Lange3 Flashcards
What type of therapy is effective in Bulimia Nervosa?
CBT
What is the comorbidity of childhood anxiety disorders (overanxious disorder, separation anxiety disorder, panic disorder) and MDD?
50%
What is the rate of Rett disorder in the monozygotic twin of a girl with Rett disorder?
100%
Approximately ___% of children with learning disorders have a comorbid psychiatric disorder.
50%! This includes, most commonly, ADHD, anxiety, and depressive disorders
___% of children with enuresis have a comorbid mental disorder.
Do more boys or more girls have enuresis?
20% Boy > girls
A child should be able to count to 50 at what age?
5
What is a frequent adverse effect of clonidine?
sedation
People with BPD showcase which defense mechanisms?
splitting, projective identification, denial
What is the mainstay of treatment for catatonia?
1) benzodiazepenes or
2) ECT, if unsuccessful
What is Mobius Syndrome?
congenital absence of the facial nerves and nuclei with resulting bilateral facial paralysis
Punchdrunk syndrome is an acquired movemetn disorder associated with traumatic damage to which part of hte brain?
substantia nigra
Frontal release signs (primitive reflexes) and perseveration are nonspecific findings common in
demented patients
Cerebellar atrophy is seen in
alcoholic patients, congenital disorders
In GAD, symptoms of anxiety last at least ___ months.
6
In borderline patients, DBT should be used in conjunction with (group/individual) therapy.
Individual. Though group therapy is a component of DBT, it should be used in conjunction, not as a replacement to individual therapy.
How do you differentiate impulse control disorder fro OCD?
impulses not as ego-dystonic (distressing); no obsessional, non-enacted (thinking) component
The 3-month mortality rate of patients with one episode of delirium is _____%. The 1-year mortality may be as high as _____%
3 month: 23 to 33%
1 year: 50%
What percentage of depressed patients eventually commit suicide? What percentage will attempt?
30% will attempt, 15% will be successful
How long does an untreated MDE last?
between 6 and 13 months; with treatment, that can decrease to 3 months
The best psychotherapy for panic disorder is
CBT
What percentage of cases of impotence in the age group 30 to 50 has a psychological etiology?
90%!!! After 50, it becomes increasingly medically-related
What class of antidepressants has the highest potential to induce a manic switch?
TCAs!
What is the difference between localized amnesia and selective amnesia?
localized = memory loss surrounding a discrete period of time selective = inability to recall certain aspects of an event, though other memories of the event may be intact
What is the difference between catalepsy and cataplexy?
cataLEPSY = immobility seen in catatonic states cataPLEXY = transient loss of motor tone assoc. with strong emotions
List the following benzodiazepines in order from least to most potent:
oxazepam, alprazolam, clonazepam, diazepam, chlordiazepoxide, lorazepam
chlordiazepoxide –> oxazepam –> diazepam –> lorazepam –> alprazolam –> clonazepam
Acute renal failure requiring dialysis is caused by lithium levels greater than
2
Though clonidine is firstline in treating mild Tourette’s, more severe Tourette’s might be better treated with
D2 antagonsits through antipsychotic medication
The only medication that may improve the symptoms of tardive dyskinesia is
clozapine
What provides the most IMMEDIATE relief of symptoms of GAD?
benzodiazepines (e.g. lorazepam)!! (SSRIs and buspirone take a few weeks for effect).
What is the most common ECG change inflicted by lithium use?
T wave depression or inversion. The changes are usually not clinically significant. Can cause SA block or AB block, but these are usually due to underlying cardiac disease.
In refractory OCD, what can be used to augment SSRIs?
2nd gen antipsychotics like risperidone!
Which receptor is most likely responsible for clozapine’s efficacy?
D4
Compare imipramine and nortryptiline in terms of their effects on alpha1-receptors (and orthostatic hypotension, as a result).
Imipramine (3* amine) blocks multiple receptors and has many side effects
Nortryptiline (2* amine) has less alpha1-blocking potency and tends to be better tolerated
Compare NALOXONE and NALTREXONE.
naloxone = opiate antagonist to reverse opiate intoxication naltrexone = opioid antagonist that can decrease the number of days a person with alcohol dependence drinks and can increase the time before relapse of heavy drinking
What is the usual dose range for lorazepam?
2 to 6 mg/day for anxiety, divided over 2-3 doses
Why isn’t flumazenil given to a patient that has severely altered consciousness when dextrose, thiamine, and naloxone are?
flumazenil can lower the seizure threshold, so it should not be used before obtaining more history
What is buprenorphine?
A mixed opioid agonist-antagonist which suppresses opioid withdrawal and blocks the effects of other opioids
T/F: Risperidone can cause orthostatic hypotension, weight loss, and anticholinergic effects.
FALSE! While it can cause orthostatic hypotension, it does not cause appreciable anticholinergic effects and it causes weight GAIN.
What is topiramate and what is it used for? Side effects?
An anticonvulsant used in the treatment of bulimia and binge eating; decreases frequency of binge episodes and leads to weight loss. Can also be used in bipolar. Can result in renal stones (1.5% risk_ and cognitive impairment
Which drug, when used in combination with citalopram, can lead to a prolongation of the QTc?
pimozide, first generation antipsychotic
What can be used to help with the sialorrhea resulting from clozapine? (30% of patients)
clonidine!
How does clozapine affect the heart?
Causes a persistent sinus tachycardia; can be treated with propanolol.
NOTE: clozapine can cause orthostatic hypotension via alpha receptor blockade, so labetalol (mixed a and b antagonist) would not be a good treatment choice!
Which of the atypical antipsychotics are least likely to cause metabolic syndrome, including weight gain, hyperlipidemia, hypercholesterolemia, and insulin resistance? Which are the most likely?
least likely: ziprasidone, aripiprazole
medium: risperidone and quetiapine
most likely: clozapine and olanzapine
Which medication can be used to treat middle insomnia (frequent awakening during the night)?
Zaleplon, a non-benzo hypnotic
Why should you use olanzapine, and not haldol, in a delirious patient with a prolonged QTc?
haldol can also lengthen the QTc (should be less than 440)
How do buspirone and citalopram affect warfarin?
can lead to decreased efficacy of warfarin! watch PT/PTT and INR
What is the difference between nymphomania and satyriasis?
insatiable sexual desire in women (nymph) vs men (satyr)
Obstructive jaundice, including fever, nausea, malaise, and pruritus, can result from use of which drug?
chlorpromazine
alpha1-receptor blockade resulting in orthostatic hypotension is particularly troublesome in which antipsychotics?
chlorpromazine and clozapine
While alcohol withdrawal with focal seizures can occur within ___ hours of cessation of drinking, DTs occur starting ___ hours after cessation of drinking.
withdrawal = 48; DTs = 72
Oxcarbazepine can result in
hyponatremia! (2.5% of cases)
Technique in which group members are used as the audience adn the cast in reenactments of scenarios and conflict in order to explore individual problems in a group setting:
psychodrama
Common technique where each group member is asked to introduce themselves, state how they are feeling, or otherwise specifically respond:
go-around
When a patient relives an emotional or traumatic experience to get rid of or purge negative emotions and move forward:
abreaction
What is the difference between the techniques of “reframing” and “clarification”?
reframing: examining how patient’s thoughts or beliefs about themselves may be skewed
clarification: further details about a patient’s experience or situation they are describing
Are reflexes reduced or increased during a trance state like hypnosis?
Reduced
In which type of therapy is a single, focal area of conflict identified?
brief psychodynamic therapy
____________ is one’s tendency to relate events to oneself without any reason for doing so
personalization
What is “selective abstraction”?
A term from cognitive therapy where the details of a scenario are taken out of context and believed while everything else contrary about the scenario is ignored
In paradoxical therapy the therapist suggests that the patietn engage in the behavior with negative connotations (phobia or compulsion). Who was it developed by?
Bateson
When expression of emotion elicits emotional response in other members of the group:
contagion
When the group recreates a family of origin or the original dynamics of a conflict which helps a patietn work through their original conflict:
corrective experience
When group emmbers test norms and compete with each otehr to establish autonomy:
differentiation
What is the “real relationship” in psychodynamic therapy?
the relationship between a psychoanalyst and patient which is not influenced by transference
Made many contributions to psychiatry and neurology with a special interest in describing hysteria:
Jean-Martin Charcot
Known as the inventor of the “cathartic” treatment or talking therapy:
Josef Breuer
Known as the developer of self-psychology:
Heinz Kohut (helped direct approaches to treatment of narcissism, selfobject transferences’ of mirroring and idealization, need self-esteem mirrored back, identify with larger whole)
Father of modern hypnosis:
Anton Mesmer
