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Brain and Behavior > Exam 3 (week 2) > Flashcards

Exam 3 (week 2) Flashcards

1
Q

hemiparetic gait - where is lesion

A

cortex (M1) down to reticulospinal or corticospinal tract

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2
Q

hemiparetic gait - what does it look like

A

flexion of arm

projection of leg is circumducted during walking

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3
Q

spastic diplegia - where is lesion

A

interhemispheric fissure of frontal cortex - bilateral leg homunculi in cortex caused by meningioma

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4
Q

what is spacticity

A

velocity dependent increase in tone

can slowly extend, but if you ramp up speed, they get stuck

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5
Q

what is spastic diplegia usually caused by

A

cerebral palsy

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6
Q

what does spastic gait look like

A

narrow, SCISSORING, stiff, spastic gait, toe gait in children

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7
Q

describe parkinsonian gait

A 
narrow based
shuffing
stooped flexed posture
slow
decreased 1 arm swing
multi-step turn
retropulson (fall back)
festination (quick steps)
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8
Q

ataxic gait - what does it look like

A

wide based
unstead - falls towards affected side
can’t do tandem gait

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9
Q

where is lesion/problem in ataxic gait

A

cerebellum

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10
Q

what causes ataxic gait (2)

A

alcohol

cerebellar lesion

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11
Q

frontal gait - what do you see

A

“magnetic gait” -feet stuck to the ground

slow, shuffling

normal arm swing

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12
Q

frontal gait - cause

A

normal pressure hydrocephalus

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13
Q

normal pressure hydrocephalus “Triad”

A

wacky (cognitive)
wet (urinary incontinence)
wobbly

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14
Q

functional gait - what do you see

A

inconsistant, lurching gait

appears dramatic and bizarre

suggestible

no falls or injuries

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15
Q

functional gait - what causes it

A

psych

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16
Q

what percent of cortex is association cortex

A

80%

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17
Q

3 “questions” asked by brain regarding cognitive information

A

attention (is it interesting?)

identification (if it is, what is it?)

planning (what do I do about it?)

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18
Q

what lobe determines if something is interesting

A

parietal lobe

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19
Q

what lobe determines what something is

A

temporal lobe

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20
Q

what lobe determines what to do about something

A

frontal lobe

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21
Q

how are brodmann’s areas distinguished

A

have different “packing” arrangements - cytoarchitectonic areas - turn out to have different functions

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22
Q

what is in cortical layer 4

A

recipient layer for thalamic neurons

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23
Q

stroke/lesion in association area of R parietal lobe causes what behavioral changes

A

contralateral neglect
INATTENTION problem

L visual field only seen by R hemisphere

R visual field seen by both R and L hemisphere

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24
Q

stroke/lesion in association area of R inferior temporal lobe causes what behavioral changes

A

problems with facial recognition - fusiform face area

prosopagnosia (sometimes congenital)

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25
Q

stroke/lesion in association area in frontal lobe causes what behavioral changes

A

working memory
executive function
couldn’t match behavior to environment around him

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26
Q

how to test prefrontal disfunction

A

wisconsin card sorting test - tests working memory and planning

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27
Q

3 areas of brain associated with “thinking” even during rest - “default mode”

A
  1. inferior temporal
  2. posterior cingulate
  3. medial prefrontal
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28
Q

what do the brains of schizophrenic patients look like compared to control in “Default mode”

A

more activity, particuarly in frontal and parietal

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29
Q

what do the brains of dementia patients look like compared to control in “Default mode”

A

hypoactivity in posterior

hyperactivity in frontal (like in schizophrenia)

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30
Q

two main features of language

A
  1. symbolic representation - matching of symbols to objects/actions (lexical)
  2. sterotypic performance - reliable order and contex for language production (syntantic and semantic)
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31
Q

lexical aspect of language controlled by what lobe

A

identification

L parietal: WERNICKES

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32
Q

syntactical/semantic aspects of language controlled by what lobe

A

planning/production

L frontal: BROCAS

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33
Q

rolling happens when in babies

A

4-6 mo

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34
Q

sitting happens when

A

6-7mo

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35
Q

crawling happens where

A

9-10 mo

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36
Q

walking happens when

A

14-15mo

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37
Q

transfering object happens when

A

6mo

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38
Q

baby bats an object

A

2-4mo

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39
Q

hands together when

A

3mo

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40
Q

grabs object hwen

A

4mo

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41
Q

bring to mouth when

A

4-5 mo

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42
Q

cooing happens when

A

2mo

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43
Q

babbling when

A

6mo

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44
Q

fin pincer grasp when

A

9-10 mo

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45
Q

word/word approximation when

A

12mo

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46
Q

vertical line drawing when

A

2 years

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47
Q

circle drawing when

A

3 years

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48
Q

proto-imperative pointing -what is it and when does it occur

A

point with finger to object they want at 12mo

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49
Q

proto-declarative pointing - what is it and when doe sit occur

A

parent says, where is dog, baby points to dog

14mo

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50
Q

what much of a difference beyond expected connotes delay

A

2 standard devations

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51
Q

for walking, what month is delayed

A

18 months

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52
Q

for speaking, what month is delayed

A

15months

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53
Q

motor apraxia

A

can’t get words out

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54
Q

at what age can you say someone has an intellectual disability

A

5 years

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55
Q

difference between mild and moderate delay/intellectual disability in terms of epidemiology

A

mild delays occur less often in developed countries

moderate-severe happen everywhere at same rate

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56
Q

seizures in children often associated with what

A

encephalopathy

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57
Q

how long do you correct for gestational age (in preterm birth)

A

until 1st year of age

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58
Q

formula for expected head circumference

A

length/2 + 9cm

std dev +/-2.5cm

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59
Q

low tone caused by what (2)

A

congenital

metabolic

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60
Q

low tone will cause what

A

delayed motor milestones

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61
Q

which developmental features are most often delayed in autism

A

social and language

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62
Q

is autism defined by genotype or phenotype

A

phenotype - we don’t have genetic testing, so autism is an umbrella term covering phenotypes

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63
Q

criteria for autism (5)

A
  1. persistent deficits in social interaction and communication
  2. restricted, repetitive behavior/interest (need more/less stimulation)
  3. early symptoms (~18mo)
  4. symptoms cause impairment in functioning (predominately social)
  5. symptoms not explained by intellectual disability or global developmental delay
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64
Q

when is MCHAT done

A

16 and 30 mo, or 18mo

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65
Q

if MCHAT is positive, then what do you do

A

ADOS - intensive. done by psychologist, on individuals 12mo through adulthood.

neuropsycho eval - will give you IQ and cognitive strengths/weaknesses

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66
Q

prevelance of autism

A

1:59

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67
Q

gender preference of autism

A

4:1

M>F

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68
Q

what percentage of patients with autism do NOT have intellectual disability (AKA only social issues)

A

15%

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69
Q

what percentage of patients with autism have seizures

A

25%

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70
Q

genetics associated with autism (3)

A

fragile X
Tuberous sclerosis
Dup15q syndrome (15q11.2-q13.1)

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71
Q

what early intervention has been proven to be helpful for autism

A

applied behavioral analysis (ABA)

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72
Q

what does karytope pick up in intellectual delay

A

chromosomal duplications/delesions, inversions, translocations (trisomy 21, turner)

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73
Q

what does CMA test pick up in intellectual delay

A

will pick up developmental delay/autism

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74
Q

what does WES test pick up in intellectual delay

A

mutations in central exons - still misses other things (repeats, mitochondria etc.)

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75
Q

gene panels - what do they pick up in intellectual delay

A

specific genes (epilepsy panel, autism panel, intellectual disability)

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76
Q

brain MRI - what will it pick up in intellectual delay

A

won’t tell you function - can see asymmetry or tone problems

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77
Q

long narrow face, large ears, prominent jaw, flexible fingers, flat feet, large testes after puberty

A

fragile X

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78
Q

diagnostic tests for fragile X (2)

A

PCR to “size” the number of repeats and

Southern blot to assess methylation

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79
Q

genetics of fragile X

A

CGG triple repeat

FMR1 gene Xq27.3

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80
Q

steryotyped wringing hand movement, microcephaly, regression of developmental milestones and loss of communication skills after 7-18mo

A

Rett syndrome

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81
Q

epidemiology of Rett

A

girls - lethal in boys

sporadic, denovo

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82
Q

death in Rett - what causes it

A

seizures.

prolonged QT - causes sudden death

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83
Q

genetics of Rett

A

X linked dominant

MECP2gene Xq28

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84
Q

how to test for Rett genetically

A

tiered targeted sequencing

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85
Q

child with neonatal hypotonia and failure to thrive hyperphagia leading to obesity
hypogonadism
almond shaped eyes

A

Prader willi

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86
Q 
girl with excessive laughing and smiling
absence of intelligible speech
protruding tongue
hyperactivity
seizures
A

Angelman

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87
Q

prader willi genetics

A

deletion of paternal 15q11-q13

inheritance of 2 copies of maternal chromosome 15 (which is disordered?)

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88
Q

angelman syndrome

A

deletion of maternal 15q11-q13

inheritance of 2 copies of paternal chromosome 15 (which is disordered?)

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89
Q

tic disorder presentation age

A

before 18yr

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90
Q

provisional tic definition

A

fewer than 12 months,

stop before puberty

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91
Q

persistant tic disorder definition

A

more than a year

one or more vocal or motor tic (NOT BOTH)

persists beyond puberty

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92
Q

tourette syndrome definition

A

2+ motor and AT LEAST 1 vocal tic

lasts more than a year

often associated with psych - OCD, anxiety etc.

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93
Q

what 2 things to think about in terms of psych in infants

A

homeostasis

attachment

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94
Q

how does reactive attachment disorder happen

A

when the environment goes wrong (neglect, abandonment, abuse etc.) - problem with Care

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95
Q

emotionally withdrawn 9 month infant, rarely seeks comfort, rarely responds to comfort, limited positive affect, persistently emotionally disturbed, not babbling, playing etc. has been removed from caregiver for some times

A

reactive attachment disorder

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96
Q

7 year old adopted kid, climbed onto stranger’s lap, walked into someone else’s house, tells strangers intimate details of her life, doesn’t check in with caretaker, no stranger danger

A

disinhibited social engagement disorder

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97
Q

what is one of the most commonly reported socially aberrant behaviors in post-institutionalized children

A

disinhibited social engagement disorder

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98
Q

how common are sleep disorders in kids 1-5

A

25-43%

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99
Q

BEARS acronym regarding sleep

A 
Bedtime routine
Excess daytime sleeping or dysfunction
Awake after sleep
Routines
Snoring
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100
Q

What are nightmares

A

parasomnia that happens during REM - so you remember

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101
Q

what chidlhood sleep disroder can be inherited

A

non-REM sleep parasomnia - night terror or sleep walking

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102
Q

what childhood sleep disorder could be linked to fear or anxiety

A

nightmares

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103
Q

what age is separation anxiety most often

A

7-8 yo

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104
Q

what is most common anxiety disorder of childhood

A

separation anxiety

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105
Q

learning disorder familial prevalance

A

4-8x higher risk in first degree relatives

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106
Q

when are learning disorders generally picked up

A

high school

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107
Q

IQ for mild intellectual disability

A

50-70

108
Q

types of ADHD

A

inattentive
hyperactive-impulsive
combination

109
Q

what ADHD type is the most common

A

combined

110
Q

what percentage of ADHD is genetic

A

80%

111
Q

do meds alone work better than meds plus therapy?

A

work the same

112
Q

what percentage of kids respond well to treatment to ADHD- complete school as normal

A

50%

113
Q

ADHD and risk for depression and substance abuse

A

untreated ADHD has 2-3x higher risk for dpression and substance abuse

114
Q

angry, irritaible kid who is defiant, vindictive interaction with someone (not sibling) where they lose tempber, argues, blames other for mistakes

A

oppositional defiance disorder

115
Q

really bad kid who’s agressive, destructive, deceitful, harmful to animals, commits serious violation of rules, theft

A

conduct disorder

116
Q

2 dimensions of disruptive behavior

A

overt (aggressive, bullies, stubborn)

covert (steals, sets fires, harms animals)

117
Q

what percentage of child mental helath referrals are due to ODD or CD

A

1/3 - 2/3

118
Q

genetic influences on conduct disorder

A

lead
peinatatl problems (smoking)
frontal lobe decreased glucose metabolism

119
Q

myer-overton corelation

A

relationship between lipid bilayer/water partition coefficient and potency

120
Q

what receptor/neurotransmitter to many anesthetics work through

A

GABA

121
Q

activation of post synatpic GABA receptors does what to post synatpic action potential generation potential

A

makes post synaptic more leaky, less excitable less voltage change

122
Q

receptor worked on by isoflurane

A

GABA

123
Q

receptor worked on by sevoflurane

A

GABA

124
Q

receptor worked on by etomidate

A

GABA

125
Q

receptor worked on by propofol

A

GABA

126
Q

receptor worked on by ketamine

A

NMDA

127
Q

receptor worked on by nitrous oxide

A

kainate and NMDA

128
Q

one dose of volatile anestetic agent is also called

A

minimum alveolar concnetration (MAC)

129
Q

at what MAC does mild anesthesia occur

A

0.3 MAC

130
Q

at what MAC does amnesia occur

A

0.5 MAC

131
Q

what is target MAC for surgery - 99% of subjects are immobile

A

1.3 MAC

132
Q

what MAC dose is potentially lethal

A

2.0 MAC

133
Q

what is induction MAC

A

2.0 MAC - could be lethal if maintained

134
Q

what works quicker - low solubility anestetics or high solubility anesthetics

A

low solubility

135
Q

halothane adverse effects (1)

A

immune response causing HEPATIC NECROSIS, fever, nausea vomiting and rash

136
Q

enflurane adverse effects (3)

A

CARDIOvascular DEPRESSION due to decreased contractility

SEIZURES

uterine muscle relaxant

137
Q

isoflurane advantages

A

cardiac is good

138
Q

isoflurane adverse effects (1)

A

progressive respiratory depression

139
Q

sevoflurane advantages

A

can be used for outpatient - rapid recovery

140
Q

desflurane advantages (2)

A

used for outpatient surgery

not soluble in fat

141
Q

desflurane adverse effects/disadvantages (3)

A

irritating to airways

needs specially heated vaporizer

can evoke tachycardia

142
Q

metohxyflurane blood:gas (high or low)

A

high

143
Q

methoxyflurane metabolism (high or low)

A

high

144
Q

methoxyflurane advantage

A

very potent

145
Q

methoxyflurane adverse (2)

A

extensively metabolized

renal failure/tox

146
Q

nitrous oxide use

A

analgesic

147
Q

advantages of nitrous oxide

A

analgesic

rapid induction

little tox

148
Q

disadvantages/adverse effects of nitrous oxide (2)

A

can’t use in patient with any enclosed air space (air embolus, loop of bowel) because it will expand

can cause hypoxia

149
Q

what is malignant hyperthermia and what is it caused by

A

inherited inability of sarcoplasmic reticulum to sequester Ca2+, volatile anesthetics and succinylcholine cause increased body temp and massive muscle contraction

150
Q

advantages of sodium thiopental

A

no vomitting or excitement after anesthetic

water sol

151
Q

disadvantages of sodium thiopental (4)

A

no analgesia

slow recovery

no antagonist

resp and CV depression

152
Q

what kind of drug is sodium thiopental

A

barbiturate

153
Q

propofol advantages

A

forgetful rest

little accumulation

rapid metabolism

154
Q

propofol disadvantages

A

no analgesia

CV depression

injection pain

not water sol

155
Q

ketamine advantages

A

no resp depression

analgesic

156
Q

ketamine disadvantages

A

hallucinations(less likely in children)

increased muscle tone and involuntary movements (less likely in children)

157
Q

etomidate advantages

A

there is an antagonist

158
Q

etomidate disadvantages

A

accumulates

no analgesia

injection pain

159
Q

what percentage of american shave alcohol or drug abuse/addiction

A

20%

160
Q

cost of drug and alcohol abuse to US society

A

~200 billion/year

161
Q

what genes are thought to be polymorphic for substance use disorder (4)

A

D4 dopamine receptor
mu opioid
delta opioid
dopa transporter

162
Q

diference between physioloigical dependence and substace use disorder

A

substance usde disorder includes behavioral syndrome - drug seeking behavior

163
Q

what 3 neuronal populations are targetted in the reward pathway

A
  1. GABA interneurons
  2. dopa neurons in VTA
  3. medium spiny GABA neurons in NAc
164
Q

what pathway do ALL drugs of abuse activate

A

mesolimbic dopa reward pathway (1 or more of the neuronal populations between VTA and NAc)

165
Q

alcohol reward pathway mech of action (3)

A

enhance GABA binding at GABAa

inhibit glutamate activation of excitatory NMDA

facilitate release of endogenous opioids in VTA

166
Q

TX for mild alcohol withdrawal (2)

A

sympathetic driven

clonidine or propranolol to suppress symp activity

167
Q

TX for severe alcohol withdrawal (1)

A

seizures

diazepam (long acting benzo)

168
Q

TX for preventing alcohol relapse (5)

A

(aversion therapy)
1. disulfram (nausea vomitting)

(anti-craving)

  1. naltrexone
  2. acamprosate
  3. topiromate
  4. SSRI
169
Q

barbiturates reward pathway mech of action (2)

A

increase GABA binding to GABAa

at high doses can directly open GABAa

170
Q

bartiburate detox tx (1)

A

to suppress seizures

reversal of dependence
stabilize patient on long acting phenobarbital, taper (4-8wk)

171
Q

benzos reward pathway mech of action

A

increase GABA binding to GABAa

172
Q

benzo withdrawal following moderate usage symptoms

A

anxiety, light sensitivity, paresthesia, cramps, dizziness, sleep disturbances

173
Q

benzo withdrawal following high dose usage symptoms

A

delirum

seizures

174
Q

benzo detox treatment

A

tapering doses of phenobarbital OR diazepam (long acting benzo)

175
Q

opioid reward pathway mech of action

A

activation of mu-opioid receptor on GABA interneurons in VTA

176
Q

opioid withdrawal tx (3)

A
  1. methodone
  2. LAAM (longer acting than methodone - 2-3/week instead of daily)
  3. buprenorphine (more favorable - partial agonist, less resp failure, antagonist to heroin, better compliance) as sublocade, suboxone
177
Q

nicotine reward pathway mech of action

A

stimulates nicotinic Ach receptors on dopa neurons in VTA

178
Q

tx for nicotine use disorder (3)

A
  1. nicotine replacement (gum/patch) - slower pharmacokinetics than smoking
  2. buproprion - antidepressant, antagonist of nicotinic Ach receptors, inhibits dopa and NE reuptake (reduces craving and withdrawal)
  3. varenicline - partial agonist on nicotinic Ach - superior (40% quit rate)
179
Q

amphetamine mech of action in reward pathway

A

enhance release of dopa and NE

also weakly blocks MAO and acts as direct agonist

180
Q

cocaine mech of action in reward pathway

A

blocks reuptake of dopa (and less so for NE and 5-HT)

181
Q

overdose of cocaine symptoms/cause

A

seizures (because of blocking GABAa, increasing CNS excitability)

182
Q

cocaine/amphetamines tolernace symptoms

A

reverse tolerance - sensitization (with chronic use can get increase susceptiility to cardiac arrhytmias and stroke)

183
Q

tx to reduce relapse for cocaine/amphetamine use disorder

A

topiramate

184
Q

5-HT related psychedelics (2)

A

LSD

psilocybin

185
Q

dopa and amphetamine related psychedelics (1)

A

MDMA

186
Q

dissociative drugs (2)

A

PCP, Ketamine

187
Q

mech of action for LSD (1)

A

agonists at 5-HT, dopa, and adrenergic reeptors

188
Q

mech of action for MDMA (3)

A

induce 5-HT and dopa release

5-HT reuptake inhibition

agonist at 5-HT, dopa and adrenergic receptors

189
Q

abuse disorder liklihood for psychedelics

A

low

190
Q

mech of action of dissociatives

A

inhibit glutamatergic NMDA in reward pathway

191
Q

peripheral effects of dissociatives

A

sympathomimetic - increased HR, BP, sweating

192
Q

classical conditioning

A

scared of thunder, which is associated with lighning. over time, lightning alone will cause fear response

193
Q

operant conditioning

A

reinforcement - press lever to get reward (positive), press lever to stop adverse stimulus (negative)

punishment - add adverse stimulus to decrease behavior (positive), remove pleasant stimulus to decrease behavior (negative)

194
Q

what type of “schedule” is the most reinforcing?

A

intermittent variable ratio

195
Q

what is the percentage range for heritability of alcohol and drug dependence

A

40-60%

196
Q

CAGE tool

A

C - had to Cut back
A - others Annoyed
G - Guilty
E - need Eye opener

197
Q

how many DSM symptoms for mild, moderate and severe use disorder

A 
mild = 2-3
moderate = 4-5
severe = >6
198
Q

alcohol withdrawal symptoms within 6-12hr

A

insomnia, anxiety, tremors, sweating, GI upset, palpitations

199
Q

alcohol withdrawal symptoms within 12-24hr

A

visual, auditor or tactile hallucinations

200
Q

alcohol withdrawal symptoms within 24-48hr

A

generalized tonic clonic seizures

201
Q

alcohol withdrawal symptoms within 48-72hr

A

delirium tremens - visual hallucinations, disorientation, tachycardia, HTN, fever, agitation, sweating

202
Q

triad with wernicke’s

A
  1. confusion
  2. ataxia
  3. abnormal eye movements
203
Q

triad with korsakoff’s

A
  1. amnesia
  2. confabulation
  3. hallucinations
204
Q

what is bruxism

A

grinding teeth - meth mouth

205
Q

PCP intoxication symptoms (Acronym)

A

RED DANES
Rage
Erythema
Dilated pupils

Delusions
Amnesia
Nystagmus
Excitation
Skin dryness
206
Q

tx for PCP

A

acidification of urine…?

207
Q

when does glial washing occur

A

slow wave sleep

208
Q

what is poor glial washing associated iwth

A

amyloid plaques in alzheimers

209
Q

how often does REM happen

A

90 - 120 min intervals - doesn’t start til 1.5 hours

210
Q

after exposure, how much time is best for learning

A

up to 2 days of sleep, and then plateaus

211
Q

how much sleep does an adult need

A

7-9 hours

212
Q

how much sleep does a teenager need

A

9.25h

213
Q

how much sleep does an 5-12 year old need

A

10-11hr

214
Q

processes of circadian rhythim

A

Process S (homeostatic sleep drive)

Process C (clock dependent alertness)

215
Q

what is the retino-hypothalamic pathway

A

there are photopic receptors (retinal gangioln cells) that process light, at dusk, secretes melatonin due to input from suprachiasmatic nucleus

216
Q

delayed sleep phase usually between what times

A

3am - 11am

217
Q

who gets delayed sleep phase

A

teenagers and some people geneticaly

218
Q

how does sleep changewith age

A

decreased slow wave, increased fragmentation

219
Q

what percentage of individual has chronic insomnia

A

15%

220
Q

what kind of insomnia responds to CBT

A

sleep onset

221
Q

symptoms for narcolepsy

A
  1. excessive sleepiness
  2. sleep paralysis
  3. hypnogogic hallucination
  4. cataplexy
  5. fragmentation of sleep
222
Q

does orexin make you awake or sleepy

A

sustains wakefulness

223
Q

degrees of hypothermia

A

mild: 90-95
moderate: 82-90
severe: <82

224
Q

degrees of frostbite

A

1st: superficial, limited to skin and superficial tissue, swelling and redness
2nd: superficial, with blisters over first 24hr that will slough off
3rd: deeper, involves bloody blisters that blacken and slough off about 2 weeks after injury
4th: muscles and bones, causes necrosis and loss of tissue

225
Q

difference between heat exhaustion and heat stroke

A

heat exhaustion: weakness and loss of water

heat stroke: results in hyperthermia (>104)

226
Q

how to determine age of lice

A

distance from scalp -> 1cm = 1month

227
Q

treatment for lice

A

permethrin 1% cream 2x (once a week later)

228
Q

why is scabies more contagious than lice

A

scabies can live on surface for 24 hours. also you can’t see them

229
Q

symptoms of scabies

A

very very itchy

230
Q

treatment for scabies

A

promethrin 5% cover whole body for a whole day and then wash off

also have to wash and dry clothing in heat

231
Q

how much more likely are patients with mental illness to suffer violence

A

10x

232
Q

what percentage of homeless individuals suffer from severe mental illness versus the general population

A

25% vs 6%

233
Q

what substances are abused most often in homeless population, and what percent

A

tobacco - 70-80%

alcohol - 38%

234
Q

what is leading cause of death in homeless population between 40s and 60s

A

cardiovascular disease

235
Q

parts of “quadruple aim” model

A
  1. patient experience of care
  2. per capita cost
  3. population health/outcomes
  4. clinician experience
236
Q

what level of government regulates most health policy

A

state

237
Q

is healthcare in the constitution?

A

no, except in the preamble that says “to promote the general welfare”

238
Q

how does federal gov get away with regulating helathcare?

A
  1. tax and spend (can create incentives for states to act - highway funds etc.)
  2. interstate commerce (health insurance, child labor, civil rights, environmental protection)
  3. necessary and proper elastic clause
239
Q

Medicare and medicaid and levels of government involvement

A

medicare - federal is direct purchaser

medicaid - state program, federal sets minimum services for baseline

240
Q

Romer’s law

A

when you build more beds, more people will fill them - also applies to technology (CT, MRI etc)

241
Q

definition of treatment resistant depression

A

people who do not respond to at least 2 antidepressants

242
Q

pros and cons of uni vs bilateral seizure induction thearpy

A

uni = less effective but fewer memory loss side effects

bi = more effective, more cognitive effects

243
Q

how much of the applied charge actually gets into the brain

A

20% - skull impedes a lot

244
Q

ECT effects (3)

A
  1. increases GABA transmission and receptor antagonism
  2. down regulates beta adrenergic receptors
  3. increaes endogenous opioids
245
Q

ECT absolutely contraindications

A

increased intracranial pressure

246
Q

can you use ECT in pregnancy

A

yes

247
Q

side effects of ECT

A

temporary retrograde amnesia and confusion

248
Q

transcranial magnetic stimulation (TMS) uses (2)

A

neuropathic pain

treatment resistant major depressive dirosder and bipolar disorder

249
Q

TMS adverse effects

A

some fainting or discomfort - not a lot

250
Q

bright light therapy uses

A

seasonal depression

251
Q

vagus nerve stimulation mechanism

A

changes blood flow in brain and boosts neurotransmitters

252
Q

deep brain stimulation uses (3)

A

MDD
OCD
Parkinsons

253
Q

what unit is measured for ECT

A

mili coulombs

254
Q

sexual response cycle

A

desire
excitement/arousal
orgasm
relaxation

255
Q

diagnostic criteria for female sexual interest/arousal disorder

A

absent/reduced sexual interest with 3 domains, of at least 6 months duration causing distress, w/o any other psych disorder, meds

256
Q

diagnostic criteria for male hypoactive sexual desire disorder

A

deficient/absent sexual desire for 6 months duration causing significant distress w/o any other psych disorder, meds

257
Q

timing for premature ejaculation

A

under 1min

258
Q

what percentage of male population suffers from premature ejaculation

A

30%

40% of men treated for sexual disroder

259
Q

demographics for premature ejaculation

A

college educated men

260
Q

treatment for premature ejaculation

A

1- squeeze technique
2- stop start
3- psychotherapy sensate focus
4- SSRIs or topical anesthetics

261
Q

4 types of difficulties you can see with genito-pelvic pain/penetration disorder

A

one of the following:

  1. difficulty with vaginal penetration
  2. difficulty with geneital pain during intercourse
  3. fear/anxiety about pain during intercourse
  4. tightening of pelvic floor muscles during penetration
262
Q

diagnostic criteria for parahpilias

A

intense, recurrent fantasies towards non consenting individuals or that humiliate oneself or others

EITHER 6 months of fantasies that cause distress or impairment

or having acted on the fantasies, with or without distress or impairment

263
Q

voyeurism

A

peeping tom

264
Q

exhibitionism

A

exposing to unsuspecting individual

265
Q

frotteurism

A

rubbing against people in crowds

Brain and Behavior (6 decks)

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