dif Flashcards
Depression - sleep
Sleep disturbances in sleep stages: 1. decreased slow wave sleep
2. decreased REM latency 3. increased REM early in sleep cycle 4. increased total REM sleep 5. Repeated nightime awakening 6. Early-morning wakening (terminal insomnia)
Narcolepsy is caused by
decreased hypocretin (orexin) production in LATERAL hypothalamus strong genetic component
intermittent explosive disorder?
like antisocial but without history of conduct disorder or other fearures of antisocial
disulfiram vs naltrexone vs acamprosate as treatment of alcoholism
naltrexone –> to reduce craving (in active drinkers)
disulfiram –> in abstinent patients (2nd line)
acamprosate –> abstinent patients
Metabolic effects of the 2nd generation antiphsycotics - highest risk drugs / how to monitor
- Clozapine 2. Olanzapine
Baseline + regular follow-up: BMI, fastign glucose + lipids, BP, waist circumference (at 3 months and then annually)
- more frequent if DM or gained more than 5% of initial weight
hoarding disaster?
distinct from OCD
- accumulation of a large number of possessions that may clutter living areas to the point that they are usuable –> distress when attempting to discard possessions
interpersonal psychotherapy - indications / features
depression
- links symptoms to current relationship conflicts + interpersonal skill deficits
supportive psychotherapy - indications / features
- lower functioning, psychotic disorders
- patients in crisis
- maintains hope, provide encouragement
reinforces coping skills, adaptive defenses
psychodynamic psychotherapy - indications / features
- higher functioning personality disorders - builds insight into unconscious conflicts + past relationships uses transference breaks down maladaptive defenses
motivational interviewing - indications / features
substance use disorders
- nonjudgmental, acknowledges ambivalence + resistance
enhances intrinsic motivation to change
dialectical behavioral therapy - indications / features
borderline personality disorder
- improves emotion regulation, distress tolerance mindfulness
decreases self harm, build skills
biofeedback - indications / features
- prominent physical symptoms
pain disorders - improves control over physiological reactions to emotional stressors
start SSRI for Major depression - when to stop them
if single episode of major depression –> continue for additional 6 months following acute response to reduce the risk of relapse
with chronic, recurrent or severe episodes –> 1-3 years
medications that decreases lithium levels
theophylline
K+ sparing diuretics
Marchiafava-Bgnami disease
dementia, motor dysfunction, dyrsarthria
- severe damage to the corpus callosum and surrounding white matter due to chronic alcohol use disorder and malnutrition
Hoover sign
impaired flexion/extension strength of the hip with intact extension on contralateral hip flexion –> incompatible with known nerve pathways -> maybe conversion
contraidication of haloperodol
seizure disorder
severe or refractory anorexia nervosa
olanzapine
catatonia?
syndrome seen in severe psychiatric and medical illness and is characterized by immobility, mutism, posturing
Lorazepam and electroconvulsive therapy are the treatments of choice
antipsychotics - long QT?
only ziprasidone in very high doses
type of amnesia as a SE of electroconvulsive therapy
anterograde and retrodrage
retrograde persists longer
Narcolepsy - diagnostic criteria
recurrent lapses into sleep or naps (at least 3 times per week for 3 months) PLUS 1 of the following: - cataplexy - low hypocretin-1 in CSF - shortened REM sellp latency
Antipsychotic extrapyramidal effects - definition
- acute dystonia: sudden sustained contraction of the next, mouth, tongue and eye muscles
2 .Akathisia: subjective restlessness, inability to stil still - Parkinsonism: Gradual onset tremor, rigidity, bradykenesia
- Tardive dyskinesia: Gradual onset tremor after prolonged therapy (more than 6 months): dyskenesia of the mouth, face, trunk and extremeties
Lipod profile how often
After 35, every 5 years
IN MEN
Bath salts properties
Amphetamines with long duration effect and not detected in routine test
Orally, inhale or injected
Dantrolene mech of action
Rhyanodine receptor antag
- decreases intracellular Ca2+
GERD, endoscopy shows barret without dysplasia - next step
Again in 1 year, if again no dysplasia, then endoscopy every 3 years
If low grade dysplasia the same
If high grade: surgery or high intensity surveillance
switch to clozapine if extrapyramidal symptoms under antipsychotics
only if tardive dyskinesia
REM sleep behavior disorder
complex motor behaviours that occur during REM
- dream enactment can occur if the muscle atonia that usually accompanies REM sleep is absent or incomplete
- latter of the night (higher % of REM)
- very transient confusion after awake
- recall heir dreams but not movements
- older adult men
- may be prodromal for Parkinson or Lewy
schizophreniform vs schizophrenia beside duration
only schizophrenia requires functional decline
medications that decreases lithium levels
theophylline
K+ sparing diuretics
catatonia - treatment of choice
Lorazepam and electroconvulsive
transient global amnesia
anterograde amnesia fro time and place that resolve in 24 h
Dissociative identity disorder - association
with childhood trauma –> chronic auditory hallucinations that have venn present since childhood and are perceived as inside the patien;s head (vs psychotice, in which voices seem to come from outside)
somatic symptoms disorder - management
regularly sceduled vistis with the same provider, avoiding unnecessary diagnostic testing and specialists referrals, exploring the role of psycholosocial stresors, promote stress deuction and healthy behaviors
- refractory: CBT, SSRI
initial apporach to patients presenting with symptoms after a trumatic incident
educate them on the range that will normalize their experience
trama focused CBT is indicated if prersistent symptoms
scizophrenia - diagnosis
2 of the following (1 frim the first 3)
- delusions
- hallucinations
- disorganied speech
- catatonic
- negative
general anx disorder - when to give benzo
nondepressed without history of substance abuse who fail to respond to or cannot toleratre antidepressants
conversion disorder management
education –> if no response –> CBT
hoarding disorder - treatment
CBT
SSRI can be used in parallel, but with limited effect
