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1
Q

What is the best predictor of complications in TCA overdose?

A

QRS duration:
>100msec –> inc risk of arrhythmias, seizures, give NaBicarb

*seizures can occur in TCA overdose

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2
Q

Indications for ECT (5)

A
  1. treatment resistant
  2. psychotic features
  3. emergency conditions:
    - -pregnancy
    - -refusal to eat or drink
    - -imminent risk for suicide
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3
Q

drug interactions w/ lithium that can cause toxicity (4)

A
  1. thiazides
  2. NSAIDs (not aspirin)
  3. tetracyclines
  4. metronidazole
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4
Q

PCP (phencyclidine) intoxication

A 
hallucinations
**nystagmus 
dissociative feelings
agitation
confusion
pupil dilation
tachy
\+/- psychotic and violent behavior 
\+/- severe HTN
\+/- hyperthermia
Duration: 8 hours
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5
Q

acute intermittent porphyria

A

intermittent neurovisceral symptoms **abdom pain (non tender on exam)
neuro/psych abnormalities
elev urine porphobilinogen

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6
Q

nightmare disorder vs sleep terror disorder

A

nightmare disorder: night awakenings, recall of disturbing dreams, consolable , nightmares during REM and usually in second half of night

sleep terror disorder: non-REM arousal disorder, incomplete awakenings, inconsolable, no recall of dreams, usually in first 1/3 of night, autonomic arousal and amnesia in the AM

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7
Q

adjustment disorder timeline

A

wishing 3 months of stressor
lasts no longer than 6 months
**dont meet criteria for other disorder

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8
Q

neuroimaging for schizophrenia, Huntington’s, autism, OCD

A

schizophrenia: loss of cortical tissue V, vent enlargement *lateral, dec V of hippocampus, dec V of amygdala
Huntington: caudate atrophy
Autism: accelerated head growth during infancy, inc total brain V
OCD: structural abnorm in Orbit-frontal cortex and basal ganglia

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9
Q

treatment for catatonia?

A

benzo: lorazepam

ECT

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10
Q

echopraxia

A

imitating mvmts

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11
Q

echolalia

A

imitating speech

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12
Q

neologisms

A

made up words

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13
Q

clang associations

A

rhyming and punning *hip hop-esque

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14
Q

perserveration

A

inability to change the topic; giving the same response to different Qs

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15
Q

agnosia

A

inability to recognize people or objects even w/ intact sensory fxn

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16
Q

synesthesia

A

sensation of one modality perceived by another (e.g. seeing sounds)

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17
Q

psychosis exacerbating drugs (4)

A
  1. BB
  2. digoxin
  3. steroids
  4. anticholinergics
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18
Q

SCZ pathophys

A

+ sxs: inc DA in mesolimbic
- sxs: dec DA in prefrontal cortex
inc 5HT, NE
dec GABA, glutamate

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19
Q

substances that can induce mood d/o (5)

A 
BB (depression)
steroids
levodopa
cocaine (mania)
OCP (depression)
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20
Q

MDD risk factors (4)

A

stroke
pancreatic cancer
loss of parent before 11
genetics

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21
Q

MDD brain

A

reduced frontal lobe blood flow and metabolism

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22
Q

mania in pregnancy tx

A

*atypicals

if h/o postpartum mania –> Lithium ppx (c/I to breastfeeding)

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23
Q

tx for rapid cycling disorder

A

(4+ mood episodes in 1 year)

tx = carbamazepine

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24
Q

anxiety NTs

A

inc NE

dec GABA, 5HT

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25
anxiety 2/2 GMC (5)
1. hyperthyroidism 2. Sjogren syndrome 3. PE 4. pheo 5. seizure
26
OCD tx
1. SSRI - fluvoxamine 2. Clomipramine (TCA) last resort: ECT, cingulotomy
27
antisocial PD tx
SSRI and mood stabilizers help reduce aggression | psychotherapy useless
28
ETOH + H2 blockers --> ?
inc ETOH levels
29
barbiturates OD tx
IV NaHCO3
30
GHB
aka: sodium oxybate CNS depressant, date rape drug tx for cataplexy
31
inhalants
CNS depressants | tx: some need chelation
32
MDMA/MDEA(ecstasy) + SSRI --> ?
Serotonin syndrome
33
caffeine
adenosine antagonist + PDE blocker --> inc cAMP | OD: tinnitus, agitation, arrhythmias, seizures, death
34
demerol
opiate pupil dilation, resp depressions, sedation, dec pain, dec GI motility + MAOI --> Serotonin syndrome
35
opioid withdrawal tx
``` CLIP clonidine loperamide ibuprofen promethazine ``` add methadone or buprenorphine if severe
36
PCP intox labs
+UDS 3-8 days inc CPK inc AST
37
chronic MJ use
resp sxs + gynecomastia
38
dronabinol
THC in pill used to treat anorexia *AIDS, cancer
39
AD brain
diffuse atrophy w/ enlarged vent and flattened sulci senile and neural plaques neurofibrillary tangles
40
levy body dementia
lewy body and neurotic accumulations in basal ganglia sxs: Parkinsonism, VH tx: AChE inh, antiparkinsonians, psychostimulants for motor sx
41
what do antipsychotics do in Parkinson's?
exacerbate dementia
42
prader willi syndrome
partial deletion of chromo 15q --> MR obesity almond eyes hypogonadism
43
coprolalia
repetitive speaking of swear words
44
Tourette etiology and tx
impaired DA regulation in caudate nucleus tx: risperidone, alpha2 agonist (clonidine, guanfacine) typical antipsychotics if sever
45
abreaction
strong reaction pts get when retrieving traumatic memories
46
dissociative amnesia
can't recall personal info but can remember obscure details, aware that they can't remember TX: psychotherapy lorazepam or amobarbital may help patient talk freely during interview
47
depersonalization disorder tx
anxiolytics or SSRI
48
ataque de nervios
Puerto rican culturally bound trance disorder that consists of convulsive mvmt, fainting, crying, visual probs
49
ganser syndrome
giving approximate answers to simple Qs (e.g. how many legs do you have)
50
intermittent explosive d/o dx and tx
dx: dec 5-HIAA in CSF | tx; SSRI + lithium + propranolol
51
anorexia lab values
inc: cortisol, QTc, chol, BUN, GH dec: RBC, WBC, LH/FSH, E/T, T4/T3, glucose
52
refeeding syndrome
fluid retention and low Ca/Mg/Ph --> RADS (resp fail, arrhythmias, delirium, seizures)
53
bulimia labs
contraction alkalosis inc BUN, bicarb, amylase abnorm T4/T3, cortisol
54
sleep EEGs
``` BATS Drink Blood beta (awake) alpha (resting) Theta (I) Sleep Spindles and K Komplexes (II) delta (III) beta (REM) ```
55
narcolepsy etiology and tx
loss of hypothalamic neurons that contain hypocretin | tx (as needed): sleep hygiene, scheduled naps, stimulants for daytime, sodium oxybate (GHB) for cataplexy
56
Kleine Levin syndrome
excess daytime sleepiness, aggression hyperplasia, hyper sexuality
57
substance induced sexual dysfunction
``` anti HTN anticholinergics antipsychotics antidepressants substance abuse ```
58
premature ejaculation tx
SSRI or TCA can help
59
frotteurism
sexual pleasure from touching/rubbing up on non consenting person
60
sublimation
satisfying impulses/feelings in an acceptable manner
61
suppression vs repression
suppression: consciously avoiding unacceptable impulse/emotion repression: unconsciously avoiding unacceptable impulse/emotion
62
reaction formation
doing the opposite of unacceptable impulse/emotion
63
displacement vs projection vs transference
displacement: redirecting thoughts/feelings about one thing onto something more tolerable projection: attributing ones inappropriate emotions/thoughts onto another person transference: patient projects unconscious feeling onto doctor
64
isolation of affect
separation of unpleasant idea from the feelings it evokes
65
serotonin syndrome tx
cyproheptadine benzo *avoid taking w/in 5 wks of each other
66
CYP inducers and inhibitors
inducers: smoking, carbamazepine, barbiturates, st john's wort inhibitors: fluvoxamine, fluoxetine, paroxetine, duloxetine, sertraline
67
teratogenic psych meds
TCAs: fetal limb defects VPA lithium Benzos: cleft palate + FAS facies
68
longest and shortest half life SSRIs
longest: fluoxetine shortest: Paroxetine
69
chlorpromazine and thioridazine adverse effects
(low potency first gen antipsychotics) anti-HAM, less so EPS and TD chlorpromazine: corneal pigmentation, photosensitivity thioridazine: retinal pigmentation --> night blindness
70
ziprasidone and eating
food is required to activate ziprasidone in the body
71
lithium overdose: when to do dialysis?
if Li >4.0
72
benzos not metabolized by liver (3)
LOT lorazepam oxazepam temazepam
73
long vs short acting benzos
long: diazepam, clonazepam intermediate: alprazolam, lorazepam, oxazepam, temazepam short: triazolam, midazolam *medical/surgical uses
74
barbiturates OD tx
sodium bicarb
75
memantine
NMDA blockers used for moderate to severe Alzheimers
76
ECT c/I (2)
recent MI | any possible/recent hemorrhagic stroke (inc ICP, aneurysms, bleeding d/o, BBB disruption)
77
parens patriae
protecting citizens that can't care for themselves
78
circumlocution
substations of word or description for a word that can't be recalled
79
verbigeration
repetitive, meaningless talking
80
glossolalia
ability to speak a new language suddenly
81
koro
asian pt believes his penis is shrinking and will disappear causing his death
82
amok
sudden unprovoked outburst of violence *to run amok person has no recollection *Asian
83
sangue dormido
Portuguese d/o with numbness, tremors, paralysis, convulsions, stroke, heart attack
84
dhat
anxiety and illness anxiety about semen discharge
85
windigo
NA d/o | possession by a demon that murders and eats human flesh
86
capgras syndrome
delusion that family and friends have been replaced by identical imposters
87
lycanthropy
delusion that one is a werewolf or other animal
88
cotard syndrome
delusion that one has lost everything, including internal organs
89
Kluver Busy syndrome
bilateral amygdala lesions --> docility, hyperplasia, hypersexuality, disinhibition
90
NE, 5HT, DA, ACh synthesis locations
``` NE = locus seules 5HT = raphe nucleus DA = substantia nigra Each = nucleus accumbens ```
91
MDMA/ecstasy/molly intoxication
synthetic amphetamine w/ hallucinogenic properties --> inc NE, DA, 5HT inc sociability, empathy, sexual desire HTN, tachy, hyperthermia, serotonin syndrome, hyponatremia, death *not detected on routine tox screen
92
sudden onset of psychosis in child/teen
think medical or substance cause - SLE - thyroiditis - metabolic/electrolyte disorder - CNS infection - epilepsy
93
SLE and neuropsych
arthralgia + psychosis (can also cause depression, anxiety, mania) thrombocytopenia, hematuria, proteinuria seizures, headaches, periph neuropathy, stroke, chorea +ANA, anti dsDNA, anti smith, anti U1 ribonucprotein
94
anorexia nervosa tx
CBT nutritional rehab olanzapine for severe cases hospitalization if medically unstable (signs of dehydration, HR <40, hypotension, hypothermia, cardiac dysrhythmias, electrolyte disturbance, liver or heart failure, seizures, pancreatitis, syncope, very low weight-<70% expected

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