Lange2 Flashcards
Wernicke encephalopathy (due to thiamine, vit B1, deficiency) is characterized by:
1) bilateral abducens nerve palsy
2) horizontal nystagmus
3) ataxia
4) global confusion accompanied by apathy
How are delusional disorders treated?
With an antipsychotic
T/F: a slight elevation in CSF protein count is possible in NMS
True
Depot injections of a neuroleptic (eg haldol) are (long/short)-acting and so have a (long/short) halflife.
Does this make them a good or bad choice for treating command auditory hallucinations?
Long/long
Bad! Takes too long to reach steady state; and command auditory hallucinations are a psychiatric emergency!
How do you distinguish a Major Depressive Episode from normal bereavement?
Consider MDE if:
1) symptoms last longer than 2 months
2) survivor has guilt about anything other than actions to prevent the death
3) prominent hallucinations (except for seeing/hearing the deceased occasionally)
4) psychomotor retardation
5) thoughts wanting to end life
T/F: A recent death excludes the diagnosis of adjustment disorder.
True
How do you treat adjustment disorder?
usually does not require pharmacological intervention, but instead may respond to supportive, individual, or group therapy
Is panic disorder more common in women or men?
women
What medications are used to treat panic disorder?
SSRIs
To diagnose GAD, there must be symptoms of excessive worry and anxiety occurring for over ___ months without discrete episodes
6
Neurologic deficits in conversion disorder involve either motor or sensory modalities and are believed to be a result of
underlying, unconscious psychological conflicts or stressors
What are the IQ scores for:
1) mild mental retardation
2) moderate
3) severe
4) profound
5) borderline intellectual functioning
1) mild: 50-70
2) moderate: 35-49
3) severe 20-34
4) profound (<20)
5) borderline: 71-84
What is the mechanism of action of atomoxetine and what is it used to treat?
Atomoxetine: selective NE reuptake inhibitor used for ADHD.
**effective for children who develop tics after using stimulants, but not a first-line agent
What neurologic abnormalities are seen in neurospyhilis?
Tabes Dorsalis
1) sensory ataxia with a wide-based gait
2) positive Romberg sign
3) loss of vibratory and proprioceptive senses initially in the lower extremities
4) DTRs decreased
5) pupil abnormalities (like Argyll-Robertson pupil, accommodates but does not react)
and/or General Paresis
1) dementing process with pupil abnoramlities, tremors, dyscoordination, and spasticity in the lower extremities
HIV-associated dementia is one of the most common manifestations of primary CNS invasion. What are the associated behavioral changes?
lethargy and social withdrawal
Hyperthyroidism may cause mild cognitive deficits in ______________ and ________________
calculation
recent memory
What is the criteria for dementia?
- Memory impairment
- Presence of at least one cognitive disturbance, such as aphasia, apraxia, agnosia, or disturbance in executive function
Lilliputian hallucinations (featuring miniature things or fantasy figures) and peduncular hallucinations (very realistic hallucinations of familiar things, in the dark, assoc w/ damage to midbrain and pons) are seen in
Lewy body dementia
In Lewy body dementia, psychiatric disturbances occur (before/after/simultaneously with) motor disturbances similar to Parkinson’s disease (eg cogwheel rigidity, shuffling gait, and reduced arm swinging).
simultaneously with
_______________ is characterized by changes in personality early in the illness along with primitive reflexes, such as suck, Babinski, and snout (tapping midline of lips causes pursing).
Pick disease (frontotermporal atrophy)
NOTE: the changes in personality BEFORE memory changes is what helps distinguish it from Alzheimers, in which memory changes occur before personality changes
On imaging, these patients have “boxcar” ventricles that appear as having corners rather than rounded edges.
Huntington disease
What is the “Beck Cognitive Triad”?
Negative thoughts regarding 1) the self, 2) the world, and 3) the future
About ___% of alcoholics will become severely depressed within the first week of abstaining from alcohol. If they can abstain for a total of 4 weeks, only ___% will continue to have symptoms of depression.
40%, 5%
Depressive symptoms during the first ___ weeks of stopping alcohol use are more likely to be substance-abuse.
4 weeks; after that, points to underlying, comorbid mood disorder
A monozygotic twin of a patient with bipolar disorder has a risk of ___% of developing bipolar disorder.
80-90%
What subtype of schizophrenia describes an absence of positive symptoms and a preponderance of negative symptoms?
residual
1) hypnagogic or hypnopompic hallucinations (vivid hallucinations upon falling asleep or waking up)
2) cataplexy (sudden dramatic loss of muscle tone, usually following an intense emotional reaction)
3) sleep paralysis (a loss of voluntary muscle tone at the beginning or end of sleep)
usually accompany…
NARCOLEPSY
What is the difference between advanced and delayed sleep-phase syndrome?
Advanced: drowsy during evening
delayed: drowsy in morning, alert in evening
T/F: Zolpidem does not have addictive behavior.
FALSE. Diphenhydramine does not, however, so prescribe this to substance abuse patient.
Which axis codes mental retardation?
Axis II
Which mood stabilizer can cause a benign increase in WBC count?
Lithium
In individuals with somatization disorder, ________________ is the personality disorder most common in females and _______________ in males.
1) histrionic in females
2) antisocial in males
In schizotypal personality disorder, when stress exacerbates their subtle disconnections from reality, patients can be treated with
low-dose antipsychotics
(Hypo/hyper)magnesemia is seen in alcoholism, as is thrombocyto(sis/penia).
Hypomagnesemia and thrombocytopenia
What movement abnormality is seen in Wilson disease?
hemiballismus
Two things to remember about nafazodone:
1) doesn’t cause sexual dysfunction
2) hepatitis/liver failure
Which antidepressant causes an increase in BP?
venlafaxine
Which two 2nd generations antipsychotics are the most weight neutral?
ziprasidone and aripiprazole
The ______________ is a short scale developed to assess psychiatric symptomatology primarily in patients with psychosis or severe impairment. Mainly used in research.
BPRS
THe ______________ is a self administered screening tool focused on common mental problems often presenting to the primary care physician.
PHQ
The ______________________ is a standard test to assess treatment outcomes in studies of schizophrenia nad other psychotic illnesses. Mainly used for research, it assesses positive symptoms, negative symptoms, and general psychopathology.
PANSS
What is blepharospasm?
spasm of the periorbital muscles causing sustained or exaggerated blinking
What is palilalia?
Repetition of one’s own words as if the person “gets stuck.”
Impulse control disorder where aggressive impulses result in assault or the destruction of property:
intermittent explosive disorder
This is a type of dissociative disorder described in prisoners characterized by approximate answers and talking past the point.
What is it associated with?
Ganser syndrome
associated with amnesia, disorientation, fugue, and conversion symptoms
Which antipsychotics can also be used first line as mood stabilizers?
risperidone, quetiapine, olanzapine
What is the difference between deja vu and deja entendu?
Deja vu = sensation that something has been seen before. Deja entendu = sensation that something has been HEARD before
What is jamais vu?
something that should be familiar seems quite unfamiliar
What is testamentary capacity and what is it based on?
The level of competence to make a valid will. Based on 1) understanding of the nature of the will; 2) knowledge of one’s assets; 3) knowledge of natural heirs; 4) absence of acute psychosis which might compromise rational decision making; 5) freedom from undue influence or coercion
What are the elements of capacity?
1) to communicate one’s wishes
2) to understand one’s illness
3) to understand the risks and benefits of treatment and nontreatment
4) to reason about one’s options
In a patient with limited schooling/powers of calculation, what can be used to assess attention?
random letter test
What is the difference between galantamine and memantine?
Galantamine is a AchE inhibitor, used firstline in Alzheimer’s disease. Memantine is an NMDA receptor antagonist (blocks glutamate) that can be added additionally.
What is the tool that asks friends and family of the patient to assess the function in his or her usual environment?
Blessed Rating Scale
The Weschler’s Adult Intelligence Scale Revised assesses intelligence in people age ____ and above
16
What is a projective test to assess personality structure?
Rorschach Test
Scores less than ____ on the MMSE are indicative of dementia.
24
What test is used to evaluate hemispheric language dominance prior to surgical amelioration of seizure focus?
The Wada Test
What is the most widely and highly standardized tst of perosnality?
Minnesota Multiphasic Personality Inventory 2
Which test is used to detect right-sided parietal lobe lesions and how can you tell if the lesion is there?
Rey-Osterrieth figure: sensitive to deficits in copying and lack of attention to detail
What does the Bender Gestalt Test indicate?
helps to determine if organic brain disease is present through copying figures
Patients with one episode of depression have a ____% risk fo having future episodes.
50%
What is the only medication indicated for the treatment of childhood depression?
fluoxetine
The best pampe in the world is?
Student doctor Neely
Doses of SSRIs should be (increased/decreased) when given with St. John’s wort?
Decreased, because ST. John’s wort acts kinda like a MAOI
Name at least 4 potential medical causes of depression:
1) thyroid dysfunction
2) vit B12 deficiency
3) adrenal disease
4) vascular disease
What is the likelihood of a full recovery from anorexia nervosa?
25%
In childhood disintegrative disorder, normal development occurs for at least the first ____ years after birth.
2 years
Blockade of which receptors accounts for parkinsonian symptoms?
nigrostriatal D2 receptors, resulting in an imbalance between dopamine and acetylcholine
Blockade of which receptor is believed to account for the antipsychotic effect of neuroleptics. Why do atypical antipsychotics have less EPS assocciated with them?
Mesolimbic D2 receptor blockade = antipsychotic
Atypical neuroleptics block more mesolimbic than nigrostriatal D2. (Nigrostriatal results in EPS)
What class of meds are the most effective at decreasing vocal and motor tics?
Atypical antipsychotics like risperidone
Which TCA can be used in enuresis?
imipramine
Hyperextendible joints and a prominent jaw are associated with which congenital abnormality?
Fragile X Syndrome
Which diagnoses are often comorbid in chidlren with histries of reactive attachment disorder?
ADHD, conduct disorder
What are considered to be the most effective class of drugs for treating atypical depression?
MAOIs!!!!
The diagnosis of schizoaffective disorder requires at least ____ weeks of pure psychotic symptoms without affective symptoms.
2 weeks
Individuals experiencing rapid cycling (at least 3 mainc or depressive episodes per year) respond best to which mood stabilizers?
valproic acid or carbamazepine (vs. lithium)
What is an antidepressant with a reduced risk of sexual dysfunction?
buproprion (also nefazodone)
What are two classes of medication helpful for PTSD?
SSRIs and alpha blockers (prazosin = a1, clonidine and guanfacine = a2)
Name all of Erik Erikson’s 8 stages!!
1) 0-1: trust vs mistrust
2) 1-3: autonomy vs. shame
3) 3-5: initiative vs. guilt
4) 6-11: industry vs. inferiority
5) 11 - end of adolescence: identity vs. role diffusion
6) 21-40: intimacy vs. isolation
7) 41 - 65: generativity vs. stagnation
8) 65 and older: integrity vs. despair
What are the personality traits associated with complex partial epilepsy (remporal lobe seizures)?
hyperreligious thinking or preoccupation with moral behavior; altered sexual behaviors; hypergraphia; over-elaborative communication sytles (viscosity); heightened experience of emotions
Doses of thioridazine should not exceed ______mg/dl to avoid risk of retinitis pigementosa.
800
What is the treatment and dose for acute dysonia?
1-2 mg IM benztropine; 50 mg diphenydramine; 20 mg pampe
TCAs are class Ia antiarrythmics because they possess properties similar to what?
Quinidine. Like all other class I antiarrhythmic agents, quinidine primarily works by blocking the fast inward sodium current
Which SSRI has a potent anitcholinergic effect and should be avoided in a patient with delirium?
paroxetine
When does heroin withdrawal peak?
72h after last use in dependent users
Intoxication by inhalants is marked by?
euphoria, disorientation, fear, and facial rash, although the symptoms are short-lived.
For a diagnosis of ADHD, symptoms have to be present in at least ___ settings for at least ______ months
2 settings, 6 months
What is the pharmacological treatment of Tourette’s?
neuroleptics and a2 agonists (guanfacine, clonidine)
What is the pharmacological treatment for night terrors?
if it has to be used, diazepam (Valium)
Hyperventilation causes hypocapnia and respiratory alkalosis lead to decreased cerebral blood flow and a decrease in ionized serum calcium. Dizziness, derealization, and light-headednss are caused by ___________, while circumoral tingling, carpopedal spasm, and paresthesias are symptoms of _________
1) cerebral vasoconstriction; 2) hypocalcemia
When it comes to Alzhemier therapay, which is first line? Which has a potential for hepatotoxicity? Which are more likely to cause GI distress/neuropsychiatric side effects?
first line = donepezil (well tolerated)
hepatotoxicity = tacrine
GI distress/psych = revastigmine, galantamine
What are the high potency first gen antipsychotics?
haldol, fluphenazine
What lab test can distinguish nonepileptic seizures from epileptic seizures?
serum prolactin (rises 20min after seizure)
What is constructional apraxia? Is it more or less likely indicative of a medical reason for disturbed behavior?
Difficulty drawing a clock or intersecting pentagons (more likely medical)
Family members expressive of hostility and overly controlling leads to what in schizophrenic patients?
increase in relapse rates
When should a patient be discontinued from a psychotic?
Remained symptom free for over 3 years (gradual reduction first)
What psychotic symptom is most common in terminally ill patients?
delusions
What is the difference between brief psychotic disorder and schizophreniform disorder?
Brief psychotic disorder occurs after a severe stressor
T/F: Splitting is common in patients with factitious disorder.
True. This means there should be regular interdisciplinary team meetings to manage these patients
As long as depressive symptoms don’t persist past ___ months after a death, it is considered bereavement.
2 months
Common complaints with long-term lithium use.
weight gain, metallic taste, acne, hypothyroidism, polyuria
Treatments of choice for dysthymic disorder:
buproprion or venlafaxine
What is the treatment for a manic patient who nevertheless has therapeutic mood stabilizer blood levels?
clonazepam or other long-acting benzos for sleep
Medical conditions causing anxiety-related symptoms:
1) endocrinopathies (pheochromocytoma, hyperthyroidism, hypercortisolemic states, hyperparathyroidism)
2) metabolic problems (hypoxemia, hypercalcemia, hypoglycemia)
3) neurologic disorders (vascular, trauma, degenerative)
T/F: Fluoxetine causes difficulty achieving erection.
False! Though it may cause retarded ejaculation or lower libido
Which neuroleptic can cause troubles with ejaculating?
perphenazine
How does modafinil work?
like other stimulants, it increases the release of monoamines, but also elevates hypothalamic histamine levels. Used to treat narcolepsy.
An overdose on which opiate specifically can lead to seizures?
Meperidine. Accumulation of normeperidine, a metabolite, with cerebral irritant properties.
