General Flashcards
Workup for dementia
CBC w/ diff; electrolytes; BUN; creatinine; B12; folate; VDRL; calcium, magneisium, phosphorus; UA; ESR; urine tox; TSH; LFTs; ECG; chest xray
Focal neurologic deficits found, you then do
Noncontrast head CT
Most common forms of dementia
- Alzheimer’s
- Vascular
Both account for 70-80% of all dementias
MDD w/ psychotic features
> 2 weeks depressive symptoms + psychosis (delusions)
Somatization disorder characterized by
Somatic complaints as well as least one neurologic and pain symptoms
Drugs mimicking SCZ
cocaine, PCP, or amphetamines
SSRI side effects
diarrhea, constipation, insomnia, nausea, headache, sexual dysufnciton, and agitation
Adjustment disorder
Onset of emotional or behavioral disturbances within 3 mos. of a significant life event. Disturbances are not as severe as MDD. Typically doesn’t have the neurovegetative signs of depression.
Acute stress disorder
Diagnosed when a patient has dissociative experiences and anxities. PTSD has rexperiencing
First line agent for panic disorder
SSRIs
Propranolol for what anxiety disorder
Social phobia
Mild mental retardation IQ
50-70
Moderate MR IQ
35-49
Severe MR IQ
20-34
Profound MR IQ
<20
Test what before starting Pimozide
ECG: can lengthen QT interval and lead to vent. arrythmias
Neurologic disease that can cause stereotypies
Epilepsy during complex partial seizures
Amphetamine toxicosis
Seizures…but possibly stereotypies
Neurosyphilis symptoms
Tabes dorslis and general paresis: wide based gait, positive Rombergs, loss of vibratory and proprioceptive senses initially in lower extremities.
Argyll-Robertson pupil
Accomodate but don’t react: Prost Pupils
Neurosyphilis
Syphilis tests
VDRL
Fluorescent treponemal antibody absorption test (FTA-ABS)
Hyperthyroidism
Depressive, hypomanic, and cognitive features:
Fine 8-12 Hz tremor
Lid lag, brisk deep tendon reflexes, proximal myopathy with muscle wasting, myalgias, hot flashes, insensitivity to heat
Hypoglycemia delirium
tachycardia, tremor, hypertension, and seizure
Workout up delirium
Same as for dementia +peripheral O2 sat, and mental status and physical exam
Dementia: CBC w/ diff; electrolytes; BUN; creatinine; B12; folate; VDRL; calcium, magneisium, phosphorus; UA; ESR; urine tox; TSH; LFTs; ECG; chest xray
Cocaine withdrawal
Fatigue, dysphoric mood with SI, increased appetite, insomnia or hypersomnia, unpleasant dreams, psychomotor agitation or retardation
MDMA effects
Enhanced perception/sensation, increased HR, hypertension, dilated pupils, trismus, bruxism, hyperthermia, diaphoresis
Best way to ascertain alcoholism
Ask family and friends
GAD definition
Excessive anxiety or worry for >6 months
GAD symptoms
Restless, fatigue, irritable, muscle tension, difficulty concentrating, sleep disturbance
Panic vs. GAD
Panic comes in earlier b/c they think they’re going to die or choke
Separation anxiety onset
before age 18
Wernicke encephalitis
ACE: Ataxia, Confusion, and Eye movement findings
Alcoholic cerebellar degeneration
Gait and stance problems but no arm ataxia or nystagmus
Subacute combined degeneration
B12 deficiency
Demyelination and axonal degeneration of the peripheral nerves, posterior and lateral columns, and cerebrum
Cognitive impairment, diminished position and vibration sense, and abnormal gait
Alcoholic peripheral neuropathy
Sensory peripheral neuropathy: alcohol directly causes axonal damage
NPH
Classic triad: Incontinence, dementia (confusion), gait ataxia
Can dysthymia and adjustment disorder have delusions
NO, they don’t get as intense as MDD
Heritability of BAD
Mono twin has 80-90% risk
Cataplexy
Sudden dramatic loss of muscle tone following an intense emotional reaction
Narcolepsy vs. Idiopathic hypersomnolence
Naps in narcolepsy are short and refreshing, unlike in IH
Thioridazine
Atypical typical, watch out for delirium due to ACh effects, you’d get less EPS than Haldol
Can lead to retinopathy
Kluver-Bucy Syndrome
syndrome resulting from bilateral lesions of the anterior temporal lobe (including amygdaloid nucleus).[1] Klüver–Bucy syndrome may present with hyperphagia, hypersexuality, hyperorality, visual agnosia, and docility.
Anticonvulsants and Blood Dyscrasias
Lithium isn’t really associated, can cause a benign leukocytosis
Carbamazepine: Commonly reduces WBCs, can cause agranulocytosis 1 in 10000
Depakote: Agranulocytosis can happen but rare. More common thrombocytopenia
Antipsychotics and Blood Cells
Can cause a decrease in leukopoeisis which normalizes.
Agranulocytosis 1 in 10,000, more for clozapine
Somatization disorder and Gender
Women get it 20:1 over men
Strongest cause of relapse into psychosis
Medication noncompliance….then stress or viral illness
Alcoholic hepatitis liver enzyme ratio
AST:ALT >2:1
Buspirone MOA
5HT1a partial agonist with anxiolytic effects
Mortality rate for anorexia
5-20%
How long before getting diagnosed with dysthymia?
2 years
Anticholinergic toxicity caused most by….
Low potency agents like Chlorpromazine and thioridazine and TCAs amitriptyline and imipramine
Atropine MOA
antimuscarinic
Anticholinesterase toxicity
N/V, bradycardia, seizures
AChE toxicity tx
Atropine
Do antipsychotics lower the seizure threshold?
yes they can
Tertiary amine TCAs and MOA
Amitriptyline, chlomipramine, doxepin, imipramine, trimipramine.
5HT reuptake blocking more than NE
Secondary amine TCAs and MOA
Desipramine, nortriptyline, and protriptyline
NE primarily
Inhalant Intoxication signs
Visual disturbances, dyscoordination, depressed relfexes, euphoria, and nystagmus
Staring into space and euphoria…what drug?
PCP
Hair loss for what anticonvulsant?
Depakote
Common side effects of Depakote?
N/V, indigestion
Sedation
Mildly elevated LFTs
Hair loss with carbamazepine, clozapine, olanzapine, or geodon?
nope!
If a young guy is having delusions/hallucinations for at least a month, they have…
SCZ
Nicotine toxicity sxs
Confusion, muscle twitching, weakness, abdominal cramps, depression, palpitations, coma, and respiratory failure.
Hallucinogens are more stimulant or depressant like?
Stimulant-like, elevated vital signs and increased activity
Tx for hypertensive crisis with MAOI
Alpha-blocker: e.g. prazosin
more effective than beta-blockers or CCBs
Seizures and Galactorrhea and Clozapine
Increased seizure risk
No effect on prolactin so no galactorrhea
Phenytoin oral symptom
Gingival hyperplasia
Phenytoin Side effects
Nystagmus, dizziness, slurred speech, ataxia, mental confusion, decreased coordination
Lithium birth defect
Ebstein Anomaly: 7.7%
Attention vs. Concentration and examples of tests
Attention is the ability to focus one’s perception on an outside or inside stimulus.
e.g. Spelling word backwards
Concentration is sustained attention to an internal thought process.
e.g. Serial 7s
amok
Malay Man starts attacking people for no reason, likely wants to be killed since Islam forbids suicide
Four types of EPS effects
Acute dystonic reactions, akathisia, pseudoparkinsonism, and TD
How to treat EPS
Reducing Dose
Try a low-potency agent
Add antiparkinsonian drug
Amantadine’s use in psychiatry?
Can help relieve EPS sxs
Ganser syndrome
Patient answers are approximate or ridiculous
Often confused with malingering
Primarily in the prison population
Tx for Elderly person with high risk of suicide from MDD and medical contraindications to medicine
ECT
Atypical Depressive Symptoms
Mood Reactivity
AND
2/4 features: increased appetite or weight gain, hypersomnia, leaden paralysis, and rejection sensitivity
Melancholic depression features
Loss of interest or pleasure in all or almost all activities or a lack of reactivity to usually pleasurable stimuli
What is Catalepsy?
Assuming an immobile position that is constantly maintained.
Pregnancy antidepressants
Fluoxentine can be used…anything else?
Most important step in treating NMS
Discontinue the offending med
Tests before Lithium
TSH, CBC, electrolytes, ECG, renal function studies….
Lithium-induced polyuria is from
Inhibition of ADH
Serotonin Syndrome Features
Abdominal Pain, diarrhea, diaphoresis, hyperpyrexia, tachycardia, hypertension, myoclonus, irritability, agitation, seziures, delirium
Fluoxetine clearance time
Up to 6 weeks
Bereavement
MDD symptoms that begin within 2 months of the loss and do not persist beyond the 2-month period
Complicated bereavement
Chronic and Unremitting distress
Bereavement tx
Don’t give them anything, it won’t make the pain go away any earlier
Purest Serotonin Antidepressant
Citalopram
Fluoxetine half-life
7 Days
What is Hallucinosis?
Hallucination in a patient who is completely alert and oriented
Where you do most commonly see Hallucinosis?
Alcohol withdrawal or chronic alcohol abuse.
How do dysthymia and MDD differ?
Dysthymia will have similar neurovegetative symptoms, but it is just less in severity and must be for >2 years.
What is Palilalia?
When you repeat your own word because you are stuck on it.
What is Parapraxis?
A slip of the tongue
Choreiform movements are…
Involuntary, irregular, and jerky but lack the ballistic-like nature of hemiballismus
Hemiballismus is…
Uncontrolled swinging of an extremity. usually sudden, and once initiated it cannot be controlled
Athetoid movements are…
Slow, snake-like movements of the fingers and hands
Testamentary capacity requires ALL 5 of the following…
1) Understanding the nature of the will
2) Knowledge of one’s assets
3) Knowledge of natural heirs
4) Absence of acute psychosis which might compromise rational decision making
5) Freedom from undue influence or coercion
3 exceptions to informed consent
1) Emergency situations
2) Waiver of informed consent
3) Situations where disclosure would harm the patient (seldom used)`
Memantine is a…
NMDA receptor antagonist, used for Alzheimer
Galantamine is a…
AChE inhibitor for Alzheimer
First thing to use for atypical depression…
Try an SSRI first, if that doesn’t work then move to an MAOI (because of side effect profiles)
First thing to do when someone comes in Crazy
Get a Urine Tox Screen to look for an exogenous cause
A recovering alcoholic needs something to sleep, give him…
Trazodone, don’t want something that touches his GABA receptors
Three components of Pervasive Developmental Disorders
1) Language
2) Social Interaction
3) Stereotypical behaviors
Worst/Best Predictor for Suicidality
Prior suicide attempts???
Patients with past attempts are the worst risk factor, those with no prior attempts are good sign.
Primary Vs. Secondary Enuresis
Primary enuresis means the patient has never achieved complete continence.
Secondary means the child had continence for over a year and then lose it.
Encopresis is…
Voluntarily or Involuntarily shitting yourself when you were once continent
Facies of Fetal Alcohol Syndrome
Microcephaly, short palpebral fissures, flat midface, and thin upper lip`
Atypical depression symptoms
1) Mood Reactivity
2) Rejection Hypersensitivity
3) Hypersomnolence
4) Increased Appetite
5) Lead Pipe Psychomotor retardation
Personality disorder NOS is…
When you have traits from numerous syndromes and don’t fit into one perfectly, commonly seen in clinical practice
Required for SAD diagnosis
Period of 2 weeks of psychotic symptoms w/o affective symptoms
Definitions:
- Type I Error
- Type II Error
- Standard Error
- Positive predictive value
- Negative predictive value
- Type 1: False positive
- Type 2: False negative
- Degree to which the means of several different samples would vary if they were taken repeatedly from the same population
- Proportion of abnormal test results that are true positive
- Proportion of normal test results that are true negative
Describe Tardive Dyskinesia
Perioral or limb musculature Choreiform movements
Personality disorders and PTSD
Increase the risk of acquiring PTSD
Complex Partial Epilepsy and Psychosis
20% with complex partial epilepsy experience psychotic features at some time
