Lange Flashcards
What is separation anxiety disorder characterized by? How is this different from reactive attachment disorder?
developmentally inappropriate and excessive anxiety concerning separation from the home or form those to whom the individual is attached (comes home immediately after school, sleep in parents’ bed, physical symptoms at school, etc.)
Reactive attachment disorder requires “disturbed social relatedness, in most contexts, beginning before the age of 5”
Risk factors for a child developing an anxiety disorder:
1) parents who have overly controlling and rejecting style
2) parents who have a history of anxiety disorder
3) insecure attachment with primary caregiver
4) inhibited and shy temperament
How long must the angry/defiant and argumentative/easily irritated behavior be present for a child to get a diagnosis of ODD?
6 months
If untreated, ODD may lead to
conduct disorder
In BN patients, which of the following is elevated and which is depressed?:
K+, Cl-, H+, Na+, protein, Hgb
elevated: Na+
lower: K+, Cl-, H+, protein, Hgb
What is more commonly seen in children with MDD compared to adolescents with MDD?
psychomotor agitation; children with MDD may seem more anxious and irritable than sad and depressed
MDD adolescents are more likely to be hypersomnic, hopeless, weight change, drug abues
What is the most common method children use when attempting suicide?
substance ingestion
The approximate comorbidty of childhood anxiety disorders (overanxious disorder, separation anxiety disorder, panic disorder) and MDD is
50%
In Rett disorder, there is normal prenatal and perinatal development, normal head circumference at birth, and normal psychomotor development through the first ____ months of life. Between the ages of ________ months, there is deceleration of head growth, loss of hand skills w/ stereotyped hand movements, loss of social interaction, etc.
first 5 months: normal
between 5-48 months = abnormal
Risk factors for developing conduct disorder:
- absence bio dad
- mom with somatization disorder or alcohol abuse
- big family
- aggressive, unsupportive parents
What is the firstline treatment for Tourette disorder?
clonidine. TCAs can also be effective; risperidone and olanzapine have also been used
What is the diagnostic criteria for Tourette’s?
1) both multiple motor tics and at least one vocal tic; do not need to occur concurrently
2) onset before age 18 (avg age of onset is 7)
3) tics nearly every day or intermittently for at least 1 year with no tic-free period longer than 3 months
What is “atomoxetine” and what is it used to treat?
Atomoxetine is a nonstimulant, NE reuptake inhibitor used to treat childhood and adult ADHD
Serum cholesterol is (high/low) in anorexia nervosa.
What about hemoglobin and WBC?
High (hypercholesterolemia)
leukopenia
normocytic normochromic anemia
Austistic chidlren generally lack what marker seen around 7 to 8 months? By which age would this marker usually go away?
stranger anxiety
7/8mo to 3/4 years
What are things associated with a better prognosis in schizophrenia?
age at onset, presence/absence of affective symptoms, acute/insidious onset, well- or poorly-differentiated symptoms, family history, premorbid functioning…
- later age of onset
- presence of affective symptoms
- acute onset
- well-differentiated symptoms
- lack of family history
- good premorbid functioning
While children with ADHD and children with mania are demonstrate distractibility, impulsivity, motoric overactivity, and pressured speech, what is different between them?
w/ ADHD: suffer from low self-esteem
w/ mania: euphoric
What is a frequent adverse effect of clonidine upon initiating treatment?
sedation; dry mouth less commonly (hypotension is also possible, but usually does not result in significant symptoms)
The coping mechanism where an individual adopts another person’s characteristics is called
identification. Note: it is also important in personality formation
Which of the following manifestations is the most likely outcome of childhood abuse?:
aggression, dissociative disorder, GAD, MDD, PTSD
MDD
Disobedience toward authority figures is characteristic of _____
Aggression and violating rules are symptoms consistent with _______
disobedience towards authority figures: OPPOSITIONAL DEFIANT DISORDER
aggression and violating rules: CONDUCT DISORDER
Alexia, agnosia, anomia, aphasia, apraxia
Alexia = Inability to read: Agnosia = Inability to recognize objects despite intact senses: Anomia = Inability to name objects seen though the object is recognizable and can be described: Aphasia = Inability to express or comprehend language (more global than alexia): Apraxia = Inability to perform learned motor skills despite normal strength and coordination:
What are the IQ ranges for mild, moderate, and severe mental retardation?
mild: 55 to 70
moderate: 40 to 54
severe: 25 to 39
What syndrome describes the following?:
Nihilistic delusional content; in addition to lost possessions, patients may feel they have lost blood, heart, intestines, as well as that the world beyond them has been reduced to nothingness.
Cotard syndrome
What syndrome describes the following?:
Delusion of doubles characterized by the belief that people have been replaced by identically appearing imposters.
Capgras syndrome
What syndrome describes the following?
Belief that familiar people assume the guise of strangers.
Fregoli delusion
Postpartum psychosis, also called puerperal psychosis, is characterized by what symptoms within which timeline?
delusions and hallucinations within 1 week of delivery
T/F: A positive tox screen for cannabis would preclude a primary psychotic disorder.
True! Symptoms must be shown to persist after sobriety is attained
Name given to disorder characterized by psychotic symptoms lasting 1 day to 1 month.
brief psychotic disorder
This disorder is characterized by: rapid mood swings, efforts to avoid abandonment, chronic feelings of emptiness, intense anger outbursts, impulsivity, fluctuations between idealization and devaluation, recurrent self-mutilation or suicidality.
borderline personality disorder
What is malignant catatonia?
Catatonia (negativism, psychomotor slowing, echopraxia) with pronounced vital sign abnormalities, possibly with marked rigidity and elevations in CPK
Catatonia is more frequently found in (schizophrenia/affective disorders)
affective disorders
What is the mainstay of treatment for catatonia?
benzodiazepenes or ECT.
In depression, how are the following bio levels affected:
1) cortisol
2) MAOs
3) catecholamines
4) sex hormones
5) immune function
cortisol: increased
MAOs: unknown
catecholamines, sex hormones, immune function: all decreased
Which are more likely to induce mania: TCAs or SSRIs?
TCAs > SSRIs
nortryptiline > paroxetine, for example
Episodic mood disturbances of hypomania and subclinical depression:
cyclothymia
What is dysthymia?
Chronic depression that does not meet severity for major depressive episode: symptoms persist for 2 years, with no more than 2 months of symptom-free periods
What is “double depression”?
when major depressive episode is superimposed on dysthmic disorder
Tachycardia, diaphoresis, pupillary dilation suggests intoxication with
cocaine
The likelihood of DTs onset is highest __ to __ days after the last drink. What is the mortality rate?
3 to 5. Mortality rate is 30%
Which benzodiazepenes are used to treat DTs and why?
oxazepam and lorazepam. They are not dependent on liver function for their metabolism (so are helpful in underlying liver disease)
What is “acute stress disorder”?
patient is exposed to a trumatic evetn and experiences reexperiencing, numbing, and increased arousal symptoms for up to 1 month after the event
What is the difference between schizoid personality disorder and avoidant personality disorder?
While both are reculsive, the lack of socialization is distressing to those with avoidant personality disorder; they are shy and fearful of social rejection.
What is the classic triad of normal pressure hydrocephalus?
What does the CT scan show?
Normal pressure hydrocephalus (NPH)–no elevation in opening pressure–is one of hte few potentially reversible causes of dementia.
1) confusion
2) gait apraxia
3) incontinence
CT scan shows dilated ventricles.
Frontoparietal atrophy is seen in _________________, while frontotemporal atrophy is found in _______________
Frontoparietal atrophy: Alzehimer dementia
Frontotemporal atrophy: Pick disease
Dementia pugilistica (punchdrunk syndrome) is a type of dementia seen following what? What is it characterized by?
repeated head trauma over the years
characterized by:
1) emotional lability
2) dysarthria
3) impulsivity
Patients with pseudodementia will often have a history of
depression
cognitive deficits on MSE are reversible with antidepressant treatment
Subcortical arteriosclerotic encephalopathy characterized by multiple small infarcts in the white matter with SPARING of the cortical regions.
Binswanger disease/small vessel vascular dementia
The onset of delusional disorder is usually what age?
middle age
What is the difference between acute distress disorder and PTSD?
In PTSD, the symptoms persist after 4 weeks following the trauma! Acute distress disorder is when the symptoms last under that
The number of ECT session for treating MDD is:
for catatonia:
for psychosis/mania:
MDD: 6-12
catatonia: 2-4
psychosis/mania: >20
The placebo effect in depressives has a __% efficacy, while antidepressants have __% efficacy.
placebo: 30%
antidepressants: 65-75%
About ___% of patients with MDD will attempt suicide, and ___% will successfully complete suicide.
30% will attempt; 15% will succeed
What is the difference between fetishism and froteeurism?
Fetishism: sexual arousal connected with nonliving objects
Frotteurism: sexual arousal by touching or rubbing against a nonconsenting person
Occupational or social dysfunction or marked distress should be caused by these activities
1) cataplexy (sudden loss of muscle tone following intense emotion);
2) hypnopompic or hypnagogic hallucinations; or
3) sleep paralysis (inability to perform voluntary movements at sleep onset or awakening that can be terrifying)
4) hypersomnia (excessive daytime somnolence)
characterize:
narcolepsy (often affects teens or twenties)
Restless legs syndrome is an example of what kind fo sleep disturbance?
Dyssomnia, NOS: reserved for sleep disturbances of unknown cause or causes associated with environmental disturbances such as those that produce prolonged sleep deprivation
How is narcolepsy treated?
Methylphenidate (a stimulant). Antidepressant treatment with TCAs has been useful in combination with methylphenidate in some patients.
When do symptoms remit in premenstrual dysthmic disorder (PMDD)?
1 weeks after menses
How long does an untreated depressive episode last? How long with treatment?
6 to 13 months
With treatment, down to 3 months
Alcohol intoxication and PCP may cause coma, but both are associated with _________ rather than pupillary size changes.
nystagmus
An unconscious conflict producing symptoms is classic of:
conversion disorder (patient presents with neurologic symptoms that are not physiologic)
Can adjustment disorders present with overt mania?
NO!
may manifest with mild mood, anxiety, or behavioral disturbances, but not overt mania
What is the treatment of acute depressive episodes of bipolar disorder?
Lamotigrine and lithium
Classically, infarcts of the left frontal hemispheres (part of left MCA) present with ____________, while those of the right frontal hemisphere present with ___________
left frontal hemisphere infarct: depression
right frontal hemisphere infarct: euphoria, inappropriate indifference, potentially mania
*OCD behaviors present after bilateral frontal injury at times
T/F: The serotonin metabolite 5-HIAA has been found to be lower in the CSF of victims of suicide and in patients with impulsivity and violence or aggression when compared to controls
True!
Fluctuation in the level of consciousness (from alert to somnolent) with deficits in attention are the hallmarks for (dementia/delirium)
Delirium! Dementia can predispose to delirium, so both can be seen in the same patient
1) short-term memory deficits
2) unstable smooth-pursuit eye movements
3) decreased ability to habituate to repeated sensory stimuli
4) difficulty conceptualizing complex visual compositions
are seen in what?
schizophrenia
What is a Jacksonian seizure?
Seizure spreads from distal part of body to ipsilateral face
What is the other term for pseudoseizure?
nonepileptic seizure (normal EEG with psychogenically-induced behavior that resembles epileptic activity)
What is Rabbit syndrome?
A late onset side effect of antipsychotic meds that involves fine, rhythmic movements of the lips
Compare derealization and depersonalization?
What is dereism?
Derealization: sense that one’s surroundings are strange or unreal
Depersonalization: feeling that one’s identity is lost or the feeling of being unreal or strange
Dereism is mental activity not in accordance with reality
Wernicke-Korsakoff syndrome is associated with what kind of memory loss?
anterograde amneisa: loss of immediate or short term memory
What is astereognosis?
inability to recognize an object by touch despite tactile sensation being intact
What is the term for “loss of memory for a period of time without the loss of ability to form new memories”?
Dissociative amnesia. Usually associated with emotional trauma; not due to drugs or medications
What is logorrhea?
Uncontrollable or excessive talking sometimes seen in manic episodes
When is formication seen?
cocaine intoxication and alcohol withdrawal
What is “scanning speech”?
Irregular pauses between syllables, which also breaks the fluidity but does not cause the repeating of sounds or syllables as in stuttering
What is dysarthria?
Poor articualtion, often due to a neurologic injury such as a stroke
Proper grammar and proper words used, but speech is nto logical or goal-directed:
loosening of associations (logical connections between ideas completely lost)
What is derailment?
Abrupt interruption of an idea and then, after a period of time (a few seconds), beginning a new topic. Usually without the patient being aware of a switch in material
What is macropsia, micropsia, and palinopsia?
Macropsia: misperception of object being larger than actually is; micropsia: smaller; palinopsia: persistence of a visual image after the stimulus has been removed
In OCD patients, there is increased activity where in the brain?
Are these changes reversible?
caudate nucleus, frontal lobes, and cingulum
These differences are reversed after adequate pharmacologic or behavioral therapy
The substitution of a word or description for a word that cannot be recalled or spoken:
circumlocution
Which of the following symptoms of depression improve first with treatment? Which later?
sleep, energy, libido, hoplessness/helplessness, suicidal ideation, appetite changes
first: sleep, energy, appetite changes
later: libido, hopelessness/helplessness, suicidal ideation
What is “transvestic fetishism”?
Arousal by cross-dressing
Describe the following culture-bound delusions:
1) koro
2) tajin-kyofusho
3) zar
koro: penis is shrinking into abdomen; South and East Asia
taijin-kyofusho: belief one’s body is offensive to others
zar: delusional belief of possession by a spirit
What is the difference between “pressured speech” and “hyperverbal speech”?
Hyperverbal speech is also at a rapid state, but it is interruptible
Which part of the brain is hyperactive in anxiety states? It contains the most neurons carrying which neurotransmitter?
locus ceruleus. Location of the most NE-containing neurons in the brain
______________ represents the tendency to project one’s own internal characteristics onto others.
Externalization
What is “sublimation”?
The channeling of drives or conflicts into goals that are gratifying but socially acceptable (eg, individuals afraid of blood and hospitals who become hospital workers or physicians)
Most serotonin in the CNS is synthesized where?
dorsal and medial raphe nucleus of the brain stem
Features of mild serotonin syndrome include:
tachycardia, flushing, fever, hypertension, ocular oscillations, and myoclonic jerks
Rotary nystagmus is associated with
ketamine use
The presence of __________ helps to distinguish PCP intoxication from other forms of psychosis.
nystagmus
Blockade at which receptor is believed to contribute to sedation and cause weight gain?
histamine-1 receptor
What is projective identification?
Can be thought of as a self-fulfilling prophecy, wherein the patient’s unacceptable feelings are projected to another but the other (eg, therapist) acts in such a way that they become true–for instance, a patient views the world as full of unloving people (she hates herself), then acts to push her therapist to a breaking point where he terminates her care, therefore confirming her belief that the world is full of unloving people.
What are the immature defense mechanisms?
denial, splitting, displacement, projection, projective identification
What are some examples of the neurotic defense mechanisms?
rationalization, reaction formation, intellectualization
What are some examples the mature defense mechanisms?
altruism, humor, identification, introjection, sublimation
Who is the best pampe in the world?
Inhabitant of 11k2
