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CL Flashcards

1
Q

Shared care

A

Degree of collaboration does not predict outcome.

INTENSITY OF FOLLOW-UP does!

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2
Q

Which antidepressant for HIV depression?

A

CELEXA
CIPRALEX

Frequent response to sub therapeutic doses

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3
Q

Major NCD due to HIV

A

SUBCORTICAL
Affects 10% of HIV patients
CD4 < 200 = risk factor

SEIZURES ARE NOT AN EARLY COMPLICATION

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4
Q

Neurosyphilis

A

First manifestation is MENINGITIS

Tremors
Dysarthria
HYPOreflexia

ARGILL ROBERTSON PUPILS (accommodate to object but don’t react to light)

Affects FRONTAL LOBE, progresses to dementia

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5
Q

SLE

A

Most frequent presentation is DEPRESSION

Anti-nuclear antibodies
Malar rash
Pericardial/pleural effusif
Splenomegaly/hepatomegaly
Lymphadenopathy
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6
Q

Psychiatric illness associated with EXOGENOUS steroids?

A

MANIA

ANXIETY

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7
Q

Psychiatric illness associated with ENDOGENOUS steroids?

A

(Cushing)

DEPRESSION

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8
Q

Psychological factors affecting other medical conditions

A

One of the following ways:

  1. Factors have influenced the course of the medical condition as shown by close temporal association between the psychological factors and the development or exacerbation of the medical condition.
  2. The factors interfere with the treatment of the medical condition (ex: poor adherence).
  3. The factors constitute additional well-established health risks for the individual (ex: using insulin to lose weight in diabetic patient).
  4. The factors influence the underlying pathophysiology precipitating or exacerbating symptoms or necessitating medical attention (ex: anxiety exacerbating asthma).

Example of severe: ignoring heart attack symptoms

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9
Q

What psychiatric manifestation most commonly associated with IBD?

A

ALEXITHYMIA

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10
Q

HYPOthyroidism

A

Most common manifestation = COGNITIVE DEFICITS
Also = depression, anxiety, rapid cycling

MYXEDEMA MADNESS (psychosis)

Can be caused by:
Lithium
Interferon
Amiodarone

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11
Q

HYPERthyroidism

A

Most common manifestation = DEPRESSION

Also = anxiety, cognitive, mania, psychosis

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12
Q

HYPERparathyroidism

A

HYPERcalcemia (correlates with symptom severity)
Most frequent presentation = DEPRESSION, anergia
Caused by Lithium

Symptoms:
abdominal pain
constipation
renal stone
fatigue
confusion
PROXIMAL muscle weakness

(Stones, bones, groans and psychic overtones)

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13
Q

Which medical condition has highest risk of MDE?

A

CANCER

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14
Q

Physical manifestation of increased ICP?

A

Cushing’s triad

BRADYCARDIA
High systolic BP
Irregular respirations

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15
Q

Psychological reactions to cardiac events?

A

1-2 days denial

4-5 days hostile-dependent

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16
Q

Vitamin B12 deficiency

A

Most frequent presentation = ANXIETY, COGNITIVE

Hyporeflexia
Glossitis
Spasticity
\+ Babinski
BLINDNESS FOR BLUE AND YELLOW
Decreased smell & taste
Hyperpigmented nails

(LEMON SKIN, SHINY TONGUE, SLUGGISH)

May be caused by
PPI
methotrexate
metformin

B12 needed to regenerate folate in body

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17
Q

Which medication has no link with MDD?

A

B-BLOCKER

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18
Q

Sydenham chorea

A

Also group A strep

RHEUMATIC FEVER

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19
Q

Which stroke causes OCD?

A

BASAL GANGLIA

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20
Q

Which AD post-MI?

A

SERTRALINE

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21
Q

Treatment depression post-TBI?

A

Sertraline

FLAME trial with Prozac

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22
Q

Most common psychiatric illness post-TBI

A

Depression
No association with severity

Risk factors:
Left front and left basal ganglia lesions
Dysphoria at 1 week
Past depression

(according to K&S)

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23
Q

Wilson’s disease

A

Autosomal recessive
Carrier rate = 1%

Increased copper in CSF AND URINE
Decreased ceruloplasmin in serum

Presents as LIVER DISEASE IN YOUNG (10-40yo)
Other manifestations = psychosis, personality changes, movement disorder

Dystonic vs. pseudosclerotic forms

KAISER FLEISCHER RINGS

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24
Q

Tumor in which brain regions cause most psychiatric symptoms?

A

FRONTAL or LIMBIC> parietal or temporal

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25
Q

Epilepsy

A

Most clearly associated with PSYCHOSIS (7-12%)
and personality change (according to K&S)

30-50% have psychiatric difficulties

Suicide risk 5x higher and up to 25x higher if temporal epilepsy!!

GESCHWIND SYNDROME (personality changes with temporal epilepsy):

religiosity
viscosity (increased experience of emotions)
sexual behaviour change
over-inclusive speech
hypergraphia
humorlessness
hyperphagia
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26
Q

Akinetic mutism

A

“Vigilant coma”

From TUMOR in upper brainstem (ex: 3rd ventricle) or medial frontal lesion

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27
Q

Which AD in MDD in liver failure?

A

CELEXA
CIPRALEX

Child-Pugh scale
A (5-6) = 75-100% regular dose
B (7-9) = 50-75% regular dose
C (10-15) = 25-50% regular dose

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28
Q

Pseudoseizures

A

33% in patients with epilepsy

Less incontinence
Less injuries
Less nocturnal episodes
Forced eye closure
"Yes" or "no" head movements
Pelvic thrusting
No increased post-ictal prolactin
No cyanosed skin post-ictal
No confusion post-ictal
Affected by suggestions
29
Q

What is GESCHWIND SYNDROME

A

Personality changes with temporal lobe epilepsy:
hyperreligiosity
viscosity (increased experience of emotions)
sexual behaviour change
humorlessness
hyperphagia

30
Q

Inter-ictal psychosis

A

More common in complex partial epilepsy

Especially in:

WOMEN
LEFT-HANDED
LEFT LESION
YOUNG ONSET

31
Q

Treatment of MDD in epilepsy?

A

(6-50%)

CELEXA
CIPRALEX
SERTRALINE
Lamictal
Folate
32
Q

Multiple Sclerosis

A

30-50% have COGNITIVE DISORDER especially memory

Does NOT correlate with severity or duration of illness

25-50% have depression, higher risk suicide
Careful with ADs as have higher prevalence of BAD

Pathological laughing/crying in 10%
Tx with SSRI or TCA

33
Q

Chronic fatigue syndrome

A

At least 6 months of severe fatigue (causes decrease in at least 50% of activity)

+ at least 4 other symptoms

  • memory/concentration difficulty
  • sore throat
  • tender lymph nodes
  • muscle pain
  • joint pain
  • new headache
  • unrefreshing sleep
  • postexertional malaise lasting > 24 hours

Often SUDDEN onset

80% have DEPRESSION
LOW suicide rate

Often NO family history of depression

NOT associated with factitious disorder

Treatment with graded exercise therapy, some have response to amantadine (antiviral, also used in Parkinson’s)

34
Q

Fibromyalgia

A

Consistent pain for at least 3 months
“Widespread pain index” at least 7
“ Symptom severity scale” at least 5

“Trigger points” most often in thoracic and cervical

Overlap +++ with MDD, PTSD, CFS (often comorbidity occurs BEFORE pain onset)

Other names:

  • myalgic encephalitis
  • functional encephalitis
  • post-viral esthenia
  • chronic mononucleosis
  • royal free disease

Treatment with Pregabalin 150mg TID, analgesics, SNRI, acupuncture

35
Q

Transplantation

A

20% depression or adjustment disorder in year post
10% have PTSD from procedure
Risk of relapse if sober < 6 months before liver transplant

36
Q

Acute intermittent porphyria genes?

A

Autosomal dominant
Chromosome 11
Deficit in heme metabolism

F > M
Starts between 20-50 years old

37
Q

Acute intermittent porphyria presentation

A

Triad of

  1. Abdominal pain
  2. Polyneuropathy (like GBS)
  3. Psychosis

Insomnia common early sign
Anxiety, agitation, phobia

Test: urinary porphobilinogen, urinary amino-levuliic acid

BARBITURATES can trigger or worsen attack
Can be caused by LEAD intoxication

38
Q

Most anticholinergic TCA?

A

Amitriptyline

39
Q

Least anticholinergic TCA?

A

Desipramine

40
Q

Interferon (Hepatitis C)

A

Causes DEPRESSION in up to 50%
Biggest risk for MDE is at 12 weeks

Risk factor = PRE-EXISTING MDE
Risk does not correlate with dose or treatment duration

1st line = CELEXA, CIPRALEX

41
Q

Pheochromocytoma

A

Causes ANXIETY
(Triad of headache, sweating, tachycardia)

Dose ACID VANYLMANDELIC (urinary catecholamines)

42
Q

Serotonin syndrome

A 
Diarrhea
Tremor
Myoclonus
Hyperreflexia
Hyperthermia
Confusion/coma/stupor
Euphoria/irritability
Diaphoresis
Sialorrhea

Abnormal labs rare

Complications:
seizure/status epilepticus
AKI
metabolic ACIDOSIS
hypotension / cardio collapse
respiratory distress

Tx: cyproheptadine (SE antagonist), methysergide (SE antagonist)

43
Q

NMS

A

0.01-0.02%
Mortality = 20-30%
Symptoms evolve quickly (24-72 hours)

Rigidity (lead pipe)
Tremors
Bradykinesia/akinesia
Hyperthermia
Altered mental status
Mutism
Dysphagia
Urinary incontinence
Hypertension or tachycardia
Diaphoresis
Labs:
Increased CK
Leukocytosis
Myoglobinuria
Decreased Ca/Mg/Po4
Increased LDH
Low iron
Complications:
tachypnea/respiratory distress
metabolic ACIDOSIS
aspiration pneumonia
pulmonary embolism
Risk factors:
young male, AP naive
injectable AP, fast increase
agitation
dehydration
physical co-morbidity/neuro dysfunction

Protective factor:
Low potency APs with high anticholinergic effect (Clozapine, Zyprexa, Seroquel)

Tx: bromocriptine, dantrolene, amatadine, benzo, ECT

44
Q

Kluver-Bucy

A

Acquired
BITEMPORAL (including amygdala)

Astereognosia + prosopagnosia
Visual agnosia
Flat affect
Hypermetamorphosis
Hyperorality
Hypersexuality
45
Q

Anton syndrome

A

Acquired
BLINDNESS AGNOSIA (failure to acknowledge blindness)
Bilateral occipital

Frequent causes are CVA, hypoxia, migraine

46
Q

Balint syndrome

A

BILATERAL PARIETAL-OCCIPITAL

Optic ataxia
Oculomotor apraxia
Simultanagnosia

47
Q

Gertsmann syndrome

A

DOMINANT PARIETAL

Digital agnosia
Dysgraphia
Acalculia
Receptive aphasia (fluent aphasia)
L/R disorientation
48
Q

Non dominant parietal

A

Anosognosia
Denial
Contralateral hemineglect

49
Q

Wernicke-Korsakoff

A

Bilateral mammillary bodies (median temporal)

Ataxia
Nystagmus
Amnesia (confabulation)
Psychosis

Causes:
EtOH
Hyperemesis gravidarum
Pyloric stenosis

Only 20% recuperate

Treat with thiamine (replete BEFORE glucose)

50
Q

Wallenberg syndrome

A

LATERAL MEDULLARY SYNDROME
CVA of vertebral artery or inferior-posterior cerebellar

Ipsilateral facial pain/numbness
Ipsilateral ataxia (fall to lesion side)
Vertigo
N/V
Contralateral pain/thermal over body
Dysphagia/hiccups

DOES NOT CAUSE AMAUROSIS FUGAX

51
Q

Global transitory amnesia

A 
Severe anterograde amnesia (repeats same question)
Anxiety
No insight
Amnesic of episode
No ictal period

Lasts 6-24 hours

MAYBE BILATERAL HIPPOCAMPUS LESION (temporo-median)

Higher in epilepsy, hypertension and migraine (compared to TIA)

Retain personal information and identity.
More common in MEN!

52
Q

Carbon monoxide poisoning

A

GLOBUS PALLIDUS

Memory
Learning problems
Parkinsonism, dystonia (“flapping”)

Neuro sx can appear days later

53
Q

Measles or measles vaccine

A

SUBACUTE SCLEROSING PANENCEPHALITIS

54
Q

Herpes simplex encephalitis

A

Anosmia
Olfactory & gustatory hallucinations
Bizarre/psychotic personality

55
Q

Rabies

A

HYDROPHOBIA (due to laryngeal and diaphragmatic spasms)

Restlessness
Overactivity
Agitation

56
Q

Which AD to avoid in diabetes?

A

PROZAC (can cause hypoglycaemia)

TCA increases glucose but safe in controlled DM

57
Q

Which AD for diabetic neuropathy?

A

CITALOPRAM

58
Q

Depression more common in OPD or inpatient medical patients?

A

EQUAL

Attendance at OPD appointments better predicted by severity of depression than by underlying medical condition.

59
Q

PROSPECT study?

A

People with diabetes and depression die less with depression care management (vs. usual care)

60
Q

Adrenal insufficiency

A 
Primary = Addison's
Secondary = Sheehan's (post-partum necrosis of pituitary gland)

DEPRESSION

61
Q

Hypercortisolism

A

Cushing’s syndrome

Causes:
pituitary tumor
pseudo (alcoholism)
exogenous steroids (psychiatric symptoms DOSE dependent)

24H urinary free cortisol > 100mcg

Moon face
Buffalo hump
Hirsutism
Amenorrhea
Erectile dysfunction
Increased risk of fractures
Glucose intolerance / weight gain
Fatigue
62
Q

QTc

A

Women < 460ms
Men < 450ms

Needs correction for HR
Diurnal pattern (highest in morning)

QTc - (QRS - 100)
Gets prolonged from wide QRS

Risk factors for torsades de pointes

  • Low Mg
  • Low K
  • Low Ca
  • Women
  • Age

Protective factor
- pacemaker

63
Q

Citalopram prolongs QTc by how much?

64
Q

Safest AP for QTc?

65
Q

Ziprasidone prolongs QTc by how much?

66
Q

Quetiapine prolongs QTc by how much?

67
Q

Risperidone prolongs QTc by how much?

68
Q

EEG

A

Cerebral cortex layers 3 & 5 (pyramidal cells)

69
Q

Childhood absence epilepsy

A

3Hz generalized spike-wave triggered by hyperventilation

Rx = ethosuximide

66% outgrow them

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