Psych Week 2 Flashcards
The largest proportion of severe intellectual disability is caused by what pathology occurring during what stage (pre-, peri-, postnatal) of development?
Give examples of potential pathologies that could occur during the other two stages of development and result in severe intellectual disability.
Chromosome abnormalities during prenatal development are the most common cause of severe intellectual disability
Perinatal: Interruption of O2 supply to the bran during delivery due to complicated delivery or separation of placenta from the uterine wall (abruptio placenta)
Post natal: Head trauma, infectious etiology (meningitis, encephalitis), or encephalopathy that may occur as the result of an inborn error of metabolism
Lecture 103b: Intellectual Disability
Objective 5: Give examples of causes of ID during prenatal, perinatal and postnatal development.
Compare and contrast normal anxiety with pathological variants as seen in diagnoses such as specific phobias, separation anxiety disorder, generalized anxiety disorder, selective mutism, social anxiety disorder, etc.
Pathological anxiety occurs in response to triggers that are thought to be normative experiences and result in an excessive and disproportionate reaction.
Pathological anxiety also has a predictable age of onset (usually pre-pubescent, 6-12 years old).
Some characteristics common to anxiety disorders include hypervigilance, reactivity to novel situations, and avoidance coping.
Lecture 105b: Anxiety and Mood Disorders in Children
Objective 1: List the different childhood onset anxiety disorders and be able to explain how they present clinically and differ from normal anxiety
Which of the following statements is TRUE about the diagnosis, etiology, and/or pathophysiology of schizophrenia? Bonus: why are the other statements false?
a. The neurotransmitter GABA is responsible for the negative symptoms of schizophrenia
b. A positive symptom of schizophrenia is affective flattening
c. Primarily negative symptoms are good prognostic factors for an individual with the disease
d. Schizophrenia is theorized to be the result of genetic factors and/or environmental/biological stresses (to a vulnerable individual)
a. False - Dopamine dysregulation is key in schizophrenia with dysregulation of the mesolimbic tract thought to result in positive symptoms and dysregulation of the mesocortical tract may result in negative symptoms. Serotonin and glutamate (via NMDA system) are also thought to be involved.
b. False – positive symptoms include things like hallucinations and delusions
c. False – primarily positive symptoms are good prognostic factors. Other good prognostic factors include later/more acute onset, good premorbid functioning, and no family history.
d. Correct
Lecture 97b: Schizophrenias
Objective 2: Describe the etiology and pathophysiology of schizophrenia
Match the side effect profile with the correct type of neurotransmitter blockade utilized in the treatment of psychosis
- Dopamine blockade in the tuberoinfundibular pathway
- H1 Histamine blockade
- Alpha-1 adrenergic blockade
- Anticholinergic (muscarinic) blockade
- Dopamine blockade in the nigrostraiatal pathway
a. Sedation and weight gain
b. Constipation, tachycardia, blurred vision, urinary retention
c. Extrapyramidal symptoms ( tardive dyskinesia, parkinsonism, akinesia, neuroleptic malignant syndrome)
d. Galactorrhea, gynecomastia, amenorrhea, and sexual dysfunction
e. Hypotension, dizziness, and sedation
- Dopamine blockade in the tuberoinfundibular pathway –d. Galactorrhea, gynecomastia, amenorrhea, and sexual dysfunction
- H1 Histamine blockade – a. Sedation and weight gain
- Alpha-1 adrenergic blockade – e. Hypotension, dizziness, and sedation
- Anticholinergic (muscarinic) blockade – b. Constipation, tachycardia, blurred vision, urinary retention
- Dopamine blockade in the nigrostraiatal pathway – c. Extrapyramidal symptoms ( tardive dyskinesia, parkinsonism, akinesia, neuroleptic malignant syndrome)
Lecture 99b: Antipsychotics
Objective 4: Describe the side effect profiles of antipsychotics
A mother brings in her child after having received multiple messages from the day care that the child doesn’t follow directions and is never listening. They act out with minimal stimulation, are constantly pulling at their clothes (especially the collars of their shirt) and don’t seem to have any friends in the classroom.
What are some potential items on your differential diagnoses for this child?
How could you evaluate to confirm a diagnosis?
Differential Diagnosis
Autism Spectrum Disorder, hearing impairment, anxiety/social phobia, social communication disorder, intellectual disability, obsessive compulsive disorder, schizophrenia
Evaluation
Structured diagnostic interview, physical examination, Vision/hearing tests, EEG, speech and language evaluation, neuropsychological testing
Lecture 102b: Autism Spectrum Disorders
Objective 4: Describe the differential diagnosis for Autism Spectrum Disorder and how to distinguish between Autism Spectrum Disorder and other disorders
Objective 6: Describe the approach to evaluating and treating Autism Spectrum Disorder
Which CORRECTLY pairs developmental tasks presented by Erikson’s model with the correct stage of development?
a. Initiative vs Guilt – Rule orientated, logical planning, relationships with non-family adults
b. Trust vs Mistrust – Imitative and imaginative play, dressing self, vocabulary explosion
c. Identity vs Role Confusion – Abstract reasoning, morality based on ideals, increased risk taking
d. Industry vs Inferiority – Egocentric, emerging self-control, symbolic play
e. Autonomy vs Shame and Doubt – dyadic self regulation, joint attention, transient stranger anxiety
Which CORRECTLY pairs developmental tasks presented by Erikson’s model with the correct stage of development?
a. Initiative vs Guilt occurs (preschool years) pairs with a maturing pencil grasp, understandable language, symbolic play, egocentric, and emerging self- control
* Tasks listed in a. are associated with Industry vs inferiority (Middle childhood)
b. Trust vs Mistrust (infancy) pairs with tasks such as roll/sit/crawl/cruise, social smile, swat/rake/pinch, transient stranger anxiety, dyadic self-regulation, joint attention
* Tasks listed in b. are associated with Autonomy vs Shame and doubt (Toddler years)
c. Correct
d. Industry vs Inferiority (middle childhood) pairs with perspective taking, logical operations, rule-orientated, relationships with non-family adults.
* Tasks listed in c. are associated with initiative vs guilt (preschool years)
e. Autonomy vs Shame (toddler years) pairs with walk/climb/run, vocabulary explosion, imitative and then imaginative play
* Tasks listed in d. are associated with trust vs mistrust (infancy)
Lecture 101b: Developmental Aspects of Psychiatry
Objective 3: Explain the developmental tasks presented by Erikson’s model for each stage of development of children through age 18-years-old.
Why are stimulants useful in the treatment of ADHD?
What is their basic mechanism of action (in a general sense)?
They stimulate portions of the brain that are underactive.
They increase the effect of dopamine and norepinephrine by blocking their reuptake and by increased their release into the synapse
Lecture 104b: ADHD
Objective 4: List and explain the different stimulant and non-stimulant options for treatment, and understand the mechanisms of action and possible side effects of these medications
Non-stimulant medications, such as guanfacine and clonidine, can also be prescribed for the treatment of ADHD. What is their basic mechanism of action?
They are both alpha-2 agonists (quiets the fight or flight response)
Lecture 104b: ADHD
Ojective 4: List and explain the different stimulant and non-stimulant options for treatment, and understand the mechanisms of action and possible side effects of these medications
A patient is doing well on lithium for several months, but then reports that it is suddenly no longer controlling his mania. Checking his serum Li level shows that they are on average only 0.3 mEq/L. Further discussion with him reveals that he was recently placed on a new medication (for a non-psychiatric concern). Which of these medications is he most likely now taking?
- Spironolactone
- Lisinopril
- Acetazolamide
- Triamterine
- Amlodipine
Explanation: The answer is C. All of the other drugs are examples of those that increase Li levels. In addition to acetazolamide, alkalizing agents also decrease serum Li levels.
Learning objective covered: Describe the mechanism of action, side effects, drug interactions, and laboratory monitoring of lithium (SM 106b)
A new mother on SSRIs reports that her newborn is “breathing strangely,” and is generally fussy and fidgety. Which of these should you do next?
Explanation: C. This is a case of neonatal adaptation syndrome, which presents in 0-30% of cases. Generally does not require a higher level of care or delay discharge postpartum
Learning objective covered: Learner will gain a deeper understanding of the use of psychotropics in breastfeeding. (SM 107b)
SIGECAPS Mnemonic for Depressive Symptoms
- Sleep disturbance (increased or decreased)
- Interest reduced (anhedonia)
- Guilt and worthlessness
- Energy loss and fatigue
- Concentration problems
- Appetite problem (increased or decreased)
- Psychomotor agitation or retardation
- Suicidality
Learning objective covered: Describe common variations in depression symptoms (SM 107/108b)
What are the most common conditions/disorders that are comorbid with major depressive disorders and bipolar illness?
Explanation: alcohol and substance abuse, and OCD and anxiety disorders (Panic Disorder, Social Phobia, Generalized Anxiety Disorder)
Learning objective covered: Describe common mood disorder comorbidities (SM 107/108b)
Which of these is true about MAOIs?
- No risk of Serotonin Syndrome
- Histaminergic side effects
- Severe interaction with Demerol
- Require tyramine supplementation in the diet
Explanation: C. MAOIs have a severe drug interaction with Demerol. They also have a risk of serotonin syndrome and a risk of hypertensive crisis with tyramine containing foods (aged cheese, wine)
Learning objective covered: List drugs that may cause potentially lethal interactions with Monoamine Oxidase Inhibitor type medications. (SM 110b)
