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Pathology Flashcards

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1
Q
  • X-linked dominant disorder seen almost exclusively in girls
  • affected males die in utero or shortly after birth
  • Symptoms usually become apparent around ages 1-4, including regression characterized by loss of development, loss of verbal abilities, intellectual disability, ataxia, and stereotyped hand-wringing
A

Rett syndrome

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2
Q

Enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms

A

oppositional defiant disorder

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3
Q
  • Common onset at 7-9 years
  • Overwhelming fear of separation from home or loss of attachment figure
  • May lead to factitious physical complaints to avoid going to or staying at school
A

Separation anxiety disorder

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4
Q

Describe the age and time frame needed to diagnose Tourette

A
  • Onset before age 18

- sudden, rapid, recurrent, nonrhythmic, stereotypes motor and vocal tics that persist for > 1 year

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5
Q

Time criteria for Delusional Disorder

A

Fixed, persistent false belief system lasting > 1 month

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6
Q

What is a Manic episode? give characteristics and time criteria

A

-Distinct period of abnormally and persistently elevated, expansive, or irritable mood that abnormally and persistently increases activity or energy lasting at least 1 weeks

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7
Q

Describe what a hypomanic episode is

A
  • Like manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization. NO psychotic features
  • Lasts at least 4 consecutive days
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8
Q

Bipolar I is defined by what

A

presence of at least 1 manic episode +/- a hypomanic or depressive episode

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9
Q

Bipolar II is defined by what

A

presence of a hypomanic and a depressive disorder

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10
Q

What is cyclothymic disorder

A

-Milder form of bipolar disorder lasting AT LEAST 2 YEARS, fluctuating between mild depressive and hypomanic symptoms

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11
Q

Time frame for Major depressive disorder

A

6-12 months usually

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12
Q

time frame for Persistent depressive disorder (dysthymia)

A

-depression, often milder, lasting at least 2 years

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13
Q

Time frame for Post-traumatic stress disorder

A

> 1 month

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14
Q

What is Acute stress disorder

A

-same as PTSD but lasts between 3 days and 1 month

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15
Q

False, nondelusional belief of being pregnant. May have signs and symptoms of pregnancy but is not pregnant

A

Pseudocyesis

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16
Q

Sleep terror disorder occurs during what stage of sleep

A

slow-wave/deep (N3) sleep

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17
Q

Describe the cause of Narcolepsy

A

-decreased hypocretin production in lateral hypothalamus

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18
Q

Positive symptoms of schizophrenia

A
  • Hallucinations
  • Delusions
  • Bizarre behavior
  • Disorganized speech
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19
Q

Negative symptoms of Schizophrenia

A
  • Flat or blunted affect
  • anhedonia
  • Apathy
  • Alogia
  • Lack of interest in socialization
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20
Q

Cognitive symptoms of Schizophrenia

A
  • Impairments in attention
  • Executive function
  • working memory
  • —> poor work and school performance
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21
Q

The 5 A’s of Schizophrenia

A
  • Anhedonia
  • Affect (flat)
  • Alogia (poverty of speech)
  • Avolition (Apathy)
  • Attention (Poor)
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22
Q

Repeats words or phrases

A

-Echolalia

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23
Q

mimics behavior (PRActices behavior)

A

EchoPRAxia

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24
Q

People born in what seasons have a higher incidence of schizophrenia?
What is the theory?

A
  • Later winter and early spring

- Seasonal variation in viral infections, particularly second trimester exposure to influenza virus

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25
Q

What is the name of the hypothesis for why schizophrenia is found in lower socioeconomic groups

A

Downward Drift

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26
Q

an unpleasant, subjective sense of restlessness and need to move, often manifested by the inability to sit still

A

Akathisia

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27
Q

What are the theorized Dopamine pathways affected in Schizophrenia

A
  • Prefrontal cortical: inadequate dopaminergic activity responsible for negative symptoms
  • Mesolimbic: Excessive dopaminergic activity responsible for positive symptoms
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28
Q

What are the other neurotransmitter Abnormalities implicated in Schizophrenia besides dopamine

A
  • Elevated Serotonin
  • Elevated norepinephrine
  • decrease in GABA: decrease expression of the enzyme necessary to create GABA in the hippocampus
  • Decrease levels of Glutamate receptors: fewer NMDA receptors, this corresponds to the psychotic symptoms observed with NMDA antagonists like ketamine
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29
Q

CT and MRI of patients with schizophrenia may show what

A
  • enlargement of the ventricles
  • diffuse cortical atrophy
  • reduced brain volume
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30
Q

Schizophrenia often involves neologisms. What is this

A

-a newly coined word or expression that has meaning only to the person who uses it

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31
Q

What factors are associated with better prognosis of schizophrenia

A
  • Later onset
  • Good social support
  • positive symptoms
  • Mood symptoms
  • acute onset
  • female gender
  • few relapses
  • Good premorbid functioning
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32
Q

What factors are associated with a Worse prognosis of schizophrenia?

A
  • Early onset
  • Poor social support
  • Negative symptoms
  • Family history
  • Gradual onset
  • Male gender
  • Many relapses
  • Poor premorbid functioning (social isolation, etc)
  • Comorbid substance use
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33
Q

What are the different types of delusions and what do they mean

A
  • Erotomanic type: Delusion that another person is in love with the individual
  • Grandiose: Delusions of having great talent
  • Somatic: Physical delusions
  • Persecutory: Delusions of being persecuted
  • Jealous type: Delusions of unfaithfulness
  • Mixed type: More than 1 of the above
  • Unspecified: Not a specific type as described
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34
Q

Koro is a psychosis found where?

What is the manifestations?

A
  • Southeast Asia (e.g. Singapore)

- Intense anxiety that the penis will recede into the body, possibly leading to death

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35
Q

Amok is a psychosis found where?

What is the manifestation?

A
  • Malaysia

- Sudden unprovoked outbursts of violence, often followed by suicide

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36
Q

Brain Fag is a psychosis found where?

Manifestation?

A
  • Africa

- Headache, fatigue, eye pain, cognitive difficulties, and other somatic disturbances in male students

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37
Q

Describe the sleep problems associated with Major depressive Disorder

A
  • Multiple awakenings
  • Initial and terminal insomnia (Hard to fall asleep and early morning awakenings)
  • Hypersomnia (excessive sleepiness) is less common
  • Rapid eye movement (REM) sleep shifted earlier in the night and for a greater duration, with reduced stages 3 and 4 (slow wave) sleep
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38
Q

Describe Major depressive disorder with melancholic features

A
  • more likely in severely ill inpatients, including those with psychotic features
  • anhedonia
  • early morning awakenings
  • depression worse in morning
  • psychomotor disturbance
  • excessive guilt
  • anorexia
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39
Q

Describe Major depressive disorder with atypical features

A
  • hypersomnia
  • hyperphagia
  • reactive mood
  • leaden paralysis
  • hypersensitivity to interpersonal rejection
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40
Q

Describe major depressive disorder with mixed features

A

manic/hypomanic symptoms present during the majority of days during MDE

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41
Q

Describe Major depressive disorder with Catatonia

A
  • catalepsy (immobility)
  • Purposeless motor activity
  • Extreme negativism or mutism
  • bizarre postures
  • echolalia
  • Especially responsive to ECT (May also be applied to bipolar disorder)
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42
Q

Describe Major Depressive disorder with Psychotic features

A

-presence of delusions and/or hallucinations

43
Q

Describe Major Depressive disorder with anxious distress

A

-Defined by feeling keyed up/tense, restless, difficulty concentrating, fears of something bad happening, and feeling of loss of control

44
Q

Describe MDD peripartum onset

A

occurs during pregnancy or 4 weeks following delivery

45
Q

Patients with Fall-onset SAD (seasonal affective disorder or “winter-depression”) often respond to what type of therapy

A

light

46
Q

what is the triad for seasonal affective disorder

A
  • Irritability
  • Carbohydrate craving
  • Hypersomnia
47
Q

Major depression with psychotic features is best treated with what?

A

-a combination of antidepressant and antipsychotic or ECT

48
Q

Socioeconomic status correlation with bipolar I disorder

A

High-income countries have twice the rate of low-income countries

49
Q

What is rapid cycling bipolar disorder

A

-occurrence of four or more mood episodes in 1 year (major depressive, hypomanic, or manic)

50
Q

What pharmacotherapy are particularly useful for rapid cycling bipolar disorder

A

-the anticonvulsants carbamazepine and valproic acid

51
Q

What is the best treatment for a pregnant woman who is having a manic episode

A
  • ECT

- it provides a good alternative to antipsychotics and can be used with relative safety in all trimesters

52
Q

long term use of lithium for bipolar reduces risk of what

A

suicide

53
Q

Bipolar II is alternatively called what

A

-recurrent major depressive episodes with hypomania

54
Q

Criteria for Persistent Depressive Disorder (Dysthymia)

A
  • Depressed mood for the majority of time most days for at least 2 years (in children or adolescents for at least 1 year)
  • At least 2 of the following: Poor concentration or difficulty making decisions, Feelings of hopelessness, poor appetite or overeating, insomnia or hypersomnia, Low energy or fatigue, low self-esteem
  • During the 2 year period: The person has not been without the above symptoms for > 2 months at a time. May have Major depressive episodes or meet criteria for major depression continuously. The patient must never have had a manic or hypomanic episode (This would make the diagnosis bipolar or cyclothymic disorder, respectively)
55
Q

Describe Cyclothymic disorder

A
  • Alternating periods of hypomania and periods with mild-to-moderate depressive symptoms
  • Numerous periods with hypomanic symptoms (but not a full hypomanic episode) and periods with depressive symptoms (but not full MDE) for at least 2 years
  • The person must never have been symptom free for > 2 months during those 2 years
  • No hx of major depressive episode, hypomania, or manic episodes
56
Q

Describe Prementrual dysphoric disorder

A

-Mood lability, irritability, dysphoria, and anxiety that occur repeatedly during the premenstrual phase of the cycle

57
Q

Describe Disruptive mood dysregulation disorder

A
  • Chronic, persistent irritability occurring in childhood and adolescence
  • Severe recurrent verbal and/or physical outbursts out of proportion to situation
  • Outbursts >/= 3 per week and inconsistent with developmental level
  • Mood between outbursts is persistently angry/irritable most of the day nearly every day, and is observed by others
  • Symptoms for at least 1 year, and no more than 3 months without symptoms
  • Symptoms in at least 2 settings (e.g. home, school, peers)
  • Symptoms must have started before age 10, but diagnosis can be made from ages 6 to 18
  • No episodes meeting full criteria for manic/hypomanic episode lasting longer than 1 day
  • Behaviors do not occur during MDD and not better explained by another mental disorder (this disorder cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder)
  • Symptoms not due to a substance or another medical condition
58
Q

Major neurotransmitter systems implicated in anxiety

A
  • NE
  • Serotonin
  • GABA
59
Q

what is the most common form of psychopathology

A

Anxiety

60
Q

This is a 5-HT1a partial agonist and is a non-benzodiazepine anxiolytic; however, it is not commonly used due to minimal efficacy and often only prescribed as augmentation

A

Buspirone

61
Q

Criteria of Panic disorder

A
  • Recurrent, unexpected panic attacks without an identifiable trigger
  • One or more of panic attacks followed by >/= 1 month of continuous worry about experiencing subsequent attacks or their consequences, and/or a maladaptive change in behavior (e.g. avoidance of possible triggers)
  • Not caused by the directs effects of a substance, another mental disorder, or another medical condition
62
Q

Intense fear of being in public places where escape or obtaining help may be difficult

A

Agoraphobia

63
Q

Performance anxiety is often successfully treated with what

A

beta blockers

64
Q

What drug do you use to stop nightmares in PTSD

A

Prazosin

65
Q

First line treatment for PTSD

A

-SSRIs or SNRIs

66
Q

Time frame for adjustment disorder

A
  • within 3 months in response to an identifiable stressful life event
  • symptoms resolve within 6 months after stressor has terminated
67
Q

Most effective treatment for Adjustment disorder

A

supportive psychotherapy

68
Q

What are the Cluster A personality disorders and vaguely describe them

A
  • Schizoid
  • Schizotypal
  • Paranoid
  • Pts seem eccentric, peculiar, or withdrawn
  • Familial association with psychotic disorders
69
Q

What are the Cluster B personality disorders and vaguely describe them

A
  • Antisocial
  • Borderline
  • Histrionic
  • Narcissistic
  • Pts seem emotional, dramatic, or inconsistent
  • Familial association with mood disorders
70
Q

What are the Cluster C personality disorders and vaguely describe them

A
  • Avoidant
  • Dependent
  • Obsessive-compulsive
  • Pts seem anxious or fearful
  • Familial association with anxiety disorders
71
Q

Histrionic patients often use what defense mechanism

A

-Regression: they revert to childlike behaviors

72
Q

Borderline patients commonly used what defense mechanism

A

-splitting

73
Q

What defense mechanism is often seen in people with dependent personality disorder?

A

regression

74
Q

What drugs often decrease the intrusive thoughts associated with OCD

A

SSRIs

75
Q

Rotatory nystagmus is strongly suggestive for intoxication with what

A

PCP

76
Q

What is the most common infectious agent known to cause cognitive impairment

A

HIV

77
Q

Rapidly progressive cognitive decline with myoclonus is suggestive of what

A

Creutzfeldt-Jakob disease (CJD)

78
Q

what are the 3 W’s of normal pressure hydrocephalus

A
  • Wobbly: Gait disturbance
  • Wet: Urinary incontinence
  • Wacky: Cognitive impairment
79
Q

Genetic causes of Mental Retardation

A
  • Down syndrome
  • Fragile X syndrome
  • Prader-Willi
  • Phenylketonuria
  • Williams syndrome
  • Angelman syndrome
  • Tuberous sclerosis
80
Q

Prenatal causes of Mental Retardation

A
  • Infection and toxins (TORCH)
  • Toxo
  • Other (Syphilis, AIDS, alcohol, illicit drugs)
  • Rubella (German Measles)
  • Cytomegalovirus (CMV)
  • Herpes Simplex
81
Q

Perinatal causes of mental retardation

A
  • Anoxia
  • Prematurity
  • Birth trauma
  • meningitis
  • Hyperbilirubinemia
82
Q

Postnatal causes of mental retardation

A
  • Hypothyroidism
  • Malnutrition
  • Toxin exposure
  • Trauma
  • psychosocial causes
83
Q

Characteristic physical features of Down syndrome?

A
  • Epicanthic folds
  • Flat nasal bridge
  • Palmar crease
84
Q

Characteristic physical features of Fragile X syndrome?

A
  • Macrocephaly
  • Joint hyperlaxity
  • Macroorchidism in postpubertal males
85
Q

Characteristic physical features of Prader-Willi syndrome?

A
  • Obese
  • Small stature
  • Almond-shaped eyes
86
Q

Three features of fetal alcohol syndrome

A
  • Growth retardation
  • CNS involvement (structural, neurologic, functional)
  • Facial Dysmorphology (Smooth philtrum, short palpebral fissures, thin vermillion border): Fetal alcohol exposure may cause a range of developmental disabilities, including ID)
87
Q

What should you always rule out before diagnosing a specific learning disorder

A

sensory deficits

88
Q

What is the primary treatment of Conversion disorder

A
  • Education about the illness

- CBT, with or without therapy, can be used if education alone is not effective

89
Q

What CSF finding has been associated with impulsiveness and aggression?

A

low levels of serotonin

90
Q

65% of pts with kleptomania also have what other comorbid psychiatric illness?

A

bulimia nervosa

91
Q

Describe refeeding syndrome

A
  • electrolyte and fluid shifts that occur when severely malnourished patients are refed too quickly
  • look for fluid retention and decreased levels of phosphorus, magnesium and calcium
  • complications: arrhythmias, respiratory failure, delirium, and seizures
92
Q

What are the cortisol levels usually in anorexia nervosa

A

increased . . . they are usually normal in bulimia nervosa

93
Q

what is an effective medication for bulimia

A

fluoxetine

94
Q

What is considered first line therapy for chronic insomnia

A

CBT

95
Q

What is the most common reason patients are put on long-term benzodiazepines

A

insomnia

96
Q

What does REM sleep do to BP, heart rate, and respiratory rate?

A

increases

97
Q

Treatment for Obstructive sleep apnea

A
  • Positive airway pressure: continuous (CPAP) and in some bilevel (BiPAP)
  • Behavioral strategies such as weight loss and exercise
  • surgery
98
Q

What drug abuse is associated with central sleep apnea

A

chronic opioid users

99
Q

What is the treatment for the cataplexy associated with narcolepsy?

A
  • Sodium oxybate (drug of choice)
  • TCAs
  • SSRI/SNRI
100
Q

Risk factors for restless leg syndrome?

A
  • Increases with age
  • strong familial component
  • Iron deficiency
  • medications
  • cardiovascular disease
101
Q

Treatment for restless leg syndrome?

A
  • Responds well to pharmacologic treatments
  • Remove offending agents
  • Iron replacement if low ferritin
  • Dopamine agonists and Benzos are first line
  • Low potency opioids can be used for treatment-refractory patients
102
Q

Describe how dopamine and serotonin affect sexual function

A
  • Dopamine enhances libido

- Serotonin inhibits sexual function

103
Q

What is the treatment for TCA overdose

A

Sodium bicarb

Psych rotation (8 decks)

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