MOC Exam#6 Flashcards
When should buprenorphine be started
- only when objective evidence of opiate withdrawal is present
- B can precipitate acute withdrawal symptoms when pt is intoxicated
- then prescribe ONCE daily (Long half life)
What is the association between Antisocial Personality Disorder and co-morbid substance use disorder?
-35%-60% of pts with SUD also meet criteria for ASPD
What is the prognosis for the association between ASPD and SUD
Compared to ASPD without SUD
- increased likelihood of using illicit substances
- greater psychopathology
- more depression, isolation
- mores impulsivity
- lessened life satisfaction
What are the symptoms of Organophosphate poisoning?
organophosphates cause excessive cholinergic activity (blocks acetylcholinesterase)
- SLUDGE
- salivation, lacrimation, urination, diaphoreses(defecation), gastrointestinal motility, emesis
What is antidote for organophosphate poisoning?
ATROPINE- muscarinic recepter BLOCKER
What is the difference between ATROPINE and PHYSOSTIGMINE?
PHYSOSTIGMINE is a cholinergic AGONIST
ATROPINE is a cholinergic ANTAGONIST, ANTI-CHOLINERGIC
Seizure risk in pts taking antidepressants
- overall incidence of seizures in pts taking antidepressants at therapeutic doses 0.1%-4%
- Clomipramine has highest seizure risk in this category at doses higher than 350 mg (among the TCA’s)
- risk of seizure after antidepressant overdose is high
Risk of suicide patients among pts with borderline personality disorder
-10%
Risk factors for suicide in pts with BPD
- high current and life time psychiatric comorbidity
- novelty seeking, impulsivity
- co-morbid personality disorders
What is hallucinogen persisting perception disorder?
- spontaneous, transitory recurrences of the hallucinogen experience
- visual distortions, AH, VH, visual “trails” behind moving objects
- occurs in 15%-80% of users of hallucinogens
Physical milestones of child development
- 4 months: hold and balance head, lift head 90 degrees from proned position
- 6 months: sit steadily and independently, and bounce actively when placed in standing position
- 8 months: crawl on hands and knees
- 12 months: walking (independently or one hand held)
Characteristics of somnambulism
- occurs during NREM (stage III-IV) deep sleep
- more common in boys
- runs in families
- at least 15% of children do it
- onset between 4 and 8 y of age (peak prevalence 12y)
What happens with deep (delta) sleep with age?
declines with age and can be almost absent in older people, AND
THERE ARE NO MEDICATIONS THAT RESTORE THIS!!
Symptom that distinguish amphetamine induced toxic psychosis from schizophrenia
- visual or tactile hallucinations (chronic meth use)
- disordered thinking (schizophrenia)
- affect flattening and alogia (schizophrenia)
- hyperactivity, hypersexuality, incoherence, confusion (meth use)
How long after single major depressive episode with remission should antidepressant be continued?
2 years at same dose
Indications prophylactic treatment with antidepressants in pts with MDD
- 3 or more episodes
- age >= 45 y
Characteristics of paraphillias
- practically all cases occur in males
- more than 50% have age of onset before age 18y
- pts usually meet criteria for 3-5 paraphilias, concurrently or at different times of life
- chronic, with peak paraphillic behavior between ages 15y-25y then declining
Treatment of paraphillias
- for non-violent (or other personal risk) SSRI SNRI
- for violent/high risk antiandrogen hormone treatments
- CBT & skills training
First line treatment for suspected TCA over dose
-gastric lavage with activated charcoal
Describe Wilson’s Disease
- hepatolenticular degeneration
- involves the liver and the brain
- disorder due to excessive copper accumulation
- Parkinsonism is present (masked facies, tremor, righdity)
- Ataxia, dystonia, dysarthria
- Kayser-Fleischer ring around iris present only in 2/3 of pts
Causes of neurocognitive disorders
- Alzheimer’s disease: 50%-60% of cases
- Vascular NCD: 10%-20%
- Parkinson’s Disease: 5%
- Huntington’s Disease: 5%
Distinguishing physiologic change characteristic of males, but not females, in the sexual response cycle
-men have refractory period after orgasm, women do not, allowing for multiple and successive orgasms
What percent of pts on Lammotrigine with develop a benign rash?
- 10%
- non-confluent, non-tender, spotty, and usually resolves in 10-14 days
The presence of tics is an absolute contraindication to use of stimulant medications for ADHA. TRUE or FALSE
FALSE
Characteristics of paranoid personality disorder
- suspicious, litigious, unable to accept their own feelings, engage in projection
- on guard and hypervigilant on being exploited, betrayed, deceived, harmed
Consequences of longterm sedative/hypnotic use on EEG
- decreased deep sleep
- increases in Stage 1 and Stage 2 sleep
- fragmented sleep
Typical age pattern of inhalant abuse
- peak age of use 14y-15y, declines by 17y-19y
- prevalence rates similar between male and female in 12y-17y range
- but sustained use after age 17y more common in males
Personality disorder that often co-exists in pts with bulimia
Borderline Personality Disorder
Risks of valproic acid in pregnancy
- spina bifida, and other neural tube defects
- development of autism spectrum disorder in child
The 2 drugs approved by the FDA for treatment of eating disorders
- Fluoxetine for moderate to severe bulimia, reducing binge-eating and purging behavior, reducing relapse in adolescents
- Lisdexamphetamine for severe binge-eating disorder in adults, reducing the number of binge days
Describe the following:
- Derailment
- Loose associations
- Perseveration
- Poverty of thought content
- Thought blocking
- derailment: sudden or gradual deviation from train of thought without blocking, synonymous with loose associations
- perseveration: the persistence of a response to a previous stimulus even though a new stimulus is presented
- poverty of thought content: thought that gives little information
- thought blocking: abrupt interruption and after brief pause, no recollection of previous train of thought
FDA Black Box warning for Atomoxetine for:
suicidal thoughts
-risk 4/1000 pts treated compared to placebo
Most common psychiatric disorder among pts with heart disease?
Major Depressive Disorder
Phase I clinical trials are conducted to:
-collection of safety and efficacy data
Phases of Clinical Trials
Phase I- collection of safety and efficacy data
Phase II-
Phase III- compare the results of people taking the new treatment with those taking standard treatment; determine if treatment results in fewer or more side effects
Phase IV- evaluate side effects of a new treatment that were not apparent before; determine the effects of drugs in populations which were not originally tested
Characteristics of melancholic depression
- anhedonia or depressed mood
- depressed mood regularly worse in the morning
- early morning waking
- marked psychomotor retardation OR agitation
- significant anorexia or weight loss
- excessive and inappropriate guilt
