BMB 3 - Miscellaneous Flashcards
Patients with ADHD have ___creased dopamine/norepinephrine in the ___________.
Patients with ADHD have decreased dopamine/norepinephrine in the striatum.
How do you manage patients during the transition time between psych medications (due to the required washout period)?
Cross titration
(a full washout will not work for a lot of patients)
If an individual has a list of specific worries, then what does this say about their anxiety?
It is likely specific social worries and not generalized anxiety disorder;
if they had episodic, sudden-onset bouts in particular situations, this would sound more like panic disorder
Which is more likely to progress to schizophrenia, schizoid disorder or schizotypal disorder?
Schizotypal disorder
True/False.
Antisocial personality disorder is almost always preceeded by conduct disorder.
True.
What is here described: an individual shows many attempts to engage with people due to her fear of abandonment. She is not avoidant and has a need for closeness; however, she ends up self-sabotaging her relationships because she cannot tolerate vulnerability.
Borderline personality disorder
A patient presents with mood symptoms and then becomes increasingly paranoid.
Is this schizoaffective disorder?
No, schizoaffective will present with psychosis FIRST
Where is GABA synthesized?
What is the rate-limiting enzyme?
The nucleus accumbens
Glutamate decarboxylase
Where is norepinephrine synthesized in the CNS?
What is the rate-limiting enzyme?
The locus coeruleus (pons)
Tyrosine hydroxylase
Where is serotonin synthesized?
What is the rate-limiting enzyme?
The raphe nucleus (medulla)
Tryptophan hydroxylase
For less than one month following an acute stressor, a patient presents with feelings of fear, hopelessness, and horror when reflecting on the event.
What is the diagnosis?
Acute stress disorder
For greater than one month following an acute stressor, a patient presents with feelings of fear, hopelessness, and horror when reflecting on the event.
What is the diagnosis?
PTSD
How is acute stress disorder managed?
CBT
How is PTSD managed?
CBT, SSRIs, venlafaxine, prazosin
What is here described?
Emotional S/Sy (depression/anxiety) that occur within 3 months of an identifiable psychosocial stressor (divorce, illness, flood) lasting < 6 months once the stressor has ended.
Adjustment disorder
(if S/Sy persist past 6 months, it is GAD.)
How is adjustment disorder managed?
CBT, SSRIs
GAD follows at least a ____-month timeframe.
GAD follows at least a 6 -month timeframe.
While adults need ____ presenting S/Sy to be diagnosed with GAD, children need only ____.
While adults need three presenting S/Sy to be diagnosed with GAD, children need only one.
What are the first-line treatments for GAD?
CBT, SSRIs, SNRIs
(Buspirone and benzos are second-line.)
Panic attacks involve ≥ ___ of the S/Sy of a panic attack plus at least ____ month of fear of future attacks, worry of the ramifications, or behavioral changes related to the attacks.
Panic attacks involve ≥ 4** of the S/Sy of a panic attack plus at least **1 month of fear of future attacks, worry of the ramifications, or behavioral changes related to the attacks.
How is panic disorder treated?
CBT, SSRIs, venlafaxine
(Benzos are second-line.)
For diagnosis, phobia disorders must last longer than _____ months.
For diagnosis, phobia disorders must last longer than 6 months.
Are there any disqualifiers to a diagnosis of an anxiety disorder in a patient?
Yes: another mental disorder, delirium, intoxication
(If pt has any of these, they do not have an anxiety disorder.)
True/False.
One can have a substance-induced anxiety disorder/
True.
n PTSD, the __________ fails to turn off the stress response, and the hippocampus might _____-consolidate memories associated with trauma.
n PTSD, the prefrontal cortex fails to turn off the stress response, and the hippocampus might over-consolidate memories associated with trauma.
Why are reactive attachment disoder and disinhibited social engagement disorder diagnosable at 9 months of age?
This is when an infant should be exhibiting separation anxiety and stranger weariness
A child from a difficult, neglectful home presents with disinhibition and an apparent ‘latching’ into strangers as if they were his caregivers.
What is the diagnosis?
Disinhibited social engagement disorder
A child from a difficult, neglectful home presents wit h no apparent desire or ability to bond with his caregivers.
What is the diagnosis?
Reactive attachment disorder
What does the mnemonic ‘PTSD is HARD’ indicate?
H: hyperarousal (2x of these S/Sy)
A: avoidance (1x of these S/Sy)
R: re-experiencing (1x of these S/Sy)
D: distress (2x of these S/Sy)
True/False.
Adjustment disorder only occurs due to non-life-threatening stressors.
True.
Name a partial opioid agonist used in treating opioid addiction.
Name a full opioid agonist used in treating opioid addiction.
Buprenorphine
Methadone
A patient has episodes of concurrent mania and depression.
What is this termed?
Mixed manic episode
What is the difference between a depressive episode and a major depressive episode?
The significance of duration and severity
Bipolar disorder is associated with a thinning of patient ______ matter.
Bipolar disorder is associated with a thinning of patient gray matter.
Manic episodes involve ≥ ____ of the DIG FAST criteria for ≥ ____ week.
Manic episodes involve ≥ 3** of the DIG FAST criteria for ≥ **1 week.
What is hypomania?
Manic symptoms for a shorter period of time and with no psychotic features
(impairment is typically less severe)
A 28-year-old female presents with more than one episode of mania.
What is the diagnosis?
Bipolar I
A patient presents with separate episodes of hypomania and depression.
What is the diagnosis?
Bipolar II
What does it mean if a patient’s bipolar disorder is rapid-cycling?
≥ 4 mood episodes (manic, hypomanic, mixed, major depressive) within 1 year (in any combination)
How is bipolar mania treated?
What if it has psychotic features?
Mood stabilizers
Add an atypical antipsychotic
Which mood stabilizers are used for acute mania?
What about bipolar mania and maintenance?
Lithium, valproate;
carbamazepine
In major depression, there is typically cortisol ______secretion and __creased glucocorticoid receptor expression.
In major depression, there is typically cortisol hypersecretion and decreased glucocorticoid receptor expression.
In PTSD, there is typically cortisol ______secretion and __creased glucocorticoid receptor expression.
In PTSD, there is typically cortisol hyposecretion and increased glucocorticoid receptor expression.
CB__ is the main endocannabinoid receptor in the CNS.
CB__ is the main endocannabinoid receptor in the immune system.
CB 1 is the main endocannabinoid receptor in the CNS.
CB 2 is the main endocannabinoid receptor in the immune system.
True/False.
CB1 and CB2 (endocannabinoid receptors) are GPCRs acting via Gi.
True.
Can we as physicians prescribe marijuana?
No, we can only recommend it.
Why do drugs like benzodiazepines cause withdrawal symptoms?
Due to altering of the GABA:glutamate balance (usually 1:1)
Which sleep aids should be avoided in treating the elderly?
Benzodiazepines
Z drugs
Antihistamines
