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Psych Flashcards

1
Q

Haldol

A

Typical antipsychotic
High potency
0.5-10mg
D2 antagonism

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2
Q

Loxapine

A

Typical antipsychotic
Medium potency
10-250mg
D1 and D2 antagonism + serotonin 5HT2 antagonism

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3
Q

Chlorpromazine

A

Typical antipsychotic
Low potency
200-1000mg
Broad antagonism: D1-D4, 5-HT1 and 5-HT2, histamine receptors, alpha1-2 adrenergic receptors, M1-2 muscarinic Ach receptors

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4
Q

Chlorpromazine S/E

A

Dopamine antagonism –> EPS
Serotonin antagonism –> weight gain, ejaculation difficulties
Histamine antagonism –> sedation, anti-emetic, weight gain, vertigo
Alpha adrenergic antagonism –> low BP, reflex tachycardia
Anti-ACh –> dry mouth, constipation, blurred vision, sinus tachy, urinary difficulties

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5
Q

Lithium starting dose

A

600 mg PO ohs

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6
Q

Lithium tx dose

A

900-1500mg PO per day

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7
Q

Lithium therapeutic levels

A

0.6-1.2 mEq/L

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8
Q

Lithium therapeutic level for mania

A

0.8-1.2 mEq/L

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9
Q

Lithium therapeutic level for maintenance

A

0.6-0.8 mEq/L

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10
Q

Lithium therapeutic level for elderly

A

0.4-0.6 mEq/L

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11
Q

Lithium mild toxicity level

A

1.5 mEq/L

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12
Q

Lithium medical emergency

A

> /= 2.5mEq/L

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13
Q

Lithium level for hemodialysis

A

> 5mEq/L or 4 mEq/L with renal impairment or > 2.5mEq/L with symptoms/renal insufficiency

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14
Q

Lamotrigine starting dose

A

25mg PO daily

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15
Q

Lamotrigine therapeutic dose

A

100-200 mg PO daily

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16
Q

Olanzapine starting dose

A

10-15mg PO daily

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17
Q

Olanzapine therapeutic dose

A

5-20mg daily

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18
Q

Quetiapine starting dose

A

50mg PO BID

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19
Q

Quetiapine XR titration

A

Start: 300 mg PO qhs
Increase by 150-300mg q1-4d
Target: 600-800mg PO qhs

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20
Q

Quetiapine therapeutic dose for BPD depression

A

300-600 mg daily

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21
Q

GAD

A

> /3 of the following 6 symptoms for the past 6 months
1. Wound up - muscle tension
2. Worn out - fatigue
3. Absent-minded - difficulty concentrating
4. Restless
5. Touchy - agitated
6. Sleepless
Difficulty controlling worry
Excessive anxiety/worry occurring more days than not for past 6 months about a number of events/activities

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22
Q

12 month prevalence of GAD

A

~3%

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23
Q

GAD 7

A

5 = mild anxiety
10 = moderate anxiety
15 = severe anxiety
Test is out of 21

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24
Q

First line tx for anxiety

A

CBT

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25
Q

Meds for anxiety

A
  1. SSRIs (start at half starting dose needed for depression then titrate up)
  2. Benzodiazepines, usually with SSRIs in the beginning then wean off after ~2 weeks
  3. Buspirone (5-HT1A receptor partial agonist)
  4. Venlafaxine (SNRI)
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26
Q

Specific phobia lifetime prevalence

A

11%

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27
Q

GAD lifetime prevalence

A

~5%

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28
Q

Specific phobia with highest familial tendency

A

Blood-injection injury

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29
Q

Social anxiety d/o 12mo prevalence

A

7%

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30
Q

Social anxiety lifetime prevalence

A

~10%

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31
Q

Specific criteria of social anxiety disorder for children

A

Must experience anxiety in peer settings, and not just with adults
Fear/anxiety may be expressed as crying, tantrums, freezing, clinging, shrinking, failing to speak

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32
Q

Lifetime prevalence of social anxiety disorder in school aged children

A

~1%

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33
Q

Lifetime prevalence of specific phobia d/o in school aged children

A

2.4%

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34
Q

Panic d/o 12mo prevalence

A

2-3%

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35
Q

Best medications for panic disorder

A

Alprazolam (xanax - benzodiaepine) and Paroxetine (SSRI)

Other SSRIs - Citalopram, escitalopram, fluvoxamine, sertraline

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36
Q

Agoraphobia 12m prevalence

A

1.7%

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37
Q

Agoraphobia

A 
At least 2 of more of the following: 
- fear of open spaces 
- fear of line ups
- fear of enclosed spaces 
- fear of public transport 
- fear of being outside of house alone 
Fear for 6mo or more
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38
Q

SSRI Discontinuation syndrome

A 
2-4d after medication cessation 
Flu-like symptoms 
Insomnia
Nausea
Imbalance 
Sensory disturbances 
Hyperarousal - increased anxiety and irritability
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39
Q

Depression

A 
5 or more of the following symptoms for at least 2 weeks, with at least 1 being depression or decreased interest:
Suicidal thoughts 
Interest decrease 
Guilt 
Energy low 
Concentration difficulty
Appetite change
Psychomotor changes 
Sleep issues
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40
Q

Depression lifetime prevalence

A

16.5% (highest of any psych d/o)

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41
Q

Depression 12mo prevalence

A

6.7%

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42
Q

Mean number of depressive episodes

A

5-6 over 20yr period

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43
Q

Rate of depression recurring in 6mo

A

25%

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44
Q

Rate of depression recurring in 2yr

A

30-50%

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45
Q

Rate of depression recurring in 5y

A

50-75%

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46
Q

2 NTs most commonly implicated with depression

A
  1. Serotonin

2. NE

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47
Q

PHQ9

A

5-9 = Minimal symptoms –> F/U in 1 month
10-14 = Minor depression, dysthymia –> watchful waiting or meds/psychotherapy
15-19 = Major depression, mod - severe –> antidepressants or psychotherapy
>20 = Major depression, severe –> antidepressant and psychotherapy
Total score out of 27

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48
Q

First line psychotherapies for depression

A

Interpersonal

CBT

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49
Q

SSRIs affect on locus ceruleus

A

Decreased arousal

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50
Q

SSRIs affect on periaqueductal grey

A

Decreased escape behaviour

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51
Q

SSRIs affect on HPA axis

A

Decreased CRF from hypothalamus, thus decreased ACTH and decreased cortisol secretion

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52
Q

SSRIs affect on lateral nucleus of amygdala

A

Inhibits sensory excitation inputs from HPA/cortical pathways –> decreased physical symptoms

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53
Q

Serotonin Syndrome

A

HARMED:
Hyperthermia (severe severe due to muscle activity, not hypothalamic temperature set point so avoid antipyretics)
Autonomic instability (rapid HR, HTN, diarrhea, dilated pupils)
Rigidity
Myoclonus (loss of muscle coordination or twitching)
Encephalopathy (confusion)
Diaphoresis

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54
Q

Serotonin syndrome tx

A
  1. Stop meds
  2. May need benzos to help control agitation and fever by reducing muscle agitation (prevent rhabdo)
  3. Serotonin blocking agents (cryptoheptadine)
  4. O2 and fluids
  5. HR and BP control
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55
Q

Wellbutrin/Bupropion class

A

NDRI

Good for atypical MDD

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56
Q

Mirtazapine class

A

NaSSA

Good for melancholic MDD

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57
Q

NT affected by TCA

A

NE, Serotonin and GABA

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58
Q

TCA Overdose antidote

A

Sodium bicarbonate

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59
Q

NT affected by MAOI

A

NE, Serotonin and Dopamine

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60
Q

MAOI risk

A 
Hypertensive crisis (inhibits monoamine oxidase --> can't break down tyramine --> tyramine build up --> BP crisis) 
Tyramine avoiding diet (strong cheese, cured meats, pickled/fermeted foods, beans, snow peas, dried fruits, alcohol)
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61
Q

Hypertensive crisis

A 
Severe headache 
Vision changes
N/V
Sweating
Severe anxiety 
Nosebleed
Fast HR 
Chest pain
SOB 
Confusion
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62
Q

Hypertensive crisis tx

A

No antidote
Aggressive decontamination via gastric lavage or charcoal
Do not usually need to treat HTN, should come down on its own, but may use shorter acting agents (ie. nitro) - avoid beta blockers

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63
Q

Transcranial magnetic stimulation (TMS) indication

A

For adults with depression who have failed one prior antidepressant medication at or above minimal effective dose and duration

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64
Q

TMS frequency

A

Daily for 4-6wks

No anesthesia needed

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65
Q

TMS contraindication

A

Implanted metallic devices or non-removable metallic objects in or around head

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66
Q

Dysthymia (Persistent Depressive D/O)

A 
HE'S 2 SAD
Hopelessness 
Energy loss or fatigue 
Self-esteem low 
2 years at least of depressed mood most of the day for more days than not (at least 1 year in children/teens); never been without symptoms for more than 2mo at a time 
Sleep increased/decreased 
Appetite increased/ decreased 
Decision making or concentration impaired
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67
Q

Mania

A 
1 week period of elevated mood AND increased energy/goal-directed energy plus 3 of the following:
DIGFAST 
- Distractibility 
- Indiscretion 
- Grandiosity 
- Flight of ideas 
- Activity increased 
- Sleep decreased 
- Talkativeness
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68
Q

Lifetime prevalence of ALL bipolar disorders

A

0-2.4%

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69
Q

12 month prevalence of bipolar disorders

A

0.6%

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70
Q

Distribution of BPD amongst men and women

A

EQUAL
-Women are more likely to have rapid cycling and mixed stated, more likely to have comorbidities, more likely to experience depressive symptoms, higher lifetime risk of EtOH use d/o

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71
Q

Bipolar disease is at high risk of…

A

Suicide (15x rest of population)

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72
Q

Epidemiology of bipolar disease

A
  • More common in high-income countries
  • More common in separated, divorced or widowed individuals
  • Strongest most consistent risk factor = family history
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73
Q

Valproate starting dose

A

250-500mg PO ohs

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74
Q

Valproate therapeutic dose

A

1200-1500mg PO daily

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75
Q

Olanzapine

A

Greatest risk of weight gain

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76
Q

Aripiprazole

A

Longest half-life (75h)

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77
Q

Ziprasidone

A

QT prolongation risk (periodic ECGs)

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78
Q

3 options for treating depression phase of bipolar

A
  1. Switch to lithium, lamotrigine or quetiapine mono therapy (AVOID antidepressant monotherapy)
  2. Add SSRI or bupropion
  3. Add mood stabilizer for combo therapy (ie. lithium and divalproex)
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79
Q

BPD drug to avoid in reproductive-aged women

A

Valproic acid

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80
Q

General tx regimen for ACUTE MANIC EPISODE

A

Lithium or valproic acid or 2nd generation antipsychotic (ie. Quetiapine)

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81
Q

General tx regimen for DEPRESSED BIPOLAR EPISODE

A

Lamotrigine +/- antimanic drug if hx of manic episodes

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82
Q

General tx regimen for MIXED BIPOLAR EPISODE

A

Valproate or 2nd generation antipsychotic

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83
Q

General tx regimen for maintenance tx in bipolar disorder

A

Lithium or valproate or lamotrigine (in its without recent mania) or 2nd generation antipsychotic

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84
Q

Hypomanic episode

A

4 consecutive day period of elevated mood and energy with 3 or more of DIGFAST
NOT sever enough to cause marked impairment in social, occupational functioning or to necessitate hospitalization

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85
Q

Bipolar Type II

A

1 hypomanic epi and 1 major depressive epi

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86
Q

Bipolar Type I

A

Manic episode

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87
Q

Risk of developing bipolar disorder in general population

A

0.5-1.5%

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88
Q

Risk of developing bipolar disorder in 1st degree relatives of ppl with bipolar d/o

A

8-10%

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89
Q

MOA of Li and VPA

A

(1) Inhibit Glycogen Synthase kinase-3 (apoptotic enzyme that leads to neuronal death)
(2) Increased expression of brain derived neurotrophic factor = promotes neuronal survival

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90
Q

Cyclothymic Disorder

A
  • At least 2yrs (1 yr in children/adolescents), numerous periods with hypomanic symptoms that do not meet criteria for hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for major depressive episode
  • Hasn’t been without symptoms for more than 2mo at a time
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91
Q

Types of delusions (6)

A
  • Reference
  • Erotomanic
  • Grandiose
  • Persecutory
  • Nihilistic
  • Somatic
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92
Q

Schizophrenia

A

2 or more of the following, for at least 1 month, with at least one being one of the first three:
-Delusions
-Hallucinations
-Disorganized speech
-Grossly disorganized or catatonic behaviour
-Negative symptoms
Continuous signs of disturbance persist for at least 6 months

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93
Q

12 mo prevalence of schizophrenia

A

1%

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94
Q

Sex differences for schizophrenia (male vs female)

A

Male = female
Female dx later in life with bimodal distribution
Men = 10-25y.o,
Women = 25-35y.o.

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95
Q

Brain abnormalities in schizophrenia

A

Smaller prefrontal cortex/hippocampus/limbic system
Enlarged ventricles
Reduced symmetry

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96
Q

4 main dopaminergic pathways

A
  1. Mesocortical*
  2. Nigrostriatal
  3. Tuberoinfundibular
  4. Mesolimbic*
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97
Q

Mesocortical

A

Brainstem –> pre-frontal cortex
A/W memory, executive function, motivation
= negative symptoms
Atypical antipsychotics help b/c improve DA and decrease serotonin in this pathway

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98
Q

Nigrostriatal

A

Substantia nigra –> basal ganglia
80% of brains dopamine
=EPS and tardive dyskinesia
Typical antipsychotics worsen TD b/c decrease DA in this pathway; atypical don’t affect b/c no major change in DA

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99
Q

Tuberoinfundibular

A

Hypothalamus –>neurohypophysis
DA tonically INHIBITS prolactin
= Prolactin levels
Typical antipsychotics cause hyperprolactinemia; atypical don’t affect b/c no major change in DA

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100
Q

Mesolimbic

A

Ventral tegmentum –> limbic system
Role in motivation, emotions, rewards
= Positive symptoms
Both typical and atypical decrease DA levels in this pathwayy –> improved positive symptom (atypical to higher degree)

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101
Q

First degree relatives of ppl with schizophrenia have ____x greater risk

A

10x

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102
Q

Factors associated with increased schizo risk

A
  • Prenatal exposures (infection, poor nutrition)
  • Late winter/early spring time of birth
  • EtOH and cannabis exposure
  • Advanced paternal age at conception
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103
Q

Nicotine use in schizo %

A

90%

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104
Q

Typical antipsychotics

A

Haloperidol
Loxapine
Fluphenazeine
Thiothixene

Thioridazine (low potency)
Chlorpromazine (low potency)

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105
Q

Classic PRN combo to settle patients

A

Haloperidol 5mg IM + Lorazepam 2mg IM

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106
Q

PRN combo TO AVOID

A

Olanzapine + lorazepam = respiratory depression

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107
Q

Atypical antipsychotics - DA and serotonin antagonists

A 
Risperidone 
Ziprasidone
Lurasidone 
Paliperidone 
Iloperidone
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108
Q

Risperidone risk

A

Acts like typical at high dose (EPS risk)

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109
Q

Ziprasidone risk

A

QTc prolongation

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110
Q

Lurasidone risk

A

Unsafe in pregnacy

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111
Q

Antipsychotic available in monthly depot

A

Paliperidone

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112
Q

Atypical antipsychotics - multi receptor

A

Olanzapine

CLozapine

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113
Q

Antipsychotic associated with weight gain

A

Olanzapine

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114
Q

Fast dislocating D2 antagonist antipsychotic

A

Quetiapine

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115
Q

Partial dopamine agonist antipsychotic

A 
Aripiprazole 
- At lower doses --> DA agonist 
- At higher doses --> DA antagonist 
= less weight gain and metabolic S/E 
High potency
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116
Q

Clozapine S/E

A 
Agraulocytosis 
Hypotension 
Diabetes 
Myocarditis 
Seizures
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117
Q

When to use clozapine

A

Tx-resistant schizophrenia, needed to have failed at least 2 antipsychotic regimens

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118
Q

Clozapine b/w

A

CBC/diff weekly for 6mo then q2wks for 6mo then q4wks thereafter

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119
Q

Clozapine titration

A

Takes about 2-3wks
Starting dose = 12.5mg OD –> increase by 12.5-25mg q3d
Target dose = 300-600mg PO qhs
Adequate trial = 4-6mo period at target dose

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120
Q

Risperidone IM titration

A

Long-acting injectable starting dose: 25mg IM q2weeks
Increase = 12.5mg q2-3 injections
Target dose: 25-50mg IM q2 weeks

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121
Q

Risperidone PO titration

A

PO tablet starting dose: 1mg PO qdaily
Increase by 1mg q24h
Target dose: 4-6mg PO qdaily

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122
Q

Olanzapine titration

A

PO tablet starting dose: 5-10mg PO qhs
Increase by 2.5-5mg q3-4d
Target dose: 10mg-20mg PO qhs

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123
Q

Aripiprazole titration

A

PO tablet starting dose: 5-10mg PO qhs
Increase by 2.5-5mg q3-4d
Target dose: 10mg-20mg PO qhs

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124
Q

S/E unique to typical antipsychotics

A

EPS/TD
Lowered seizure threshold
Hyperprolactinemia

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125
Q

If first episode of psychosis, pt needs _____ minimum on meds with signs of functional recovery

A

1-2 years

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126
Q

Highest suicide risk period for schizophrenics

A

1yr after first psych hospitalization

127
Q

Multi-episode patients should receive maintenance tx for at least ____ with pharmacotherapy on indefinite basis

A

5 years

128
Q

Approach to manage poor responders

A

SWITCH TX

Do not add another antipsychotic

129
Q

Strategies for switching pharmacotherapy (4)

A 
Abrupt discontinuation 
Taper switch (taper one, start the other immediately) 
Cross-taper switch (taper one, titrate the other) 
Plateau cross-taper switch (keep original, titrate the other, then taper original)
130
Q

Parkinsonian syndrome

A 
TRAP 
Tremor 
Rigidity (cogwheel) 
Akinesia 
Postural instability
131
Q

Tx for EPS

A

Best = switch to antipsychotic with less EPS
Reduction in antipsychotic dose if possible
Benztropine (anticholinergic)
Or beta blockers, benzodiazepine

132
Q

EPS vs TD

A 
EPS = acute reaction
TD = chronic reaction
133
Q

TD symptoms

A

Sucking/smacking lips, tongue twisting, facial grimacing, lateral jaw movements, choreiform movements

134
Q

S/E more common in LOW potency medications

A

Sedation (chlorpromazine, clozapine, quetiapine)

135
Q

Drugs that cause Anti-Ach S/E

A

Chlorpromazine, clozapine, olanzapine

136
Q

Drugs that cause QTc prolongation S/E

A

Clozapine, Ziprasidone , Haloperidol

137
Q

QTc numbers

A

> 440ms for men
460ms for women
500ms = TdP risk

138
Q

Neuroleptic Malignancy syndrome (symptoms and lab findings)

A

Related to DA antagonism (esp high potency ie. haldol)
FARM
- Fever (>38)
- Autonomic instability (tachycardia, labile BP, tachypnea, dysrhythmias)
- Rigidity (lead-pipe)
- Mental status change
Elevated CK, leukocytosis, low Fe

139
Q

NMS tx

A

Stop med, intensive management for CV support, control of hyperthermia and fluid/lyte balance
Medical tx = dantrolene, bromocriptine and amantadine (dan’s a man who’s a dope bro) = dopamine agonists
ECT if not response to medical tx for 1 wk

140
Q

NMS prognosis

A

Resolves within 2 weeks without neuro sequelae

Wait at least 2 weeks before restarting antipsychotics

141
Q

Delusion d/o

A

> /1 delusion for 1 month or longer
Fxn not markedly impaired
Mania or major depressive epis brief relative to duration of delusions

142
Q

Most freq subtype of delusional d/o

A

Persecutory

143
Q

Brief psychotic d/o

A 
One or more of the following, with at least one being one of the first three:
- Delusions
- Hallucinations
- Disorganized speech 
- Grossly disorganized behaviour 
More than 1d, less than 1 mo
Eventual return to premorbid level of functioning 
~50% go onto develop chronic psych
144
Q

Schizophreniform d/o

A

Same criteria is schizophrenia but for at least 1 month and <6months
Return to baseline
60-80% progress to schizophrenia

145
Q

Schizophreniform epidemiology

A

Common in young adults/teens
Men&raquo_space; women (5x)
Less common than schizo («1%)

146
Q

Tx for schizophreniform d/o

A

Brief course of antipsychotic drugs (3-6mo)

147
Q

Schizoaffective d/o

A

Major mood eps CONCURRENT with Criterion A of schizo
Delusions/hallucinations for 2 or more weeks WITHOUT major mood eps during duration of illness
Major mood eps symptoms present for majority of total duration of active portions of illness

148
Q

Schizoaffective epidemiology

A 
Bipolar = equal in men and women, more common in young 
Depression = 2x more common in females. more common in older
149
Q

Schizoaffective tx

A

Tx appropriate symptoms
BPD –> mood stabilizers
Depression –> SSRIs
Psychotics –> antipsychotics

150
Q

Catatonia

A

3 or more of the following:
♣ Stupor (ie. no psychomotor activity; not actively relating to environment
♣ Catalepsy (ie. passive induction of posture held against gravity)
♣ Waxy flexibility (ie. slight, even resistance to positioning by examiner)
♣ Mutism (ie. no or very little verbal response)
♣ Negativism (ie. opposition or no response to instructions or external stimuli)
♣ Posturing (ie. spontaneous and active maintenance of posture against gravity)
♣ Mannerism (ie. odd, circumstantial caricature of normal actions)
♣ Stereotypy (ie. repetitive, abnormally frequent, non-goal-directed movements)
♣ Agitation, not influenced by external stimuli
♣ Grimacing
♣ Echolalia (mimicking another’s speech)
♣ Echopraxia (mimicking another’s movements)

151
Q

Catatonia related to which mental health illness most frequently

A

Mood disorders (depression/BPD) > schizophrenia

152
Q

Catatonia tx

A

Benzos can provide temporary improvement

ECT for severe

153
Q

Scale for testing TD S/E from antipsychotics

A

Abnormal Involuntary Movement Scale (AIMs)
Rate items from 0-4
Score of 2 in two or more movements
or Score of 3 or 4 in single movement = TD

154
Q

Atypical antipsychotics in order of potency

A

High –> Low

Risperidone > paliperidone > aripiprazole > Lurasidone (mod) > clozapine > quetiapine > olanzapine

155
Q

Two antipsychotics affected by smoking

A

Olanzapine and clozapine

Smoking increases CYP1A2 activity

156
Q

GOOD prognostic features of sz

A 
Older age of onset 
Female 
Shorter duration of untreated psychosis
Tx adherence
Absence of illicit substance use 
Stable support network
Abrupt onset 
Absence fof pre-morbid disturbance 
Fam hx of affective illness
157
Q

Personality Disorder

A 
Enduring pattern
Deviates from individual's culture 
2 or more of the following areas:
- Cognition
- Affectivity
- Interpersonal functioning 
- Impulse control
158
Q

General population % affected by PD

A

10-20%

159
Q

Projection

A

Defense mechanism; pt attributes own unacknowledged feelings to others

160
Q

Projective identification

A

Defense mechanism; pt projects part of a past, internalized relationship onto therapist and exerts subtle, interpersonal pressure on therapist to become like projected part

161
Q

Transference

A

Displacement of feelings/thoughts/behaviours experienced in relation to significant figures during childhood onto person involved in current interpersonal relationship

162
Q

Counter-transference

A

Displacement of feelings, thoughts and behaviour from psychiatrist to patient

163
Q

Cluster A personality d/o

A

Odd or eccentric cluster
Paranoid
Schizoid
Schizotypal

164
Q

Paranoid personality d/o

A 
4 or more of: 
SUSPECT 
- Spousal infidelity suspected 
- Unforgiving 
- Suspicious 
- Perceives attacks 
- Enemy or friend? 
- Confiding in others is feared 
- Threats perceived in benign events
165
Q

Paranoid PD prevalence in general population

A

2-4%

166
Q

Paranoid PD tx of choice

A

Psychotherapy

167
Q

Schizoid PD

A

Detachment from social relationships and restricted range of expression of emotions in interpersonal settings
4 or more of
- Neither desires nor enjoys close relationships
- Always chooses solitary activities
- Little interesting in sexual experiences
- Takes pleasure in few activities
- Lacks close friends other than relatives
- Appears indifferent to praise of others
- Shows emotional coldness, detachment or flattened affectivity

168
Q

Schizoid PD prevalence in general population

A

5%

169
Q

Schizoid PD tx of choice

A

Psychotherapy

Pharmacotherapy

170
Q

Schizotypal PD

A 
Acute discomfort with and reduced capacity for close relationships and cognitive or perceptual distortions and eccentricities of behaviour
5 or more of: 
ME PECULIAR 
- Magical thinking
- Experiences unusual perceptiokns
- Paranoid ideation
- Eccentric behaviour/appearance 
- Constricted or inappropriate affect 
- Unusual thinking/speech
- Lacks close fiends 
- Ideas of reference
- Anxiety in social situations
- Rule out psychotic or pervasive developmental d/o
171
Q

Schizotypal PD prevalence in general population

A

3%

172
Q

Schizotypal tx

A

Psychotherapy

Pharmacotherapy - antipsychotics, antidepressants

173
Q

Cluster B personality d/o

A 
Dramatic, emotional, erratic cluster 
Antisocial 
Borderline 
Histrionic 
Narcissistic
174
Q

Antisocial PD

A 
Disregard for and violation of rights others since 15y.o. 
3 or more of: 
CORRUPT 
- Cannot conform to law 
- Obligations ignored 
- Reckless disregard for safety
- Remorseless
- Underhanded (deceitful) 
- Planning insufficient (impulsive)
- Temper (irritable and aggressive) 
Must be at least 18 
Conduct d/o with onset before age 15
175
Q

Antisocial PD prevalence rate in 12 month period

A

0.2-3%

176
Q

Antisocial PD epidemiology

A

More common in poor urban areas
Most common in men with EtOH use, prison populations
5x more common among first degree relatives of men with d/o

177
Q

Antisocial PD tx

A

Psychotherapy
Pharmacotherapy - psychostimulants if signs of ADHD, anticonvulsants to control impulsive behaviours, beta blockers for aggression

178
Q

Borderline PD

A 
Instability of interpersonal relationships, self image and affects, marked impulsivity 
5 or more of: 
DESPAIRER 
- Disturbance of identity 
- Emotionally labile 
- Suicidal behaviour 
- Paranoia or dissociation
- Abandonment (fear of) 
- Impulsive in at least 2 areas that are self-damaging 
- Relationships unstable 
- Emptiness (feelings of)
- Rage (inappropriate)
179
Q

Borderline PD prevalence in population

A

1-2%

Women&raquo_space; men

180
Q

Neurobiological theory of borderline PD

A

Impaired serotonergic control of amygdala by prefrontal cortex –> loss of control over emotional expression

181
Q

Histrionic PD

A

Excessive emotionality and attention seeking
5 or more of:
PRAISE ME
- Provocative or seductive behaviour
- Relationships considered more intimate than they are
- Attention (need to be centre of)
- Influenced easily
- Style of speech (lacking detail, impressionistic)
- Emotions (rapidly shifting, shallow)
- Make up (physical appearance)
- Emotions exaggerated

182
Q

Histrionic PD prevalence in general population

A

1-3%

Women > men

183
Q

Narcissistic PD

A 
Grandiosity, need for admiration and lack of empathy 
5 or more of : 
GRANDIOSE 
- Grandiose
- Requires attention
- Arrogant 
- Need to be special 
- Dreams of success and power 
- Interpersonally exploitative 
- Others (unable to recognize needs of)
- Sense of entitlement
- Envious
184
Q

Narcissistic PD prevalence

A

1-6%

185
Q

Cluster C

A

Anxious, fearful cluster
Avoidant
Dependent
Obsessive-compulsive

186
Q

Avoidant PD

A

Social inhibition, inadequacy and hypersensitivity to negative evaluation
4 or more of:
CRINGES
-Criticism or rejection preoccupies thoughts in social situations
-Restraint in relationships d/t fear of shame
-Inhibited in new relationships
-Needs to be sure of being liked before engaging socially
-Gets around occupational activities with need for interpersonal contact
-Embarassment prevents new activity
-Self-viewed as unappealing or inferior

187
Q

Avoidant PD prevalence in general population

A

2-3%

188
Q

Avoidant vs schizoid PD

A

Avoidant WANTS social interaction but are fearful vs schizoid want to be alone

189
Q

Dependent PD

A

Submissive and clinging behaviour and fears of separation
5 or more of:
RELIANCE
- Reassurance required
- Expressing disagreement difficult
- Life responsibility assumed by others
- Initiating projects difficult
- Alone
- Nurturance (goes to excessive lengths to obtain)
- Companionship sought urgently when relationship ends
- Exaggerated fears of being left to care for self

190
Q

Dependent PD prevalence in general population

A

0.6%
Women > men
More common in children

191
Q

Obsessive compulsive PD

A 
Orderliness, perfectionism and mental and interpersonal control 
4 or more of: 
SCRIMPER 
- Stubborn
- Cannot discard worthless objects
- Rule obsessed 
- Inflexible
- Miserly 
- Perfectionistic 
- Excludes leisure d/t devotion to work
- Reluctant to delegate to others
192
Q

Obsessive-compulsive PD prevalence rate

A

2-8%
Men > women
More common in older siblings

193
Q

PD with good insight and where tx often sought on pt’s own

A

Obsessive compulsive PD

194
Q

Anxiety affects ___ of children and adolescents

A

10-20%

195
Q

Common forms of anxiety in youth

A

Separation anxiety d/o
GAD
Social anxiety disorder

196
Q

Normal anxiety in infancy/toddlerhood

A

Loss of physical contact to caregivers, loud noise, separation

197
Q

Normal anxiety in preschooler

A

Animals, dark, separation, imaginary characters (monsters)

198
Q

Normal anxiety in school/age children

A

Natural disasters, performance, illness, mortality, germs

199
Q

Normal anxiety in adolescent

A

Rejection in social or intimate relationships, existential, future

200
Q

S/E of SSRI in youth

A

Small decrease in growth rate (reversible upon d/c)
Agitation and disinhibition in younger children
VERY rare increased rate of suicidal thoughts and behaviours

201
Q

Normal separation anxiety peaks btwn __ and __ months and should diminish by about ___ y.o. Most common between ages ___.

A

9 and 18 months
2.5 y.o.
7-8 y.o.

202
Q

Separation anxiety d/o (8)

A

Beyond developmental expectations
At least 3 symptoms for at least 4 weeks
- Fear of untoward event separating them from caregiver
- Unable to sleep without being near caregiver
- Reluctance to go to school b/c fear of separation
- Repeated nightmares with theme of separation
- Physical symptoms when separation anticipated
- Distress with anticipated separation from home or caregiver
- Worry about harm to caregiver
- Reluctance to be alone

203
Q

GAD prevalence in school-aged children and teens

A

School-aged children = 3%

Teens = 3.7%

204
Q

Prevalence of social anxiety disorder in children

A

1%

205
Q

Social anxiety d/o

A

Must experience anxiety in peer settings, not just with adults
6 mo or more
May be restricted to performance only

206
Q

Prevalence of specific phobias in school-aged children

A

~2.4%

207
Q

Specific phobia

A

Marked fear or anxiety about specific object or situation

6mo or more

208
Q

Panic d/o

A 
Recurrent unexpected attacks - abrupt surge of fear or intense discomfort reaching peak within MINUTES during which time 4 or more of the following occur: 
- Palpitations, pounding heart, high HR 
- Sweating 
- Trembling/shaking 
- Blurred vision 
- Light-headedness 
- Chills or heat sensations
- Paresthesias 
- Derealization
- Fear or losing control
- Fear of dying
- Sensation of SOB or smothering 
- Feelings of choking 
- CP or discomfort 
- Nausea 
At least one attack followed by 1 mo or more of one or both of:
- persistent corn or worry about more panic attacks or their consequences
-Significant maladaptive change in behaviour related to attacks
209
Q

Selective mutism

A

Consistent failure to speak in specific social situations in which there’s an expectation for speaking despite speaking in other situations
At least 4 weeks
Not d/t lack of knowledge of spoken language

210
Q

Tic d/o

A

Tourette’s
- Multiple motor and one or more vocal tics (not necessarily concurrently)
- May wax and wane in frequency, but present for more than 1y since onset
- Onset before age 18
Chronic Motor OR vocal tic d/o
- Single or multiple motor OR vocal tics but NOT BOTH
- May wax and wane in frequency, but present for more than 1y since onset
- Onset before age 18
Provisional tic d/o
- Single or multiple motor and/or vocal tics
- Present for less than 1y since first tic onset
- Onset before age 18
- Not fully met criteria for Tourette’s d/o or chronic motor/vocal tic d/o

211
Q

Sensory phenomenon which occurs before person does tic

A

Premonitory urge

212
Q

Classifications of tics

A

Simple motor (ie. blinking, grimacing, mouth widening, nose scrunching. eyebrow raising, shoulder struggling)
Simple vocal tics (ie. throat clearing, sniffing, squeaking, grunting)
Complex motor tics (ie. ie. touching things multiple times, obscene gestures/copropraxia, self-biting)
Complex vocal tics (ie. coprolalia/swearing, echolalia, palilalia/repeating own words)

213
Q

2 major common comorbidities with tic d.o

A

OCD

ADHD

214
Q

Tic d/o tx

A

Behaviour tx (need premonitory urge)
Tic neutral environment
Education
Meds - alpha agonist (clonidine), dopamine blockers (risperidone)

215
Q

4 attachment styles

A

Secure
Insecure - avoidant
Insecure - ambivalent
Disorganized-inhibited or disinhibited

216
Q

Secure attachment style

A

Healthy, good enough parenting
Child learns that they will get attention when they need help
60% of children
Mentally healthy adolescents and adults

217
Q

Insecure - avoidant attachment style

A

Emotionally rejecting parenting style
Child learns they will not receive attention when they need help and try to avoid expressing distress/do not seek parents for help
20% of children
May be at higher risk of behaviour d/o
Emotionally inhibited adults but still live fulfilling lives

218
Q

Insecure - ambivalent attachment style

A

Inconsistent parenting
Seek caregiver for help but difficult to soothe
Show increased distress in face of stressors
More problems in relationships as teens/adults
Increased risk of future psych d/o (esp anxiety)

219
Q

Disorganized-inhibited or disinhibited attachment style

A

Scary or fearful caregiver
Unable to organize strategy for seeking help
Inhibited –> child won’t go to anyone for help –> reactive attachment d/o
Disinhibited –> child will go to anyone for help –> disinhibited social engagement d/o
HIGHEST RISK for later developing psychopathology

220
Q

Attachment

A

First 3 years of life critical

Can change over time

221
Q

Dyadic therapy

A

Therapy with infant and parent

222
Q

Reactive attachment d/o

A

A. Pattern of inhibited, emotionally withdrawn behaviour towards caregivers, manifested by BOTH of:
- Rarely seeks comfort when distressed
- Rarely responds to comfort when distressed
B. Persistent social and emotional disturbance characterized by at least 2 of:
- Minimal social/emotional responsiveness
-Limited positive affect
- Epis of unexplained irritability, sadness ,or fearfulness
C. Experienced pattern of extremes of insufficient care as evidenced by at least 1 of:
- Social neglect or deprivation in form of persistent lack of having basic emotional needs for comfort, stimulation and affection
- Repeated changes of primary caregivers that limit opportunities to form stable attachments
- Rearing in usual settings that severely limit opportunities to form selective attachments

Disturbance before age 5
Developmental age of at least 9mo

223
Q

Disinhibited social engagement d/o

A

A. Child actively approaches unfamiliar adults and exhibits at least 2 of:
- Reduced or absent reservation in approaching unfamiliar adults
- Overly familiar verbal or physical behaviour
- Diminished or absent checking back with adult caregiver after venturing far away
- Willingness to go off with unfamiliar adult
B. Behaviours not limited to impulsivity but include socially disinhibited behaviour
C. Child experienced pattern of extremes of insufficient care by at least one of:
- Social neglect or deprivation in form of persistent lack of having basic emotional needs for comfort, stimulation and affection
- Repeated changes of primary caregivers that limit opportunities to form stable attachments
- Rearing in usual settings that severely limit opportunities to form selective attachments

224
Q

Autism Spectrum D/O

A

A. Persistent deficits in social communication and social interaction across multiple contexts as manifested by:
- Deficits in social-emotional reciprocity
- Deficits in nonverbal communicative behaviours used for social interaction
- Deficits in developing, maintaining and understanding relationships
B. Repetitive patterns of behaviour interests or activities manifested by at least 2 of:
- Stereotyped or repetitive motor movements, use of objects or speech
- Insistence on sameness
- Highly restricted, fixated interests that are abnormal in intensity or focus
- Hyper or hyperactivity to sensory input or unusual interest in sensory aspects of enviro
C. Symptoms present in early development

225
Q

Mild intellectual disability

A

Grade 6 level

226
Q

Moderate intellectual disability

A

Elementary level

227
Q

Severe intellectual disability

A

Language limited to single words or phrases

Support required for all ADLs

228
Q

Profound intellectual disability

A

Very few conceptual skills gained

Dependent on others

229
Q

ASD Screening Instruments (2)

A

Autism Screening Questionnaire (ASQ)

ADI-R (Structured Interview of parents used to dx autism)

230
Q

Locus ceruleus

A

Mostly affected by NE

Panic/stress response

231
Q

Percent of school-aged children affected by ADHD

A

5-10%

232
Q

Percent of adults affected by ADHD

A

2.5%

233
Q

____% of children continue to meet criteria for ADHD in adolescence

A

60-85%

234
Q

Up to ____% of ADHD children meet criteria for comorbid psych d/o

A

70%

235
Q

Superior and temporal cortices

A

Focusing attention

236
Q

External parietal and corpus striatal regions

A

Motor executive functions

237
Q

Hippocampus

A

Memory

238
Q

Pre-frontal cortex

A

Shifting from one stimulus to another

239
Q

ADHD prognosis

A

60-85% continue to have symptoms in adolescence and adulthood
Sometimes hyperactivity disappears but inattentive/impulsivity remains
Mixed or predominantly hyperactive-impulsive are more likely to have stable dx over time than just inattentive

240
Q

ADHD - 1st line pharmacologic tx

A

CNS STIMULANTS

  • Methylphenidate
  • Dextroamphetamine
  • Dextroamphetamine and amphetamine salt combos
241
Q

Methylphenidate

A

Ritalin, Concerta, Biphentin (small granules that can be sprinkled into food)
Dopamine AGONIST

242
Q

Dextroamphetamine

A

Dexedrine, Vyvanse

Dopamine AGONIST

243
Q

Dextroamphetamine and amphetamine salt combos

A

Adderall

244
Q

ADHD non-stimulant medications

A

Atomoxetine HCl (Straterra)
Clonidine and guanfacine
Wellbutrin

245
Q

ADHD CNS stimulant C/O

A

V rare risk of sudden cardiac death
C/I in pts with known cardiac risk
Cardiac consult needed for anyone with high risk
NO risk factors = routine ECG/cardio referral not needed

246
Q

Atomoxetine HCl

A

Straterra
NE uptake inhibitor
BLACK BOX WARNING - increased suicidal thoughts or behaviours

247
Q

Clonidine and guanfacine

A

Alpha agonists
Clonidine works on prefrontal cortex –> decreased BP and HR
Often used n children with comorbid tic d/o

248
Q

Monitoring while on stimulants

A

Height (decrease growth by ~2cm)
Weight (may have weight loss/decreased appetite)
BP (systolic may increase 3-8mmHg; diastolic 2-14mmHg)
Pulse (increase 3-10BPM)
on quarterly basis
P/E annually

249
Q

1st line tx for ADHD In preschool aged children (4-5 y.o.)

A

Behaviour modification in classroom and at home

Child-centred play, positive reinforcement, ignore poor behaviour

250
Q

ADHD

A

A. Inattention AND/OR hyperactivity-impulsivity that interferes with fining or development
- Inattention: 6 or more of (for at least 6 months)
* Fails to pay close attention to details
* Difficulty staying focused
* Does not listen when spoken to
* Doesn’t follow instructions
* Avoids tasks that requires sustained mental effort
* Loses things necessary for tasks
* Easily distracted by extraneous stimuli
* Forgetful in daily activities
- Hyperactivity and impulsivity: 6 or more of (for at least 6months) or 5 or more if older teen/adult
* Fidgets with or taps hands/feets
* Leaves seat when not supposed to
* runs or climbs a lot/feels restless
* unable to play or engage in leisure activities quietly
* On the go, acting as if driven by motor
* talks excessively
* blurbs out answers
* can’t wait his/her turn
* interrupts or intrudes on others
Symptoms present before age 12
Symptoms present in 2 or more settings

251
Q

OCD epidemiology

A

0.5% children/teens affected
Lifetime prevalence of 2-4%
Females > males (Slightly) but boys > girls
More prevalent than schizophrenia or BPD
4th most common psych d/o after substance use d/o, phobias and MDD
Mean AOO = 20y.o.

252
Q

Most commonly reported obsession

A

Extreme fears of contamination

253
Q

Second most commonly reported obsession

A

Worries related to harm to themselves, family or fear of harming others d/t losing control over aggressive impulses

254
Q

Initial intervention for OCD

A

CBT

255
Q

Pharmacotherapy for OCD

A
  1. SSRI
  2. If SSRI doesn’t work –> clomipramine (TCA with highest selectivity for serotonin reuptake)
  3. If neither SSRI nor clomipramine work, ADD valproate, lithium, carbamazepine OR try another drug (ie. venlafaxine, MAOI, buspirone, clonazepam, or atypical antipsychotic)
256
Q

SCOFF questions for ED

A

Do you make yourself feel Sick b/c you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone (14lbs) in a 3 month pre?
Do you believe you’re Fat when others say you’re thin?
Would you say that Food dominates your life?

If >2, likely AN or BD

257
Q

Female athlete triad

A
  1. Disordered eating
  2. Amenorrhea
  3. Osteopenia
258
Q

Medication C/I with ED d/t increase in seizure risk

A

Bupropion

259
Q

2 different subtypes of AN

A
  1. Restricting type

2. Binge eating/purging type

260
Q

Anorexia nervosa

A
  1. Significant low body weight
  2. Fear of gaining weight
  3. Disturbance in body weight self-evaluation
261
Q

AN severity

A

Mild: BMI >/= 17
Moderate: BMI 16-16.99
Severe: BMI 15-15.99
Extreme: BMI <15

262
Q

AN prevalence rate

A

0.5%

263
Q

Sick euthyroid syndrome

A

TSH normal but peripheral conversion from T4 to T3 is decreased, leading to signs and symptoms of hypothyroidism

264
Q

Anorexia tx

A

Maudsley Family-Based Therapy
Phase 1= Weight-restoration
Phase 2 = Returning control back to child
Phase 3 = Set healthy adolescent identity

265
Q

Anorexia prognosis

A

Rule of thirds
1/3 recover fully
1/3 recover but relapse when stressed
1/3 have chronic relapsing course

266
Q

Bulimia nervosa prevalence rate

A

1-2%

267
Q

Bulimia nervosa

A
  • Binge eating
  • Inappropriate compensatory behaviours to prevent weight gain
  • Bing eating and inappropriate compensatory behaviours occur at least 1x/wk for 3mo
  • Self-evaluation influenced by body shape/weight
  • Disturbance not occurring exclusively during episode of AN
268
Q

Binge eating

A

Both of:

  • Eating more than one normally would in a set period of time
  • Sense of lack of control during eating episode
269
Q

Bulimia nervosa severity

A

Mild: 1-3epis/wk
Mod: 4-7 epis/wk
Severe: 8-13 epis/wk
Extreme: 14 or more epis/wk

270
Q

Russel’s sign

A

Calluses on knuckles or back of hand due to repeated self-induced vomiting caused by incisor teeth during gag reflex

271
Q

Tx for bulimia nervosa

A

CBT

SSRI sometimes

272
Q

Binge eating d/o

A
  • Recurrent epis of binge eating
  • Epis associated with 3 or more of:
  • Eating more rapidly than normal
  • Eating alone b/c embarrassed
  • Feeling gross with oneself afterwards
  • Eating until uncomfortably full
  • Eating large amounts when not hungry
  • Marked distress regarding binge eating
  • Occurs ~1x/wk for 3mo
  • NOT associated with recurrent use of inappropriate compensatory behaviour
273
Q

Oppositional defiant disorder

A 
At least 6mo 
at least 4 symptoms from any of the categories when interacting with at least 1 person who is not a sibling:
- Angry or irritable mood 
- Argumentative/defiant behaviour 
- Vindictiveness
274
Q

ODD severity

A

Mild - confined to one setting
Moderate - Present in at least 2 settings
Severe - Present in 3 or more settings

275
Q

ODD prevalence

A

1-11%

276
Q

ODD general course

A

ODD > conduct disorder > antisocial personality disorder but not always
Usually appears during preschool

277
Q

ODD tx

A

Parent training
Parent-child interaction therapy
Individual/family therapy

278
Q

Conduct disorder

A

3/15 symptoms present in past 12mo with at least 1 criterion present in past 6months

  • Aggression to people and animals
  • Destruction of property
  • Deceitfulness or theft
  • Serious violation of rules (missing school, staying out, running away from home)
279
Q

CD prevalence/gender distribution

A

2-10%
Males > females
Earlier onset generally worse prognosis

280
Q

PTSD

A
  • Exposure to actual or threatened death, serious injury or sexual violence (actually experiencing, witnessing, learning it happened to close family member/friend, repeatedly experiencing exposure)
  • Presence of >/1 intrusive symptoms:
  • Recurrent memories
  • Recurrent distressing dreams
  • Dissociative rxns (flashbacks)
  • Intense psych distress at exposure to int/ext cues that symbolize aspect of traumatic event
  • Marked psych runs to internal or ext cues that symbolize or resemble an aspect of trauma
  • Persistent avoidance of stimuli a/w trauma (memories or reminders)
  • Negative changes in cognitions/mood a/w traumatic event
  • can’t remember important parts of event
  • Exaggerated -ve beliefs about oneself or world
  • Distorted cognitions about cause or consequences of trauma
  • Persistent -ve emotional state etc.
  • Marked alterations in arousal/reactivity a/w trauma
  • Duration MORE THAN 1 MONTH
281
Q

PTSD prevalence among adults

A

3.5%

282
Q

PTSD lifetime prevalence in general population

A

8%

283
Q

PTSD gender differences

A

Women > men

284
Q

PTSD course and prognosis

A

Delay can be as short as 1wk or as long as 30yrs

After 1yr, 50% recover

285
Q

PTSD tx

A

SSRIs are FIRST LINE tx for PTSD
Psychotherapy - CBT, exposure therapy, stress management, eye movement desensitization and reprocessing (EMDR), group therapy, family therapy

286
Q

___% of older adults have depressive symptoms

A

15

287
Q

Depressive symptoms more common in older patients

A

Somatic symptoms
Memory complaints
Psychotic features/paranoia

288
Q

Scale for geri depression

A 
Geriatric Depression Scale (GDS)
0-4 = Normal
5-9 = Mild depression
10-15 = Severe depression
Differs from PHQ-9 because has less focus on somatic symptoms which are very common in older pts so can give false positive
289
Q

MOCA score

A

26/30 or above is normal

290
Q

Major neurocognitive disorder (dementia)

A 
Insidious onset 
Lasts months to years 
Stable and progressive course 
Orientation usually impaired to time and then later to place
Slowed thoughts/word finding difficulty/poor judgements/paranoid and delusions common
\+/- Visual hallucinations 
Labile/irritable emotions
Difficulty sleeping 
Poor insight
291
Q

Geri depression tx

A

Studies have shown combined therapy of pharmacy and psychotherapy superior to either modality alone

292
Q

Common SSRIs

A 
Citalopram
Escitalopram
Fluoxetine
Sertraline 
Paroxetine 
Fluvoxamine
293
Q

Trazodone drug class

A

SARI (Serotonin antagonist and reuptake inhibitor)

294
Q

Common MAOI

A

Phenelzine

295
Q

Age group with highest rate of suicide

A

Elderly

Especially white me over age 65

296
Q

Suicide Risk Assessment

A 
SAD PERSONS 
Sex (+1 if male) 
Age (+1 if under 19 or over 45) 
Depression (+1 if present) 
Previous Attempt (+1 if present) 
Ethanol abuse (+1 if present)
Rational thinking loss (+1 if psychotic for any reason) 
Social support lacking (+1 if lacking0
Organized plan (+1 if plan made and method legal) 
No spouse
Sickness
0-2 = low risk
3-4 = moderate risk, follow closely 
5-6= high risk, consider hospitalization
7-10 = very high risk, hospitalize or commit
297
Q

Drugs associated with delirium

A 
Sedatives 
Opioids 
Anticholinergics 
EtOH 
Drug withdrawal
298
Q

1yr mortality rate for pt with delirium episode while in hospital

A

As high as 50%

299
Q

Delirium: major NT involved, major neuroanatomical area involved, major neuro pathway involved

A

ACh, reticular formation of brainstem (attention and arousal), dorsal tegmental pathway

300
Q

Delirium treatment

A 
Environmental support (calendars, clocks, pictures) 
Pharmacotherapy - benzos first line, halloo PRN, atypical antipsychotics not as well studied
301
Q

Areas of cognition affected in major neurocognitive disorder

A 
Complex attention
Executive function
learning and memory 
Perceptual motor 
Social cognition
302
Q

Top 3 most common forms of major neurocogntivie disorder

A
  1. Alzheimer’s Type (50-60%)
  2. Vascular dementia (15-30%)
  3. Mixed vascular and alzheimer
303
Q

Prevalence of major neurocognitive disorder in population >65 and >85

A

5%, 20%

304
Q

Alzheimer’s type dementia

A

Amyloid deposits, neurofibrillary tangles, neuronal loss (in cortex and hippocampus especially)
Evidence of causative gene on chromosome 21 in family hx OR all 3 of:
1. clear decline in memory and learning and at least 1 other domain
2. steadily progressive, gradual decline in cognition, no plateaus
3. No evidence of mixed forms of dementia

305
Q

Vascular dementia

A

More focal neuro symptoms but may affect wide areas of brain

Atherosclerotic plaques or thromboembolisms in small-medium sized cerebral vessels

306
Q

Frontotemporal dementia/Pick’s disease

A

Men > women
Personality/behaviour changes with relative preservation of cognitive function
Pick bodies = build-up of tau proteins in neurons

307
Q

Lewy body disease

A

Visual hallucinations, parkinsonism features and EPS

Lewy body build up in cerebral cortex (alpha synuclein proteins)

308
Q

Neurocognitive disorder tx

A

Benzos for insomnia and anxiety
Antidepressants for depression
Antipsychotics for delusions/hallucinations (risperidone is only one actually approved for this use)
Cholinesterase inhibitors (Dementia a/w LOW ACh) - donepezil*, rivastigmine, galantamine, tacrine

309
Q

Lamotrigine major S/E

A

Steven Johnson

Associated with rate of increase (don’t increase by more than 25mg/wk)

310
Q

Divalproex and lamotrigine interaction

A

Divalproex can cause lamotrigine levels to be significantly higher than expected base on dose alone (~2x dose)

311
Q

Most likely comorbidity with specific phobia d/o

A

Other anxiety disorders

312
Q

Best tx for specific phobia

A

CBT

313
Q

Exposure response prevention therapy

A

Form of CBT for OCD

Clerkship (7 decks)

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