Pathology Flashcards
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
2
Q
Enduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms
A
oppositional defiant disorder
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
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
5
Q
Time criteria for Delusional Disorder
A
Fixed, persistent false belief system lasting > 1 month
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
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
8
Q
Bipolar I is defined by what
A
presence of at least 1 manic episode +/- a hypomanic or depressive episode
9
Q
Bipolar II is defined by what
A
presence of a hypomanic and a depressive disorder
10
Q
What is cyclothymic disorder
A
-Milder form of bipolar disorder lasting AT LEAST 2 YEARS, fluctuating between mild depressive and hypomanic symptoms
11
Q
Time frame for Major depressive disorder
A
6-12 months usually
12
Q
time frame for Persistent depressive disorder (dysthymia)
A
-depression, often milder, lasting at least 2 years
13
Q
Time frame for Post-traumatic stress disorder
A
> 1 month
14
Q
What is Acute stress disorder
A
-same as PTSD but lasts between 3 days and 1 month
15
Q
False, nondelusional belief of being pregnant. May have signs and symptoms of pregnancy but is not pregnant
A
Pseudocyesis
16
Q
Sleep terror disorder occurs during what stage of sleep
A
slow-wave/deep (N3) sleep
17
Q
Describe the cause of Narcolepsy
A
-decreased hypocretin production in lateral hypothalamus
18
Q
Positive symptoms of schizophrenia
A
- Hallucinations
- Delusions
- Bizarre behavior
- Disorganized speech
19
Q
Negative symptoms of Schizophrenia
A
- Flat or blunted affect
- anhedonia
- Apathy
- Alogia
- Lack of interest in socialization
20
Q
Cognitive symptoms of Schizophrenia
A
- Impairments in attention
- Executive function
- working memory
- —> poor work and school performance
21
Q
The 5 A’s of Schizophrenia
A
- Anhedonia
- Affect (flat)
- Alogia (poverty of speech)
- Avolition (Apathy)
- Attention (Poor)
22
Q
Repeats words or phrases
A
-Echolalia
23
Q
mimics behavior (PRActices behavior)
A
EchoPRAxia
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
25
What is the name of the hypothesis for why schizophrenia is found in lower socioeconomic groups
Downward Drift
26
an unpleasant, subjective sense of restlessness and need to move, often manifested by the inability to sit still
Akathisia
27
What are the theorized Dopamine pathways affected in Schizophrenia
- Prefrontal cortical: inadequate dopaminergic activity responsible for negative symptoms
- Mesolimbic: Excessive dopaminergic activity responsible for positive symptoms
28
What are the other neurotransmitter Abnormalities implicated in Schizophrenia besides dopamine
- 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
29
CT and MRI of patients with schizophrenia may show what
- enlargement of the ventricles
- diffuse cortical atrophy
- reduced brain volume
30
Schizophrenia often involves neologisms. What is this
-a newly coined word or expression that has meaning only to the person who uses it
31
What factors are associated with better prognosis of schizophrenia
- Later onset
- Good social support
- positive symptoms
- Mood symptoms
- acute onset
- female gender
- few relapses
- Good premorbid functioning
32
What factors are associated with a Worse prognosis of schizophrenia?
- Early onset
- Poor social support
- Negative symptoms
- Family history
- Gradual onset
- Male gender
- Many relapses
- Poor premorbid functioning (social isolation, etc)
- Comorbid substance use
33
What are the different types of delusions and what do they mean
- 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
34
Koro is a psychosis found where?
| What is the manifestations?
- Southeast Asia (e.g. Singapore)
| - Intense anxiety that the penis will recede into the body, possibly leading to death
35
Amok is a psychosis found where?
| What is the manifestation?
- Malaysia
| - Sudden unprovoked outbursts of violence, often followed by suicide
36
Brain Fag is a psychosis found where?
| Manifestation?
- Africa
| - Headache, fatigue, eye pain, cognitive difficulties, and other somatic disturbances in male students
37
Describe the sleep problems associated with Major depressive Disorder
- 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
38
Describe Major depressive disorder with melancholic features
- more likely in severely ill inpatients, including those with psychotic features
- anhedonia
- early morning awakenings
- depression worse in morning
- psychomotor disturbance
- excessive guilt
- anorexia
39
Describe Major depressive disorder with atypical features
- hypersomnia
- hyperphagia
- reactive mood
- leaden paralysis
- hypersensitivity to interpersonal rejection
40
Describe major depressive disorder with mixed features
manic/hypomanic symptoms present during the majority of days during MDE
41
Describe Major depressive disorder with Catatonia
- catalepsy (immobility)
- Purposeless motor activity
- Extreme negativism or mutism
- bizarre postures
- echolalia
- Especially responsive to ECT (May also be applied to bipolar disorder)
42
Describe Major Depressive disorder with Psychotic features
-presence of delusions and/or hallucinations
43
Describe Major Depressive disorder with anxious distress
-Defined by feeling keyed up/tense, restless, difficulty concentrating, fears of something bad happening, and feeling of loss of control
44
Describe MDD peripartum onset
occurs during pregnancy or 4 weeks following delivery
45
Patients with Fall-onset SAD (seasonal affective disorder or "winter-depression") often respond to what type of therapy
light
46
what is the triad for seasonal affective disorder
- Irritability
- Carbohydrate craving
- Hypersomnia
47
Major depression with psychotic features is best treated with what?
-a combination of antidepressant and antipsychotic or ECT
48
Socioeconomic status correlation with bipolar I disorder
High-income countries have twice the rate of low-income countries
49
What is rapid cycling bipolar disorder
-occurrence of four or more mood episodes in 1 year (major depressive, hypomanic, or manic)
50
What pharmacotherapy are particularly useful for rapid cycling bipolar disorder
-the anticonvulsants carbamazepine and valproic acid
51
What is the best treatment for a pregnant woman who is having a manic episode
- ECT
| - it provides a good alternative to antipsychotics and can be used with relative safety in all trimesters
52
long term use of lithium for bipolar reduces risk of what
suicide
53
Bipolar II is alternatively called what
-recurrent major depressive episodes with hypomania
54
Criteria for Persistent Depressive Disorder (Dysthymia)
- 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
Describe Cyclothymic disorder
- 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
Describe Prementrual dysphoric disorder
-Mood lability, irritability, dysphoria, and anxiety that occur repeatedly during the premenstrual phase of the cycle
57
Describe Disruptive mood dysregulation disorder
- 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
Major neurotransmitter systems implicated in anxiety
- NE
- Serotonin
- GABA
59
what is the most common form of psychopathology
Anxiety
60
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
Buspirone
61
Criteria of Panic disorder
- 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
Intense fear of being in public places where escape or obtaining help may be difficult
Agoraphobia
63
Performance anxiety is often successfully treated with what
beta blockers
64
What drug do you use to stop nightmares in PTSD
Prazosin
65
First line treatment for PTSD
-SSRIs or SNRIs
66
Time frame for adjustment disorder
- within 3 months in response to an identifiable stressful life event
- symptoms resolve within 6 months after stressor has terminated
67
Most effective treatment for Adjustment disorder
supportive psychotherapy
68
What are the Cluster A personality disorders and vaguely describe them
- Schizoid
- Schizotypal
- Paranoid
- Pts seem eccentric, peculiar, or withdrawn
- Familial association with psychotic disorders
69
What are the Cluster B personality disorders and vaguely describe them
- Antisocial
- Borderline
- Histrionic
- Narcissistic
- Pts seem emotional, dramatic, or inconsistent
- Familial association with mood disorders
70
What are the Cluster C personality disorders and vaguely describe them
- Avoidant
- Dependent
- Obsessive-compulsive
- Pts seem anxious or fearful
- Familial association with anxiety disorders
71
Histrionic patients often use what defense mechanism
-Regression: they revert to childlike behaviors
72
Borderline patients commonly used what defense mechanism
-splitting
73
What defense mechanism is often seen in people with dependent personality disorder?
regression
74
What drugs often decrease the intrusive thoughts associated with OCD
SSRIs
75
Rotatory nystagmus is strongly suggestive for intoxication with what
PCP
76
What is the most common infectious agent known to cause cognitive impairment
HIV
77
Rapidly progressive cognitive decline with myoclonus is suggestive of what
Creutzfeldt-Jakob disease (CJD)
78
what are the 3 W's of normal pressure hydrocephalus
- Wobbly: Gait disturbance
- Wet: Urinary incontinence
- Wacky: Cognitive impairment
79
Genetic causes of Mental Retardation
- Down syndrome
- Fragile X syndrome
- Prader-Willi
- Phenylketonuria
- Williams syndrome
- Angelman syndrome
- Tuberous sclerosis
80
Prenatal causes of Mental Retardation
- Infection and toxins (TORCH)
- Toxo
- Other (Syphilis, AIDS, alcohol, illicit drugs)
- Rubella (German Measles)
- Cytomegalovirus (CMV)
- Herpes Simplex
81
Perinatal causes of mental retardation
- Anoxia
- Prematurity
- Birth trauma
- meningitis
- Hyperbilirubinemia
82
Postnatal causes of mental retardation
- Hypothyroidism
- Malnutrition
- Toxin exposure
- Trauma
- psychosocial causes
83
Characteristic physical features of Down syndrome?
- Epicanthic folds
- Flat nasal bridge
- Palmar crease
84
Characteristic physical features of Fragile X syndrome?
- Macrocephaly
- Joint hyperlaxity
- Macroorchidism in postpubertal males
85
Characteristic physical features of Prader-Willi syndrome?
- Obese
- Small stature
- Almond-shaped eyes
86
Three features of fetal alcohol syndrome
- 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
What should you always rule out before diagnosing a specific learning disorder
sensory deficits
88
What is the primary treatment of Conversion disorder
- Education about the illness
| - CBT, with or without therapy, can be used if education alone is not effective
89
What CSF finding has been associated with impulsiveness and aggression?
low levels of serotonin
90
65% of pts with kleptomania also have what other comorbid psychiatric illness?
bulimia nervosa
91
Describe refeeding syndrome
- 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
What are the cortisol levels usually in anorexia nervosa
increased . . . they are usually normal in bulimia nervosa
93
what is an effective medication for bulimia
fluoxetine
94
What is considered first line therapy for chronic insomnia
CBT
95
What is the most common reason patients are put on long-term benzodiazepines
insomnia
96
What does REM sleep do to BP, heart rate, and respiratory rate?
increases
97
Treatment for Obstructive sleep apnea
- Positive airway pressure: continuous (CPAP) and in some bilevel (BiPAP)
- Behavioral strategies such as weight loss and exercise
- surgery
98
What drug abuse is associated with central sleep apnea
chronic opioid users
99
What is the treatment for the cataplexy associated with narcolepsy?
- Sodium oxybate (drug of choice)
- TCAs
- SSRI/SNRI
100
Risk factors for restless leg syndrome?
- Increases with age
- strong familial component
- Iron deficiency
- medications
- cardiovascular disease
101
Treatment for restless leg syndrome?
- 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
Describe how dopamine and serotonin affect sexual function
- Dopamine enhances libido
| - Serotonin inhibits sexual function
103
What is the treatment for TCA overdose
Sodium bicarb
