lange qbank review Flashcards
Cotard syndrome content of delusion
Nihilistic, rejecting all religious and moral principles in the belief that life is meaningless or that their body is no longer in existence, can feel like they are rotting.
Capgras syndrome content of delusion
People familiar to pt have been replaced by exact look alike
Delusional disorder
Non bizarre delusions.
Postpartum psychosis
Characterized by depression, mood lability, delusions, and a hallucinations. Most cases are a result of bipolar disorder.
Sleep disturbance associated with depression
Early morning waking.
Cortisol and catecholamine levels in depression
Increased cortisol levels.
Decreased catecholamines.
Cyclothymia
Cycling between hypomania and dysthymia.
Double depression
MDD superimposed on dysthymic disorder.
Psychotic presentation with abdominal pain
Porphyria.
Kluver-Bucy syndrome
Presents with docility, lack of fear response, anterograde amnesia, hyperphagia and hypersexuallity.
Due to severe damage to or disconnection of the amygdala bilaterally
Punchdrunk syndrome
Acquired movement disorder associated with traumatic damage to the substantia nigra.
Treatment of choice for Panic Disorder with or without agoraphobia
Fluoxetine (SSRI)
Common side effects of TCA SSRI MAOI Li Depakote
TCA: dry mouth, dizziness (associated w/ hypotension), and urinary hesitancy (due to anticholinergic blocking).
SSRI: GI upset, sexual dysfunction, and agitation.
MAOI: hypotension (less likely to have anticholinergic effects)
Li: (DI),polyuria, polydipsia, tremor and mental confusion at higher doses.
Depakote: GI upset, sedation, and tremors
What differentiates dependence from abuse?
Pt’s inability to quit drinking regardless of a desire to quit or knowledge of its negative aspects best differentiates dependence from abuse.
Lab findings in alcoholic pts
Elevated GGT
AST>ALT (both elevated)
Increased uric acid (thus increase risk of gout)
Macrocytic anemia
Increased serum triglycerides (part of liver dz)
ECT treatment by the numbers
2-4 for Catatonia
6-12 for Major Depression
>20 for Psychosis or mania
Frotteurism
Sexual arousal by touching or rubbing up against a nonconsenting person.
Fetishism
Sexual arousal connected to nonliving objects.
Stigmata of narcolepsy
HYPERSOMNIA
CATAPLEXY
SLEEP PARALYSIS
HYPNAGOGIC HALLUCINATIONS (vivid dream like hallucinations during wake sleep transition).
Cataplexy
a sudden and transient episode of muscle weakness accompanied by full conscious awareness, typically triggered by emotions such as laughing, crying, terror, etc.
Negative prognostic factors in schizophrenia
Early onset, poor premorbid social and work functions, withdraw/autistic behavior, positive family hx, poor social support, negative symptoms, neurologic symptoms and hx of perinatal trauma.
Suicide risk in depression
10-15%
Pharmacological treatment of PTSD
SSRI
Factitious disorder vs malingering
In factitious disorder the secondary gain is to assume the sick role.
In malingering the secondary gain is a material financial or material.
Left frontal hemisphere infarct vs right frontal hemisphere infarcts
Left frontal hemisphere -> depression.
Right frontal hemisphere -> euphoria, inappropriate indifference, or mania.
Rates of schizophrenia w/ 1 affected parent vs 2 affected parents
One parent = 12% risk of developing schizophrenia.
Two parents = 40% risk of developing schizophrenia
Schizophrenia rates amongst twins
50% monozygotic
12% dizygotic
8% siblings
Neurologic signs associated with schizophrenia
Short term memory deficits.
Unstable smooth pursuit of eye movements
Sensory gating abnormalities (habituation to repeated sensory stimulus).
Haptic hallucinations
Tactile hallucination, pt feels as if they are being touched.
Hypnagogic vs Hypnopompic hallucinations
Hypnagogic occur as you fall asleep
Hypnopompic occur as you wake up
Difference between localized amnesia and selective amnesia
Localized amnesia involves a discrete period of time where all memories are lost.
In selective amnesia, parts/aspects of the memory are blocked,
Sleep pattern changes in depressed pt
Increased sleep latency (hard to fall asleep).
Increased REM latency (harder to reach REM sleep).
Early morning awakening.
Increased wakefulness.
REM sleep mostly in first half of the night.
Areas of brain affected by OCD
Increased activity (metabolism) in the caudate nucleus, frontal lobes, and cingulum.
Examples of culture bound delusions
Koro: worry that penis is shrinking into abdomen, found in south east asia.
Zar: delusions of possession by spirit.
Taijin Kyofusho: belief that body is offensive to others.
Ideas of reference
Delusion that others are focusing on you in some positive or negative way. Commonly seen in paranoid schizophrenia. Eg. TV is speaking to pt, parents are trying to kill pt.
Locus Ceruleus
Alarm center of the brain, it is hyperactive in agitated states (tachycardia, diaphoresis, dilated pupils).
Serotonin syndrome cause and presentation
Pt on MAOI, then takes an SSRI, TCA, Buspirone, Venlafaxine. Results in dysautonomia, flushing, fever, and myoclonic jerks.
Where is serotonin synthesized?
Dorsal and medial raphe nucleus
Where is NE synthesized?
Locus Ceruleus
Conversion disorder
Sudden onset of singular neurologic deficit, often in setting of stress.
Hallmark of hypochondriasis
Belief that pt has illness.
Dangerous withdrawals drugs
Benzodiazepines and alcohol.
Treatment for panic disorder with agoraphobia
SSRI - specially Paroxetine and Sertraline
Effect of stimulants such as methylphenidate on tics
They can make them worst.
Treatment of Tics and Tourette’s
Haloperidol or Pimozide (D2 receptor antagonist, Typical antipsychotics)
Describe Tardive Dyskinesia
Consists of a number of abnormal and involuntary movements such as lip smacking, facial grimacing, and dance like movements of limbs and trunk.
Treatment of GAD
Immediate relief with Benzos - Alprazolam. Long term relief with Buspirone (5HT1A partial agonist). It takes 2 weeks to kick in.
Pharmacological intervention for BPD
SSRI and antipyschotics
SSRI discontinuation syndrome
Occurs 1-3 days after stopping SSRI. Most commonly manifest as dizziness, nausea, vomiting and flu like symptoms.
ECG changes associated with lithium
Inverted T-waves.
Drugs that increase/decrease lithium levels
Increase: Thiazide diuretics, K sparing diuretics, NSAIDS (excepts ASA) and metronidiazole.
Most effective treatment of OCD
Clomipramine (TCA with serotonin re-uptake inhibition)
