Lange Adult Psychopath Flashcards
Cotard syndrome
Nihilistic delusions - lost possessions, may also feel like they lost blood, heart, intestines, world has been reduced to nothingness
Capgras syndrome
Delusion of doubles characterized by belief that people have been replaced by identically appearing imposters
Fregoli delusion
Variation of delusion of doubles - belief that familiar people assume guise of strangers
Folie a deux
Shared psychotic disorder
Post partum psychosis apepars when?
Within 1 week of delivery
Most cases of post partum psychosis will eventually manifest as?
BPAD
Mainstay tx of catatonia is?
Benzos or ECT
What are the contraindications to ECT?
No ABSOLUTE contraindications. However, may be dangerous to do ECT on patient with space occupying mass. May increase intracranial pressure.
What is the most common sleep distrubance (there are many sleep distrubances) in major depression?
Early morning awakenings.
Levels of what are increased in depression? What is decreased?
Coristol is increased. Catecholamines, sex hormones, and immune function is decreased.
Untreated DT mortality rate?
30%
What is Kluver Bucy syndrome?
Docility, lack of fear response, anterograde amnesia, hypersexuality, hyperphagia.
Mobius syndrome
Congenital absence of the facial nerves and nuclei with resulting bilateral facial paralysis.
What lobes are preferentially atrophied in Picks disease
Frontal and temporal lobes
Dry mouth, dizziness, urinary hestiancy due to which antideprssant?
Due to anticholienrgic and adrenergic effects of TCAs such as imipramine
Classic triad of NPH
ataxia, confusion, incontience.
What lobes are preferentially atrophied in Alzheimers
Frontal and parietal
What does CT scan show for NPH?
Dilated ventriles cue to increased pressure waves impinging wtihin ventricular system
Cerebellar atrophy is seen most commonly in which disorders?
Alcoholism and congenital disorders
Alcohol dependence criteria can be met without what qualifier
Physiologic dependence
Duration of disturbance for brief psychotic disorder is
Less than 1 month
Timing difference between Acute Stress Disorder and PTSD
If sx persist after 4 weeks => PTSD
How long do sx have to be present for GAD dx?
6 months
Lifetime incidence of suicide in schizophrenia patients is
10%
Clozapine has been which to be effective in what kind of patients and also, shows what kidn of benefit
Tx refractory depression. Shown to decrease suicidality
Projection
Primitive defense mechanism in which one assigns emotions to another person to defend against presence of emotions within oneself
Best long term tx for borderline personality patients
Individual psychotherapy and good social support
What can calm an agitated patient with delirum?
Antipsychotic like haldol
What is the rate of completed suicide in MDD?
15%
what % of people with MDD with attempt suicide
30%
Sexual sadism vs masochism
Sadism = you give the punishment, masochism = you receive the punishment
Narcolepsy
affects ppl in teens/twenties. Disorder of REM sleep mechanisms, characterized by cataplexy (sudden loss of muscle tone following intense emotion)
What is pre-menstrual dysphoric disorder and how it diferent from PMS?
remits after menses. Sx are more disruptive and cause more distress than purely PMS
How long is the average untreated depressive MDD episode? How long if treated?
6 to 13 months, with tx duration decreases to 3 months. Tx also decreases risk of recurrence in future.
How does naloxone work?
Blocks CNS opioid receptors
What is the best pharm tx for PTSD?
SSRI. May use antipsychotics in conjunction, esp if psychotic sx are present. Avoid benzos.
Factitious disorder is
UNCONSCIOUS desire to have sick role. CONSCIOUS production of sx
What % of impotence cases in 30-50 years old is psychological?
90%
Levels of what are lower in impulsive, violent, aggressive, suicide patients?
Serotonin or 5HIAA
which antidepressant also used for headahces?
TCAs.
Which antidepressant shown to have a slightly higher rate to induce manic switch?
TCAs more so than specific SSRIs
What are pseudoseizures and how are they different from seizures?
They are psychogenically induced behavior that resembles epileptic activity but EEG is normal. Often occurs in reaction to stress or in setting o personality disorder, affective disorders or conversion reactions. Not uncommon for patients to have concurrent seizure disorder.
Wernicke Korsikoff manifests with?
Anterograde amnesia, loss of immediate or short term mem
What is confabulation
Fluent fabrication of fictiious responses in compensation of memory loss
What is formication
Particular type of tactile hallucination in which one has sensation of bugs crawling on or under skin. Seen in cocain intoxication or alcohol withdrawal
What does neuroimaging show for OCD?
increased activity (metabolism) in caudate nucleus, frontal lobes, and cingulum
What are the first things to respond to antidepressants. What responds later?
Energy, sleep, appetite respond first. Later by libido, hopelessness and SI
Voyeurism
deriving sexual pleasure from secretly watching someone undress or do other sexual activity
Frotteurism
Recurrent, intense sexual fantasies and behaviors involving rubbing or touching nonconseting adult
What does the locus ceereulum do. When is it active. What does it contain most of?
It’s the alarm center in the brain. It is hyperactive in anxiety states. Contains most of NE containing neurons in brain
What does the amygdala and hippocampus do/what is it a part of
Part of the limbic system. Involved in fear/anger responses and memory formation, respectively
Where is most serotonin in the CNS synthesized?
Dorsal and medial raphe nucleus of the brain stem
Nuccleus accumbens is located in striatum and involved with?
sensations of reward and pleasure as well as addictive behaviors
What part of the brain synthesizes dopamine
Substantia niagra
Serotonin syndrome
Tachycardia, flushing, fever, myoclonic jerks, HTN, oscular oscillations. And more severe = hyperthermia, autonomic instability, coma and death
Cocaine withdrawal
dysphoric mood, hypersomnia, fatigue and increased appetitie.
Blockade of what receptor by atypical antipsychotics causes orthostatic hypotension, dizziness and ssedation?
alpha-1 R
Blockade of dopaminergic receptors in what areas are responsbile for reduction of schiz positive symptoms?
Mesolimbic and mesocortical areas
Blockade of D2 receptor in what pathway is responsbiel for EPS?
nigrostriatal
blockade of D2 receptor in what pathway responsbiel for prloactnimea
Tubero-infundibular
Blockade of what R causes sedation and weight gain with antipsychotics
Histamine
Antipsychotics also block what receptor to case sedation, dry mouth and constipation
Cholinergic receptors
Projective identification defense mechanism
Can be thought of as a self fulfilling prophecy - patient’s unacceptable feelings are projected to another but the other acts in a way that they become true. For example, patient ocntineus to cancel all appts and then you terminate her as a patient.
