Lange Q/A Flashcards
What stage of sleep do sleep terrors occur?
Deep sleep. Stages 3&4
Sleep walking also occurs during stages 3/4
What stage of sleep do nightmares occur?
REM
Expressive language disorder
Markedly limited vocabulary
Making errors in tense
Having difficulty recalling words or producing sentences with developmentally appropriate length or complexity
Most effective treatment for bulimia nervosa
Cognitive-behavioral therapy
Most common method children use when attempting suicide
Substance ingestion
Side effects associated with Desmopressin
Headaches
Nausea
What is the percentage of comorbid child anxiety disorders and MDD?
50 %
Most common adverse effects of fluoxetine
Nausea (GI upset)
Insomnia
Agitation
Headaches
Rett disorder
Between 5 months and 48 months there is a deceleration of head growth, loss of hand skills with development of stereotyped hand movements such as hand wringing, loss of social interaction, appearance of poorly coordinated gait or trunk movements, severely impaired expressive and receptive language development with severe psychomotor retardation
Monozygotic twin concordance for Rett syndrome?
100 %
Following a diagnosis of Type I Diabetes, what percentage of children develop Adjustment Disorder?
33 %
First-line treatment for Tourette disorder
Clonidine
Most common comorbid disorder associated with Tourette’s?
Obsessive-compulsive disorder
Requirements for dx of Tourettes?
Both multiple motor tics and at least one vocal tic
Potential risk with taking stimulant
Tics
*Can exacerbate tics
What percent of children with learning disorders have a comorbid psychiatric disorder?
50 %
*Most commonly ADHD, anxiety, and depressive disorders
Likelihood that child with persistent enuresis will have a comorbid mental disorder
20 %
Common adverse effects of stimulants
Insomnia Decreased appetite Weight loss Dysphoria Irritability
Stimulants are effective in treating ADHD in what percent of people?
70 %
nonstimulant treatment of both child and adult ADHD
Atomoxetine
Common lab finding in anorexia nervosa
Hypercholesterolemia
This finding alone justifies inpatient admission for anorexia nervosa
cardiac arrhythmia
How old are children when the begin to understand the irreversibility of death?
7 to 8 years old
Frequent adverse effect of clonidine
Sedation
Identification
Process of adopting other people’s characteristics
Displacement
Defense mechanism in which emotions are shifted from one idea or object to another that resembles the original but evokes less distress.
Reaction formation
Defense mechanism. An unacceptable impulse is transformed into its opposite
Most common outcome of abuse
Major depressive disorder
Alexia
Inability to read
Agnosia
Inability to recognize objects despite intact senses
Anomia
Inability to name objects even though the object is recognizable and can be described by the patient
Nonpharm treatment for OCD
CBT
Chapped hands
Common in OCD due to extensive hand washing
MAOIs
Phenelzine
Isocarboxazid
Tranylcypromine
Treatment for severe serotonin syndrome
Cyproheptadine
*5-HT2A antagonist
Serotonin syndrome features
Mental status changes
Autonomic hyperactivity
Neuromuscular abnormalities
(tachycardia, flushing, fever, hypertension, ocular oscillations, myoclonic jerks)
Atypical features of depression, such as weight gain, hypersomnia, mood reactivity, respond best to which drug?
Phenelzine (MAOI)
Most patients who are going to have a response to antidepressants, do so in what time frame?
6 weeks
However, it can take 12 weeks to achieve a full response
Benzos that are metabolized by only glucoronidation and can be given to patients with elevated LFTs
LOT
Lorazepam
Oxazepam
Temazepam
Lithium level of 1.2
Nausea
Tremor
Diarrhea
Ataxia
Lithium level of 1.5 to 2
seizures
Lithium level of 2 or more
Acute renal failure
Li level greater than 2.5
Coma/death
If patient has akathisia and no other EPS, start what drug?
Propranolol
Treatment of dystonia, parkinsonism
Benztropine
First-line treatment options for Bipolar II
Lithium
Lamotrigine
Quetiapine
Most common dangerous complication of NMS
Rhabdomyolysis
Although there are no specific lab findings for NMS, what labs are often elevated
WBC
Creatine phosphokinase
What long term side effect can occur if patient takes high dose Thioridazine.
Retinal pigmentation
*It may not remit with thioridazine is discontinued and can lead to blindness
Labs that should be obtained before starting Lithium
Electrolytes
Creatinine
BUN
Thyroid studies (Li inhibits synthesis of thyroid hormone and its release from the thyroid)
Don’t use this drug for pain in a person on Lithium
Ibuprofen
It can cause the Lithium level to become high
*Aspirin is safe
2 most common side effects of methylphenidate
Difficulty falling asleep
Decreased appetite
Antidepressant with risk of causing hypertension
Venlafaxine
Medication that best improves the symptoms of tardive dyskinesia
Clozapine
Risk of Sertraline during pregnancy
Persistent pulmonary hypertension of the newborn
Treatment of bulimia nervosa
Fluoxetine,Topiramate, or psychotherapy
*meds are not generally helpful in anorexia
Symptomrs of SSRI discontinuation syndrom
May occur 1 to 3 days after abruptly stopping SSRI. Dizziness, N/V, fatigue, lethargy, flu-like symptoms
Anxiety, crying, irritability are not uncommon
Which SSRI does not require tapering due to its long half life?
Fluoxetine
Use of what medication concurrently with Lamotrigine will cause its levels to be low
Oral contraceptives
*Lamotrigine may also induce the metabolism of OCPs potentially rendering them less effective
Most common EKG change in about 30 % of patients on Lithium
t wave inversion/depression
What class of drugs/drugs can increase lithium levels owing to decreased lithium clearance
Thiazide diuretics Ethacrynic acid Spironolactone Triamterine NSAIDs Metronidazole Tetracycline
Most effective treatment of OCD
Clomipramine
Patient with moderate response to SSRI for treatment of OCD…what is viable option for augmenting tx with SSRI?
Risperidone
Management for performance anxiety
Propranolol
Severe side effect of Lamotrigine
Rash that can turn into SJS
Opisthotonos
Spasm of neck and back that causes patient to arch forward
Oculogyric crisis
spasm of extraocular muscles, resulting in patient looking up and unable to look down.
Pleurothotonos (Pisa syndrome)
Leaning posture induced by spasm of torso muscles
torticollis
spasm of neck muscles that usually brings the neck to one side or another but may pull it forward or backward
Antidepressant approved for treatment of depression and neuropathic pain
Duloxetine
Antidepressants that do not cause sexual side effects
Mirtazapine
Buproprion
Patient on warfarin with anxiety…only class of drugs for anxiety treatment that won’t interact with warfarin?
Benzodiazepines
Anticonvulsant used in treatment of bulimia and binge eating disorder
Topiramate
Risk of using topiramate
Renal stones
Cognitive impairment, word-find difficulty, short-term memory problems
Retrograde ejaculation
Thioridazine
Rabbit syndrome
Risperidone
*Repetitive rapid movements of mouth but not tongue
Pigmented retinopathy
Thioridazine
Obstructive jaundice
Chlorpromazine
Orthostatic hypotension
Chlorpromazine
Clozapine
How long after last drink does delirium tremens usually develop?
3 days
Hyponatremia
Oxcarbazepine
Testamentary capacity
Level of competence required to make a legally valid will
Current basis for establishing an insanity defense
American Law Institute Test (Model Penal Code)
