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1
Q

Difference btw schizophrenia, schizophreniform, and brief psychotic disorder

A

brief psychosis < 1 month
Schizophreniform 1-6 months
Schizophrenia > 6 months

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2
Q

Adjustment disorder time frame

A

Occurs within three months of a stressor and lasts no more than six months with anxiety/depression/disturbed behavior

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3
Q

Features of narcolepsy

A 
Sudden naps 3x/week for 3 months
At least one of the following:
1. cataplexy
2. los CSF hypocretin-1
3. shortened REM latency

Associated with hallucinations right before or after sleep and sleep paralysis

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4
Q

Diff btw narcolepsy and hypersomnolence

A

persistent daytime sleepiness that are not refreshed with napping

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5
Q

Difference between classical and operant conditioning

A

Operant conditioning produces a particular action. Classical conditioning elicits a natural response (like salivation

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6
Q

Transference

A

projection of feelings towards other persons onto physician (i.e. treating physician like parent)

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7
Q

Dissociation

A

ego defense: temporary change in personality, memory, consciousness, or motor behavior

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8
Q

Displacement

A

feelings (anger) transferred to another person (vs transference, where you are treating one person as if they are someone else)

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9
Q

Fixation

A

Staying at a childish level

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10
Q

Identification

A

Modeling behavior after another more powerful person

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11
Q

Infant deprivation effects

A

Weak wordless, wanting (socially), and wary

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12
Q

how long infant deprived for irreversible effects?

A

6 months

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13
Q

Peak incidence of child abuse

A

9-12 years

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14
Q

common signs of child abuse

A

retinal hemorrhage
detachment
coup-countercoup head trauma

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15
Q

What is the most common form of child maltreatment?

A

neglect

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16
Q

ADHD onset before age

A

7

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17
Q

brain in ADHD

A

decreased frontal lobe volume

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18
Q

Tx: ADHD

A

methylphenidate, amphetamine, atomoxetine

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19
Q

Oppositional defiant disorder

A

hostile, defiant toward authority, without violating serious social norms (conduct disorder)

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20
Q

How long to have sx to be diagnosed with tourette’s

A

Over 1 year

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21
Q

Coprolalia

A

Involuntary obscene speech

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22
Q

Tourettes associ’d with

A

OCD

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23
Q

Tx: tourette’s

A

antipsychotics/behavioral therapy

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24
Q

Tourette’s onset

A

Before age 18

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25
Age group for separation anxiety disorder
7-9 years
26
Presentation: separation anxiety disorder
fear of separation from home or loss of parent. May make up excuses to stay at home
27
Tx: separation anxiety disorder:
SSRI/behavior
28
Narcolepsy caused by
loss of hypocretin-1/2
29
pointing
social development 1 year
30
Lots of imitation
social development 2 year
31
Parallel play
social development 3 year
32
cooperative play
4 yr
33
pincer development
1 yr
34
walking
1 year
35
says mom or dad
1 year
36
page turn
2 yr
37
draw shapes
3 yr
38
dress self
4 yr
39
jump
2 yr
40
tricycle
3 yr
41
run
4 yr
42
simple sentence
3yr
43
complex sentence
4 yr
44
2 words
2 yr
45
Tx: autism
behavioral/supportive
46
Signs autism
language impairment, poor social skills, focus on objects, repetitive behavior -->usually below normal intelligence
47
Asperger's
normal intelligence, no verbal deficits | --problems socially, repetitive behavior and all-absorbing interests
48
Inheritance of rett's
X-linked
49
Rett's
regression age 1-4 loss of development, verbal skills, and retardation STEREOTYPED HAND WRINGING ataxia
50
Childhood disintegrative disorder
2 years of normal development | -Loss of language skills, social skills, bowel/bladder control, play/motor skills
51
which childhood development disorder is more common in boys
Childhood disintegrative disorder and autism
52
Anxiety neurotransmitters
Increased NE Decreased GABA Decreased Serotonin
53
Alzheimer's neurotransmitters
decreased Ach
54
Huntington's neurotransmitters
Decreased Gaba Decreased Ach Increased dopamine
55
Parkinson's neurotransmitters
Increased serotonin, increased Ach, decreased dopamine
56
Korsakoff's amnesia
ANTEROGRADE amnesia with confabulations
57
Dissociative amnesia
Forget important personal information after trauma/stress (i.e. borne identity)
58
Delirium vs dementia
Delirium has decreased arousal. Also, more likely reversible and 2ndary cause. Will see hallucinations, in dementia usually not the case
59
EEG in delirium
Abnormal
60
Which drugs likely for delirium
anticholinergic drugs (atropine, benztropine)
61
Pseudodementia
In elderly pts, depression can present as dementia
62
EEG in dementia
normal
63
Olfactory hallucination associated with:
epilepsy/brain tumor
64
Tactile hallucinations
alcohol withdrawal | Cocaine abusers
65
Schizophrenic brain
decreased dendritic branching
66
schizophrenia associated with
frequent cannabis use
67
Positive sx in schizo
Delusions hallucinations disorganized speech disorganized/catatonic behavior
68
Negative sx in schizo
flat affect social withdrawal lack of motivation lack of speech/thought
69
Five subtypes of schizo
``` paranoid disorganized catatonic (automatism) Undifferentiated Residual ```
70
Delusional disorder
Fixed false belief lasting > 1 month
71
Dissociative identity disorder
Tamu. | At least 2 personalities
72
Dissociative identity disorder associ'd with
sexual abuse
73
Persistent feelings of detachment/estrangement from body, social situation, environment
depersonalization disorder
74
Abrupt change in geographic location with inability to recall past, may assume new identity with SIGNIFICANT DISTRESS
dissociative fugue
75
dissociative fugue associated with:
natural disaster, wartime, trauma
76
Manic sx:
``` DIG FAST distractible irresponsible grandiosity flight of ideas agitation/activity sleep (less needed) talkative ```
77
Criteria for manic episode
At least 1 week - 3/7 sx - OR if hospitalized
78
Hypomanic episode
Same as manic, but less than a week or not enough disturbance to impair/hospitalize
79
Bipolar disorder always requires
depressive sx
80
What can precipitate a manic episode
antidepressants
81
What r u most worried about in manic episode
suicide risk
82
Tx for bipolar disorder
lithium, valproid acid, carbamazepine | atypical antipsychotics
83
Bipolar I vs bipolar II
Bipolar I: 1 manic episode | Bipolar 2: 1 hypomanic episode
84
cyclothymic disorder
mild bipolar, lasting 2 YEARS | -alternating mild depression and hypomania
85
MDD sx
``` SIG E CAPS sleep disturbed Interest Guilt Energy Concentration Appetite Psychomotor agitation/retardation Suicidal ideation Oh, and FEELING DEPRESSED ```
86
Criteria for MDD:
5/9 Sx for at least 2 weeks | Episodes usually last 6-12 months
87
Dysthymia
mild depression lasting at least 2 years
88
Atypical depression
Hypersomnia/weight gain instead of lack of sleep/weight loss - leaden paralysis - sensitivity to interpersonal rejection - reactive mood
89
Incidence of baby blues
50-85%
90
Incidence of postpartum depression
10-15%
91
Sx of baby blues
depressed affect, tearfulness, and fatigue 2-3 days after delivery. MUST RESOLVE in 2 weeks.
92
Tx of baby blues
support and follow up
93
Pospartum depression
depressed affect, anxiety, and concentration 4 weeks after delivery. Lasts at least 2 weeks-1 year
94
Postpartum psychosis
delusions/hallucination. May have homicidal ideation. Lasts days to 4-6 weeks
95
Tx: postpartum psychosis
antipsychotics, antidepressants, inpatient hospitalization
96
A post-partum mother says she feels depressed. How do you know if it is regular MDD or postpartum depression?
If < 4 weeks after delivery, then postpartum.
97
When would you consider giving ECT?
Refractory MDD Pregnant women with MDD Catatonic, psychotic Or acutely suicidal
98
What are the major adverse effects of ECT?
amnesia and disorientation, but goes away after 6 months
99
Risk factors for suicide completion
``` SAD PERSONS Sex Age (teen/elderly) Depression Previous attempt Ethanol/drug use Rational thinking loss Sickness Organized plan No spouse Social support lacking ```
100
Prevalence of anxiety disorders
30% in women, 19% in men
101
Sx of panic disorders
``` Palpitations Paresthesias Abdominal dispress Nausea Intense fear of dying Lightheadedness Chest pain Chills Choking Sweating Shaking Shortness of breath ``` PPANICCCSSS
102
Treatment of panic disorder
CBT SSRI Venlafaxine Benzo
103
Criteria for panic disorder
Discomfort peaking in 10 minutes with at least 4 sx
104
Tx of phobia
SSRI
105
OCD associated with
tourettes
106
Treatment of OCD
SSRIs, clomipramine
107
Acute stress disorder
PTSD: lasts between 2 days and 1 month
108
Sx of PTSD
flashbacks, fear, helplessness, horror | -Avoidance of stimuli associated with trauma
109
Criteria for PTSD
Disturbance for at least 1 month with significant distress.
110
Treatment for PTSD
psychotherapy and SSRIs
111
Generalized anxiety disorder
anxiety for at least 6 months
112
Tx for generalized anxiety
SSRI/SNRI
113
Adjustment disorder
emotional anxiety/depression after a distinct stressor lasting LESS than 6 months
114
Somatization disorder
multiple organ system (4 pain, 2 GI, 1 sexual, 1 pseudoneuro like sz or loss of feeling) -Must occur before the age of 30
115
Conversion disorder
Sudden loss of sensory or motor function after an acute stressor. More common in females and adolescents.
116
la belle indifference
seen in conversion disorder.
117
How old does pt have to be to dx a personality disorder
18
118
Cluster A personalities
paranoid, schizoid, schizotypal
119
Cluster B disorders
antisocial, borderline, histrionic, narcissistic
120
Cluster C personality disorders
Avoidant Obsessive compulsive dependent
121
cluster A disorders associated with
schizophrenia
122
cluster B disorders associated with
mood disorder and substance abuse
123
cluster C disorders associated with
anxiety disorders
124
avoidant personality
wants relationship with others, but inhibited/timid
125
Egosyntonic/egodystonic example
OCPD is egosyntonic | OCD is egodystonic
126
Anorexia nervosa associated with
depression
127
Bulimia nervosa side efects
parotitis, enamel erosion, electrolyte disturbances, alkalosis
128
russell's sign
dorsal hand caluses from induced vomiting
129
signs of substance dependence
``` tolerance withdrawal more taken than desired persistent desire or attempt to cut down significant energy spent on getting substance reduced social/occupational activities reduced Continued use despite problems --3+ needed! ```
130
Substance abuse
failure to fulfill major obligations at home/work use in physically hazardous situations legal problems persistent problems, yet continued use
131
sensitive test for alcohol use
gamma-glutamyltransferse (GGT)
132
Signs of alcohol withdrawal
anxiety, insomnia, tremor. Severe=autonomic hyperactivity and delirium tremens
133
opoid signs
respiratory/CNS depression Decreased gag reflex Pupil constriction Seizures
134
Tx for opioid overdose
naloxone/naltrexone
135
Opioid withdrawal
dilated pupils, piloerection, fever sweating, rhinorrhea, diarrhea, GI, (flu like sx) YAWNING
136
why would you use benzos before barbiturates?
greater safety margin
137
Sign of barbiturate tox
Marked respiratory depression
138
barbiturate withdrawal
delirium, CV collapse
139
benzo intox:
ataxia, mild respiratory depression
140
tx: benzo overdose
flumenazil
141
benzo withdrawal
anxiety, seizure, sleep disturbance, depression
142
euphoria, grandiosity, pupillary dilation, wakefullness and attention, hypertension, tachycardia, paranoia, fever
amphetamines
143
pupillary dilation, hallucinations (tactile), paranoid ideation, sudden cardiac death
cocaine
144
tx for cocaine o/d
benzos
145
anhedonia, increased appetite, hypersomnolence
amphetamine withdrawal
146
nictotine withdrawal
irritability, anxiety, craving
147
drugs for nicotine withdrawal
buproprion/varenicline
148
hypersomnolence, malaise, severe craving, depression/suicidality
cocaine withdrawal
149
belligerence, impulsiveness, vertical + horizontal nystagmus, homicidality, psychosis, seizures
PCP
150
tx for PCP
benzo or antipsychotic
151
depression, anxiety, irritability, restless, anergia, disturbed thoughts/sleep
PCP withdrawal
152
anxiety, paranoia, visual auditory distortion, depersonalization
LSD
153
how long is MJ detected in urine
4-10 days
154
how long do MJ sx last
5-7 days but peak in 48 hours
155
dronabinol
prescription MJ, for chemo or appetite stimulant in AIDS
156
Heroin users are at risk for
hepatitis, abscess, hemorrhoids
157
Methadone
long acting opiate
158
naloxone plus buprenorphine
partial agonist do decrease withdrawal. naloxone blocks the opioid receptor and becomes active if injected to prevent buprenorphine from being abused
159
wernicke's encaphalopathy
confusion opthalmoplegia ataxia
160
korsakoff's psychosis
loss of memory making capabilities
161
When does DT occur?
2-5 days after last drink
162
sx of DT
tachy, tremor, anxiety, seizures THEN psychotic symptoms and confusion
163
bulimia tx
SSRI
164
tx: panic disorder
SSRI, venlafaxine, benzodiazepine
165
Tx: tourette's
haloperidol, resperidone, other antipsychotics
166
mechanism methylphenidate, destroamphetamine, methamphetamine
Increase NE and dopamine at synaptic cleft
167
name the antipsychotics
haloperidol, trigluoperazine, fluphenazine, thioridazine, chlorpromazine (haloperidol + azines)
168
Mechanism antipsych
block D2 dopamine receptors | -->increased cAMP
169
High potency antipsych
Trifluoperazine, fluphenazine, haloperidol
170
Low potency antipsych
Chlorpromazine, thioridazine
171
side effects of high potency antipsychotics
``` extrapyramidal sx: dystonia (4 hr) akathisia (4 day) bradykinesia (4 wks) tardive dyskinesia (4 mos) ```
172
chlorpromazine side effect
corneal deposits
173
thioridazine side effects
reTinal deposits
174
haloperidol side effects
tardive dyskinesia and neuroleptic malignant syndrome
175
antipsychotic side effects:
endocrine (galactorrhea from dopamine block) dry mouth, constipation, hypotension sedation (histamine receptor block)
176
Neuroleptic malignant syndrome signs
rigidity myoglobinuria autonomic instability fever
177
Tx of neuroleptic malignant syndrome
dantrolene or | bromocriptine (D2 agonist)
178
Is tardive dyskinesia reversible?
no
179
Atypical antipsychotics
``` Olanzapine Clozapine quetiapine risperidone aripiprazole ziprasidone ```
180
Atypical antipsychotic uses
bipolar, OCD, anxiety, depression, tourettes
181
olanzapine side effect
weight gain
182
clozapine side effect
agranulocytosis seizure weight gain
183
ziprasidone side effect
prolongation of QT interval
184
Lithium side effects
LMNOP Movement Nephrogenic diabetes insipidus Hypothyroid pregnancy problems
185
Clinical use of lithium
bipolar | SIADH
186
lithium birth defect
ebstein anomaly | malformation of vessels
187
What do you need to monitor with lithium
Check serum levels frequently cause narrow therapeutic window. Excreted by kidneys
188
Buspirone: mechanism
stimulates serotonin1A receptors
189
buspirone clinical use
generalized anxiety disorder
190
benefits of buspirone
no addiction/sedation/tolerance. BUT takes 1-2 weeks to work
191
Name the SSRIs
fluoxetine paroxetine sertraline citalopram
192
How long does it take for antidepressants to have an effect
4-8 weeks
193
tox: SSRI
GI distress serotonin syndrome sexual dysfunction
194
serotonin syndrome
``` clonus hyperthermia tremor flushing, diarrhea CV collapse ```
195
tx: serotonin syndrome
cyproheptadine, a serotonin antagonist
196
SNRIs
venlafaxine, duloxetine
197
venlafaxine indications
depression, anxiety, panic disorder
198
duloxetine indications
diabetic peripheral neuropathy.
199
tox of SNRI
increased BP, stimulant effect
200
TCAs
-tryptyline -imipramine doxepin amoxapine
201
Mechanism of TCA
block reuptake of NE and serotonin
202
clinical use of imipramine
depression, bed wetting
203
clinical use clomipramine
OCD/depression
204
clinical use TCA
fibromyalgia/depression
205
Side effect of TCA
convulsions, coma, cardiotoxicity - postural hypotension - atropine like effects
206
which TCA to give to elderly
nortriptyline | -fewer anticholinergic side effects causing confusion and hallucinations
207
desipramine effect
less sedating higher seizure threshold
208
MAO inhibitors
tranylcypromine phenelzine isocarboxazid selegiline MAO takes pride in shanghai
209
MAO uses
atypical depression anxiety hypochondriasis
210
MAO side effect
hypertensive crisis with tyramine | Contraindicated with SSRI, TCA, st. John's Wort, meperidine, and dextromethorphan to prevent serotonin syndrome
211
Atypical antidepressants
bupropion mirtazapine maprotiline trazodone
212
Mechanism of bupropion
Increase Ne and dopamine
213
Bupropion tox
tachycardia, insomnia, but NO SEX SIDE EFFECTS
214
who is bupropion contraindicated in?
bulimic pts--seizure risk
215
mirtazapine
alpha-2 and 5-HT antagonist (increases release of NE and serotonin)
216
tox: mirtazapine
sedation appetite weight gain dry mouth
217
maprotiline mech
blocks NE reuptake
218
maprotiline tox:
sedation, hypotension
219
trazodone mech
inhibits serotonin reuptake
220
trazodone use
insomnia
221
tox: trazodone
sedation, nausea, PRIAPISM, hypotension
222
What is Epstein's abnormality
Apical displacement of tricuspid valve with a SMALLER right ventricle. Also atrialization of the right ventricle.
223
Fetal alcohol syndrome
1. facial anomalies 2. Growth retardation 3. Mental retardation
224
Schizoaffective disorder
at least 2 weeks of stable mood with ONLY psychotic symptoms PLUS a major depressive, manic, or mixed episode. Differentiate from bipolar disorder/MDD with psychotic features--psychotic features only occur DURING an episode
225
Risperidone side effect
Hyperprolactinemia, with breast soreness and amenorrhea. low dopamine in the brain causes high prolactin. Inhibits GnRH
226
What does carbidopa not reduce in the side effects of levodopa?
anxiety and agitation
227
Undoing defense mechanism
confession or atonement to nullify unacceptable thought

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