High yield MCQ stuff Flashcards
Effect of divorce on chilren
From memory:
most have problems early
most adjust eventually, takes 3-5 years
child’s age and how parents get a long are importan
Kubler Ross stages of grief
DABDA
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Tx of sleep DO
Cataplexy: 1st line: sodium oxybate, 2nd TCA s esp clomipraine
Sleep paralysis and hypnagogoc Hal: TCA, SSRIS, venlafaxine
enuresis: TCA
Sleep attacks:modafinil
rem sleep behaviour DO: clonazepam
Erikson’s stages
- trust vs mistrust: 0-18 m. Virtue: hope
- autonomy vs shame and doubt: 18m-3 yrs. will
- initiative vs guilt: 3-5. purpose
- industry vs inferiority: 5-13. competence
- identity vs role confusion: 13-21. fidelity
- intimacy vs isolation: 21-40. love
- generativity vs stagnation: 40-60. care
- integrity vs despair: 60-death. aisdome
mirtazapine actions
blocks: H1, Ser 2, 3, alpha 2, increases NA
from memory
PKU
AR, purine metabolism
lech nyhan
X linked recessive?
hyperuricemia, self mutilation , MR
benzo conversion
1 Xanax=10 of diazepam?
Prader willi
chromosome 15, dleletion, paternal
compare conversion and malingering
-
compare depression and grief
-
turner’s syndrome
XO
no MR
thomas and Chess temperaments
IRAQ TAAAD
approach/withdrawal (response to new situations)
adaptability (to change)
activity level (time spent in activities)
attention span
distractibility
intensity (energy level)
threshold responsiveness (intensity required to get response)
quality of mood
rythmnicity (regulation of functions)
mahler
ASD PRO autism symbiosis differentiation practicing rapprochement object constancy
GAF for:
SI
delusions, Hal
suicide attemtp
41-50
21-30
11-20
stages of change: Prochasca
pre-contemplation contemplation preparation/determination action maintenance relapse prevention
motivational intrerviewing
DEARS develop discrepancy express empathy avoid arguments roll with resistance support self effciacy
Cloninger’s 2 types of alcoholism
Type 1= milieu limited: female, over 25, environmental, passive avoidance, harm avoidance low noverly seeking
Type 2=male limited: early onset, male, more criminal activity, high novelty seeking
tx of other impulse control DO
i. kleptomania: serotonergic antidepressants
ii. pyromania: anticonvulsants (limited data)
iii. pathological gambling: antidepressants due to link with affective disorders (limited data)
iv. intermittent explosive disorders: carbamazepine, lithium, propranolol, serotonin selective medications (buspirone and SSRIs)
v. paraphilias: antiandrogen medications (medroxyprogesterone and cyproterone), chemical castration (leuprolide, triptorelin), oral estrogen, clomipramine and SSRIs
dementia pracox coinedby?
Kraeplin
double bind theory
bateson
poor prognosis in schiz
early onset lack of precipitating factors insidious onset poor premorbid function withdrawn, autistic behavior single, divorced, or widowed family history of schizophrenia poor support systems negative symptoms neurological signs / symptoms history of perinatal trauma no remissions in three years many relapses history of assaultiveness
good prognosis in schiz
late onset precipitating factors acute onset good premorbid function mood disorder symptoms Married Family history of mood disorder good support systems positive symptoms and apparently having an Ok twin
RF for paranoid PPD
minorities
immigrants (like Delusionall DO)
deaf like delusional DO)
(compare to delusional DO RF)
• Does not tend to run in families (unlike delusional DO)
but can have family hx of schizophrenia.
• Men>women (unlike delusional DO)
MR
DSM-IV had IQ cut-offs for MR: 50-55 to 70 Mild 35-40 to 50-55 Moderate 20-25 to 35-40 Severe Below 20-25 Profound
prevalence of delusional DO
Paranoid PS
- 025 (females more)
0. 5-2.5 (men more than women)
delusional DO facts
0.025 more women holds true no relation to mood DO and schiz good functioning starts in 40s usually can have premorbid paranpoid PD traits?
RF: advanced age sensory imparement isolation family Hx (but no fam Hx of schizophrenia) personality features recent immigration
ED criteria for admission
This is from memory:
Temperature below 36C
Pulse below 40 (near 40 in child, 50 inMCQs) or over 110
Postural changes (increasein HR by 20 BPM, or decrease in BP by 20)
BP< 90/60 (lower accepted in children
BDD CB
• Likely to be unmarried, history of MDE (90%), anxiety (70%), psychosis (30%)
Porphyria
Acute Intermittent Porphyria: • Autosomal dominant metabolic disirder • Problem in heme production • Second most common porphyria (1st is cutanea tarda) • 95% of people have abdominal pain • Urinary symptoms (dysuria, dark urine) • Peripheral neuropathy • Proximal motor weakness • Sympathetic nervous symptoms (circulating catecholamines are increased) • Hyponatremia can occur due to SIADH
Expressive language DO
Expressive Language Disorder
K&S p. 1175
• Selective deficit in expressive language development relative to receptive skills and nonverbal intelligence
• In IQ testing verbal level may appear depressed compared to IQ
• Below expected levels of vocabulary, tense usage, sentence construction, and word recall
• Often present as younger than age
• Can be developmental (majority) or acquired; usually congenital without an obvious cause
• Expressive deficits often occur without receptive, though receptive dysfunction often causes expressive problems
• Two to three times more common in boys, and children with fam history of communication issues
• High comorbidities:
o ADHD (19%)
o Anxiety Disorder (10%)
o ODD and CD (7%)
o Higher risk for speech disorder, receptive d/o, learning d/o
o Associated with reading d/o, developmental coordination d/o
o Other communication d/o
• Delayed motor skills and enuresis are common
• Soft neuro signs, depressed vestibular response, EEG abnormalities
Boys with severe behaviour issues have high levels of undiagnosed language dysfunction
• 50% of children with mild difficulties recover spontaneously without signs of impairment. Children with more sever impairment may continue to display features.
Tourette’s Disorder
Tourette’s Disorder
K&S p. 1235
-Motor component usually emerges by age 7, while vocal by age 11.
-M:F = 3:1
-Natural history is a reduction or complete resolution by adolescence
-Initially occur in face and neck and over time travel downwards
-Up to 50% have ADHD (appears before tics) and 40% OCD (after tics)
-OCD is more common in high IQ, and tends to be more symmetry/counting/repetition
-Head and neck is most common area. Most frequent initial symptom is eye-blink, then head tic or facial grimace.
-Corporlalia occurs in 1/3 of patients, often in adolescence
-Older children, ados, and adults often report a “premonitory urge” (unpleasant sensation)
Disulfiram precautions
metronidazole
alcohol in perfumes
high impulsivity, likely to drink while using it, history of psychosis, DM, epilepsy, hepatic dysfunction hypothyroid, renal impairment, rubber contact dermatitis
Tests for:
Information processing speed
motor dexterity
Language
Executive functions
Information-processing speed
WAIS-R or WAIS-III Digit Symbol: rapid graphomotor tracking
Trailmaking Part A: rapid graphomotor tracking
Stroop A and B: rapid word reading and color naming
Motor dexterity
Finger tapping: right and left index finger dexterity
Language
Boston Naming Test: word retrieval
Executive functions
Trailmaking Part B: rapid alternation between tasks
Stroop C: inhibition of an overlearned response
Wisconsin Card Sorting Test: categorization and mental flexibility
Verbal fluency : rapid word generation
Design fluency: rapid generation of novel designs
biological RF for CD
- Low levels of dopamine beta hydroxylase (converts DA to NE)
- High blood serotinin, low CSF 5HIAA
- Greater right frontal EEG activity at rest
reward in the brain?
VTA
nucleus accumbens
part of DA system?
sunstantia nigra
nucleus accumbens
subthalamic nucleus?
apparently not raphe nucleus
tuberous sclerosis
second most common of the neurocutaneous syndromes (behind neurofibromatosis which is also AD)
- Autosomal dominant – 2/3 of cases are sporadic
- mental retardation in 2/3rds of affected people
- seizures, adenoma sebaceum and ash-leaf spots, adenomas in ventricles
HIV psychiatry
MOst common dx: adjustment DO
depression slightly higher than gen pop, less specific sx, increases with progression to AIDS
mania same as gen pop in asymptomatic HIV (10 times)
