Psych and substance abuse Flashcards
Patient with liver dysfunction has alcohol withdrawl symptoms.. which benzo do we use?
Outside The Liver
Oxazepam
Tenazepam
Lorazepam
Somatic symptom vs illness anxiety disorder
Somatic symptom - excessive anxiety over 1 or more unexplained symptoms.
Illness anxiety disorder - Fear of having a serious ilness despite few or NO symptoms and consistently negative evaluations.
what is the normal age range for stranger anxiety?
6 months to 2 years
Normal child at birth.. then develops LOSS of ability to speak, feed. + abnormal gait and hand rubbing is seen in what syndrome?
RETT syndrome.
mainly seen in girls due to mutations in x-linked MECP2 Gene.
They often get numerous SEIZURES and get worse with age.
Angelman syndrome features
developmental delay FROM BIRTH.
Happy disposition + Jerky Gait + Hand Flapping.
Delayed Sleep wake disorder
Sleeping late.. and not able to get up early
Advanced sleep wake disorder
Cant stay awake in evenings (after 7pm).. and wake up early in the mornings
Shift work disroder
Shift work making it difficult to form a good sleep pattern. Leads to day time sleepiness.
Delerium tremens does not only present with psych findings.. what are some of the physical symptoms?
FEVER, TACHYCARDIA, HYPERTENSION, diaphoresis, hallucinations, confusion, agitation
HIV associated neurocog disorder
Occurs after long standing HIV disease and CD4 below 200.
Results in Impaired Memory, Attention, Personality and behavioral changes, And Motor symptoms (ataxia, slowed movement).
Diagnosis - clinical presentation, neuropsych testing.
MRI will show DIFFUSE increase in INTENSITY in the WHITE MATTER
Children with a history of ABUSE, NEGLECT, prolonged institutionalization.. inconsistent care (multiple foster homes) are predisposed to having what pscyh disorder?
Reactive Attachment disorder.
These patients seldom seek comfort, and do not respond to attempts to comfort them.
Other symptoms include LACK of SOCIAL RESPONSIVENESS, lack of emotions, and episodes of unexpected irritability or sadness in response to nonthreatening encounters.
Prenatal exposure to Opiates vs Cocaine symptoms
Opiates including Methadone and Heroin - INTRAUTERINE GROWTH RESTRICTION, SIDS and Neonatal Abstinence Syndrome ( Irritablity, HIGH PITCHED CRY, sleeping and feeding difficulties, tremors, seizures, SWEATING and SNEEZING, tachypnea, vomiting.
Cociane exposure: Jitteriness, Excessive sucking, and Hyperactive MORO REFLEX.
what is a bipolar med that is safe in pregnancy?
Lamotrigrine.
anytime you switch from one med to another, pregnancy should be DELAYED by 3-6 months to assess the EFFICACY of the med. If its effective and stable.. then get prego.
Acute Dystonia (an extra pyramidal symptom) can occur with antipsychotics and what other drugs?
AntiEMETICS –> Metoclopramide and Prochlorperazine (anti emetic but also antipsychotic).
Language disorder
Persistent difficulties in COMPREHENSION (receptive) and / or PRODUCTION (expression) of written language.
May involve any part of language (grammar, syntax, vocabulary, functional use of language etc).
OCD therapy
SSRI + CBT (exposure and response prevention therapy)
McCune-Albright Syndrome features
- Precocious puberty –> onset of secondary sexual characteristics in girls before 8 or in boys before 9.
- Irregular Cafe-au-lait macules on ONE SIDE of the body
- Polyostoic Fibrous Dysplasia
Caused by Mutation in GNAS gene resulting in constant activation and OVERPRODUCTION of pituitary hormones.
Peripheral precocious puberty (GNRH independent!!!.. caused by release of LH and FSH). and also TSH (thyrotoxicosis) + Acromegaly (GH) + ACTH (Cushing)
Central vs peripheral precocious puberty
Central Precocious puberty - Caused by EARLY INACTIVATION of the hypothalamic-pituitary-gonadal axis –> release of GnRH
Peripheral Precocious Puberty –> caused by premature secretion of sex horomones INDEPENDENT of GnRH
how does an adreanl tumor cause premature adrenarche?
It causes ISOLATED premature adrenarche and specifically Pubic, axillary hair, acne, body odor.. but not other sexual characteristics like Breast development.
Sturge Weber syndrome findings
Intellectual disability, seizures and visual impairment due to capillary-venous malformations.
Skin lesions - Port Wine stain over the territory of the Trigeminal Nerve.
Marfans syndrome findings
JOINT HYPERMOBILITY, skin hyperELASTICITY, Long fingers, PECTUS EXCAVATUM, SOLIOSIS / KYPHOSIS.
Face is LONG Plate is ARCHED teeth are CROWDED Lens DISLOCATION FEET are flat AORTIC ROOT DILATION - most life threatening finding. can result in ANEURYSMS and AORTIC ARCH DISSECTION.
MVP is also a common finding in these patients –> misystolic click and late systolic murmur.
First degree relatives should undergo genetic testing.
Homocystinuria vs marfans
Patients look very similar to marfans (Pectus deformity, tall stature, arachnodactyly)
however Homocystinuria has FAIR complexion, THRomboemboic events, and intellectual disablity.
Also LENS dislocation in Homocystinuria is DOWN wards (bend down like homo)
and UPWARDS in marfans.
why do you get swelling in turners syndrome?
lymphatic network dysgenesis.
NON pitting EdemA.
Protein rich interstitial fluid accumulates in the hands, feet and neck. Severe obstruction of lymphatic vessesl can result in a CYSTIC HYGROMA of the neck and fetal hydrops.
Turner Syndrome Findings
Webbed neck, carpal and pedal edema, nail DYSPLASIA, HORSESHOE KINDEY
Increased risk of osteoperotic fracture. The OVARIAN DYSGENESIS leads to STREAK OVARIES –> estrogen deficient and thus amenorrhea with mininal or no breast development.
Estrogen normally inhibits osteoclastic bone resorption. Since there is no estrogen in Turners.. they have increased bone resorption –> decreased bone mineral density –> increased risk for osteoporotic fracture.
