which two cranial nerves have CNS myelin covering
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Optic nerve (CN II)
Acoustic Nerve (CN VIII) |
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An elderly, hypertensive man has vertigo, nausea, and vomiting. He has a right sided Horner's syndrome, loss of the right corneal reflex and dysarthria because of paresis of the palate. Which way does the palate deviate?
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LEFT
The patient has a right sided lateral Medullary (Wallenberg's) Syndrome. This syndrome includes crossed hypalgesia (right-facial and left truncal) and right sided ataxia. The palates deviates to the left because the right sided palatal muscle weakness Because the cerebrum is spared, patients do not have emotional or cognitive impairment or physical signs of cerebral damage, such as visual field cuts or seizures. |
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Pregnant women in last trimester of normal pregnancy develops pain in her lower back. Immediately before delivery the pain spreads down her right anterolateral thigh. That quapriceps muscle was slightly weak and its CTR was reduced. By 2 weeks postpartum after birth of 11 lb baby girl, all signs and symptoms have resolved. What was the diagnosis
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Compression of the femoral nerve or its roots
An enlarged uterus can compress the lumbosacral plexus in the pelvis or the femoral nerve as it exits from the inguinal area |
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What is Meralgia Paresthetica
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Results from nerve compression in the inguinal region, is painful but not associated with weakness or DTR loss
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Where is the primary damage in Wilson's disease, Huntington's dz, and choreiform cerebral palsy?
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Extrapyramidal System
These dz, like parkinson's dz, damage the basal ganglia which are the foundation of the extrapyramidal motor system. Basal ganglia dysfunction causes: tremor chorea athetosis rigidity bradykinesia |
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Signs of Corticospinal tract dysfunction
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spasticity
hyperreflexia DTR Clonus Babinski signs |
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Anton's Syndrome
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A form of anosognosia
Denial of the sudden onset of blindness from occipital lobe infarction |
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pt has astereognosis, where is the lesion
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contralaterial parietal lobe
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Athetosis
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An involuntary movement disorder characterized by slow writhing, sinuous movement of the arms or legs that is more pronounced in the distal part of the limbs.
It usually results from basal ganglia damage from perinatal jaundice, anoxia, or prematurity |
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Chorea
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Is a disorder of involuntary movement characterized by intermittent, random jerking of limbs, face or trunk.
Medications such as levadopa and typical neuroleptic and many basal ganglia disease may cause it |
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Dysdiadochokinesia
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Impairment of rapid alternating movements that is characteristic of cerebellar injury, but may be result of red nucleus damage
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Gerstmann's Syndrome
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Combination of aphasia, finger agnosia, dyscalculia, and inability to distinguish right from left
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Dymetria
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Irregularities on performing rapid alternating movements
Terms does not refer to a measure of distance but to rhythm |
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percentage of patient receiving <40mg per day prednisone that will develop neurpsych symptoms
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1%
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percentage of patients receiving >80mg per day of prednisone that will develop neuropsych symptoms
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15-25% (20)
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Symptoms of steroid withdrawal
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depression
fatigue anxiety confusion slowed mentation disorientation anorexia |
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TCA that has the lowest propensity to induce hypotension
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Nortriptyline
Second generation TCA Nortriptyline also presents clinically relevant post-synaptic antagonism of muscarinergic, histaminergic and 5HT2A receptors the incidence of side effects with nortriptyline is lower than with the first-generation tricyclics (e.g., imipramine (Tofranil), amitriptyline (Elavil)) |
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what two cheese do not cause MAOI induced hypertensive crisis
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cream cheese
cottage cheese |
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What are some H2 blockers used to treat nausea and dyspepsia
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ranitidine
cisapride metoclopramide famotidine |
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Some of the uses for Cyproheptadine
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hayfever
nightmares associated with PTSD moderate to severe Seretonin syndrome relieve SSRI induced dysfunction appetite stimulant prevent migraines in child and adol |
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tx for MAOI-induced paresthesias
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Pyridoxine
supplementation with 50-150 mg at bedtime may help relieve MAIO-induced pyridoxine deficiency and subsequent paresthesias |
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list some drugs to help relieve antidepressant induced sexual dysfunction
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yohimbine
buproprion buspirone amantadine cyproheptadine |
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effects of lithium and thiazide drug combination
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lithium levels will rise by roughly 25% with use of thiazide diuretics
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Define Sleep latency
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Period of time from turning out the lights until the appearance of stage 2 sleep
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Frequency of nightmares in children 3 to 6 y/o
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50%
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Effects on body during REM sleep
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frequent genital tumenscence
decreased cardiac output increase cerebral glucose metabolism increase respiratory rate increase brain temperature increase in pulse rate poikiothermic conditions are present |
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Anatomical sites implicated in the generation of NREM sleep
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basal forebrain area
thalamus and hypothalamus dorsal raphe nucleus medulla |
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What is the effect of total sleep time in the elderly
a. increased b. decreased c. remains the same |
C
average daily total sleep time is the same |
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What stage of sleep does sleep walking occur
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NREM
Stages 3 and 4 |
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What stage of sleep does Bed-wetting(enuresis) occur
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NREM
Really considered a diffuse sleep disorder |
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What stage of sleep does Paroxysmal hemicrania occur
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REM Sleep
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What Stage of sleep does Erections occur
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REM sleep
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What stage of sleep does D sleep occur
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REM sleep
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What stage of sleep does paradoxical sleep occur
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REM sleep
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What stage of sleep does Slow wave sleep occur
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NREM Sleep
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What stage of sleep do you see EEG Synchronized sleep
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NREM sleep
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Which stage of sleep occurs mostly in the last half of the night
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REM Sleep
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What stages of sleep is autonomic functioning usually slow and steady
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NREM sleep
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What is Jactatio Capitis Nocturnus
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Head banging while sleeping, seen in children
Disorder of wake-sleep transition disorder tx - decrease stess, BZD, TCA and behavior modification |
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treatments for obstructive sleep apnea
|
weight loss
cpap bipap nasal surgery tracheostomy uvulopalatoplasy SSRI and Heterocyclic anitdepressants sometimes help by decreasing the amount of item spent in REM Sleep Theophylline has been shown to decrease number of episodes of apnea, but may interfere with the over quality of sleep AVOID SEDATIVE MEDICATIONS |
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What stage of sleep to apneic episodes
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REM sleep
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What is REM Latency
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Period of time from the onset of sleep
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Define Early Morning awakening
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a time of being continuously awaken from the last last stage of the sleep until the end of the sleep record (usually a 7am)
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Delayed sleep phase syndrome is
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a persistent pattern of late sleep onset and late awakening times, with an inability to fall asleep and awaken at a desired earlier time
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Advanced sleep phase syndrome is
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early sleep onset and early awakening, with an inability to fall asleep and awaken at a desired later time
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what is the circadian rhythm
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our endogenously regulated biological clock located in the suprachiasmatic nuclei of the anterior hypothalamus which in turn is synbdromized with the environment by visual or other nonphotic time clues (zeitgebers, meaning, time givers)
Time clues *core body temperature *cortisol |
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two processes that influence the sleep-wake cycle
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1) endogenous biological clock, which drives the circadian rhythm of the propensity for sleep and the characteristics of sleep across th 24 hour period
2) Homestatic process that increase sleep propensity the longer the period of wakefulness prior to sleep |
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What are the effects of a lesion on the suprachiasmatic nuclie
|
arrhythmic rest-activity patterns, which no longer follow a circadian rhythm but are distributed in numerous short bouts of sleep and wakefulness during the 24 hour period
Total amount of sleep and wakefulness in the 24 hour remains fairly constant |
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Major Circadian pacemaker
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1) suprachiamastic nuclei
2) retina |
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What is the EEG characteristic sequential patter from wakeful state to sleep
|
regular activity at 3 to 7 cycles a second
sleep spindles and K complexes Delta waves |
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Characteristics of waking EEG
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alpha waves of 8-12 cycles a second, low voltage activity of mixed frequency
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EEG for stage 1 sleep
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lightest stage of sleep
low-voltage regular activity at 3 to 7 cycles last seconds to minutes |
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EEG for Stage 2 sleep
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spindle-shaped tracings at 12 to 14 cycles a second (sleep spindles)
Slow triphasic waves (K complexs) |
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Describe Delta waves
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High-voltage activity at 0.5 to 2.5 cycles a second
If less then 50% of tracing in Stage 3 If greater then 50% of the tracing Stage 4 |
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Sleepwalking disorder
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More commonly seen in boys then in girls
often have vivid hallucinatory recollections of emotionally traumative events with no memory upon wakening Occur in the first third of the night, NREM stages 3 and 4 No impairment of consciousness several minutes after awakening begins between 6-12 years of age tends to run in families |
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5 anatomical sites implicated in the generation of NREM sleep
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basal forebrain area
thalamus hypothalamus dorsal raphe nucleus nucleus tractus solitarius of the medulla |
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where is the reticular nucleus located
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in the thalamus
plays an important role in generation of cortical sleep spindles (12 to 14 hz) and Delta waves (0.5 to 3.5hz, 75mV or greater) |
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Changes in REM sleep patterns in depressed patients
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shortened REM latency (60 min or less)
increase percentage of REM sleep (over 25% normal) shift in REM distribution from mostly occurring in first half of night |
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what is poikilothermia
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state in which body temperature varies with the temperature of the surrounding medium
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symptoms of narcolepsy
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excessive daytime sleepiness
cataplexy sleep paralysis hypnagogic hallucinations |
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Sleep paralysis
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brief episodes of an inability to move or speak when awake or asleep
due to temporary dysfunction of reticular activating system |
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BZD, and sedative/hypnotics effects on sleep
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Decrease Slow wave sleep (stage 3 and 4)
Decreased REM sleep Increased Beta and sleep spindles activity |
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Dreams in REM sleep
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abstract, vivid, surreal
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Dreams in NREM Sleep
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concrete, realistic
lucid and purposeful |
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Temperature and REM Sleep
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A condition of temp regulation similar to reptiles
poikilothermia (body temp varies with temp of environment) |
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L-tryptophan def. accosicated with
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less time in REM sleep
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Effects of ingesting large amounts of tryptophan
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decrease sleep latency
decreased nocturnal awakening |
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Paroxysmal hemicrania
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type of unilateral vascular headache that is exacerbated during sleep and occurs only in associated with REM Sleep
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D Sleep
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REM Sleep
Dreaming Paradoxical Sleep (because activity of EEG during sleep) |
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S Sleep
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NREM Sleep
EEG Synchronized sleep Slow wave sleep |
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When is Delta sleep its highest
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1st NREM period of night and declines with each successive NREM period
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Epiletiod personality
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used to convey the seizure like quality of outburst seen in intermittent explosive disorder
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Defense Mechanism in Intermittent explosive disorder
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Identification with aggressor
*in which the explosive violence of parent or close relative is internalized -- so typically narcissistic injury, lowered self esteem or feeling shame or humiliation evokes attack |
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Reaction Formation
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management of unacceptable impulse by permitting expression of impulse in antithetical form
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Four Phases of Pathological Gambling
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Winning phase
Losing phase (chasing occurs) Desperation Phase Hopelessness Phase |
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Childhood predisposing factors for development of intermittent explosive disorder
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encephalitits
perinatal trauma minimal brain dysfunction hyperactivity |
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Adjustment disorder characteristics
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Occurs in all age groups
No correlation with severity of stressor More Female then Males Not a type of bereavement |
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A 32 y/o female with history of Generalized anxiety disorder and OCD had been taking a SSRI and alprazolam was recently switched to another SSRI. She becomes ataxic and has trouble staying awake, Which SSRI was she likely switched too?
a) venlafaxine b) sertraline c) paroxetine d) fluvoxamine e) buspirone |
FLUVOXAMINE
known to increase plasma levels of benzodiazepines due to its inhibition of enzyme Cytochrome P450 |
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side effects of Clozapine
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sedation
tachycardia hypersalivation dizziness constipation nausea headache hypotension fever dose-related seizures weight gain diabetes agranulocytosis (1%) |
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effects of antacids on chlorpromazine
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impair its absorption
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Antipsychotic that increase alcohol levels
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Haloperidol
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antihypertensive that increases chlorpromazine and thioridazine levels
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Propranolol
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anti-anxiety medication that increases haldol levels
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buspirone
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antifungal and antibiotic that increase clozapine levels
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erythromycin
ketoconazole |
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What is tobaccos level on antipsychotics
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it lowers their blood levels
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Risk factors for Agranulocytosis with Clozapine
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ashkenazi jew with blood markers of HLA B38, DR4, DQw3
Finnish |
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Blood testing for Clozapine guidelines
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weeks for first 6 months
Biweekly after 6 months and for duration of treatment |
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Drugs to avoid in patients taking Clozapine due to increase risk of agranulocytosis
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carbamazepine
captopril sulfonamides propylthiouracil |
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Which cytochromes metabolize Clozapine
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P450 -> 1A2 and 3A4
(1 and a 2, & 3 and a 4) |
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describe MAOIs effect with diabetes
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low dose may increase sensitivity to insulin
high dose by increase insulin resistance |
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Medical conditions that are contraindicated for patient considering to give MAOI
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pheochromocytoma
Congestive heart failure hepatic disease |
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Two drugs hows levels are increased by trazadone
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Digoxin
Phenytoin |
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Drugs that increase lithium levels
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NSAIDS
Thiazide diuretics ACE inhibitor Calcium Channel Blockers |
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Drugs that decrease level of carbamazepine
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phenytoin
phenobarbitol primidone |
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Drugs that increase level of carbamazepine
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SSRI
cimetidine erythromycin isoniazid |
