behavior and psych

Question 1

what criterion is the APGAR based off of

a score below what requires evaluation? what does the APGAR score relate about future childhood development

Answer 1

APGAR= NOT prognostic for future childhood developmental milestones

Question 2

what are the infant reflexes and when do they disappear

Answer 2

moro reflex = extension of limbs when startled

palmar reflex= grasping of objects in palm

babinski reflex

rooting reflex= nipple seeking when cheek is brushed

disappear within first year

Question 3

what is the finnegan scale

what are the criterion

Answer 3

assess neonates for the common signs and symptoms of neonatal drug withdrawal syndrome

CNS, respiratory, metabolic, and GI disturbances

-scare determines the severity of drug withdrawal sx and assesses the rsolution of sx after trx has begun

Question 4

how to neonates with intrauterine opioid intoxication present

• at birth
• day 2-3

treatment at birth vs long term trx

Answer 4

• at birth
  
  • respiratory depression, CNS depression, pinpoint pupuls
  • low birth weight, premature birth, intrauterine growth retardation syndrome
  • trx= naloxone
• day 2-3
  
  • opiate withdrawal= neonatal abstinence syndrome
  • tachycardia, dilated pupils, diaphoresis, sympa hyperactivity, diarrhea and vomiting, excessive crying and agitation
• long term trx= methadone to relieve the sx of withdrawal, eventually taper down to weane pt off

Question 5

• what are the four classic signs+sx of narcolepsy
• what type of hallucinations are associated with narcolepsy
• what kind of sleep does the patient immediately enter after a narcoleptic episode
• how can narcolepsy be treated

Answer 5

• cataplexy (sudden, transiety loss of M tone), sleep paralysis (inability to talk/move upon waking or falling asleep), hypnagogic hallucinations, excessive daytime sleepiness
• associated with hypnagogic hallucinations = occur before falling asleep (‘gogic =’go to sleep’)
  
  • vs hypnopompic hallucinations= occur during waking, can also be associated with narcolepsy
• REM sleep within 10 min of falling asleep
• trx=
  
  • CNS stimulants (methylphenidate amphetamine) for excessive daytime sleepiness
  • TCAs (clomipramine and imipramine) for cataplexy (sudden loss of M tone)
  • +lifestyle changes (reducing stress, increasing exercise, and taking frequent daytime naps)

Question 6

what EEG findings are associated with major depressive disorder

Answer 6

decreased REM latency and decreased stage 4, slow-wave sleep

-effective trx with antidepressants can reverse these findings

Question 7

what are the 5 stages of falling asleep, with the associated EEF waveforms

what drugs affect stage 4 sleep

what physiological changes occur in REM

Answer 7

• awake w eyes closed
  
  • alpha waves
• stage 1
  
  • light sleep = 5%
  • theta waves
• stage 2
  
  • deeper sleep (45%)
  • sleep spindles and K complexes
• stage 3-4
  
  • deepest, non-REM sleep (25%)
  • delta waves= lowest frequency, highest amplitude, slow wave sleep
  • stage 4: shortened by imipramine (TCA) and benzos –> trx enuresis and night terrors, respectively
• REM (25%)
  
  • dreaming, loss of motor tone
  • beta waves
  • inc in pulse rate and variability + REMs + inc BP with inc variability : penile/clitorial swelling/ vascular engorgement

Question 8

• at what stage of sleep does nocturnal enuresis occur
• by what age is nocturnal enuresis a problem
• what pharamcologic agent can treat the condition in older children

Answer 8

• stage 4 sleep, the deepest form of sleep that’s not REM
• girls can stop by 6 yo, and boys by 7 yo
• imipramine= a TCA –> trx for primary nocturnal enuresis
  
  • decreases the duration of stage 4 sleep

Question 9

what NT

• initiates sleep,
• promotes REM,
• reduces REM

Answer 9

• initiates sleep,
  
  • seretonin
• promotes REM,
  
  • Ach
• reduces REM
  
  • NE

Question 10

what are night terrors and what drugs are used to treat them

Answer 10

night terrors = abdrupt awakenings from sleep, often with gasping/screaming. afterwords, the pt goes back to sleep and has no memory of the event

benzos are used to treat night terrors, bc they shorten stage 4 sleep

Question 11

which antidepressant drugs …

• x the metabolism of NE and 5-HT
• x alpha-1 receptors on presynaptic noradrenergic receptors
• x NE reuptake
• x 5-HT reuptake
• work on Dopamine
• blocks H1 receptors
• is a 5-HT(1A) partial agonist
• is a nAchR partial agonist
• is a 5HT(1A) agonist and 5HT(2) antagonist

Answer 11

• x the metabolism of NE and 5-HT
  
  • MAO-inhibitors (MAO is in the pre-synaptic N and will breakdown the NE+5HT into metabolites
• x alpha-1 receptors on presynaptic noradrenergic receptors
  
  • mirtazapine
• x NE reuptake
  
  • TCAs, SNRIs, bupropion
• x 5-HT reuptake
  
  • TCA, SSRI, SNRI, trazodone
• work on Dopamine
  
  • MAO inhibitors and bupropion
• block H1 receptor
  
  • trazodone (also 5HT2, alpha adrenergic)
• is a 5-HT(1A) partial agonist
  
  • Vilazodone (+5HT reuptake inhib)
• is a nAchR partial agonist
  
  • varenicline
• is a 5HT(1A) agonist and 5HT(2) antagonist
  
  • vortioxetine

Question 12

the ____pathway connects the hypothalamus to the pituitary gland is responsible for the tonic inhibition of prolactin secretion

Answer 12

tuberoinfundibular

Question 13

differentiate between somatic symptom disorder, conversion disorder, factitious disorder

Answer 13

Question 14

what drugs are used to end the craving for alcohol

• what is the MOA

what drug ends the dopamine release from nicotine stimulation (end the reason for addiction)

Answer 14

naltrexone = mu opioid receptor antagonist

• inhibits rewarding and reinforcing effect

acamprosate= modulating glutamate

• modulate neurotransmission at the NMDA receptor

varenicline

• ends the dopamine release from nicotine stimulation (end the reason for addiction)

Question 15

what is the treatment with

• serotonin syndrome
• neuroleptic malignant syndrome
• drug-induced antiparkinsonianism
• akathisia
  *

Answer 15

• serotonin syndrome
  
  • Cyproheptadine: 5HT2 blocker
• neuroleptic malignant syndrome
  
  • Dantrolene: direct acting skeletal M relaxant
• drug-induced antiparkinsonianism
  
  • (caused be D2 block in nigrostiatal pathway via antipsychotics/antiemetics)
  • benztropine: anticholinergic agent
  • DONT USE levodopa– can exacerbate/precipitate psychosis
• akathisia
  
  • (subjective restlessn and inability to sit still rather than rigidity and tremor)
  • diazepam: benzodiazepine + propranolol: beta blocker

Question 16

define the defense mechanism ‘reaction formation’

Answer 16

Question 17

TCA’s cardiotoxic effects are due to action at which receptor

Answer 17

Question 18

what is the treatment for narcolepsy first line

Answer 18

narcolepsy = modafinil (nonamphetamine stimulant, probably at D-receptor)

amphetamines are second line

Question 19

what is the difference between brief psychotic disorder, schizophreniform disorder, schizophrenia

Answer 19

Question 20

differentiate between oppositional defiant disorder and disruptive mood dysregulation disorder

Answer 20

Question 21

• what stage of sleep do nightmares happen (describe the EEG findings of this stage)
• differentiate from night terrors

Answer 21

nightmares= REM

night terrors= stage 4 sleep

Question 22

who are the low potency and high potency first generation generation antipsychotics

MOA

and what are their adverse effects and trx of them

Answer 22

MOA= block D2 receptors in mesolimbic and striatofrontal systems

all 1st gen=

• highly lipophilic =slow to be removed from body
• prolactinemia (via adverse effect of blocking D in tubuloinfundibular pathway)
• metabolic syndrome = dyslipidemia, weight gain, hyperglycemia
• inc risk SEIZURES
• QT prolongation = torsades de pointes, sudden cardiac death
• neuroleptoc malignant syndrome (all drugs, but inc risk with high potency)
• Chlorpromazine= Corneal deposits: Thioridazine= reTinal deposits
• (M-block in low potency)anti-muscruinc : dry mouth, constipation >> others
• (H1 block in low potency) sedation
• (alpha-1 block in low potency) orthostatic hypotension and tachycardia

1st gen, high potency = characterized by EPS

“ADAPT” = order of EPS sx AD-A-P-T

• hrs: Acute Dystonia = M spasms and stiffness, oculogyric forced, sustained elevation of eyes
  
  • trx= benztropine, diphenhydramine
• days-wks: Akathisia= restlessness + inability to sit still + Parkinsonism
  
  • trx akathisia- beta-block, benztropine, benzopiazepine ::::: trx parkinsonian= benztropine, amantadine
• months-yrs: Tardaive Dyskinisia (chorea, esp orofacial= lip smacking, tongue protrusions, grimacing)
  
  • trx=atypical antipsychotics clozapine, valbenazine, deutetrabenazine

Question 23

what are the big three symptom types seen in Huntington vs Freidrich Ataxia

Answer 23

HD:

• chorea
• psychiatric sx
• subsequent dementia

Freidrich Ataxia:

• neurologic dysfunction
• cardiomyopathy
• diabeted mellitus

Question 24

what are the 4 mood stabilizers used in the treatment of bipolar ds and what are the AEs of each

-which of the above drugs can also be used as anticonvulsants

Answer 24

Valproate, carbamezapine, and lamotrigine are also anticonvulsants

Question 25

Answer 25

Question 26

Answer 26

Question 27

clozapine and olanzapine are both drugs in which class?? what AE are they both at high risk of causing, and how should patients on these meds be monitored

Answer 27

Question 28

which toxicities are the following antidotes used for: * physostigmine * flumazenil * naloxone * cycloheptadine * fomepizole

Answer 28

fomepizole= alcohol toxicity

Question 29

drugs and MOA used to treat opioid addiction

Answer 29

Question 30

what is the initial approach to parents who refuse to treatment for their family member (child, elderly parent..)

Answer 30

Question 31

describe the 3 types of neuropsych AEs that can be seen with chronic antupsychotic use

Answer 31

Question 32

what are the 4 dopaminergic pathways in the brain which ones are affected by antipsychotics, and to what effect

Answer 32

Question 33

what drug class is chlordiazepoxide

Answer 33

benzodiazepine

Question 34

Answer 34

Question 35

what are the 4 most characteristic physiologic signs seen with marijuana use

Answer 35

Question 36

which anti-convulsant drugs can be used or * partial/focal seizures * absence seizures * tonic-clonic seizures * status epilepticux

Answer 36

* partial/focal seizures * carbamezapine, * gabapentin, vigabatrin * lamotrigine, levetiracetam * phenobarbital, phenytoin, fosphenytoin * topiramate * valproic acid * absence seizures * ethosuximide * lamotrigine * valproic acid * tonic-clonic seizures * carbamezapine * lamotrigine and levetiracetam * phenobarbital and phenytoin+fosphenytoin * topiramate * valproic acid * status epilepticus * benzodiazepines * phenobarbital, phenytoin, fosphenytoin

Question 37

what drug is most effective for the trx of * acute status epilepticus * maintence + prophylactic trx of status epilepticus * trx of refractor status epilepticus

Answer 37

* acute status epilepticus = **benzodiazepine** * maintence + prophylactic trx of status epilepticus **= phenytoin** * trx of refractor status epilepticus **= phenobarbital**

Question 38

* what is the classic triad of autism * what association does autism have with mental retardation * what are three other, less pervasive developmental disorders that ought to be included in the ddx of autism

Answer 38

autism * **impairments in social interaction** (dec aware of social cues, failure to respond to name, inability to take turns) * **severe language deficits** (including echoing) * **repetitive and stereotyped patterns of behaviors** (including hand flapping, body rocking, or marked daily routines) * ~70% also are dx with mental retardation ddx of autism: * **Aspergers**: no cognitive or language delay = repeptiive behaviors and problems with social relationsips; stiff, monotonus speech and clumsy, w unusually intense interest in a narrow subject area * **Rett disorder**: genetic syndrome in girls = regression in dev at ~1 yo * **Childhood disintegrative disorder**: onset of developmental delays @ ~3yo

Question 39

define psychosis and list the three characteristic findings that define it

Answer 39

psychosis= distorted perception of reality 1. delusions: strongly held beliefs that are incongruent with reality 2. disorganized thought: demonstrated by disorganized speech 3. hallucinations: perception of a stimulus when there is not stimulus present (vs illusion= misperception of a present stimulus)

Question 40

the follow types of hallucinations are associated with what setting * visual * auditory * olfactory * tactile

Answer 40

* visual * medical illness (often in hospital) + drug intoxication * auditory * psychiatric illness * olfactory * aura associted with temporal lobe epilepsy + brain tumor * tactile * alcohol **withdrawal** or stimulant **intoxicity** (cocaine, amphetamines) * "cocaine crawlies"

Question 41

which antiepileptic drugs work by * blocking voltage gated Na channels * blocking SV2A * blocking voltage gated Ca channels * agonizing GABA(A) * antagonizing NT re-uptake * inhibiting the formation of siccininc semi-aldehyde (SSA)

Answer 41

* blocking voltage gated Na channels * --\> block release of glutamate * carbamezapine, (fos)phenytoin, lamotrigine, topiramate, valproic acid * blocking SV2A * block glutamate vesicle activation towards the membrane for glutatmate release * levetiracetam * blocking voltage gated Ca channels * block Ca influx--\> glutamate vesicle activation towards the membrane for glutatmate release * ethosuximide, gabapentin * agonizing GABA(A)-R * GABA(A)-R activation --\> Cl- influx --\> inhibit AMPA and NMDA receptor-influenced depolarization * benzos, phenobarbital, topiramate, propofol * antagonizing NT re-uptake * inhibit GABA reuptake receptor * tiagabine * inhibiting the formation of siccininc semi-aldehyde (SSA) * inhibit GABA transaminase = x(GABA--\>SSA) * valproic acid, vigabatrin

Question 42

what is the difference between OCD and obsessive-compulsive personality disorder

Answer 42

OCD= disorder involving obsessions and compulsions that are irresistable and unpleasant to the patient * egodystonic OCPD= patients have a rigid preoccupation with order and control, but they view their beliefs and behaviors as simply part of who they are egosyntonic

Question 43

what are the three clusters of personality disorders and what disorders fall into each cluster

Answer 43

**cluster A**: odd or eccentric, "weird" * paranoid PD * schizoid PD * schizotypal PD **cluster B:** dramatic, emotional, or erratic "wild" * antisocial PD * borderline PD * histrionic PD * narcissistic PD **cluster C:** anxious or fearful "worried" * avoidant PD * dependet PD * OCPD Weird, DramaW, Worried

Question 44

serotonin syndrome is highly associated with these drugs because their effects are irreversible

Answer 44

MAO-inhibitors

Question 45

Rett Syndrome - etiology - presentation + clin sx - trx+ prognosis

Answer 45

-etiology * X linked xMECP2 gene: methyl-binding protein in brain, gene suppressor during fetal and childhood development * affected males die in utero, only females are affected in life -presentation + clin sx * stage 1= 6-18mo * subtle delays in gross mototr skills, less eye contact, reduced interest in play * stage 2- 1-4 years * rapid loss of purposeful hand movements and loss of speech, with periods of apnea and hyperventilation * stage 3= 2-10 years * ataxia, motor problems, seizures * stage 4= reduced mobility, curvature of the spine (scoliosis), and M rigidity -trx+prognosis * allevaiting sx w careful management of nutrition, pharm for seizures, speech therapy, physical therapy * patients can live for decades with successful treatment

Question 46

* what drugs can induce a manic episode * what are the signs, sx, and lab findings in drug induce mania * trx

Answer 46

* cocaine, amphetamines, and corticosteriods MC associated with drug induced mania * sx: dilated pupils, HTN, mood elevation+general inc activity, tachycardia * ECG shows arrhythmia/ischemia: can order urine+serum toxicology to assess for drug * trx: lower dose of steroids: haloperidol, lorazepam: CCB for autonomic sx

Question 47

what risk factors increase risk of EPS sx with the use of anti-psychotics

Answer 47

DM hx of movement disorders tobacco use typical antipsychotics, at higher doses for longer times

Question 48

what is the treatment of tourrettes

Answer 48

in many cases: education and reassurance may be sufficient if tics are significantly interfering with social interactions * first line- guanfacine (alpha blocker)- * haloperidol, risperidone

Question 49

co-administration with what drugs can lead to lithium toxicity signs and sx of acute + chronic lithium toxicity

Answer 49

any drug that dec GFR : lithium build up

Question 50

serotonin is derived from which AA

Answer 50

tryptophan

Question 51

in patients with pre-disposed risk of having bipolar disease, what medication can precipitate a manic episode?

Answer 51

antidepressants

Question 52

which drug is the sedative-hypnotic that is proven to be safe in the elderly where in the CNS does it work

Answer 52

ramelteon suprachiasmatic nucleus, binds the melatonin receptors

Question 53

what PE findings are associated with anorexia nervosa.. differentiate between the fears and behaviors associated with anorexia vs bulimia

Answer 53

anorexia : low weight, amenorrhea, small hairs inc on arm, parotid gland swelling (if associated with vomiting)

Question 54

Answer 54

Question 55

differentiate between borderline personality disorder, dependent personality disorder, and histrionic personality disorder

Answer 55

Question 56

define classical vs operant conditioning

Answer 56

Question 57

what ways should you conduct a motivational interview with patients at the following stages of change * precontemplation * contemplation * preperation * action * maintenence * identification

Answer 57

Question 58

distribution of what drug can precipitate opioid withdrawal in a patient with opioid dependence

Answer 58

Question 59

what assessments can be done in the ED to assess for * orientation * comprehension * concentration * short term memory * long term memory * langiage * visual spatial * executive function

Answer 59