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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
Epilepsy
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 ```
26
Akinetic mutism
"Vigilant coma" From TUMOR in upper brainstem (ex: 3rd ventricle) or medial frontal lesion
27
Which AD in MDD in liver failure?
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
28
Pseudoseizures
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
What is GESCHWIND SYNDROME
Personality changes with temporal lobe epilepsy: hyperreligiosity viscosity (increased experience of emotions) sexual behaviour change humorlessness hyperphagia
30
Inter-ictal psychosis
More common in complex partial epilepsy Especially in: WOMEN LEFT-HANDED LEFT LESION YOUNG ONSET
31
Treatment of MDD in epilepsy?
(6-50%) ``` CELEXA CIPRALEX SERTRALINE Lamictal Folate ```
32
Multiple Sclerosis
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
Chronic fatigue syndrome
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
Fibromyalgia
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
Transplantation
20% depression or adjustment disorder in year post 10% have PTSD from procedure Risk of relapse if sober < 6 months before liver transplant
36
Acute intermittent porphyria genes?
Autosomal dominant Chromosome 11 Deficit in heme metabolism F > M Starts between 20-50 years old
37
Acute intermittent porphyria presentation
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
Most anticholinergic TCA?
Amitriptyline
39
Least anticholinergic TCA?
Desipramine
40
Interferon (Hepatitis C)
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
Pheochromocytoma
Causes ANXIETY (Triad of headache, sweating, tachycardia) Dose ACID VANYLMANDELIC (urinary catecholamines)
42
Serotonin syndrome
``` 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
NMS
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
Kluver-Bucy
Acquired BITEMPORAL (including amygdala) ``` Astereognosia + prosopagnosia Visual agnosia Flat affect Hypermetamorphosis Hyperorality Hypersexuality ```
45
Anton syndrome
Acquired BLINDNESS AGNOSIA (failure to acknowledge blindness) Bilateral occipital Frequent causes are CVA, hypoxia, migraine
46
Balint syndrome
BILATERAL PARIETAL-OCCIPITAL Optic ataxia Oculomotor apraxia Simultanagnosia
47
Gertsmann syndrome
DOMINANT PARIETAL ``` Digital agnosia Dysgraphia Acalculia Receptive aphasia (fluent aphasia) L/R disorientation ```
48
Non dominant parietal
Anosognosia Denial Contralateral hemineglect
49
Wernicke-Korsakoff
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
Wallenberg syndrome
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
Global transitory amnesia
``` 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
Carbon monoxide poisoning
GLOBUS PALLIDUS Memory Learning problems Parkinsonism, dystonia ("flapping") Neuro sx can appear days later
53
Measles or measles vaccine
SUBACUTE SCLEROSING PANENCEPHALITIS
54
Herpes simplex encephalitis
Anosmia Olfactory & gustatory hallucinations Bizarre/psychotic personality
55
Rabies
HYDROPHOBIA (due to laryngeal and diaphragmatic spasms) Restlessness Overactivity Agitation
56
Which AD to avoid in diabetes?
PROZAC (can cause hypoglycaemia) TCA increases glucose but safe in controlled DM
57
Which AD for diabetic neuropathy?
CITALOPRAM
58
Depression more common in OPD or inpatient medical patients?
EQUAL Attendance at OPD appointments better predicted by severity of depression than by underlying medical condition.
59
PROSPECT study?
People with diabetes and depression die less with depression care management (vs. usual care)
60
Adrenal insufficiency
``` Primary = Addison's Secondary = Sheehan's (post-partum necrosis of pituitary gland) ``` DEPRESSION
61
Hypercortisolism
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
QTc
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
Citalopram prolongs QTc by how much?
10-20ms
64
Safest AP for QTc?
Abilify
65
Ziprasidone prolongs QTc by how much?
20ms
66
Quetiapine prolongs QTc by how much?
14.5ms
67
Risperidone prolongs QTc by how much?
10ms
68
EEG
Cerebral cortex layers 3 & 5 (pyramidal cells)
69
Childhood absence epilepsy
3Hz generalized spike-wave triggered by hyperventilation Rx = ethosuximide 66% outgrow them

RC Nuggets (20 decks)

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