Behavioral Science Flashcards
use of alendronate sodium?
阿伦膦酸盐, block osteoclasts, 用于治疗骨质疏松
use of teriparatide?
特立帕肽, stimulate osteoblasts, 用于治疗骨质疏松
诊断精神病时measure的代谢产物：
Dopamine?
NE?
5-HT?
Dopamine: HVA (homovanilliac acid, 高香草酸） 记忆法：DA和HVA都以A结尾
NE： VMA（vanillylmandelic acid, 香草扁桃酸）
MHPG (3-methoxy-4 hydroxyphenylglycol； 3－甲氧基4－羟基苯乙二醇）
5-HT：5-HIAA (5-hydroxyindoleacetid acid； 5-羟(基)吲哚乙酸）
DA converted to NE的主要location?
locus ceruleus 蓝斑,脑桥色素核
serotonin/5-HT的前体？作用？localization?
derived from Tryptophan (5-HT: T = tryptamine)
controls mood, sleep, sexuality, impulse
elevated 5-HT: improved mood and sleep, decreased sexual function
过高导致psychotic symptoms
生成5-HT的神经元locate in the dorsal raphe nucleus in the upper pons and lower midbrain
anti-AD drugs? (FDA approved 5)
2 types:
- AchE blockers (to increase [Ach] ): donepezil (Aricept), rivastigmine (Exelon), galantine (Reminyl), tacrine (Cognex)
- NMDA-R antagonist: Memantine (Nemenda)
抗精神病药物引起sedation, increased appetite and weight gain最常见的机制是？
block histamine receptor
Ach异常implicated in which diseases?
Ach decrease: AD
glutamate异常implicated in which diseases?
Glut : AD and schizophrenia
serotonin异常？
5-HT decrease: 1) assaultive, impulsive, aggressive behavior ; 2) depression, 3) bulimia 神经性贪食
(measured by 5-HIAA)
NE异常？
NE decrease: depression (measured by VMA)
DA异常？
DA decrease: PD (measured by HVA)
DA increase: schizophrenia
amygdala responsible for?
- evaluate sensory stimuli to emotion;
i. e.: see photos taken in a difficult time - hateful feelings - in Kluver-Bucy sym (性格变得温顺，好吃，性欲增强）
anxiety中神经递质的变化？
↑ NE, ↓ GABA, ↓ 5-HT,
depression mostly associated with which region of the brain?
left front lobe
decreased impulse control, poor social behavior, lack of characteristic modesty: damage in which brain area?
orbitofrontal cortex
lesion results in disinhibition, inappropriate behavior, poor judgement
decreased executive functioning (motivation, concentration, attention)： lesion?
dorsolateral convexity of the frontal lobe
schizophrenia中神经递质的变化？
increased HVA (= increased DA)
Dx: intense abdominal pain + psychiatric symtoms (such as delusion) + purplish red urine?
porphyria
increased porphobilinogen in urine
If using Lithium (mood stabilizer), what should be monitored?
thyroid function + kidney function
- can develop hypothyroidism, occasionally hyperthyroidism
- narrow therapeutic window
Addison disease
hypocortisolism
physical Cx: skin hyper pigmentation, low BP, pain, fainting, hypoglycemia, diarrhea, vomitting
+ psychiatric sym: fatigue, depression, psychosis, confusion
porphyria: Cx?
abdominal cramping, diarrhea, vomiting, seizures, cardiac arrhythmia, flushing, “PURPLE/RED URINE” - caused by elevated porphobilinogen
paranoid delusion, hallucinations, depression, anxiety
计算IQ formule? normal range?
cut-off for retardation?
superior intelligence?
borderline?
IQ = MA/CA * 100 (mental age/chronological age)
normal range: 90-109
mean = 100, SD = 15
IQ < mean - 2 SD = 70: retardation
IQ > mean + 2 SD = 130: superior intelligence
71-84: borderline
Dx delusion vs. hallucination
delusion: false belief
hallucination： false perception
e.g.: pts complains that CIA is listening to her telephone - delusion
child has terrifying dream:
if cannot remember - happens at which sleep stage? Dx?
If can remember: which stage?
if cannot remember: delta wave stage (stage 3/4, 最深的睡眠相. most relaxed) - sleep terrors; 另外associated with episodic body movements, enuresis 尿床,
can remember - REM (most active phase) - can awake and relate the nature of the dreams ; + erection, paralysis of skeletal muscles, increased brain O2 use
neurotransmitter changes in psychiatric disorders:
- anxiety?
- sleeping disorders?
- anxiety: NE ↑, 5-HT ↓, GABA ↓
Dx: anti-anxiety agents
3大类：
- BZ: benzodiazepine 苯(并)二氮卓， chlordiazepoxide
fast acting, but high risk for dependence/addition, likely to be abused - only used for a limited time for acute sym, 比如戒酒病人在刚刚开始戒酒的初期阶段
- buspirone (BuSpar): 丁螺环酮
与苯(并)二氮卓正相反：low abuse potential, but slow action (take 2 weeks to become effective): long term maintain for GAD, but little immediate effect - b-blocker: control ANS sym (tachycardia)
most effective long-term management for PTSD?
for OCD (obsessive - compulsive disorder)?
PTSD: support group!！！ (pharmacological treatment is an adjunct)
for OCD: anti-depressents, particularly a selective serotonin reuptake inhibitor (SSRI) such as fluvoxamine (Luvox) or a heterocyclic agent such as clomipramine.
what is “cohort study”?
2组人，然后一组exposed to a risk factor (or treatment), 一组没有。比较结果差异，是prospective的比较。特例就是clinic treatment trial
Absolute, relative, and attributable risks are calculated for cohort studies
what is “case-control study”?
2组人，一组有specific case/disease, 一组没有。然后追述生病前的history
An example of a case-control study would be one in which the smoking histories of women with and without breast cancer are compared
The odds ratio is calculated for case-control studies.
major drawback of MAOI?
potential fatal reaction from interaction of certain food/medication - noradrenergic/hypertensive crisis - lead to stroke or even death)
MAO metablize tyramine 酪胺 in the GI; 用MAOI的抑郁病人如果吃了含tyramine的食物（cheese, beer）或者用拟交感药物，会引起tyramine升高 - 导致高血压危象
代表药物：’tranylcypromine 反苯环丙胺
serotonin syn: cause? Cx? how to prevent?
fatal, caused by 1) MAOI + serotonergic analgesic, or 2) MAOI + SNRIs or HCA
needs WASHOUT periods when giving depressed pt. the combination of these drugs: 2 weeks for HCA, 5 wks for SNRIs
calculate sensitivity?
specificity?
sensitivity = TP / (TP + FN)
specificity = TN (TN + FP); = TN / all people without the disease. should be high to ↓ false positives
Dx: antipsychotic side effect, involuntary movements including chewing and lip-smacking?
tardive dyskinesia 发性运动障碍,
Tardive dyskinesia usually occurs after at least 6 months of starting a high-potency antipsychotic (haloperidol),
and is best treated by changing to a low-potency (thioridazine) or atypical agent (clozapine, risperidone) ; stopping the antipsychotic medication will exacerbate the symptoms.
bipolar: acute manic episode: immediate management? long-term management?
immediate management: high-potency, fast acting antipsythotic agents, such as haloperidol
long-term management: lithium
抑郁症病人不想gain weight, 该用什么antidepressant?
Fluoxetine (SSRI): 抗抑郁同时会减重
最易引起priapism (consistent erection) 和extreme sedation的抗抑郁药？
trazodone 三唑酮
最易引起心脏症状（sinus tachycardia, flat T wave, prolonged QT intervals, depressed ST)的抗抑郁药？
TCAs, e.g.: imipramine 米帕明,丙咪嗪
服用fluoxetine抗抑郁的病人最容易出现的sexual dysfunction是什么？caused by what change in neurotransmitter?
delayed orgasm - caused by ↑ 5-HT
not secondary ED :
fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) are more likely to cause delayed or absent orgasm (orgasmic disorder). That is why the SSRIs are useful in managing premature ejaculation.
effects of neurotransmitters on aggression:
aggression facilitated by? inhibited by?
5-HT, GABA: ↓ aggression
DA, NE: ↑ aggression
effects of heroin, cocaine, amphetamines, and PCP (phencyclidine 苯环利定) on aggression?
heroin: little affect on aggression
cocaine, Amph, PCP all increase aggression
calculate relative risk?
attributable risk?
relative risk (fold increase), 除法 = incidence rate with a factor (i.e., smoking)/ incidence rate without the factor
attributable risk （做减法）= the incidence rate of the illness in exposed individuals - the incidence rate of the illness in those who have not been exposed to a risk factor.
how to calculate NNT (numbers needed treat)?
NNT = numbers of people needed to be treated for 1 person to be benefited
NNT = 1 / (absolute risk in control - absolute risk in treatment)
CSF change in narcolepsy?
↓ Hypocretin-1 (orexin-A)
produced only on the neurons in lateral hypothalamus; it promotes wakefulness and inhibits REM sleep-related phenomena.
Differential Dx:
Brief psychotic disorder, schizophreniform disorder, vs. schizophrenia?
时间长短从短到长：
Brief psychotic disorder：psychotic episodes last ≤ 1 m, + develop in direct response to psychological stress
schizophreniform disorder: 1 - 6 months (30 ~ 50% pt will not develop schizophrenia)
schizophrenia: > 6 mo
criteria for schizophrenia?
2 or more syn active f> 6 mo:
- positive syn: HDD (delusion, hallucinations, disorganized speech)
- disorganized behavior
- negative syms: flat affect, social withdrawal, lack of motivation, lack of speech or thoughts
if sym duration is < 1 m: brief psychotic disorder (stress related)
1-6 mo: Dx schizophreniform disorder
Dx: if at least 2 wks of stable mood + psychotic sym + a major depressive or manic, or both, episode
2 subtypes: 1) bipolar; 2) depressive
difference between suppression vs. repression as defense mechanism?
suppression: intentionally withhold distressing unconscious material - mature defense
repression: unconscious removal of disturbing psychological material from conscious awareness
white-coat sym is what kind of physiological phenomena?
classical conditioning:
pair an unconditioned stimulus with a 2nd, neutral (conditioned) stimulus to elicit a response
In the white coat sym: white-coat-wearing doctor is the unconditioned stimulus, white coat is the conditioned stimulus; fear is the response
Define: rationalization
an immature ego defense mechanism - one invents logical reasons to explain actions actually performed for other reasons (to avoid self-blame)
reaction formation
redirection of an unacceptable impulse into its opposite
e.g.: a recovering alcoholic rallies to ban alcohol sale;
a man who is angry at his wife but instead compliments her on her dress
2 immediate physiological symptoms for marijuana use?
rapid heart rate, conjuctival injection
if see miosis: suspect which substance abuse?
opiate
if see bradycardia + respiratory depression: suspect which substance abuse?
GHB (gamma hydroxybutyric acid γ-羟基丁酸), opiate, benzodiazepine
all 3 are CNS depressants
if see nystagmus and ataxia: suspect which substance abuse?
PCP
define “splitting” as the defense mechanism
an immature defense mechanism frequently employed by pts with borderline disorder where people, events or actions are either all good or all bad
e.g.: a woman thinks her BF as “the love of her life” until they had an argument, and now she thinks he is the “worst human on earth”
define “projection” as the defense mechanism
an immature defense mechanism where unacceptable or personally disagreeable impulses or drives are attributed to others
e.g.: a homosexual accuses men around him of being gay
which drugs is currently responsible for the majority of overdose-related death in the US?
opioid pain relievers
比cocaine + heroin还多
BZ used in which diseases?
short -acting BZ (< 6hr)? intermediate (6 - 24 hrs)? long acting (> 24 hrs)?
BZ used in anxiety, insomnia, acute seizures, alcohol withdrawal
short-acting: Triazolam (T = transient)
intermediate: Lorazepam
long acting: CDF (chlordiazepoxide, diazepam, flurazepam)
hallmark for generalized anxiety disorder?
Dx?
excessive worry over several different issues > 6 months
Dx: antidepressants (certain SSRIs including paroxetine, sertraline), Buspirone, venlafaxine) and BZ (for short-term use)
define “beta error”
a conclusion that there is no differennce between the groups studied when a difference truly exists
define “recall bias”
results from the inaccurate recall of past exposure by subjects. It applies to mostly to case-control studies
measures calculated for cohort study?
for case-control study?
cohort study: people are followed over time for developing a disease (从受试开始看）：
measures: absolute, relative (incidence fold change), attributive (incidence做减法） risks
Case-control study: people with or without the disease are asked about PREVIOUS exposure to the variable
measure: odds ratio
calculate ARP (attributable risk percent)?
= (risk in exposed - risk in unexposed)/risk in exposed = (RR-1)/RR
e.g.: cohort study reveals that smokers have 5 times more risk of carcinoma compared to non-smokers. what percentage of carcinoma in smokers can be attributed to smoking? ARP = (5-1)/5 = 80%
which will be influenced by prevalence:
sensitivity, specificity, positive/negative predictive value?
positive/negative predictive value
positive predictive value = TP/ # of subject testing positive for a test
Hawthorne effect
the tendency of a study population to affect the outcome due the knowledge of being studied
ie: a research to study how often PCPs take the sexual histories of their patients - the PCPs become aware of the the study
In normal/bell-shaped distribution:
percentage within 1 S.D.? 2 S.D.? 3 S.D?
68%, 95%, 99.7%
how to measure reliability?
reliability = reproducibility
measure by “CV” (coefficient of variation） = S.D./mean
how to calculate # needed to treat (NNT)? and number needed to harm (NNH)?
NNT = 1/ARR (absolutely risk reduction) = 1/ (sick/total placebo - sick/total treated)
NNH = 1/ attributable risk = 1/ (sick/total treated - sick/total placebo)
what is “power of a study”?
power = 1 - beta (beta: type II error, i.e.: stating there is no difference when one truly exists); this is the probability of rejecting the null hypothesis when it is truly false
calculate 95% CI? 99% CI?
95% CI = mean ⍏ 1.96 * SD/ √n
SEM (standard error of the mean) = SD/ √n
99% CI = mean ⍏ 2.58 * SD/ √n
Rx: 什么情况考虑用phenelzine， or tranylcypromine
phenelzine : 苯乙肼
tranylcypromine: 反苯环丙胺
MAOI （抗抑郁）, 因为太多副作用和drug interaction已经很少用；但在atypical depression, or when the usual 1st-line medications没用时。
Atypical depression特征？和typical depression有什么区别？
- mood reactivity (will improve to sth positive) - most important Dx with typical depression
- laeden fatigue
3) rejection sensitivity
4) increased sleep and appetite
note:
- no auditory hallucination, delusion of persecution (虐待幻想），- 精神分裂的特征
- agoraphobia (旷野恐怖) - anxiety 特征
- suicidal ideation - major depression特征，但不常见于atypical depression
Rett disorder: 什么疾病？遗传特征？发病年龄？
pervasive developmental disorders 全身性发育迟缓 （另一种是autism)
X-linked, hit girls 100% (males die in utero)
1-4岁起病，regression in development, loss of verbal abilities, intellectual disability, ataxia, stereotyped handwringing 搓手(焦虑状)
neurotransmitter change in depression?
↓ NE, ↓ DA, ↓ 5-HT, [抑郁起来什么都下降】
neurotransmitter change in AD?
↓ Ach
neurotransmitter change in HD?
↑ DA, ↓ Ach, ↓ GABA
neurotransmitter change in PD
↓ DA, ↑ Ach, ↑ 5-HT
neurotransmitter change in schizophrenia?
↑ DA
orientation: order of loss
时空人
1st -time
2nd - place.
3rd - person
Define: Korsakoff amnesia:
anterograde or retro?
cause?
affected structure?
anterograde,
thiamine deficiency
mammillary bodies
cognitive disorder分类？鉴别？
- delirium: rapid onset, hallucination (often visual), usually secondary; abnormal EEG; Rx with antipsychotics (mainly by haloperidol)
- dementia: gradual onset, memory deficits, usually primary, could be secondary [NPH, VB12 deficiency, hypothyroidism, neurosyphilis, HIV]
normal EEG;
psychosis3大特征？
HDD: hallucination, delusion, disorganized speech
visual vs. auditory hallucination: which is MC in medical illness, which is MC in psychiatric illness?
visual hallucination is MC in medical illness,
auditory hallucination is MC in psychiatric illness
tactile hallucination常见于什么情况？
alcohol withdrawal, cocaine abusers
Dx delusional disorder需要时长？is functioning impaired?
Dx delusional disorder需要时长: > 1 month
is functioning impaired - No
Dissociative disorders分类？
- dissociative identity disorder： = former “multiple personality disorder”
- depersonalization / derealization disorder
Dx manic episode需要时长? Cx?
和hypomanic episode鉴别？
躁狂性发作
> 1 wk
Cx: at least 3 of “DIG FAST”
hypomanic episode： > 4 days
Major depressive disorder:
Dx所需时长？症状？
6 - 12 months
at least 5 of 9 sym (SIDGE CAPS) for > 2 wks
Panic disorder:
Dx? Rx?
Dx:
1. recurrent panic attack peaking in 10 min +
- 4 out of “PANICS” (13条症状）:
- P2: palpitation; paresthesias 感觉异常的
- Abdominal distress
- Nausea
- I2: Intense fear of dying or losing control, lIght-headedness
- C4: chest pain, chills, choking, disConnectedness,
- S3: sweating, shaking, shortness of breath, - attack followed by 1 month (or more) of > 1 of the following:
1) persistant concern of additional attack
2) worry the consequences of the attack
3) behavioral changes related to the attack
Rx:
1) cognitive behavioral therapy
2) SSRIs
3) venlafaxine 文拉法辛
4) BZDs (risk of tolerance, physical dependence)
Generalized anxiety disorder:
Dx所需时长？Rx?
> 6 months
Rx:
1) SSRIs,
2) SNRIs
3) buspirone
4) behavioral therapy
adjustment disorder诊断要点？
- identifiable psychosocial stressors
- emotional sym causing impairment
- < 6 m (if chronic stressor, > 6 m)
Obsessive-compulsive disorder: Cx?
associated with?
Rx?
Association: Tourette disorder
Rx:
1) SSRIs
2) clomipramine 氯米帕明,海地芬,安拿芬尼[抗抑郁药]
PTSD: 时长？小于这个时长但出现症状-诊断？
> 1 m
(if 3 d - 1 m): acute stress disorder
Dx: 装病，述求是primary goal (internal) or secondary goal (external)?
primary goal (internal): - factitious disorder 造作性精神病
secondary goal (external) - malingering 装病
somatic symtoms and related disorders: 特征？
illness production and motivation are UNCONSICOUS DRIVE
Personality disorders分类？代表？
Clusters A, B, C: Weird, Wild, Worried
- Clusters A (Weird: Accusatory, Aloof, Awkward)
1) paranoid
2) schizoid: 分裂性人格者 d = distant
3) schizotypal: t = magical thinking - Cluster B:
1) antisocial (“conduct disorder if < 18)
2) borderline
3) histrionic
4) narcissistic - Cluster C: Worried
1) Cowardly: Avoidant (vs. schizoid)
2) obsessive-compulsive
3) dependent
In anorexia nervosa:
↓ BMI to which extent? Associated with?
Over time, 常见一个什么症状？
↓ BMI to < 17 kg/m2
Associated with ↓ bone density
Over time, 常见一个什么症状: osteoporosis (cause by ↓ E2)
Diff: sleep terror disorder vs. nightmares?
发生在睡眠哪一相？有无记忆？
sleep terror disorder： slow-wave, non-REM sleep, no memory of arousal
nightmares: during REM, + memory
narcolepsy: cause?
association?
Rx?
[‘nɑ:kәlepsi]
n. 嗜眠发作
cause: ↓ orexin in the lateral hypothalamus; strong genetic
cataplexy: 猝倒
Rx: daytime stimulants (amphetamines, modafinil) + nighttime sodium oxybate (GHB) 羟基丁酸钠
Alcohol:
intoxication最敏感的指标？
Lab AST和ALT哪个高？
withdrawal最危险的问题？Rx?
intoxication最敏感的指标: serum GGT
Lab AST和ALT哪个高: AST > ALT
withdrawal最危险的问题: DT (delirium tremens 震颤性谵妄)
Rx: BDZs
Opioids (morphine, heroin, methadone):
intoxication特征？ Rx?
withdrawal特征？ Rx?
intoxication特征: pinpoint pupils, ↓ gag reflex, seizures,
Rx：naloxone, naltexone
withdrawal特征: dilated pupil, piloerection (立毛,竖毛, “cold turkey)
Rx:
1) long-term support,
2) methadone (本身就是一个鸦片肽，长效合成的鸦片受体激动剂，高浓度时抑制euphoria, 所以用于长期控制opioids dependence)
3) buprenorphine 叔丁啡
Buprenorphine is an opioid, a semi-synthetic derivative of thebaine. It is a mixed agonist–antagonist opioid receptor modulator that is used to treat opioid addiction in higher dosages, to control moderate acute pain in non-opioid-tolerant individuals in lower dosages and to control moderate chronic pain in even smaller doses
Barbiturates:
intoxication特征？ Rx?
withdrawal特征？ Rx?
intoxication特征: 对呼吸和心跳的抑制很强，不安全
Rx： 对症
withdrawal特征：cardiovascular collapse
Benzodiazepines:
intoxication特征？ Rx?
withdrawal特征？ Rx?
intoxication特征: 对呼吸和心跳的抑制较弱（比barbiturates安全）
Rx： 对症 + flumazenil (BZD antagonist)
withdrawal特征：flumazenil can trigger seizure
Amphetamines:
intoxication特征？
withdrawal特征？
intoxication特征: pupillary dilation, cardiac arrest, seizure
withdrawal特征: anhedonia, 快感缺失,
cocaine:
intoxication特征？ Rx?
withdrawal特征？
intoxication特征: hallucinations (tactile, 蚁爬感）pupillary dilation, sudden cardiac death
Rx: BZDs
withdrawal特征: severe psychological craving, depression/ suicidality
PCP: 全名？
intoxication特征？ Rx?
withdrawal特征？
Phencyclidine: 苯环己哌啶[hallucinogen, 镇痛药,静脉麻醉药]
intoxication特征：精神病症状，杀人倾向
Rx：BZDs, 快速起效抗精神病药
withdrawal特征： depression, anxiety, 失眠~~~~
LSD: 全名？
intoxication特征？
lysergic acid diethyl amide, [抗精神失常药], hallucinogen
intoxication特征: depersonalization, visual or auditory distortion
canabinoid
intoxication特征？ 医用包括哪些form?
withdrawal特征？peak和延续时间？在尿里多长时间还能检测到？
marijuana, 大麻素
intoxication特征: dry mouth, conjunctival injection, 感觉时间变慢， hallucination
医用包括哪些forms:
dronabinol 屈大麻酚(化疗里的镇吐药），AIDS病人加强食欲
withdrawal特征
Heroin addiction的治疗？
- methadone
- naloxone + buprenorphine
- naltexone 环丙甲羟二羟吗啡酮[吗啡拮抗剂]
Alcoholism Rx药物？
associated的2大病？
Disulfiram 双硫仑,[治疗慢性酒精中毒药]
- Wernicke-Korsakoff syn
- Mallory-Weiss syn
