3.5 Flashcards
do panic attacks have sudden or gradual onset
sudden
when do panic attacks peak
within 10 minutes (usually)
when do panic attack resolve
usually within 1 hour (most end within 30 min)
hallmark signs of panic attack
sense of impending doom or dread
first line treatment for panic attack
BZDs
average onset of panic disorder
20s
what increases your risk of developing panic disorder
1st degree relative
most people with panic disorder also have
major depression (65%)
how many panic attacks do you have to have to be diagnosed with panic disorder
at least 2 attacks that may or may not be related to a trigger
anxiety about being in places or situations from which escape may be difficult
agoraphobia
what is most effective for treatment of panic disorder
pharmacotherapy + CBT
in what population is generalized anxiety disorder most common
females
in what age does onset of symptoms for GAD generally occur
early 20s
in majority of cases of GAD, patients also have comorbidity with
major depression or other anxiety disorders
excessive anxiety and worry must occur for majority of days and for how long in GAD
at least 6 months
is generalized anxiety disorder episodic
no
is panic disorder episodic
yes
what is most effective treatment for GAD
psychotherapy + pharmacotherapy
stimulation or overactivity of what part of the brain may cause anxiety disorders
amygdala
hyperventilation syndrome
increase in minute ventilation that exceeds metabolic needs
does hyperventilation syndrome cause respiratory alkalosis or acidosis
respiratory alkalosis
what are carpopedal spasms, which are associated with hyperventilation syndrome
frequent and involuntary muscles contractions in the hands and feet that are associated with pain
what population of people does major depressive disorder affect more?
females
peak onset of major depressive disorder
20s
main NT affected in MDD
norepinephrine
serotonin
dopamine
how long must you experience symptoms to be diagnosed with MDD
at least 2 weeks
persistent depressive disorder is also called
dysthymia
in what population is dysthymia more common
females
for how long do you have to meet criteria to be diagnosed with dysthymia
at least 2 years in adults
at least 1 year in children/adolescents
what is the strongest risk factor for developing bipolar I disorder
1st degree family relative
what population is more affected by bipolar I disorder
men and women are equally affected
what increases the likelihood of psychotic features and poor prognosis in people diagnosed with bipolar I disorder
earlier onset
what is the only criteria to be diagnosed with bipolar I disorder
at least 1 manic or mixed episode
are major depressive episodes required for diagnosis of bipolar I disorder
no
abnormal and persistently elevated, expansive or irritable mood
mania
how long does mania have to last to be diagnosed with bipolar I disorder
at least 1 week (or less if hospitalization required)
is cyclothymic disorder more or less severe than bipolar II disorder
cyclothymic disorder is less severe
abnormal and persistently elevated, expansive or irritable mood at least 4 days that does not require hospitalization and is not associated with marked impairment of social/occupational function
hypomania
how long do you have to have symptoms to be diagnosed with cyclothymic disorder
at least 2 consecutive years
at least 1 year in children
cyclothymic disorder is characterized by
hypomanic symptoms that fall short of meeting criteria for a full hypomanic episode
numerous periods of mild to moderate depressive symptoms that fall short of meeting criteria for a major depressive disorder
how long are patients symptomatic in cyclothymic disorder
at least half the day (present more days than not)
not symptom free for more than 2 consecutive months
what has to be present to be diagnosed with bipolar II disorder
at least 1 major depressive episode + at least 1 hypomanic episode
how long does mood disturbance occur in bipolar II disorder
at least 4 consecutive days
are episodes in bipolar II severe enough to cause marked impairment in social or occupational function or necessitate hospitalization?
no
are episodes in bipolar I severe enough to cause marked impairment in social or occupational function or necessitate hospitalization?
yes
what is the strongest predict factor of suicide
previous attempt
who attempts suicide more
females
who is more successful at committing suicide
males
who has the highest risk of suicide in the US
elderly white men
what is serotonin syndrome
potentially life-threatening syndrome due INCREASED serotonergic activity in CNS
cognitive effects in serotonin syndrome
anxiety
agitation
confusion
GI effects of serotonin
nausea
vomiting
increased bowel sounds
diarrhea
autonomic instability in serotonin syndrome
hyperthermia
tachycardia
hypertension
diaphoresis
neuromuscular hyperactivity in serotonin syndrome
tremor
spontaneous clonus
hypertonia
hyperreflexia
muscle rigidity
positive babinksi
what will you notice about the pupils in someone with serotonin syndrome
mydriasis (dilated pupils)
during what season in seasonal affective disorder most common
winter
SAD is a subtype of
major depressive disorder
bipolar I disorder
bipolar II disorder
in what latitudes of the world do people have increased risk of SAD
northern latitudes
CHRONIC condition in which the patient has prominent physical symptoms but not physical cause found on work up and is associated with significant distress or functional impairment
somatic symptom disorder
how may body systems are affected in somatic symptom disorder
at least 1
what population does somatic symptoms disorder most commonly affect
females
the state of being symptomatic is persistent and usually lasts how long in somatic symptom disorder
usually > 6 months
people with somatic symptom disorder predominantly complain of
pain
are symptoms faked by patient in somatic symptom disorder
no
Screening for alcohol abuse
Audit-C or CAGE
What population is most affected by migraine headaches
females
what is the most common type of migraine
migraine without aura (75%)
is migraine usually bilateral or unilateral
usually unilateral
where is a migraine headache usually localized
frontotemporal & ocular area
migraine is often associated with
nausea
vomiting
photophobia
phonophobia
how long do auras last in migraines
< 60 minutes
most common type of aura in migraine
visual
does pain worsen with movement in migraine
yes
what population of people is more affected in cluster headaches
males
what increases risk of cluster headache
alcohol
tobacco use
prior brain surgery/trauma
family history
when are cluster headaches typically worse
at night
are cluster headaches bilateral or unilateral
unilateral
how long do cluster headaches typically last
< 2 hours
will autonomic symptoms be ipsilateral or contralateral in cluster headache
ipsilateral
in what type of headache do we see partial Horner’s syndrome
cluster headache
what is partial Horner’s syndrome
ptosis and/or miosis
other symptoms that we will see on ipsilateral side during cluster headache
nasal congestion/rhinorrhea
conjunctival injection
lacrimation
eyelid edema
facial swelling
first line treatment for cluster headaches
100% oxygen
what is the most common overall cause of primary headache
tension headache
are tension headaches bilateral or unilateral
bilateral
are tension headaches worse with activity
no
trigeminal neuralgia occurs due to compression of what nerve root
trigeminal nerve root
what compresses the trigeminal nerve root in trigeminal neuralgia
superior cerebellar artery or a tortuous vein
in what population and time period is trigeminal neuralgia most common
middle-aged women
headache pain in trigeminal neuralgia
brief
episodic
severe
stabbing
sharb
lancinating
shock-like
how long do trigeminal neuralgia headaches tend to last
a few seconds (up to 2 minutes)
when is trigeminal neuralgia worse
washing face
brushing teeth
touching those areas
shaving
talking
chewing
grimacing
exposure to a draft of air
why is MRI recommended in patients presenting with trigeminal neuralgia
to rule out MS
medication overuse headache/rebound headache occurs
15 or more days per month for > 3 months
what does cerebellum slip through in chiari malfomation
foramen magnum
what are chiari malformations commonly due to
underdevelopment of posterior fossa
only cerebellar tonsils herniate into foramen magnum
type 1 chiari malformation
what ventricle is compressed in type 1 chiari malformation
4th ventricle
what can result from type 1 chiari malformation
syringomyelia
what is syringomyelia
fluid pools in spinal canal
what incomplete spinal cord syndrome does syringomyelia cause
central cord syndrome
what is type 2 chiari malformation also called
arnold-chiari malformation
which is more severe between type 1 and type 2 chiari malformations
type 2 chiari malformation is more severe
herniation of cerebellar tonsils and cerebellar vermis
type 2 chiari malformation
what type of spina bifida are type 2 chiari malformations commonly associated with
myelomeningocele
what type of headaches occur in type 2 chiari malformations
occipital headaches
what will you see on brain MRI for chiari malformations
cerebellar structures are more than 5 mm below foramen magnum
surgery for chiari malformations
posterior fossa decompression surgery / craniotomy
idiopathic intracranial hypertension is also called
pseudotumor cerebri
what is pseudotumor cerebri
idiopathic increased intracranial pressure on CSF exam with no clear identifiable cause evident on neuroimaging
in what population is pseudotumor cerebri most common
overweight women of childbearing age
(female, fat, fertile)
medications that may cause pseudotumor cerebri
withdrawal from long-term corticosteroids
vitamin A toxicity
most common presenting symptom in pseudotumor cerebri
headache
when does pain worsen in pseudotumor cerebri
eye movement
what is the hallmark on funduscopic exam for pseudotumor cerebri
papilledema (usually bilateral and symmetric)
what vision deficits may be seen in pseudotumor cerebri
visual field loss
what cranial nerve palsy will we see in pseudotumor cerebri
cranial nerve 6 palsy
what can cranial nerve 6 palsy cause
diplopia
what will we seen on LP in pseudotumor cerebri
increased CSF pressure (250 or greater) + otherwise normal CSF
infection of the brain parenchyma
encephalitis
most common identified virus in encephalitis
HSV-1
what distinguishes encephalitis from aseptic meningitis
altered mental status
change in personality, speech, and movement
what lobe is commonly involved if HSV-1 is the cause of encephalitis
temporal lobe
first line treatment for encephalitis
acyclovir
what type of waves will you see in deep sleep (stage 3)
delta waves
in a spinal test, what should you look for in someone with sleep issues
hypocretin levels
hypocretin is an NT that helps regulate sleep
Willis-Ekbom disease is also called
restless leg syndrome
most common cause of restless leg syndrome
CNS iron deficiency
when are symptoms worse for RLS
in the evening
with prolonged periods of rest or inactivity
When are symptoms better for RLS
With leg movement
