ABPN General Psychiatry Flashcards
“good enough mothering” theorist
Winnicott
“Man presents to ER in acute state of disorientation with tachycardia, ophthalmoparesis, diaphoresis, and ataxia. Dies 48 hours later”
Wernicke’s encephalopathy (mental confusion, ophthalmoplegia, gait ataxia)
***ophthalmoplegia = 6th CN palsy usually
% of schizophrenics known to smoke tobacco
50-90%
3 Hz stimulation on EMG
Lambert-Eaton
3-per-second spike and wave pattern on EEG
absence seizures
4 primary symptoms of Parkinson’s disease
Tremor, Rigidity, Bradykinesia, Postural instability
4p16.3 abnormality
Huntington’s Disease
60 yo woman with stiffness in right leg but not left. Takes her longer to complete tasks and complains she has the pace of a turtle. Sometimes forgets how to walk. Sometimes feels as if hands don’t belong to her. All symptoms over last year.
Corticobasal ganglionic degeneration (CBD)
- degeneration of cerebral cortex & basal ganglia
- asymmetric motor & cognitive impairments
- apraxia, alien limb phenomena, aphasia, parkinsonism
65 yo M with worsening hypersomnia, poor memory and concentration, social withdrawal, lack of motivation (pseudobulbar state). History of HTN. BP 170/90. Flat affect, depressed mood. Reflexes slowed. Labs are normal. MRI shows subcortical degeneration.
Binswanger disease = subcortical leukoencephalopathy (a form of small-vessel vascular dementia)
7 criteria of schizoid personality disorder
DSS-ACNE
- D- Doesn’t desire or enjoy relationships/family
- S- Chooses solitary activities
- S- Little interest in sex
- A- Takes pleasure in few, if any, activities
- C- Lacks close friends or confidants
- N- Appears indifferent to praise or criticism
- E- Shows emotional coldness, detachment, or flattened affectivity
A child has inhibited emotionally withdrawn behavior toward adults and minimal social or emotional responsiveness toward others due to social neglect or deprivation has:
A. Reactive attachment disorder
B. Disinhibited social engagement disorder
A. Reactive attachment disorder
a child who actively approaches and interacts with unfamiliar adults after experiencing social neglect or deprivation has:
A. Reactive attachment disorder
B. Disinhibited social engagement disorder
B. Disinhibited social engagement disorder
a man enjoys wearing female underwear
fetishistic disorder
Aaron Beck
founder of CBT
Aaron Beck’s cognitive triad is a model for what?
What is the cognitive triad?
Model for depression
Thoughts about:
- one’s self
- the world
- the future
Abulia means what?
an absence of willpower, reduced impulse to act or think with indifference related to consequence
Literally means = “without will”
acalculia, agraphia (without alexia), right and left confusion, finger agnosia (inability to name fingers)
Gerstmann’s syndrome = left angular gyrus / parietal lobe damage
action-oriented psychotherapy that teaches individuals to identify, challenge, and replace self-defeating thoughts and beliefs with healthier thoughts that promote emotional wellbeing and goal-achievement
Rational Emotive Behavior Therapy (REBT)
- Albert Ellis
- later influenced CBT
- ABC techniques of irrational beliefs: Activating event leads to irrational Beliefs which causes upsetting emotional Consequences
ADHD symptoms must be present prior to the age of:
12
agonist / partial agonist at 5HT1A receptor & agonist/antagonist at D2 receptor
Buspar - mainly works at 5HT1A receptor, some activity at D2 (mechanism is complex and not fully understood)
agoraphobia
fear of public spaces where escape is difficult, being outside, being in a crowd, etc
Examples:
- public transportation
- open places (parking lots, open markets, bridges)
- enclosed places (shops, theaters, cinemas)
- standing in line
- being in a crowd
- being outside the home alone
akinetic mutism lesion
Bilateral anterior cingulate
Alexithymia
Inability to describe one’s emotions
Alice is a 20 yo college student who often feels stressed and tends to eat compulsively to relax. She has been binging on whatever she can get her hands on about 3x/week. She feels lack of control to stop and eats until she is uncomfortably full. Then feels ashamed and disgusted. Feels fat and ugly and is depressed. Tries to induce vomiting but can’t. Compensates by running 2-3 hours in a row and feeling faint. After binging, often goes whole next day without food or water.
Diagnosis:
Bulimia nervosa
= binge-eating + inability to control + compensatory behaviors
(normal weight compared to anorexia)
Alopecia is a known side effect of which psychotropics? (2)
Depakote, Lithium
Alpha synuclein in
- striatum:
- striatum & cortex:
- striatum & cerebellum:
- striatum / basal ganglia: parkinson’s disease
- striatum / basal ganglia & cortex: DLB
- striatum / basal ganglia & cerebellum: MSA
Alpha synuclein = Lewy bodies
striatum = basal ganglia
anterior horn cell degeneration, upper and lower motor neuron degeneration
ALS
anterograde and retrograde amnesia while preserving identity and knowledge, self-resolving and time-limited
transient global amnesia
<24 hours
antiepileptic that causes hirsutism, facial changes, and gingival hypertrophy
phenytoin
Antiepileptic that induces its own metabolism
Carbamazepine
Antipsychotic approved to treat schizophrenia, nausea and vomiting, acute intermittent porphyria, tetanus, and intractable hiccups
Chlorpromazine (Thorazine)
Antipsychotic that causes dark circles around eyes (oculocutaneous hyperpigmentation in sun-exposed areas)
Chlorpromazine (Thorazine)
Antipsychotic use in elderly with dementia
Black box warning! NEVER use! Due to increased risk of death
Piblokto
anxiety, depression, confusion, depersonalization, and derealization ending in stuporous sleep and amnesia that occurs in female Eskimos of northern Greenland
Are SSRIs effective for conversion disorder?
No - evidence has only supported CBT, TCAs, Haldol and ECT
Asian delusion that the penis will disappear into the abdomen and cause death
Koro
At what spine level does the spinal cord typically end in an average adult?
T12-L1
ATP7B gene
- Disease
- What protein?
- Wilson’s disease
- copper-transporting ATPase2 (transports copper from liver to other parts of body)
Benefits of Cariprazine
Vraylar!
Better side effect profile - less metabolic effects, less QTc prolongation, doesn’t affect prolactin
–> may cause nausea & akathisia
Benefits of Desipramine over other TCAs
Less histaminergic & muscarinic affinity
(less sedating & less anticholinergic effects)
bilateral acoustic schwannomas is classic for:
Neurofibromatosis 2 (NF2)
bitemporal hemianopsia, decreased libido, diabetes insipidus
Craniopharyngioma (common in kids)
- distinguishing feature from pituitary adenoma is the endocrine abnormalities
*diabetes insipidus may present as urinary frequency
brain pathways involved in schizophrenia/antipsychotics:
- prefrontal cortex
- mesolimbic
- tuberoinfundibular
- nigrostriatal
- prefrontal cortex: negative symptoms
- mesolimbic: positive symptoms
- tuberoinfundibular: hyperprolactinemia
- nigrostriatal: extrapyramidal side effects
Brief sensation of dryness and burning in the throat, a suffusing warmth & hunger for air. Hyperpnea, with a brief outcry, follows the first breath. In <1 minute, apnea, a few gasps, loss of consciousness and convulsions occur. Sometimes include a bitter almond-like breath and a rose-colored hue of the skin. Oxyhemoglobin in the blood.
Cyanide poisoning
callosal thinning, corpus callosum atrophy
MS
Carl Jung psychological types
8 psychological types - basis of the Myers-Briggs personality test
- helps to explain how people interpret respond to the world so differently
CATIE trial
Clinical Antipsychotic Trials of Intervention Effectiveness
- showed equal efficacy for atypical and typical antipsychotics
cerebellar brain tumor that presents with ataxia
Medulloblastoma
child presents with chronic headaches & visual changes + nausea, intracranial calcified mass with cystic spaces and cholesterol-rich fluid
Craniopharyngioma
childhood epilepsy with centrotemporal spikes
Rolandic epilepsy - benign, doesn’t require treatment, outgrow after puberty
Chronic schizophrenic taking medication every day for 20 years is an example of what kind of prevention? Primary, secondary, or tertiary?
Tertiary
Primary = prevent onset of disease (reduce risk factors, etc)
Secondary = identifies disease early and seeks prompt treatment
Tertiary = reducing deficits caused by illness to improve functioning
Chronic toluene inhalant exposure can lead to what symptoms?
Mimics MS! Due to DEMYELINATION
- brisk deep tendon reflexes, ankle clonus, nystagmus, ataxia
- personality & cognitive changes
classic triad of spongiform vacuolation, loss of neurons, and astrocyte cell proliferation
Creutzfeldt-Jakob disease (CJD) - prion disease
common migraine presentation in children (compared to adults)
- laterality?
- location?
- associated symptoms?
- duration?
bilateral (instead of unilateral)
frontotemporal
+photophobia common
+n/v common
shorter duration
compensatory behavior in binge-eating disorder
there is none! if there is –> bulimia or anorexia!
compulsive utterance of obscene words
coprolalia
Condition where patient can’t move or speak, but eyes can follow observer walking around room
akinetic mutism
conjunctival injection, increased appetite, dry mouth, tachycardia intoxication
cannabis
Criteria for bipolar I disorder:
1. At least _______ (time) of mania
2. _____ or more of the following symptoms: grandiosity, decreased sleep, talkative, racing thoughts, distractible, goal-directed activity, risky behavior
3. marked impairment in __________, requires ________________, or involves ________ features
- At least one week of mania
- 3 or more of the following symptoms: grandiosity, decreased sleep, talkative, racing thoughts, distractible, goal-directed activity, risky behavior
- marked impairment in functioning, requires hospitalization, or involves psychotic features
Criteria for Reactive Attachment Disorder:
- symptoms evident before age ___
- child has a developmental age of at least _______
- symptoms have been present for at least _______
- symptoms evident before age 5
- child has a developmental age of at least 9 months
- symptoms have been present for at least 12 months
CSF assay for 14-3-3 and tau proteins
Creutzfeldt-Jakob Disease (CJD) prion disease
cytokines consistently elevated in MDD
TNF-alpha & IL6
decreased fluency of spontaneous speech & impaired repetition, but intact comprehension (can follow verbal commands)
Name + Lesion?
Broca’s aphasia, inferior frontal gyrus of the dominant hemisphere
Wihtigo
delusional fear displayed by Native American Indians of being turned into a cannibal through possession by a supernatural monster
Diagnostic criteria for anorexia (3)
- Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health
- Intense fear of gaining weight or becoming fat, even though underweight
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
diarrhea, restlessness, extreme agitation, myoclonus
serotonin syndrome
Diseases associated with chromosome 21 abnormalities
Down’s syndrome & Alzheimer’s disease
distinguishing feature between schizoid & schizotypal personality disorders
schizoid - w/o the below
schizotypal - perceptual disturbances + eccentric behavior
does attachment last for life?
yes, according to the theorists (Bowlby) - predicts later life relationships
Dorsal column volume loss
Vit B12 deficiency
drive theory
Freud
Edrophonium chloride vs. Pyridostigmine in MS
Edrophonium chloride used to diagnose
Pyridostigmine used to treat
Embryonic hindbrain develops into:
Cerebellum, Pons, Medulla
Embryonic midbrain develops into:
Colliculi, Tegmentum, Cerebral peduncles
Emil Kraeplin
mental disorders have different outcomes
examples of cognition-oriented therapies
reality orientation (dementia) & cognitive retraining (helps with memory, attention, tasks, etc)
examples of stimulation-oriented therapies
art, music, pet therapy
exhibitionistic disorder
sexual arousal from exposing genitals to a stranger
FDA approved medication for bulimia
Fluoxetine (Prozac)
FDA approved medications to treat PTSD in adults
Sertraline, Paroxetine
first vs. second generation antipsychotics
first = dopamine antagonist
second = dopamine and serotonin antagonist
first-line treatment for MS acute attack
IV steroids followed by oral steroids
frontal lobe lesion that leads to apathy with limited spontaneous movement, gesture, and speech
medial frontal lobe
frontal lobe lesion that leads to depression
left frontal lobe / prefrontal cortex
frontal lobe lesion that leads to mania, euphoria, laughter
right frontal lobe / prefrontal cortex
frontal lobe lesion that leads to profanity, irritability, irresponsibility
orbitofrontal
Pick’s disease
frontotemporal atrophy
= Pick’s (frontotemporal) dementia
- may include hyperorality and hypersexuality
frotteuristic disorder
sexual arousal by touching or rubbing against a nonconsenting person
Ganser syndrome
When a patient gives an answer that doesn’t quite answer the question
For ex - When asked what 1+1 is, answer is 3.
Generalized muscle weakness with improvement in strength after minimal exercise
Lambert-Eaton
genetic factors account for ____% of risk for developing schizophrenia
60-80%
Gower’s maneuver
Duchenne’s muscular dystrophy - patient gets up from floor or chair using hands
Halstead-Reitan Battery
tests for brain damage
HAM-D rating scale
Hamilton Depression Rating Scale
Highest prevalence:
A. Depressive disorders
B. Anxiety disorders
C. Schizophrenia
D. Dementia
E. Substance abuse
B. Anxiety disorders
How do neurotransmitter levels change with age?
- Serotonin
- Dopamine
- GABA
- Glutamate
All decrease with age!
How is Methadone affected in pregnancy?
Clearance is increased and half-life decreased during trimester 2/3 –> may need to increase dose or decrease dose interval
How long can these drugs be found in urine?
- PCP:
- Cannabis:
- Cocaine:
- Heroin:
- PCP: 8 days
- Cannabis: 4 weeks
- Cocaine: 8 hours
- Heroin: 72 hours
How to diagnose Huntington’s disease
PCR - examines trinucleotide repeats
(>35 in adults, >50 in kids)
HTN, blurry vision, diaphoresis, stiff neck, headache, n/v while eating fancy cured meats, wine, beer, cheese
“Tyramine hypertensive crisis”
- Tyramine-containing foods can’t be broken down in presence of MAOIs so Tyramine acts as a sympathomimetic
Insomnia, unsteady gait, headache, nystagmus, upward gaze paralysis (can’t look up), eyelid retraction
Pineal gland tumor (Parinaud syndrome) = Pineoblastoma
**insomnia due to secretion of melatonin
infantile spasms, hypsarrhythmic EEG, psychomotor delay with age of onset between 3-8 months
West syndrome (infantile spasms)
IQ 20-40
Severe ID
IQ 40-50
Moderate ID
IQ 50-70
Mild ID
IQ 71-84
Borderline IQ
IQ < 20
Profound ID
key difference between paranoid and schizotypal personality disorder
magical thinking
Paranoid personality disorder - pervasive distrust & suspiciousness of others, perceive others as malevolent, doubt loyalty of others, reluctant to confide in others, bearing grudges
Schizotypal personality disorder - ideas of reference, magical thinking, unusual perceptual experiences, odd thinking, suspiciousness, odd behavior, lack of friends, social anxiety
known side effects of Gabapentin
SJS, DRESS, erythema multiforme, depression/SI, renal failure, thrombocytopenia
Lamictal use in pregnancy
safe!
lesion associated with abulia
lateral or bilateral frontal lobe injury
lesion to what area of hypothalamus can lead to obesity?
ventromedial
lethargy, disorientation, vomiting in someone after starting Depakote
hyperammonemia / hyperammonemic encephalopathy
Levomilnacipram (Fetzima) MOA
SNRI
LGBTQ teens revealing their sexuality to others at school leads to what with self-esteem and bullying?
increased self-esteem
increased bullying
lifetime prevalence of GAD
5-8%
likelihood of a male child inheriting Huntington’s disease from one parent who is an affected carrier
50%
autosomal dominant inheritance
low 5-HIAA & MHPG + hypoglycemia
firesetters
major excitatory neurotransmitter of the brain
Glutamate (acts on NMDA receptor)
major inhibitory neurotransmitters
GABA + Glycine
MAOI inhibitors work on what neurotransmitters?
Serotonin, Norepi, Dopamine
Mechanism of action of Zolpidem
GABA-A alpha-1 agonist (NOT a benzo)
- important distinction from benzos is that it preserves deep sleep stages (whereas benzos disrupt deep sleep)
**benzos non-selectively bind to all GABA subtypes
Mechanism of Vilazodone (Viibryd)
SSRI + partial serotonin (5HT1A) agonist
medication to help with decreasing alcohol intake when not ready to completely quit
Naltrexone (decreases cravings by decreasing reward pathway)
compared to Acamprosate or Disulfiram which can be uncomfortable and dangerous with alcohol use
microhemorrhages in the periventricular gray matter, around the aqueduct and 3/4 ventricles and superior vermis
Wernicke’s encephalopathy
Mnemonic for TCA side effects
Tachycardia
Cardiac effects (increased QTc, arrhythmias)
Anticholinergic effects (flushing, dilated pupils, urinary retention)
Sedation
MOA of Memantine
NMDA antagonist
MOA of the drug that causes people to vomit if drinking alcohol
aldehyde dehydrogenase irreversible inhibitor (Disulfiram)
–> causes flushing, n/v, hypotension, vertigo, chest pain if alcohol is consumed
**can include mouthwash, cough syrup, vinegar, vanilla extract
mood stabilizer that inhibits inositol monophosphatase
Lithium
Mood stabilizer with side effect of acne and psoriasis flares
Lithium
Most accurate confirmatory way to diagnose Creutzfeldt Jakob Disease (CJD)?
Pathological exam of the cortex (brain biopsy)
most common genetic marker for:
- Alzheimer’s
- early-onset familial Alzheimer’s
- Alzheimer’s: ApoE4
- early-onset familial Alzheimer’s: Presenilin-1
Most common viral cause of viral meningitis
Enteroviruses cause 85% of viral meningitis
most reliable psychological test
Wechsler adult intelligence scale
Muscle weakness that
- improves with rest
- improves with activity
- improves with rest = Myasthenia gravis
- improves with activity = Lambert-Eaton (small cell lung cancer)
Neonatal myasthenia gravis
- origin?
- course of illness?
- origin: from mother’s autoantibodies
- course of illness: resolves within months
Nefazodone (mechanism + side effect concerns)
serotonin antagonist & reuptake inhibitor (SARI)
known for liver monitoring & orthostatic hypotension
nerve entrapment from lying wrong, arm over chair or crutches that leads to weakness in wrist/fingers, inability to extend arm or turn forearm over
Saturday night palsy = Radial nerve entrapment
neural changes to the gray/white matter in brains of 3-6 year olds with MDD
decrease in gray matter volume and gray matter thinning
no change in white matter volume
neurotransmitter effects of MDMA (molly, ecstasy)
- serotonin
- norepinephrine
- dopamine
- vasopressin
- oxytocin
long-term damage comes from what?
- serotonin: increases
- norepinephrine: increases
- dopamine: increases
- vasopressin: increases (indirectly)
- oxytocin: increases (indirectly)
***the latter increase or enhance love, trust, sexual arousal, social experiences
long-term damage comes from effects on serotonergic nerve terminals
Neurotransmitters that decrease aggression
GABA - inhibits aggression
Serotonin - decreases frequency of aggression
Norepi - decreases aggression
**Dopamine seems to increase aggression
new-onset headache, fever, fatigue, muscle aches, joint pain, night sweats, weight loss, jaw claudication (tiredness with chewing), decreased vision
Giant cell temporal arteritis
Nigrostriatal depigmentation
Parkinson’s
normal bereavement timeline
<2 months
normal reflex grade
2+
(0 or 1+ = sluggish or no response)
(3+ or 4+ = hyperactive or brisk response)
Omega 3 benefits for Alzheimer’s disease
MINIMAL improvement in depressive and agitation symptoms
Origin of craniopharyngioma
Rathke’s pouch
parkinsonism, flapping tremor, ataxia, dystonia, bulbar signs (dysphagia, dysarthria)
Wilson’s disease
pathological gambling is most associated with what?
Mood disorders, particularly MDD
Patient is asked to imagine a difficult situation they have encountered in the past and then works with the therapist to practice how to cope successfully with the problem
Cognitive rehearsal (a CBT technique)
Patients between age 54 to 66 present with loss of memory, change in intellectual function, and changes in mood. Associated with HTN and old age. Subcortical degeneration of white matter.
Binswanger disease = subcortical leukoencephalopathy (a form of small-vessel vascular dementia)
Paxil during pregnancy
First trimester risk of atrial & septal defects, recommended to switch but okay if benefit>risk
(Category D)
pergolide - drug type?
dopamine agonist for Parkinson’s disease (like Bromocriptine, Pramipexole, Ropinirole)
Person can speak fluently with normal prosody and rhythm but what they’re saying doesn’t make sense, sounds like gibberish words jumbled together. Comprehension and repetition impaired. They seem unaware of not making sense.
Name + Lesion?
Wernicke’s aphasia, superior temporal gyrus in the dominant hemisphere
Person can’t reach for an object or point to it with their arm - Lesion of?
Dorsal stream - “where” stream
- relays info related to movement and spatial relationships between objects in the visual field
person is unable to remember certain categories of information (places, activities, people)
systematized dissociative amnesia
phonological disorder vs. fluency disorder of childhood
phonological disorder = pronunciation difficulty (articulation, speech impediment)
fluency disorder = stuttering
Pimavanserin MOA
selective serotonin 5HT2A inverse agonist
Pramipexole side effects
- hallucinations
- sleep attacks
- congestive heart failure
- n/v, dizziness, orthostatic hypotension
Pregnancy Drug Categories:
Category A = safe
Category B = No human studies, animal studies show no risk
Category C = No human studies, animal studies show some risk
Category D = Human studies show some risk, benefit > risk
Category X = Evidence shows risk, risk > benefit
preserved speech fluency and comprehension but difficulty with repetition
Lesion?
arcuate fasciculus (conduction aphasia) - connects Broca’s & Wernicke’s areas
• left (dominant) interior parietal or superior temporal
Prosopagnosia
face blindness (inability to recognize faces)
**fusiform gyrus in the brain
Prozac washout period before starting an MAOI
5 weeks
pseudocyesis
false pregnancy
Psych drugs that are known to cause SJS (3)
Armodafinil, Lamictal, Carbamazepine
RAISE study
Recovery After an Initial Schizophrenic Episode
comprehensive care for first-episode psychosis improves functional & clinical outcomes
Recreational substance that is known to cause early dementia
Inhalants
Risk of SSRIs beyond week 20 of pregnancy
pulmonary HTN
safe psychotropic to combine with MAOIs
Lithium
Schizoid vs. Schizotypal personality disorder - how to remember and set them apart
Schizo = split (latin)
Schizoid - split, like to be alone, don’t desire relationships
Schizotypal - more like schizophrenia with odd eccentric magical thinking & perceptual experiences
Sedating TCAs
“Just a TAD sleepy”
Trimipramine
Amitriptyline
Doxepin
self-psychology theory theorist
Kohut
Simple vs. complex phonic tic
Simple = grunt, sniffle, throat clearing
Complex = words, phrases, vulgar language
Someone can’t perceive or identify the size, shape or orientation of an object - Lesion where?
Ventral stream
spinal tract for conscious fine muscle control of skeletal muscle
Anterior + Lateral + Corticobulbar Corticospinal Tract
spinal tract responsible for subconscious regulation of reflex activity
Medial Reticulospinal Tract
Spinal tract responsible for subconscious upper limb muscle tone and movement
Lateral Rubrospinal Tract
spinal tract that subconsciously controls eye, head, upper limb position in response to visual and auditory stimuli
Medial Tectospinal Tract
Spinal tract that subconsciously regulates balance and muscle tone
Medial Vestibulospinal Tract
SSRI effect on cytokines
Decrease in IL1B
(may decrease TNF alpha & IL6 but not significant)
Stage of sleep for night terrors
NREM Stage 3/4
STARD trial
Sequenced Treatment Alternatives to Relieve Depression
patients who fail multiple antidepressants show higher rates of relapse and lower remission
STEP-BD trial
adjunctive antidepressants does not help bipolar depression or cause mania
Systematic Treatment Enhancement Program for Bipolar Disorders
Studies show that acupuncture has a __% success rate for treating insomnia
90%
(increases GABA & sleep quality)
Sudden awakening from sleep with piercing scream, panicky fear, and palpitations. Takes a few minutes to calm down, doesn’t seem aware of surroundings or husband. Doesn’t remember the episode.
Night terror
Amok
Sudden rampage involving homicide and/or suicide in Malaysian culture
TADS study
The Treatment of Adolescents with Depression Study
combination of antidepressants + therapy better than either alone
TCA known for less sedation effect
Protriptyline
Technique to ameliorate GI side effects of Lithium
switch from Lithium carbonate to Lithium citrate (syrup)
the emotional dependence of an infant on its mother
-vs-
the emotional attachment of a mother to her child
attachment
-vs-
bonding
theorist of attachment theory
John Bowlby
Therapist asks patient to defend the validity of his or her thoughts and beliefs. Therapist performs Socratic questioning to determine the accuracy of the patient’s maladaptive thoughts. If the patient cannot produce objective evidence supporting his or her assumptions, the invalidity is exposed.
Validity testing (a CBT technique)
Therapist focuses on developing patient’s self-esteem, ego functioning, and adaptive skills
Supportive psychotherapy
timeline for persistent depressive disorder
2 years
timeline for sexual disorders (like fetishistic disorder)
> 6 months
TORDIA study
Treatment of Resistant Depression in Adolescents
- adolescents with initially SSRI-resistant depression have improved outcomes with combined meds + psychotherapy
Trail-making test tests for:
executive functioning
Treatment for absence seizures
1) Ethosuximide
2) Depakote
treatment for rumination disorder in:
- adults:
- infants & those with intellectual disabilities:
- adults: diaphragmatic breathing
- infants & those with intellectual disabilities: behavioral habit reversal & aversive training
treatment of acute mania
Lithium, Valproate, Atypical antipsychotic
treatment of bipolar depression (5)
Quetiapine, Olanzapine/Fluoxetine, Lurasidone, Cariprazine (Vraylar), Lumateperone (Caplyta)
tremor entrainment test
if positive –> functional neurologic tremor
Types of dissociative amnesia:
________ – unable to remember an event or period of time (most common type)
________ – unable to remember a specific aspect of an event or some events within a period of time.
________ – complete loss of identity and life history (rare)
localized – unable to remember an event or period of time (most common type)
selective – unable to remember a specific aspect of an event or some events within a period of time.
generalized – complete loss of identity and life history (rare)
ventral tegmental area (VTA)
dopamine, reward pathway
Victims of bullying in adolescence have a *** times greater risk of developing GAD, panic disorder and agoraphobia as an adult
4 times higher!
Vomiting, fever, restless sleep caused by the evil eye occurring in Mediterranean people
Mal de ojo
voyeuristic disorder
sexual arousal from watching a person get naked without knowing
What is Adderall XR?
Amphetamine/Dextroamphetamine combo (2 isomers, extended release)
What is the most common disorder that adults with childhood-onset fluency disorder go on to develop?
Social anxiety disorder
What is the nutritional deficiency in Wernicke’s?
Thiamine (B1)
What percentage of children with ADHD will go on to be adults meeting criteria?
60%
What to know about sodium oxybate for narcolepsy
Improves quality of overnight sleep & thus improves daytime wakefulness
Treats catalepsy
Can cause daytime sedation –> treat with low-dose amphetamine
When is DBS indicated for Parkinson’s disease?
Late in the course when severe symptoms resistant to meds
Why is the Geriatric Depression Scale unique?
Used to evaluate depression in elderly with complex history, can distinguish depression from parkinson’s or dementia vs. mdd
Wisconsin card-sorting test tests for:
executive functioning
YMRS Scale
Young Mania Rating Scale
ZODIAC study
Ziprasidone Observational Study of Cardiovascular Outcomes
Those on Ziprasidone did not have higher cardiovascular outcomes than those on Olanzapine despite Ziprasidone’s known risk of QTc prolongation
what part of the brain is damaged by Thiamine deficiency (Wernicke’s)?
mamillary bodies
Correcting hyponatremia vs. hypernatremia too fast
Hyponatremia:
- From low to high, your pons will die (osmotic demyelination syndrome / central pontine myelinolysis) = locked in syndrome
Hypernatremia:
- From high to low, your brains will blow (cerebral edema / herniation)
lifetime prevalence of schizophrenia
1%
69 yo presenting with acute onset vertigo, lack of coordination, left-sided facial numbness. Loss of pinprick over left face and right body, left-sided dysmetria, rotatory nystagmus, left-sided ptosis and miosis.
Left Lateral Medullary (Wallenberg) Syndrome
- PICA (Vertebrobasilar)
Contralateral hemiparesis or hemisensory loss, ipsilateral facial sensory loss, CN palsies, diplopia, dysarthria, ataxia, vertigo, vomiting
Posterior circulation stroke (PICA) - vertebrobasilar
Lateral medullary = Wallenberg Syndrome
Contralateral face, arm weakness and sensory loss, eyes deviated toward lesion
MCA (left MCA = aphasia) stroke
Contralateral foot and leg weakness, behavioral change, confusion, impaired gait and stance (apraxia), akinetic mutism, urinary incontinence, grasp and suck reflex
ACA stroke
Arylsulfatase A deficiency
Metachromatic leukodystrophy
logorrhea
uncontrollable excessive talking
log = words
rrhea = flow/discharge
Brown Sequard Syndrome
- _____________ hemiparesis
- _____________ pain & temp loss
- _____________ propioception & vibration
lesion to hemisection (half) of spinal cord
- ipsilateral hemiparesis
- contralateral pain & temp loss
- ipsilateral propioception & vibration
term for rapid shifting from one topic to another
flight of ideas
Dramatic flinging/flailing of left arm
Name + Lesion
Hemiballismus - right subthalamic nucleus lesion
**hemiballismus = contralateral subthalamic nucleus
Postpartum hemorrhaging causing hypotension and requiring transfusion –> Mom is tired, losing weight, can’t breastfeed
Sheehan syndrome - postpartum pituitary infarction leading to panhypopituitarism
**can be associated with bitemporal hemianopsia (can compress the chiasm), neck stiffness & positive Kernig’s (meningeal irritation)
Vertebrobasilar
~vs~
Carotid artery
stroke/TIA symptoms
Vertebrobasilar - cerebellar symptoms (ataxia, vertigo, diplopia, dysphagia, dysarthria)
Carotid artery - blindness, sensory or motor loss, aphasia, visual field deficits
Myasthenia gravis is associated with what type of tumor?
Thymoma (20% of adults with MS have a thymoma)
**75% of adults with MS have some thymus abnormality, whether thymoma or thymus hyperplasia
male to female ratio for schizophrenia
1:1
What chromosome is associated with migraines?
Chromosome 19
most common neurological complication of chronic alcoholism?
alcoholic neuropathy
(Alcohol directly damages nerves)
acute descending paralysis with ophthalmoplegia, ataxia, areflexia
Miller-Fisher variant of Guillain-Barre Syndrome (anti-GQ1b ganglioside)
classic nerve conduction abnormalities of conduction block and prolonged F-wave latencies
pathognomonic of Guillain-Barre Syndrome (GBS)
3 receptor types associated with glutamate
AMPA, kainate, and NMDA
MOA of PCP (drug)
NMDA antagonist
Author of “Ego and Mechanisms of Defense” and founder of the defense mechanisms
Anna Freud
dementia pugilistica
Boxer’s dementia
“Punch drunk syndrome”
“chronic traumatic encephalopathy”
What chromosome puts people at higher risk for boxer’s dementia?
chromosome 19 (ApoE4)
TCA with most antihistaminergic activity
Doxepin
TCA used to treat enuresis in kids
Imipramine
Why does grapefruit juice interact with Methadone?
CYP3A4 inhibition (which increases Methadone levels)
a non-motor symptom that often appears in Parkinson’s patients before onset of motor symptoms
Decreased olfactory sense
Benefit of Pimavanserin compared to other antipsychotics for Parkinson’s
Doesn’t worsen motor symptoms
most common comorbidity in delusional disorder
depression
Hydroxyzine contraindications
Cardiac - QT prolongation, MI, CHF, bradycardia
Metabolic - electrolyte abnormalities
Pulmonary - asthma
Other - hot environmental temperature (risk of heat stroke)
Chronic paroxysmal hemicrania vs. Cluster headaches
- More common in men vs. women:
- # of attacks per day:
- Attack duration:
- Triggered by:
- Main treatment:
- Relation to circadian rhythm:
- More common in men vs. women: CPH women; Cluster men
- # of attacks per day: CPH up to 40 per day; Cluster up to 8 per day
- Attack duration: CPH 2-30 min; Cluster 15 min to 3 hours
- Triggered by: CPH turning head, alcohol; Cluster alcohol
- Main treatment: CPH indomethacin; Cluster High flow oxygen, sumatriptan
- Relation to circadian rhythm: CPH unrelated; Cluster mostly at night
35 yo with severe pain behind left eye. Reports intense stabbing pain that woke him at midnight, improved in 30 minutes, then returning right before he fell back asleep. Several months ago had similar episodes of pain that resolved spontaneously after 2 weeks. Exam reveals left-sided ptosis, miosis and rhinorrhea.
Cluster headache - can have horner syndrome, occurs in clusters then no periods of headaches
timeline for Tourette disorder
at least 1 year
timeline for GAD
at least 6 months
antipsychotic that is mainly metabolized/excreted via renal/urine
Paliperidone (80% excreted via urine)
**compared to most other antipsychotics that are hepatically metabolized
Timeline for erectile dysfunction disorder
6 months
Timeline for rumination disorder
1 month
Pioglitazone relevance to psychiatry
It is a an insulin sensitizing drug. Can be used as an adjunctive antidepressant in treatment-refractory cases and seems to help in non-diabetic adults with insulin resistance
1 cause of loss of years of healthy life in both high- and low- income countries
Depression!
evidence is best for what treatments for depersonalization/derealization
CBT + SSRI or Benzo
2 blackbox warnings for Latuda
- can increase suicidality in children and adolescents
- can increase mortality in dementia-related psychosis
brain tumor that causes cognitive slowing, fatigue, weight loss, headaches, new-onset seizures, speech impairment
oligodendroglioma
most common location of ischemic stroke in migraine infarction
posterior circulation
treatment of Hallucinogen Persisting Perception Disorder (HPPD) after use of LSD
Benzos (GABA agonist!)
HPPD involves persisting perceptual disturbance after d/cing use of hallucinogen, primarily involves visual hallucinations
timeline for aura in migraine to be considered “persistent aura” without evidence of infarction?
at least 1 week
Why is Desipramine sometimes used for cocaine dependence and smoking cessation?
Inhibits noradrenergic reuptake
Acamprosate MOA
GABA + Glutamate agonist
- used for alcohol dependence
Acamprosate contraindication
Severe renal impairment
Myasthenia gravis vs. Lambert-Eaton with regards to pre- vs post-synaptic ACh receptor malfunction
Myasthenia gravis = post-synaptic
Lambert-Eaton = pre-synaptic
MTA study
Multimodal Treatment of ADHD Study - revealed both medication alone and combination of med + therapy were superior to therapy alone for patients with ADHD
curative surgery for epilepsy
temporal lobectomy
**corpus callosotomy or extra-temporal resections are palliative
most common cause of sporadic fatal encephalitis worldwide
Herpes simplex virus type 1
encephalitis affecting bilateral temporal lobe involvement
herpes simplex
heritability of bipolar disorder based on twin studies
60-90%
dystonia in Parkinson’s disease more common in what population?
Young-onset Parkinson’s (before age 40)
- think of VA guy
- can be the initial presenting symptom in this population (compared to late-onset)
atypical antipsychotic least likely to result in weight gain
Abilify
HAM-D vs. BDI
HAM-D: 17 questions asked by provider (ham-D for Doctor does it!)
BDI: 21 questions completed by patient
(bdI for I do it!)
Antipsychotic MOA
dopamine antagonist
Cyclothymic disorder criteria
- timeline:
- symptoms:
- timeline: 2 years
- symptoms: hypomanic & depressive symptoms that don’t meet criteria for hypomania, mania, or MDD
Cluster A personality disorders:
- described as:
- what are they?
- described as: odd, eccentric
Paranoid, Schizoid, Schizotypal
Cluster B personality disorders:
- described as:
- what are they?
- described as: dramatic, emotional
Histrionic, Borderline, Narcissistic, Antisocial
Cluster C personality disorders:
- described as:
- what are they?
- described as: anxious, fearful
Avoidant, Dependent, Obsessive-Compulsive
most common side effect of Vortioxetine (Trintellix)
persistent nausea (does not resolve like typical SSRIs)
MOA of Vortioxetine (Trintellix)
SRI (serotonin reuptake inhibitor, not selective)
FDA approved meds for PMDD
Zoloft, Prozac, Paxil
first drug of choice for generalized seizures
Depakote
Timing for premature ejaculation
Less than 1 minute
Most common side effect of DBS from the direct electrical stimulation?
Hypomania - can be reversed by decreasing stimulation settings
unique benefit of Vortioxetine (Trintellix)
shows improvement in COGNITION independent of mood improvement. Cognitive improvements can occur even prior to mood changes.
New neuromod technique that uses electrical signals to stimulate the trigeminal nerve CN V through a battery-powered patch placed on the patient’s forehead
Trigeminal Nerve Stimulation (TNS)
Trigeminal Nerve Stimulation (TNS) is FDA approved to treat what condition
ADHD
most common population for rumination disorder
infants between 3 months to 1 year of age
When do myelination & synaptogenesis start, occur, peak, and end in the brain?
Myelination: starts in utero, peaks right before birth, continues through life
Synaptogenesis: starts in second trimester, peaks in toddlerhood (age 2), ends around age 10 (synaptic overproduction occurs before that, then synaptic pruning begins)
Hz of Parkinson’s disease tremor
4-6 Hz
acute stress disorder timeline
3 days to 1 month
Circumlocutions
word substitutions to avoid problematic words in childhood-onset fluency disorder
Brexpiprazole is FDA approved to treat:
MDD as adjunctive agent, schizophrenia
It is the goal of the ______ to satisfy the needs of the id in a socially acceptable way
ego
The ego balances the id’s unconscious urges and desires with the superego’s restriction of moral standards
30 yo resident complaining of excessive daytime sleepiness for the past 3 months. Works in the hospital during the day and moonlights at night. Increases caffeine intake for moonlighting. Has difficulty falling asleep at night bc afraid of pager going off. Daytime sleepiness so bad that she falls asleep driving to work and ran a red light.
Circadian rhythm sleep disorder
- persistent or recurrent sleep disturbance due to either intrinsic (altered circadian rhythm, blindness) or extrinsic (travel, daytime sleep schedule) factors with consequences, which include- insomnia, excessive daytime sleepiness, wake time dysfunction
Types:
- Delayed or advanced sleep-phase type
- Irregular sleep-wake type
- Shift work type
- Jet lag type
- Free-running type
person-centered psychotherapy
Carl Rogers
Criteria for migraine without aura:
- at least ___ attacks
- lasting for __ to __ hours
- at least __ of the following characteristics: ___lateral location, _________ quality, __________ or __________ pain intensity, aggravation/causing avoidance of routine activity
- at least __ of the following: photophobia, phonophobia, nausea, vomiting
- at least 5 attacks
- lasting for 4 to 72 hours
- at least 2 of the following characteristics: unilateral location, pulsating quality, moderate or severe pain intensity, aggravation/causing avoidance of routine activity
- at least 1 of the following: photophobia, phonophobia, nausea, vomiting
Criteria for migraine with aura:
- at least __ attacks
- __ or more of the following aura symptoms: visual, sensory, speech, language, motor, brainstem, retinal
- at least __ of the following: one spreads gradually over >5 minutes, 2 or more aura in succession, each aura lasts 5-60 min, at least one aura is unilateral, at least one aura is positive, aura is accompanied by or followed within 60 min headache
- at least 2 attacks
- 1 or more of the following aura symptoms: visual, sensory, speech, language, motor, brainstem, retinal
- at least 3 of the following: one spreads gradually over >5 minutes, 2 or more aura in succession, each aura lasts 5-60 min, at least one aura is unilateral, at least one aura is positive, aura is accompanied by or followed within 60 min headache
MMSE scoring:
21-24: Mild impairment
10-20: Moderate impairment
0-9: Severe impairment
31 yo woman 5 mos postpartum ingests chalk and clay since delivery. Has been craving and eating chalk and clay for over 4 mos and is hoping it will help her lose weight. She thinks she is overweight. She has been binging at least twice a week on food mixed with clay and chalk. Eats slowly over 3 hours until she feels uncomfortably full. Adds chalk to regular meals, as it satisfies her cravings. Sometimes she just chews on it then regurgitates it.
Pica
= persistent intake of nonnutritive substances for at least 1 month
she meets features of a few other eating disorders but does not meet criteria for them!
Hypnagogic vs. Hypnopompic hallucinations
Hypnagogic = with sleep onset (feeling GROGGY)
Hypnopompic = with waking (POPPING awake!)
Levomilnacipran FDA approved for?
MDD
Cannabinoid 1 vs 2 receptors
CB1 = psychiatric effects
CB2 = immune system, inflammatory response, pain
Piaget stage where conservation is achieved
Concrete operations = CONservation
Genetic inheritance of Tourette’s
Autosomal dominant
Concordance of Tourette’s disorder in monozygotic twins
85%
Heschl’s gyrus
Primary auditory cortex - bilateral superior temporal lobe
periodic high-amplitude sharp triphasic wave complexes on EEG
Creutzfeldt-Jakob disease
Periodic lateralizing epileptiform discharges (PLED) on EEG
Herpes encephalitis
CSF:
- opening pressure: elevated
- WBC: elevated lymphocytes
- protein: elevated
- glucose: low
Fungal/TB Meningitis
CSF:
- opening pressure: elevated
- WBC: elevated neutrophils
- protein: elevated
- glucose: low
Bacterial Meningitis
CSF:
- opening pressure: normal or elevated
- WBC: elevated lymphocytes
- protein: normal to elevated
- glucose: normal low
Viral (Aseptic) Meningitis
Mahler’s stage in which baby spends more time asleep than awake
Normal autism (birth to 2 mos)
Mahler’s stage when baby is developing the ability to distinguish the inner from the outer world. The child perceives itself as being part of a single entity with its mother.
Symbiosis (2-5 mos)
Mahler’s stage when child is drawn further into the outside world and begins to distinguish itself from its mother.
Differentiation (5-10 mos)
Mahler’s stage when baby has the ability to move independently and explore the outside world (crawling, walking, exploring)
Practicing (10-18 mos)
Mahler’s stage in which the child’s independence vacillates with its need for its mother. The child moves away from the mother, then quickly returns for reassurance. Now they’re more tentative and want to make sure mom is still there.
Rapprochement (18-24 mos)
Mahler’s stage in which the child understands the permanence of other people, even when they are not present, allowing separation.
Object constancy (2-5 yrs)
statistical test that checks differences between means of 2 versus 3 or more groups
2 = t-test
> 3 = ANOVA
statistical test that checks difference between 2 or more categorical outcomes
chi-square
Head bleed resulting from tear of middle meningeal artery
Epidural hematoma
Epidural = middle meningeal ARTERY
Subdural = bridging VEINS
Head bleed resulting from tear of meningeal bridging veins
Subdural hematoma
Epidural = middle meningeal ARTERY
Subdural = bridging VEINS
toxicity of acetylcholinesterase inhibitors (physostigmine) (organophosphates) (pesticides)
DUMBBELS
Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Emesis
Lacrimation
Salivation
**cholinergic toxicity
Pt presents with vomiting, shortness of breath, bradycardia, hypoxia, pinpoint pupils, lacrimation, widespread rhonchi, muscle fasciculations, increased bowel sounds and diarrhea.
diagnosis + management
Insecticide poisoning (organophosphates, anticholinesterase inhibitor, increases cholinergics)
–> immediate atropine (anticholinergic/antimuscarinic)
**remove clothes bc can be absorbed via skin
most common sleep disruption in depression
early morning awakening
hypsarrhythmia
EEG pattern for infantile spasms
West syndrome = infantile spasms, hypsarrhythmia, and psychomotor developmental arrest
microcephaly, a characteristic “mousy” odor, infantile spasms, and light hair and skin pigmentation
PKU (Phenylketonuria)
Brain structure suspected to be involved in Tourette’s with dopaminergic activity
Caudate nucleus - causes the movements related to Tourette’s, Parkinson’s, tics
rate-limiting enzyme in the dopamine synthetic pathway
Tyrosine hydroxylase
Drugs that work on GABA-A vs GABA-B
GABA-A: Benzos, Barbiturates, Alcohol
GABA-B: Sodium oxybate, Lioresal (antispasticity agent)
Entacapone & Tolcapone MOA
COMT inhibitors
Benzos metabolized by conjugation
LOT =
Lorazepam
Oxazepam
Temazepam
long-acting benzos that bypass oxidation so safer in hepatic disease, also have no active metabolites
method of obtaining a prediction for the value of one variable in relation to another variable is called
regression analysis
triphasic waves on EEG
hepatic encephalopathy
compulsive eating, hypersexuality, hyperorality, visual agnosia, docility (calm, subserviant)
Kluver-Bucy Syndrome = bilateral lesions of the temporal lobe disconnecting amygdaloid bodies
While working on the ward of a state hospital, a psychiatrist comes across a patient with schizophrenia. The patient sits in one spot for extended periods of time, without changing position. This phenomenon is best described as:
catalepsy
= immobile position that is constantly maintained.
How is sleep affected in elderly?
- # REM episodes:
- Length of REM:
- % of N1:
- % of N2:
- % of N3:
- # REM episodes: increased
- Length of REM: decreased
- % of N1: increased
- % of N2: increased
- % of N3: decreased
alogia
lack of speech that results from a mental deficiency or dementia (lack of thought content)
To meet criteria for rapid cycling specifier in bipolar disorder, the patient must present with at least _____ mood episodes over the past ___ months
4 mood episodes over 12 months
age to be considered late-onset in schizophrenia
45
of neurons in the developed human brain
86-100 billion
Premonitory phase of migraines symptoms (6)
Hypo/peractivity
Fatigue
Depression
Food cravings
Yawning
Neck stiffness
Occurs hours to days before migraine
Mirtazapine MOA
alpha-2 antagonist (+histamine H1 blockade –> sedation; +5HT3 antagonism –> antinausea)
FDA-approved meds for pediatric bipolar disorder (6)
Lithium
Four atypicals:
- Abilify
- Risperdal
- Quetiapine
- Olanzapine
- Asenapine
Timeline for seizures in alcohol withdrawal
first 48 hours
Prazosin MOA
alpha-1 antagonist
Ketamine MOA
glutamate NMDA antagonist
hypnagogic hallucinations are a known side effect of what antipsychotic
Asenapine
bipolar disorder rapid cycling definition
at least 4 mood episodes in the last 12 mos
most appropriate effective treatment for hypoactive sexual desire disorder
Stimulants
narcolepsy criteria:
- symptoms at least ___ times per week over the past ___ months
- recurrent episodes of uncontrollable sleepiness, lapsing into sleep, or napping during the same day
At least one of the following:
- Episodes of cataplexy occurring at least ___ times a month
- ____ Hypocretin
- REM sleep latency of ___ minutes and a mean sleep latency of ___ minutes
- symptoms at least 3 times per week over the past 3 months
- recurrent episodes of uncontrollable sleepiness, lapsing into sleep, or napping during the same day
At least one of the following:
- Episodes of cataplexy occurring at least several times a month
- Low Hypocretin
- REM sleep latency of 15 minutes and a mean sleep latency of 8 minutes
oligoclonal bands in CSF
Multiple Sclerosis
Saffron use in Alzheimer’s
similar cognitive improvements and efficacy compared to Donepezil with fewer side effects (less nausea)
body integrity identity disorder
feeling that a limb or other body part is foreign and doesn’t belong to them, needs to be removed
most common psychiatric illness/comorbidity in Lupus
depression
best OCD meds target what receptor profile
serotonin
What does SCOFF stand for?
Sick (vomit)
Control
One
Fat
Food
SCOFF sensitivity and specificity
High sensitivity (identifies all eating disorder patients, low false negatives)
Low specificity (low false positives, may falsely diagnose some but at least all of the real ones are captured)
least common type of seizure in Lennox-Gastaut
myoclonic
falls & vertical gaze palsy, writing smaller (micrographia) –> progresses to symmetric rigidity & dementia
progressive supranuclear palsy (PSP)
**rapidly progressive and fatal
management of autonomic dysreflexia (high BP) in spinal cord injury patients
- Look for urinary retention of bowel distention (triggered by insults below the level of injury)
- Treat with IV short-acting antihypertensive agent - sodium nitroprusside or labetalol
nondominant hemisphere in most people
right hemisphere
Stroke-
With eyes closed, touch left arm and can feel it. Then touch both arms and can only feel right.
Name for syndrome?
Lesion to what?
What side of brain?
Hemineglect syndrome
= lesion to parietal or frontal lobe of nondominant hemisphere (right)
Dominant Left = pays attention to right only
Non-Dominant Right = pays attention to both right & left (preferentially to left)
Thus: if non-dominant right is damaged –> the left brain will outweigh –> thus the right side of body will be preferenced
Most common comorbidity in hoarding disorder
Depression (NOT OCD!)
FDA approved drug for Lennox-Gastaut Syndrome
Felbamate
BARS scale
Barnes akathisia rating scales
Vagus nerve stimulator known to reduce what seizure type
Complex partial
Gabapentin anacarbil
= Gabapentin XR
take with FOOD!!!!
major active metabolite of Risperidone
Paliperidone
Painless transient loss of vision in one eye described as “curtain falling over eye” that only lasts a few seconds
Name + Etiology + Next step in diagnosis:
Amaurosis fugax - retinal ischemia secondary to small embolism in ophthalmic artery originating from carotid artery
technically a TIA*
**question hint may be carotid bruit on exam
–> Carotid duplex ultrasound
Location of synthesis of neurotransmitters:
- Serotonin:
- ACh:
- GABA:
- NE:
- Dopamine:
- Serotonin: raphe nucleus
- ACh: basal nucleus of Meynert
- GABA: nucleus accumbens
- NE: locus ceruleus, adrenal medulla
- Dopamine: substantia nigra
Man with recent flu vaccine presents with acute onset paraparesis and urinary incontinence. Symptoms began a week ago with progressive low back pain that led to bilateral leg weakness.
Transverse myelitis
**question stem may make you think of Guillain-Barre but think of this when there’s sensory level loss and bowel/bladder dysfunction after a URI or vaccine
- course = back pain –> leg weakness –> urinary incontinence
Reliability vs. Accuracy in diagnosis
Reliability = Precision = consistence = can apply across he board (doctors at diff locations would agree on the diagnosis)
Accuracy = Validity = how accurate = how true values are (the disorder has features that are characteristic enough to separate it from other disorders)
Term for when a diagnosis allows doctor to predict clinical course and treatment response (a test is able to predict a future outcome)
- Face validity
- Content validity
- Construct validity
- Convergent validity
- Predictive validity
Predictive validity
Term for when a diagnosis is based on underlying pathophys and the use of biologic markers to confirm the disease
- Face validity
- Content validity
- Construct validity
- Convergent validity
- Predictive validity
Construct validity
the extent to which a test assesses all the aspects of the condition it purports to assess
ex: a rating scale that doesn’t measure neurovegitative signs would have low ***** validity for assessing depression
- Face validity
- Content validity
- Construct validity
- Convergent validity
- Predictive validity
Content validity
The extent to which a test correlates with other tests for the same condition
Ex: New depression rating scale correlates highly with HAM-D scores, therefore has high *** validity
- Face validity
- Content validity
- Construct validity
- Convergent validity
- Predictive validity
Convergent validity
Child with horner syndrome in setting of cervical paravertebral mass
Neuroblastoma
Horner’s syndrome etiology
Lesion of thalamus or medulla, or common carotid
Prosopagnosia
inability to recognize familiar faces
Astereognosis
inability to recognize and identify items by weight, texture, and form alone when items are held in hand (a form of tactile agnosia)
a=without
stereo=solid, 3D, texture
gnosis=recognition/knowledge
Aprosodia
deficit in emotional aspect of expressive or receptive speech
Bells palsy vs stroke
Bells palsy = full face
Stroke = spares upper third of face (brow, eyelid, forehead)
35 yo presents with complaints of muscle weakness and sensory loss in upper extremities. MVC 7 yrs ago, sustained whiplash C spine injury. Moderate wasting of small hand muscles and impaired pain/temp in bilat UE. Light touch vibration position sense intact.
Central cord syndrome due to Syrinomyelia
- CSF drainage from central canal of spinal cord is disrupted –> fluid filled cavity compresses surrounding neural tissue
- most caused by Arnold-Chiari malformation
- classic is cape or shawl pattern sensory deficit of upper arms and trunk
- sensory deficits (pain and temp) + LMN signs (flaccidity, muscular atrophy, fasciculations)
Opsoclonus-myoclonus in an infant vs. an adult
Paraneoplastic movement disorder seen most often in infants 6-18 mos, 50% or more associated with neuroblastoma
“dancing eyes and dancing feet syndrome” (multifocal myoclonus and rapid dancing movements of the eyes)
In adults = lung cancer
Bells palsy vs. Ramsay-Hunt
Both facial droop involving forehead, ear pain, hearing abnormalities, but Ramsay-Hunt includes a rash in the ear
Ramsay-Hunt = VZV reactivation in sensory ganglion affecting facial (7) and acoustic (8) cranial nerves
Anton’s syndrome
Visual anosognosia = blindness without insight, patients often confabulate and refuse to believe they are blind.
Results from stroke or brain damage to occipital lobe
Riluzole MOA + indication
Glutamate antagonist
ALS
AIDS patient with CD4 of 50 presenting with gait instability, spasticity, leg weakness, sphincter dysfunction, loss of proprioception
Vacuolar myelopathy
- most common cause of spinal cord pathology in AIDS patients
- occurs in late-stage AIDS with low CD4 count
HIV, low CD4 count, visual symptoms, gait ataxia, asymmetric patchy non-enhancing white matter lesions
Progressive Multifocal Leukoencephalopathy (PML) - JC virus
HIV patient presenting with fevers, headaches, vomiting, papilledema, encapsulated yeasts on LP
Cryptococcal meningitis
- cryptococcus replicates in CNS –> clogs arachnoid villi –> CSF outflow obstruction –> increased ICP –> headaches, n/v, confusion, lateral gaze palsy, etc
HIV patient with floaters and blurry vision
CMV Retinitis
HIV patient with cognitive and personality changes
HSV encephalitis (affects temporal lobes)
HIV patient with gradual onset of incoordination, lack of attention and motivation, memory loss. MRI with white matter changes.
HIV dementia
- early symptoms of attention and concentration problems
- slowed thought (bradyphrenia)
- social withdrawal, apathy, depression, fatigue
–> can lead to gait incoordination, rigidity, slowed gait
***white matter changes! (diffuse increase in intensity of white matter)
Cervical myelopathy + Bilateral optic neuropathy
Neuromyelitis optica = Devic’s disease (variant of MS)
Kuru
prion disease affecting cannibalistic Fore people - manifests as progressive cerebellar ataxia
Triad of headache, ipsilateral Horner’s syndrome and contralateral hemiparesis
Carotid artery occlusion
– horner’s itself can cause headache
Vet presents with 4-week history of headache, vague fever, paresthesias in fingers and toes. Temp is 103.5 F. Complains of difficulty swallowing with pharyngeal spasms for the past 3 days.
Rabies!!!
- hydrophobia - fear of drinking due to pharyngeal spasms
Double vision, ptosis, difficulty swallowing, nausea, dry mouth. Had potato salad yesterday from home-canned potatoes
Botulism = Diplopia, Dysarthria, Dysphagia, Dyspnea, Urinary retention
Pure motor hemiparesis on same side of face and body
Lacunar infarct - contralateral face, arm, leg affected with motor symptoms (no sensory deficits usually)
= posterior limb of internal capsule!
Balint’s syndrome
Rare stroke from simultaneous lesions to bilateral parietal-occipital lobes
Leads to Ocular apraxia (inability to scan extrapersonal space), Optic ataxia (jerks that can impede vision), Simultanagnosia (inability to perceive a scene with multiple parts to it)
Ocular apraxia (inability to scan extrapersonal space), Optic ataxia (jerks that can impede vision), Simultanagnosia (inability to perceive a scene with multiple parts to it)
Balint’s syndrome
Is depression or schizophrenia a higher risk factor for completing suicide?
Depression
blepharospasm and oromandibular dystonia
Meige’s syndrome
blepharospasm = eyelid blinking
involuntary contraction of eyelids and lower facial muscles
Scanning speech
Ataxic speech - cerebellar lesion
(irregular, choppy speech)
Aphemia
near muteness with normal reading, writing, and comprehension
(a=without; phenia=phasia=voice=speech)
least anticholinergic TCA
Desipramine
Hoover’s sign
patient suspected of a hysterical or psychogenic hemiparesis does not give effort in the contralateral (unaffected) lower extremity when asked to lift the paretic (affected) lower extremity off the table
The examiner places a hand under the patient’s heel on the unaffected side to feel if the patient is pushing down toward the bed in an attempt to give a full effort at raising the affected leg. In a real hemiparesis, the patient would be expected to make every effort to brace himself with the unaffected leg while trying to raise the paretic leg.
Hoffman’s sign
equivalent of Babinski’s in the upper extremity
Tiagabine
selective GABA reuptake inhibitor for partial complex seizures
GABA type that benzos target
GABA-A
Head bruit
Hallmark of AVM
Mixed opioid agonist/antagonist
Buprenorphine
Hallervorden-Spatz syndrome
autosomal recessive neurodegenerative disease of childhood that presents with dementia and parkinsonism, caused by lesions to basal ganglia
dementia, dermatitis, diarrhea
triad for Pellagra (Vitamin B3 / Niacin deficiency)
Pimozide
dopamine antagonist approved for tics / tourette’s
(in europe, antipsychotic approved for schizophrenia)
treatment for atypical depression
NOT STANDARD TREATMENT!
–> MAOIs!
**Atypical depression shows excellent response to MAOIs compared to other meds
BPRS
Brief psychiatric rating scale - used for schizophrenia and psychosis
Antipsychotic that can cause retrograde ejaculation and impotence
Thioridazine
Donepezil MOA
Acetylcholinesterate inhibition
What neurotransmitters does ecstasy affect?
Dopamine and Serotonin
Kleine-Levin syndrome
rare disorder with hypersomnia interrupted by irritability, hyperorality, hypersexuality
other symptoms can include confusion, disorientation, incoherent speech, apathy, hallucinations, delusions, memory impairment
avg onset age 10-20, resolves by age 40
Relative contraindications to Amantadine
Renal disease, Seizure disorder
Defense mechanism associated with specific phobia
Repression
**spider bite as a kid leads to fear of spiders, despite repressing and not remembering the spider bite
Meds that can be useful for binge-eating (5)
1) SSRIs (Fluoxetine is the best!)
2) Topamax, Atomoxetine, Sibutramine, Duloxetine
Brodmann areas associated with language production and speech
Brodmann areas 44 & 45
Brodmann area 17
primary visual cortex
Brodmann area 4
primary motor cortex
Brodmann areas associated with the primary auditory cortex
Brodmann areas 41 & 42
Most common psychiatric comorbidity in narcissistic personality disorder
Anxiety disorders
Only MAOI that is specific to MAO-B
Selegiline
Recurrent brief attacks of vertigo that occur without warning and resolve spontaneously in otherwise healthy children
Diagnosis + age of onset
Benign paroxysmal vertigo of childhood (BPVC)
Age of onset is 3-4 years old
Spinal cord level that leads to autonomic dysreflexia
T6 or above
AUD remission timeline
Early remission = 3-12 months
Sustained remission = >12 months
**none of criteria met, SOBER and symptom FREE!
Tonic seizures:
- duration:
- occur during wakefulness or sleep?
- symmetry:
- extremity movement:
- duration: 5-20 seconds
- occur during wakefulness or sleep? sleep
- symmetry: symmetrical
- extremity movement: flexion OR extension
Criteria for intermittent explosive disorder:
- Verbal aggression (temper tantrums, arguments, fights) or physical aggression toward property, animals or other individuals occurring ___ x per week for at least ___ months.
OR
- __ episodes of aggression or outbursts that result in damage of property or others in a __-month period
- Verbal aggression (temper tantrums, arguments, fights) or physical aggression toward property, animals or other individuals occurring 2x per week for at least 3 months.
OR - 3 episodes of aggression or outbursts that result in damage of property or others in a 12-month period
Hydroxyzine MOA
Central & peripheral histamine H1 receptor antagonist
Minamata disease
Methylmercury intoxication or mercury-induced encephalitis
Atrophy of visual calcarine cortex and cerebellum
Mercury intoxication/encephalitis
- causes cerebellar ataxia, dysarthria, intention tremor, gaze nystagmus, dysmetria, dysdiadochokinesia
distinguishing factors between NMS and Serotonin Syndrome
Both present with: AMS, autonomic instability, diaphoresis, mutism, can have elevated CPK
Distinct to SS are: myoclonus, hyperreflexia, GI symptoms (diarrhea)
NMS presents with rigidity and slowed reflexes
Also - SS is abrupt onset, NMS is gradual
caudate head atrophy
Huntington’s disease
most common source of brain mets
Lung
subdural vs epidural hematoma shape
epidural can’t draw an S (lemon)
subdural could draw an S (banana)
ring-enhancing lesion on MRI (4 causes)
tuberculosis, lymphoma (HIV), toxoplasmosis (HIV), Nocardia
alexia without agraphia stroke / territory
left PCA (posterior cerebral artery) - affects posterior occipital lobe / corpus collosum
PTSD brain imaging finding
decreased hippocampal volume (unclear if that’s what predisposes individuals to developing PTSD vs if PTSD causes it)
Sphingomyelinase deficiency
Niemann-Pick disease
may initially present in adulthood with psychosis, and when psychosis is associated with a vertical supranuclear gaze palsy, various dyskinesias, and seizures, NPC should be suspected
most common cause of mental retardation
Fragile X > Down syndrome
chromosome 7q11 deletion
Williams’ syndrome
Elfin facies, short stature, mild MR, hypoplastic teeth, friendly personality, gifted musically
Williams’ syndrome (7q11 deletion)
mature defense mechanisms (5)
Altruism, Humor, Sublimation, Suppression, Anticipation
Do prodromal symptoms count toward the 6 months to meet criteria for schizophrenia?
Yes, to meet criteria, must have a 6-month period of active-phase symptoms (delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms), prodromal symptoms, or residual symptoms
Triptan MOA
Serotonin 5HT1B/1D agonist
Frovatriptan unique quality
not contraindicated in combo with MAOIs or SSRIs (like other triptans)
Triptans work by _______ cranial vessels, ______________ neuropeptide release, and reducing pain transmission in the __________ pathways
Triptans work by constricting cranial vessels, decreasing/inhibiting neuropeptide release, and reducing pain transmission in the trigeminal pathways
Priapism is a known side effects of what psych meds (5):
Trazodone, Antipsychotics, Prazosin, Stimulants, Strattera
Latuda MOA
Dopamine D2 and Serotonin 5HT2 antagonist
less histamine activity so less weight gain compared to other antipsychotics
Conduct disorder precursor and later manifestation
Precursor = often ODD
Later manifestation = Antisocial personality (after age 18)
Which antipsychotics can lower WBC (through bone marrow suppression)?
SGAs / Atypical antipsychotics
(Risperdal, Abilify, Zyprexa, Quetiapine, Clozapine)
- dones and -pines
elements of “evidence-based treatment practice” (3)
1) scientific/research evidence
2) Clinical expertise / expert opinion
3) Choices, values and goals of the patient
Reactive attachment disorder vs. Disinhibited social engagement disorder
RAD = fearful, untrusting, doesn’t seek comfort in others, minimal social/emotional response to others, irritable
DSED = friendly with strangers (disinhibited), lack of fear or caution, over-familiar, seek attention in strangers
antisocial personality disorder criteria:
- must occur prior to age ___
- must be at least age ___
- must occur prior to age 15 (evidence of conduct disorder prior to that age)
- must be at least age 18
Criteria for encopresis:
- Age must be ___ yo
- repeated passage of feces into inappropriate places, e.g., clothing or floor
- intentional or involuntary?
At least ___ such event must occur every month for at least ___ months
- Age must be at least 4 yo
- repeated passage of feces into inappropriate places, e.g., clothing or floor
- intentional or involuntary? EITHER!
At least 1 such event must occur every month for at least 3 months
Partial vs. Full remission in binge-eating disorder
Partial = binging less than 1x/week for a sustained period
Full = Not meeting criteria at all for a sustained period
core conditions of Carl Rogers’ client-centered therapy (3):
empathy, congruence/acceptance, unconditional positive regard
timeline to meet criteria for pica
at least 1 month
timeline for alcohol withdrawal:
8-12 hours: Tremulous, insomnia, anxiety, autonomic instability (diaphoresis, palpitations)
12-48 hours: Seizures (highest in 24-48 hours!!!), hallucinations
48-96 hours: Delirium tremens (fever, disorientation, SEVERE agitation, confusion, hallucinations) **emergency, treat with benzos!
unilateral complete loss of sensation
Contralateral thalamic stroke
**thalamus is the major relay for all sensory information
the “talk and die” syndrome, where there is a brief loss of consciousness followed by a period of lucidity then sudden deterioration
epidural hematoma
**vs subdural which is progressive, gradual increasing headache and confusion, often goes unrecognized in alcoholics with frequent falls
Older person with headache and sudden onset blindness in one eye. Recent complaints of fever, pelvic and shoulder girdle pain, weight loss, elevated ESR.
Temporal (giant cell) arteritis
+ Polymyalgia rheumatica
- usually elderly female
- can cause jaw claudication
- blindness due to ophthalmic artery occlusion
- due to focal granulomatous inflammation
- treated with steroids before temporal artery biopsy!
Sudden onset headache (“worst headache of my life”) with vomiting, collapse, photophobia, preserved consciousness. Some neck stiffness on exam.
subarachnoid hemorrhage
**often caused by aneurysm or AVM rupture
childhood brain tumor causing cerebellar symptoms
pilocytic astrocytoma (eosinophilic, corkscrew fibers) vs. medulloblastoma (rosettes, small blue cells)
PA is most common brain tumor in childhood, benign, good prognosis
MB is most common malignant brain tumor in kids, poor prognosis
neuroimaging findings in schizophrenia
- enlarged lateral & 3rd ventricles
- decreased metabolic activity / thinning of frontal lobes
Cause of hyperkalemic periodic paralysis
sodium channel mutation
most common risk factors for lacunar strokes (3)
HTN, diabetes, current tobacco smoking
Dandy-Walker malformation
fourth ventricle balloons out and cerebellum doesn’t develop
startle myoclonus
creutzfeldt-jakob disease
Kohut self-object terms:
- Mirroring
- Idealizing
- Twinship
- Mirroring – This is where the parent (usually the mother) would reflect back at the child a sense that he or she is worthy, loved and special. Praise, pride! Experience where the caregiver recognizes the child’s capabilities and talents and affirms the child’s feelings of strength.
- Idealiizing – Kohut believed that children need to idealize their caregiver and see them as powerful and knowledgeable. The child needs to feel as though they can turn to their caregiver to meet their needs and to help them make sense of their world. Their caregiver needed to be able to calm and reassure them. Children need someone whom they can admire and idealize and from whom to gain beliefs, values, aspirations, and strength. As the child feels connected to a powerful selfobject other, she develops a sense of self through the unconscious experience that says, “You’re powerful; you make me feel better. I’m connected to you; therefore, I’m powerful, too”
Twinship – Kohut believed that children need to feel they fit in with others. They have a need to be similar to their parents – not too different that they felt “wrong”. Children mimic behaviours or characteristics from their caregiver and gradually as the child matures, would be able to feel more comfortable with any differences. Example is shaving next to dad in the mirror.
Behavioral theory behind gambling
Operant conditioning
Location of TMS
Left dorsolateral prefrontal cortex
Indication for TMS
Failed benefit from one antidepressant at adequate dose/duration
contraindications to T3 for depression augmentation (3)
cardiac disease, angina, HTN
Only anxiety disorder with equal rates in men and women
VS
Mood disorder with equal rates in men and women
OCD
Bipolar disorder
term for
- when a diagnosis is based on a general consensus among experienced clinicians and researchers:
- when a diagnosis is based on an understanding of the underlying pathophysiology:
- when a diagnosis is based on characteristic features that distinguish it from other disorders:
- when a diagnosis is based on a general consensus among experienced clinicians and researchers: face validity
- when a diagnosis is based on an understanding of the underlying pathophysiology: construct validity
- when a diagnosis is based on characteristic features that distinguish it from other disorders: descriptive validity
conditioning type that exposure is based on
classical conditioning
extinction = no longer get conditioned response with unconditioned stimulus
extinction burst = sudden increase in response’s frequency
Psychotropics for intractable hiccups (3)
Thorazine, Perphenazie, Metoclopramide
Beck Anxiety Inventory primarily screens for what?
Panic disorder
Feeding centers of brain + functions + lesions + hormones
Lateral Hypothalamus = increases appetite via Ghrelin (makes you hunGGHREEE). Lesion of LH –> Less Hunger!
VentroMedial Hypothalamus = satiety via Leptin (makes you fuLLLLL). Lesion of VMH –> Very Much Hunger!
Sleep stages:
- “slow-wave sleep”
- K complexes
- high frequency beta
- slower alpha
- Delta
- Theta waves
- Sleep spindles
Stage 1: Theta waves
Stage 2: Sleep spindles, K complexes
Stage 3/4: “slow-wave sleep,” Delta
REM: Rapid eye movement
Awake: high frequency Beta, slower Alpha
Kohlberg
theory of moral development
Operant Conditioning principles:
- Reinforcement:
- Punishment:
- Positive:
- Negative:
- Reinforcement: response increases in frequency
- Punishment: response decreases in frequency
- Positive: introduce stimulus
- Negative: remove stimulus
Defense Mechanism:
“I can’t remember a time before the divorce”
- Repression
- Suppression
- Reaction Formation
- Projection
- Rationalization
- Displacement
- Sublimation
- Isolation of Affect
- Undoing
Repression = unconsciously remove idea/feeling from consciousness
Defense Mechanism:
“I don’t know what to think about it right now”
An olympic athlete focuses on training activities to put aside anxiety about upcoming competition
- Repression
- Suppression
- Reaction Formation
- Projection
- Rationalization
- Displacement
- Sublimation
- Isolation of Affect
- Undoing
Suppression = conscious repression
Defense Mechanism:
Using baby talk to give bad news
Going home when stressed so parents will do laundry and cook for you
- Repression
- Suppression
- Reaction Formation
- Projection
- Rationalization
- Displacement
- Sublimation
- Isolation of Affect
- Undoing
Regression = returning to earlier stage of development
Defense mechanism:
Fighting with someone you have a crush on
- Repression
- Suppression
- Reaction Formation
- Projection
- Rationalization
- Displacement
- Sublimation
- Isolation of Affect
- Undoing
Reaction Formation = unacceptable impulse transformed into the opposite
Defense Mechanism:
Man who cheated convinced of his wife cheating
- Repression
- Suppression
- Reaction Formation
- Projection
- Rationalization
- Displacement
- Sublimation
- Isolation of Affect
- Undoing
Projection = place wishes, thoughts, etc onto others
Defense Mechanism:
“I know cheating is wrong but my teacher didn’t teach us this”
- Repression
- Suppression
- Reaction Formation
- Projection
- Rationalization
- Displacement
- Sublimation
- Isolation of Affect
- Undoing
Rationalization = Justifying attitudes, beliefs, or behaviors
Defense Mechanism:
Taking anger out on dog or wife when mad at boss
- Repression
- Suppression
- Reaction Formation
- Projection
- Rationalization
- Displacement
- Sublimation
- Isolation of Affect
- Undoing
Displacement = changing target of emotion
Defense Mechanism:
Boss attracted to employee becomes her mentor
Putting anger into winning a tennis match
Instead of self-harming by cutting one’s wrist, using an ice cube instead to feel pain.
- Repression
- Suppression
- Reaction Formation
- Projection
- Rationalization
- Displacement
- Sublimation
- Isolation of Affect
- Undoing
Sublimation = channeling unacceptable impulse in a socially acceptable direction
Defense Mechanism:
Despite being devastated by his divorce, John said with a straight face that he had no feelings about having just been left by his wife.
- Repression
- Suppression
- Reaction Formation
- Projection
- Rationalization
- Displacement
- Sublimation
- Isolation of Affect
- Undoing
Isolation of Affect = Separating feelings from ideas and events. The ego represses the affect (emotion) but the thought remains conscious. The person seems devoid of feeling to others.
Defense Mechanism:
Jane stole merchandise at work and then gave a dollar to a homeless person on the street on her way home.
- Repression
- Suppression
- Reaction Formation
- Projection
- Rationalization
- Displacement
- Sublimation
- Isolation of Affect
- Undoing
Undoing = The ego’s chance at a “do-over.” The ego gets to reverse something it feels is unacceptable or uncomfortable.
Erikson Stage:
Age 0-18 mos
“Can I trust the world?”
Learning to trust, paying attention to environment
Trust vs. Mistrust
Erikson Stage:
Age 18 mos-3 years
“Can I do things myself or must I rely on others?”
Independence, learning to do things on own, encouragement builds you up and punishment breaks you down
Autonomy vs. Shame and Doubt
Erikson Stage:
Age 3-6 years
“Is it okay for me to do, move, act?”
Exploring and taking initiative to do things on your own, asserting one’s self to gain a sense of purpose
Initiative vs. Guilt
Erikson Stage:
Age 6-12 years
“How can I be good?”
Developing self-confidence through learning things, trying to meet social and academic demands to feel competent
Industry vs. Inferiority
Erikson Stage:
Age 12-18 years
“Who am I?”
Trying to discover who you are, trusted with more responsibility, treated like an adult at times and a kid at other times, developing a sense of self and identity
Identity vs. Role Confusion
Erikson Stage:
Age 19-40 years
“Can I love and be loved? What do others think of me?”
Relying on others and intimate relationships for support
Intimacy vs. Isolation
Erikson Stage:
Age 40-65 years
“What can I contribute to the world?”
Provide value to society through productivity and mentorship to others, feeling accomplishment or usefulness to others
Generativity vs. Stagnation
Erikson Stage:
Age 65+
“Was my life a good one?”
Reflection on life, providing wisdom and fulfillment vs bitterness and regret
Integrity vs. Despair
Mahler:
Continuation of intrauterine life, there is no difference between self and external world. No sight, sleeping all the time, always on mother.
Stage + Age?
Normal Autism
(birth to 2 mos)
Mahler:
Vaguely acknowledges the mother’s existence, not as a unique entity but as the main source of need-satisfaction. “Mutual cueing” & social smile.
Stage + Age?
Symbiosis
(2-5 mos)
Mahler:
Infant starts to “hatch” and begins to see self as separate from mother. Can be held by others, separation anxiety, crawling away & back.
Stage + Age?
Differentiation
(5-10 mos)
Mahler:
Increased exploration of the outer world, intent to separate as a distinct self. Walking away.
Stage + Age?
Practicing
(10-18 mos)
Mahler:
A balance b/w a desire to assert autonomy and independence as a separate object with a fear of abandonment with complete separation. Begin to see that good and bad can overlap. Toddlers saying no, no, no. “terrible twos” and temper tantrums.
Stage + Age?
Rapprochment
(18-24 mos)
Mahler:
Marks the development of an internalized mental model of the mother, which unconsciously accompanies and supports the child even when they are physically separated. Playing and knowing Mom will return.
Stage + Age?
Object Constancy
(2-3 yrs)
Piaget:
Acquires knowledge through sensory experiences and manipulating objects - through reflexes, sense, motor responses. Achieve objective permanence (things continue to exist when not seen).
Stage + Age?
Sensorimotor
(0-2 yrs)
Piaget:
Emergence of language, using words and pictures to represent objects with symbolic thought. Egocentric, struggles to see perspective of others. Concrete. Learn through pretend play.
Stage + Age?
Preoperational
(2-7 yrs)
Piaget:
Begin thinking more logically about concrete events (logical thought), achieve concept of conservation (amount of liquid in short wide cup equals tall skinny cup), less egocentric, realize their thoughts are their own
Stage + Age?
Concrete Operational
(7-11 yrs)
Piaget:
Abstract thought, hypothetical reasoning. Begin to think about moral, philosophical, ethical, social, political issues. Use deductive logic and scientific reasoning.
Stage + Age?
Formal Operational
(12 yrs+)
Ages for Freudian stages:
Oral
Anal
Phallic
Latency
Genital
Oral = 0-1 yrs
Anal = 1-3 yrs
Phallic = 3-5 yrs
Latency = 5 yrs until puberty
Genital = puberty to adulthood
Distinguish between simple partial and complex partial seizures
Both are “Focal” or “Partial” seizures
Simple = focal aware
Complex = focal unaware
Types of Generalized Seizures (compared to focus/partial):
(8)
~ Absence
~ Atonic (“drop attack”) - involuntary loss of muscle control
~ Tonic - spontaneous rigidity of muscles
~ Clonic - repetitive contractions (convulsions)
~ Generalized tonic-clonic - tonic following by clonic most common type!
~ Myoclonic - Brief non-rhythmic muscle spasms/jerks
~ Infantile spasms
~ Febrile
Developmental Milestone Age:
- cooing, social smile, holding head up 45 degrees, recognizes parent
2 months
Developmental Milestone Age:
- cooing, laughing, grasping, weight bearing on legs, rolling
4 months
Developmental Milestone Age:
- Imitating sounds, single syllables, transferring objects from hand to hand, sits up with support
6 months
Developmental Milestone Age:
- Babbling, playing peek-a-boo, waves bye-bye, sits up without support, army crawling or crawling
8 months
Developmental Milestone Age:
- Dada/Mama, Playing simple ball games, standing alone, walks holding on, thumb-finger pincer grasp
12 months
Developmental Milestone Age:
- 1-2 word vocabulary, indicating desires by pointing, walking, stoops and recovers
14/15 months
Developmental Milestone Age:
- 16 word vocabulary, able to feed self, walking well without any support
18 months
Developmental Milestone Age:
- Combining words, helping undress, running well, walks up stairs, kicks a ball
24 months
Developmental Milestone Age:
- knows full name, pretend play, taking clothes off, jumps off ground with both feet
30 months
Developmental Milestone Age:
- Riding a tricycle, standing on one foot, drawing a circle
36 months (3 years)
Developmental Milestone Age:
- Hopping on one foot, using scissors
48 months (4 years)
Developmental Milestone Age:
- Skipping, copying a triangle, counts to 10
60 months (5 years)
When do white matter tracks mature? Vs. white matter volume peaks?
Mature: age 30
Volume peaks: age 50
Most common defense mechanisms used in histrionic personality disorder
Repression, Dissociation
4 yo boy who has been jealous of siblings, increasingly competitive, ambitious about taking on the world. Has been searching for his purpose and role within the family. Erikson stage?
Initiative vs. Guilt
sleepwalking is most common in what age group
middle-age children (peaks at age 10)
Features that make retinal migraine unique:
- Unilateral vision disturbance
- Gradual onset
- +/- headache
Can involve scintillations, scotomata or blindness
psychiatric disorder with highest risk of violence
substance use disorders!!!!!!»_space;»» schizophrenia
what is the risk of tyramine-foods with MAOIs?
hypertensive crisis (HTN, neck stiffness, diaphoresis, n/v)
Seeing setbacks as a reflection of your core self. Rather than thinking, “I
made a mistake,” you think, “I’m a loser.” This distortion also occurs when
assessing others.
Essentializing (cognitive distortion term)
4 skill modules of DBT:
Acceptance = Mindfulness + Distress tolerance
Change = Emotion regulation + Interpersonal effectiveness
Indications for schema therapy
Borderline & Narcissistic personality disorder
Information from the environment is fit into existing schemas
“Toddler calls a horse a big dog”
Assimilation or Accommodation?
Assimilation
Accommodation would be being able to differentiate a horse from a dog based on learning distinguishing features
Prozac CYP enzyme
CYP2D6 inhibitor
Stage of sleep for sleepwalking
Stage 3
Psychotropics that are excreted unchanged in the urine (2)
Paliperidone, Gabapentin
Grapefruit juice CYP
CYP3A4 inhibitor
What should all patients be started on within 48 hours of stroke to reduce risk of stroke recurrence, disability & death?
Aspirin!
Most common anxiety disorder
Specific phobia! (we don’t think of it because regular people out in the world don’t see psychiatrists for it!)
Drug that reduces accumulation of plaques and disability in patients with MS?
Interferon B-1a
Who coined the term “epigenetic principle”?
Erikson
= human development occurs in sequential, clearly defined stages, and that each stage must be properly resolved for development to proceed normally.
Sudden onset symmetrical muscle weakness + elevated CK =
+ rash =
vs. Asymmetrical muscle weakness =
Sudden onset symmetrical muscle weakness + elevated CK = polymyositis
+ rash = dermatomyositis
vs. Gradual onset asymmetrical muscle weakness = Inclusion body myositis
Sadism vs Masochiasm
Sadism - hurting other is SAD
Masochism - like to hurt Myself
positive sharp waves and fibrillation potentials on EMG
ALS
adult brain tumor where seizure is a common presenting symptom
Glioblastoma multiforme
Treatment of abnormal involuntary movements in Huntington’s
Haldol - treats chorea
Involuntary gait acceleration
Festination (Parkinson’s)
Meningitis triad
Headache, fever, neck stiffness
% of sleep in REM
25%
Criteria for OCD
obsessions OR compulsions OR both
age of onset required for conduct disorder
prior to age 13
Latin terms to be found guilty of a crime (2)
Mens rea (evil intent) + Actus reus (voluntary conduct)
statistical measure used to quantify the degree of agreement between two raters in a study (how much two people agree)
Kappa
Tricuspid valve abnormality in fetus
Ebstein’s anomaly - Lithium
timeline required to meet criteria for panic disorder
1 month
Psychotropics excreted as changed drugs in feces
Abilify, Geodon
CYP1A2 inducers vs. inhibitors
+ what drugs it mainly affects
inducers = tobacco
inhibitors = fluvoxamine
Clozapine, Olanzapine
CYP2C9 inducer
+ what drug it mainly affects
St. John’s Wort
Valproic acid
CYP3A4 inducers vs. inhibitors
+ what drugs it mainly affects
inducers = carbamazepine, st. john’s wort
inhibitors = grapefruit juice, -onazoles
lots of SSRIs & antipsychotics & other psychotropics
Why to not combine Clozapine and Carbamazepine
risk of agranulocytosis
55 yo with multiple falls and dizziness. Dry mouth, dry skin, erectile dysfunction. Recent onset resting tremors. Diagnosed with diabetes 6 mos ago, controlled with diet. + orthostatic hypotension. Rigidity and bradykinesia on exam.
MSA (Multiple System Atrophy) / Shy-Drager Syndrome
= parkinsonism + cerebellar + corticospinal + autonomic dysfunction (postural hypotension, sweating, bowel/bladder incontinence, salivation/lacrimation, ED)
Malan’s Triangle of Conflict
Defenses, Anxiety, Feelings
Short-term Brief Psychodynamic Therapy model
Timeline for Agoraphobia
6 mos (like most other anxiety disorders)
Timeline for Separation Anxiety Disorder in a child
at least 1 month
Khyâl Attacks
“Wind attacks” = panic attacks in Cambodians
Parder-Willi chromosome
absence of paternal chromosome 15
Receptor that makes Clozapine unique
D4
Object permanence —> separation anxiety age
8 months (sensorimotor)
